Diploma in Ayurvedic Lifestyle & Nutrition

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1 Diploma in Ayurvedic Lifestyle & Nutrition Module 6 16 th & 17 th February 2019

2 ROGA PARIKSHA Examination of Disease 2

3 ROGA PARIKSHA Examination of disease The word disease is constituted from two terms, i.e. dis and ease and conveys the meaning of discomfort or un-wholesomeness in the body. According to the Caraka Samhita disease is nothing more than a disequilibrium of the dhatus. According to the Susruta Samhita anything which produces pain and discomfort in the body is called disease. Ruja thi thi Roga Whatever causes pain or discomfort whether physical or psychological is called disease. Dosha dhatu Sammuchary Roga Any dosha or dhatu imbalance is called disease The five therapeutics of disease In the treatment of disease the following aspects require examination: 1. Nidana (Aetiology, defined as the cause of a disease or manner of causation of a disease) 2. Purva-Rupa (Premonitory signs and symptoms, defined as the forewarning signs and symptoms of disease) 3. Rupa (Actual signs and symptoms) 4. Upasaya (Exploratory therapy) 5. Samprapti (Pathogenesis defined as the manner of development of a disease) From a practical perspective, it is crucial that a practitioner understands the cause of the disease as it gives the whole picture about the disease and informs treatment. The other four therapeutics of disease are dealt with in relation to specific diseases in practical sessions. 3

4 Nidana or Aetiology Nidana is used in two senses in Ayurveda depending on context. Firstly, it can mean diagnosis of the disease and secondly it can mean aetiology of the disease. Nidana is important in the context of Ayurveda as, if it is neglected, a physician cannot treat a patient. This is because as long as the cause of the disease is not identified and prevented, there can be no alleviation of the disease. It is thus a principle of Ayurvedic treatment to identify and prevent the cause of the disease. Aetiology is the science of study of the causes of disease, both direct and pre-disposing and the mode of their operation. Causative factors of disease are classified under 5 categories (although mostly only the first three are referred to as the last two are subsumed by them). The Caraka Samhita cites that the general cause of diseases of the body, mind and consciousness are of the first three kinds. In short, it amounts to the excessive, wrongful or partial or total lack of use (or conjunction) of (i) motor or psychic activities (ii) objects of the senses or (iii) seasonal variations. So for any of these factors we can use them excessively, wrongfully or be lacking in their use to any degree. The five factors are: 1. Prajnaparadha (Intellectual blasphemy or misuse of intelligence) 2. Asatmyendriyartha Samyoga (Unwholesome contacts of senses with their objects) 3. Kala Parinama (Seasonal perversions and age) 4. Karma or Samskara (Causative factors or disease caused by acts in a previous life) 5. Krmi (Germs and parasites, that is visible (sthula) and invisible (sukshma) organisms) 4

5 1. Prajnaparadha (Crime against wisdom or misuse of intelligence) In the Caraka Samhita this is defined as harmful or undesirable action done by anybody who has lost his understanding, intellect or memory. It means carrying out an act contrary to the understanding of an awakened consciousness. This covers the following yoga of karma or action which has been defined as an effort of the body, mind or speech: a. Ayoga (non-activity or stimuli) b. Atiyoga (excessive activity or stimuli) c. Mithya yoga (inappropriate activity or stimuli) Thus examples of these in relation to the body, mind and speech are: a. The body - Suppression of natural desires such as micturation; defecation without its feeling; excessive sexual indulgence; holding the breath; excessive massage; undue physical exertion b. Speech - Speaking of anything harsh or unkind or false, quarrelling, verbal abuse c. The mind - Fear, grief, anger, avarice, hallucinations, jealousy 2. Asatmyendriyartha Samyoga (Unwholesome contact of senses with their objects) Sound, texture, colour, taste and smell are the five sense objects broadly corresponding to the five senses. Whenever there is Asatmya or harmful conjunction between the senses and their objects there is potential for disease. The harmful conjunction incorporates nonconjunction (Ayoga), excessive conjunction (Atiyoga) and wrongful conjunction (Mithya yoga). 5

6 a. Examples of excessive use of sense objects i. prolonged hearing of high pitched and rough sounds such as roaring, thunder, beating of drums ii. excessive use or handling of very hot or very cold things; too much bathing or massage iii. excessive exposure to bright or powerful light iv. too much taste of any or all of the six rasas v. excessive smelling of very strong or pungent or putrid substances b. Examples of wrongful use of sense objects i. hearing of harsh or disagreeable or fearful sounds or mournful news ii. touching poisonous air, exposure to stormy winds or untimely advent of hot or cold weather or to be struck by anything iii. to see extremely fine and small objects very near to the eye or at very great distance; or to see loathsome, dreadful or hostile objects; or any distorted vision iv. to have recourse to only one kind of taste in excess or to exclude one altogether or take very little of one to include in one s diet; articles of food whose combination is harmful v. to smell putrid, poisonous, nauseating things c. Examples of non-use of sense objects This is self-explanatory it is isolation of the senses from any kind of sound, object to touch whether cold or hot; no sight of any object; no taste of six rasas; and nothing to smell 3. Parinama (Seasonal perversions and age) Parinama is called kala or time. The whole year has been divided in the three main seasons, where the climatic characteristics of these have been recognised by cold, heat and rain. 6

7 When a particular season manifests its own characteristic of cold, heat or rain in an excessive degree, we call it Atiyoga of kala. When these characteristics are deficient we call it ayoga of kala. When a season manifests symptoms which are opposite to its particular characteristics, we call it the mithya yoga of kala. Parinama also means that people who are subjected to extreme seasonal change can become imbalanced in accordance with their constitution. For example, people born in the country of their genetic origin have natural immunity to changes in the weather. It can also refer to diseases caused by ageing such as menopause and osteoarthritis. Thus we find that all the cause of any possible disease, whether modern or ancient fall under one or other of the three heads. 7

8 Classification of Diseases In Ayurveda, diseases have been classified by different authors based on different bases. For instance, classification based on causative factors or on prognosis or pathophysiology or treatments. Some of these methods of classification are set out below. The primary method of classification of diseases uses the doshas to distinguish. This method is the most practical, easily discernable and effective in the treatment of existing disorders. This is used extensively in this training as we view diseases through the lens of doshic imbalance. The classifications set out below assist in further understanding the causes of disease and the most suitable preventative measures. Example of classification according to pathophysiology (i) (ii) Bodily (Sarira) Mental (Manas) Pathophysiology Bodily (Sarira) Mental (Manas) Nija Aganthuka Nija Aganthuka Both of these can be subdivided into two groups: (i) (ii) Those due to internal cause (nija) Those due to extraneous cause (agantuka) 8

9 Besides these, there are various other ways of classification depending upon the curable and incurable nature of diseases and according to the degree of aggravation of doshas. Example of classification according to treatment Susruta classifies the diseases into two broad groups (i) (ii) Surgical Medical Treatment Surgical Medical Example of classification according to causative factors This affliction or pain may be three kinds: (a) Adhyatmika (pertaining to the soul) (b) Adhibahutika (pertaining to physical environment) (c) Adhidaivika (pertaining to the acts of God or nature or karma) Causative factors Adhyatmika (pertaining to the soul) Adhibahutika (pertaining to physical environment) Adhidaivika (pertaining to the acts of God or nature or karma) Example of classification according to causative factors 9

10 Causative factors Adi bala Pravrtta Janamabala Pravrtta Dosha bala Pravrtta Samghata bala Pravrtta Kala bala Pravrtta Daiva bala Pravrtta Svabhava bala Pravrtta (i) Adi bala Pravrtta (Originated from any primary inherent cause) These are hereditary diseases. Leprosy, asthma, piles etc. are said to have an inherent defect in the spermatozoon or ovum of the respective parents. This type naturally falls into two sub-divisions according to whether the original defect had been (a) in the father or (b) in the mother. (ii) Janamabala Pravrtta (congenital) These are due to any improper conduct on the part of the mother regarding food or hygiene during the period of gestation. The subdivisions are according to whether the disease is due to (a) Rasa (improper food) or (b) lack of mindfulness of the hygienic principles during gestation. These diseases can happen in spite of the fact that there is no defect in the germ cells of either parent. (iii) Dosha bala Pravrtta (due to deranged body doshas) 10

11 This category of disease occurs due to derangement of any of the doshas followed by improper diet or unhealthy habits or due to one disease secondary to previous one. These can be sub-divided as (a) Bodily (produced by the three doshas) or (b) Mental (produced by the mental doshas that is Rajas and Tamas) (iv) Samghata bala Pravrtta (due to extraneous causes) These are diseases caused by extraneous factors. They can be caused by (a) an implement or (b) by any ferocious or poisonous animal. (v) Kala bala Pravrtta (due to climatic and seasonal distemper) In this category disease precipitates due to excessive variability in climates of season, atmospheric temperature or humidity. This type can be subdivided into two heads according to whether the season exhibits its normal features or the contrary. (vi) Daiva bala Pravrtta (divine or natural havocs) Disease caused by any curse or divine wrath or brought about by mystic charm or infection (such as herd infections). These can be produced either by lightning or any malignant influence and can occur by association or by accident. (vii) Svabhava bala Pravrtta (Physiological or natural type) Hunger, thirst, old-age, death, sleep etc. are considered as natural or physiological diseases. These may be of two types (a) timely and (b) untimely. The first variety comes on in due course of time even when one strictly observes the rules of health. The second variety is due to one s negligence of these rules. 11

12 Vyadhiksamatva or Immunity One of the main objectives of Ayurveda is the prevention of disease. This is achieved through the strengthening of one s immunity or Vyadhiksamatva. It is for this reason that the concept of immunity happens to be one of the many significant concepts developed in Ayurvedic literature. The body s resistance is of tremendous importance to the daily welfare of living beings. In view of prevention and recovery from diseases immunity plays a very significant role. Among persons living in infected surroundings, only some of them are found to be affected, while others are left without any effect. It shows that the pathogenic causes require some of the essential favourable conditions and susceptibility of the individual in order for disease to form. In the absence of such conditions they will be destroyed by themselves. This means that we can have greater safety from disease if we maintain good immunity. 12

13 Loney says in his Bacteriology: The ability of a bacterium to produce diseases depends not only upon the properties of the organism but also upon the resisting power of the individual. A true understanding of bacterial diseases therefore requires consideration of the seeds and soil. The same view is also expressed in the following proverbs taken from Manusmrti, Mahabharata and Pancatantra: The seed sowed in non-fertile soil gets destroyed underneath and the fire thrown in a fuel-less or air-less place gets subsided by itself Acarya Caraka and Susruta also give due importance to the body resistance or bala: Arogya (health in respect of prevention and recovery) depends on bala or body resistance Caraka Cikitsa Always try to maintain the bala or resistance of a person, if restored, it arrests the progress of the disease Susruta Cikitsa In one who has extremely lost the bala, it is not possible to make him free of the diseases Susruta, Sutra Ojas In Ayurveda it is the ojas that is considered to play a vital role in the defence mechanism of the body. In conditions like madhumeha (diabetes mellitus), malnutrition etc. where loss of ojas is a constant feature, the persons are seen susceptible to other inter-current diseases and super-added infections. This happens because of low vitality and may be interpreted as due to loss of ojas. Hence an adequate explanation of the concept of ojas in relation to immunity is also essential. In other words, high immunity is the result of the preservation of ojas. 13

14 In Ayurveda, instead of focusing on the prevention of individual disease, the focus is on strengthening immunity as a whole. This is because from an Ayurvedic perspective, the human organism is an indivisible union of mind, body and soul. Therefore, Ayurveda teaches that all efforts should be made to preserve ojas in both quantity and quality. The subject of immunity in Ayurveda is so vast and divers, that in order to better illustrate it, the information is correlated with concepts in modern medical science, such as definition, mechanism of immunity, ojas and its role in defence mechanism, classification, grades, factors affecting the grades of immunity, measures to maintain or upgrade the natural body resistance. Definition The definition of Vyadhi-ksamitva given by Cakrapani is of high order, when fully explored. It confines the idea of all the natural, acquired, non-specific and specific types of immunity against all sorts of diseases, microbial or non-microbial. According to the term Vyadhiksamitva used by Caraka denotes the resisting power of the body, which reacts to arrest the progress, occurrence or re-occurrence of diseases. In his definition two significant terms vyadhi-bala-virodhitva and vyadhutpadapratibandhakatva have been used in particular order. The first term denotes the natural immunity, generally of non-specific type, which attempts to defend the body in the first occurrence of any disease. Similarly the second term indicates that when the natural immunity once being thus experienced in any way e.g. vaccination etc. it often succeeds even to check the re-occurrence or occurrence of certain diseases also. There is similarity in the views of William Boyd on the concept of immunity Immunity is only one of the weapons in the basic struggle of life and denotes the resistance which an organism offers against aggression by a parasite (Fundamentals of Immunology). In relation to the second term he states that In the broadest terms the development of immunity is a process by which the body learns from experience of past infections to deal more efficiently with subsequent ones (Textbook of Pathology). 14

15 In modern science the following evidences are generally taken in account to conceive a basic idea of body resistance. (1) Occasionally it has been seen that some of the diseased persons get rid of their diseases even without any treatment. This spontaneous cure is due to a particular power of the body, which stands against the disease to arrest its progress and eliminate the ailment. (2) In spite of living in infected surroundings and utilising the contaminated materials, only some of the persons get affected while others are left without effect. This also supports the presence of a particular opposing power of the body, which tries to obstruct the pathogenesis of the diseases. (3) The occurrence or non-occurrence, mildness or severity, rapid or slow onset of diseases relatively depends on the amount of body resistance and virulence of aetiological factors. This variability in course and intensity of the disease in persons gives a positive support to the presence of body resistance. In support of this basic approach, some identical references from Caraka Samhita are worth mentioning e.g. (1) Patients recover even without undergoing any treatment (2) There is a certain inhibiting factor on account of which any deviation from hygiene rules does not produce a sudden ill effect among the unwholesome or contaminated diet-takers. (3) The significant peculiarities in the form of non-occurrences, poor manifestations and full manifestations of diseases are dependent on characteristics of aetiological factors, reacting humours and body tissues. (Caraka, Nidana) It is from these very factors that diverse kinds of diseases mild or severe, rapid or slow occur. Mechanism of Immunity 15

16 The mechanism of immunity is the phenomenon that deals with the reaction of the body towards foreign agents, its eventual outcome and the process by which it gets specified against certain diseases, whenever there is an interaction in between antigenic substances (Dhadhatu pratyanika Dravya) and the body tissues (Dehashatus). Ojas and its role in Body Resistance Ojas is not only a source of energy but also a factor of resistance. As regards the kinds of ojas, there are multiple senses of the word which relate to the anti-bacterial qualities of the tissues, the intercellular fluid, the blood and the mucoid and serous secretions of the body respectively. Thus immunity depends upon the anti-bacterial qualities not only of the blood but also that of the tissues, the intercellular fluids, lymph and so forth. The role of ojas in relation to body resistance can also be explained from the point of view of the twelve seats of ojas sonita (blood), mamsa (muscular tissue), medas (adipose tissues or fat), asthi (bone tissues), majja (bone marrow), sukra (genital secretions), sukla (some watery secretions of the body), sweda (sweat), pitta (gastro-intestinal secretions), slesman (mucoid secretions), mutra (urine), purisa (stool). It is well known in modern medicine that secretions like salivary, nasal, lacrimal, laryngopharyngeal, bronchial, intestinal, urethral, vaginal, seminal and excretions like urine, stool, ophthalmic, ottorheal and sweat also contain a bacteriolytic substance called lysozymes. The twelve seats of ojas mostly cover all these secretions. Classifications of immunity Ayurveda has classified the bala into two types sahaja (natural or innate) and yuktikrta (acquired or induced). There is also a third type of bala known as kalaja or periodic bala, which varies according to the different seasons and age of the individual. 16

17 Modern classification of natural immunity, such as species immunity, racial immunity, and individual immunity may also be incorporated into Ayurveda. According to Ayurveda yuktikrta bala is that which is obtained by means of nutritive diet, proper mode of life activities and certain vitalising medicines. A diet rich or poor in proteins, vitamins and minerals and also work which is non-fatiguing or fatiguing in nature in its consequence, certainly bring a good or bad effect on body resistance respectively. Factors affecting the Grades of Immunity Like any other hereditary characteristics, immunity is also inherited and greatly influenced by several other factors, such as diet, environment, mode of living, psychic patterns, growth or development, age and pathological conditions of the individuals. In Ayurveda factors affecting the immunity have been classified into two groups: (i) (ii) factors that lessen immunity factors that enhance immunity Lessening factors The following conditions generally lower the defence mechanism of the body a. severe infection - bhutopghata b. excessive loss of body fluids - ativartna of kapha, sonita, sukra and mala c. wasting - ksaya d. physical exertion srama & vyayama e. intoxicating liquors ruksa pana f. prolonged awakening prajagara 17

18 g. mental stress such as anger, anxiety, fear, and grief kopa, cinta, bhaya & soka h. injury, accidental or surgical abhigata i. nutritional disturbances ksut, anasana, atilanghana, ruksalpaprami tatsana j. season, environment, and age kala, vatatapa & jara k. severe humoral upset dosha vega Enhancing factors a. characteristics of race and generation in which birth has taken place b. genetic peculiarity of parents c. favourable climate d. balanced diet e. constitutional characteristics f. want of hyper sensitivity g. mental peace h. outcome of something latent i. adolescence j. proper exercise k. proper stimulation Measures to maintain or upgrade the natural body resistance Natural immunity which is generally of a non-specific nature has a greater relative value and wider range than artificial immunity. Acquired immunity is generally of specific nature and variable in durability and so has limited scope. Only a few of the diseases can be prevented by artificial immunity. It is natural immunity which tries to protect the body against almost all diseases. It is natural or non-specific immunity which forms the first lines of defence. If these lines of defence are broken then the body brings into play the second lines of defence in which immune mechanism occupy an important position. We can have greater safety if we can maintain or raise our natural immunity. In order to maintain and upgrade the natural immunity Ayurveda has advocated the regular and methodical use of Urjaskara medicine like Rasayana and Vajikarana and an enriched balanced diet. 18

19 In the Susruta it is the view that no such types of diseases can occur if effective rasayana and vajikarana are taken beforehand. In Vagbhatta it is advised to take vivifying drugs such as milk, meat-juice and fats as a remedy in diminished state of ojas. 19

disease Yogahealer.com copyright 2012 Yogahealer, llc all rights reserved with Cate Stillman

disease Yogahealer.com copyright 2012 Yogahealer, llc all rights reserved with Cate Stillman 6 stages of disease Yogahealer.com with Cate Stillman 1 What is health? Health consists of a balanced state of the 3 doshas (energies), the 7 dhatus (tissues), the 3 wastes (malas) and agni (digestive