6 Stages Known As Shatkriya Kala

Abstract

Ayurveda is not only for diagnosis but it gives information about the stages of disease. Shatkriya kala is a fundamental topic which deals with the knowledge of stages of disease. Understanding the process of Shatkriya kala, helps in early detection of disease so that disease progression could be arrested. In modern pathology there are two stages of disease progression i.e., Pre-pathogenesis and Pathogenesis. Pre-pathogenesis can be correlated with sanchaya, Prakopa, Prasara. As the intensity of the disease in these three stages and pre-pathogenesis stage is minimal. Pathogenesis stage can be correlated with Sthanasamsraya, Vyakti and Bheda as the intensity of the diseases fully established in these stages.

Introduction

Ayurveda is the branch of medical science which deals with prevention and curative aspects of disease. Because it has deep knowledge about the stages of pathogenesis of the disease. According to Ayurveda, diagnosis is not always in terms of the name of disease but in terms of the nature of the phenomenon of the disease.

The term Shatkriya kala refers to recognition of different phases or stages of disease formation in its own unique way and the appropriate time of treatment as per stages of the disease.

Shatkriya kala is the fundamental concept of Ayurveda which is described by Acharya Sushrut in Vranaprashna adhyaya. It can be correlated with disease pathogenesis.

Shatkriya kala means; shat means six, kriya means treatment, and kala means time or stage. Thus, it is the time for proper management or treatment of disease manifestation1.

Acharya Sushruta beautifully explains the phases or stages of disease pathogenesis under shatkriya kala. There are six time periods for management of disease.

Aim & Objectives

To understand the concept of Shatkriya kala and its relation to pathogenesis along with some Ayurvedic home remedies, lifestyle and classical therapies.

Material & Method

Review of literature is collected from samhitas and available commentaries and research articles from various sites regarding Shatkriya kala.

Type Of Study

Formation or progression of disease explains in 6 stages known as Shatkriya kala these are –

Sanchaya
Prakopa
Prasara
Sthanasamsraya
Vyakti
Bheda

1. Sanchaya

It is the first stage of disease formation known as the stage of accumulation. In this stage, doshas are accumulated in their own place due to various nidanas.

In this stage there is a desire to the opposite gunas of the dosha and aversion to the similar rasa, gunas of the doshas.

TABLE 1 : SANCHAYA LAKSHANAS

Dosha	Sanchaya lakshanas
Vata	Stabdhapurnakoshatha (feeling of stiffness and fullness of the abdomen)
Pitta	Pitavabhasta (yellowish discoloration of the body Mandoshmta (decrease in body temperature)
Kapha	Angagourava (feeling of heaviness in the body) Angasada (weakness) Mandagni (decrease in digestive fire)

This is the first opportunity for treatment. When these doshas are eliminated in this first stage, doshas do not attain successive stages.

Doshas sanchaya also occurs in concerned season and diurnal variation, in this condition ritucharya and dincharaya should be followed. And in pathological condition nidan parivarjan and saman chikitsa should be followed.

2. Prakopa

This is the second stage of disease formation known as stage of vitiation. If the nidanas are still continued, doshas will move in prakopa stage which means doshas increase in their quantity and are motivated to leave their place but not moving.

TABLE 2 : PRAKOPA LAKSHANAS

Dosha	Sanchaya lakshanas
Vata	Koshta toda sancharan (pricking pain in abdomen) Karshnyam (blackish discoloration)
Pitta	Amlika (sour eructation) Pipasa (thirst) Paridaha (burning sensation)
Kapha	Annadvesha (aversion to food) Hridayokleda (excessive salivation) Avipaka (indigestion) Mukhamaduryam (sweet taste of the mouth)

TREATMENT

Sodhana and samana chikitsa are employed.

3. Prasara

It is the third stage of disease progression and known as the stage of dissemination. If the nidana still continues, aggravated (prakopit) doshas leave their place and move to another place. These doshas disseminate in the whole body with the help of vayu. As, Vayu has chal guna, it is responsible for movements of doshas from one place to another place.

TABLE 3 : PRASARA LAKSHANA

Dosha	Sanchaya lakshanas
Vata	Vayorvimargagamana (movement of vayu to different parts in the body) Atopa (flatulence)
Pitta	Osha (burning pain) Chosa (sucking pain) Paridaha (Burning sensation in the body) Dhumayana (feeling of hot fumes coming out from mouth)
Kapha	Annadvesha (aversion to food) Chardi (vomiting) Avipaka (indigestion) Angasada (heaviness in the body)

TREATMENT

Hetu linga chikitsa and sthanika dosha chikisa are advised.
If the vata moves to pitta sthana then pittahara chikitsa should be done.
If the pitta moves to Kapha sthana then Kaphahara chikitsa should be done.
If the kapha moves to vata sthana then vatahara chikitsa should be done.

4. Sthanasamsraya

This is the fourth stage of disease formation and known as the stage of localization. If the nidans are continued then the vitiated doshas go into sthanasamsraya avastha. Wherever there is srotovaigunya i.e., vikriti in the srotas (deformity in the channels), the vitiated doshas settle there.1 At this place doshas combined with the localized tissue known as dosha dushya sammurchana and at this stage purvarupa (premodial symptoms) of the disease appears.

TREATMENT

In this stage, treatment is totally according to the symptoms1. Treatment at this level is helpful in preventing the disease and its complications. Purvarupa are also important factors for diagnosis of disease and deciding the treatment. Purvarupa are also helpful for disease prognosis. If the disease carries its all the purvarupa then the disease is of bad prognosis.

5. Vyakti

This is the fifth stage of disease formation and known as the stage of clinical symptoms. If there is continuation of nidanas, sthanasamsraya leads to vyakti avastha. This is the stage in which the disease completely blew its picture. There is clear manifestation of sign and symptoms of the disease.

TREATMENT

After diagnosis, treatment should be planned according to the disease.

6. Bheda

This is the sixth and last stage of disease progression. If the disease is not treated in the fifth stage, the disease will progress to attain complications or finally may lead to death. It indicates a bad prognosis of disease.

Discussion

In kriyakala, there are six stages which describe the progression of disease. The stages are Sanchaya, Prakopa, Prasara, Sthanasamsraya, Vyakti, Bheda. In modern pathology there are two stages of disease progression i.e., Pre-pathogenesis and Pathogenesis. Pre-pathogenesis can be correlated with sanchaya, Prakopa, Prasara. As the intensity of the disease in these three stages and pre-pathogenesis stage is minimal. Pathogenesis stage can be correlated with Sthanasamsraya, Vyakti and Bheda as the intensity of the diseases fully established in these stages. Shatkriya kala helps in prevention of disease. Prevention comprises of four stages:

Primordial – Prevention of development of risk factors. In the sachaya stage, there is a need for primodial prevention, by using the measure that inhibits the emergence of environmental, economic, social and behavioral conditions.
Primary Prevention – Management of risk factors and prevention of onset of disease. Prakopa and Prasara stage needs primary prevention. It stops the disease progression by protecting the health by good nutrition, immunization and eliminating environmental risk factors.
Secondary Prevention – Early diagnosis and treatment. Sthanasamsraya needs secondary prevention by early diagnosis to control the disease progression.
Tertiary Prevention – Reduce the complications. Vyakti and Bheda stage needs tertiary prevention to minimize the disability and complications of disease.3

Conclusion

Shatkriya kala helps in early diagnosis, prognosis and treatment of disease. It gives the knowledge about the time of treatment in the process of disease manifestation and prevents the disease progression.