Ayurvedic Disease Classification – Charaka Sutrasthana 19

The 19th chapter of Charaka Samhita Sutrasthana is called  Ashtodareeya Adhyaya. This chapter deals with scientific disease classification based on Ayurvedic principles.
Ashta Udareeya means eight types of Udara (ascites) disease.

Number of the various types of diseases

There are –
8 types of Udara (Ascites – abdominal diseases),
8 types of Mutraghata (urinary obstruction),
8 types of Ksheera Dosha (breast milk vitiation),
8 types of Reto Dosha (semen vitiation),

7 types of Kushta (skin disorders)
7 types of Pidaka (carbuncles)
7 types of Visarpa (spreading type of skin disorder)

6 types of Atisara (diarrhoea / dysentery)
6 types of Udavarta (reverse movement of Vata)

5 types of Gulma (abdominal tumour)
5 types of Pleeha Dosha (spleen disorders)
5 types of Kasa (cold and cough)
5 types of Shwasa (asthma, dyspnoea, difficulty in breathing)
5 types of Hikka (hiccups)
5 types of Trushna (excessive thirst)
5 types of Chardi (vomiting)
5 types of anorexia(tastelessness)
5 types of Shiroroga (disorders of head)
5 types of Hridroga (heart disorders)
5 types of Pandu (anaemia, early stage of liver disorder)
5 types of Unmada (insanity)

4 types of Apasmara (epilepsy)
4 types of Akshi Roga (eye disorder)
4 types of Karna Roga (ear disorders)
4 types of Pratishyaya (coryza/running nose)
4 types of Mukha Roga (oral cavity disorders) 
4 types of Grahani Dosha (malabsorption syndrome / IBS)
4 types of Mada (intoxication)
4 types of Murcha (Syncope / unconsciousness)
4 types of Shosha (emaciation)
4 types of Klaibya (impotency)

3 types of Shopha (inflammation)
3 types of Kilasa (a type of leucoderma)
3 types of Raktpitta (bleeding disorder)

2 types of Jwara (fever)
2 types of Vrana (ulcer)
2 types of Ayama (tetanus, leading to bending of body)
2 types of Gridhrasi (lumbar spondylosis / sciatica)
2 types of Kamala (jaundice)
2 types of Ama (disturbed digestion and absorption process)
2 types of Vatarakta (gout)
2 types of Arsha (hemorrhoids)

1 type of Urusthamba (thigh stiffness)
1 type of Sanyasa (coma)
1 type of Mahagada (psycho-neurosis)

20 types of Krimi (intestinal worms)
20 types of Prameha (urinary disorders)
20 types of Yoni Vyapat (gynaecological disorders)

Like this, there are 48 diseases with its types. [3]

Classification of diseases having eight types

1. 8 types of Udara (ascites)

Vatika – because of Vata
Paittika – because of Pitta
Shlaishmika – because of Kapha
Sannipatika – Due to combined influence of Vata, Pitta and Kapha
Plihodara – due to splenic disorder – splenomegaly
Dakodara or Udakodara – ascites
Baddhodara – also called as Baddha Gudodara (due to intestinal obstruction)
Childrodara – Chidra means rupture, it is due to intestinal perforation

2. Eight Mutraghatas (dysuria – difficulty in passing urine),
Vatika – due to Vata,
Paittika – due to Pitta
Shalismika – due to Kapha
Ashmarija – due to stone / calculi in urinary tract
Sharkaraja – due to gravels in urinary tract
Shukraja – due to semen, a condition called as spermolyth
Shonitaja – due to vitiation of blood.

3. Eight Ksheera Dosha (Vitiation of milk)
अष्टौ क्षीरदोषा इति वैवर्ण्यं वैगन्ध्यं वैरस्यं पैच्छिल्यं फेनसङ्घातो रौक्ष्यं गौरवमतिस्नेहश्च |
aṣṭau kṣīradoṣā iti vaivarṇyaṃ vaigandhyaṃ vairasyaṃ paicchilyaṃ phenasaṅghāto raukṣyaṃ gauravamatisnehaśca |

Vaivarnya – Discoloration,
Vaigandhya – bad smell,
Vairasya – bad taste,
Paicchilya – sliminess, highly sticky,
Phenasangata – foaminess,
Raukshya – excessively dry,
Gaurava – excess heaviness,
Atisneha – unctuousness, excessive oiliness.

4. Eight Reto doshas (seminal disorder),
अष्टौ रेतो दोषा इति तनु शुष्कं फेनिलमश्वेतं पूत्यति पिच्छलमन्यधातूपहितमवसादि च |
Tanu – Thinness,
Shushka – dryness,
Phenila – foaminess,
Ashveta – absence of whiteness,
Atipoota – putrid smell,
Atipicchila – over sliminess, stickiness
Anya Dhatu Upahita – combination with other Dhatus(tissue elements), like presence of blood
Avasadi – heavy, less viscous, high specific gravity.

Classification of diseases having seven types

सप्त कुष्ठानीति कपालोदुम्बरमण्डलर्ष्यजिह्वपुण्डरीकसिध्मकाकणानि, सप्त पिडका इति शराविका कच्छपिका जालिनी सर्षप्यलजी विनता विद्रधी च, सप्त विसर्पा इति वातपित्तकफाग्निकर्दमकग्रन्थिसन्निपाताख्याः (२);
sapta kuṣṭhānīti kapālodumbaramaṇḍalarṣyajihvapuṇḍarīkasidhmakākaṇāni, sapta piḍakā iti śarāvikā kacchapikā jālinī sarṣapyalajī vinatā vidradhī ca, sapta visarpā iti vātapittakaphāgnikardamakagranthisannipātākhyāḥ (2);

5. Seven Kusthas(skin diseases) – Kaphala, Udumbara, Mandala, Rushyajihva, Pundarika, Sidhma and Kaakanaka
6. Seven Pidakas (abscess or carbuncle) – Sharavika, Kacchapika, Jalini, Sarsapi, Alaji, Vinata and Vidradhi.
7. Seven Visarapa (spreading type of skin diseases) – Vatika, Paittika, Slaismika-agnivisarpa, Kardamaka, Granthi Visarpa and Sannipatika Visarpa (due to combined influence of Vata, Pitta and Kapha).

Classification of diseases having six types

षडतीसारा इति वातपित्तकफसन्निपातभयशोकजाः, षडुदावर्ता इति वातमूत्रपुरीषशुक्रच्छर्दिक्षवथुजाः (३);
ṣaḍatīsārā iti vātapittakaphasannipātabhayaśokajāḥ, ṣaḍudāvartā iti vātamūtrapurīṣaśukracchardikṣavathujāḥ (3);

8. Six types of Atisara (diarrhoea) –  Vatika, Pittika, Slaismika, Sannipatika, Bhayaja (due to fear) and Shokaja ( due to grief).
9. Six Udavartas (abdominal diseases characterized by retention of faeces), Vataja (due to flatus), Mutraja (due to urine), Pureeshaa (due to faeces), Shukraja (due to semen), Chardija (due to vomiting) and Kshavathuja (due to sneezing).

Classification of diseases having five types

10. Five Gulmas (abdominal tumor) – Vatika, Paittika, Shlaismika, Sannipatika and Raktaja(due to blood).
11. Five types of Pleeha – Splenic disorders (as above)
12. Five Kasa (coughing) – Vatika, Paittika, Shlaismika, Kshataja (due to ulceration / injury) and Kshayaja (due to tissue wasting, as in tuberculosis).
13. Five Shvasa (dyspnoea) – Mahashvasa, Urdhvashvasa, Chinnashvasa, Tamaka Shvasa and Kshudra Svasa.
14. Five Hikkas(hiccup) – Mahahikka, Gambhira Hikka, Vyapeta(intermittent ), Kshudra and Annaja (due to food).
15. Five Trana (Thirst) – Vatika, Paittika, Amja (due to improper digestion), Kshayaja (due to tissue depletion) and Upasargatmika (as a secondary development, due to another disease).
16. Five Chardi (Vomiting) – Dvishtartha samyogaja(by coming in contact with obnoxious articles), Vatika, Pittika, Slaismika and Sannipatika.
17. Five Aruchi (Anorexia) – Vatika, Paittika, Shlaismika, Sannipatika and Dveshaja (due to repugnance).
18. Five Shiro roga (head disorder) – Vatika, Pittika, Shlaismika, Sannipatika and Krimija(due to infection).
19. Five Heart diseases (as above).
20. Five Pandu (anaemia) – Vatika, Paittika, Shlaismika, Sannipatika and Mrit bhaksanaja (due to eating mud)
21. Five Uamada (insanity) – Vatika, Paittika, Shlaismika, Sannipatika and Agantuja (due to exogenous Causes).

Classification of diseases having four types

चत्वारोऽपस्मारा इति वातपित्तकफसन्निपातनिमित्ताः, चत्वारोऽक्षिरोगाश्चत्वारः कर्णरोगाश्चत्वारः प्रतिश्यायाश्चत्वारो मुखरोगाश्चत्वारो ग्रहणीदोषाश्चत्वारो मदाश्चत्वारो मूर्च्छाया इत्यपस्मारैर्व्याख्याताः, चत्वारः शोषा इति साहससन्धारणक्षयविषमाशनजाः, चत्वारि क्लैब्यानीति बीजोपघाताद्ध्वजभङ्गाज्जरायाः शुक्रक्षयाच्च (५);
22. Four Apasmara (epilepsy) – Vatika, Paittika, Shlaishmika and Sannipatika.
23. Four Eye diseases – same as above
24. Four Ear diseases – same as above
25. Four Pratisyayas(coryza) – same as above
26. Four Grahani (malabsorption syndrome / IBS) – same as above
27. Four Mada (intoxication) – same as above
28. Four Muka Roga (diseases of oral cavity) – same as above
29. Four Murcha (fainting / syncope) – same as above
30. Four Shosha (emaciation) – due to overstrain, suppression of natural urges, tissue wasting and irregular dieting.
31. Four Klaibya (impotency) – bejeopaghataja( due to the affliction sperm /ovum), dhvajabhanagaja (due to erectile dysfunction), Jaraja (due to old age) and Sukra kshayaja (due to diminution of semen).

Classification of diseases having three types

32. Three Shothas (oedema) – Vatika, Paittika, Slaismika .
33. Three Kilasas (an obstinate skin disease) – leucoderma,  coppery and white colored.
34. Three Raktapittas (a disease characterized by bleeding from various parts of the body) – Urdhvabhaga (affecting the upper channel), Adhobhaga(affecting the lower channel) and Ubhayabhaga (affecting both upper and lower channels).

Classification of diseases having two types

35. Two Jvara(fever)
(1) Ushnabhipraya –  Arising out of cold where the patient is desirous of hot substance,
(2) Sheeta Samuttha – Arising out of heat where the patient is desirous of cold substances.
36. Two Vranas (ulcer) Ninja – Endogenous and Agantuja – exogenous.
37. Two Ayamas (body bending) – Bahirayama – Opisthotonous and Antarayama – emprosthotonos.

38. Two Gridhrasi (sciatica) – Vatika and Vata-Shlaismika
39. Two Kamala (Jaundice) – Kostashraya (Hepatic and Prehepatic) and Shakhasraya (Obstructive).
40. Two Ama (disorders due to improper digestion and metabolism) – Alasaka and Visuchika.
41. Two Vatarakta (Gout) – Gambhira( deep) and utthana (superficial)
42. Two Arshas (piles) – Shushka( non-bleeding) and Ardra (bleeding).

Diseases having only one type

43. One Urustamabha (caused by) – Ama-Tridoshaja.
44. One Sanyasa(Coma) – Sannipatika.
45. One Mahagada( Psychic perversion) – due to mental and moral perversion.

Classification of diseases having twenty types

46. Twenty Krimis( germs including parasites),
विंशतिः क्रिमिजातय इति यूका पिपीलिकाश्चेति द्विविधा बहिर्मलजाः, केशादा लोमादा लोमद्वीपाः सौरसा औदुम्बरा जन्तुमातरश्चेति षट् शोणितजाः, अन्त्रादा उदरावेष्टा हृदयादाश्चुरवो दर्भपुष्पाः सौगन्धिका महागुदाश्चेति सप्त कफजाः, ककेरुका मकेरुका लेलिहाः सशूलकाः सौसुरादाश्चेति पञ्च पुरीषजाः;
viṃśatiḥ krimijātaya iti yūkā pipīlikāśceti dvividhā bahirmalajāḥ, keśādā lomādā lomadvīpāḥ saurasā audumbarā jantumātaraśceti ṣaṭ śoṇitajāḥ, antrādā udarāveṣṭā hṛdayādāścuravo darbhapuṣpāḥ saugandhikā mahāgudāśceti sapta kaphajāḥ, kakerukā makerukā lelihāḥ saśūlakāḥ sausurādāśceti pañca purīṣajāḥ;

Yuka and Pipilika both reside outside the body in the excreta,
6 -due to blood vitiation – Keshada, Lomada, Lomadveepa, Saurasa, Audumbara and Jantumatara
7 – due to Kapha vitiation – Antra, Udaravesta, Hrdayada, Curu, Darbhapuspa, saugandhika and Mahaguda
5 – Pureeshaja – inhabit in feces – Kakeruka, Makeruka, Leliha, Sasulaka, and Sausurada

47. Twenty Prameha (a kind of urinary disorder),
विंशतिः प्रमेहा इत्युदकमेहश्चेक्षुबालिकारसमेहश्च सान्द्रमेहश्च सान्द्रप्रसादमेहश्च शुक्लमेहश्च शुक्रमेहश्च शीतमेहश्च शनैर्मेहश्च सिकतामेहश्च लालामेहश्चेति दश श्लेष्मनिमित्ताः, क्षारमेहश्च कालमेहश्च नीलमेहश्च लोहितमेहश्च मञ्जिष्ठामेहश्च हरिद्रामेहश्चेति षट् पित्तनिमित्ताः, वसामेहश्च मज्जामेहश्च हस्तिमेहश्च मधुमेहश्चेति चत्वारो वातनिमित्ताः, इति विंशतिः प्रमेहाः;
viṃśatiḥ pramehā ityudakamehaścekṣubālikārasamehaśca sāndramehaśca sāndraprasādamehaśca śuklamehaśca śukramehaśca śītamehaśca śanairmehaśca sikatāmehaśca lālāmehaśceti daśa śleṣmanimittāḥ, kṣāramehaśca kālamehaśca nīlamehaśca lohitamehaśca mañjiṣṭhāmehaśca haridrāmehaśceti ṣaṭ pittanimittāḥ, vasāmehaśca majjāmehaśca hastimehaśca madhumehaśceti catvāro vātanimittāḥ, iti viṃśatiḥ pramehāḥ;

10 – Due to Kapha imbalance – Udakameha, Iksudalikarasameha, sandrameha, sandraprasadameha, Suklameha, Sukrameha, Sutameha, Sanairmeha, Sikatameha and Lalameha
6 – due to Pitta – Ksharameha, Kalameha, Nilameha, Lohitameha, Manjisthameha and Haridrameha
4 – due to Vata – Vasameha, Majjameha, Hastimeha and Madhumeha

48. Twenty Yoniroga (diseases of the female genital tract):
Vatika, Paittika, Slaismika and Sannipatika, Raktayoni(menorrhagia), Arajaska(Amenorrhoea), Acharana (colpitis mycotica), Aticharana(chronic vaginitis), Prakcharana (deflorative vaginitis), Upapluta (secondary dysmenorrhea), Paripluta(acute vaginitis), Udavartini (primary dysmenorrhoea), Karnini (endo-cervicitis), Putraghni(abortive tendency), Antarmukhi (inversion of uterus), Suchimukhi (pin hole os), Shushka( colo-xerosis), vamibi (Profluvium seminis), Sandhyaoni(undeveloped female sex organs) and Mahayoni(Prolapse of the uterus)

The above are the forty- eight diseases described in brief. Details thereof will be enumerated subsequently.[4]

Simile regarding the role of dosas in Aetio- pathogenesis of diseases

सर्व एव निजा विकारा नान्यत्र वातपित्तकफेभ्यो निर्वर्तन्ते,
यथाहि- शकुनिः सर्वं दिवसमपि परिपतन् स्वां छायां नातिवर्तते, तथा स्वधातुवैषम्यनिमित्ताः सर्वे विकारा वातपित्तकफान्नातिवर्तन्ते|
वातपित्तश्लेष्मणां पुनः स्थानसंस्थानप्रकृतिविशेषानभिसमीक्ष्य [२] तदात्मकानपि च सर्वविकारां स्तानेवोपदिशन्ति बुद्धिमन्तः||५||

sarva eva nijā vikārā nānyatra vātapittakaphebhyo nirvartante,
yathāhi- śakuniḥ sarvaṃ divasamapi paripatan svāṃ chāyāṃ nātivartate, tathā svadhātuvaiṣamyanimittāḥ sarve vikārā vātapittakaphānnātivartante|
vātapittaśleṣmaṇāṃ punaḥ sthānasaṃsthānaprakṛtiviśeṣānabhisamīkṣya [2] tadātmakānapi ca sarvavikārāṃ stānevopadiśanti buddhimantaḥ||5||

All the endogenous diseases occur invariably due to the vitiation of Vata, Pitta and Kapha. As the bird can not transgress its own shadow even though flying throughout out the day, so also no endogenous diseases caused by the disturbance of equilibrium of Dhatus can occur due to the vitiation of Vata, Pitta and Kapha so, considering the location, signs, symptoms and causes of vitiation of Vata, Pitta and Kapha, all the diseases caused by them are diagnosed on the basis of the vitiation of respective Doshas.[5]

Difference in the exogenous and endogenous diseases

भवतश्चात्र-
स्वधातुवैषम्यनिमित्तजा ये विकारसङ्घा बहवः शरीरे|
न ते पृथक् पित्तकफानिलेभ्य आगन्तवस्त्वेव ततो विशिष्टाः||६||

svadhātuvaiṣamyanimittajā ye vikārasaṅghā bahavaḥ śarīre|
na te pṛthak pittakaphānilebhya āgantavastveva tato viśiṣṭāḥ||6||

Thus it is said:
All the bodily diseases arising due to disturbance of the equilibrium of Dhatus are ultimately caused by nothing but by the disorder of Pitta, Kapha and or Vata. It is only the exogenous diseases which are caused otherwise.[6]

Coexistence of exogenous and endogenous diseases

The endogenous diseases are at times followed by the exogenous ones and even the exogenous ones are followed by the endogenous ones of the most vehement type. One should accordingly start the treatment paying due regard to the secondary development (anubandha) and the primary nature of the disease [7]

Summary

In the chapter Ashtodareeya Adhyaya, three diseases in each having twenty varieties, one variety an three varieties, eight diseases having two varieties, ten diseases having four varieties, twelve diseases having five varieties, four diseases having eight varieties, two diseases having six varieties and three diseases having seven varieties are described.[8-9]
Thus ends this chapter, written by Master Agnivesha and redacted by Master Charaka. [19]