Published online in http://ijam.co.in ISSN: 0976-5921 Panja AK, et al., Microbial Infections in Caraka

Review article

Clinical Consequences of Microbial Infections in Samhita

Panja AK*, Patra A1, Chaudhuri S2, Chattopadhyaya A3

1. Ayurvedic Medical officer, Uluberia Sub-divisional Hospital, Govt. of West Bengal 2. Dept of Samhita & Siddhanta, J.B.Roy. State Ayurvedic MCH, Kolkata 3. Dept. of Sharir & Samhita, Institute of Post Graduate Ayurvedic Education & Research, S.V.S.P. Hospital, Kolkata

Abstract

The diseases in are categorized into endogenous and exogenous. Infections exercise a major part among the exogenous categories. A vivid description of infectious diseases, their pathogenesis and treatment have been documented in Ayurvedic treatises. Microbes are responsible factor for infection. So to combat the microbes and their newly developing strains is a great challenge. Though, the term microbes or microbial activity have not been clearly described in Ayurvedic texts but similar concept, their functional activities and remedies have been depicted. , on the basis of its own underline philosophy and the then prevailing thoughts, has described almost all possible aspects of microbial infections in rational consequential way. The present article deals with the ancient approach of microbial infections and its clinical consequences in Charaka Samhita.

Key words: Microbes, Microbial infection, Ayurveda, Charaka Samhita

Background: basically the etiology was categorized in the The diseases are the outcome of the purview of incompatible diet and conduct etiological factors and subsequently the but apart from those the rudimentary view of complex phenomena of the substantial different segmental etiology were sequenced pathogenesis. The quality of the disease is in causation of disease. Some invisible specified in-terms of its etiological factors. factors were also specified for producing the The qualitative etiology is responsible for disease. But with the advent of era, those the production of the respective disease and rudimentary views in respect to etiology are therefore the analysis of the etiology in the explored and now a day it seems that very specific disease is essential. The infective diseases caused due to microbial fundamental aim of the treatment or organism are very dreadful entity. The diagnosis is to detect the responsible concepts of microbes were incorporated in etiological factors. In the ancient era the terms bhuta. Narrating the quality of the sign and symptom of different diseases * Corresponding Author: mentioned in the ancient text, the essence of Dr. Panja. A. K. infection can be revealed. The identical Dept of Basic Principles, views of microbes for pathology are National Institute of Ayurveda, Jaipur similarised. The conceptual study is hereby E-mail: [email protected] presented maintaining the chronological Phone: +91-9982082832

107 Published online in http://ijam.co.in ISSN: 0976-5921 International Journal of Ayurvedic , 2011, 2(3), 107-114 chapters of the diseases mentioned in the particularly vulnerable as they favour the Chikitsa sthana of Charaka Samhita. growth of the anaerobic bacillus (8). Transformation represents the The Conceptual study: various changes that accompany the The concepts of microbes were also conversion of a normal cell into a malignant highlighted in Charaka Samhita and as such cell (9). These phenomena may also produce the significance is justified in the etiologies, granthi (10) & arbuda (11). The detail signs and symptoms of different diseases. etiologies of kushtha (12) are very important The relevancies of microbial infections are illustration for microbial contamination or almost seen in every disease and therefore in culture and growth (13). Intake of uncooked the succeeding paragraphs the consequences food material, performance of physical of the microbial infections are analyzed to exercise in excessive heat and cold are one magnify the said perspective in different of causative factor for microbial invasion. dimensions. Variations of temperature are very much The affection of abhighata (trauma) important factors for microbial growth (both and abhishanga are external causes for jvara bacteria and virus) (14). Bacteria vary in (1). Bhuta (external invisible aetiologies their requirement of temperature for growth. disrupt body homeostasis) is also included The affected dhatus like skin, , under abhishanga variety. From the views muscle, and body fluid, lymph (15) show the of pathogenesis of jvara, the aggravation of trans-migratory pathway of the microbes. It are also considered like vayu and is already evident and mentioned in the vayu or pitta in case of abhighata or context of leprotic infection early in Vedic abhishanga jvara respectively, but here period in and from Biblical times in sudden onset of cardinal features, i.e., Middle East (16). santapa is manifested before aggravating Kushtha is regarded as chronic features of doshas (2). Some external disease developed gradually (17). etiologies are also mentioned as the cause of Superficial infections comprise the various doshaja jvara (3). The vitiated doshas are types of tinea or ring worm affecting skin, located in rasa, rakta, etc. dhatus, sign and hair and nails are having very mild and symptoms like vomiting, diarrhoea, both chronic in nature (18). The features of vata, diarrhoea and emesis, discolouration of pitta and kapha predominance in skin body, pain abdomen etc. are manifested and disease (kushtha) are roughness, dryness, associated with high rise of temperature coarseness, etc. caused by vayu; burning (4).When the vitiated doshas in aggravated sensation, redness, itching, exudation, srota afflict the deeper dhatu like asthi, suppuration, foul smell, stickiness are majja, then that condition is difficult to cure, caused by pitta; white colouration, itching, and in case of afflicted shukra it is incurable localization, elevation, maggot formation, (5). In case of virulent organisms, it may be etc. are caused by kapha. These are common difficult to cure or incurable when the multi- signs and symptoms causes by bacterial and systems are involved. fungal infection on skin. Daruvaha’ is microbial invasion The history of infection by yakshma which spreads all over the body through (19) from outside into immunocompromised circulating media and activates fever in ‘Chandra’ due to excessive sexual acute or delayed basis (6). Vitiation of vata intercourse directly refers the existence of in both abhighataja and vataja jvara is due microbes. The source of infection is usually to cold affliction (7). Puncture wounds are an open case of pulmonary tuberculosis. The

108 Published online in http://ijam.co.in ISSN: 0976-5921 Panja AK, et al., Microbial Infections in Caraka Samhita mode of infection is by direct inhalation of and symptoms of the svayathu roga, the aerosolized bacilli contained in droplet infected cellulites. nuclei of expectorated sputum, the majority Parasitic invasion causes painful of inhaled bacilli are arrested by the natural abscess in the sites of anal orifice and the defenses of the upper respiratory tract. abscess if get suppurated and burst, the Concept of sosha and or rajayakshma is also condition is known as infected vagandara documented the immunocompromised state (29). The pitta predominant aggravated referring the concept of AIDS due to HIV dosas cause serious type of migratory infection. The pathogenesis of dhatukshaya swelling associated with high fever and in either pratiloma or anuloma route denote morbid thirst afflicting the blood results the transmission through body fluids (like suppuration, known as jalagardhava (30). rasa, rakta, shukra, etc.). In both ways it This condition is result of bacteria. All the affects at first rakta and other deep tissue exogenous swelling are caused due to later (20). aggravated vata along with vitiated blood The aetiologies like viruddha- which in terms causes localized reddish dushta-ashuchi diet (21) of unmada roga swelling and infected swelling is required denote the microbial infection of psycho- antimicrobial therapy (31). neurology. Here the viruddha-dushta- The ingestion of the contaminated ashuchi is incompatible, contaminated, and food aggravates the doshas and obstructs the impure food substances respectively (22) channels resulting indigestion as the which are common growth places of manifestation of udara (32) and in paittik pathogenic microorganisms. Description of udara, the pitta gets immediate accumulated eight types of bhutagraha for the because of ingestion of same, aggravating manifestation of agantuka unmada (23) is vata and pitta subsequently, obstructs the caused by abuse or contamination of any channels later and moving upwards it type, either by improper present habit or past suppresses digestive power and metabolism deeds (genetic spread) (24). with the severe manifestation of burning Clinical features of kshata and fever, thirst, fainting, diarrhoea, and kshina are the chest pain and haemoptysis; giddiness (33). The complication of cough and haematuria, pain in flanks and udakodara (34) itself signifies the back respectively (25) refer the manifestation of the bacterial infection. inflammatory sign due to respiratory Arsha is a disease characterized by infection or urinary tract infection. The the morbid growth by muscle tissue (35) and strong evidence of transmission of organism the characteristics of the paittika type of the by the cited aetiology mentioned as arsha is excessive sweating, sticky excessive intercourse. It can also be discharge, foul smell, suppuration (36) mentioned that kshatakshina is less severe which signifies the direct involvement of the than rajayakshma and prognostically it can secondary infection. The discharge from the be turned into rajayakshma if not treated piles mass is large quantity and continuous properly (26). If the superficial skin is and this discharge is white, red in colour and affected by the trauma or infected materials, associated with severe itching seen in that results an exogenous type of oedema kaphaja arsha (37) may be associate with (27) and it is manifested with hyperpyrexia, secondary infection (either fungal or burning in the eyes and the dilatation of the bacteria). affected vessels (28) in the premonitory sign The vectors or the micro-organism in the form of dust, smoke and wind enter into

109 Published online in http://ijam.co.in ISSN: 0976-5921 International Journal of Ayurvedic Medicine, 2011, 2(3), 107-114 the lungs and produced shvasa roga involvement of the micro-organism or state specifically if the breathlessness is of the secondary infection and likewise the associated with fever and faintness and sannipatika visarpa where all the dhatus are termed as pratamaka shvasa, the significant pervaded specially rakta with the disease of the affliction of micro-organism instantaneously spreading ailments (46) (38). suggestive of microorganism infiltration. In The obstruction in the movement of this condition the exposure to polluted air is vayu causes paittika kasa and manifested strictly contraindicated (47). with morbid thrust, burning sensation, and The micro-organisms responsible for spit phlegm associated with pitta and fever, urinary infection, tuberculosis and continuous kasa (39). In kasa spitting is a asthma are accountable in the production of generalized feature (40) in vataja, pittaja aupsargika trishna (48). and kaphaja kasa respectively. Apart from The exogenous ulcer is caused due to those kshataja kasa and kshayaja kasa are exposure to micro organism, fire etc.(49) the outcome of microbacterial infection like and the snayu kleda is the specific tuberculosis and manifested with blood characteristics the indicative of the mixed phlegm, fever, morbid thirst (41) and microbial infection and the site of the different colour phlegm fever etc. (42) manifestation of the ulcer are skin, vessel, respectively. muscle tissue, ligaments, vital organ and the The aggravated pitta on account of viscera.(50) its liquidity suppress the power of and The discharge of pus, blood and the disintegrate the stool in colon because of its different coloured materials (51) clarify the heat liquidity and morbidity and liquidity involvement of the micro organisms which causes paittika type of atisara. It is also supported by the manifested presented with various coloured liquid complication of the ulcer like, convulsion, defecation. The stool is mixed with blood, morbid thirst, dysponea etc.(52). The foul smell, morbid thirst, burning sensation virulence of the micro organism are also and suppuration of the anus. The extensively analyzed though the manifestation of snayu aggravated pitta along with instantaneous kleda, sira kleda, gambhira, krimi vitiation of rakta leads to morbid thirst, colic bhakshana (appearance of maggots) (53) pain, burning sensation and suppuration of and the ulcer which is affected by the micro the anus, termed as raktatisara (43). It also organism, if excessively secreted with foul denotes secondary infection. Vata, pitta and odour is incurable in nature. The deep routed kapha gets aggravated due to invasion of ulcer is affected by the different types of microorganism in the site of amadosha and aerobic and anaerobic micro organism, cause vomiting through the circulation of therefore it is presented with differ type of those organisms and presented with pain, discharges. burning sensation morbid thirst, and vomitus One of the causative factor of the substances are mixed with blood (44), the dysuria is the trauma in the uro-genital tract categorical indication of infection. and is called raktaja mutrakrichchhra, The intense state of chardi is because of the excessive vitiation of the manifested with vomited material associated blood, it may be due to the invasion of the with blood, pus, and frothing is also micro organism after traumatic injury , and indicative of infection (45). may be as a result of excessive sexual The manifestations of two verities of intercourse (54). In the paittika type of visarpa (Agni and Kardamaka) reveal dysuria, the pain, burning sensation and

110 Published online in http://ijam.co.in ISSN: 0976-5921 Panja AK, et al., Microbial Infections in Caraka Samhita urine mixed with blood is the indicative of tissue is characterized by redness, primary infection (55). The heart diseases suppuration and bursting pain in pita caused by micro-organism infestation get predominant vatarakta (67). If it is acute pricking pain and itching (56) and associated with secretion of exudates (68) therefore in krimija hridroga antimicrobial then it is suggestive of micro-organic treatment is indicated (57). infestation. The suppurated vatarakta, the The seasonal variations, excessive excessive vitiation of pitta and rakta lead to exposure to the dust are the favorable factors bursting open of the wound associated with for viruses and these vulnerable viruses the discharge of putrid blood and pus (69), inflamed the nasal mucosa causing the the classical indication of secondary aggravation of vayu with the production of pyogenic infection. rhinitis. This condition of rhinitis is exposed The genital tract of the female to bacteria that results purulent and subject gets infected by the microorganism sanguineous rhinitis, fever, supporative and causes excessive offensive menstruation rhinitis etc. (58) and termed as dushtya associated with suppuration, burning pratishyaya. Supportive rhinitis is also sensation, fever etc. (70) and menstrual caused by acute infection of rakta and pitta discharges with itching etc. (71) , signify the and characterized by burning sensation, affliction of primary micro-organism. The redness, suppuration of nose etc.(59) and the unhygienic condition of the genital tract secondary infection leads to the production causes the growth of microbes and is of puyarakta (60). attended with severe itching termed as Krimija shiroroga is manifested with acharana--roga (72). the aggravated severe headache (61) and may be the result vayu associated with kapha affect the female of meningitis, encephalitis, tuberculoma, genital organ and is characterized with and neurocystisercosis. Sannipatika mucous discharge and pain (73), and karnaroga is manifested with putrid likewise the bluish and yellowish discharge of different colour (62) and results menstruation is caused due to aggravated of micro-organism. Pattika type of eye vayu associated with pitta in paripluta may disease is characterized by burning be caused by sexual intercourse (74). sensation, excessive pain, redness, discharge The vitiated semen is characterized of sticky material of yellow and extremely by frothy, thin, unctuous, discoloured, putrid hot lacrimation (63) resembling with smell, slimy, and or mixed with other tissue infective conjunction. elements (75) suggestive of micro-organism The heat of the body in association infestation. Sexual intercourse with woman with vata and other doshas scorches of the suffering from chronic diseases or with hair root causing instantaneous rise to quadruped animals or trauma to the phallus, alopecia (64), a fungal infection. In ardita, excessive infection etc are the causative vayu gets aggravated and the facial nerves factor for dhvajabhangaja klaivya and this is are affected by the viruses with the affliction characterized by ulceration and suppuration of blood (65). The aggravated vata located of the phallus, exudation, high rise of in the back side of the neck, causes the temperature, appearance of maggots of the constrictions of nerves resulting the bending phallus etc.(76). This is the resemblance of of the body like a bow (66) resembles with the features of sexually transmitted tetanus. infection. On account of the simultaneous The menstrual discharge resembling aggravation of vata and rakta, the necrosed like the juice of kinshuka, the bluish,

111 Published online in http://ijam.co.in ISSN: 0976-5921 International Journal of Ayurvedic Medicine, 2011, 2(3), 107-114 yellowish and reddish menstrual discharge kanthashaluka, vidalika, vidradhi (bahya & associated with burning sensation, fever etc, abhyantara), upakusha, danta vidradhi, and dense menstrual discharge are the alaji, sirashotha, vidarika, kaksha, manifestation of vatika pradara (77), romantika, masurika, unmargi bhagandara, paittika pradara (78), and kaphaja pradara jalagardhava, paittika udara, sannipatika (79), may be caused due to the microbial udara, chidrodara, baddhagudodara, infection. The breast milk if affected by udakodara, kaphaja arsha, pittaja arsha, vayu makes it a mass of frothy substances vatika grahani, paittika pandu, mrit- (80), the breast milk becomes discoloured, bhakshanaja pandu, kamala, shvasa, blue and yellow due to affliction of pratamaka shvasa, kasa, atisara, aggravated Pitta (81), and the breast milk raktatisara, amaja chardi, agni visarpa, becomes unctuous due to aggravation of kardamaka visarpa, aupasargika trisna, afflicted Kapha (82), Intake of this vrana, raktaja & pittaja mutrakrichchhra, contaminated breast milk causes the baby krimija hridroga, dushta pratishyaya, unhealthy (83). This state is found in the krimija shiroroga, sannipatika karnaroga, ingestion of infected or contaminated food paittika chakshu roga, darunaka, ardita, by the baby. vahirayama, vatarakta, acharana, paripluta, stanyadosha, shukradosha, dhvajabhangaja Discussion: klaibya, pradara etc. are caused due to the The principle and basic mechanism microbial infection. of microbial infection is summarized incorporating the important steps that Summary and conclusion: occurred during the pathogenesis of the On the basis of that it may be infection. The microbes are entered with the concluded that the term bhuta is significant different modes of transmission and get to compare with microbes. In almost all the attached with the epithelial cell resulting diseases mentioned in Charaka Samhita, the vriddhi, dosha prakopa and srota microbial infections are well detected in vaigunya respectively. These lead to the respect to etiology and its signs and luminal infection and tissue invasion for symptoms. The severe burning sensation, which cell injury takes pace and causes pus secretion, suppuration, inflammation, dhatu avarana and dhatu kshaya, with the necrosis, gangrene and excruciating pain are production of the diseases. Right from the the well define characteristic of microbial entry of the pathogen into the host up to the infection which are specified in diseases. srotadushti and the dhatu pradushana the pathogens may remain dormant and requires References: the favourable factors for the manifestation 1 Acharya, Pt. Y T: Caraka Samhita, of the disease process, this period is known Ayurveda Dipika Commentry by as incubation period. And the process which Cakrapanidutta, Rastriya Sanskrit takes pace from the tissue injury upto the Samsthan , Reprint 2006 . 407-408p production of the disease is termed as 2 Acharya, Pt. Y T: Caraka Samhita, (pathogenesis) samprapti. Abhighataja and Ayurveda Dipika Commentry by abhishanga jvara, santata variety of Cakrapanidutta, Rastriya Sanskrit vishama jvara, sannipatika jvara due to Samsthan , Reprint 2006 . 201-202p external cause, nichaya gulma, kushtha, 3 Acharya, Pt. Y T: Caraka Samhita, rajayakshma, bhutagraha, agantuja Ayurveda Dipika Commentry by unmada, kshatakshina, sthanika shotha,

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Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan, Reprint 2006. 199p Samsthan , Reprint 2006 . 467-469p 4-7 Acharya, Pt. Y T: Caraka Samhita, 25-26 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 405-408p Samsthan , Reprint 2006. 478p 8 Ananthanarayan R. & Paniker CKJ: 27-28 Acharya, Pt. Y T: Caraka Samhita, Text Book of Microbiology, Orient Ayurveda Dipika Commentry by Longman Private Limited, 7th Cakrapanidutta, Rastriya Sanskrit Edition 2008. 84p Samsthan , Reprint 2006. 483p 9 Ananthanarayan R. & Paniker CKJ: 29-34 Acharya, Pt. Y T: Caraka Samhita, Text Book of Microbiology, Orient Ayurveda Dipika Commentry by Longman Private Limited, 7th Cakrapanidutta, Rastriya Sanskrit Edition 2008. 579p, column 2 Samsthan, Reprint 2006. 490-494p 10-11 Acharya, Pt. Y T: Caraka Samhita, 35-37 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 489p Samsthan , Reprint 2006 . 501-503p 12-13, 17 Acharya, Pt. Y T: Caraka 38 Acharya, Pt. Y T: Caraka Samhita, Samhita, Ayurveda Dipika Ayurveda Dipika Commentry by Commentry by Cakrapanidutta, Cakrapanidutta,Rastriya Sanskrit Rastriya Sanskrit Samsthan , Reprint Samsthan , Reprint 2006 . 535-536p 2006 . 450- 451p 39-42 Acharya, Pt. Y T: Caraka Samhita, 14 Ananthanarayan R. & Paniker CKJ: Ayurveda Dipika Commentry by Text Book of Microbiology , Orient Cakrapanidutta, Rastriya Sanskrit Longman Private Limited, 7th Samsthan , Reprint 2006 . 540-541p Edition 2008, . .22 & 453 p 43 Acharya, Pt. Y T: Caraka Samhita, 15 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006. 573p Samsthan , Reprint 2006 . 436p 44-45 Acharya, Pt. Y T: Caraka Samhita, 16 Ananthanarayan R. & Paniker Ayurveda Dipika Commentry by CKJ:Text Book of Microbiology , Cakrapanidutta, Rastriya Sanskrit Orient Longman Private Limited, 7th Samsthan , Reprint 2006. 556p Edition 2008. 370p 46 Acharya, Pt. Y T: Caraka Samhita, 18 Ananthanarayan R. & Paniker Ayurveda Dipika Commentry by CKJ:Text Book of Microbiology , Cakrapanidutta, Rastriya Sanskrit Orient Longman Private Limited, 7th Samsthan , Reprint 2006 . 562p Edition 2008 . 612p 47 Acharya, Pt. Y T: Caraka Samhita, 19-20 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 565p Samsthan , Reprint 2006 . 459-461p 48 Acharya, Pt. Y T: Caraka Samhita, 21-24 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 568p

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49-53 Acharya, Pt. Y T: Caraka Samhita, 67-68 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 592-593p Samsthan , Reprint 2006. 629p 54-55 Acharya, Pt. Y T: Caraka Samhita, 69 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 599-600p Samsthan , Reprint 2006. 623-624p 56-64 Acharya, Pt. Y T: Caraka Samhita, 70-74 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 604-606p Samsthan , Reprint 2006, . 635p 65-66 Acharya, Pt. Y T: Caraka Samhita, 75-83 Acharya, Pt. Y T: Caraka Samhita, Ayurveda Dipika Commentry by Ayurveda Dipika Commentry by Cakrapanidutta, Rastriya Sanskrit Cakrapanidutta, Rastriya Sanskrit Samsthan , Reprint 2006 . 618p Samsthan , Reprint 2006. 640-645p

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