UTERATURE

Chapter 3

LITERATURE. ayurvedic

Definitions of khalitya and palitya.

I. Definition:

In order to study khalitya and palitya, it is important to first define khalitya

and palitya.

acarya VagbhaHa has specified that gradual falling of hair should be called

khalitya. This gradual falling of hair slowly leads to baldness.

When pitta combines with vata or kapha to destroy the hair, it is called

khalitya. When the kapha do*?a combines with rakta dhatu it results in the

degeneration and shutting down completely of hair follicles thus leading to

baldness.

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xlJicg41i ~ c1'1lri1~IJitl~:II~~11

ct~~<j,l{1 ~ -=q ~1§~ill~Rl ~ (cn.\3". ~ ~)

In the text, two terms are mainly used for hair fall viz. indralupta

and khalitya.

6

Differentiation between indralupta and khalitya.

Indralupta Khalitya

i.Hairs are lost suddenly. Hair loss is gradual.

ii.Hairs are lost patch by The hair loss is generalized

patch. over the scalp.

iii.lts synonyms are Rucya,

Cacha.

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C1 fG ~ 1 cci XSlI f?5 ,4 'b \.Til Rl -:q fcl'+fTCml II ~ ~ II

XSl0Rl ~~1L(1111: ~-

(3)

(err.B. ~ ~)

(Xj.f.1. 9 ~ )

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Khalitya and palitya have been mainly grouped under two types-

i. siroroga

ii. K9udra roga.

Charakacarya has included urdhvajatrugat diseases in siroroga.

K~udra roga -

K9udra roga has been described in many ways.

1) Those diseases which have small or insignificant hetu, lak9al)a, and

treatment are called Ksudra roga.(4) .

2) The discription of their causes, sign and treatment has been brief in the

ayurvedika Texts. Hence they are called K!?udra roga ..

#

7

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(l1f. f.1". ~~,~~)

3) K9udra means terrible or mean. The diseases which do not leave the

patient easily, e.g. Palitya are described in K9udra roga.

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(l1f. f.1".~~,~ ~.)

4) It is simply a nomenclature used by the Acharyas.

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(~. f.1". 9 ~/~,~I~~I"<i ~)

8

II. Hetu of khalitya and palitya.

In order to make a complete study of causes and pathogenesis of khalitya

and palitya, it is necessary to study the causes of siroroga too. Following

are the causes of siroroga.

i. Stop the urge to pass stools or urinate.

ii. Sleeping after lunch.

iii. Sleeping late at night.

iv. Consuming alcohol.

v. Exposure to eastern wind.

vi. Too much sex.

vii. Inhaling unpleasant smell.

viii. Dust.

ix. Smoke.

x. Exposure to cold.

xi. Exposure to harsh sunlight.

xii. Consuming heavy food. (guru) i.e. food which is difficult to digestt.

xiii. Drinking cold water.

xiv. Taking sour food, green chillies, garlic, ginger, etc.

xv. Taking bath with cold water.

xvi. Trauma on head.

xvii. ama.

xviii. Excessive crying.

xix. Stop the urge to cry.

xx. Cloudy weather.

xxi. Mental strain.

xxii. Abnormal weather conditions.

xxiii. Excessive sleeping.

xxiv. Excessive sweating.

xxv. Drinking too much water.

xxvi. krumi.

xxvii. Not taking bath (head bath).

xxviii. Not applying oil.

xxix. Bending the neck for a long time.

These causes lead to the derangement of vata and other do~a which go to

the head leading to siroroga or diseases of the head.

9

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daruQaka -

Deranged kapha and vayu cause minute fissures on the scalp which are dry

and show signs of itching and lead to hairfall. Many times along with kapha

and vata, pitta too gets deranged leading to darul)aka.

It is hard to touch, hence it is called darul)aka.

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Darun means hard. Although vitiation of kapha and vata has been

mentioned in Darul)aka, Anubandhya of Pitta and Rakta is also seen.

10

Indralupta, khalitya-Deranged vata and pitta go to the hair follicle and cause hairfall. Vitiated

kapha combines with rakta dhatu to shut down the follicle, thus preventing

the growth of hair from hair follicle. This is called indralupta. (5)

Hetu

D Vitiation of Vat a and Pitta Do~a, vitiation ofkapha and rakta.

D Go to the hair follicle, closes the follicle.

D

Hair Fall .

..0.. Baldness

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d~~<1,l{"j ~1~C"lj fj\}"~Rl -=q fcl~ II ~ ~ II (~.f.1. 9 ~)

When this procedure is generalised and gradual it is called khalitya.

When khalitya is due to vata it causes burning over the scalp; when due to

pitta it causes sweating and when due kapha it causes thickening of the

skin.

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cplf>ICFI'1('CPqolf~:q ~ Plfih'iq ~ II

11

(Asadhya) incurable khalitya-

When khalitya is accompanied by following symptoms, it is

incurable.

1) The color of the scalp is like the nails.

2) The appearance of hair and scalp is like that of burnt skin, without hair and

with severe burning sensation.

~: '<iqlpfcl: '<i~\t'<iltm "'<il ~'BT

~IFr+iq Pt0TJil '<i~Ii51 <n-=c.r~ II:(L (cn.\J.:(~)

Ruhya-

'Kartika' has called the falling of hair from all over the body as Ruhya.

c6lRfcp~li5

~~C1Lci ~Ji~JfUl ~ ~1~c=4 ~I\ttilq ~ -=c.r '<i4~i5 ~ I

("BT. f.l.~~,~ tTcPr. Palitya-

When the body heat increases due to sorrow, anger and over exertion, the

pitta is vitiated due to the increase in the heat. This heat in the form of pitta

goes to the head. The pitta then combines with the other d09a and changes

the colour of the hair leading to palitya .... (6)

Sadness, Anger, Exertion

.[J..

Increases Heat of body .

..[]..

Goes to Head along with pitta and vata.

Palitya

12

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~~:~~~:II~~II

~~ ~lx1'<11S1"J1 ~1'<l~ld:

fitffi 'q ~ ~ ~ cf.l ~ II~GII ,

Harita keshata -

(Xj.f.1. 9 ~)

If the hair follicle is affected very mildly by the vitiated pitta then the colour of

the hair becomes like that of monkey's hair ... (7)

Differentiation as per the D09a -

1) Palitya caused by the dominance of vitiated vata is fissured, blakish grey in

colour with rough skin i.e. dry and watery in looks

2) That due to pitta is yellowish with burning sensation on the scalp.

3) That due to kapha is completely white and shining.

4) Palitya caused by headache has many colours and tenderness.

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According to Charakacarya palitya is caused by trid09a but susrutacarya

has only listed pitta as the d09a responsible for causing palitya. Hence Pitta

should be considered as the main d09a and other as subordinate d09a. In

Palitya roga, both agni and pitta have been described as the cause.

~ ~lx1'<1G!ffi ~EIfr.1:lfitffi ~ filct1S1fil ~1'<l~ld ~ ~I

(l""Jl. f.1. ~ ~,~ itcPr.)

13

Skin disease (Ku~1ha) and Khalitya -

The skin diseases arising due to vitiated pitta lead to loss of hair in that

particular area. Burning sensation is also caused alongwith hairfall in that

area.

Whenever it is over the scalp it will cause Khalitya due to skin disease.

("~.X:X1. ~ o/l9)

Other causes of Khalitya and Palitya are

A) Excessive consumption of salt in the diet leads to Khalitya and Palitya

early. Even a person who is used to eating too much salt suffers from

Khalitya and Palitya early.

B) Too much consumption of k9ara leads to khalitya and palitya.

Charakacarya has said that those villagers, city dwellers consume too much

k9ara regularly suffer from these two entities.

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C) Not following the rules after taking nasya leads to khalitya and palitya.

Getting angry, laughing talking too much, sneezing, over exertion after

taking nasya lead to khalitya and palitya .... (8)

0) Charakacarya has mentioned in the sign of dushta pratishaya that hair

fall occurs and the hair of the head become like that of a monkey.

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('q.f~f. ~ G)

14

III. Pregnancy and khalitya and palitya-

• In the intra uterine life the bones, nails, hair are formed during the six

month.

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( 31.x=T. ,Tf~lqf.1lS1~)

Derangement of do~a during this month due to irregular and improper diet

and behavior of the mother can lead to bones which are not formed

properly.

• acarya Sushrut has mentioned that combing hair excessively during the

ovulatory period of the mother leads to hair fall in the Child.

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~ I (31qM~-1 Cb'S·CbffiCbI~'11 ¢~If1JOO1I\J:f'1)

• Also acarya vagbhaHa has clearly mentioned that vitiation of pitta due to

improper diet during pregnancy leads to hairfall in the child.

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(cn.m. 9)

• Excessive consumption of Lavat:la rasa during pregnancy causes khalitya

early in the child.

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15

IV) Basic principles of ayurveda in relation to khalitya and

palitya -

A) Padarth vidnyaan -The Imbalance of Kala (time), Artha and Karma leads to diseases and their

balance leads to a healthy life.

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This imbalance is the main cause of any disease. While treating any

disease, although it is necessary to establish the equilibrium of the do~;a, it

is equally important to restore the balance of these three factors.

Kala-Kala can be considered in different ways with reference to health

and disease.

1) Although the body seems to be the steady (Sthira), the innumerable cells

in the body are constantly undergoing change. This change constantly

occurs in the form of utpatti, sthit T, and laya. New molecules are formed

from the diet. They take part in maintaining the body and then undergo

destruction. Their place is again taken by new molecules ... (9)

2) Kala again manifests itself in the form of age of the body. During

childhood the process of formation of new cells is more than destruction;

during middle age the sthit T is maintained to a large scale; where as in the

old age laya i.e. destruction is more than utpatti.

3) Where kala as the hetu of the disease is considered various factors like

sleeping time, time to take meals etc are very important.

Aartha -This includes exposure to objects of the sense organs to the

surroundings.

16

Karma -Karma means actions. Our actions individually as well as collectively are

responsible for causing diseases. Sarikhya have put forward the

satkaryavad regarding dravya, gut:la, and karma. They believe that the

dravya gut:la and karma are not separate entities but are linked with each

other. As per this theory, the dravya as per its gut:la, is converted into

actions or Karma. Whatever is there is manifested by the energy stored in

the dravya. Nothing new is created. For e.g. when triphala causes loose

motions it is thrown out with the stools because the dravya triphala gets

converted into action of motion.' .. (1 0)

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Classification -Karma can be classified in many ways:

1) KARMA

Kayika Vacika

Kayika (Physical Actions) -

Manasika

In the course of the day to day living our body carries out many actions and

functions. These are Kayika karma.

Vacika -

Thoughts converted in words are Vacika Karma

Manasika (mental activity) -

The functions carried out by the mind (Mana) like thinking intellect,

etc. are mental functions .... (11)

2) KARMA

Samyaka Hlna Mithya yoga Ati yoga

17

Samyaka karma leads to health because it is the balance of correct actions.

Atiyog (too many actions), HI na (too less actions) and Mithyayog lead to

diseases .... (12)

3) KARMA

Vya~~1 karma are personal actions. The wrong actions carried out by a

person, leading to diseases are called Vya~~i karma.

Sama~~i Karma are collective actions carried out by group of people

causing diseases in many people. Wrong Sama~~i karma cause same type

of diseases in many people due to polluted air, water, earth, etc .... (13)

18

B. PancamahabhOta -Parka mahabhOta are the building blocks of nature. As the body is the

miniature form of nature, they form the building blocks of the body too.

Trid09a ,dhatu, mala and all the tissues of the body are made of

PancamahabhOta. Hence, while studying any disease, it is necessary to

take into consideration this theory of PancamahabhOta.

cj"ilJOJ~I~d~I{J'<t1JOJqlll: ~ ~ ~ ~fcpct1I~: I ( en.)

The following are the PancamahabhOta-

MahabhLita gUl}a i9alT

akasa Light ( laghu), Subtle (Sukf?ma), etc. srotrendriya

Organ - ear.

Vayu Movement (Chala) sparsanendriya

Organ - Skin

Teja Heat (Uf?l}a) Rupendriya

Organ - Eyes.

apa Liquid (Jala), cold (€lila), Oily (Snigdha) Rasendriya

Organ - Tongue

Pruthvi Smell (Gandha), Heavy (Guru), Stable ghral}endriya

(Sthira), Hard (Kathin) Organ - Nose

(14)

PancamahabhOta, Trido9a, and Sapta dhatu

DOf?a & Dhatu Pruthvi apa Teja Vayu akasa

Vata -- -- -- ++ +

Pitta -- + ++ ++ --Kapha + ++ -- -- --Rasa -- ++ -- -- --Rakta -- ++ + -- --Mary1sa ++ + -- -- --Meda + + -- -- --Asthi ++ -- -- + --Majja -- + -- -- --sukra -- + -- -- --

(15)

19

C] Prakruti-Prakruti is the body constitution of a person. It is formed in the foetal life.

Hence this is acquired from birth and cannot be changed. Each type of

prakruti has certain characteristics. As per the prominence of the d09a,

prakruti is mainly of three types viz vata, pitta and kapha. Again

depending on their combinations there are three types, vata pitta, pitta

kapha, vata kapha. The seventh which is found rarely is sama prakruti.

There all the d09a are equal. Let us study the characteristics of Prakruti in

relation to hair .

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~~ ... II~~II (=cr.f<l.~)

characteristics of Prakruti in relation to hair.

Kapha Pitta Vata

Firmly rooted in the scalp Soft hair Hair rough in texture

(DrU(;Jha)

The hair over the scalp are Brownish in colour Dry hair.

symmetrical.

Oily hair The veil us hair, beard and Sparse hair

hair are not thick

Curly or wavy hair Hairfall (Khalitya) Starts in Smoky in colour

early age. become bald

early.

Grow very long Greying sets in at an early They have split ends.

age.

Black in colour Vellus hair are very less and

not prominently seen.

Grow thick

(16)

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20

(=cr.f<l. ~)

0] Importance of Do~a -

There are three do~a in the body viz. Vata, Pitta and Kapha. They occupy a

place of prominence not only in carrying out the physiological functions of

the body but also in causing diseases. The day to day functions of the

body cannot be carried out without the three do~a. When the equilibrium of

the do~a is maintained in the body, a person lives a healthy life. When these

do~a increase or decrease due to improper diet, they interact with the

dhatu to cause diseases.

The study of any disease is incomplete without the study of trido~a . Let us

consider them one by one.

a) Vata Do~ - Just as the wind or vayu regulates everything in nature and

disturbance in vayu causes a lot of destruction, so is the case in the body.

Hence even if any disease is caused by derangement of pitta or kapha, vata

do~a always has a role to play in it.

Vata gut:1a-

1) Dry - Ruk~a

2) Light - laghu

3) Cold - s Ita

4) Rough - Khara

5) Subtle - SOk~ma

6) Unsteady - Chala

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Location - All the do~a are present in the whole body. The main location of

vata d09a is the large intestine and its main interactive dhatu is asthi.

~ ~ cm];: ........ II~GII

21

~ qld'RI ~ ~ ru~ll"ld: 11911

............. ~ ('541 CtJ I ~~: (crr.~ 99)

b) Pitta do9a - Pitta helps in the digestion of the food. The appropriate

temperature required to carry out the metabolic activities in the body is

maintained by the Pitta 009a.

c) Pitta gUl!a -

1) Slightly oily - Snigdha

2) Corrosive - TTk91!a

3) Hot - Usna

4) Light - laghu

5) Metallic smell - visra

6) Sara

7) Liquid - Orava.

~:JUT fqct1:ttilj cfiaut ~ ru'tlSi~ ~ "'q ....... 11 ~ 1911

fqITf f1 'f"i ~cflauITmt ~ fcRl m ~ .. .

Location - The main location of Pitta is in the duodenum (Grahal!i). Its

interactive dhatu is rakta.

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£Cf)" ~"'q fqct1'R1 ~ ru~ll"ld: II~II ,

(crr.~. 99)

(crr.~. 9 ~)

d) Kapha 009a - Kapha gives strength to the body. It keeps the constituents

of the body together and helps in the growth of cells by providing nutrients

through the dhatu.

Kapha gUl!a-

1 ) Oily - Snigdha

2) Cold - slta

3) Heavy - Guru

4) Slow-Manda

22

5) Slimy or smooth - slak9t:la

6) Sticky - Mrutsna

7) Thick - Ghana

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(=q.fct.d~ G)

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Location - Stomach is the main location of the kapha d09a. It is present in

the chest and it interacts with rasa, mamsa, meda, majja and sukra dhatu.

m\!IJiI~lll: (cn.Xi9~)

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Causes of vitiation of D09a - When we put forward the concept of

increase or decrease in the d09a it means qualitatively and quantitatively.

The diet we take, our behavior, our actions, seasons affect the d09a

increasing or decreasing it qualitatively i.e. by its gut:la, thereby affecting it

quantitatively.

For e.g. eating sour fruits like oranges will increase pitta by its u9t:la

and drava gut:la thereby increasing it qualitatively and quantitatively. Let us

see the causes which vitiate the D09a.

Vata prakopa Hetu -

a) Dietary

1) Food that is pungent, bitter and astringent to taste.

2) Food that is light to digest.

3) Dry, cold food.

4) Dried vegetables, sprouted seeds, lentils, onions, eating less food, grams,

peas, chana, fOra dala, mCiriga dala etc.

b) Behaviour-

1) To stop the urge to urinate, pass stools, sleep, etc.

2) Irregular meals, irregular sleep

3) To move around for a long time on a vehicle.

23

4) Too much walking.

5) Too much exercise, to exercise more than one's strength,

6) Too much sex

7) Too much mental strain

8) Trauma

9) To run faster than one's capacities, jumping, swimming.

10) Sleeping late at night.

11 ) To lift heavy weight

12) Long ride on animals like horse riding

13) Too much talking, talking loudly

14) Too much bleeding

15) Accident

16) Excess of Panchakarma

17) To ride over anything that goes up and down, ride in speedy, open vehicle.

18) To jump from a high place.

19) To carry heavy burden

20) Fasting

c) Mental Activities -

1) Anxiety

2) Tension

3) Sorrow

4) Fear

5) Jealousy

6) Wishes

d) kala-

1) Rainy season, when it is cloudy.

2) When cold winds are blowing

3) Winter

4) Early morning

5) Evening

6) Cold climate

7) Four to five hours after meals ... (17)

24

Xt)&i ('5~~f1d qJi'i ~ ~"iI'i I~ I 4'1 ~I ~1 ~ ~"iI'i I fd 1I1"1 CZI III IJi ~ "1x-1'Cl1 "! 011'1 ~I'i I f11 ~ IdCZlq Ilil ct~ "1~ncn~ll fOld Ifd~ cn\J1I"I"! 01~~Ji~I,<1"!'""lIlfI'RIlSfdfl~21'Rll Cff"9;

: J>lCf>14JiI4t121119~11 (:q.f.1.9)

Jffi ~ J>lCf>1401l~ q~: Cf-5f 6I('5qFq:q£l$lfdCZllllIJiCZlqllll~lI'iJ>l4d

~ ('5;S~~'i l('5q '1 J>ld "! 01 "! 18!\J1I"I"! Ol~ I"! $"! OI<iI\J1g"! <il"!~

~I fd"illil cnscn~ III fd Cfd '{i')&i('5~~f1d cfl4~tq)~lIcnq ~"! q,,! Cf>l q:~

~ Cf>l"! 'i\til ~lIIJi I cn41ql"!Jjq:"IJi'tt,"! 1(t)c6)$~ uJcn('5ll1~ tq Iq 1'i~I'i ~~Ji 1~1'i 1\:Xl

~1'iqld~?lg,<1~:wnmf4&1CT~ 6Iltq~"1 ~~ldl~~f4~l~ql'3): J>lCf>14JiI4

ucf 119~11 Xl ~'!:lJ>lql21~ ~Jil..fl -=q ~~l~d: ....

(Xj.Xi ~ 9)

cnns~l"!I8!:tCfdI'ii cfS~: W1m'!11 ~ II (err.Xi 9)

Pitta prokopa hetu -

a) Dietary-

1) Food that is pungent, sour or salty to taste.

2) Very hot food.

3) Corrosive food

4) Light food

5) Acidic food that causes burning sensation.

6) Sesame oil

7) Mustered seeds

8) Green leafy vegetables

9) Curd, watery contents of curd

10) Sour fruits and food.

11) Bread

12) Alcohol

13) Butter milk

14) Fish

25

b) 1 )

2)

3)

4)

5)

6)

7)

c)

1)

2)

3)

d)

1 )

2)

3)

4)

5)

6)

Behaviour -

Fasting

Over exertion

Too much sex

Contact with smoke

Dust

Heat

Exposure to strong sunlight

Mental Causes -

Anger

Sorrow

Fear

kala-

Summer season

Autumn season

Afternoon

Midnight

Two to three hours after meals

Middle age .(18)

~'+1 II I II Ifll q q 1*1 ~ ~ ~W)~'1l q ~ 1J1'1 Cf)~qJO{i")Mq old1aun till M~~ ~ I ffiRl M

~ M~ oll 1Cf)g=>Mce:l*1~q ItHi1$RdCf)~IICf)~ ncq lJ1ct=l1l\l1I~Cf)J1 i*1 ~~dWCf)FCf)IJ1

'«J)'{:flc?I"!Cf)'<j"! 1~Cf)I"! IJO{i")Lf)MCf)~q,,! ~~:~ ~if)lqJ1lq€H1 II ~ 9 II

d ~ti1l "!i ru I Cf) I c1 -=q t:I '11 ~ -=q ~ ~1 til d:~ ~ -=q \Jft ~l\-ll;;i -=q ~

"d" II ~ ~ I (~.Xi ~ 9)

qtiltf49) ~ ~ct1'«l .... (err.Xi. 9 ~)

Kapha prakopa hetu -

a) Dietary-

1) u<;lTda Dal

2) Sesame

26

3) Wheat

4) Food items made from any type of flour

5) Dates

6) Food items made from milk

7) Sweets

8) Sugarcane juice

9) Jaggery

10) Sea food like fish, crab, etc.

11)Ghee

12) Oil

13) New grains

14) Cold food

15) Cold drinks

16) Cold water

17) Sweet, sour and salty food items

18) Curd

19) Slimy food items

20) Food items difficult to digest

21) Fried food

22) Sweet fruits

23) Drinking excess water

b) Behavior-

1) Sleeping after lunch

2) Laziness

3) Lack of physical work and exercise

4) Sedentary life

5) Drinking water before sleeping

6) Too much sleep

7) Eating too much

8) Eating when not hungry

c) Mental causes -

1) Tension free life

2) Happy go lucky attitude

27

d) kala-

1) Morning

2) Evening

3) Cold weather

4) Cool breeze

5) Immediately after meals . 6) Childhood

7) Winter season

Region with moist weather also increases kapha.

rq q Ix-q Gi'i I ~ 11IIJOOt I (15fl1 JOOt'1'<! 1f(l'5(15q oF~ft d R"il'Cl jXifCl fiuMi ~ tX:I PGl5ll1'i cpll q

~6f>cJOOt I~JOOtl5IJOOt I~ l n'ii~ R\(15fCllX:R1 pR\ ~~ p~1 '<! Iq 11I~ItlR1cpl'<! 11\4'1 ~

cpJOOt i'{Ntll f6l tl4fOII(15cp~Xicp~J'S~lIClcpJOOt'1,<!q <.>0'lq)(15tlJOOt~H 1'UI~I'iSl~: ~

~ SlCf>lqJOOtlq€H1 II~~II

"'{1~: ~ftdcpl~ -=q ~ -=q R1~l~d: ... 1 (~.Xi-~9)

These causes which vitiate the do~ are important while studying any disease as they help us to understand the pathogenesis of the disease. Proper understanding of the pathogenesis enables the vaidya to give exact treatment. .(19)

28

E) Agni-

The food that we consume cannot be absorbed as it is into the body. Many

physical and chemical reactions are brought about in it, as it mixes with the

saliva and other digestive juices. The constituent essential to bring about

these reactions is called the Agni or the Fire in the body. This Agni in the

form of heat is present in many forms and at many locations in the body.

Just as we cook food in the presence of heat to make it easy to digest, so

does the Agni in the body. It makes the food easy to absorb by making it

similar to the body constituents

There are 13 types of Agni in the body. The main is

1) Jathara Agni.

This is located in the gastro-intestinal tract in the abdominal organs. The

ingested food is first digested by this agni. This process is carried out in

the stomach and small intestine. If this Agni becomes weak due to excess

of improper diet, like eating too much heavy food (ahara), wrong behavior

(Vihara) like irregular meals, eating without being hungry, the food is not

digested properly leading to vitiated ahara rasa called ama. Proper

functioning of this Agni leads to healthy formation of trido!?a and seven

dhatu.

Since this is the main Agni, it gives strength and support to other agni. The

weakening of this Agni weakens other Agni and the increase in this Agni

increases the other Agni. .. (20)

2) Dhatvagni-

The ahara rasa which is formed due to the digestion by the jathara Agni is

then taken by Vayu to the first Dhatu that is rasa. It is simultaneously taken

to other dhatu too. Each dhatu has its own digestive fire which is called

Dhatvagni. The nutritive contents of each dhatu are thereby digested by

the Dhatvagni of that particular Dhatu thus strengthening the Dhatu. These

Dhatvagni are seven in number.

29

3) BhUtagni -

The jathara Agni breaks the food constituents changing not only the

physical appearance of the food but also separating its basic constituents

that is the PancamahabhOta.The molecules of each mahabhOta are in turn

digested by the Agni of that particular mahabhOta. Thus the five mahabhOta

have five bhUtagni making a total of thirteen Agni. All five bhOtagni are

present in each dhatu. In addition, these bhOtagni are also present in a

dormant form in the PancamahabhOta present in it in the dravya. When the

food is ingested and the process of digestion begins these bhOtagni

present in the pancamahabhOta in the dravya become active. Thus the

action of bhOtagni starts simultaneously with that ofJathara Agni continuing

till the end of digestion. The five bhOtagni digest the five ahara gut:la i.e.

parthiva ,apya, tejasa, vayavya and nabhasa. This five ahara dravya

gut:la after being digested by their respective bhOtagni nourish their

respective dravya gut:la in the body i.e. parthiva ahara gut:la nourishes

parthiva deha gut:la and so on ... (21 ;22)

,,~''':'' ~'"'O<"T"TTTTT .:oj I fJ I QlI J ., II q III all: 4.:>'i'.W5'i I ° I: x=r-=rr~:

4.:r"ilI$I'<jOIl;:x:qli ~~ 4"i1'Tllj) II~~II

~ ~ -:q gt9JIPd -qq'CIT ~C1~olli ~~

~: ~~: ~l~i~"iI ~$JII~ IIGol1 ,

(crr.m. ~)

30

F) Rasa-

The word rasa has been used in many ways and forms in ayurveda.

While considering ahara of a person the word Rasa denotes the taste

experienced by the tongue i.e. rasendriya. Hence it is indriya artha.

Therefore it is defined as the artha (subject) experienced by the rasendriya.

(23)

Rasa are six in number.

1) Madhura (Sweet)

2) Amla (Sour)

3) lavar)a (Salty)

4) Tikta (Bitter)

5) KaW (Pungent)

6) Ka!?aya (Astringent)

'<1f1lfdIQq ~-l1Y)'<1I~(Y5QolCf)S,RlCfdCf)t'lllll: II ~ II

('q.fcl. 9)

These rasa are present in the dravya by samavaya sambandha. Every

dravya contains one or more rasa. The taste which can be felt prominently

and immediately by the tongue is called the main rasa of that dravya. The

taste of rasa which is felt at the last part of chewing process or sometimes

not felt or experienced by the tongue is called anurasa.

The difference between rasa and anurasa is as follows -

Rasa Anurasa

Taste experienced immediately by Taste is experienced at the end of

the tongue chewing.

It is preserved in the dried form of It is not preserved in the dried form

the dravya of the dravya e.g. pippali is

madhura when wet and katu when

dry. Hence madhura is its anurasa.

It exerts its action prominently on It exerts its action mildly on the

the body body.

31

(24)

Action of Rasa - when different dravya containing different rasa come in

contact with the body they exert different actions as per their properties. As

per the samanya vise~a sidhanta, the do~a, dhatu, mala, comprising

particular mahabhOta as that of a particular rasa, increase by it and those

with opposite properties decrease by that particular rasa. E.g. madhura

rasa increases kapha, helps in nourishing rasa marylsa, meda, majja and

sukra dhatu. At the same time decreasing vata.

Action of rasa -

1) Madhura rasa - increases rasa rakta and majja dhatu, helps in healing of

bones and acts as a hair tonic.

2) Amla rasa - helps in improving rakta dhatu. When consumed in excess, it

causes vitiation of rakta dhatu and weakening of bones.

3) lavar)a rasa - excess consumption causes khalitya and palitya.

4) Katu rasa - reduces the sneha of the majja dhatu.

5) Tikta rasa - helps in strengthening bones, reduces rasa dhatu due to

excess intake.

6) Ka~aya rasa - strengthens bones and helps in healing of bones. Reduces

majja dhatu.

32

Sr. Rasa gut:la Effect on Constituent Diseases

No dosa s of due to

Pancamah excessive

abhOta consumptio

n

1 Madhur Sticky Increases Pruthvi and Prameha,

a (snigdha) cold kapha. apa. kasa,

(Sweet) (8 Ita) heavy Decreases 8vasa,

(Guru) vata and diseases of

pitta. kapha.

2 Amla Sticky Increases Agni and Diseases of

(Sour) (snigdha)hot kapha and pruthvi rakta, daha

(u9t:la) light pitta, bhrama.(gi

( laghu) decreases ddiness)

vata.

3 lavat:la Sticky Increases apa and Impotency,

(Salty) (snigdha) hot kapha and teja palitya,

(usna) heavy pitta, khalitya

(guru decreases

vata

4 Katu Dry (ruk9a) Increases Vayu and Impotency,

(Pungen hot (usna) vata and agni giddiness,

t) light ( laghu) pitta burning,

decreases thirst.

kapha.

5 Tikta Dry (ruk9a), Increases Vayu and Decreases

(bitter) cold (8 Ita) vata, akash dhatu,

light ( laghu) decreases weakness,

kapha and giddiness,

pitta diseases of

vata.

6 Ka9aya Dry (ruk9a) Increases Pruthvi and Flatulence,

(astringe cold (8 Ita) vata, vayu blocking of

nt) heavy (guru) decreases srotasa,

kapha and deceases

pitta of vata.

(25)

33

G) Vipaka-The rasa which is formed at the end of digestion i.e. after the action of

ja~haragni is over is called vipaka. Since it does not alter by any other

reaction, it is also called nishthapak. Vip aka are of three types

1) Madhura

2) Katu

3) Amla

Vipaka of madhura and laval)a rasa is mostly madhura that of amla dravya

is mostly amla and vipaka of ka~u, tikta and Ka~aya dravya is mostly ka~u.

Cf>~fdCfdCf>~lllIOli Rl41Cf>: ~: ~:

~S~ -q=c;m) t<l1~4W (Y5qOI'«1~ II~CII

(:q.X!. ~ ~)

Action of vipaka is similar to that of the corresponding rasa. (26)

H) Virya

The dynamic property or the potency of the dravya is called v T rya . The

dravya acts by its vlrya . (27)

In practice, a dravya has mainly two types of vTrya.

1) s Ita (Cold)

2) Usna (Hot)

................ ~:II~~II

~n d~ til I fi1 fd cft<f TI ~ <R -m fipm

(~.X!.)

34

I) Dhatu po~aka nyaya -

The food is digested by the agni and converted into ahara rasa.

Food

I

I action of jatharagni

I

ahara rasa mala

This ahara rasa is then re-digested by the dhatvagni and

bhOtagni and finally converted into dhatu. After being digested by the

jatharagni. it is channelized through different channels called srotasa.

Various theories regarding the nourishment of dhatu from the

ahara rasa have been put forward in the form of three nyaya (nyaya means

conclusions derived from known facts) called the dhatu po~aka nyaya.

They are as follows -

1) KedarTkulya nyaya - as per this nyaya the ahara rasa moves through

channels (which are sub divided into smaller channels) to every dhatu.

d?ll"tt§ RPc;.cJi"ifll ~ fclt:llct'tFt ~ II ~ 911

ti Ix ~ xl[{lf~ptm 1l~ ~S~:

x ti I~ Cfd dt1'lJi ifi Jiiti I~ ~'«1dlS~ -:q II ~ ~ II

~ ~ m=r: ~ wPlct~I'4: >I\i1llh4

cpcf): ~ ~: ~ >It<l~l '1'!51"11Ji -:q II ~ ~ II

~S~t"CIftq~llsfl\J11 ~ ~~:

>ltil~RPc;.2'J ~ 41¢I~q ~: II~~II

~ f"it:;4xRlxl

CpRl~I§x~xl?lIC1Sl'St:;1~4~ ~ 11~'111

(err :~rr. ~ )

35

(28; 29)

The constituents providing nutrition to a particular dhatu are then digested

by the agni of that dhatu resulting in the formation of p01?ya form of that

dhatu and the waste part that is mala of that particular dhatu.

2) K1? T ragadhi nyaya-

This nyaya has been put forward by chakrapani. Just as milk gets

converted into curd in the same way the dhatu are formed one by one from

the ahara rasa due to the action of the respective dhatvagni. As per this

nyaya the rasa dhatvagni first acts on the ahara rasa forming rasa dhatu.

After that all the dhatu are formed as per their sequence. (30)

3) Khalekapota nyaya -

As peg ions (kapota) pick up grains which they require from the barn, in the

same way each dhatu absorbs those constituents which are nutritious for it

from the ahara rasa via its srotasa. The ahara rasa is circulated alongwith

rasa dhatu through the rasavaha srotasa. In this process, it is distributed

to each dhatu. The further the dhatu in the sequence of dhatu more is the

time required to nourish it. (31)

36

J) Dhatu-

These are the building blocks of the body. Strong and well formed dhatu

keep the body healthy. Strength and energy of an individual is dependent

on these dhatu.

The seeds of these dhatu are sown at the time of conception. The

formation start during the foetal life and they are nourished after birth.

These dhatu work tirelessly and without rest thus carrying out the metabolic

activities of the body. This leads to depletion of the dhatu which is

replenished by the nourishing constitutents of these dhatu, which the body

gets through ahara.

Functionally and qualitatively the dhatu can be devided into two parts. Each

dhatu has a

1) asthayi or P09aka dhatu

2) Sthayi or P09ya dhatu.

1) The dhatu which circulates through the srotasa carrying the nutritional

constituents of a particular dhatu to the p09ya dhatu is called p09aka

dhatu. Its quality and quantity keeps on changing and is dependent on the

nutritients provided by the ahara rasa.

2) The p09ya or sthayi dhatu is present in a definite quantity in the body. It is

provided nourishment by the p09aka dhatu. The p09ya dhatu supports the

body and are in turn supported by the p09aka dhatu.

In the day to day wear and tear of the body or due to improper diet the

quantity of the p09aka dhatu is reduced resulting in ka9aya of that dhatu

but the body maintains the quantity of the posya dhatu.(32)

The dhatu are dependent on each other. The dhatu is provided nutrition by

its earlier dhatu and is affected by the ka9aya or vruddhi of the later dhatu.

This is prati srotasa nyaya.

Each dhatu carries out certain function in the body. Its efficient functioning

is dependent on the following factors:

1) Availability of the proper nutrition

2) Proper functioning of dhatvagni

37

3) Proper functioning of the srotasa carrying the po:;:;aka dhatu

4) kala - e.g. the strength and efficiency of the dhatu decreases during old

age. (33)

1)

2)

1)

2)

3)

4)

5)

Let us now consider the four dhatu which play an important role in khalitya

and palitya.

Rasa dhatu-

The fine quality liquid formed after proper digestion of the food by the agni

is called rasa. Its main location is the heart and it is circulated to all parts of

the body through vessels connected to the heart. This is the first dhatu that

is formed from the ahara rasa. It provides nourishment to the other dhatu

and tissues of the body by circulating day and night through out the body.

(34)

ffi -q#~-

"ff?f -qT5Tr41 Rl Cf)'M ~ ~ ~ *1 'M fqq Fcl\:l q14'M I tC fcttl4) 4'M

~' ~ ~ , ens Cf)jOI'Mjq;gCfd'MI~IO;:'M *1~~q ol(1'M 1I \J1j~: X1R: qO;:Jixta-

11: Xl ffi: ~,;gUH1 C'f'M" ~ ~ Xl &\C{lIl'ci1g;Fcf~IRl\:lJi;f)O;:j~

~ ~ crm tllJIlfl1;:x:j~iHHH:q Rl4n ll: ~ ~1,<1O;:Ji~O;:~'«1qllRl

(~.Xi. 9~)

It has two upa dhatu.

Raja

Stanya

Its mala is kapha.

Properties of rasa dhatu -

It is liquid in form.

It has a soothing (saumya) property

Kapha do:;:;a resides in rasa dhatu.

It is subtle.

Its rasa is madhura and anurasa is lavar:1a (35)

Functions -

1) Tu:;:;li - nourishes the mind keeping it pleasant

2) tarpa~a / pu:;:;l T - nourishes the tissues of the body keeping them fresh.

38

3) Vardhana - as it provides nourishment to the dhatu and other organs, it

helps them in their growth.

4) Dharal)a it gives support to other dhatu by nourishing them.

5) yapana (36)

qRqCfCl~ ~ 4>llIlfill

qe;i4~'i ~ fFrmrt ~ ~: ~+=rl==>. ~ "" 9)l'iIll Ri ~mg1 i'& 01· ... fP-lI qq Cfq 1 S ~:C1l q Ji: II ~ II

(W.~.G)

crcf<m1 tllxllffl 1I1qllffl 'illt~~gCp'i ~ ~ ~1·tlxJij

mmSjJiI'iI(:plffl'6q(l'5~~dCllI ~: dfflF! '<icf~h:lxlqllq~lt'lm

gJi 01 ~ III I j'<il R fill ffi fG1 $11 '<il fcp Ji li -«I R:I «l \i1 '<i ~

3l-::l1i21d'<i ~ Siqlj'<il~ -H$'i\Jflq'id

~: ~ ~flIq~lR:ld II~II

(~.~9~)

Rasa dhatu in turn is provided nutrition by the po*?aka rasa i.e. the ahara

rasa. Following factors are responsible for formation and functioning of fine

quality rasa dhatu.

1) Good quality food

2) Proper functioning of agni

3) Proper water intake

4) Healthy rasavaha srotasata (37)

Rasa Ka*?aya -

When the quantity of rasa dhatu is reduced it is called rasa ka*?aya . Its

causes are

1) Fasting or reduced intake of food and water

2) Anxiety, stress.

This can also be temporary and sudden due to overexertion or due to over

exposure to sun.

Signs and symptoms -

1) Dryness.

2) Shrinkage of tissues ( so*?a)

3) Giani

39

4) sabdasahisnuta (intolerance of noise)

5) Rutpi9a (pain in the chest)

6) Kampa (tremor)

7) Trwj>l)a (thirst)

8) srama (weakness)

9) Under Nourishment of rakta dhatu.

10) sunyata (feeling of absence)

11) Palpitation

12) Irritation

13) Lack of enthusiasm (38)

1)

2)

3)

4)

5)

6)

7)

ffi ~~ J>lll: ~ ~: ~16GlflffitilJdl... (en.Xi 99)

~~ t?Nl\SlcpA:l~t"\!Oldl'«t&J1I "E.T ... 119~11 .................. (Xj.X!.9~)

Rasa vruddhi -

Signs and symptoms -

Loss of appetite

Excess saliva secretion.

Laziness

Ja9ya

Anaemia

Feeling of coldness

Excess sleep. (39)

.......... ~SfT.1fl~'1!A~cpl(1')'flI ~fl'<! q111l911

~ ,1I ~,1I ~(1')~ I\S'~ I~ ~q Ifl cplfll ~ PI Si d I: ,

xmsflt ~MlSIiqq ........................... IILII

(en.X!.9 9)

xms~ t?~\ql~ci ~ illql~lI~ .... 119 ~II

(Xj.Xi 9~)

Rasa dushti (vitiation of rasa dhatu)

Rasa dhatu gets vitiated due to improper diet and improper behavior. This

also leads to improper functioning of the srotasa carrying rasa dhatu.

Following are the causes of vitiation of the srotasa of rasa.

1) Food that is heavy to digest (Guru)

2) Over eating

40

3) Cold food

4) Fattyfood

5) Excessive thinking.

These factors cause the vitiation of rasa dhatu.

:!'6~ndJi Rl R"PtlJiRlJi I~ XiJi~'1d 14.

'<Xiql~Pl ~lXIPd RI,,{l 1'1 i 'ilIRlRl"'d'1lct 119 ~II ('q.fct.~)

Signs and symptoms of vitiation of rasa dhatu -

1 ) Loss of appetite

2) Bad taste in the mouth

3) aruci

4) Loss of knowledge of taste

5) Nausea

6) Heaviness

7) tandara (sleepyness)

8) Bodyache

9) Fever

10) Tama (feeling of darkness in front of the eyes)

11) Anaemia

12) Block channels

13) Klaibya

14) sada (feeling of prostration)

15) Loss of weight or wasting

16) Loss of digestive capacity

17) Premature signs of aging like palitya and wrinkles over the skin.

3f~ 'ill '6 RI ~'ill 'tlI~ '< 'tlI Ji '< Xi $1 d I

~ (>01 til ~ ~ Xi I '5~ ~ I Ji ~1 \.Tq '< '«1 Ji: II ~ II

qlo'§~ '¢l'ldXii 'Wl: ~"ffi"Ci: p~II'5~~ldl

-.=nms~ Cf(i5(l: q ~d I Pl 'q 119 0 II

Susrutacarya has further elaborated on the process of vitiation of rasa

dhatu saying that the hetu which increase vata are responsible for causing

the extreme wasting of the body due to decrease of rasa dhatu. These

hetu are

1) Eating food that increases vata

2) Exercise (more than one's capacity)

41

3) Over exertion

4) Too much sex

5) Recitation

6) Fear

7) Sorrow

8) Anxiety

9) Meditation

10) Sleeping late at night

11) Thirst

12) Hunger

13) Consuming too much ka~a.ya rasa.

14) Eating less (crash diet or dieting)

This hetu cause wasting of rasa dha.tu due to which the rasa

dha.tu does not circulate properly in the body. As this rasa is also less in

quantity it does not provide proper nourishment to the tissues.

C'I"?I" 9,..1C1h1 (i')1l51"!~ ~;:fjSfftClllllIJiCllCI 11I1~~1I~nCf)'UlI'i"! 18!\Jl1

JI,,!Ulrqql*1lltlC"Cf>~llIl(,>qI~I'iSl_: ~1;{),,!Ji'ijWl

Ji"i(,>qcql"i q)Ullfft d'{+jl~fftCf)I~4 .... 1 (Xj.X!.9~/~~)

Rakta Dhatu -

The dha.tu which circulates in the body along with rasa is rakta. The rasa

acquires red stain after passing through the liver and spleen, after the

action of ranjaka pitta and rakta dhatvagni; it is then called rakta.

~ "4ft"~-

"'{i" {51 (><11 L<ll xm 1I <p~ l51;:fj >rfQT "! I J I j~ fft II ~ II , cj)' ~C")I I ~ 1fCRf:

"!f.%Jd 1«I\Jl*1 I ~: ~I;{)"!~ ~~'iIJi "

~ClIlq"il: SI*1;;i'i ~ II~II

Rakta shelters the pitta.

(Xj.Xi- 9 ~)

Its upa dha.tu are kat:19ara. and Sira (blood vessels)

Its mala is pitta.

42

Its source is liver and spleen.

Functions of rakta dhatu -

1) Keeps the complexion pleasant.

2) Has life sustaining properties Uivana)

3) Keeps the sense organs healthy

4) Maintains a healthy appetite

5) Maintains the metabolic activities

6) Keeps the body nourished and healthy

7) Provides energy and strength to the mind and body. (40)

Rakta Ka~aya -

When rakta dhatu is formed in insufficient quantity following signs

and symptoms are seen.

1) Craving for cold and sour food

2) sira saithilya (loss of tone of blood vessels)

3) Dryness - when the water content in the blood vessels reduces, there is an

increase in heat and vata resulting in dryness.

4) Pain in the heart

5) Weakness

6) Skin becomes lusterless, rough, dry and fissured

7) Pain in calf muscles

8) Hairfall

9) Reduced vigour and vitality.

10) Irritability

11) Depression

12) Amenorrhoea

13) Reduced lactation

(en·Xi 9 9)

............ ~nfUldlfnl (qCf?ql'blSlP"lSO(")~fl(1S1I~ ~ -=cr ........ 119 ~ II

(Xj.X!. 9~)

Properties of rakta dhatu

1) It has a metallic smell

2) It is liquid

3) It is warm

43

4) Oily

5) Its rasa is sweet and anurasa is salty

6) It is heavy

7) It is deep red in colour (41)

When rakta dhatu increases following signs and symptoms are seen

1) Skin, urine and eyes become red

2) Liver and spleen are enlarged

3) Blisters, abscess formation

4) Bleeding (42)

.................. ~ ~'{icf~~~S(~ 11c::11

fq , gJ&3qldl'a ct11'a:J)(*I14 gJ~lcpIJi(,,)I:

Cll$~~ II fl'o1"'1l~1 '{iH{I~x Cft1~$~;i?l~?ld I: II ~ II (en .Xi, 9 9 )

............. ~ xCft1I$~~II~ fflxll[of~ ~ ......... 119~11

Vitiation of rakta dhatu is caused by

1) Acidic food items which cause burning

2) Hot food

3) Oily food

4) Too much liquid intake

5) Over exposure to heat

6) Exposure to strong wind

~~I~'XI"""'14I"'1IP1 ~ S(QlfUl ~

xCft1QI~PI g)tSlOIPd ~ "qld4I"'1M1 119~11

~~~-

~

(Xj·Xi 9~)

fq ct1 Sl cnl 4 Ul ~ Q -=m'+ftaut S( Q R·Pc~ '11 ~ I~ f4Q I t<l G"rwl'tll"'l (") I d 4-wnf

1it:lldl\Jftof~'6q:~~I"'II~~f4:i1~xXiCJ? Slcn'14JiI4E:121 II ~ ~ 111I'fJ1IS(Cfci fcl "IT ~ cp~l~ct SlgJQlffi ........... (Xj.Xi ~ 9)

Signs and symptoms of vitiation of rakta dhatu

1) Skin diseases

44

2) 3)

4)

5)

6) 7)

8)

9)

Bleeding

Menorrhagia

Gudapaka

Stomatitis

Enlarged spleen

Abcess

Jaundice or hepatitis

Freckles (vyariga)

gJl'Qq1f1ltfCl;ScPl "!CfdfClct"P""Ifl 4G"!: 119911

:!G~5RI'tllqlcp~iI ~ ~S~ ~:

'11 f(>jcpl cpli101 ~: fCl C(l'5ClR<i0cpI0cpl: 119 ~ II ,

(8)~il4G(") ~ -qp:n Cf)ldl"CIi1 0 ;S0st

"! Cfd!>l q'IISIl\T\ilI~;:fI ..................... 119 ~ II (:q ."fcl. ~ G)

Asthi Dhatu -

This is the hardest dhatu of the body. Just as the pillars of the building

support the building, so does the asthi dhatu support the body. The

destruction of asthi dhatu is not caused easily. It prominently consists of

pruthvi mahabhOta . The porosity in the asthi is caused by vayu and it is

filled with majja. It is pitruja ie. the father's genes play an important role in

determining the role of asthi in the offspring. (43)

Properties -

1) It has a peculiar smell

2) It is pinkish in colour

3) Its rasa is madhura, ka:;>aya

Two types of bones are mainly present in the body

1) the hard bones

2) the soft bones or the cartilage

Women have lighter and smaller bones than men. As the female body is

agneya, the process of bone formation is completed earlier than in

males.(44)

Its upa dhatu is teeth.

45

Its mala is hair and nails

Function - function of asthi dhatu is to give support to the body.

Asthi ka9aya -

The ka9aya of asthi dhatu is caused in two ways.

1) The nutrition to the asthi dhatu is reduced due to improper diet or due to

vitiation of rasa dhatu and its srotasa.

2) Due to increase in vata, the bone matrix starts reducing thus increasing the

porosity of asthi dhatu.

In women, during and after menopause, asthi ka9aya is observed leading

to osteoporosis. This is due to changes in the function of rasa dhatu and its

upa dhatu. In men, osteoporosis is observed comparatively at a later age.

Its signs and symptoms are

1) Dryness

2) Pain in the bones - this pain is deep and not cured by mere application of

oil externally

3) Breaking of nails and teeth, caries in the teeth.

4) Weakness

5) Hairfall

6) Loosening of joints

7) Roughness of skin (45)

~: ~ ~'"'dCp~I'1~IR~ ...... 119~11. (cn.Xi99)

........ ~~Sft~H!\C'5~'"'d'1~~ ~axt "il ......... 119 ~II (~.Xi.9~)

Asthi vruddhi

Excess intake of parthiva diet and diet rich in minerals leads to increase in

asthi dhatu.

Its signs and symptoms are

1) Formation of extra teeth

2) Formation of extra bones. (46)

46

.... ~ .... 119~11 (Xj.Xi. 9~)

Apart from ka9aya and vruddhi, the vitiation of dhatu leads to diseases.

Causes of vitiation of asthi dhatu are

1) Exercise - this includes too much exercise, too much physical work i.e.

beyond one's capacity. This leads to vitiation of asthi dhatu.

2) Anger

3) Trauma

4) Diet and behavior leading to increase or vitiation of vata d09a.

ell I £I lSi I Gfdxi&TI~ lSi fdRl t:icC'"1Id ... ...

~ 1tS£1Ri ClldMI"'Ii -=q ~Cl"'llq 1191911

Signs and symptoms of vitiation of asthi dhatu -

1) Extra bones in the form of osteophytes, spurs e.g. calcaneous spur, etc.

2) Extra teeth,

3) Caries in the teeth

4) Pain in the teeth

5) Pain in bones and joints

6) Severe breaking pain in the bones. This is cause by vitiated vata.

7) Discolouration in bones and teeth.

8) Diseases of hair, nails and teeth.

~ G'i1I~~ RlCloidl

Cp~IM1Si"'l'<Sl~Si~W~1t511~'iHr~H~~1t51'J1I: 119 ~ II (-=q.fcl. :U~)

Majja Dhatu -This is the sixth dhatu. Although it has been widely accepted that majja

dhatu has no upa dhatu, sharangdhar has considered kesa as the upa

dhatu of majja dhatu. (47)

The majja dhatu is deeply embedded in asthi hence it is called majja.

Properties of majja dhatu -

1) Very oily

47

2) Heavy

3) Hot

As it is very oily, it is filled in asthi to control the ruk~a vayu. (48)

Function of Majja -

1) Intelligence, memory, etc. and many other mental functions

2) Filing of asthi thus reducing its porosity.

3) Providing oilyness to skin and stools.

4) To provide nutrition to 8ukra dhatu (49)

Ka~aya of Majja Dhatu -

1) Bones becomes porous. The porosity of the bones caused by asthi ka~aya,

differs from that which is caused by majja ka~aya . In asthi ka~aya , the

bone matrix is reduced whereas in majja ka~aya the bones become

hollow.

2) Vertigo

3) There is darkness in front of the eyes.

4) Pain in joints

5) Piercing pain in the bones.

6) Bones become weak and light due to hollowness. There is a feeling that the

bones are breaking and falling apart.

7) The person always suffers from diseases of vata. (50)

l/ ~ Cf>'RI d ~""Xl 'RI ~~ q of! ISII:q

~SiI'Od~~~cj mm ~ dclollq (crr.~ 99)

l=f\Nf~S C"4 wPd I -qcf~s~ ~ '«1~ ~~ Sf~~H!\rlI d I -=q ....... 11 9 ~ II

(Xj.Xi. 9~)

Increase in majja dhatu -

Signs and symptoms -

1) Heaviness in the body and eyes.

2) Boils on the joints

48

Vitiation of majja dhatu - its causes are

1) Trauma

2) Pressure on the bones

3) viruddha ahara and vihara.

\3~ 1Sl14,1I ~ &I"G14~ t:( 1('11('1 !OI4)\S'1I('1 , ,

JO"j\T\i1C1Ig1P1 i3)&lR1 ~ 'q flCI'1lq 119 <:: II

Signs and symptoms of vitiation of majja dhatu -

1) Joint pain

2) Vertigo

3) Syncope

4) Darkness in front of the eyes

5) Boils on joints.

~ -qcfurt w:fl ~ ~ ('1 JO"j Xi '«1~

~ ~(>51(>5I'1i Qcf\i1I'1i 'q 4~f'1SOJ. 1191911

JO"j\T\i1!01~llSllq ..... ........ ............ ('q.fct.:(' <::)

49

K) Upa dhatu -

Dhatu support the body and upa dhatu help them in supporting the body.

They don't provide nutrition to the body but are dependent on the dhatu to

nurture them. Hence they are called upa dhatu.

Distinguishing features of upa dhatu -

1) They don't have their own agni hence they are dependent on dhatu for their

nutrition.

2) All upa dhatu are not always present in the body e.g. stanya.

3) Qualitative and quantitative increase or decrease of a particular dhatu results

in increase or decrease of the corresponding upa dhatu.

4) Dieases of upa dhatu are included in the k9udra roga.

Although upa dhatu are dependent on dhatu for their nutrition, they are not

formed from the dhatu. They are present in the body during foetal life in a

subtle form. Following are the upa dhatu of the dhatu -

1) Rasa - stanya, raja

2) Rakta - kal)<;Jara, sira

3) Marylsa - vasa, 9at tvaca

4) Meda - snayu (51 )

50

L) Mala-

The ja!haragni acts on the food resulting in the formation of stools and

urine. The dhatvagni acts on the ahara rasa to form the dhatu and mala of

the respective dhatu.

The quantity and quality of the mala, is dependent on the proper functioning

of the agni and the raw material supplied to it in the form of diet. If the diet

is insufficient then the mala formed will be less. When the diet is proper or

more but the agni is weak, the process of digestion will not be proper

resulting in increase in the mala. Again, if the agni is strong, the mala will

be formed in less quantity leading to the ka~aya of mala.

1) Stools (purish) -

Stools perform the function of ava~!ambha i.e. helping and supporting the

body. Decrease or increase in quantity of stools leads to vitiation of vata.

Stress, anxiety leads to increase in vata resulting in malavarodha.

(52)

2) Hair - it is the mala of asthi dhatu and is dependent on it for nutrition.

3) Sveda (Sweat) -

it is the mala of meda dhatu. Sveda is formed in the sweat glands from the

kleda present in the fat below the skin. It is carried by the vyana vayu

through the sweat ducts to the skin to be excreted from the body.

(53)

Functions of Sveda

1) It carries the excess heat out of the body thus regularizing the body

temperature.

2) Maintains the softness of the skin and hair. (54)

Increase in sweat leads to bad smell of the body and itching of the skin.

51

Decrease sweating leads to

1) Hairfall

2) Raising of hair

3) Fissured and dry skin.

4) stabdharomata

5) Altered sense of touch.

6) Results in decrease or no sweating. (55)

~ "<lJi=qfd:~ ~c;:j ~: II=?=?II

(crr.~. 99)

The following are the mala form after digestion by all the agni.

1) Food - stools and urine

2) Rasa - kapha

3) Rakta - pitta

4) Mamsa - khamala

5) Meda - sveda

6) Asthi - kesa , loma

7) Majja - mala of the eyes and sneha of the skin.

cp1l): ~ l1(i)f: ~ Slt<l~l 'H!N1Ji -:q II t. ~ II ~s~~flq~IIS11\J11 ~ ~ l1(i)f:

(crr.Wr. ~)

52

M) Sara-

The dhatu which is healthy, has good strength and contains stable matter in

appropriate quantity is called sara.

til"<ct~~Rl til"<loll~ 9)'6till oli 6I0iil'1~~ltil$lI'1I~jqR~ll..fl ~­

~£ICfdiiiti~G1S~ii\}"\J1~tictql--tlRl 1190:( II (Tl.fct. L)

Chakrapani has called sara as the purest content of the dhatu. During the

metabolic activities of the body, the action of the dhatvagni on the diet

produces pure dhatu and the dhatu mala. This dhatu which also contains

this mala is called pure dhatu. When this mala is separated from the dhatu

it becomes purer. The form of the dhatu purer than this form is the purest

form of the dhatu also known as sara (56)

The sara dhatu of the body has a higher metabolic rate. Its digestion,

division, growth is more than the other dhatu of the body. This is because

the dhatvagni of the sara dhatu is strong. This process is more right from

the foetal life as the saratva of the dhatu is determined in the foetal life itself.

This is dependent on three factors.

1) Heredity

2) Health of parents at the time of conception.

3) Mother's diet and behavior during pregnancy.

Saratva of the dhatu is present from birth. It can be divided in four sub

categories -

1) Asara (not sara)

2) Alpasara (less sara)

3) Madhayama sara (medium sara)

4) Uttama sara (good sara) (57)

Asaratva-

When very few contents of the purest form of dhatu are present in the

body the dhatu fails to perform its function properly. Also these contents

fail to exert a positive influence on the organs constituting that dhatu.

53

Alpasaratva -

When the dhatu is able to exert its influence on the body in a small

proportion and has less immunity it is said to have alpasaratva.

Madhyam saratva -

The dhatu has medium strength and exerts a considerable influence on the

body.

Uttama Saratva -

Good quality and strong matter of the dhatu is present in large proportion

exerting a good influence on the body thus keeping away the diseases of

that dhatu.

Again, each dhatu has saratva in two ways.

1) Quantitatively

2) Qualitatively (58)

1) The purest matter of the dhatu is present in large quantity. This has an

effect on the physical signs of that dhatu.

2) Qualitatively - The gut)a (qualities) of the dhatu are present in appropriate

proportion. This has an effect on the mental signs of the dhatu. (59)

E.g. in quantitative saratva a person of asthi saratva will be tall and well built

but might not have a firm mind. In qualitative asthi saratva the person might

not be very tall and well built but will have a very firm mind. In Uttama

saratva the person will have both the qualities.

Dhatu saratva and diseases -

The body is constantly attacked by external factors like weather, stress,

polluted air etc. this leads to disturbed equilibrium or vitiation of the dOl?a

which in turn attack the dhatu. If the dhatu is strong, it will repulse the

attack maintaining its health. Also those dhatu which are weak will be

attacked first.

The weak dhatu will succumb to these attacks, leading to diseases in a very

short time. If the attacking factors are very strong the sara dhatu will also

54

succumb to these factors but after a long duration. Also the severity of the

disease will be less. This process leads to destruction of the dhatu matter

which has to be made up by the right type of diet.

Let us consider the signs which indicates saratva in the following dhatu -

i} Rasa dhatu saratva

1) Skin has lustre; it is soft, glowing, smooth, oily, fresh looking. Oust as it

looks after a bath).

2) Body hair are sparse, the roots of the hair are firm, deep. Scalp and body

hair are soft.

3) Wounds heal quickly.

4) Skin diseases are rarely found in such people.

5) They rarely get high fever.

6) They can tolerate fasting.

7) Do not feel giddy by slight vomiting or diarrhoea.

8) Can tolerate noise

9) Their concept of happiness is eating good food, wearing good cloths etc.

i.e. happy with material comforts. (60)

~ ~aul~~~ *1"'1 Xia+llCAP I Aft ~ XigJft I ~ 01ft I ~1)q T.f ~

Cf:I ffi I ~ lOW! ~ "ffR"ffi Xi\!Sl '8'i 101 I ~ ~ ~q m4111 ~ 11~tI fcl til ~~ ~ ~ ~ ~ ~o 1I'""'l'1I ~lSl:I,

ct illiltZ ...... 1 (T.f.fct.L)

ii} Rakta Saratva

1) The skin is reddish wherever it is thin.

2) Extremities are reddish.

3) Ear lobes, eyes, tip of nose, lips, tongue, palms, soles of feet, nails are all

red.

4) Cannot do much physical work.

5) Delicate built.

6) Gets angry quickly.

7) Intelligent and well read.

8) Not very in.clined towards material comforts

9) Diseases due to impurities of the blood are rare. (61)

55

~:!)\!5IrvH::ql"1Ix:fl6dqlfUlqlC::dM"1\!51MMlc4~;:j ~

·S!>,fpn:p:lI fGt &I]) 'I! Cfd fll 'I! I 0 111 fll 'fTffifT '{j\!51 j<ttmi -4m JOJ "1 R-c! (CJ x:fl OW JOJ 14JOJ

"1R161MJOJCf0~lfl~WJ~jrullfl~&I])(CJ illiI~ 119 0 ~ 11. ..... (':q.f~. L)

iii) Asthi Saratva

1) The skin is rough and thick

2) Body is tough, tall and well built.

3) Chest is broad

4) Eyes are big with piercing gaze.

5) Hands and feet are big. Jaw is broad, shoulders are broad, knee joint and

phalangeal joints are big.

6) Teeth are big.

7) These people are dashing and brave.

8) They can do lot of physical work and are always ready to fight.

9) They are restless. (62)

q If"Wl:!C'lf)\J1lrq'l! f61\J1~~~¢~1 'I! :~:

() JOJ~'tct1I~I: Rb'Qlq--c1: Cf0~lfl~l: fll'l!~'I!~I'<"I'I!1 ~q",'QI'Q~--c1~iI ... 1

('=q.fct. L)

iv) Mana saratva

1) They are slightly thin, delicate but have good strength.

2) They have oily skin and stools.

3) Skin and eyes are pleasant and shining

4) Joints are round, shapely and big

5) Voice is deep and soft.

6) These people are kind hearted, intelligent, learned, lucky and wealthy.

7) They are respected by everyone.

8) They are social, having lots of friends. (63)

~q:q\S~411 6IMq--c1: ~: ~ JOJ\T\J1fll'l!l: () cfi­~ 6IMq--c1: wPdfclct1fcl$1I'ilq,'Qx=iJOJI"1~ ~ 1190 L II ...

.. ('q.fct.L).

56

N)ama-

Due to the weakness of the agni, the digestive juice, which is not digested

properly is called ama. This is the first cause of all diseases.

3lfcl4crcflsIT.iJOOjI~'1 <IT W: X1 Pi~liW:11

~'Plluli ;!~ ~: flCftijIJOOjIJOOjfi$~1 " (<n.x.-cr. ~) There are various theories put forward in the formation of ama.

1) Due to diminished ja!haragni

Due to weakness of Ja!haragni, the first dhatu i.e. rasa is not formed

properly. It stays in the digestive system and gets vitiated by the three do~a.

(f)t5i1 UhS(>Lf6l0f()'1 cq Ig)JOOj ItlJOOj 4 I RI dJt I

g)t5CJOOjIJOOjI~I~~ld ~flJOOjIs:j "j;fq/ffif ,,~~ II

2) Due to vitiation of do~a and mala sancaya .

JOOj0fiil~: ~ Gltijg)~ err I

("iI'.ftf. 9 ~/~ ~ I iI<'k4lfUl ~.)

Here the word mala has two meanings. The first is waste products. When

due to any reason the waste products are not thrown out of the body, their

collection (sancaya) in the body leads to formation of ama.

The second meaning has being used in the term of do~a. When do~a are

increased and not thrown out of the body in time, it leads to the formation

of ama.

3lPt 3l"1~fi ~ ~ n JOOj0fiil~: I , , ~

(11T. f.t ~ ~/ 9 ,~)

57

Causes for the formation of the ama.

1) Drinking too much water

2) Irregular meals i.e. not eating at a particular time, irregular quantity of food

3) Stopping the unstoppable urges.

4) Sleeping during day and keeping awake at night

5) Jealousy

6) Fear

7) Anger

8) Greed

9) Sorrow

10) Poverty stricken.

11) Hatred

12) Anxiety, tension

13) Seating or sleeping for long hours

14) Sleeping late at night

15) Overeating

16) Heavy, dry, cold, acidic food

17) Incompatible food, food which causes constipation, unhealthy food, food

which is disliked. (64)

~ -:q ~ Cpq0~Rp""lI?l~ql~I"!"!I~I~I~!;IC:~1~en"!fflit§Pd 3lfq g ~-~ ~~!§) (1 ~f¢fq:q ~Fc1 ~fA1 Fc1 C{ I e:;q ~RI Fc1 f) ¥'J1'11 ~ en 10 ill"""' 4 I '11

'11 14 ~ q;:j en I ~m1~~ Jil ~ tSl:Il-~ ~n en~ I '11 q~ 41~ ~ 4 d L(1 ~ '1 fil err <:rG"l

41'1~4;g\T;q~ dC{QJI~~q ~<i\ISf;qRl II ell

(-:q .f~l. ~ )

Due to these causes, the ahara that is light to digest, taken in right quantity

and eaten in time is also not digested properly.

58

0) Definations of Nidana Pancaka

In ayurveda there is a well defined methodology of diagnosing a disease

called Nidana Pancaka. It includes

1) Hetu - premonitory signs and symptoms

2) Purvarupa - the signs and symptoms before the occurrance of the

disease.

3) Rupa - the signs and symptoms of the disease.

4) Samprapti - the pathogenesis of the disease.

5) upasaya (trial and error method) - the process which helps to confirm the

diagnosis of the disease.

f.1 i{ I '1 4.:>-'iI en SOf -,

~ g:cf'{t)4IfUl '{t)41014~lll«1~ I

fi~IfQ:t~i)fd fcl$l;:j "!~Plloli ~ ~ "~,,

(~.f.1. 9)

/) Hetu -It is also called Nidana. The causes responsible for the onset and progress

of the disease are called Nidana.

~ ,,!'p n~ I i{ en~: 1f.1cnrr Cf)RUf ~ Bcffi ~I e:er.-&cPr) ~ \i~Rtt ~: f.1i{1'11 I

(~.f.1. 9,~ -eT<m)

The concept of hetu is of prime importance in ayurveda as treatment is

totally dependent on hetu and lakl?aoa. Hetu along with samprapti is

responsible for the occurrence of the disease. In order to understand hetu,

one must know the Karya karaoa bhava of the disease, the disease being

the Karya and the hetu the karat:la. These hetu of the disease can be

classified in many ways.

59

a) Hetu

Samavayi Asamavayi cause. (65)

Samavayi and Asamavayi Cause -

The increase in the do9a and weakning of the dhatu is the Samavayi cause.

The do9a affecting the dhatu i.e. the pathogenesis is the Asamavayi cause.

b) Hetu

Sannikru~ta Viprakru~ta Vyabhicarl Paradhanika

(66)

Sannikru9ta -

This is the immediate or nearest cause of the disease.

Viprakru9!a -

This is the remote cause of the disease.

Vyabhicarl -

These hetu are strong enough to cause the disease. When they are

supported by other causes, they cause the disease.

Paradhanika -

Its effects are independently and definitely observed in a disease.

c) Hetu

Asatmendriyartha Sar!lYoga prajnaparadha ParTnama

60

Asatmendriyartha Sarpyoga-

This is the association of the indriya, with the cause which cannot be

tolerated by it. For e.g. noise pollution leads to atiyog of sound creating

stress on the srotrendriya, leading to strain on the mind.

prajnaparadha -

The wrong actions due to incorrect decisions of the mind, leading to a

disease for e.g. too much exercise leading to asthivaha srotasa dushti.

~RlXiRl~~: cp1f <R! ~S~~ Q$1lq'l:!l~ ('f ~€:/Itt '{i4~1t1Qq?lqoIJOf. 119 o~11 (~. -m. 9)

ParTQama -

Effect of season on the do~a leading to vitiation of the dosa and the

disease. (67)

d) Hetu

Do~a Hetu Roga Hetu Ubhaya Hetu

This hetu lead to increase in the do~a . E.g. exposure to sun leads to

increase in pitta. They are of two types - 1) Vyanjaka. 2) Utpadaka

~ "¥'ill ~~ crrm: ~4Pt1 't1.:>-'tIllJOf. 119 ~ II

~ ~CfdI«flau"€:/I~'tI4 fgC'df'Q ~ II ~ 0 II

~"¥'ill:~: ~ ~0GiOI~'tIllJOf. 11~911

('err.Xi. 9 ~)

Roga Hetu-

This leads to the formation of the disease. E.g. excessive consumption of

lavaQa rasa leads to khalitya.

61

Ubhaya Hetu-

This increases the do~a and leads to diseases.

e) Hetu

I

External Hetu

External Hetu -

Internal Hetu

They are the diet and behavior causing the vitiation of the do~a. They are

multiple in numbers.

3l(f ~ ~Cf)140IIPl Cfax:rr+l: (f5f 6J(Y')qrqqtl~IRlCLII~tJ""ICLlql~I'Cll\~F1~4d

~ (Y')\S~t:I"1qryq"1~d~OI ~lf.3I\JlI~I~OI1iI~~~OI~I\Jlg;~~I~~

~ IRl"il ~l cpS;cplSIl~Rl Cfd~~(Y')~r~nd4)4~tq?~llcpq c><t~ q~ Cf)1 C{~(Y')lcp

Cf)1~ ,&(H~ 1J=t Icp~q I~~C{~ 1J=t*!\,,< I(t)q))~~ UJcp(Y') I ~Pl ti:j Iq 1"1~I"1 fcllSlJ=t I~H 1'Cll~I"1q I

d1\?lg;ftlSlwnm~~~ 6J1ti:j~~1 fclt:lldlf4f11Fc:hY~Clf~l ~Cf)14JOfI4't1ct II

9 ~ " (Xj.xt. =< 9 )

~1i ~ I ~ 1 *1'1 4 q I 'ti fcl ~ ~~"11 q ~ I J=t"1 CP<. q SO(l'5 M q 0 I dlau fJ tD I M y;fcl ~ I ~ Rl (Y')

~ (Y')fq u~ Icp~M~'titt4 Id'{il~RdCP~llcp~ ntllJ=t~ 1\JllfclcpJ=t i'ti ~~dw~RlcplJ=t

*tt'{fl en ~ cp '{j~ I fcl cp I ~ I SO(l'5 45 M cp <. q ~ ~ ~ :'fiTffi ~ Cf) 'I 4 J=t I 4 'tI ct " =< 9 "

(Xj. Xi, =< 9 )

f4q 1'{"qG"'\ ICLII ~ 1J=t 1(Y')~J=t~~ ISO(l'5MClOI ~ndff"1 ~tl2'(jfq fiuI(Y')1 ~ISGIPG~I~"1cp~q

~C"Cf)cJ=t 11SIJ=t~IJ=t I lSI ~ fJ\{fI Rl(Y')fq IZfcl<pRl~~ <p~I~ 141 ~~P4fclcpl~ l1\ttl ~

cpJ=t i'tiq'til~ 'ti~OIl(Y')cp~'(jcp~J\S~~ IclcpJ=t'l1~ q ~45(Y')'tiJ=t~I"1I'Cll~I"1~~: ~

~ ~CP14J=t14't1ct "=<~,,

(Xj.xt. =< 9 )

62

Internal Hetu -

The do~a, dhatu and mala are the internal hetu.

f) Hetu

I

Prakruta Hetu

Prakruta Hetu -

Vikruta Hetu (68)

A person of pitta prakruti suffering from a disease due to increase in pitta

leads to the ka~1asadhyatva of that disease. E.g. pitta vruddhi in a

person due to exposure to anger leading to Palitya in a person with pitta

prakruti will be difficult to cure.

Vikruta Hetu -

A person of kapha prakruti suffering from a disease due to increase in pitta

due to anger will not be very difficult to cure. E.g. Palitya caused in a

person of kapha prakruti, due to increase in pitta caused by anger will not

be very difficult to cure.

g) Hetu

I

Anubandhya Hetu

Anubandhya Hetu -

Anubandha Hetu (69)

This is the main do~a leading to disease formation due to a single important

hetu.

Anubandha Hetu -

This is dependent on the main do~a in the formation of the disease.

63

h) There are some general hetu which play an important role in disease

formation.

1) Vegadharat:la. (70)

2) Wrong diet and behavior

3) Eating too much food

4) Fear

5) Contaminated water

6) Sleeping late at night

7) Getting wet often

8) Wasting of dhatu

9) Irregular food habits and behavior - this is the general cause of all the

diseases.

10) Viruddha ahara - various combinations of diet and behavior over a long

period of time which are not beneficial for health, lead to formation of

diseases. (71)

II ) pOrvarupa -( premonitory signs and symptoms)-

It gives the idea about site of affliction.

~~~~II~II

\i Rtl d '{j"! I Ji 1I1 ~l ~ Fcl ~1 ~ 0 1I'":II~f~xf: I

F0\s·~IJi~CfdJi<."lltcll~~ltfRt ~ II G II " " "

(~.f.t 9)

III) Rupa - (characteristic signs and symptoms)-

The process of do~a diJ~ya sammurchana appears in the form of rupa or

lak~at:la which facilitates to define the disease.

64

~-

~ ClICffidi <:ffi'f ~ I

~ ClI5\l1;:oj ~ (i)~ Rl E",'P"lI if Rl: 111911

(l1T.f.1. 9)

IV) Upasaya-The medicine, diet and behaviour which is suitable for the disease is called

upasaya. This is also a method of diagnosis. When the signs and symptoms

of disease are not clear or similar in two or more diseases, some specific

treatment is given.

\3q~llI -

~9)ClII ~ Fcl q 4«1 Fcl q 4«11~Cf) I ROil +t I

~tjl"1Rl~I ... noIlJjq~'pi Xj~lq~+t II ell

Rl'l1I<£q~IGj cmtl: Xl ~ '{i1~fi:lRl ~ I

(l1T.f.1. 9)

V) Samprapti -

Starting from the hetu the complete process of disease formation is called

pathogenesis or Samprapti. (72)

The development of a disease can be described in 6 steps.

1) Sancaya

2) prakopa

3) Prasara

4) Sthana sarylsraya

5) vyakti

6) Bheda (73)

65

P) Samprapti (Pathogenesis)-Description

Starting from the hetu the complete process of disease formation is called

pathogenesis or Samprapti. The development of a disease can be

described in 6 steps.

The process in which a particular do::>a, vitiated due to certain causes, is

activated and reaches a particular dhatu or organ, i.e. site which is

vulnerable due to the vitiated dhatu, leading to the disease is called

Samprapti.

fll=j;ll~ -

<:r~ ~ ~ <:r~ illj~flcfC11 I

~cJffu'<l41l1'«1lxf1 'f1~I~\J1fRl'<I~IRl: 119011 (llT.f.1. 9)

This accumulated do::>a either alone or along with other do::>a travel through

the body channels or vitiate the vitiated dhatu leading to diseases. Oo::>a

has movement (Gati) as well as direction. Its nine movements are

1) Ka::>aya (decrease)

2) Vruddhi (increase)

3) Adha (downwards)

4) Ko::>tha (from mouth to anus)

5) marmasthisandhi (inner vital organs)

6) Sthana (Place)

7) Urdhva (Upwards)

8) Tiryaka (slanting)

9) sakha (various dhatu )

~: ~ "iI" ~ Gll"lloli ~ 1'ffi1: \Wf ~ Rl4Cfi1 ~~1I1 ~SlRT 1199 =?II

~ "iI"ml Cf)ll'D~II'<!5lI4141f~

~69)CfC11 ~~ Gll"lloli f3rfctm 1'ffi1: 119 9 ~ II

The development of a disease can be described in 6 steps.

66

(~·Xi. =? 9)

1) Saficaya-

Hetu act as stimuli which lead to change in the state of trid09a. If the

activity of the trid09a cannot be regulated by feedback mechanism, they

start accumulating which is called Chaya or Saficaya. In this stage, the

d09a increased due to the similar qualities of diet and behavior collects in

their natural place. Their natural places are

1) Urahsthana i.e. lungs and stomach is the place of kapha.

2) Liver, Small intestine, umbilical region is the place of pitta.

3) Large intestine is the place of vata. (74)

~ ~ ~ ~ ti-qlll~ ~: ~ ti'ill/~g'Q4d: (f3f

tiRldl'1i ~ ~'jt'jloli x:G"&/lTOiq;)~dl "tfunq~ 41~'tlSlidl 'il1'5'~1I ~ ~ ,

'li ~ft,<!q4110fti 'ill/CfjI,<!olfc1<{~t'j~~Rl ~~ ~ (f3f ~: un-1I1Cfj10: 119(11 (~.Xi.=?9)

2) prakopa (Accumulation of do~a in excess)

When the accumulated dOl?a increase to a large quantity, they cannot be

contained in their place and come to the stage of spreading. Even a single

hetu is sufficient to cause increase in d09a. But the occurrence of multiple

hetu accelerates th prakopa of the d09a. (75)

~ :qCPl q let cP'j ~dl Gti'il '<! olls:01CfjlfLI qlti IqRGIi!WTf<{~t'j~G\Q'j~GI~'il1J11

~ (f3f ~qcfl4: ffi>4ICfjI(i'):II=?l911 (~.Xi.=?9)

3) Prasar (dissemination of dOl?a )

The d09a starts spreading to the other places. As this requires momentum,

67

vata d09a plays an important role in carrying these d09a to the vulnerable

site i.e. the dhiHu. In this stage, if there is sthana vaiguf)ya / dhatu vaigut:1ya,

these d09a vitiate the weak dhatu leading to disease. If the dhatu are

strong and the immunity is good, then the d09a either subside or they take

shelter remaining dormant in the dhatu, waiting for the right time (kala) to

cause disease. In this condition, although the disease does not manifest

itself, the person also does not have a feeling of well being. (76)

3m ~ "!RR qaxrR:~: !'IgJfLld Irti fcpoq') Cf)fLl~'{p""lq I~

~q')~Cfdlrti ~ ~ ~ ql9)~H~Ji('fC/lq !'I'{i~OI~~r '{i,~Qj~d~ "'{i" f' ~ ~~: x\l1~i.I !'Iqclch x=rct~"IIqlrtI1 ~IJi~ljGCf)tii.l£llS~: ~

JiqGI~~q~onG4Jrt ~.I!>T: x=rcfu': ~ ~ cITtn: Cf)GI~~Cf)~n ~:

'{iJiffil: ~nruld'{irgdl errs~ !'I'{i~Pd ~: fQro' ~ ~nruld err ~ qld~~Gilol'l fLl«1~~Giloll (Hd~llfUI8 fLlctwnfUI8 ~~Gi~nruI8 cmrt" q«1~nfUld IPI qld~MGi~nfUld IPI fLlct1~0Gi~nruld IPI q IdfLlct1 Cf)4'JI:

qldfLlct1Cf)4'J~nruldl"11rd ~ q~"iJG~lm !'I'{i"!PdII =? L II

~~-

~St)S~ errsfit ~?lI$~i) gJfLlffi ~

~ ~.,~ i!tlqct1?1 ~ II~~II

~cl g5fLld~i.llfLl ~ ~ ffitOffi Plt5!>k~;:flCf): ~ ~gJiI'{iltl g5QJrd lI~oll

4) Sthana sal"flsraya (localization of dOl?a )

(~.Xi. =? 9)

In this stage the pathogenesis of the do~ ends and the pathogenesis of a

particular disease starts. The hetu which lead to the vitiation of the d09a

may also be responsible for developing sthana vaigut:1ya, in the form of

weakning of the dhatu. The poor local defense mechanism may be genetic

or acquired. The acquired cause may be dietic, environmental and

traumatic or sequeal of previous illness etc. In the absence of sthana

vaigut:1ya there will be no disease, but only the signs of vitiated d09a. This is

the difference between the general hetu of vitiation of d09a and particular

hetu of a particular disease. In this manner. the dhatu which is in a normal

condition and has a natural immunity; repulses the attack of the vitiated

68

do~a. If that dhatu does not get proper nutrition from the diet, it decreases.

Its formation reduces, its strength reduces, as a result of which the dhatu

and the organs comprising of that dhatu, become weak. The vitiated do~a

are attracted towards the weak dhatu. These do~a flow towards the weak

dhatu through its srotasa.

Sthana vaigut:lya

I

Dhatu vaigut:lya / Organ

I

I

Flow of vitiated dosa

Disease

If the functioning of the srotasa is proper, the vitiated do~a do not stay in

the dhatu, but if the process of formation, growth and thus the health of a

dhatu is disturbed then it leads to weakening (Vaigunya) of the dhatu and

the vitiated do~a make a place for themselves in that dhatu. In this

condition the signs and symptoms of the vitiated dhatu are observed.

This dhatu vaigut:lya increases due to the diet and the behavior which

increase the gut:la, which are opposite to that of the dhatu. The

pOrvarupa (premonitory signs and symptoms) of the disease are seen in

sthana salTlsraya. The do~a can vitiate a single dhatu or many dhatu and

mala. It should be understood that the do~a dhatu and the mala which are

mentioned in the pathogenesis of the disease are vitiated and so are the

organs consisting of these dhatu. Do~a and dO~ya are the samavayi karat:la

of the disease whereas their combination is asamavayi karana of the

disease. (77)

69

3RT ~ ~J!>T<t CflRTTll: ~ Q$fqdldi'«1ISi ~1;fl'<Q~~II"1PI~di'«1I"1 , ,

~ \l1"1l1Pd -cr lIG.1G:;Hi~~~i $cfPd ....... d~llfUldClldCf>OcCf>Q~

f1Cll\S~JPldl \TCI"!f1C11\S~JI;{JJIQ~ d~14C1JiI11 {H~rutel"1i ~4'{\)qQI5>~

: ct Qffi"!IJj CflRTTll: ~ ~4'{\)qJld~ ~cl: fihlllCf>10:11 ~ ~II

(~.~.~ 9)

5) Vyakti (Disease stage) -

The disease manifests itself completely and shows its distinguishing signs

and symptoms. During this stage the original constitution of the dhatu and

the srotasa alters. The function of the dhatu and its organs is not carried

out properly. This process maintains its continuity due to the continuous

negative effect of the gUt:1a of the vitiated do~a on the dhatu and its srotasa.

This results in the progress of the disease. The nature of the destruction of

the dhatu is according to the degree of the gUr)a of the vitiated do~a. (78)

3RT ~ ~ CflRTTll:_ >r~ QlICfC10~

\TCI'<ldlf1I'<Q~ -=q ~~: IffilllCf>I(>'5: ,,~~ II (~"~i- ~ 9)

6) Shada

When the signs and symptoms of both the do~a and disease can be clearly

observed in a disease, it is the final stage of the pathogenesis of the

disease.(79)

3RT ~4dtilIJiClG)oI1"1i ~~IClJilq'""'1I"1i ~: IffillICfjI0: ...... II ~ <-s II

(~.Xi- ~ 9)

Types of Samprapti-

1) Sarikhya

2) Vikalpa

3) Vidhl

4) Pradhanya

5) Sala

6) kala

70

(~.f.1. 9)

1) Sarikhya-

Each d01?a is vitiated due to many causes. The causes of the disease are

called samutthana. The vitiation of the d01?a, the condition of the disease,

changes as per the severity and the number of hetu. Vikar prakruti means

Vata and other d01?a. Just as the d01?a, vitiated due to different hetu causes

different diseases, in the same way, the d01?a also cause different diseases

as per the sthana or the organ which is affected by it. (80)

In this way, as per the samutthana, and as per the sthana one d01?a

can cause many diseases. Different permutation and combination also lead

to different types of diseases. For convenience, they have been given

definite numbers like 8 types of jvara etc. This limited types of each disease

mentioned in the text is called Sarikhya Samprapti.

~ *1f!>1l~ -

x=rr ~ <l~S~ q~S~ \TcRl ~ 119 9 II

(~.f.1. 9)

2) Vidh I Samprapti -

The types of disease found by considering various angles regarding the

disease is called vidhI samprapti. (81)

Example curable - non curable diseases; Nija-agantu diseases.

3) Vikalpa Samprapti -

This includes the study of the gUf!a, their intensity which has caused the

vitiation of the gUt:la. (82)

fcl Cfj (>LI *1 f!>Il ~ -

GltstlOli *1Ji~C1I'1i fclCfj&lr'lS~li~ICfj(>LI'11 I

71

4) Pradhanya Samprapti -

When any disease is classified as per the vitiation of the do~a, it is

important to note which do~a is most vitiated. Accordingly, that do~a has

to be mentioned first. Ex. In diseases involving two or more do~a, most

vitiated do~a, should be given importance during treatment. E.g. in the

diarrhoea caused due to vata and pitta, Vata do~a is most vitiated followed

by pitta. The signs and symptoms of the most vitiated do~a can be

observed clearly. The causes are many and can be observed as mentioned

in the literature. The equilibrium of these do~a can be restored as per the

treatment mentioned in the text. (83)

~ *1'101I~-

'{:q Id;:::;LIq Ix d'"?lI'RfT ~: mtll~sot 1~~1C'! 119 ~ II (11r.f.1. 9)

5) Bala Samprapti -

This tells us about the strength of the disease. Disease is a Karya and as

per the rule of the Karya karat:la bhava the stronger the cause, the stronger

is the karya . Hence, the more and the stronger is the hetu, the stronger is

the disease.

6IC') *1~I~ -

~~ I ~ Cf) I ctrlIfClll~ 4(>5 161 (>5 fcl ~1 ~ 0 I sot I "

(11r.f.1. 9)

6) kala Samprapti - this is the time of the day or the year etc. when the

strength of the disease increases. This is observed as per the most vitiated

do~a. E.g. the signs and symptoms of a disease in which pitta is vitiated

will be seen prominently during 10am to 2pm and also at 10pm to

2am.Also, it will increase during sarada rutu and 2-3 hours after meals.(84)

cp]('5 *1~I~ -

"1cffl~"1d~~lsot(>51119~11

~ ~ f.1GI"1I~: Xl: dllfl':!'lq~m I

72

(11r.f.1. 9)

LIT£RATURE - MODERN

Epidermis [

Dermis

Subcutaneous [ fat

Structure of hair-

Sebaceous gland

Bulge region

Outer root sheath

Inner root sheath

Hair fiber

Dermal papilla

Hair is a dead substance, is a part of living scalp that can be nourished and

stimulated by hair follicle. Hair is made from protein called keratin. The part

seen out of the skin is called hairshaft and the embedded part is hair follicle.

The hair shaft has an outermost protective layer cuticle, which is very thin

and colourless. The middle layer cortex, determines the strength, hair

colour and whether the hair is straight or curly. The inner layer melulla gives

thickness. The hair "manufacturing plant" is the hair follicle, a cavity in the

scalp sourounded by cells called papillae. Papillae are gorged with blood

from capillaries which stimulates them to make hair cells.

The part of the hair that we see is called the shaft and it protrudes from the

follicle. The follicle is a tubelight pocket of epidermis i.e. located just below

the skin surface. It is absolutely essential for hair growth because the hair is

73

actually rooted in the base of the pouch. Also the thickness of each hair

shaft is determined by the size of the follicle. The root is the area in the

follicle where blood capillaries are found. The blood capillaries nourish the

hair and encourage growth. Hair is essentially made up of a collection of

rapidly dividing cells and the base of the hair is close enough to the

capillaries for these cells to be living. New cells forming at the root push the

hair out of the follicle far enough for it to harden and undergo

pigmentation.The shafts are eventually separated from nourishment and die.

In human beings hair is of minimal functional benefit but is all important for

personal adornment. Thus in modern civilization, it is either loss of hair or

excess of hair, change in shape or colour of hair, which excite medical

interest.

There are two types of hair. Lanugo (Vellus) hair and Terminal hair. Lanugo

hair constitutes the fuzz present all over the surface. Terminal hair is

coarse, thick and pigmented and is best developed on the face, scalp and

extrimities.

mature anagen catagen telogen

\01'--- dermal papilla

early anagen

mature anagen

A hair does not continue to grow indefinitely, its growth is cyclic. There are

two main phases in the cycle. A growing phase (anagen) and a resting

74

phase (Telogen). At the end of growing phase a club of resting hair is

formed (catagen Phase) the catagen phase lasts for 14 days. Under normal

conditions a hair count would reveal 85-95% in anagen and 1 % in catagen

and from 4-14% in telogen phase. Scalp hair follicles are normally raised

for three months and are active for 2-6 years but are known to grow for as

long as 25 years.

Anatomy and Physiology

Introduction -

For the evolutionary reasons hair follicles are not all under identical control

mechanisms.To match the animal pelage to seasonal changes in ambient

temperature or environmental background, requires moulting and

replacement of the hairs. The process appears to involve an inherent

follicular rhythm modified by circulating hormones such as steroids or

thyroxine, whose secretion is in turn geared to environmental cues through

the hypothylamus and hypophysis.

Hair grows from follicles which are stocking like inpushing of the superficial

epithelium each of which encloses at its base a small stud of dermis known

as the dermal papilla. The cylinder of hair may be regarded as a holocrine

secretion arising by division of cells surrounding the papilla, in a region

known as bulb. The follicles are slanted in the dermis and the longer one

extends into the adipose layer. An oblique muscle, the arrector pili, runs

from a point in the mid region of the follicle wall to the dermoepidermal

junction. Above the muscle one or more sebaceous glands, and in some

regions of the body and apocrine gland also open into the follicle. In all

mammals, including man but with the possible exception of the merino

sheep, hair follicle shows intermittent activity. Thus each hair grows to a

maximum length, is retained for a time without further growth, and is

eventually shed and replaced.

Development and distribution of hair follicles -

Rudiments of hair follicle appear first in the regions of the eyebrows upper

lip and chin at about nine weeks of embryonic development, and in other

75

regions in the four month; by twenty two weeks, the full complement of

follicle is established. The total number of follicle in an adult man has been

estimated at about 5 million, of which about 1 million are in the head and

perhaps 1 lac in the scalp. There appear to be no significant, sexual or

racial differences in follicle number.

The active follicle -

Adrl.lII.JII!Itj'Cl..n CaUiIIICt5 toxic: dama.qe. rachc:.al

TaxAnGS P'~:ZCl cybopl_auc au c:rotubulCI.

The hair and its keratinized cells are ultimately desquamated. Investing it is

the outer root sheath, which is continuous with the superficial epithelium

and this is itself enclosed in a non cellular partition known as the vitreous or

glassy membrane. The entire follicle is surrounded by a connective tissue

sheath formed of collagenous fibres, a few elastic fibres and fibroblasts.

New cells are formed by division in the region of the bulb surrounding the

lower two thirds of the dermal papilla.

Composition of hair keratin -

Hair contains hard keratin which differs from the soft keratin of

desquamating tissues by its higher sulphur content.

76

Ultra structure-

The cuticle of the hair - the cuticle consists of 5- 10 overlapping cell layers,

each 350 to 450nm thick.

Outer root sheath -

In the adult human scalp the activity of each follicle is independent of its

neighbour. Such a pattern is known as a mosaic. At anyone time on

average about 13% of the follicles are in telogen, though the range is large,

it has been recorded as 4-24%. Only 1 % are in catagen. If there are about

1 lac follicles in the scalp and their period is about a 1000 days, about 100

hairs ought to be lost each day. In practice the average recovery of said hair

is usually rather less and over 100 can be regarded as high. Follicle through

out the body as well as those under scalp is out of synchrony and, indeed,

has different periodicities.

Many animals mould in a characteristics wave pattern. In the rat, for e.g.

replacement of hair start in the venter and bands of activitiy and sheding

move over to the flanks of dorsum, subsequently spreading to the head and

tail regions. Undoubtedly, the changes in the hair cycle may be involved in

transient hair loss in man. Some of the conditions formerly grouped under

the description "alopecia symptomantica" which can result from a variety of

mental and physical stresses, involve the simultaneous precipitation of

many follicles into categen. Kligman described several cases of post febrile

alopecia in which shedding of club hairs began about 3-4 months after the

fever and continued for 3-4 weeks. At the height of sheding the telogen

count made from scalp biopsies ranged from 34% to 53%. Regeneration

was well under way 6 weeks later. Similarly, a prisoner who underwent a

series of trials for murder began to loose hairs at the rate of over 1000 per

day about ten weeks after conviction; there were no histological

abnormalities except for an increased proportion of follicles in telogen. The

phenomenal has been given the name "telogen effluvium". The nature of

the neuro endocrine or other mechanism by which it is brought about

remains to be elucidated. The condition bears some similarity to postpartum

Alopecia, which is presumed to follow hormonal changes.

77

Hormonal influences -

Each hair follicle appears have an intrinsic rhythm. Plucking of hair from

resting follicles brings forward the next period of activity, and such follicles

continue out of phase with their neighbours, at least for a time.

The hypothalamus and the hypophysis may thus exert their influence by

way of thyroid, with the adernal cortex and the gonads forging a link

between environmental, reproductive and moulting cycles.

Hormones also influence follicles in anagen.

Human hair is profoundly affected by thyroid hormones. In a

study carried out in Sheffield, sixteen out of 150 women who complained of

hair loss were diagonised as hypothyroid on the basis of serum protein­

bound iodine levels confirmed by radioiodine tracer studies. Mean hair

diameter was reduced whereas diameters in normal subjects had a

symmetrical distribution with a marked peak at O.OBmm, in all subjects with

hair loss and especially in those with hypothyroid,the spread was much

wider, with separate peaks at 0.04mm and 0.06mm. The proportion of

roots in telogen has been shown to be abnormally high in hair plucked from

the occipital and parietal areas of hypothyroid subjects; treatment with

thyroid hormone restored it to normal after B weeks.

The phenomen of postpartum hair loss also appears to result from a

hormonally mediated change in the cycles of scalp follicles. A loss of hair at

about two to three times the normal rate gives rise to a transient alopecia

about 4-6 months after parturition. At this time, the proportion of hairs in

telogen can be as much as 15%, whereas in late pregnancy, it may be less

than 5%, which is only about a third of normal. This suggests that the

passage of follicles into catagen, followed by shedding of club hairs is

slowed down by pregnancy, but occurs preciptitously after parturition when

hormonal conditions are altered; particularly by rapid fall in oestrogen level.

The pattern of fluctuation in the anagen - to -telogen have been observed

over three consecutive pregnancies in one subject over a period of nine

years; the change became less marked in each successive pregnancy.

Androgen dependent hair -

Scalp hair differs in that its growth does not require any androgenic

stimulus. However, in gentically ordained subjects, androgen is

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paradoxically responsible for postpubertal hair deficiency on the vertex of

the scalp. The existence of testosterone receptors in scalp hair follicles is

implied by the fact that female diffuse alopecia can be alleviated by oral

antiandrogens. The finding that despite normal plasma testosterone, bald

men tend to have lower SHBG and higher salivary testosterone does

suggest that they might enjoy more available androgen.

Most female diffuse alopecia is andogenetic. While it may be associated

with virlism and high androgen levels resulting from disorders of the adrenal

cortex or ovaries, plasma androgens are more usually normal. However, as

in males, there is a tendency for SHBG to be lower, though with a

considerable overlap of a normal range.

Postnatal hair may be divided at the extreme into two kinds. Velles, which

are soft, unmedullated, occasionally pigmented and seldom more than 2cm

long, and terminal hair, which is longer, coarser, and often medullated and

pigmented.

Energy Metabolism in hair follicle -

Hair follicles utilize glucose via the Emdenmeyarhoff pathway, the pentose

cycle and the tricardoxylic acid cycle. However, hair follicles differ from

muscle in several respects. They have a faster glycolytic rate; a slower

respiration rate and a considerable pentose cycle activity, although this is

insignificant in muscle.

Active and resting follicles differ remarkably. In active follicles, compared

with wasting follicles, glucose utilization is increased by 200%, glycolysis by

200%, activity of the pentose cycle by 800%, metabolism of other pathways

by 150% and ATP production via the respiratory chains by 270%.

Changes with Age -

At puberty, terminal hair gradually replaces veil us, starting in the pubic

regions. In both boys and girls the first pubic hair is sparse, long, downy,

slightly pigmented and almost straight. It later becomes darker, coarser,

and more curled and extends in area to form an inverse tiangle. A british

study shows that boys had a first recognizable pubic hair at an average age

of 13.4 years, and the full adult male pattern at 15.2 yrs, about three and

half years after the start of the development of the genitalia. The

79

corresponding mean ages for girls were considerably earlier, namely 11.7

years and 13.5 yrs. In about 80% of men and 10% of women, the pubic

hair continues growing until their mid -twenties or later.

Certain follicles of the scalp may regress with the age to produce only fine,

short vellus hair. This condition of patterned baldness is inherited and

requires male hormone. It is prevented by castration before puberty,

though not substantially reversed by castration in maturity.

The trichogram -

The proportion of active to resting fOllicles in the scalp can be determined

from plucked hairs and is a useful clinical parameter. Barman and co

workers first described such an analysis as a "trichogram" but included

within the term data on the density of hair follicles, thickness of hair and rate

of growth.

ANAGEN - The root is usually largest at its base, though it may have an

equal diameter through out. The inner root sheath is usually present and

firm. The plucked roots may show an angle of 20 degree or more with the

shaft, which is presumably artefactual.

TELOGEN - The root is clearly characterized by its club shape with smooth

contours, lack of angulation and loose sheath.

Dysplastic - The matrix is diminished in diameter and often deformed. The

root sheath is loose or absent.

Dystrophic - The changes are so severe that the root has broken up at the

narrowest level and tapers to a point; root sheaths are never present.

The highest ratio of anagen to telogen hairs, over 90%, occurs in children.

In adult men, even those not clinically bald, the ratio is lowest in the

frontovertical region, but non- bald women- as distinct from those with

alopecia androgenetica - show any regional differences. A study of scalp

hairs from 146 clinically normal subjects reveled that the overall proportion

of hair in anagen was 83% in men and 86% in women. The corresponding

figures for telogen were 15% and 11 %. Catagen hair accounted for only

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2.9% of the total in men and 2.1 % in women, and was only demonstrable in

31 % of males and 19% of females. Dystrophic anagen hair were found in

46% of men, where they accounted for 3.2 % of the total, and in 48% of

women where they accounted for 2.5%/

For assessment of the degree of androgenetic alopecia, Rushton and co­

workers have proposed the "unit area trichogram" in which the root status

and shaft diameters are determined for all of the hair plucked from a small

defined area. In their view, only hair over 40 Micro mm in diameter are likely

to grow longer than 80mm and thus provide meaningful hair in the

cosmetic sense.

Season Changes -

Orentreich reported that three women in New York experienced maximum

hair fall in November. Clear and statistically significant data on seasonal

variation have been provided by a study of 14 young Caucasian men in

Sheffield, England, at latitude of 53.46N.

Scalp-

The proportion of scalp follicles in anagen, as determined by plucking hairs,

reached a single pick of over 90% around March and fell steadily to a

trough in September. This pattern appeared to be shared by all the areas

of scalp.

The numbers of shed hairs collected by the subjects closely followed the

pattern of activity of the follicles. Hair loss reached a pick around August /

September, when the fewest follicles were in anagen. At this time, the

average loss of hairs was about 60 per day more than double that during

the previous March and compatible with the observed increase from 10% to

20% in the proportion of follicles in telogen. The diameter of growing scalp

hair exhibited no seasonal fluctuations.

Rate of hair growth -

The rate of hair growth varies from species to species and within one

species from one region to another region as well as sex and age. On the

crown of the scalp this rate averages to about 0.5mm per 24 hours, being

slightly less on the margins. Though the scalp hair grows faster in women

than in men, the rate before puberty is greater in boys than in girls.

81

Alopecia -

I) Androgenetic alopecia -

Androgenetic alopecia is widely referred to as male- pattern alopecia, but

this term is too restrictive and leads to missed diagnoses especially in

females. Studies in animals have demonstrated clearly that common

baldness is a physiological process in genetically pre-disposed individuals.

Terminal follicles are progressively transformed into vellus follicles.

TIl8 [;,U~ laale fOf Female ~attem Hail Loss (Addrogenelc Alo~) 1

Gradf1 I: MIl~

Venning and dawber have shown a change of patterning in 100% of 564

women over 20 years old. They analysed their patients by decade and

found that 87% of premenopausal women showed vaultal thinning of the

Ludwig pattern I-III and 13% had Hamilton type II-IV. Post menopausal

women showed and increased tendency to the male patterning with 63% of

Ludwig I-III and 37% of Hamilton II-V, including some women with deep M

shaped by bitemporal frontoparietal recession.

Inheritance - Some authorities' differenciate between early onset (before

the age of thirty in men) and the same pattern 20yrs later. Some think that

baldness is determind by a single pair of sex - influenced factors. It is

nevertheless certain that both are inherited and both depend upon

androgenetic stimulation of susceptible follicles.

82

The development of baldness is associated with shortening of anagen

phase of the cycle and consequently with an increase in the proportion of

the telogen hair. Normal male levels of androgen are sufficient to make

manifest the degree of baldness determined genetically for the individual

Cut section of skin

Fo1Jicle with hair Follicle without hair

In women, the maximum change in hair pattern occurs after menopause;

when oestrogen levels decline and more androgenic environment exist.

During the course of baldness, the total no of subaceous glands decreases

significantly. In women, however, increase sebum production occurs

following a small increase in circulating androgens.

Clinical features -

In females, increased shedding of telogen hair accompanies the reduction

of shaft diameter but the follicles first affected are more widely distributed

over the frontovertical region. As a result, many secondary vellus hair are

interspersed with hair which are still normal and others only slightly reduced

in diameter. Partial baldness is sometimes apparent on the vertex. But

mostly it is diffused. In men, bi- temporal recession followed by balding on

the vertex is common.

II) Disturbances of the hair cycle -

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Telogen effluvium

This is a term to describe the shedding of normal club hair which follows the

premature precipitation of anagen follicles into telogen, a process which

may be regarded as the common response of the follicles to many different

types of stress. They are

• Fever (prolonged fever like typhoid)

• Prolonged or difficult child birth

• Surgery

• Haemorrhage

• Crash diet

• Emotional stress

The proportion of the follicles affected and hence the severity of the

subsequent alopecia depends partly on the duration and severity of the

stress and partly on the unexplained individual variation in susceptibility. The

most common is postpartum effluvium due to withdrawals of factors which

have prevented normal entry to catagen during late pregnancy. The same

condition prevails after the contraceptive pill is discontinued. The alopecia

induced by heparin is similar.

III) Diffuse alopecia of endocrine origin -

• Hypopituitary state - In pituitary deficiency beginning after puberty the scalp

hair become very thin.

• Hypothyroidism - Diffuse loss of scalp hair and later of body hair is

frequent. Proportion of roots in telogen shows to be abnormally high,

suggesting either prolonged telogen or premature catagen or both. Alopecia

has occurred in iodine induced hypothyrodisim in which· the serum protein

bound iodine level was high.

• Hyperthyroidism - In this diffuse alopecia developes in 40-50% of cases

but is rarely severe.

• Hypoparathyrodism - The scalp hair is coarse, sparse and dry. It is easy to

shed with slight trauma and the alopecia may appear irregularly patchy.

• Oral contraceptives - Diffuse alopecia has been attributed to oral

contraceptives but the evidence is conflicting.

84

IV) Alopecia of chemical origin -

Many chemicals are capable of inducing alopecia.

~ Thallium - Thallium is rapidly taken up by the anagen follicles. Many hair

breaks within the follicle. Many other follicles enter catagen prematurely.

Alopecia is the most constant symptom. The loss of hair begins after ten

days as diffuse shedding.

~ Thyroid antagonists - Thiouracil or carbimazole develop a diffuse alopecia.

~ Anticoagulants - All the anticoagulant drugs like heparin, heparinoids and

coumarins will induce alopecia.

~ Cytostatic agents -Aminopterin, cyclophosphamide, cantharidin given

therapeutically or with criminal intent cause hair loss.

~ Triparanol causes alopecia.

~ Hypervitaminosis A - Excess consumption of vitamin A causes slowly

progressive thinning of scalp and body hair, eyebrows and eyelashes.

~ Boric acid - Occupational exposure to sodium borate has caused diffuse

alopecia. Boric acid mouth wash have caused similar hair loss.

V) Alopecia of nutritional and metabolic origin -

Hair is affected by the following deficiencies -

.:. Protein deficiency - in this the hair is brittle and is easily shed and partial or

complete alopecia may occur .

• :. Iron deficiency - iron deficiency is occasionally associated with diffused

alopecia even in the absence of anemia .

• :. Zinc deficiency - the hair is dry and unruly. This alopecia arises due to a

failure in absorption of zinc.

VI) Chronic diffuse alopecia -

More or less evenly distributed loss of hair occurring continuously but

sometime fluctuating in severity is common in both sexes. There is diffuse

reduction in follicle density which occurs from the third decade onwards.

VII) Alopecia Areata -

The essential basis is cessation of hair growth with premature club hair

formation. Heredity, emotional stress, endocrine upset and autoimmunity

85

(due to its frequent association with autoimmune disorders like Addison's

disease, thyrotoxicosis, hashimoto's disease and pernicious anemia) have

been implicated as etiological factors.

Clinically, the patient presents with sudden loss of hair over a circumscribed

area and during the period of the active hair loss a characteristics club

shaped and exclamation mark hair are seen. There is no evidence of

atrophy. There may be only 2-3 patches or the entire scalp may be

involved. Individual patches doe not tend to enlarge greatly after they

appear, though the development of new lesions with coalescence may give

such an impression. The areas are white and smooth and the loss of hair is

complete except for a variable amount of inconspicuous lanugo hair.

Nail pits, ridges and transverse furrows can be seen as an association of

alopecia areata. The course of the disease is unpredictable and capricious.

New patches may appear while hair is returning in older ones. Alopecia

areata developing in childhood and larger number of lesions carry a poor

prognosis.

VIII) Traumatic alopecia-

The term traumatic alopecia is applied to alopecia induced by

physical trauma. It is due to

1) psychological conditions - trichotillomania

Hair is plugged more frequently from one frontoparietal region. There is an ill

defined patch on which the hair are twisted and broken.

2) Cosmetic traumatic alopecia -

Hair sometimes already weakened by chemical applications, may be

broken by friction or by tension. They can be

• Procedures intended to straighten kinky hair.

• Pony-tail

• Tight braiding

• Twisting and tying tightly.

• Traction due to tight scarf or hats.

• Brush roller alopecia - brush roller, if applied frequently and with too much

vigour.

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• Hot comb alopecia - hot combs used to straighten hair.

Massage alopecia - application of meditation with firm massage may cause

baldness.

• Brush alopecia - vigorous brushing may damage to hair which are already

fragile.

• Hair weaving 3) Accidental traumatic alopecia - this results due to accidental trauma.

IX) Cicatricial alopecia -This may be due to

~ Developmental defects

~ Physical injuries

~ Burns

~ Fungal infections - dermatophytosis by zoophillic fungi

~ Bacterial infections - tuberculosis, syphilis

~ Pyogenic infections - carbuncle

~ Viral infections - herpes zoster

~ Tumours

~ Clinical Syndromes - dissecting folliculitis, folliculitis decalvans

X) Pseudopelade -

This term is used to describe a slowly progressive cicatricial alopecia

without clinically evident folliculitis and no marked inflammation.

XI) Weathering of hair shaft -

.:.

.:.

.:.

.:. . :.

.:.

.:.

The term weathering of hair has been limited by some authorities to

structural changes in the hair shaft due to cosmetic procedures. In this all

hair fibres undergo some degree of cuticular and secondary cortical

breakdown from root to tip before being shed during the telogen or early

anagen phase of hair cycle. This can be caused by

Combing,

brushing,

bleaching

Permanent weaving .

Natural friction

Wetting

Ultraviolet radiation

87

GREYING OF HAIR -

In man, hair pigmentation depends entirely on the presence of melanin from

melanocytes. But the actual colour perceived may sometimes depend also

on physical phenomena. The range of colours produced by melanins is

limited to shedes of gray, yellow, brown, red and black. The whole range of

human hair colour is due to two types of melanins

• Eumelanins, which are mainly in black and brown.

• Phaeonelanins which are yellow or red and give auburn and blonde hair.

The white colour of hair seen when melanin is absent is an optical effect

due to reflection and refraction of incident light from various interfaces at

which zones of different refractive index are in contact.

Greying of hair - (CAN ITES)

Graying of hair is usually a manifestation of aging process and is due to a

progressive reduction in melanocyte function. There is gradual dilution of

pigment in graying hair i.e. the full range of colour from normal to white can

be seen both along individual hair and from hair to hair.

Loss of hair shaft colour is associated with decrease and eventual

cessation of tyrosinase activity in the lower bulb. In white hair melanocytes

are infrequent or absent or possibly dormant. It has been suggested that

auto immunity plays a part in the pathogenesis of graying. Gray hair

88

certainly has an association with the autoimmune disease pernicious

anaemia.

Greying of hair is progressive and permanent though melanogenisis during

anagen may be intermittent for a time before finally stopping.

Premature Greying -

It is often stated that premature graying may be an early sign of pernicious

anemia, hyperthyroidism and less commonly hypothyroidism, all auto

immune diseases which have a genetic predisposition.

This can also be due to hereditary defects like albinism.

Colour changes induced by drugs and other chemicals -

Some systemic drugs alter hair colour by interfering with phaeomelanin

pathway.

a) Chloroquine interfers with phaeomelanin synthesis.

b) Mephenesin causes pigmentary loss in dark hair people.

c) Triparanol and fluorodutyrothenone interfere with keratinization and cause

hypopigmentation and sparse hair.

d) Hydroquinone causes hypopigmentation of skin and hair.

Colour changes due to nutritional deficiencies -

The lightening of hair colour from black to brown described in severe iron -

deficiency anemia may be an effect on keratinization rather than on

malanocytic function.

Hair Cosmetics -

a) Shampoos

Excessive use leads to hair fall.

b) Cosmetic hair colouring - Metallic dyes give a rather dull appearance and

may cause brittle or damaged hair if used too often.This causes hair fall.

They cannot be removed without hair damage.

Synthetic organic dyes penetrate the hair cuticle. Permanent or oxidation

dyes must not be applied more frequently than every 2-3 weeks since hair

damage will occur leading to hair fall.

89

Bleaching is very damaging to the hair rendering it dry, porous and

more prone to tangle. Overuse may cause hairfall.

c) Permanent weaving -

This has been defined as the process of changing shape of the hair so that

the new shape persists through several shampoos. Three stages are

involved in hair weaving .

• :. Softening -great skill is involved in this process since failure to judge the

time of application of chemicals and heat may cause severe damage .

• :. Reshaping - rollers or curlers used to reshape softened hair depends on

the training of the hairdresser .

• :. Hardening - in this process neutralizers are used. Some of them content

shellac which may react with alcohol groups to cause hair discolouration.

d) Hair straighteners -

Hot comb method - structural damage and breakage of hair is common

with this process and scarring alopecia may occur as a result of hot waxes

entering the follicle.

e) Hair setting lotions and spray -

There is now grave concern about the damage to the ozone layer from the

chlorofluorocarbon propellants.

f) Methylolated compounds -

Many cosmetic preparations, by their action, on the keratin molecule,

irreversibly weaken the hair.

Complications of Hair cosmetics -

Matting of scalp hair is most commonly a sudden, usually irreversible and

tangling of scalp hair due to shampooing. Excessive bleaching, permanent

weaving and straightening procedures may induce excessive weathering

and fragility of hair, leading to hair fall. (85)

90