Shat Kriya Kala (Six Stages of Pathogenesis)

Abstract

Shat kriya kala includes 6 different stages in the occurrence of a disease. As we study in modern science the concept of pathogenesis we had this concept of shat kriya kala in Ayurveda in the Vedic era of India. This principle of shat kriya kala was given by Acharya Sushruta in his book named Shushruta Samhita(vol.1). Acharya Sushruta the father of both vedic and modern surgery studied the inflammatory process of vranas(open wound) and conceptualised this shat kriya kala. This kriya kala is not just a tool to get knowledge of pathogenesis but it also helps us to treat an ailment before it reaches an extreme or a lethal stage. So in this topic, we will try to learn about shat kriya kala along with the modern take.

Introduction

Ayurvedic diagnosis and treatment are based on clinical observation and assessment. In Ayurveda, we stress mainly two concepts i.e. how to keep a healthy person healthy so that he or she never falls ill and secondly to treat a diseased person

प्रयोजनं चास्य स्वस्थ्यस्य स्वास्थ्यरक्षणमातुरस्य  विकारप्रशमनं च ।

So this concept of shat kriya kala helps us to study a particular disease at 6 different levels or stages. Every level of disease has different symptoms. So we study and analyse these symptoms very carefully and decide the treatment plan or whether the disease is treatable or not and how hard it will be for us to treat a particular ailment. As the name sounds षट् क्रिया काल “षट्” means six “ क्रिया काल” means the stages so one can understand that it means the 6 stages of disease manifestation.

षट् क्रिया काल (shat kriya kala

Acharya sushruta has divides shat kriya kala into 6 different stages

संचयं च प्रकोपं च प्रसरम् स्थान संश्रयं। व्यक्तिं भेदं च यो वेत्ति दोषाणां स भवेत् भिषक्।। (सुश्रुत संहिता २१/३६)

1. सञ्चय- stage of dosha accumulation
2. प्रकोप- stage of aggravation of dosha
3. प्रसर- stage of spreading
4. स्थान संश्रय- stage of dosha lodging in tissue(dhatu)
5. व्यक्तावस्था- stage of manifestation of disease
6. भेद अवस्था- stage of complication

These 6 stages can be divided into 2 broader categories

1. Dosha kriyakala –  सञ्चय, प्रकोप, प्रसर

If we diagnose and assess the symptoms of doshas in these 3 stages We can treat a disease before it shows its full symptoms.

1. Vyadhi kriya kala – स्थान संश्रय, व्यक्तावस्था , भेद अवस्था

In this stage the disease starts showing symptoms and the stages under this category provide us the chances to treat the ailment with efficacy.

सञ्चय (stage of accumulation)

In this stage  there is accumulation of doshas(toxins) which will act as the building blocks for a disease. One should be very good at observation so that disease can be cured at this stage.

For example in ayurveda we normally study the accumulation of vata pitta and kapha

1. Sites of vata accumulation- large intestine, pelvis, hips, thighs, ears ,bones etc
2.  Sites of pitta accumulation- skin, sweat, lymph, upper part of gut, blood and eye.
3. Similar site of accumulation of kapha- chest, throat, head, nose, tongue, plasma etc.

Symptoms of Dosha Accumulation

संचितानाम् खलु दोषाणाम् स्तब्ध पूर्णकोष्ठतापीतावभासता मन्द ऊष्मता च अंगानाम् गौरवं आलस्यं लिगांनि भवन्ति।।(सु० सू० 21/18)

VATA ACCUMULATION- Hardness of intestines, feeling of fullness.

PITTA ACCUMULATION- Yellowish colour of skin, sensation of heat

KAPHA ACCUMULATION- Low temperature of body, laziness, heaviness in body.

प्रकोप(stage of vitiation)

In this stage previously lodged or accumulated doshas get aggravated in their accumulated sites and get ready to spread in the body.

Causes of Prakopa for Vata, Pitta and Kapha

1. Vata –excessive use of– dry, cold, light characteristics in diet, dry vegetables, excessive exercise, malnutrition, fracture, injury, grief, fear, excessive sexual indulgence etc.
2. Pitta – excessive use of –  irritant, corrosive, irritant characteristics in diet sour,  salt, chillies, alcohol etc. Anger also increases pitta dosha.
3.  Kapha – excessive use of – heavy, cold, liquid in diet sweet, sour, salt, oily food,etc. Sleeping in day also increases kapha dosha in the body.

Symptoms of Dosha Prakopa

तेषां प्रकोपात् कोष्ठतोद संचरणाम्लिका पिपासा परिदाह अन्नद्वेष ह्रदयोत्क्लेद च जायते।। (सु०सू० 21/27)

VATA

Constipation, flatulence, tremors, insomnia, delirium, vertigo, body pains, blackish discoloration, numbness, pricking pain, roughness, dehydration, rigidity etc.

PITTA

Gastritis acid reflux, sour belching, burning sensation, excessive heat, reddish discoloration, sweating, discharge, excessive thirst etc.

KAPHA

Indigestion, excess salivation, heaviness in body, dyspnoea, sleepiness, feeling of cold, weight gain, indigestion, feeling of cold, sticky or slimy skin, indigestion etc.

प्रसर (Stage of Transmission)

In this stage  there are two probabilities either the doshas come into normalcy due to better diet plan and proper lifestyle changes  if not then the doshas spread into the body via blood circulation.

It can be of three types according to the gati (direction) of doshas

URDHWA (upward movement)

Upward movement of doshas leads to diseases like  disease of ent(ear, nose, throat), mania, epilepsy, hiccoughs, coughs etc.

ADHO GATI (downward movement)-

Doshas move to the downward direction and cause diseases like diarrhoea, filariasis, swelling of knees etc.

TIRYAK GATI (lateral movement)-

Doshas move laterally in the body and cause diseases like tetanus, hysteria, hypertension and many skin disorders etc.

Cause of Transmission of Doshas

1. Over exertion/ over exercise.
2. Increase in the digestion process(tikshna agni).
3. Improper diet.
4. Due to vitiation of vata.

Symptoms of Prasara of Doshas

1. VATA – regurgitation, flatulence, increased bowel sound    
2. PITTA –  sensation of boiling, burning, squeezing
3. KAPHA – anorexia, dyspepsia, vomiting

स्थान संश्रय – (stage of dosha lodging in tissue)

This is the stage where the symptoms of the disease start to manifest and patients may  start to feel the symptoms. This is the prodromal stage. In this  doshas get into the minute channels of tissue(microchannels) of a particular area or an organ(this is called dosha-dushya sammurcchana).

स्थान संश्रयः इति दोषदूष्यस्य संश्रयः।।(चक्रपाणि सु०सू० 21/31)

According to the location of dosha-dushya sammurcchana  different diseases occur for example

1. In abdomen – abdominal tumours, abdominal cyst, abscess, ascites, flatulence, anorexia etc and other abdominal diseases occur.
2. Urinary bladder – diabetes, urinary calculus, urine retention.
3. Rectum – piles, fistula, fissure
4. Feet- gout, spur, filariasis

व्यक्तावस्था- (stage of manifestation of disease)

This is the stage where the disease finally occurs and we see the proper symptoms of the disease.we can say this the stage of disease with its full manifestation. This is the stage where we can name a particular disease.

This stage has the clear cut symptoms of a disease. Cardinal or particular symptoms are expressed in this stage. for example

1. Increased temperature in fever.
2. Excessive passage of watery stool in diarrhoea.
3. Abdominal enlargement in udara (abdominal) roga

भेद अवस्था- (stage of complication)

This is the stage where disease becomes sub-acute, chronic or incurable. In This stage a disease may produce complications and may cause temporary or permanent disability. This is also the last stage where we can treat a disease.

For example

1.  Formation of ulcers
2. Chronic fever(jeerna jwara)

Importance of Shat Krita Kala

If diagnosed earlier it is easy to treat a disease and shat kriya kala provides the 6 different chances to treat a disease.if doshas as stopped at earlier stages they will not progress  further stages  hence there will be no occurrence of the disease. Knowledge of shat kriya kala will help in the selection of the best possible treatment of the disease. Treatment is simply the breakdown of samprapti(pathogenesis) and this shat kriya kala provides the best tools.

Also the dosha sanchaya which is the base of any disease can be analysed and stopped at the very starting stage.

Conclusion

To conclude the topic we can say that shat kriya kala helps in proper understanding of the process of manifestation of the disease. If  a physician diagnoses a disease according to shat kriya kala then he or she will be able to give the best treatment plan for a disease.knowledge of shat kriya kala helps us in analysing the chronicity of a disease or if the disease is treatable or it has gone beyond the stage of treatment.