INTRODUCTION- word kriya means action and kala

INTRODUCTION-                                            Sanchayansh, prakopansh, prasaram,sthansansrayam                                             Vyakti, bhedash yo vettidoshanam sa bhavedbhishag                                                                                                                           (Su.Su.21/36) Theword kriya means action and kala means time.

Therefore, the literalmeaning of the word kriyakala istreatment time. The concept of kriyakala is introduced in Varna prashnaadhyaya of “Susruta Samhita”. “Charaka” & “Vagbhata” give a versionof evaluation of doshic disturbances predicted in three consecutive stages viz.Chaya, Prakopa & Prasama.Susruta version does not include the prasamastage. In short, sad kriya kalais a complex process taking place in the body from the initiation ofaccumulation to manifestation of disease. This leads to structural &functional derangement of the body elements.

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Disease formationis not immediate process, it occurred through the different stages. Theformation of the disease through the six different stages is called asShatkriyakala. If first understand these stages ‘physician’ prevent theformation of disease & avoid the further complication. In the process of diseasemanifestation, the movement of morbid doshainto the next stage depends upon the nidana.If three Doshas, Seven Dhatus &three Malas are in normal state thereis no disease occurs. The etiological factors disturb this normal functioning& manifest as a disease.

A disease begins when the provoked doshas get settledat the defective site. Stages of sad kriya kal-  1)   Sanchaya- (Stage of accumulation orincreased level): –   This stage represents the beginning phase ofdisease characterised by indefinite & illdefined symptoms. This is theaccumulation of doshas in their principleplace. The accumulationof dosha due to various nidana factors. It is seen as theopportunity to perform the action or the time for the initial treatment. It isthe initial phase where is a requirement of active intervention of thephysician. At this stage, the doshas accumulate and flow in their ownplaces and do not circulate freely. v  InVata sanchaya – Stabdhapurnakoshthata, v  in Pitta sanchaya- Mandoshmata,Pita-avabhasata v  in Kapha sanchaya -– Gaurava,Alasya  lakshana are observed.

1)     Prakopa-  Prakopa is defind as themovement of Doshas away from theirprincipal location. It is graded as achayapurvaka prakopa & chaya purvakaprakopa. When the doshas are in sanchaya condition, if nidana intake persists, dosha prakopa stage follows. Dosha increases in quantity and isready to move. Specific symptoms and signs are seen in this stage such as-vVata prakopa-Koshtha- toda, Sancharana of vayu in koshtha v Pitta prakopa- Amlika, Pipasa, Paridah         vKapha prakopa-Annadvesha, Hridayotklesh . Vilayan- rupavriddhi of doshas is observed in prakopa stage said by “Acharya Dalhana”.

“Acharya Chakrapani” have described two typesof Prakopa (Vriddhi) in their ownwords-a) Chayapurvaka(with accumulation): with successive accumulation, stage by stage or insidiousincrease. In the next stage of increase, it spreads to its other seats and infurther stages it spreads to the Dhatus(tissues) and produces a disease after a reasonable time. b) Achayapurvaka(without accumu- lation): without successive accumulation or quickly. This kindof sudden increase is also in many stages but the stages develop so quicklythat it is not clearly recognizable. 3). Prasara- (Spread of the excited Dosha):  Prasarameans diffusion or expansion from their usual place into other places’.

In thisstage, Dosha which had been provoked,overflow and spread over in body. Vata,Pitta and Kapha which have theirusual situations leave their places and extend abnormally. In the Vataprasaravastha – Vimargagamana, Atopa , In Pittaprasaravastha- Osha, Chosha, Paridah, Dhumayan and In Kaphaprasaravastha- Arochaka, Avipaka, Angasada, Chardi are observed.

Hetu, lingachikitsa of dosha is advised up to prasaraavastha , after which vyadhichikitsa is followed.  Fifteen kinds or varieties of Prasara are described as:- 3- Simple Prasara of only Vata, Pitta and kapha types, 1- Caused by vitiation of Rakta only 6- Prasara by vitiation of either of two Doshas and Rakta 4-Caused by vitiation of triple interaction 1- Caused by vitiation of all thefour i.e.

Vata, Pitta, Kapha and Rakta Total = 15  AcharyaSushruta himself says Rakta (blood). 4)   Sthanasamshraya-(Stage of Localization): This stagerepresents the prodrome state of the disease that is yet to be menifested. Itis defined as the localization of all persistent doshas of prasara stageto a specific locus. This is the stage in which the disturbed morbid factorsextended to parts other then their principal seats, localizes due to srotovaigunya ( derangement of channels)leading to unwholesome interaction between dosha& dushya.

22 During the firstthree stages, the Dosha were movingfrom place to place along with the RasaDhatu. Ahitahara-Vihara Sevana(Indulence in unhealthy diet and lifestyle) produces their further increase (Vriddhi Karanas), which bring aboutabnormalities in the Srotas of the Dhatus (Sroto Dushti), all these factors make way for the development ofthis fourth stage. The Dosha undergofurther increase and get mixed with the Dushyas,while circulating in its channels finds itself incapable of entering into theminute Srotas (cell pores) in suchplaces where Srotodushti has alsotaken place.

The Dosha being presentin the Rasadhatu also get settled inthose places. This activity is known as Sthanasamshrayaof the Dosha (localization). These two Vikrita (abnormal) Dosha and Dushya give rise to development of symptoms of distress to thebody. Such symptoms are actually the Purvarupaof specific diseases.

Thus the fourth Kriyakalais a very important stage during which abnormalities are found at the level of Dosha, Dushyas, Srotas and Agni. Purvarupa (prodromal symptoms) is de- fined as those symptoms,produced by the Dosha which havebecome localized in specific places and which indicate the approaching disease.Purvarupa is of two kinds viz. a) Samanya (general) and b) Vishishta (specific). Laskshanas (symptoms) produced due to Sammurchhana of Dosha and Dushya indicatingthe Vyadhi without pointing  towards the involved Dosha, means by SamanyaPurvarupa the generating Vyadhi canbe identified. These kind of prodromal symptoms have been specifically mentionedin the texts while describing the disease.

For ex.-Shrama, Arati, Vivarnata such Lakshanasindicates that Utpadyamana Vyadhi is Jwara, but here knowledge of PrakupitaDosha can’t be gained.Vishishta Purvarupa is defined as the appearance of the specific symptoms ofthe future disease itself. For ex.- Jrimbha(yawning) as Purvarupa of Vataja Jwara, Nayana Daha (burning ofthe eyes) of Pittaja Jwara and Aruchi (dislike of food) of KaphajaJwara.

26 By recognizing theprodromal symptoms the onset of the future disease can be prevented.5)    Vyakti Avastha- (Full manifestation of a disease)- The manifestation of disease in itsfully recognizable form is vyakti. It is defind as vyakta lingata i.e.

the symptoms are recognisable. The abnormalitiesget aggravated further and suppose the intense form known as disease (theresult of Dosha- Dushya Sammurchhana),manifesting clearly with all its characteristic features These features alsocalled by several synonyms such as Rupa,Samsthana, Vyanjana, Linga, Lakshana, Chinha and Akriti. The signs andsymptoms appearing in this Vyaktistage are broadly classified into two kinds:  a) Samanya Lakshanas:general signs and symptoms produced by the increased Dosha which may be seen inall disease commonly.  b) Pratyatma Lakshanas: specific or peculiar signs andsymptoms which are seen in any one disease characteristically.  6). Bhedavastha-(Final stage of Disease)-The distinctive change that occurs to a disease after itsfully manifested stage i.

e vyaktaavasthais Bheda  which is an indication of bad prognosis . Thedifference between previous kriya kala& bheda is that the physiciancannot neglect this stage, if he fails to intervene at this stage the diseasewill become incurable.Importance of stages of Sad kriya kala-v The knowledge about the stages of Sad kriya kal is useful in differentialdiagnosis, knowing the prognosis & deciding the line of treatment of adisease.v On the cause & effect basis , thecareful observation of symptoms can help in finding the cause of that diasease.The disease can be prevented by avoiding the cause.v The sad kriya kala gives knowledge about provocated Doshas, route of disease & system ororgan affected.

This is useful in deciding the treatment.v The differential diagnosis of adisease is possible by the knowledge of Sadkriya kala. v By giving early treatment, thedisease process can be arrested at accumulation or provocation or spread of doshas. The actual stage of Sad kriya kal ( Dosha-dushya-sammurchchhana) can be prevented. OBESITY-    obesity is definedas an excess of adipose tissue that imparts health risk, a body weight of 20%excess over ideal weight for age, sex & height is considered a health risk.Obesity is a serious socio economic & also increasingly clinical problem.

Obesity can be considered to result from an imbalance between the amount ofenergy consumed in the diet & the amount of energy expended throughexercise & bodily functions. Other factors of energy imbalance may include(1) Decreased sleep (2) Ingestion of Trans fat (3) Perinatal exposures (4)Differences in macronutrient quality.  Obesity is not a disease but it postures aserious risk for the development of type 2 diabetes mellitus, cardiovasculardisease, non-alcoholic fatty liver disease, endocrine problems & certainforms of cancer. Adipocyte insulin resistance, production of adipokines, freefatty acids, inflammatory mediators & elevation of systemic dysfunctionthat leads to clinical manifestations & sequel of obesity. Chronicimbalance of calories consumed vs used causes increased storage of the excessenergy in the form of adipocyte intracellular tryglycerides stores.

In adults- ·       BMIabove 30-40 kg/m2 is defind as obesity·       BMIabove 40 kg/m2is severe obesity.Synthesisof triglycerides-                                              Liver & adipose tissue are the major sites of triacylglycerol (TAG)synthesis. The TAG is synthesized by esterification of fatty acyl coA witheither glycerol -3-phosphate or dihydroxy acetone phosphate ( DHAP). Theglycerol part of the fat is derived from the metabolism of glucose.

DHAP is anintermediate of glycolysis. Liver produces fatty acid & TAG which istransported as VLDL( very low density lipoprotein) in the blood. Etiologyof obesity-    major etiological factors fordevelopment of obesity  1)   Sedentary lifestyle2)   Food intake more( meals outside thehome, sugar sweetened beverages, refined corbohydrates)3)   Less exercise4)   Genetic factor5)   Environmental factorsSecondary obesity mayresult following a number of underlying diseases such as hypothyroidism, Cushing’sdiseases, insulinoma & hypo thalamic disorders & leptin deficiency.

 Pathogenesis  ofobesity- Although it is known thata disturbance of the homeostatic mechanisms controlling energy balance causesobesity, it is less clear how the balance is disturbed, since the mechanism arevery complex & involve numerous systems in the body, but other places some books described as When fat droplets are overloaded the nucleus of adiposetissue cells degraded, cell is destroyed & TAG becomes extracellular. Thefatty acid from VLDL are taken up bound to adipose tissue with the help oflipoprotein lipase & stored as TAG. TAG cannot metabolically reutilize& forms the dead bulk of obese individuals.           Sanchaya stage                    not doing any exercise, Indulgingin day sleep, Consuming foods that promote sleshma                                                          Increase the fat     2)Prakopa stage         Due to the obstruction of the passageby the fat                         The movement of vata is specially confined tokostha 3) Prasara stage         Stimulation of digestive power of food.

                                     Patients digestfood quickly & become an insatiable eater.                                                     Accumulation of fat 4) Sthan sanshraya         Stage                    Dyspnea,thrist,delusion, excessive sleep,& Stinkingof the body  5)Vyatka stage              Smell from body, excessive hunger present  6)Bheda stage           Owing of an excessive increase of fat & muscle tissue,                      The buttock, breast& abdomenbecome pendulous &  His strength isreduced.                                                                    Obesity Complication of obesity-                                                   ·       Metabolic syndrome·       Coronary artery disease·       Dyspnea·       Asthma·       Nonalcoholic fatty liver disease·       Low back pain·       Depression·       Stroke·       Obesity related glomeroneuropathy·       osteoarthritis                                                                                    CONCLUSION From above literature & discussion it is concluded thatShatkriyakala is unique concept of Ayurveda & can be explain in modernscience perspective especially in terms of usual history of disease. By knowingthe concept of Shatkriyakala the disease process can be capture at initialstage & avoid the probabilities of complications.  The treatment of a disease should be startedat the proper time.

Sushruta’s six stages areincluded in these two stages. First two stages of Shatkriyakala according toAyurveda can be comparing with stage of pre pathogenesis stage of modernscience. Obesity is a well-established metabolic & cardiovascular riskfactor. 

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