An effort to analyze & Differentiate ‘Shadupakram’ as per clinical significance

 

An effort to analyze & Differentiate ‘Shadupakram’ as per clinical significance

S.No.	Vibhedakatva	Snehan	Brinhan	Stambhan	Rukshan	Langhan	Swedan
		SAMTARPAN			APATARPAN
	Paryay/ Synonym as physical state	Snigdha, Abhishyan	Brimhit, Sthool, Mansal	Stambhit, Grah	Ruksha, Rukshit	Langhit, Krisha, Ksheena, Kshata	Swinna, Swedita
1.	Definition (Ch.Su.-22/9-11)	स्नेहनं स्नेहविष्यन्द मार्दवक्लेदकारकम्	बृहत्त्वं यच्छरीरस्य जनयेत्तच्च बृंहणम्	स्तम्भनं स्तम्भयति यद्गतिमन्तं चलं ध्रुवम्	रौक्ष्यं खरत्वं वैशद्यं यत् कुर्यात्तद्धि रूक्षणम्	यत् किञ्चिल्लाघव करं देहे तल्लङ्घनं स्मृतम्	स्तम्भगौरवशीतघ्नं स्वेदनं स्वेदकारकम्
2.	Guna-dominance (Ch.Su.-22/12-17)	द्रवं सूक्ष्मं सरं स्निग्धं पिच्छिलं गुरु शीतलम् । प्रायो मन्दं मृदु च यद्द्रव्यं तत्स्नेहनं मतम् ॥१५॥	गुरु शीतं मृदु स्निग्धं बहलं स्थूल पिच्छिलम् ॥१३॥ प्रायो मन्दं स्थिरं श्लक्ष्णं द्रव्यं बृंहणमुच्यते ।	शीतं मन्दं मृदु श्लक्ष्णं रूक्षं सूक्ष्मं द्रवं स्थिरम् । यद्द्रव्यं लघु चोद्दिष्टं प्रायस्तत् स्तम्भनं स्मृतम् ॥१७॥	रूक्षं लघु खरं तीक्ष्णमुष्णं स्थिर- मपिच्छिलम् ॥१४॥ प्रायशः कठिनं चैव यद्द्रव्यं तद्धि रूक्षणम् ।	लघूष्णतीक्ष्णविशदं रूक्षं सूक्ष्मं खरं सरम् ॥१२॥ कठिनं चैव यद्द्रव्यं प्रायस्तल्लङ्घनं स्मृतम् ।	उष्णं तीक्ष्णं सरं स्निग्धं रूक्षं सूक्ष्मं द्रवं स्थिरम् । द्रव्यं गुरु च यत् प्रायस्तद्धि स्वेदनमुच्यते ॥१६॥
3.	Types as Therapeutic measures (Ch.Su.-22/12-17)	Detailed types are mentioned in Snehadhyaya, Ch. Su.- 13	Not mentioned, Practically Tarpan, Santarpan etc terms may be taken as other types; mentioned in Raktapitta etc chapters.	Not mentioned clearly but concept of ‘Grahi’ may be taken as an other type.	Not mentioned clearly but ‘Kharatva’ may be a closer as well as advance version of ‘Rukshan’.	चतुष्प्रकारा संशुद्धिः पिपासा मारुतातपौ । पाचनान्युपवासश्च व्यायामश्चेति लङ्घनम् ॥१८॥	Detailed types are mentioned in Swedadhyaya, Ch. Su.- 14
4.	Types as Constitution or Physical states seen in the Patient. (Ch.Su.-22/12-17)	बृहत्त्वं यच्छरीरस्य जनयेत्तच्च प्रभूतश्लेष्मपित्तास्रमलाः संसृष्टमारुताः ।	बृहच्छरीरा त्वग्दोषिणां प्रमीढा३नां स्निग्धाभिष्यन्दिबृंहिणाम् ।	‘Stambhan’ is more concerned to affection of body movements either physio/ pathological conditions rather than a physical state only.	क्षीणाः क्षताः कृशा वृद्धा दुर्बला नित्यमध्वगाः । स्त्रीमद्यनित्या   शोषार्शोग्रहणीदोषैर्व्याधिभिः कर्शिताश्च ये ।	क्षीणाः क्षताः कृशा वृद्धा दुर्बला नित्यमध्वगाः । स्त्रीमद्यनित्या   शोषार्शोग्रहणीदोषैर्व्याधिभिः कर्शिताश्च ये ।	पित्तक्षाराग्निदग्धा ये वम्यतीसारपीडिताः । विषस्वेदातियोगार्ताः
5.	‘Samyak-yog’ Signs & Symptoms of proper execution as therapeutic measures/procedures.	वातानुलोम्यं दीप्तोऽग्निर्वर्चः स्निग्धमसंहतम् । मार्दवं स्निग्धता चाङ्गे स्निग्धानामुपजायते ॥५८॥ Ch.Su.-13	बलं पुष्ट्युपलम्भश्च कार्श्यदोषविवर्जनम् । लक्षणं बृंहिते……	स्तम्भितः स्याद्बले लब्धे यथोक्तैश्चामयैर्जितैः ॥३९॥	स्थौल्यमति चात्यर्थबृंहिते ॥३८॥ कृतातिकृतलिङ्गं यल्लङ्घिते तद्धि रूक्षिते ।	वातमूत्रपुरीषाणां विसर्गे गात्रलाघवे । हृदयोद्गारकण्ठास्यशुद्धौ तन्द्राक्लमे गते ॥३४॥ स्वेदे जाते रुचौ चैव क्षुत्पिपासासहोदये । कृतं लङ्घनमादेश्यं निर्व्यथे चान्तरात्मनि ॥३५॥	शीतशूलव्युपरमे स्तम्भगौरवनिग्रहे । सञ्जाते मार्दवे स्वेदे स्वेदनाद्विरतिर्मता ॥१३॥   Ch.Su.-14
		As these procedures are applicable in physiological (early identification before the manifestation of concerned disease- Preventive) as well as pathological conditions (esp. in various types of diseases; so the ‘Samyak-yog’ signs & symptoms summarized in concise words. A physician must focus the underline disease as per the ‘Samprapti’ if management is being applied in specific pathological conditions.
6.	‘Ati-yoga’	पाण्डुता गौरवं जाड्यं पुरीषस्याविपक्वता । तन्द्रीररुचिरुत्केशः स्यादतिस्निग्धलक्षणम् ॥५९॥Ch.Su.-13	स्थौल्यमति चात्यर्थबृंहिते ॥३८॥ Ch.Su.-22	श्यावता स्तब्धगात्रत्वमुद्वेगो हनुसङ्ग्रहः । हृद्वर्चोनिग्रहश्च स्यादतिस्तम्भितलक्षणम् ॥४०॥ Ch.Su.-22	कृतातिकृतलिङ्गं यल्लङ्घिते तद्धि रूक्षिते ।	पर्वभेदोऽङ्गमर्दश्च कासः शोषो मुखस्य च । क्षुत्प्रणाशोऽरुचिस्तृष्णा दौर्बल्यं श्रोत्रनेत्रयोः ॥३६॥ मनसः सम्भ्रमोऽभीक्ष्णमूर्ध्ववातस्तमो हृदि । देहाग्निबलनाशश्च लङ्घनेऽतिकृते भवेत् ॥३७॥	पित्तप्रकोपो मूर्च्छा च शरीरसदनं तृषा । दाहः स्वराङ्गदौर्बल्यमतिस्विन्नस्य लक्षणम् ॥१४॥
7.	‘Ayoga’	लक्षणं चाकृतानां स्यात् षण्णामेषां समासतः । तदौषधानां धातूनामशमो वृद्धिरेव च ॥४१॥ इति षट् सर्वरोगाणां प्रोक्ताः सम्यगुपक्रमाः । साध्यानां साधने सिद्धा मात्राकालानुरोधिनः ॥४२॥ (Ch.Su.-22)
8.	Nidanas of 6 types of Physical States	This analysis is mainly highlighting ‘Shadupakramas’ as 6 types of physical-states, that may be seen as an individual physical-state like ‘Sthoola/Atibrimhit’ but this may be combined with ‘Snigdha/Atisnigdha’ or ‘Swinna/atiswinna’ or ‘Stambhita/atistambhita’; this is well commented by Acharya Chakrapani तस्मात्तत्साधनार्थमुपक्रमा अपि सङ्कीर्यन्ते मिश्रतां यान्ति। यथा- क्वचिल्लङ्घनस्वेदने, क्वचिद्बृंहणस्नेहने hence applicable procedure might not be single, that Chakrapani stated ‘मिश्रतां यान्ति।‘ means combination of 2 or more procedures may be applicable simultaneously. So as these are not only 6 types of paired therapeutic measures but also physical states of the body because of presence of various pathological factors. A disease or group of diseases or A single Dosha/dushya or group of Doshas/dushyas may modify the human-body in any of 1 or 2 or more pathological physical state/states and these are categorized combinedly as ‘Samtarpan’ & ‘Apatarpan’. Here we get the clue about the Nidanas that first type is concerned to ‘Shleshma’ & later one is related to Vatadosha mainly in very concise way. So we can say that these 6 types of physical states may be a result of multiple causative factors hence specific ‘Nidanas’/causative factors have not been described in details.
9.	Dosha	Shleshma mainly	Shleshma mainly	Shleshma mainly	Vata	Vata & Pitta	Pitta
		No direct ‘Dosha/Dushyas’ involvement has been mentioned in ‘Shadupakram’ concept but these are based on the concept of Gunas/properties mainly and we know ‘that Doshas/Dushyas’ are consisted with Gunas/properties too So we may say that ‘Doshas/Dushyas’ are broader terms & concise clinical application of ‘Panchamahabhootas’ in the term of ‘Dosha’/‘Dhatu’ while Gunas/properties are finer (and also inbuilt with ‘Panchamahabhoot’) but the ultimate functioning unit in the body as well as drugs.
10.	Dushya	Medas	Mansa Meda	-	Shleshmavargiya Dhatus	-	Rakta, Medas
		It is very difficult to fix specific Dushyas in ‘Shadupakram’ state that’s why Charak skipped it, but as per the condition of ‘Nidan-panchak’ & nature of the disease, these dushyas must be understood individually as per disease & ‘Purusham-purusham-veekshya’ principal.
11.	Purvaroop	As these are most important group of physical states and therapeutic measures too so the early identification of changes in physical state may be taken as ‘Purvaroop’ like sudden weight gain or loss etc. Charak skipped this because of presence of multiple ‘Doshas’, ‘Srotasas’ & ‘Dhatus’ in the pathogenesis & disease entities for the manifestation of six types of physical states. Full manifestation of a specific physical condition may be taken as ‘Roop’. Contemporary science has also developed this as the description of ‘Metabolic-syndrome’ & ‘Cachexia’  that purely based on physical state. Acharya Charak has specifically dedicated four concerned chapters in Sutrasthan from 21 to 24 where the concept of physical states and its management have been prioritized.
12.	Roop
13.	Samprapti	These 6 physical states are the result of multiple ongoing ‘Sampraptis’ manifested through the imbalance in ‘Gunas/properties’ with or without signs & symptoms. A physician must examine the other components of Samprapti like ‘Dosha’, ‘Dhatu’, ‘Srotas’, ‘Agni’ etc individually and treat accordingly.
14.	Upashay-anupashay	‘Upashay-anupashay’ is the base of the ‘Shadupakram’ where ‘Santarpan’ & its 3 types are exact opposite to ‘Apatarpan’ & its 3 types and vice-versa.
15.	Chikitsa-sutra (Line of Treatment)	Rukshan	Langhan	Swedan	Snehan	Brimhan	Stambhan
		These are very much superficial literary guidance as mentioned above & each ‘Upakram/procedure’ is a group of multiple therapeutic, dietetic & daily regimen procedures as well as modification applicable step by step. For example ‘Snehan’ & ‘Swedan’ are not only procedures mentioned in ‘Shadupakram’ but also the base of ‘Panchakarma therapy’ and these are so important that Charak has dedicated two separate chapter in ‘Sutrasthan’- 13 & 14. That’s why charak has stated decisively that ‘दोषाणां बहुसंसर्गात् सङ्कीर्यन्ते ह्युपक्रमाः । षट्त्वं तु नातिवर्तन्ते त्रित्वं वातादयो यथा ॥४३॥‘ whatever the combination of Doshas in the manifestation of diseases and whatever the management or line of treatment is designed or planned, all can not be out of these ‘Shadupakram’, means whatever the therapeutic line of treatment would be applied in any pathological condition that would be within the range of ‘Shadupakram’. If we say that these are mother of all therapeutic procedures then it will not be a wrong statement as charak has instructed.
16.	Description of ‘Shadupakram’ (Physical-state) in  Pathogenesis & Management	Physical-states mentioned as per ‘Shadupakram’ has been utilized in description of almost all kind of pathogenesis viz. Jwar, Udar-rog, Gulm, Yakshma, Prameh, Hikka-shwas, Marmastha diseases etc. as ‘Ruksha, Ksheen, Ksham, Sthool, or Krisha etc. terms have been used and management applicable in such conditions is always varied accordingly. This is the base of ‘Purusham purusham vikshya…’ principal.
17.	‘Shadupakram’ & 6 ‘Rasas’ Relation (Karakatva)	Madhur- ++++            Amla- + Lavan- +	Madhur- ++++ Amla- + Lavan- +	Kashay- ++++ Madhur- +	Kashay- ++++ Katu- ++++ Tikta- ++++	Katu- ++++ Tikta- ++++ Amla- +	Katu- ++++ Lavan- ++++ Amla- ++
	‘Shadupakram’ & 6 ‘Ritus’ (Seasons) Relation (Karakatva)	Hemant	Hemant	Varsha Basant	Greeshma Shishir	Greeshma Varsha	Sharad Greeshma
		Efforts have been made to corelate ‘Shadupakram’ with ‘Shat-ritu-chakra’ & ‘Shadras’ that is mainly superficial, not well highlighted or discussed and almost hidden because many factors affect these three simultaneously so exact correlation must be understood as per the subject/patient, Desh/locality, Sattva, Satmya etc. individually.

 

Conclusions:

1.   ‘Shadupakrama’ description is based on the constitution as well as appearance of the physical body. We can say that it is a collective clinical approach with appropriate nomenclature or classification to understand the ‘Samhanan’, ‘Praman’, ‘Saatmya’, ‘Sattva’, ‘Saar’, Vayas etc. ‘Dash-vidh-pareeksha’ and their applicable therapeutic procedure.

2.   Physical states mentioned in ‘Shadupakram’ as Snigdha, Sthoola, Ruksha & Krisha etc. have been highlighted as well as targeted in the each & every description of ‘Nidan-panchak’ in all ‘Samhitas’ and management is also instructed & modified everywhere according to physical presentations.

3.   These are not only concerned to the constitution but also the therapeutic procedures too and this proves that Ayurveda considers the human-body as a functioning unit.

4.   These are closely related to the Six types of the ‘Ritus’/seasons and ‘Rasas’/tastes.

5.   These are based on the ‘Ritu-chakra’ held in Indian subcontinent & it does cause physical changes in human body naturally  due to the movement of Sun & Moon hence ‘Ritu-chakra’ has been given great priority and changes generated by ‘Ritu-chakra’ are closer to the ‘Shadupakrama’ too that is not merely a coincident but actually ‘Ritu-chakra’ is the base of ‘Shadupakrama.

6.   These are also concerned to the ‘Sadrasas’ esp. if taken an individual ‘Ras’ e.g. Madhur etc excessively as well as regularly. Each rasa capable to generate or manifest one or more physical states mentioned in ‘Shadupakrama’ if taken regularly as well excessively for prolonged time as ‘Abhyas’/practice.

7.   These are broadly categorized in ‘Santarpan’ & ‘Apatarpan’, first consists ‘Snehan’, ‘Brimhan’ & ‘Stambhan’ while later includes ‘Rukshan’, ‘Langhan’ & ‘Swedan’ and this sequence is also concerned to ‘Shadrasas’ as well as ‘Ritu-chakra’.

8.   As a physical states, these are a mediocre physical states, where manifestation of the disease may or may not be there or subject heading towards the manifestation of the specific types of disease/diseases if he/she falls under any one or more physical states of ‘Shadupakramas’.

9.   The concept of therapeutic procedures or measures in ‘Shadupakrama’ is a unique & wonderful itself that Ayurveda recognizes the human body appearance, responses, behaviors and adaptation to the environment exclusively and the solution is again identified within the ‘Shadupakramas’, hence these are paired as Snehan-rukshan, Brimhan-langhan & Stambhan-swedan; just opposite to each other.

10. Charakacharya has heralded that all the therapeutic procedures applied in any kind of management are under these ‘Shadupakramas’.

11.  Concept of ‘Tridosha’, ‘Saptadhatus’ & ‘Srotasas’ etc are not highlighted or we can say ignored in the description of ‘Shadupakramas’ while physical state has been given supreme importance because it is the most important in the management of any disease.

12.  ‘Gunas’/properties are linked to ‘Shadupakrama’ exclusively though these are called ‘Upakramas’/therapeutic procedures and this is the reason that Acharya Charak could skip the very important principal of ‘Tridosha’ etc. here but the ‘Gunas’/properties are not only contributing in formation of ‘Tridosha’ but also ‘Panchamahabhoot’   too. This shows the importance of the description of ‘Gunas’/properties in physical state, Drugs, Diets & any kind of management.

13.  All diseases either of ‘Koshta’ or ‘Shakha’/Marmasthisandhi originated or any other type will definitely come under ‘Shadupakramas’ either as a physical state or concerned their management as per ‘Shadupakramas’ .

14.  On the basis of above description we can say that appearance and physical state of the body of the subject/patient has been given supreme priority in the management of any disease and As ‘Upakramas’ these six may be called super line of management and these to be understood & applied first in almost all kind of management whether it is ‘Shodhan’ or ‘Shaman’ or ‘Rasayan’ or ‘Bajikaran’ etc.

15.  In current era, the drugs/ toxins/chemical-based-medications/ surgical-processes applied and used by contemporary medical science does affect/modify these six types of physical states and that must be understood, evaluated and analyzed as per the subject and the causative factor individually prior to any kind of the management. 

16. Careful consideration on various types of 'Prakritis' leads link to 'Shadupakrams' because these are clinical extention of Saar, Samhanan etc. 

तत्र प्रकृतिर्जातिप्रसक्ता च, कुलप्रसक्ता च, देशानुपातिनी च, कालानुपातिनी च वयोऽनुपातिनी च, प्रत्यात्मनियता चेति । जातिकुलदेशकाल वयःप्रत्यात्मनियता हि तेषां तेषां पुरुषाणां ते ते भावविशेषा भवन्ति ॥५।। 

So we can say that 'Shadupakrams' are the base of 'Chikitsa' where various physical 'Bhavas'(Influcial factors) taken into consideration either as 'Preventive' or 'Curative' aspect.

17. Prolonged & loaded administration of Chemical as well as molecule based drugs do modify the characters of human body viz. excessive & unnecessary over use of 'Steroids' may lead to 'Mithya-brinhan/Snehan' that seems 'Brinhan/Snehan' with weight gain while actually this is a result in the adulteration in the functions of 'Dhatvagnis'. Similarly excessive use of antidepressants, sedatives, tranquilizers, antischizophrenic, antiepileptic, opoid-derivatives  drugs etc may cause the suppurative 'Stambhan'  effects in the body while Chemical as well as molecule based drugs with 'Ushna,' 'Teekshna', 'Ruksha' etc 'Gunas',  like 'NSAIDs' etc may cause 'Rukshan'/'Langhan' if used excessively for the longer duration. A Physician must obtain the drug-history carefully assessing the Physical status of the body because such drug-administration may modify the components of the basic 'Sampraptis' esp. 'Dosha', 'Dhatu' and 'Mala'.  Sometime such history may act as 'Nidanarthakar' independently.

Presented by

Prof. Surendra A. Soni

M.D., Ph.D (Kayachikitsa)

H.O.D.

P.G. Dept. of Kayachikitsa

Govt. Akhandanand Ayurved College,

Bhadra, Ahmedabad, Gujarat, India.

email: kayachikitsagau@gmail.com