Introduction

The importance of Ayurveda in global scenario is because of its comprehensive approach towards positive life style. The complete health care system is the outcome of the great power of observation, generalization and analysis of hundreds of investigators spread over thousands of years. It deals with both the preventive and curative aspects of diseases in a most comprehensive way.  By knowing Shatkriyakala the physician can give the treatment to weakened area or organ so that further Sthansamshray avastha can be prevented and the Sadhyasadyatva of the disease can be done or one can get the knowledge of Sadhyasadyatva. Shatkriyakala described by Sushruta gives an idea about the consecutive stages of the disease and accordingly preventive measures were described to overcome complication. Early diagnosis of disease helps to cure the disease successfully without much discomfort in planning treatment. If physician able to detect the changes in early stages like Sanchaya (accumulation), Prakop etc. based on the manifestation of Dosha symptomatology and advise the techniques at that stage to prevent further stages, so that disease may not become stronger Shatakriyakala is the process of understanding the pathogenesis of disease in consecutive stages. Mainly 6 stages are described for the successive manifestation of the disease. i.e.

1) Sanchaya

2) Prakopa

3) Prasara

4) Sthanasamshraya

5) Vyaktavastha

6)Bhedavastha

By knowing the six Avasthas of Kriyakala one can get the knowledge of Hetusevana and so that he can stop Hetusevana and thus the further Avastha can be prevented. With the help of Shatkriyakala one can give actual treatment with the use of various drugs. By knowing Shatkriyakala the physician can give the treatment to weakened area or organ so that further Sthansamshraya Avastha can be prevented. The Sadhyasadyatva of the disease can be done or one can get the knowledge of Sadhyasadyatva. It facilitates the knowledge about the prognosis of diseases in the respective Avasthas. The disease pratishyaya can be compared to allergic rhinitis in modern medicine characterized by sudden and frequent attacks of sneezing, profuse watery nasal discharge associated with nasal obstruction which is intermittent watering of eyes, heaviness of head, respiratory distress and anosmia. It facilitates the knowledge about the prognosis of diseases in the respective Avasthas. Hence study is plan to explore the etiopathogenesis and Shatkriya Kalatmak Samprapti Vivechan of Pratishyaya.

SHADA VIDHA KRIYA KALA:

Shatakriyakala is the process of understanding the pathogenesis of disease in consecutive stages. Mainly 6 stages were described for the successive manifestation of the disease i.e.

1) Sanchaya: Gradual accumulation of Dosha in respective seats.

2) Prakopa: Accumulated Doshas moving to other sites other than its main site.

3) Prasara: Aggravated Doshas leave their original place and spread to the other parts of the body through different Strotas.

4)Sthanasamshraya: Agitated Doshas spreads to different places and struck somewhere because of obstruction in Srotas due to abnormality in Srotas is called Sthana samshraya.

5) Vyaktavastha: Appurtenance of clear-cut symptoms of the disease.

6) Bhedavastha: In this stage specific sign and symptoms of the disease’s manifests.

1) Sanchaya of Pratishyaya: During this stage one or more of the Doshas undergo increase in their chief site i.e. Vata in Pakwashaya (large intestine), Pitta in Pachyamasaya (small intestine) and Kapha in Urah Desha (chest). This accumulation of Dosha produces mild symptoms in the form of Iccha and Dvesa (like and dislikes) for certain foods, activities etc. Liking or desire is for those which possess qualities opposite to those of the increased Dosha (Viparita Guna Iccha) and dislike or aversion is for those which causes the increases of the DoshaDoshas when in a balanced state shall remain in their own Ashayas as normal body phenomena, but any disturbance results to an in equilibrium between them. There is over accumulation, though remaining within their original limited spaces. This is characterized by vague symptomatology.

• Predominance of Vata -Recognized by Stabdha Koshtha & Purna Koshtha
• Predominance of Pitta - Peetavabhasata Predominance of
• Kapha - Gaurava & Alasya

Acharya Dalhan clarifies phenomena of each doshas in relation to head49

• Pranavayu - Its field of activity is related to the functions of head
• Alochaka Pitta   - Its field of activity is related with vision
• Tarpaka Kapha   - Its field of activity is related with all sense organs (Indriyas)
• Shonita (Rakta) - Circulating through blood vessels

All these get accumulated at their sites in Sanchaya stage.

2) Prakopa of Pratishyaya: In the second stage Prakopa (vitiation), the further increased Dosha leads to vitiation excitation state. He can easily get over this abnormality by suitable adjustment in foods, activities and simple drugs and remedial measures by consulting a physician. Negligence of appropriate action leads to the next stage of Prasara. When the provocative factors for the previous stage can act further the previously accumulated Doshas, gets vitiated, still seated in their own original sites. Thus, sufficiently vitiated Doshas will give rise to additional generalized Doshika symptoms, which were seen in the Sanchaya stage. The signs & symptoms of this stage will be generalized as well as localized.

3)Prasara of Pratishyaya: Acharya Sushruta says that the Doshas, which have become Prakupita, due to causes already mentioned, expand & overflow from the limits of their respective locations. Further he points out that Vayu which possess the power of locomotion or extreme motility should be looked into as the cause of the expansion or overflowing of Prakruta Doshas either alone (Eka), two together (Samyoga Dwanda) or in the three together (Sannipata) with Rakta expand & run in the body in all directions. If the person continues to indulge in unhealthy foods etc., or if the treatment is ineffective, the abnormality continues further to the onset of the fourth stage. During the first three stages, the unhealthy foods and activities not only bring about increase of the Doshas but at the same time, also bring about mild abnormalities in the Kosthagni (digestive activity in the alimentary tract), the Dhatus (tissues), the Srotas (pores, channels of the Dhatus, cell pores, ducts.) and the Ojas (the vital fluid material present in every Dhatu and responsible for its strength vis-à-vis the strength of the body). The Koshthagni, which digests the food, becomes abnormal (Agni Vaishamya) by the action of the unhealthy foods etc. and by the increase of the Doshas. Increase of Vata causes Vishamagni (irregular, unpredictable, erratic) making digestion of food variable from time to time, day-to-day etc. increase of Pitta causes Tikshnagni (excessively keen, strong) making digestion unusually quick and changing of food materials, and increase of Kapha causes Mandagni (weak, poor) making inadequate and delayed digestion of food. In all these abnormal states, the food does not undergo perfect digestion and undigested materials – Ama – (improperly) processed, over processed or inadequately processed intermediary products of digestion) remain over in the Ahara Rasa (essence of food). The quantity of such materials is more in case of Mandagni, moderate in case of Vishamagni and very little in case of Tikshnagni. In Prasara Avastha the vitiated Dosha through Rasa and Raktavaha Channels circulates throughout the body.

4) Sthana Samsraya of Pratishyaya: The circulating Doshas mixed with the circulating Rasa Dhatu, now tend to settle at  certain place in the Dhatus (Sthana Samsraya) and bring about abnormalities there, especially in the Srotas (pores, channels of cells of tissues) The Dhatus (tissues) may not fall on easy prey to the attack of the Dosha. They have their defense, with a fluid material known as Ojas that is responsible for their Bala (strength), to carry out their functions and to prevent diseases. As long as the Ojas is normal in its Pramana (quantity) and Gunas (qualities), the Doshas cannot vitiate the Dhatus or the Srotas. The Ojas undergoes Kshaya (decrease) due to many causes such as lack of food, physical strain, injury to vital organs, excess indulgence in alcohol and such other substances of poisonous nature; anger, grief, worry and other emotions; loss of blood, semen and other tissues etc. The decrease of Ojas makes the Dhatus poor in strength and susceptible to the bad effect of the increased Doshas. The Srotas may undergo following four kinds of abnormal changes (Sroto Dushti or Khavaigunya).

1) Atipravriti – increased functioning.

2) Sanga or Rodha – obstruction, blockage, decreased functioning and consequent increase in size.

3) Granthi – growths, thickening, etc.

4)Vimargagamana – movement of material in wrong direction, passage or place. The place or site (organ) where one or more of these Srotodushti/ Khavaigunya has taken place, becomes the site of origin of the disease. The Ama, which was formed by Mandagni accumulates in the Rasa Dhatu and brings about changes in it. Its normal Tanutva (thinness) changes to Bahalatva (thickness), Visadatva (non-sticky nature) to Pichhilatva (sticky, slimy) and normal Pramana (quantity) to increased quantity (Vriddhi). This kind of Sama Rasa (Rasa mixed with Ama) circulating all over the body finds difficulty in entering into the minute Srotas, which have also become abnormal by this time. Sama Rasa blocks the Srotas, accumulates outside the Dhatu Pramanas (tissue cells) and makes for Dhatu Vriddhi.50 Every Dhatu has its own specific Agni analogous to the Koshthagni (digestive) activity in the alimentary tract); these Dhatvagnis derive strength from the Koshthagni and work similarly. They also become Tikshna (strong) and the latter causes Vriddhi (increase) or Kshaya (decrease) of the Dhatus have been considered as Vaishamya (abnormalities). Even the four kinds of Srotodushti also form part of Dhatu Vaishamya; hence Dhatu Vaishamya itself is termed as the disease. Thus, in the fourth stage, important abnormalities occurring inside the body are further increase of the Doshas, their localization at certain place, (Sthanasamshraya), decrease of Ojas (Ojas Kshaya), vitiation of Srotas (Srotodushti, Khavaigunya), accumulation of Ama (Ama Sanchaya) and union of abnormal Doshas with Dushyas (Dosha-Dushya Sammurchana); all these act as essential prerequisites for the onset of the disease. This Kriyakala is the stage of actual commencement of the disease. It is characterized by appearing of Purvarupa/Pragrupa (premonitory, prodromal symptoms), which are produced by each one of the above said abnormalities. This Prana, Kapha, Pitta Avrita Udana Vata gets lodged in the Pranavaha Srotasa, especially in Nasa, where Khavaigunya is available. The premonitory symptoms of the disease can be demonstrated in this stage. In this stage patient gets following premonitory symptoms of Pratishyaya.

• Shirogurutvam (Heaviness of the head)
• Kshavathu (Sneezing)
• Parihrishtaromata (Generalized horripilation)

5) Vyaktavastha of Pratishyaya: This is the fifth Kriyakala and characterized by the full manifestation of the disease (Vyadhivyakti) with all its symptoms and signs (Rupa). Each one of the previously mentioned abnormalities contributes to its own symptoms and signs, which are clearly recognizable. They are varying in number and strength from one patient to the other, depending upon the age, sex, constitution, strength of the causes and many other factors. The diseases are given specific names based on the chief symptom/sign or the organ affected and many other factors. They are even classified as arising for many one of the Dosha (Ekadoshaja), two of them together (Dvidoshaja, Dvandvaja, or Samsargaja) or by all the three of them together (Tridoshaja, Sannipataja). The abnormalities, though profound, can be brought to normal easily when effective treatment and all other favorable factors are present and with difficulty in the presence of unfavorable factors. Sometimes the disease is uncontrollable and progresses further to the sixth and final stage. In the process of Vyaktavastha the following symptoms of Pratishyaya may be present.

• Shirahshula

• Kaphotklesha

• Ghrana Viplava

• Nasa Avarodha

• Swarabheda etc.

6) Bhedavastha of Pratishyaya: During the sixth Kriyakala all the abnormalities become still more profound and irreversible. Despite the best treatment, they continue to persist and make the patient very debilitated, by loss or depletion of the Dhatus, give rise to one or more Upadrava complications). Sometimes even Arishta Lakshanas (signs and symptoms which herald death) might also manifest. All these grave symptoms and signs differentiate this person from others. Hence, this stage is called as Bheda. In case of the disease Pratishyaya, one can easily conclude that the disease is either chronic or complicated on the symptomatology of anaemia, deafness etc. It may lead to production of, Dushta Pratishyaya and Kasa, Swasa, Kshaya also. Hence the concept of Shada Kriyakala in reference to the disease Pratishyaya seems to be more scientific both from the understanding of the disease process, as well as its treatment view point.

No much reference is available in the classics of Ayurveda regarding the classification of Pratishyaya according to different stages. Dalhana has quoted the opinion of Vriddha Sushruta regarding the stages of Pratishyaya i.e. Ama and Pakwa.51 The symptoms of Ama stage include anorexia, distaste in mouth, nasal catarrh, pain, aversion to everything, heaviness of head, sneezing and fever. The symptoms of Pakwa stage include relief in congestion of nose, oral passage and head as well as thick yellow discharge from the nostrils.

The term Amavastha could better be correlated with the term Nava Pratishyaya postulated by Sushruta while planning the treatment of Pratishyaya [intake of ghee is to be avoided in the treatment of Nava Pratishyaya52. Amavastha, if not compensated, will enter Jirna or Pakwa stage.

All the types of Pratishyaya, irrespective of the consideration of the Doshas actively involved in the pathogenesis, get converted into Dushta Pratishyaya if not treated properly.

Discussion

The term Pratishyaya itself suggests a recurrent condition that has posed challenges for physicians over time, often triggered by even minor causative factors. This disease is marked by symptoms such as nasal obstruction, nasal discharge, headache, sneezing, and heaviness in the head. Since the nose is directly exposed to the external environment during respiration, it encounters numerous microorganisms and pollutants present in the air. With rising environmental pollution and the prevalence of various flu viruses, rhinitis has become increasingly common in today’s world. If not properly managed, this condition can progress to sinusitis and may eventually lead to chronic sinusitis or even severe acute respiratory conditions. Etymologically, the term Nidana means “that which gives indication about a disease.” It is wide and extensive term by which we get the indication by the inquisitive logic of affirmation or negation, and finally arrive at a conclusion regarding the diagnosis. The Nidanas of Pratishyaya could broadly be classified under Sadyojanaka Nidanas and Kalantarajanaka Nidanas. The analysis of the detailed list of etiological factors mentioned by various Acharyas it could be seen that majority of them come under the immediate triggering factors and some of them like Mandagni, Ajirna, and other diseases producing Pratishyaya as a complication of a disease while Dushta Pratishyaya is the chronic stage of Pratishyaya, which occurs due to neglect or improper management of the disease Pratishyaya.

The Sannikrishta Hetus described by Acharya, cause Achaya Purvaka Dosha Prakopa which leads to the disease, whereas the Viprakrishta Hetus lead to Chaya and then only to Prakopa. While explaining the Samprapti of Pratishyaya in any person that there is pre-existing Agnimandya and mild Srotovaigunya, when such persons get an exposure to any of the triggering factors [Sadyojanaka Nidanas] they produce Sanchaya Prakopa of Doshas resulting in the production of the disease. They produce Agnimandya resulting in the production of Ama. Because of the intercourse of abundantly vitiated Doshas a toxic condition is produced in the body. Moreover, the vitiated Doshas and Dushyas getting mixed with Ama get circulated all over body causing obstruction in Srotas and produce the disease as per following stages.

1. Sanchaya: Gradual accumulation of Dosha in respective seats.
2. Prakopa: Accumulated Doshas moving to other sites other than its main site.
3. Prasara: Aggravated Doshas leave their original place and spread to the other parts of the body through different Strotas.
4. Sthanasamshraya: Agitated Doshas spreads to different places and struck somewhere because of obstruction in Srotas due to abnormality in Srotas is called Sthana samshraya.
5. Vyaktavastha: Appurtenance of clear-cut symptoms of the disease.
6. Bhedavastha: In this stage specific sign and symptoms of the disease’s manifests.

Conclusion

In conclusion, understanding the six stages of Kriyakala empowers one to identify and cease exposure to causative factors (Hetusevana), thereby preventing disease progression. Through Shatkriyakala, physicians can provide targeted treatment using various medications to protect vulnerable organs, thus preventing the onset of the Sthansamshraya stage. This framework aids in assessing the prognosis (Sadhyasadyatva) of diseases at different stages. In Ayurveda, Pratishyaya aligns with modern allergic rhinitis, marked by symptoms like sneezing, nasal discharge, nasal obstruction, eye watering, head heaviness, respiratory distress, and anosmia. This study aims to delve into the etiopathogenesis and Shatkriyakala-based pathogenesis (Samprapti Vivechan) of Pratishyaya.