Chikitsa: Treatment Types, Ayurvedic classification

Article by Dr Raghuram Y.S. MD (Ay)
Man has been a victim of one or the other disease throughout the journey of evolution; be it related to the body or mind or both. Many diseases disappeared into extinct and many new diseases came into existence. With advancement of science and technology, man became a victim of not only psycho-somatic diseases but also a of many stress related diseases, infectious diseases, immunodeficiency diseases, metabolic diseases, occupational diseases, traumatic diseases and a lot more.

But in spite of all these, the man did not lose the battle with the disease. His attitude to live a better quality and quantity of life and to conquer the disease led to the advent of medical system; medicines and various modalities of treatment and preventive approaches. The medical system is still battling out to provide a better quality and quantity of life to mankind.

Ayurveda is privileged to have taken the first step towards writing down medical treatises which includes extensive coverage of comprehensive information regarding preventive and curative modalities of treatments and medications towards appreciable body-mind cure.

All the other medical sciences are built, developed and evolved on the foundation of health concepts laid by Ayurveda.

Ayurveda has called treatment as ‘Chikitsa’.
In this article we shall try to analyze the meaning of the word Chikitsa and enlist its types as per Ayurvedic science.

Chikitsa Nirukti

Nirukti (word derivation) of Chikitsa –
Kit rogapanayane, kit+kit+san+a=chikitsaa
The word Chikitsaa is made out of root words ‘kit rogapanayane’ kit+kit+san+a=chikitsaa

The root word Kit is used in the meaning of removal or eradication. Thus kit means separation of the disease or eradication of the disease from the body, or to control the disease or destroy the disease and disease process.

Chikitsaa ruk pratikriya (Ref – Amarakosha 2/6/50)
Treating or eradicating pain or disease is called Chikitsa

Chikitsaa roga nidaana pratikaare (Ref – vaidhya shabda sindhu)
Separating or keeping away from the causative factor or factors of a disease is called Chikitsaa. In short, avoiding the causative factor or factors of a disease is called Chikitsa.

Yaa kriyaa vyaadhi haarinee saa chikitsaa nigadhyate (Ref – Bhava Prakasha parishishta)
Any activity or approach which alleviates or destroys a disease is called Chikitsa. This means to tell that the ‘disease destroying approaches’ are called Chikitsa.

Synonyms

Other names of Chikitsa –
Below said are the synonyms of Chikitsa:
Bheshaja – That which conquers the fear of disease
Aushadha – That which is made up after mixing the medicinal herbs
Bhaishajya – That which helps in destroying the disease or fear of disease is called Bhaishajya
Agada – That, by the use of which the disease doesn’t exist
Jaayu – That which wins over the disease
Chikitsita – That which is helpful for chikitsita or patient
Vyadhi hara – That which alleviates or destroys a disease
Pathya – that which is beneficial for patha or srotas (channels of transportation in the body)
Saadhana – That which helps in making or keeping the body healthy
Praasyaschitta – That which destroys sins or diseases caused due to sins
Prashamana – That which pacifies the diseases
Prakruti sthapana – That which establishes dhatu samya or equilibrium of body tissues
Hita – That which destroys the pains of the body and nourishes the body
Kriya – Activities or measures leading to destruction of diseases
Upaya – Methods of destroying disease or disease process
Karma – Activities done to destroy a disease process
Cheshta – Same as Karma
Pravrutti – Same as Karma
Karana – Same as bheshaja
Pratikarma – Antagonistic to disease or disease process
Upakrama – Methods and sub-methods of dealing diseases
Bhishagjita – Four limbs of treatment i.e. Physician, patient, medicine and care-takers (nursing staff) are called Chikitsa Chatushpada or Bhisagjita. The integrated approach of all these 4 factors towards eradication of a disease or disease process will yield perfect results of treatment.
Upachara – Handling the patient according to their mindset
Nigraha – That which controls all the diseases
Vaidhya karma – Duty of a physician is called Chikitsa
Bhishak Karma – Same as Vaidhya Karma
Ullaghanam – That which provides freedom from diseases

Definition

Definition of Chikitsa –
Yaa kriyaa vyadhi haarinee saa chikitsaa nigadhyate
Dosha dhaatu malaanaam vaa saamyakrut sa eva rogahrut (Ref – Bhava Prakasha Poorva khanda 11)
Any activity or approach which alleviates or destroys a disease, which brings about an equilibrium in the physical doshas (Vata, Pitta, Kapha), mental doshas (rajas and tamas) and Sapta dhatus (7 tissues of the body) by destroying the aswasthyakara vaishamya (or pathological deviation in the form of abnormal decrease or increase) is called Chikitsa. This means to tell that the ‘disease destroying approaches’ are called Chikitsa.

Note –
The Sapta Dhatus or 7 tissues are as mentioned below:
Rasa(Circulatory Fluid)
Rakta(Blood cells)
Mamsa(Flesh/Muscles)
Meda(Fat or adipose tissue)
Asthi(Bone)
Majja(Bone Marrow)
Shukra(Semen/Sperms/Reproductory tissue)

Yaabhihi kriyaabhihi jaayante shareere dhaatavaha samaaha
Saa chikitsaa vikaaraanaam karma tad bhishajaam matam (Ref – Charaka Sutra 16/34)
All those activities or approaches or methods through which the doshas, dhatus and malas of the body revert back to the stage of their normalcy (equilibrium) by losing their morbidity are called Chikitsa.

Chaturnaam bhishak aadeenaam shastaanaam dhatu vaikrute
Pravruttihi dhaatu saamyaarthaam chikitsaa iti abhidheeyate (Ref – Charaka Sutra 9/5)
The selfless indulgence of the 4 padas of chikitsa (4 limbs of treatment) enriched in their qualities towards establishing dhatu saamya (equilibrium of doshas, dhatus and malas by eradicating the disease or disease process) is called Chikitsa.

Note –
Chikitsa Chatushpada or 4 limbs of treatment are:
Bhishak – the physician
Dravya – the medicine
Upasthatha – the attendants or nurse
Rogi – the patient

Uttama Chikitsa

Uttama Chikitsa (The best treatment) –
Yaa hi udeernam shamayati na anyam vyaadhim karoti cha
Saa kriyaa na tu yaa vyaadhim harati anyat udeerayet (Ref – Sushruta Chikitsaa 35/23)
The treatment is said to be the best and comprehensive when it subsides or pacifies the disease for which it is being administered but doesn’t cause yet another disease.

On the contrary, any chikitsa which subsides or pacifies a particular disease but produces another disease in the process is not to be a good treatment.

Bhishak aadau pareeksheta rugnasya aayuhu prayatnataha
Sati cha aayushi visteerne chikitsaa saphalaa bhavet (Ref – Bhava Prakasha Poorva 54)
Before commencing the treatment of any disease, the ayu or life span of the patient should be thoroughly examined and analyzed, because any treatment will be fruitful only in the presence of ayu or good life span. If there is no hope that the person in question will survive, it makes no fun in administering treatment or medicines.

Even in the presence of ayu, the diseased will not recover and get going if treatment is not done at proper time. Just like an elephant trapped in a wet whirl of mud cannot escape without help, the patient too cannot recover without the administration of treatment.

Even in the presence of the ayu, if suitable treatment is not done on time, the disease will worsen and the patient will die, just like a lamp will be put off even in the presence of oil and wick if not protected from the strong wind.

If the diseases are not treated properly, their prognosis gets to become worse. The curable diseases will progress to maintainable diseases and these diseases with due course of time will progress to incurable diseases in due course of time. When the diseases get to become incurable, they will cause death of the patients.

Even in those people in whom the quality and quantity of ayu is indecisive (unpredictable) or can’t be determined, the treatment has to be done until the patient is breathing his life because many times the patients survive in spite of the Arishta lakshanas (signs and symptoms of impending death) being present by the virtue of God’s grace (daiva yoga).

Types of Chikitsa

The main aim of Chikitsa or treatment is to eradicate the disease or prevent it. For the convenience of understanding, many classifications of Chikitsa have been mentioned.

Types of treatment are many because the diseases are also many. Let us see the types of Chikitsa mentioned in Ayurvedic texts.

Eka-vidha Chikitsa

Eka-vidha Chikitsa (1 type of treatment): 
The treatments are said to be only of one type based on two factors:
Nidana – causative factors
Pathya – wholesome food and lifestyle practices

Nidana Parivarjana –
The causative factors leading to the disease and the disease which gets manifested have cause and effect relationship. Diseases are not manifested without the process being initiated by the Nidanas or causative factors.

So the best and easiest form of treatment is to keep away or avoid those causative factors which are responsible for the causation of that particular disease in question.

Avoidance of causative factors is called Nidana Parivarjana (Nidana = causative factors, Parivarjana = Keeping away or avoiding). ‘Prevention is better than cure’ is a proverb which possibly has its roots in this concept of Ayurveda.

Pathya Sevana –
Pathya means ‘that which is good and beneficial for the Patha or Srotas’ (the channel and duct systems of the body which are responsible for transportation of nutrition and other essentials in the body and also to throw away the unnecessary and unwanted things from the body).

Many foods and lifestyle practices which are unwholesome and non-beneficial or harmful for the Patha or srotas are called Apathya. Keeping away from the Apathyas and making it a habit of consuming Pathyas is the best way of avoiding the diseases.

Even if the disease has manifested and is in the initial stages of manifestation,with feeble signs and symptoms, ‘following Pathya’ will help in quick recovery from the disease.

In these conditions Pathya itself works as chikitsa. In chronic diseases, Pathya becomes a mandatory co-prescription to the main line of treatment or medicines. Without following pathya it is difficult to conquer the diseases and procure health.

Note –
Nidana parivarjana and Pathya sevana are not taken as two; in fact they are taken as different examples of Ekavidha chikitsa.

Dwi-vidha Chikitsa

Dwi-vidha Chikitsa – (Two types of Treatment)
Sheeta upachara and Ushna upachara:
Sheeta upachara means cold comforts. Cold is opposite to hot. When the disease has been manifested due to heat, predominance of heat or causes which induce heat, then the treatment should be antagonistic. Thus cold comforts and food should be administered in Ushnata janya vyadhis (diseases manifested due to excess heat).

Ushna upachara means hot comforts. Hot is opposite to cold. When the disease has been manifested due to cold, predominance of cold or causes which induce cold, then the treatment should be antagonistic. Thus hot comforts and food should be administered in Sheeta janya vyadhis (diseases manifested due to excess cold).

Santarpana and Apatarpana Chikitsa:
Santarpana means nourishing treatment. It is also correlated to Brimhana (bulk promoting). This treatment is preferred in those who are suffering from diseases having their origin in less nutrition or malnutrition. It is also used to enhance bulk in thin people. Thus Santarpana is an ideal treatment for Karshya (emaciation, thinning).

Apatarpana means depleting treatment. It is also correlated to Langhana (starvation, thinning therapies, and lightening therapies). This treatment is preferred in those who are suffering from diseases having their origin in over nutrition or saturation.

It is also used to deplete fat stores and emaciate bulky, fatty and stout people. Thus Apatarpana is an ideal treatment for Sthoulya (obesity, over-weight).

Shodhana and Shamana –
Shodhana means cleansing or evacuatory treatments. These treatments are preferred to throw away the unwanted metabolic wastes and tissue toxins out of the body.

To tolerate this treatment, the patient needs to be stronger. Thus, Shodhana treatment is given for people who have more bala (strength) and mamsa (muscle and tissue bulk which denotes good strength). It should be thought of only in the presence of ‘Bahu dosha’ excessive morbidity.

Shamana means pacificatory or palliative form of treatment. Shaman or samshamana treatment is opposite of Samshodhana or shodhana chikitsa. This should be considered in those patients who are not fit to undergo Shodhana chikitsa.

Thus, Shamana chikitsa is administered in the patients who have less bala (strength) and mamsa (muscle bulk). It is also thought of in the presence of heena (less) or madhyama (moderate) quantity of morbidity.

Swasthasya Urjaskara and Artasya Roganut chikitsa –
Swasthasya urjaskara means the treatment which promotes, fortifies and enhances health in an already healthy individual.

Even healthy people who desire good health and longevity will need some medicines which fortify their health and prevent the diseases. Thus preventive medicines fall into the list of Swasthasya Urjaskara. It is again of 2 types, Rasayana (rejuvenators, anti-ageing, immune modulators) and Vajikarana (aphrodisiacs)

Artasya Roganut means that which helps in eradicating a disease or disease process. Medicines and treatments used in treating the diseases and removing them from their roots and all the disease modifying medicines will be included in this category.

This again is of 2 types, Roga prashamana (those which destroy the diseases) and Apunarbhava Chikitsa (those which prevent recurrence of a disease)

Rasayana and Vajikarana –
Rasayanas are a group of medicines (non-medicines, activities also) which are beneficial for the enhancement of the quality and quantity of all the tissues of the body.

As discussed above, Rasayana falls into the category of Swasthasya urjaskara type of treatment i.e. they promote health in an already healthy individual and are predominantly preventive in nature.

But Rasayanas are also disease-modifying medicines and help in curing the diseases. They help in enhancing the ayu (life span), buddhi (intellect) and bala (strength and immunity) of the person.

Vajikaranas are a group of medicines (non-medicines, activities also) which are beneficial for enhancement of the quality and quantity of all the semen. They also enhance sexual vigour. They are the best medicines to cure infertility and impotence.

As discussed above, Vajikarana falls into the category of Swasthasya urjaskara type of treatment i.e. they promote health in an already healthy individual and are predominantly preventive in nature.

But Vajikaranas are also disease-modifying medicines and help in curing the diseases. They help in enhancing the pourusha shakti (sexual potency) praharsha (sexual exhilaration and vigour), shukravardhana (enhancement of quality and quantity of semen) and Santana utpatti (begetting healthy kids).

Roga prashamana and Apunarbhava chikitsa –
Roga prashamana means to pacify and mitigate the diseases. As already discussed, roga prashamana is included under Artasya roganut type of treatment i.e. they destroy the disease and disease process from the roots.

Thus Roga prashamana chikitsa is predominantly curative in nature. The diseases cured by Roga Prashamana chikitsa can recur.

Apunarbhava means those medicines and treatments which help in preventing the recurrences of the diseases. These medicines and treatments not only cure the diseases but also avoid their recurrence.

As already discussed, apunarbhava is included under Artasya roganut type of treatment i.e. they destroy the disease and disease process from the roots.

Thus apunarbhava chikitsa is predominantly curative in nature. The diseases cured by Apunarbhava chikitsa, unlike Roga prashamana chikitsa do not recur.

Dravyabhuta and Adravyabhuta Chikitsa –
Dravyabhuta chikitsa is a type of treatment in which medicines or different materials are used in the treatment.
Adravyabhuta chikitsa is a type of treatment in which medicines are not used for treatments.

Rather, different methods (upaya) are used in treating the patients. Some of the upayas used in the treatment are as below mentioned –
Bhaya darshana – causing fear in the mind of the patient
Vismarana – making to forget
Kshobhana – causing irritation or provoking
Harshana – causing joy or happiness
Vadha – beating
Bandhana – tying etc

Trividha Chikitsa

Trividha Chikitsa (3 types of treatment):
Daiva-vyapashraya, Yukti-vyapashraya and Satvavajaya Chikitsa –
Daiva-vyapashraya Chikitsa means the treatment based on believing on divine power, divine remedies. This includes mantra (enchanting hymns), aushadha (medicines), mani (wearing gems), mangala (auspicious things), bali (animal etc sacrifices), homa (fire sacrifices), niyama (rigid living), prayaschita (confession), upavasa (fasting) etc measures.

Yukti-vyapashraya chikitsa – Yukti means intelligence or skill, Yukti vyapashraya chikitsa is a treatment in which the medicines, lifestyle, and diet are skilfully planned and administered. This is done after a thorough diagnosis and after having analyzed the constitution of the person in question and after having learnt about every minute detail of his or her morbidity.

Satvavajaya – Satva means mind, avajaya means to win or conquering. Thus, Satvavajaya treatment is to gain control over the mind of the patient and helping them to keep their mind and senses detached from the unwholesome subjects (including stress, anxiety etc). This can be correlated to the modern day psychiatry or mind medicine. This also includes patient counselling.

Antah parimarjana, Bahi parimarjana and Shastra pranidhana –
Antah parimarjana – Antah means inside, parimarjana means to cleanse or purify, Thus Antah parimarjana means to cleanse or purify or heal from within. In this the medicines which are taken by mouth go inside the body and act on the disease pathology and establishes health.

Bahih parimarjana – Bahi means outside, parimarjana means to cleanse or purify or heal, thus bahih parimarjana means to cleanse or purify or heal from outside. In this, the medicines are applied outside the body (at the site of pathology), these medicines heal from outside after coming into contact with the body.

Example, Abhyanga (herbal oil massage), Swedana (fomentation or application of heat), Dhara (stream pouring of liquid medicines), Lepa (application of medicinal pastes) etc

Shastra pranidhana – Shastra means instruments, pranidhana is application, thus Shastra pranidhana means application of instruments to eradicate the diseases. This includes all the surgical methods of intervention.

Aasuri, Maanushi and Daivi Chikitsa –
Aasuri chikitsa – Asura means demon. Treatments done using instruments i.e. surgical procedures are considered as Aasuri chikitsa because it looks cruel to apply instruments.

Maanushi Chikitsa – Manusha means man or human. Treatments done using medicines like powder, decoction, infusion, tablets etc is called Maanushi chikitsa since it looks more humanly.

Daivi Chikitsa – Daiva means God or divine. Treatments done administering Rasayanas (rejuvenators, anti-ageing, immune modulators etc) and Vajikarana (aphrodisiacs) are called Daivi chikitsa.

Bhouma, Audbhida and Jaangama Chikitsa –
Bhouma chikitsa – Bhouma means earth. Treatments wherein the metals like gold, silver and salts etc obtained from the earth and ores are called Bhouma chikitsa.

Audbhida Chikitsa – Audbida means to sprout. In this the herbs are used as medicines.
They are basically of 4 types: Vanaspati (plants not bearing flowers), Vaanaspatya (plants bearing both flowers and fruits), Veerudha (plants like creepers and climbers which climb and wind over the other plants and supports) and Aushadha (plants which die after yielding fruits).

Jangama chikitsa – In this the animal products are used as medicines. Example, ghee, honey etc.

Apakarshana, Prakriti-vighatana and Nidana-tyaga –
Apakarshana means to remove. This is of 2 types.
Bahya Apakarshana – In this, the cysts, tumours, crooked eyelashes, worms, etc foreign bodies which have external manifestations over the surface of the body are removed or extracted with the help of surgical instruments or hands.

Abhyantara Apakarshana – In this, the morbid doshas inside the body are removed or extracted by administration of evacuation or cleansing treatments like Vamana (therapeutic emesis), Virechana (therapeutic purgation) etc.

Prakriti Vighatana means to pacify. This again is of 2 types.
Bahya Prakriti vighatana – In this the external measures like Abhyanga (oil massage), Swedana (fomentation or sweat inducing treatment) etc are administered.
Aabhyantara Prakriti Vighatana – In this, deepana (appetite enhancers or medicines used to kindle the internal fire or metabolism), pachana (digestants) etc are administered to pacify the morbid doshas internally.

Nidana Tyaga – Nidana means the causative factors of the disease. Tyaga means to keep away or sacrificing. Thus Nidana Tyaga means to keep away from the causes of a disease or avoid the causative factors of the disease.

Hetu vipareeta, Vyadhi vipareeta and Ubhayarthakaari Chikitsa –
Hetu Vipareeta Chikitsa – In this, the medicines, food and activities antagonistic to the causative factors of the disease are administered.

Example, Foods and medicines having qualities like Laghu (light), Ruksha (dry) Ushna (hot) etc antagonistic to Guru (heavy), Snigdha (oily), Sheeta (cold) etc qualities causing the disease are administered.

Vyadhi Vipareeta Chikitsa – In this the medicines which pacify or alleviate or destroy the particular disease in question are administered.

Example, Patha (Cissampelos pareira), Kutaja (Holarrhena antidysenterica) etc medicines are used to stop the loose stools in Atisara (diarrhoea) etc. Thus disease specific medicines are administered in this type of treatment.

Ubhayarthakari Chikitsa – In this, the medicines, food and activities antagonistic to both cause and disease are administered.

Example in Vataja Shotha (swelling caused due to vitiated vata), Dashamula kwatha (decoction prepared from 10 roots) is used which acts in a byway i.e. it pacifies Vata (causative dosha) and also relieves shotha (disease).

Langhana, Langhana-Pachana and Doshavasechana –
Langhana means the treatment which produces lightness in the body. Lightness is achieved when the digestion and assimilation of food takes place in a proper way and when the unwanted metabolic wastes are thrown out of the body in right proportions in right time.
Langhana is usually preferred in those people who have less strength (alpa bala) and less morbidity (alpa dosha) in their body. Read more about Langhana therapy

In these people strong medicines and strong treatments like evacuation and cleansing (shodhana chikitsa) can be harmful. Langhana enhances the digestive fire (agni) and Vayu, which in turn will subside or pacify the aggravated doshas in the body.

Langhana-Pachana is an extension over Langhana wherein it is skilfully combined with Pachana. Pachana means to digest, in this context it is to digest ama (immature nutritive essence in circulation, which due to its sticky nature clogs the channels of the body and depletes nutrition and essentials to the body tissues).

When the patient has Madhyama bala (moderate strength) and Madhyama dosha (moderate quantity of doshas or morbidity) both, Langhana and Pachana are administered.

Doshavasechana means eliminating the morbid doshas out of the body. This is also called as shodhana or samshodhana.
When the doshas are in high quantity (bahu dosha) and the patient also has good strength to tolerate the strength of the treatment (bahu bala), Doshavasechana should be done, by administering cleansing measures such as Vamana (therapeutic emesis), Virechana (therapeutic purgation) etc

Chaturvidha Chikitsa

Chaturvidha Chikitsa (4 types of treatments)
Brimhitavya, Prashamayitavya, Nirhartavya and Paripaalya (Su.chi.33/3) –
Brimhitavya – This means to increase the doshas which have decreased and to bring them back to normalcy.

Prashamayitavya – This is opposite of Brimhitavya, the increased doshas should be decreased and brought back to normalcy.
Nirhartavya – The aggravated doshas should be expelled from the body
Paripaalya – The doshas which are in a condition of normalcy (equilibrium) should be guarded and balanced

Vanaspati, Vanaspatya, Virudha and Aushadha –
As already discussed these are the 4 types of Audbhida Dravyas.

Audbhida Chikitsa – Audbida means to sprout. In this the herbs are used as medicines. They are basically of 4 types:
Vanaspati (plants not bearing flowers),
Vaanaspatya (plants bearing both flowers and fruits),
Veerudha (plants like creepers and climbers which climb and wind over the other plants and supports) and
Aushadha (plants which die after yielding fruits)

Samshodhana, Samshamana, Aahara and Aachara –
Samshodhana –
Samshodhana means cleansing or evacuation or expelling the morbidity in the body.
They are of 2 types:
Bahirashraya (External cleansing) – This is achieved by means of:
Shastra – instruments (surgical)
Kshaara – alkalis (cauterization)
Agni – fire (cauterization)
Pralepa adi – anointments, ointments and application of medicinal pastes etc

Antarashraya (Internal cleansing) –
This is achieved by means of:
Vamana – therapeutic vomiting
Virechana – therapeutic purgation
Niruha – enemas with herbal decoctions (asthapana vasti or kashaya vasti)
Raktamokshana – blood letting
Shiro virechana – nasal medication

Samshamana –
Samshamana means pacification or palliative treatment wherein the doshas (morbidity) are handled at their place or location without worrying about their evacuation.

They are of 2 types:
Bahya Samshamana (External palliative treatment) – This is achieved by means of:
Aalepa – application of medicinal pastes. Read more about Lepa kalpana
Parisheka – stream pouring or showering of medicinal liquids
Avagaha – tub bath or insertion of the body or part of body in medicated fluids
Abhyanga – massage using herbal oils
Shiro vasti – oil pooling over the head
Kavala graham and Gandoosha – oral rinsing, gargling, oil pulling  etc

Aabhyantara samshamana (internal palliative treatment) –
This can be achieved by administration of:
Pachana – medicines which digest ama or metabolic toxins (immature essence of nutrition in circulation, which by the virtue of its sticky nature clogs the channels of the body, thus depleting nutrition and essentials to the body tissues and organs)
Lekhana – scraping or fat depleting treatments
Brimhana – bulk promoting treatments. Read more about Brihmana therapy
Rasayana – rejuvenation, anti-ageing, immune modulation treatments
Vajikarana – aphrodisiacs
Visha shaman – anti-toxins to nullify or neutralize the effect of external and internal poisons

Ahara means food or diet. The food here acts as treatment.
This again is of 4 types:
Peya – drinkables
Lehya – foods which can be licked
Khadya – foods which can be chewed and eaten
Bhakshya – foods which can be swallowed

Aachara means lifestyle practices and activities done over a period of time.
They are again of 4 types:
Kaayika aachara (physical activities) – can be administered in the form of:
Prakshepana – flexion
Utkshepana – extension
Avakshepana – abduction and adduction etc

Vaachika aachara (verbal activities) – can be administered in the form of:
Paata – teaching
Svaadhyaaya – reading etc

Maanasa aachara (mental activities) – can be administered in the form of:
Chintya – thinking
Vicharya – analyze
Uhya – guess
Dhyeya – resolution
Sankalpa – determination or decision etc

Pancha-vidha Chikitsa

Pancha-vidha Chikitsa (5 types of treatment): 
The 5 types of Samshodhana Chikitsa (cleansing, evacuation treatments) can be included in Pancha-vidha chikitsa. They are also called as Pancha Karma (5 superior treatments).

They are:
Vamana – therapeutic emesis (medicine induced vomiting), mainly used to expel morbid kapha or to effectively tackle kapha predominant diseases

Virechana – therapeutic purgation (medicine induced purgation), mainly used to expel morbid pitta or to effectively tackle pitta predominant diseases

Niruha Vasti (Asthapana Vasti or Kashaya Vasti) – enemas given with herbal decoctions (kashaya), mainly used to gain control over morbid Vata or to effectively tackle vata predominant diseases

Nasya or Shirovirechana – nasal medication in which herbal juices decoctions, powders, fumes etc are instilled into the nasal passages, mainly used to tackle the diseases occurring above the level of the collar bone, i.e. the diseases of head, eyes, ears and nose.

Rakta-mokshana – rakta means blood, mokshana means letting, thus raktamokshana means blood-letting. This is mainly used to expel the morbidity occurring in the blood and to treat effectively the diseases manifested due to vitiation of blood (blood-borne diseases).

Shat-vidha Chikitsa

Shat-vidha Chikitsa (6 types of treatment)
Langhana, Brimhana, Rukshana, Snehana, Swedana and Stambhana are said to be the 6 types of treatments. When implemented skilfully in proper time, they are capable of conquering many diseases effectively.

Langhana – means producing lightness. Anything which produces Laghutva or lightness in the body is called Langhana.

They are again of 10 types:
Vamana – therapeutic emesis
Virechana – therapeutic purgation
Shirovirechana (nasya) – nasal medications
Niruha vasti – evacuation or cleansing enemas
Pipaasa – not drinking water
Maruta – exposure to breeze
Aatapa – exposure to sunlight
Paachana – medicines or treatments which can digest and destroy ama (metabolic wastes)
Upavasa – starvation
Vyaayaama – exercise

Brimhana – means to promote bulk or enhance the mamsa (muscle) etc tissues in terms of quantity. Anything which increases the bulk of the body by quantitative enhancement of Mamsa etc tissues is called Brimhana.

Rukshana – means producing dryness. Anything which brings about dryness and roughness in the body is called Rukshana.

Snehana – means to produce unctuousness or oiliness in the body. Anything which produces oiliness, wetness (fluidity) and softness (smoothness) in the body is called Snehana.

Snehana can be administered in 2 types – Bahya snehana (external application of sneha in the form of Abhyanga – massage, Dhara – stream pouring of herbal oils, Sthanik Vasti – local oil pooling etc) and Abhyantara Snehana (intake of medicated oils, ghee or both).

Swedana – means fomentation or steaming or sudation. This is a treatment used to induce sweat. Anything which destroys stambhana (stiffness of body parts), sheeta (coldness) and gaurava (heaviness) and induces sweating is called Swedana.

Stambhana – means to stop. Anything which stops the things in movement (especially liquids) is called stambhana. This treatment is used in conditions like diarrhoea, excessive bleeding etc conditions.

Sapta-vidha Chikitsa

Sapta-vidha Chikitsa (7 types of treatment): 
Ref – Ashtanga Hridaya Sutra 14/6-7
The 7 types of Shamana (palliative treatments) can be included under Sapta-vidha chikitsa.

They are as below mentioned –

Paachana – medicines which digest ama or metabolic toxins (immature essence of nutrition in circulation, which by the virtue of its sticky nature clogs the channels of the body, thus depleting nutrition and essentials to the body tissues and organs)

Deepana – Treatments and medicines used to kindle the internal fire (jataragni and dhatwagni), i.e. the gut and tissue fires so as to make them competent enough to digest the food properly and also convert and process them into components which can be readily utilised by various tissues to conduct normal body functions.

Kshudha – Fasting (forced starvation) or eating in negligible quantity will boost the metabolic process in the body because by not consuming food we would have given a break and rest to the digestion apparatus, which in turn helps in kindling the interior fire (agni).

Trushna – Not drinking water or drinking small and negligible amounts of water (forced thirst) is called Trishna nigraha. This too works on similar lines of Kshudha nigraha or forced starvation.
Vyaayama – Exercise
Aatapa – Exposure to heat of the sun
Vayu – Exposure to wind

Dasha-vidha Chikitsa

Dasha-vidha Chikitsa (10 types of treatment): 
Chatuhu prakaara samshuddhihi pipaasa maaruta aatapau
Paachanaani upavaasaha cha vyaayaamaha cha iti langhanam
Ref – Charaka Sutra Sthana 22/18
The 10 types of Langhana can be included into Dasha-vidha chikitsa.
Many types of shamanas as mentioned by Vagbhata in Ashtanga Hridaya (as discussed just before this) are included in this 10 fold treatments explained by Charaka.

They are as below mentioned –
Vamana – therapeutic emesis
Virechana – therapeutic purgation
Niruha Vasti – evacuation enemas, mainly herbal decoction enemas
Nasya – nasal instillation of medicines
Pipasa (same as trishna nigraha) – forcibly controlling the thirst or drinking less water
Vaayu sevana – exposure to wind
Aatapa sevana – exposure to the heat of the sun
Paachana – medicines used in digesting ama (immature circulating nutritive essence)
Upavasa (same as kshudha nigraha) – forced starvation or fasting
Vyaayama – exercise

Ashtadasha-vidha Chikitsa

Ashtadasha-vidha Chikitsa (18 types of treatment): 
18 types of Upashaya explained in Pancha Nidanas can be included under Ashtadasha-vidha Chikitsa.
Pancha Nidanas are 5 fold examination of a disease.

They are:
Nidana – Causative factors of a disease
Purvarupa – Premonitory stage, Premonitory signs and symptoms of an impending disease
Rupa – Signs and symptoms of a manifested disease
Upashaya-Anupashaya – Disease can also be examined on the basis of aggravating and relieving factors of a disease. When it becomes difficult to diagnose a disease or its nature, it is wise to do a trial and error method and diagnose the disease. This is called Upashaya (knowing the disease through relieving factors) and Anupashaya (Knowing the disease by the factors which do not pacify a disease, in fact can aggravate a disease).

It is a method of examining a Guda-Linga Vyadhi (disease with concealed symptoms). Upashaya-Anupashaya is of 18 types. They are not only tools of examination of a disease but also become the treatment of the disease because while doing trial and errors we would have many times administered the perfect treatment or medication for the disease in question. (I would clear the doubts through the examples given below).
Samprapti – means etio-pathogenesis of a disease or the step ladder pattern of the formation of disease in stages.

Hetu vyaadhi viparyasta viparyasta artha kaarinaam
Sa aushadha anna vihaaraanaam upayogam sukhaavaham
Vidhyaat upashayam vyadhehe, sa hi saatmyam smrutaha
Ref – Ashtanga Hridaya Nidana 1/6,7
Upashayatmaka chikitsa is basically of 6 types, each again has 3 components which makes a total of 18.

They are as below mentioned –
Hetu Viparita – Antagonistic to the cause of the disease, has 3 components i.e.
Aushadha – medicine,
Ahara – diet and
Vihara – activities

Vyadhi Viparita – Antagonistic to the disease, has 3 components i.e.
Aushadha – medicine,
Ahara – diet and
Vihara – activities

Hetu-Vyadhi Viparita – Antagonistic to both, the cause of the disease and the disease, has 3 components i.e.
Aushadha – medicine,
Ahara – diet and
Vihara – activities

Hetu Viparitarthakari – Similar to the cause of the disease, has 3 components i.e.
Aushadha – medicine,
Ahara – diet and
Vihara – activities

Vyadhi Viparitarthakari – Similar (agonist) to the disease, has 3 components i.e.
Aushadha – medicine,
Ahara – diet and
Vihara – activities

Hetu-Vyadhi Viparitarthakari – Similar (agonist) to both, the cause of the disease and the disease, has 3 components i.e.
Aushadha – medicine,
Ahara – diet and
Vihara – activities

Now we will try to undersand the above said with suitable examples. To make the understanding easy, we shall take each component of the 6 types as individual chikitsa and sum up the 18 types as explained below –

Hetu Viparita Aushadha (Medicines antagonistic to the cause of the disease) – Example, in fevers caused by excessive cold and vitiated Kapha (sheeta-kaphaja jwara), administering Ushna Aushadhas (medicines with hot potency which are antagonistic to the cold quality and kapha, which is also cold in nature)

Hetu Viparita Ahara or anna (food antagonistic to the cause of the disease) – Example, in Shramaja jwara (fever caused due to excessive physical exhaustion) or Vataja Jwara (fever caused by vitiated vata), administering Mamsa rasa (meat soup) and odana (rice) or rice with meat soup which are antagonistic to shrama and vata, the causes of fever in this context

Hetu Viparita Vihara (activities and lifestyle practices antagonistic to the cause of the disease) – Example, advising ratri jagarana (awakening throughout the night) in case of kapha vitiation caused due to excessive diva shayana or diva swapna (day sleeping), is antagonizing to the cause.

Excessive day sleep will cause abnormal increase of Kapha. Awakening throughout the night will increase Vata which is antagonistic to kapha. The increased Vata will decrease the kapha (vata and kapha have antagonizing qualities).

Vyadhi Viparita Aushadha (Medicines antagonistic to the disease) – Example, administration of disease specific or disease modifying medicines like Patha or Kutaja in atisara (both medicines are anti-diarrhoeal), Khadira in Kushta (skin diseases), Haridra (turmeric) in Prameha (urinary disorders and diabetes) etc

Vyadhi Viparita Anna or Ahara (food or diet antagonistic to the disease) – Example, administration of Masura (red lentils) to stop loose stools (stambhana) in atisara (diarrhoea)

Vyadhi Viparita Vihara (activities or lifestyle practices which are antagonistic to the disease) – Example, Pravahana (straining) in Udavarta (disease caused due to upward movement of Vayu or vitiatied vata)

Hetu-Vyadhi Viparita Aushadha (medicines antagonistic to both the cause of the disease and the disease itself) – Example, administration of Dashamula kwatha (decoction prepared using 10 roots) in Vataja Shotha (swelling caused by vitiated Vata), here Dashamula Kwatha is best in alleviating Vata (antagonistic to vata which is a cause of the disease shotha) and also in alleviating shotha or swelling (antagonistic to disease shotha).

Hetu-Vyadhi Viparita Anna or Ahara (food and diet antagonistic to both the cause of the disease and the disease itself) – Example, administering Peya or thin gruel in fever caused by vata which has been vitiated by sheeta (cold foods and comforts), here the gruel being a food is helpful in alleviating the cause i.e. vata aggravated due to cold and also cures jwara (disease).

Hetu Vyadhi Viparita Vihaara (activities and lifestyle practices antagonistic to both the cause of the disease and the disease itself) – Example, advising Ratri Jagarana (awakening throughout the night) as a remedy in Tandra (drowsiness) caused due to excessive consumption of snigdha ahara (oily foods) and diwaswapna (excessive day sleep).

Ratri Jagarana being dry in nature (as it causes an increase of Vata which is phenomenaly dry in nature, thus increasing the dryness in the body) is antagonistic to the cause (i.e. snigdha ahara and divaswapna) and also to the disease (tandra).

Hetu Viparitarthakari Aushadha (medicines similar to the nature of the causative factor of the disease) – Example, administration of ushna upanaha (hot poultices) over the vrana (wounds or ulcers) caused by vitiated pitta, here hot poultice is similar in nature to pitta (cause of the disease) because pitta too is hot in nature.

The upanaha should have aggravated pitta (by further vitiation of pitta) but though similar in nature, ushna upanaha doesn’t aggravate pitta but pacifies it.

Hetu Viparitarthakari Anna or ahara (food or diet similar to the nature of the causative factor of the disease) – Example, administration of vidahi anna (foods which cause burning sensation or corrosive foods) in Pittaja Vrana (ulcers or wounds caused by vitiated Pitta), Vidahi anna should actually aggravate Pitta and worsen the condition, but in spite of being similar to the nature of pitta (both vidahi anna and pitta are hot in nature), vidahi anna pacifies pitta when administered in pittaja vrana.

Hetu Viparitarthakari Vihara (activities and lifestyle practices similar to the nature of the causative factor of the disease) – Example, implementing Bhaya darshana (creating fear) in Vataja Unmada (insanity caused due to vitiated Vata), actually fear is antagonistic to the nature of Vata and as a rule it should have vitiated Vata, which here is a causative factor for Unmada, but bhaya darshana pacifies the causative factor of unmada i.e. vata.

Vyadhi Viparitarthakari Aushadha (medicines similar to the nature of the disease) – Example, administration of Madanaphala (which is an emetic) in Chardi disease (vomiting), actually madanaphala being an emetic is antagonistic to the disease (vomiting) and should further aggravate the vomiting, but what happens is the contrary. Madanaphala alleviates vomiting.

Vyadhi Viparitarthakari Anna or Ahara (food or diet similar to the nature of the disease) – Example, administration of milk (food) to cause virechana (purgation) in atisara (diarrhoea), here being antagonistic to the disease (atisara), milk (cause) should have worsened the disease but actually it alleviates atisara.

Vyadhi Viparitarthakari Vihara (activities or lifestyle practices which are similar to the nature of the disease) – Example, Pravahana (straining) for inducing vomiting in Chardi disease (vomiting), in this pravahana is antagonistic to the disease (chardi) but instead of aggravating the disease (chardi), pravahana (vihara) pacifies it.

Hetu Vyadhi Viparitarthakari Aushadha (medicines which are similar in nature both to the causative factor of the disease and the disease itself) – Example, administration of paste of agaru etc medicines (which are hot in nature) in fire burns and administration of visha (poison) in vishajanya visha (poisonous effect caused by another poison), in both these instances the treatments being similar to the nature of cause (fire and poison) and disease (burns and poisoning) will not aggravate the diseases.

Hetu Vyadhi Viparitarthakari Anna or ahara (food or diet which is similar both to the nature of the cause of the disease and the disease itself) – Example, administration of Madhya (alcohol) in Madatyaya (alcoholic intoxication – disease) caused due to excessive consumption of Madhya (alcohol – cause of the disease madatyaya), here, Madhya being similar in quality to the cause (alcohol) and the disease (intoxication) will be a remedy instead of aggravating the disease.

Hetu Vyadhi Viparitarthakari Vihara (activities and lifestyle practices similar in nature to both the cause of the disease and the disease itself) – Example, advising swimming as a remedy in Sammudha-vata or urustambha (disease characterised with stiffness of thigh) caused by vyayama (excessive exercise), here swimming being of similar nature to the cause (vyayama) and disease (urustambha) should actually aggravate the condition, but on the contrary will alleviate the disease.

When the above said work in favour of the disease (upashaya) are considered as chikitsa (treatment), in that case the medicine or food or activity which has alleviated the disease or had worked antagonistic to the cause, disease or both (in spite of being antagonistic or similar in nature to the cause, disease or both) shall be continued.

When the above said doesn’t work in favour of the disease and aggravates the dosha or disease, they are considered to be anupashaya (aggravating factors) and should be discontinued.

Upashaya (pacification of dosha and or disease) and anupashaya (aggravation of dosha and or disease) are basically therapeutic tests done to diagnose a disease when the other tools of diagnosis have failed to find out the disease or the signs and symptoms of the disease are latent.

Following the diagnosis, if the ahara, anna and vihara alleviate the dosha or disease or both, they shall be continued. In this perspective, the therapeutic tools act like chikitsa and will also be called as satmya (compatible things). If the test tools of diagnosis aggravate the disease, then they are stopped.

Ashta-vidha Chikitsa

Ashta-vidha Chikitsa (8 types of treatment, surgical perspective)
The surgical school of thought has given 8 types of treatment wherein the surgical methods are applied.
According to Sushruta, 8 types of shastra karmas (surgical remedies) are as below said –
Chedana (Excision) – In this the pathological parts are cut and separated. Example, chedana is done in arshas (piles), bhagandara (fistula), charmakeela (polyps) etc conditions
Bhedana (incision) – In this the diseased part is incised, Example, bhedana is done in vidradhi (abscess) etc

Lekhana (scraping) – In this, the diseased part is scraped with the help of instruments, example, lekhana is done in rohini (diphtheria), kilasa (leukoderma) etc conditions
Vedhana (puncturing) – In this, the diseased part is punctured, Example, vedhana is done while conducting sira vedha treatment (vein puncture, a type of bloodletting treatment)
Eshana (probing) – In this, the diseased part is probed using probing instruments, Example, tracking the pathway of nadivrana (sinus tracts)
Aaharana (extraction) – In this, the foreign body is extracted, Example, aaharana is done in forcible extraction of mudha garbha (impacted foetus)
Visraavana (drainage) – In this, the morbid material is drained out, Example, drainage of contaminated pus, blood etc
Seevana (suturing / stitching) – In this, the torn structures are sewed or sutured, Example, suturing the wounds etc

Shashta Vidha Chikitsa

Shashta Vidha Chikitsa (60 types of treatment): 
The Shashti upakrama (60 types of treatment strategies used in surgical practice) explained by Sushruta can be included in hashta vidha chikitsa.

They are as below mentioned –
Apatarpana – starvation
Alepa – anointment of medicinal pastes
Parisheka – stream pouring of medications
Abhyanga – massage
Sweda – fomentation or sudation (sweat inducing treatments)
Vimlapana – gentle pressing / cleansing measures
Upanaha – poultices
Paachana – causing maturity in suppuration (helping the pus to form properly so as to drain it out)
Visraavana – drainage
Sneha – inducing oiliness or unctuousness
Vamana – therapeutic emesis
Virechana – therapeutic purgation
Chedana – excision
Bhedana – incision
Daarana – splitting / tearing
Lekhana – scraping
Eshana – probing
Aaharana – extraction
Vyadhana – puncturing
Vidraavana – liquefaction
Seevana – suturing
Sandhana – unification (as in promoting union of fractures)
Peedana – compression
Shonita sthapana – checking the bleeding and establishing proper quality and quantity of blood
Nirvapana – application and stream pouring of medicines which are cold in nature
Utkaarika – warm semi-solid pastes prepared with medicines which alleviate vata, mainly used in inflamed and or necrosed wounds
Kashaaya – administering herbal decoctions
Varti – application or inserting suppositories
Kalka – application of herbal pastes
Sarpi – use of medicated ghee
Taila – use of medicated oils
Rasa kriya – administration of semi-solid extracts of medicines
Avachurnana – sprinkling of herbal powders
Vrana dhupana – fumigation of wounds
Utsaadana – Elevation of wounds (the wound having depressed or deep floor due to less developed granulation tissue are treated with some herbs which improve granulation tissue so that the floor of the wound is raised)
Avasaadana – Depression of wounds (to remove unhealthy, unnecessary hyper-granulation tissue from floor of the wound which produces delayed healing)
Mrudu karma – softening procedures (wound margins and edges are made soft)
Daaruna karma – hardening the margins of the wounds (some wounds have less tensile strength so that the wound margin easily separate causing early dehiscence and wound healing delayed. To avoid long time wound healing, daaruna karma is done)
Kshaara karma – application of alkalis (cauterization)
Agni karma – application of fire (cauterization)
Krushna karma – inducing black colour (hypo-pigmentation area made normal like surrounding tissue)
Pandu karma – inducing white colour (hyper-pigmentation area made normal like surrounding tissue)
Pratisaarana – tablets made up of rough powder of medicinal herbs is rubbed on soft shiny skin (after wound healing) so as to make the skin surface rough, just like the normal skin
Roma samjanana – treatments and medicines (measures) enabling growth of hairs
Loma apaharana – treatments and medicines (measures) enabling removal of unnecessary hairs
Vasti karma – medicinal enemas
Uttara vasti karma – enemas given through urinary and genital passages
Bandha – bandages
Patra daana – covering the wounds with leaves
Krimighna – disinfectants
Brimhana – bulk promoting and strengthening treatments
Vishagna – anti-toxins, treatments and medicines which nullify or neutralize the effect of poisons and toxins
Shiro virechana – nasal instillation of medicines
Nasya – nasal instillation of medication
Kavala dharana – rinsing of mouth with medicinal liquids
Dhooma – fumigation
Madhu sarpi – administration of honey and ghee
Yantra – instrumentation
Aahara – dietetic regimen
Rakshaa vidhana – sterilization (the surgical ward, instruments etc should be sterilized by fumigating with guggulu (Commiphora mukul) etc herbs and Mantra uccharana (uttering or reciting holy hymns) to kill the small pathogenic organisms)

Just before finish –
Na hi vistarasya pramaanam asti na cha api ati sankshepo alpa buddheenaam saamarthyaaya upakalpate tasmaat anati sankshepena anati vistarena cha upadishtaaha| etau anto hi alam alpa buddheenaam vyavahaaraaya buddhimataam cha sva lakshanya anumaana anumaana yukti kushalaanaam anukta artha jgnaayeti (Ref – Charaka Sutra 4/20)
We have just seen how broad the classification of treatment or chikitsa has been done in Ayurveda. The diseases have been said to be infinite in number when they get classified on the basis of permutations and combinations of pain (ruja), colour (varna), causative factors (kaarana), signs and symptoms (lakshana) and fractional (quality wise) vitiation of doshas (doshamsha vikalpa).

Based on this the classification of the treatment also will be innumerable and infinite. With this concept in mind, Ayurveda teachers give us a liberty of planning and implementing the treatment on situational intelligence and wisdom (yukti), without being totally dependent on the types of chikitsa which are mentioned and explained in the texts.

Situational planning of treatment is the key. This shows that the above classifications of the treatment is a gross idea and not complete.

The Ayurvedic teachers further tell that the classification of chikitsa is only for an average learner and has been provided as a ready reckoner, but the intelligent learner (doctor) will get an idea from this classification and expand his vision in understanding the unsaid part of the classification of treatment and will skilfully invent judicious treatment as and when required.

The earliest and the best description of Chikitsa vis-à-vis Treatment and its classification are found in the Ayurvedic treatises.
As the saying goes ‘old is gold’ it truly fits in relation to Ayurveda. There is no doubt that this holistic medical science has been widely accepted for its exemplary results and for providing it in a natural way.
Believe in Ayurvedic treatment and experience it. You will never complain for feeling ‘healthier than ever’.

Q: Does taking Nutritional medicines at the time of diseased condition aggravates the disease.
ie after cleansing process only Nutritional medicines has to be given

Answer:
In Ayurveda, when there is a disease, only if the patient is very weak even to tolerate the medicines, only then nutritional medicines are given. Till the patient recovers from the disease, primary target of medicine is to cure the disease without harming the health of the patient.

If the patient’s digestion strength is low and if we are supplying nutrition rich medicines, they may further lower the digestion strength in some cases. So, target the disease first, while keeping patient’s strength to tolerate the medicines / treatment in mind.
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