Kiyanta Shiraseeya — Classification of Diseases

The Question

Charaka opens this chapter with the question: *kiyanta shiraseeyaha rogaah* — "how many head-located diseases are there?" This becomes the framing for a much larger discussion on how all diseases should be enumerated and classified.

The chapter answers by giving 5 systematic classifications of disease — the conceptual map every BAMS student must internalise.

Classification 1: By Dosha

Eka-doshaja (single dosha) - **Vataja roga** — 80 examples enumerated (vata-vyadhi) - **Pittaja roga** — 40 enumerated - **Kaphaja roga** — 20 enumerated

Dvi-doshaja (samsargaja — combined two) - **Vata-pittaja** — most common combination clinically - **Vata-kaphaja** — common in winter, ageing - **Pitta-kaphaja** — common in obese with hypertension

Tri-doshaja (sannipataja) All three doshas vitiated. Often severe disease (sannipata jvara is the model). 13 sub-classifications based on dosha proportions.

This is the most clinically used classification — every patient's vikriti is first read at this level.

Classification 2: By Sthana (Location)

Sharirika roga Body-located diseases. Sub-classified by: - **Avayava** (organ): hridroga (heart), netra roga (eyes) - **Dhatu**: rasa-pradoshaja, rakta-pradoshaja, etc. - **Srotas**: pranavaha sroto-vyadhi (respiratory), annavaha sroto-vyadhi (digestive), etc. - **Marma**: marmagata roga (vital point disorders — often serious)

Manasika roga Mind-located diseases. Sub-classified by: - **Triguna**: rajasika (anxiety, anger, lust spectrum), tamasika (depression, lethargy spectrum) - **Manas-pradoshaja**: kama, krodha, lobha, moha, irshya, mada, shoka, chinta, udwega, bhaya

Agantuja roga Externally caused. Trauma, snake bite, infections, accidents.

Classification 3: By Hetu (Aetiology)

Nija (intrinsic) roga Caused by doshic disturbance from within. Most chronic disease.

Agantuja (extrinsic) roga External cause that then triggers doshic disturbance: - Bhautika (physical injury, accidents) - Aupasargika (infectious — contagion theory in classical Ayurveda) - Visha (poisoning) - Bhuta (psychiatric — broadly interpreted)

This nija-agantuja distinction matters: in agantuja, treating the external cause is primary; nija requires deep doshic reasoning.

Classification 4: By Kala (Chronicity)

Navotpadya / Adyatana roga Acute, recently arisen. Vata-pitta dominant typically. Aggressive shamana + langhana approach.

Madhyama Sub-chronic, weeks to months. Mixed approach.

Chirakaala / Jeerna roga Chronic, established. Often kapha-vata dominant; ama involvement common. Slow systematic shodhana + rasayana approach.

Kaalantarothpadya Disease arising with seasonal/circadian cycle — vata vyadhi in winter, pitta vyadhi in summer-autumn.

Classification 5: By Sadhya-Asadhya (Curability)

This is the most clinically important classification. Charaka divides all diseases by curability:

Sadhya (curable) - **Sukha-sadhya** — easily curable. Single dosha, recent onset, healthy patient, no complications. Most acute fevers in young patients. - **Kricchsadhya** — curable with difficulty. Multi-dosha, sub-chronic, partially healthy patient, some complications. Many chronic conditions early-stage.

Asadhya (incurable) - **Yapya** — controllable but not curable. Manageable with lifelong treatment. Chronic diabetes, controlled HTN, well-managed RA. - **Pratiyatya** / **Anupakrama** — incurable, not even amenable to control. Terminal disease, severe sannipata jvara, severe marma-injury.

The Doctor's First Duty

Charaka explicitly says: *prathama eva sadhyatva-nirupanam karyam* — "first determine curability."

The reasoning: - Treating asadhya as sadhya = wastes patient resources, gives false hope, often hastens death - Treating yapya as sadhya = same problem - **Refusing treatment of asadhya** is sometimes the ethical action

A senior physician's mark is honest sadhyata assessment.

Modern Correlations

The Ayurveda classification framework corresponds approximately to:

Many diseases shift category over time. A type 2 diabetes detected very early may be sukha-sadhya through lifestyle. The same diabetes with complications becomes yapya. Untreated for decades with severe sequelae — asadhya.

Clinical Application

When a new patient presents:

1. **Identify dosha** (eka, samsarga, sannipata)
2. **Identify sthana** (sharirika/manasika/agantuja)
3. **Identify hetu** (nija/agantuja)
4. **Identify chronicity**
5. **Determine sadhyata**

Only then proceed to treatment selection. This is the senior physician's mental flowchart for every case.

Self-test

• List the 5 classification axes from Kiyanta Shiraseeya.
• Differentiate samsargaja and sannipataja roga.
• Define yapya disease with one modern example.
• Why does Charaka emphasise sadhyata determination as the first duty?
• A 35-year-old with newly diagnosed type 2 diabetes + mild symptoms — what classification category and treatment approach?