Charaka Roganikam Vimana: 6th chapter

The 6th chapter of Charaka Samhitha Vimana Sthana is Roganikam Vimanam. It deals with management of diseases affecting persons with different body types and determination of the specific characteristics of diseases, etc.
“Let us explore Roganika Vimana Adhyaya – the chapter on the determination of the specific characteristics of diseases” thus said Lord Atreya [1-2]

Disease classification

Various types of classification of diseases:
Diseases are classified into two groups on the basis of the five different criteria, as follows:-

Types of diseases as per Ayurveda:
Prabhava Bheda – Based on Prognosis – Curable, Incurable (Sadhya, Asadhya)
Bala Bheda – Based on intensity – mild, severe (Mrudu, Daruna)
Adhishtana Bheda – based on location – Mental, Physical (Mano Adhishtana, Sharira Adhishtana)
Nimitta Bheda – based on nature of the causative factors – Endogenous, Exogenous (sva dhatu vaishamya nimitta, agantu nimitta)
Ashaya bheda – based on site of origin – Having origin from Amashaya (stomach), Having origin from Pakvashaya (colon) (Amashaya samutta, Pakvasay samuttha)
Even though diseases are of two groups based on prognosis, intensity, location, nature of the causative factors and site of origin, still by different permutations and combinations they can be classified as one or in many ways.

Diseases as single classification:
All diseases may be of one group because manifestation of pain is common for all- Dukha Samanyaat.
They may be of many groups on the basis of their tenfold classification according to prognosis etc., described above.

Multiplicity of the classification of diseases
Diseases can be numerable or innumerable. Their innumerability has been described in the 19th chapter of Sutra sthana – Maharoga Adhyaya and their innumerability on the basis variations in pain, color. [3]

Justification for different types of classification:
If the diseases are classified in different bases does not take away the validity of those classifications.
An individual has the liberty to classify things as he likes. If something is already classified into some groups in a particular manner, he may reclassify it on the basis of different criterion which may result in changes in the number of groups in different ways.
This does not invalidate the number of groups according to some other mode of classification. In some cases the criterion of classification may appear to be the same as the previous one but the specific features of each of these criterion is observed based on the validity of this classification.
The same term may carry different meanings, e.g the word “Roga” denotes both the Doshas as well as diseases. similarly various terms which are synonymous may denote only one thing, e.g Roga, Atanka, Yakshman, Doshaprakrti (having polluting nature) and Vikara (morbidity- these terms carry the meaning of or are synonymous with both Dosha and Vyadhi (diseases) for the rest like Hetu (etiology) etc., this term, viz Roga carries a different meaning. [4]

Doshas and vitiation

Physical and mental Doshas and their vitiations:
Because of their highly multitudinous nature, diseases are innumerable. On the other hand, Doshas are numerable because of their limitation in number. So only some of the diseases will be explained by way of illustrations where as Doshas will be explained in their entirety.

Mano Doshas

Rajas and Tamas are the Doshas pertaining to the mind and the type of morbidity caused by them are Kama (lust), Krodha – anger, Lobha – greed, Moha – attachment, Irshya – envy, Mana – ego, Mada – pride, Shoka – depression, Chinta – worry, Udvega – anxiety, Bhaya – fear, Harsha – excitement etc.
Vata, Pitta and Kapha- these three are the Doshas pertaining to the body.

Sharirika Dosha

Diseases caused by them are fever, diarrhea, oedema, emaciation, dyspnoea, Meha – diabetes, urinary tract disorders, skin diseases. Thus, Doshas and diseases are explained:

Causes for vitiation

Causes for vitiation of mental and physical Doshas:
Both the types of Doshas have three types of etiological factors, viz .,
Asatmya Indriya Artha Samyoga – unwholesome contact with the object of senses,
Prajnaparadha – intellectual Blasphemy and
Parinama – seasonal changes. [5-6]

Factors responsible for manifestation of innumerable disease:
Depending upon the specific nature of the causative factors and also the specificity of the nature elements afflicted, Doshas when aggravated manifest innumerable types of diseases. [7]

Psycho-somatic disease:
When allowed to persist for long, these psychic diseases, Viz, Kama (lust) etc, and somatic diseases viz, fever etc., at times get combined with each other. [8]

Psychic Doshas- their eternal union:
There is an eternal union between the two Mano Doshas – Rajas and tamas.
Tamas cannot manifest its actions without Rajas. [9]

Combination of physical Doshas:
Vata, Pitta and Kapha located in same place and having similar attributes mostly combine with one another (samsarga) or with all together (Sannipata) to form disease. Attributes of Doshas resemble those of the factors which vitiated them. [10]

Anubandhya, Anubandha Roga

Primary and secondary diseases: Anubandhya, Anubandha Roga
Characteristic features of primary and secondary (subordinate) diseases:
Anubandhya – primary disorder and
Anubandha – secondary disorder.
Anubandhya – primary disease will have its own specific characteristic features. It is caused due to specific etiological facctors mentioned in text books. The other type of disease, without specific features or causes is called Anubandha – secondary.
Sannipata – Here, all the three Doshas are primarily vitiated at a time.
Samsarga – Here two Doshas get vitiated at a time to produce disease.
Based on permutation and combination of causative factors and symptoms, both the above two types of diseases can be classified in different ways. Considering such characteristic features, physician attribute various names (like Jvara – fever or fever) and Atisara – diarrhoea, dysentery or diarrhea) to different conditions caused by Doshas and diseases. [11]

Four types of Agni

Depending upon strength, Agni (factors responsible for digestion and metabolism) can be classified under four categories, viz
Teekshna – sharp, high intensity
Manda – mild, low intensity
Sama – regular, normal intensity
Vishama – irregular intensity
Teeksnagni – Capable of tolerating all types of diet irregularities
mandagni – minor food irregularity leads to diseases
Samagni – moderate food irregularity leads to disease, otherwise maintains health
Vishamagni – Sometimes it gets impaired and sometimes it does not get impaired by food irregularities. (unpredictable variations)

Agni and Dosha body types

Four types of Agni occur in 4 types of individuals.
In a person with balanced Tridoshas – Samagni.
Vata body type person will have Vishamagni
Pitta person will have Teekshnagni
Kapha person will have mandagni . [12]

Prakruti

Prakruti – Physical constitution:
Some scholars opine that no person can have all the three doshas in equilibrium, because food always has one or the other dosha dominance in it. They only believe that there are three Prakrutis – Vata, Pitta and Kapha.
But this is not true because, physicians consider an individual as healthy only when Vata, Pitta, and Kapha are in equilibrium and health represents the natural state of the body. It is with a view to maintaining good health that all types of treatments are prescribed.
Hence, there exists people with Tridosha equilibrium.
The Dosha body types are determined by aggressive, but healthily dominant Dosha in the body, not by vitiated Doshas.
The 4 types of body type (Sama, Vata, Pitta and Kapha) should follow 4 types of regimen.
The person with Sama prakruti – all Doshas in equilibrium should adopt a normal and healthy diet and lifestyle.
The Vata, Pitta and Kapha body type people should follow diet and lifestyle with opposite characteristics to their Dosha.

Vata Prakruti treatment

Treatment principles in Vata Prakriti:
The single Dosha prakruti persons are called Sadatura – they get afflicted by their respective Doshic disorders easily.
In Vata Prakruti person, Vata gets aggravated very easily with Vata vitiating causes. Here, Pitta and kapha does not vitiate easily. Vata aggravation leads to depletion of
Bala – strength
Varna – colour
Sukha – health
Ayusha – quality of life.
Such disorders are treated with
Sneha – oleation
Sweda – sweating treatment
Mrudu Samshodhana – mild Shodhana (elimination) therapies with medicines having
Sneha – unctuousness, hot, sweet, sour, salt properties.

Abhyanga – Massage, Upanaha – poultice, Udveshtana – bandage, Mardana – kneading, Parisheka – effusion, Avagaha- tub bath, Samvahana, (pressing and massaging by hand), Peedana – pressing, Vitrasana – terrorizing,
Vismapana – surprising and
Vismarana – re-memorizing.
Use of Sura and Asavas (fermented drinks)
usage of different fats with Deepana, Pachana, Vatahara, Virechanaeeyopaga properties, boiled hundred and thousand times and be administered in different ways viz, internal use, massage, enema with all proper rules and regulations of enema therapies etc

Pitta Prakruti treatment

Characteristics of Pitta Parkriti and its management:
If a Pittala individual resorts to Pitta aggravating activities, he develops diseases immediately. In him, Vata and Kapha Doshas do not aggravate easily.
The imbalanced Pitta afflicts the individual by the manifestation of diseases resulting in the impairment of strength, complexion, happiness and longevity.
The following therapies alleviates Pitta Dosha –
Intake of ghee
Oleation by ghee
Purgation – Virechana treatment
Use of medicines and diets having sweet, bitter and astringent tastes and cooling property
Use of scents which are mild, sweet, fragrant, cooling and cordial
Use in the chest of pearls, jewels and garlands which are kept in excessively cold water
Frequent sprinkling of cold water and cold air of Agrya Chandana (Santalum Album Linn), Priyangu (Callicarpa Macrophylla), Kaliya (yellow variety of Chandana (Sandalwood – Santalum album) and Mrunala(Lotus stalk) mixed with Utpala (Nymphaea alba), Kumuda (a variety of Utpala (Nymphaea alba)) Kokanada), Sugandhika (a varieties of Utpala (Nymphaea alba) and Padma – Lotus (Nelumbo nucifera)
Hearing of songs and music which are pleasing to ears, mild, sweet and agreeable
Hearing the information regarding prosperity
Keeping company of friends
Company of agreeable ladies wearing cooling garments and garlands
Residence in building which is cooled by the moon rays and exposed to the breezes from all sides
Residence in cold places in mountains and river banks , use of cold apparel and exposure to the cold winds of fans
Visiting beautiful gardens having pleasing, cold and the body is the most cherished one.

Management of Persons having different types of physical constitution:
Four types of regimens are prescribed for the benefit of these four categories of individuals. For an individual having the balanced state of all Doshas, all the regimens to be adopted by balanced state all Doshas, all the regimens to be adopted by him is of balanced type.
When there is predominance of Doshas, depending upon the nature of the Doshas involved, it is useful to adopt such there regimens as would be in contradiction with these three predominating Doshas till there is normalcy of Agni. It is only after the normalcy of the Agni is attained, balanced regimens are adopted. Similarly, various therapies and other regimens are administered to these four categories of individuals. We shall now explain them in detail. [14]

Characteristic of Vatala constitution and its management:
Vatala (dominance of Vata), Pittala (dominance of Pitta) and Sleshmala (dominance of Kapha) these three are the morbid states in individuals, even though, according to another school of thought they represent the natural states of the body. Their characteristic features are as given below:
Vatala, Pitala and Sleshmala types of individuals are more susceptible to Vatika, Paittika and Sleshmika diseases respectively and such diseases in the respective types of individuals become very severe.
If a Vatala type of individual resorts to such thing as are aggravators of Vata, Vata in his body gets aggravated immediately.
This does not happen in the case of the remaining two Doshas. The aggravate Vata afflicts individuals by manifestation of diseases already described], resulting in the impairment of strength, complexion, happiness and longevity.
The following therapies alleviate this Doshas:
Proper administration of oleation and fomentation;
Mild purgative prepared by the addition of fat, hot things and substances having sweet, sour and saline tastes
Food having the ingredients of the above mentioned properties
Massage, poultices, bandage, kneading, effusion, bath, samvahana (pressing and by hand)pressing, terrorizing, surmising and rememorizing use of wine and Asavas (fermented drinks)
Use of wine and Asavas (fermented drinks)
Fats from different source mixed with drugs having digestive, stimulant, carminative, Vata- alleviating and purgative properties- they may be boiled hundred and thousand times and be used for being administered in different times ways, viz, internal use, massage, enemata etc and
Enemata and regimens to be adopted along with it, the number of enemata may be according to the description available in Siddhi section for Karmabasti, Kalabasti, Yogabasti etc., cf Siddhi 1:47 [ 15-16]

Characteristics of Pittala constitution and its management:
If a Pittala individual resorts to such things as are aggravators of Pitta, Pitta in his body gets aggravated immediately. This does not happen in the case of the remaining two Doshas. The aggravated Pitta afflicts the individual by the manifestation of diseases already described resulting in the impairment of strength, complexion, happiness and longevity.
The following therapies alleviate Pitta Dosha:
Intake of ghee
Oleation by ghee
Purgation
Use of drugs and diets having sweet, bitter and astringent tastes and cooling property
Use of scents which are mild, sweet, fragrant, cooling and cordial
Use in the chest of pearls, jewels and garlands which are kept in excessively cold water
Frequent sprinkling of cold water and cold air of AgryaChandana (santalum Album Linn), Priyangu (Callicarpa Macrophylla VahL), Kaliya (yellow variety of Chandana) and Mrnala (lotus stalk) mixed with Utpala (Nymphaea Alba Linn), Kumuda (a variety of Uptpala) Kokanada , Sugandhika (a variety of Utpala) and Padma (Nelumbo Nucifera Gaertn)
Hearing of songs and music which are pleasuring ears, mild, sweet and agreeable
Hearing the information regarding prosperity
Keeping company of friends
Company of agreeable ladies wearing cooling garments and garlands;
Residence in buildings which is cooled by the moon rays and exposed to the breezes from all sides;
Residence in cold places in mountains and river banks, use of cold apparel and exposure to the cold winds of fansl.
Visiting beautiful gardens having pleasing, cold and fragrant wind
Use of the flower of Padma (Nelumbo Nucifera Gaertn), Utpala (Nymphaea Alba Linn), Nalina (a type of lotus), Kumuda (a variety of Utpla), Saugandhika (a variety of Utpala) pundarika (Nymphaea lotus Linn) and Satapatra (a variety of lotus) and
Adoption of such other regimens as are of soothing nature. [17]

Kapha Prakruti treatment

Characteristics of Kapha Prakruti and management of aggravation:

If a Sleshmala type of individual resorts to Kapha increasing activities, Kapha easily gets aggravated. In him, Vata and Pitta do not aggravate easily.
The aggravated kapha afflicts the individual by the manifestation of diseases, leading to impairments of strength, complexion, happiness and longevity.

The following therapies alleviate Kapha Dosha:
Proper administration of strong and hot elimination therapies – Vamana
Intake of diet which is mostly ununctuous and is composed of ingredients having pungent, bitter and astringent tastes
Running, jumping, swimming whirling, keeping awake during night, fighting, sexual intercourse, exercise, unction, bath and oil massage.
Intake of strong wines preserved for a long time
All lightening therapies (Langhana) along with Dhumapana – herbal smoking
Use of warm apparels and
Giving up comforts of life with to enjoying happiness ultimately. [18]

Thus it is said:-
A man well versed with the specific features of all diseases, principles of their treatment and properties of all medicaments, is entitled to be a royal physician. [19]

To sum up:-
Various categories of diseases classified on the basis of different criteria , absence of any contradiction in these statements, identical nature of (Roga (disease) and Dosha , number of Doshas, partial description of diseases, factors responsible for the aggravation of Doshas, digestive powers of digestion, therapies for the maintenance of the health of various types of individuals, viz, Vatala etc, all these topics have been described in this Chapter on “Roganeeka Vimanam”. [20-22]
Thus ends the Sixth Chapter – Roganeeka Vimana Adhyaya – Determination of Specific Characteristics of Diseases of the Vimana Section of Agnivesha’s work, redacted by Charaka. [6]