Koshta – Large Anatomical Body Cavities

Article by Dr Raghuram Y.S. MD (Ay)
House is a basic amenity of mankind. We can imagine the lives of those who are homeless and are exposed to all sorts of extremes of climate and everyday dangers.

Blessed are we who have a shelter in the form of a house where we live in and are protected and secured. More blessed are we who transform a construction called house into an abode of love, affection and bonding called ‘home’.

Be it a home or house or a construction which serves as our work place, they are built with a purpose of accommodating certain amount of people who own it or who are hired to live in it.

They, on the outlook are nothing but 4 walls with a base and an overlying roof with doors for inlet and outlet and windows for air and ventilation.

The interiors are divided into many compartments or rooms meant for purposes of living like living, sleeping, reading, working, cooking, bathing etc. particular compartments of purpose are well equipped with basic amenities needed to be used immediately, as and when the need arises.

A kitchen looks incomplete without a stove and shelves of basic utilities like plates, cups etc. at the same time, the stove placed in a bedroom or bathroom looks weird. Thus everything should be placed in the place assigned and designed for it.

When right things are put in right places, the place is fit for happy living and will be considered as a picture perfect construction.

Now, in a site which deals with medical information and articles related to it, what are we doing by discussing about houses and homes?

Well, we need this to understand the topic of discussion in this article.

Before constructing a house for selves or transforming them into homes, we all should remember that we are all blessed with a beautiful home of our own immediately when the destiny plans that we are going to descend as tenants into this creation. That home is called ‘Physical body’.
The human body resembles a home with bones and muscles forming the protecting walls.

The interiors comprise of huge cavities which accommodate various organs designed and assigned to be located in the place allotted to them, designed to perform an assigned set of activities and comprising of ingredients and amenities to accomplish those functions.
The large spaces (or cavities or rooms) of our body which accommodate the organs (koshtangas / ashayas) are called Koshtas.
In this article we shall try to understand an Ayurvedic term called ‘Koshta’ with an anatomic vision.
(Note – The term Koshta is also used in a physiological meaning, which we shall discuss in the next article)

What is Koshta?

Koshta means a place or cavity or space.
The human body is made up of large cavities called Koshta. Koshta accommodates the organs of our body.
Example, the chest cavity is a larger space which accommodates Lungs and heart, a part of food pipe etc and doesn’t allow any other organ because the space is designed to accommodate only these set of organs.

The abdomen cavity or cavity of our tummy gives place to digestive organs like stomach, intestines, gall bladder, glands like Liver, spleen, and pancreas, urinary apparatus including kidneys and ureters (tubes carrying urine from kidney to urinary bladder) etc.
The pelvic cavity located just below the abdominal cavity accommodates urinary bladder, uterus (womb), lower parts of intestine etc.

The thoracic cavity (chest cavity), the abdominal cavity and pelvic cavity are the large spaces and accomodate the above said organs. Thus they can be included under Koshta.
The organs located within the Koshta are called Koshta Anga’s (Koshtangas) or organs of Koshta. They are also called Ashayas.

Definition

स्थानानि आम अग्नि पक्वानां मुत्रस्य रुधिरस्य च।
हृत् उण्डुक फुफ्फुसः च कोष्ठ इति अभिधीयते॥(सु.chi.२/१२)
Sthaanaani aama agni pakvaanaam mutrasya rudhirasya cha
Hrut unduka puphusaha cha koshta iti abhidheeyate (Ref – Sushruta chikitsa 2/12)
Sushruta explains the Koshta as a place or cavity occupied by the below said organs:
Aamashaya – Organ accommodating improperly digested or semi-digested food (wherein first part of digestion takes place), Stomach or upper part of digestive tract from mouth to stomach should be considered

Agni-Ashaya – Site of fire, though the Pitta sthana (place of pitta) i.e. the entire digestive tract involving the function of digestion of food should be taken as place for Agni or fire (Agni, in the body is represented in the form of Pitta) i.e. stomach, small intestine, pancreas, liver etc, we should mainly consider Pancreas as the site of Agni (since the names for other organs have been separately mentioned)

Pakwashaya – Organ accommodating the digested food, Intestines (mainly large intestines, but the term also can include small and large intestine put together, i.e. starting from the end part of stomach to the anal opening) should be considered as Pakwashaya

Mutrashaya – Organ holding urine, mainly the term Mutrashaya includes urinary bladder (but the whole of urinary apparatus starting from kidneys to urinary bladder can be taken)

Rudhira ashaya / Rakta ashaya – Organs related to formation of blood, Liver and spleen should be considered as Rakta ashaya

Hrut or Hridaya – The organ related to pumping the blood, oxygen and nutrients to all parts of the body, the Heart

Unduka – The organ which receives the digested food and starts forming the stools, the Cecum or beginning part of Large intestine should be taken as Unduka

Phuphusa – The organ or organs related to breathing mechanism, the Lungs

The above said organs are considered as Koshtangas. Or the above mentioned organs put together are called Koshta.

Analysis of Sushruta’s explanation

Analysis of Koshta explained by Sushruta –
When we see the Koshta anga’s (organs occupying the Koshta) explained by Sushruta, the list of organs looks incomplete.

We can justify by telling that, Sushruta has intelligently given a few examples of the organs comprising of Koshta without giving an entire list of the organs.
He has included Hridaya and Phuphusa i.e. lungs and heart which are the main organs occupying the Uro-guha or chest cavity or thoracic cavity.
He has mentioned Amashaya, Pakwashaya, Agnyashaya, Rudhirashaya, Unduka as representatives of Udara-Guha or abdominal cavity

Sushruta has mentioned Mutrashaya as an organ of Pelvic cavity. If we classify the Pakwashaya or Large intestine into an abdominal part and a pelvic part, we get sigmoid colon and rectum into the pelvic cavity.

Then why did Sushruta mention Unduka or caecum separately? The answer could be
Being the first part of Large intestine and larger in shape there is every possibility for Sushruta to have taken it as a separate organ

Considering Unduka as a separate organ, he would have taken the small intestine and the part of large intestine above the ileocecal junction (junction of last part of small intestine and first part of large intestine) as Pakwashaya

There is a possibility of the author clubbing certain organs and giving a broader meaning of an organ. Example, there is a possibility of Sushruta clubbing the oral cavity and oesophagus under the term Amashaya.

Since he has directly mentioned the term Pakwashaya, we feel like the small intestines being missed from the list. Even the small intestine might be clubbed in the term Amashaya or Agnyashaya or even Pakwashaya.

We need to take the broader meaning rather than translating the terms. We also have to take the interconnected organs within a term for better understanding.

Thus he has not skipped mentioning ‘organ representation’ of any major cavity or Koshta. Thus Sushruta’s explanation of Koshta becomes clear and valid.

पञ्च दश कोष्ठ अङ्गानि – नाभिः च, हृदयं च, क्लोमं च, यकृत् च, प्लीहा च, वृक्का च, वस्तिः च, पुरीष आधारः च, आमाशयः च, पक्वाशयः च, उत्तर गुदं च, अधर गुदं च, क्षुद्र अन्त्रं च, स्थूल अन्त्रं च, वपावहनं च।(च.शा.७/१०)
Pancha dasha koshta angaani – Naabhi cha, hridayam cha, klomam cha, yakrit cha, pleehaa cha, vrukkaa cha, vastihi cha, pureesha aadhaaraha cha, aamaashayaha cha, pakwaashayaha cha, uttara gudam cha, adhara gudam cha, kshudra antram cha, sthoola antram cha, vapaavahanam cha (Ref – Charaka Shaareera 7/10)

Koshtangas according to Charaka

Charaka has given a big list of Koshtangas (organs located in Koshta or collectively form Koshta).
They are as below mentioned –
Nabhi – Naval region or umbilicus region is considered as Nabhi.
Hridaya – Heart
Kloma – Pancreas, Lungs or Trachea
Yakrut – Liver
Pleeha – Spleen
Vrukka – Kidneys
Vasti – Urinary bladder
Pureeshaadhara – Caecum
Aamashaya – Stomach
Pakwashaya – Large intestine
Uttara Guda – Sigmoid colon and Rectum
Adhara Guda – Anal canal and anal opening
Kshudrantram – Small intestine
Sthoolantram – Large intestine
Vapavahanam – Peritoneum (layers covering and protecting the abdominal viscera)

Analysis of Koshta explained by Charaka –
Though there is some similarity with respect to some organs mentioned by Sushruta, Charaka has mentioned some more organs or parts of organs which lead to confusions. We will try to analyse and sort out the meanings of these terms.

Hridaya, Yakrit, Pliha, Vasti (Mutrashaya by Sushruta), Pakwashaya, Amashaya, Pureshadhara and (Unduka by Sushruta) are explained in the list of Koshtangas by both Charaka and Sushruta.
We will now discuss about the other organs mentioned by Charaka.

Nabhi or navel region or umbilicus – cannot be considered as an organ. The word ‘Nabhi’ is often used interchangeably with Pitta sthana (predominant site of Pitta).
Pitta sthana includes the organs and parts of digestive tract which actively take part in the digestion process, the organs predominant with fire or hot components needed to digest the food (can be compared to acids of stomach, bile from liver and digestive enzymes and juices of small intestine and pancreas).

Since we do not find the mention of Grahani (duodenum) or Agnyashaya (Pancreas) or Pittashaya (gall bladder) in the list of Koshtangas, it is wise to include all these organs under the term ‘Nabhi’.
Kloma is a controversial organ. It is one of the Udakavaha Srotas i.e. water balancing or carrying channels in the body. Kloma is often related to pancreas, lungs or trachea or thirst regulating centers in the brain. We are left with considering trachea or pancreas.

If we consider a term called Agnyashaya as Pancreas and include it in Nabhi, we can take trachea or lungs as Kloma. It is also wise not to include Pancreas in the term ‘Nabhi’, considering Pancreas as Kloma, we can also consider it as an organ of abdominal cavity.

Charaka has not mentioned Phuphusa or lungs separately in the list of Koshtangas. If Pakwashaya is taken as Phuphusa (see the discussion in the later paragraphs), then we will be left out with only trachea to be considered as Kloma.

The speciality of Charaka is mentioning both intestines separately. He has named Kshudra-antra and Sthula-antra in the list of Koshtangas (Ksudra=small, Sthoola=Large, Antra=Intestines). But he has also mentioned Pakwashaya, which also means Large Intestine.

But why Charaka has mentioned both Sthoola-antra and Pakwashaya? The reasons could be –
We can see Charaka mentioning each and every part of the Large intestine, Pureeshadhara (caecum), Uttara Guda (Rectum) and Adhara Guda (Anal canal).

By their large appearances, these organs or parts of large organs would have been visualised as separate organs in ancient days. Now let us subtract these and come to the reminder of Large intestine, i.e. the ascending colon, transverse colon, descending colon and sigmoid colon.

He could have considered these things put together as Pakwashaya (site of digested food) and the whole large intestine put together as Sthulantra.

But he has already named caecum as Pureeshadhara (site of formation of stools or we can consider as the beginning part of large intestine in which the re-absorption and formation of stools begin, the whole process being completed by the time the contents reach rectum).

Naming wise, he cannot put the site for faeces (Pureeshadhara) before the site of digested food (Pakwashaya), since physiologically these events take place in a chronological way i.e. first the intestine receives digested food and later it is transformed into stools.

Now we will come to another reference from Charaka –
कोष्ठः पुनः उच्यते महा स्रोतः शरीर मध्यं महा निम्नं आम पक्वाशयः च इति।(च.सू.११/४८)
Koshtaha punaha uchyate mahaa srotaha shareera madhyam mahaa nimnam aama pakwashayaha cha iti (Ref – Charaka Sutra 11/48)
This gives a gross definition of the term Koshta. Charaka tells that Koshta is also called Maha Srotas (Antaha srotas), which means the largest channel of the body. It is located in the deep recess in the middle portion of the body and is comprised of Amashaya and Pakwashaya.

According to this definition, the term Koshta comprises of Amashaya and Pakwashaya. Charaka in a later context (Shareera sthana, which comes after Sutra sthana in the treatise), explains Koshtangas without defining what is Koshta because he had already quoted it in Sutra Sthana.

This also gives us an idea that according to Charaka, Amashaya and Pakwashaya are the major components of Koshta and all the other viscera surrounding them are called Koshtangas or organs in the vicinity of Koshta.
Amashaya sits in a place allotted for it in the abdominal cavity.

This space or cavity is termed as Koshta for Amashaya. Similarly the space allotted for Pakwashaya is Koshta for Pakwashaya.

Thus this reference in Sutra Sthana points towards the spaces allotted (Koshta for Amashaya and Pakwashaya), but the terms Amashaya and Pakwashaya mentioned in Shareera sthana are Koshtangas or the organs occupying the region of Koshta specified to them.

If we take Amashaya as the central cavity of digestive tract (Maha srotas) to be a cavity extending from mouth to the end part of stomach and Pakwashaya comprising of the lumen within the small intestines and large intestines put together, the Pakwashaya mentioned in the Koshtanga list would still be ‘intestines’ or the whole part of digestive tract wherein the food is thoroughly digested.

The confusion still doesn’t end because of the use of another term called Sthoolantra which also means Large intestine.

Let us get some clarification to this –
Bhela, the author of Bhela Samhita, who was a contemporary of Agnivesha, who has written Charaka Samhita, has not mentioned Pakwashaya in the list of Koshtangas. Instead of Pakwashaya he has mentioned an organ called Avahanana.

In the treatise Yagnavalkya Smriti too we can find this word, Avahanana.

Some scholars suggest the word ‘Pakwashaya’ in Charaka should be read as Avahanana. Avahanana is said to be Phuphusa, the lungs.

Since Charaka has not mentioned Phuphusa (Sushruta has mentioned), it makes sense to consider Pakwashaya as Avahanana or Phuphusa, since the term indicating Large intestine – Sthoolantra has already been mentioned in the list.

But, the word Pakwashaya is always used for Large intestine everywhere in Ayurvedic texts and it looks weird to use it for Lungs, but we need to sort out our queries.

Anyhow, this controversy doesn’t end here and is thrown open for research works to be done. Since we are not doing a research work here, it is wise enough to stop the discussions without creating a web of confusions any further.
Vapavahana or peritoneum is a sac covering the visceral organs, lubricating and protecting them.

They also help the organs to expand and contract and allow space for their moments. They connect one organ to the other.

Peritoneum is actually not an organ but since it is large enough and covers most part of the abdominal cavity and is also different from the large cavities (koshta), Ayurvedic teachers might have seen it as an organ.

Importance of knowing Koshta

Shareera Rachana or Human anatomy is the basis for any medical science. We need to know about the construction of human body which includes the cells, tissues, organs and organ systems.

The knowledge of Koshta gives us a precise anatomical knowledge of the cavities of human body and the viscera’s included therein.

The physiology related to the human body, according to Ayurvedic basics are governed by the actions of Tridoshas i.e. Vata, Pitta and Kapha. These 3 forms of energies control the entire activities of the body in a smooth way, provided they are in a state of equilibrium.

These 3 doshas are moving around the entire body. Each dosha has certain tissues and or organs as their abode. They stay in those organs and control the activities.

Example, Phuphusa, Amashaya, etc are important sites of Kapha, Pakwashaya is an important abode and controlling centre for Vayu, Nabhi, Amashaya, Agnyashaya, Hridaya etc are the sites of Pitta. We need to understand the Koshta to understand the related physiology.

Many of the organs of Koshta form the Ashaya or residence or place of stay for many elements. The name of the organ itself explains its relationship with that element.

Example, the term Amashaya means an abode for Ama or improperly processed or semi-digested food. Pakwashaya is an abode of digested food and holds it until it is converted into faeces and excreted.

Mutrashaya holds the urine until it is voided. We need to understand the anatomical and physiological relationships between these Ashayas (abode) and the elements staying in them. For this the knowledge of Koshta is essential.

Many of the organs of the Koshta form the root or point of origin for Srotas (channel or duct or transportation system in the body). It is said that the whole body is composed of millions of srotas.

They connect each and every tissue of the body and also carry on almost all the functions of the body. They are also related to one or more of the organs forming the Koshta.

Srotodushti or blocking / clogging or morbidity of the Srotas is essential for the diseases to be formed in the body, which also includes the diseases occurring in various organs forming the Koshta.

Example, Hridaya is the point of origin of Rasavaha Srotas (channels carrying the nutritive essence to each and every cell, tissue and organ of the body), Yakrit (Liver) and Pliha (spleen) are the roots of Raktavaha Srotas (haemopoetic organs taking part in the formation and maturation of blood cells), Kloma is the root of Udakavaha Srotas (channels carrying the water or balancing and regulating the water metabolism in the body) etc.

To understand the nature of Srotas and Sroto-dushti, we need to understand the Koshta and the organs embedded in it.

Understanding Koshtas and the organs embedded in them, their relation with Doshas, dhatus (tissues), malas (excreta), srotas (channels) etc will help in proper diagnosis of the diseases and in combating them effectively.

Summing up –
Taking both Charaka and Sushruta’s explanation of Koshta and Koshtangas, we can conclude that the larger cavities of the body are taken as Koshtas and the organs occupying the Koshtas as Koshtangas.

Both authors together have almost covered all the main organs located in the thoracic, abdominal and pelvic cavities, leaving apart some controversial words and concepts.

This concept not only gives us details about the opinions our Ayurvedic teachers had about the viscera in the body, but also explains the insight and extensive knowledge they had over the human anatomy.

Understanding human anatomy and physiology is the key to decode the pathology of a disease and plan an effective treatment protocol.

Without the knowledge of the basics like Koshta, Koshtanga etc, it becomes difficult to understand the basics of Ayurvedic treatment in its real sense.
Click to Consult Dr Raghuram Y.S. MD (Ayu) – Email: drraghuramys@gmail.com