Kayachikitsa कायचिकित्सा

Internal medicine · Third (Final) Professional (Tritiya Varsha) · AyUG-KC

Papers

• Paper I — Vyadhi Vishesha Chikitsa I
• Paper II — Vyadhi Vishesha Chikitsa II
• Paper III — Manas Roga, Rasayana and Vajikarana

Units in this subject

Study notes

The largest clinical subject and the one the final year is built around. Kaya means the body and, more precisely, agni — so Kayachikitsa is the treatment of disorders of agni and of the systemic diseases that follow from it.

Jwara

• Called the king of diseases; Chikitsasthana chapter 3. Eight types in all — seven doshaja (three single, three dual, one sannipatika) and agantuja as the eighth, which is INCLUDED in the eight, not additional to them.
• Purvarupa, rupa, and the distinction between sama and nirama jwara — which decides whether langhana or brimhana is appropriate.
• Langhana in the early stage, and the prohibition on shodhana while ama is present.
• Vishama jwara and its types; jeerna jwara.

Shadvidha and dwividha upakrama

• Charaka Sutrasthana 22 gives the six upakrama: langhana, brimhana, rukshana, snehana, swedana and stambhana. Every treatment is one of these six or a combination, which is why the chapter is called Langhana-brimhaniya and not named after a disease.
• Langhana is anything that makes the body light — it includes the whole of shodhana, upavasa, pipasa, vyayana, atapa and maruta sevana. It is not a synonym for fasting, and saying so is the commonest error.
• Brimhana is what builds: madhura, snigdha, guru ahara, ksheera, mamsa rasa, sleep and rest. Indicated in kshina, after shodhana, in the aged and in the child.
• Rukshana dries; snehana oleates; swedana sweats and removes stambha; stambhana arrests — used in atisara, raktapitta and where a flow must be stopped, with sheeta, kashaya and laghu dravya.
• Sushruta reduces the six to two: santarpana and apatarpana — nourishing and depleting. Brimhana, snehana and stambhana are santarpana; langhana, rukshana and swedana are apatarpana. This is the dwividha upakrama and is asked against the shadvidha constantly.
• Santarpana done wrongly produces the santarpanottha vyadhi — prameha, sthaulya, kushtha — and apatarpana done wrongly produces the apatarpanottha. Each treatment carries its own diseases of excess, and naming one of each is the usual follow-up question.
• The sequence matters: langhana before snehana where ama is present, because snehana over ama drives it deeper. This single rule decides most Kayachikitsa case questions.

Gastrointestinal

• Atisara: six types. Grahani: the disease of agni itself, following untreated atisara. Arsha, Arocaka, Chhardi, Amlapitta.
• Udara: eight types including jalodara. Pandu (five types) and Kamala, which follows pandu.
• Krimi: twenty types by site.
• The thread through all of them is agni. An answer that ignores agni in this section is incomplete.

Vata and joint disease

• Vatavyadhi: eighty named disorders. Their general chikitsa is snehana, swedana, basti — basti being the principal treatment for vata.
• Amavata: the combination of ama and vata, and why snehana is contraindicated at the start of it.
• Sandhivata, Gridhrasi, Katigraha, Avabahuka, Pakshaghata, Ardita.
• Vatarakta and its two types.

Prameha, Kushtha and the chest

• Prameha: twenty types — ten kaphaja, six pittaja, four vataja. Madhumeha is the vataja one. Kaphaja prameha are sadhya, pittaja yapya, vataja — including madhumeha — asadhya.
• Kushtha: seven mahakushtha and eleven kshudrakushtha. Khadira heads the kushthaghna dravya.
• Shwasa: five types, of which tamaka is the one most examined. Kasa: five types. Rajayakshma and its eleven rupa.
• Hridroga: five types.

Manas, Rasayana and Vajikarana

• Unmada and Apasmara and their types. Medhya rasayana: Mandukaparni, Yashtimadhu, Guduchi, Shankhapushpi — Charaka's four, and Mandukaparni is named first.
• Rasayana: kutipraveshika and vatatapika. Achara rasayana — conduct as rasayana, with no drug.
• Vajikarana and its dravya.
• Modern correlates: diabetes, hypertension, ischaemic heart disease, COPD, tuberculosis, rheumatoid arthritis, and the honest statement of where correlation is approximate rather than exact.

Atisara and Grahani

• Atisara: six types — vataja, pittaja, kaphaja, sannipataja, bhayaja, shokaja. The last two are psychological in origin, which is worth noting.
• Amatisara must not be stopped with grahi dravya before ama is digested — stopping it early is the classical error.
• Grahani is the disease of agni itself and typically follows untreated atisara. Four types.
• Kutaja heads the dravya for atisara; its bark and its seed (Indrayava) are separate articles.

Arsha and Udara

• Arsha: six types; shushka and ardra; sahaja and janmottara kalaja. Four lines of treatment — bheshaja, kshara, agni, shastra.
• Udara: eight types, of which jalodara (ascites) is the one most examined and the one described as the most difficult.
• Kshara sutra for bhagandara and Kshara karma for arsha belong here as much as in Shalya.

Manas roga and Unmada, Apasmara

• Unmada: five types — four doshaja plus agantuja. Apasmara: four types.
• Manas dosha are rajas and tamas; the treatment includes Daivavyapashraya, Yuktivyapashraya and Sattvavajaya — the three approaches to treatment in Charaka.
• Sattvavajaya is the classical psychotherapy and is a distinctive contribution worth explaining in an answer.
• Medhya rasayana and their role; modern correlates and when referral is required.

Hridroga

• Five types: vataja, pittaja, kaphaja, sannipataja and krimija.
• Arjuna is the dravya named for it, and the texts treat its hridya action as prabhava.
• Modern correlates: ischaemic heart disease, heart failure, arrhythmia — and the honest point that chest pain needs urgent assessment rather than a decoction.
• Pushkaramoola's classical indication is parshvashoola with breathlessness. That presentation includes myocardial infarction, which is exactly why it is not a herbal indication: chest pain needs urgent assessment, and Laisha's entry for the dravya says so on its own page.

Modern medicine correlates

• Diabetes and Prameha: overlapping but not identical. Prameha includes conditions that are not diabetes.
• Hypertension has no single classical counterpart and an answer that invents one is weaker than one that says so.
• Rheumatoid arthritis and Amavata correspond reasonably well; osteoarthritis and Sandhivata likewise.
• Tuberculosis and Rajayakshma correspond well, and Rajayakshma's eleven rupa map recognisably onto its clinical picture.

Jwara — the chikitsa, not only the classification

• Chikitsa sutra: langhana in ama avastha, then pachana, then shamana. Charaka Chikitsa 3. Langhana is the first step and the commonest error is skipping it — a jwara with ama given brimhana becomes a longer jwara.
• The rule that decides everything: no snehana until the jwara is nirama. Sneha in sama jwara is the classical contraindication and the modern one.
• Shadanga paniya — musta, parpata, ushira, chandana, udichya, nagara — boiled and cooled, is the standard trishnahara and jwarahara drink. It is the one formula worth knowing by its six members.
• Named yoga: Amrita (Guduchi) kwatha and Amritarishta in jirna jwara; Tribhuvana Kirti rasa and Anandabhairava rasa in navina jwara with kapha; Sudarshana churna in vishama jwara; Godanti bhasma with shirashoola.
• Vishama jwara: the four types by interval — santata, satata, anyedyushka, tritiyaka and chaturthaka. Chaturthaka is the hardest and the texts say so.
• Jwaramuktalakshana: the signs of release — laghuta, kshut, swedа, normal pulse and taste returning. A jwara without these has abated, not resolved.

Raktapitta — Charaka Chikitsa 4

• Definition: bleeding from the upper or lower passages driven by pitta having vitiated rakta. Urdhwaga (nose, mouth, eyes, ears) is sadhya; adhoga (rectum, urinary, vaginal) is yapya; ubhayaga is asadhya. That prognosis triad is a certain question.
• Chikitsa sutra: langhana first if bala permits, then virechana in urdhwaga and vamana in adhoga — the opposite of what intuition suggests, and the reason it is examined. The principle is to draw the dosha AWAY from the bleeding site.
• Sheeta, madhura, kashaya dravya throughout. Tandulodaka is the classical vehicle.
• Named yoga: Vasa swarasa with madhu, Durva swarasa, Sheeta kashaya of the panchavalkala; Vasavaleha; Praval pishti and Mukta pishti; Chandanadi kwatha.
• Pathya: shali rice, mudga, ghrita, dugdha, draksha. Apathya: katu, ushna, lavana, amla, vidahi ahara, madya, atapa and vyayama.

Gulma — Charaka Chikitsa 5

• A palpable, mobile, knotted swelling in the koshtha with pain — not a fixed mass. Five types: vataja, pittaja, kaphaja, sannipataja and raktaja. Raktaja gulma occurs only in women and is the one that must be distinguished from garbha.
• Panchavidha gulma sthana: the five sites are hrid, nabhi, basti and the two parshwa.
• Chikitsa sutra: snehana and swedana first, then mridu virechana or niruha basti. Vata is the anubandhi dosha in every type, so vatahara measures run throughout.
• Named yoga: Hingvashtaka churna, Shivakshara pachana churna, Gulmakalanala rasa, Dashamoola kwatha, Eranda taila with dugdha.
• Raktaja gulma: the classical caution is never to give a garbhapatana measure until pregnancy is excluded. The texts say to wait and observe, which is the right answer in a viva.

Shotha, Visarpa and Madatyaya

• SHOTHA: three by dosha plus sannipataja, plus abhighataja and visha-janya — six in Charaka. Sarvanga shotha with shwasa and aruchi is asadhya. Chikitsa: langhana, rukshana, deepana; Punarnavadi kwatha and Punarnava mandura are the named yoga.
• VISARPA: seven types — vataja, pittaja, kaphaja and the sannipatika forms agneya, granthi, kardama and vataja-pittaja. Granthi visarpa and kardama visarpa are the dangerous ones. Spreads rapidly, which is what visarpa means.
• Visarpa chikitsa: raktamokshana early, sheeta lepa, and no snehana — sneha in visarpa worsens it, which is the trap.
• MADATYAYA: four stages by the classical reckoning — paramada, panatyaya, panavibhrama and panajirna. Managed by the same dosha that caused it; sheeta upachara in pittaja, ushna in vataja.
• Madya guna: laghu, ushna, tikshna, sukshma, vyavayi and vikasi — ten in the full list, and the vyavayi-vikasi pair is why intoxication is fast and systemic.

Trishna, Urustambha, Kshatakshina and Shwitra

• TRISHNA: seven types in Sushruta — vataja, pittaja, kaphaja, kshataja, kshayaja, amaja and upasargaja. Chikitsa is sheeta jala, tandulodaka, Shadanga paniya, and treating the cause. Trishna appearing in a kshina patient is a grave sign.
• URUSTAMBHA: the one vata disorder where snehana is CONTRAINDICATED. Ama and kapha obstruct in the thighs; treatment is ruksha swedana, langhana and udvartana. Giving sneha here is the classic error and the reason the disease is taught separately.
• KSHATAKSHINA: injury to the chest leading to depletion. Chikitsa is brimhana with madhu, ghrita and dugdha, never shodhana. Named yoga: Vasavaleha, Chyawanprash, Ksheerabala taila.
• SHWITRA: kilasa. Three by the dhatu involved — daruna (rakta), aruna (mamsa), and the sthira white type (medas), the last being the hardest. Bakuchi (Psoralea corylifolia) internally and externally is the classical drug; the treatment is long and the texts say so.

Trimarmiya — the three vital sites

• Basti, hridaya and shiras are the trimarma, and Charaka gives them a chapter in both Siddhisthana and Chikitsasthana. Injury or disease at any of the three is more serious than the same at any other site.
• Trimarmiya chikitsa (Cha.Chi.26) covers hridroga, mutraghata, ashmari and shiroroga together for this reason.
• HRIDROGA five: vataja, pittaja, kaphaja, sannipataja and krimija. Krimija hridroga is the one caused by worms and is distinct. Named yoga: Arjuna ksheerapaka, Prabhakara vati, Hridayarnava rasa.
• MUTRAGHATA thirteen and MUTRAKRICHRA eight — the counts are examined, and the distinction is that mutraghata is obstruction and mutrakrichra is painful micturition.
• SHIRORPOGA eleven in Sushruta. Ardhavabhedaka is the classical migraine; Suryavarta is the one that rises and falls with the sun, and that description is the answer expected.

Where the texts disagree

• Charaka's eighty nanatmaja vata vyadhi, forty pittaja and twenty kaphaja are the examinable counts; other texts give slightly different lists.
• Whether amavata is a separate disease or a form of vatarakta is treated differently by the later texts than by the Samhitas.
• The classification of jwara as eight in Charaka is not matched exactly by Sushruta's account.

Commonly confused

• Amavata (ama plus vata, in the joints) and Vatarakta (vata obstructed by rakta).
• Pandu (rakta dhatu) and Kamala (its pitta-predominant sequel).
• Grahani (the organ and the disease sharing a name).
• Langhana (reducing) and Brimhana (building) - opposed members of the shad upakrama.

Practise it, and prove it