Koshţha Pareeksha (kosta assessment) essentially means “Examination of Cavities or spaces”. Kostha means space or room while Pareeksha means examination. Body cavities contain crucial body organs called “Kosthangas– parts/ constituents of koshtha” which are also called “Aashayas or residences”.
Cavities examination is an important part of Panchakarma where the procedures are performed to bring proper balance of all doshas within the body to facilitate the best optimal health of each organ.
Functionally, Kostha is defined as the nature of bowel habit which is the result of basic constitution (Prakriti) of human since conception. A person’s bowel habit may not always have pathological roots but may just be the result of his/her basic constitution. For this reason, first the basic constitution of person is considered and then other Vata aggravating factors i.e. acquired lifestyle reasons are inquired about.
Constitution Of Kostha:
Exactly what cavities and organs and make Kosthas? From the various Ayurvedic Texts, information below is discernable.
“Sthaanani aama agni pakvaanam mutrasaya rudhirasya cha Hrut unduka puphusaha cha koshta iti abhidheeyte”.
–Sushruta Chikitsa Sthan 2/12
As per Sushruta, Ayurvedic texts mention these organs as Koshthangas or parts of Koshtha:
- Amashaya: meaning Stomach. Food is present as Ama– undigested state here. It is received and digestion starts here after being moist. Another reference by Chakrapani mention stomach as Sleshmashaya (seat of Sleshma- where all the bound material is placed).
- Agni Ashaya: meaning the site of fire. This primarily pertains to Pancreas as the main site of Agni but also includes digestive tract as a whole containing stomach, small intestines, liver, pancreas.
“Tatrapi pakwashayo viseshana vatasthanam”.
Meaning Colon which is the main site of Vata (i.e.Vatastanam). Vata is air and it moves in all directions which then include transverse colon, small intestine and sigmoid colon of large intestine.
4. Mutrashaya: which is the site of urine i.e. urinary bladder.
5. Rudhirashya: are the sites of blood formation which means Liver and spleen.
6. Hrut: means heart, also known as hridaya. This is considered the main organ that facilitates circulation of blood and plasma.
7. Unduka: Which means the proximal part of rectum which holds waste material especially stool.
8. Puphusaha: meaning lungs which aid air circulation.
Charak has defined parts of Koshtha/ Koshtangas below:
“Pancha dasha koshta angaani – Naabhi cha, hridayam cha, kloma cha , yakrit cha, pleeha cha, vrukka cha, vastihi cha, pureesh aadhaaraha cha, aamaashayaha cha, pakwashayaha cha, uttaragudamm cha, adharagudam cha, kshudra antram cha, sthoola antram cha, vapaavahanam cha”.
– Charak Samhita 7/10.
- Vrukka– Kidneys
- Naabhi– umbilicus
- Vastihi– urinary badder
- Aamashya– Stomach
- Pleeha– Spleen
- Kshudra antram– Small intestine
- Sthoola antram– Large intestine
- Hridayam– Heart
- Kloma– Lung, tracheas
- Uttara guda– Sigmoid colon and rectum.
- Adhara guda – Anus
- Yakrit – Liver
- Pakwashya– Colon as described above.
- Vaapavahanam– peritoneum which is the protective covering that covers vital organs above inside the abdominal cavity.
Thus what broadly forms Koshtha include:
- Thoracic Cavity: This accommodates lungs, oesophagus and heart.
- Abdominal Cavity: digestive system including intestines, stomach, gall bladder, liver, pancreas, spleen.
- Pelvic Cavity: Urinary apparatus including bladder and ureters, intestines, Uterus, reproductive organs.
Types of Koshtha:
3 Types of Koshthas are mentioned each showing dominance of a particular dosha.
- Krura (Hard) Koshtha: when Vata Dosha is most predominant in digestive tract.
- Mridu (Soft) Koshtha: when Pitta Dosha is predominating and
- Madhya (Medium) Koshtha: when Kapha is dominant.
This type or Koshtha is development of aggravated Vata dosha. Vata or air is dry ruksha and rough khara in nature and hence stool doesn’t get enough water content to stay moist and add bulk thus making it difficult to be eliminated finally. Oiliness and stickiness of stool consistency is also disturbed in Vata imbalance. Krura, thus meaning “hard”, explains the state of internal organs.
Sushruta also mentions the presence of Krura in mixed states of Vata-Kapha predominant people ( Sushruta Chikitsa 29/33). Kapha is helpful in maintaining stickiness and smoothness of stools and Vata helps in excretion. Hence when both Doshas are imbalanced, it may manifest as Krura Koshtha.
Thus Krura Koshtha has these symptoms-
- Frequent constipation, non-regular passage of stools.
- Requires a long duration or straining effort to pass it out.
- Hard dry pellet-like stools (Kathina Sushka mala) with or without constipation.
- Feeling of improper evacuation of stool or unsatisfactory passage (Krite api akrita samdnya).
- Unpredictable nature of stools- sometimes good and hard at other times.
- Bowel movement needs to be encouragement or stimulation as by using coffee, hot water, cigarettes.
- Abdominal bloating, pain abdomen, excessive need of straining are other symptoms.
- Mild Purgatives like hot milk, grape juice, sugarcane juice and triphala powder don’t help in relieving stools. More drastic measures are to be sought.
- Condition gets even more aggravated in winters, monsoons, excessive exercise and sex, cold climates and on taking dry and cold foods.
Does that mean that every person with Vata personality will definitely develop Krura Kostha?
No, if the Vata dosha is in balance (also called Prakruti), Krura may not manifest to cause obvious problems but whenever Vata is imbalanced/ aggravated (now called Vikruti), it will manifest as a problem. That means that Vata personalities can have normal stools for a long times till Vata is in harmony with other elements and then suddenly develop constipation at times when Vata is out of sync or vitiated. In Vata people, thus number of episodes of constipation are more than episodes of normal stools (samanya-normal kostha) expressing the effect of their bodies’ mother constitution.
Note that genetic coding of the organ systems of Vata personality always favours a tendency for Krura Koshtha. If this person additionally indulges in lifestyle practices that aggravate Vata, chances of manifestation are even higher. Similarly, by modifying incorrect lifestyle one may avoid the condition from time to time.
What Are Unfavourable Lifestyle Choices That Aggravated Vata?
Habits or lifestyle flaws that aggravate Vata creating an imbalance are:
- Exposure to very Cold environment (Shaityadi)
- In Monsoons or rainy seasons (Vari ghanagame), vata element is predominant in the environment.
- Intake of cold foods
- Excessive fasting (Apatarpana)
- Excessive internal cleaning practices like Panchakarma (Atishuddhi)
- Excess fear (Trassat)
- Waking for late at night or excessive vigility (Jaagaarat)
- Excess irritation (Kshobha)
- Excessive intake of astringent foods (Kashaya)
- Excessive intake of pungent foods (Katu)
- Excessive intake of bitter foods (Tikta)
- Fall or Injuries (Prapatana)
- Reduction of body tissues or muscle mass ( Kshaya)
- Excess supression of natural desires (Veganam cha vidharanat)
- Taking excess of Dry foods (Ruksha)
- Excessive indulgence in sexual activity (Vyavaya)
- Excessive exercising habits (Vyayama)
- Evening time (Aprahane) is the time of Vata excess and so one should be careful to avoid being in above activities even more.
Shall Pitta and Kapha Personalities Never Be Affected By Krura Koshtha?
Even though Pitta and Kapha dominant personalities don’t have a natural tendency to develop Krura Koshtha, they can still manifest Krura Koshtha pathologically if they follow unfavourable lifestyle choices as explained above. Vata, Pitta and Kapha all doshas are present in all people but in varying proportions and only one of them is more dominant than others. Whenever Vata dosha is aggravated, tendency for Krura Koshtha definitely increases.
In people of dwandwa prakritis (twin dominant dosha) e.g. Vata-pitta, Vata-kapha, Pitta-kapha or Kapha-vata, those with Vata as most dominant prakriti will have more chances to develop Krura Kostha i.e. Vata-pitta and Vata-kapha.
Remember that whenever there is a person with tridwandwa prakriti (three doshas personality), the dosha which will dominate the most will decide the nature of Koshtha and so koshtha may change its nature from time to time.
How To Avoid Krura Koshtha?
It is best to avoid the situation than trying to rectify it later with purgatives or digestive aids. Prevention has always been better and long lasting help for people of Krura Kostha. What to avoid is noted below:
- Follow proper Ayurvedic Monsoon routine (Varsha Ritucharya) in rainy season to avoid aggravation of Vata. This regime includes antagonist foods to stop getting into this situation.
- Avoid all of the above Lifestyle factors as mentioned already.
- In general, Vayu is controlled by taking these measures:
- Steam or sweat therapy
- Intake of salty food
- Intake of sour food
- Pouring of medicated oils on body
- Oil and ghee based enemas taken in lukewarm condition
- Consuming hot and fresh foods
- Intake of sweet food
- Massages with medicated oils which are ghee or oil based
- Enemas like Mridu shodanam in which enema is made with the help of mild ingredients like milk, ghee and soups.
- Vata alleviating oils are massaged into fists in procedures of Mardana.
- Intake of self-fermented alcoholic medications made from carbohydrates like flours (Paishtika Madhya) and jaggery (Goudika Madhya).
Mridu meaning “Soft” is the characteristic of organs/ Koshthangas when Pitta dosha is either aggravated or in Pitta dominant personalities. Pitta is responsible for formation of soft, smooth, moist stools as it adds dravya or fluid to the faecal matter. The person with Mridu Kostha will have most (if not all) of these characteristics:
- Daily passage of motion, once or twice a day.
- Stools are formed, loose or semi-formed.
- Less duration required to pass out stools, quick and easy motion.
- Diarrhoea may occur after taking mild laxatives.
- Satisfaction of good evacuation is achieved.
- Tea, milk and hot drinks often lead to frequent loose stools.
Mridu Koshtha may also occur pathologically in Vata and Kapha people if they take in excess foods or live the lifestyle which is very much conducive for the aggravation on Pitta.
Also not all Pitta persons will have Mridu Koshtha all the time. They will mostly pass regular normal stools with episodes of Mridu on and off whenever Pitta is vitiated (Vikriti). But if episodes of Mridu increase too much and Pitta is highly aggravated, Pitta persons will face a diseased state and will become a pathologic entity (Disease).
How Mridu Koshtha or Pitta Dosha is aggravated?
Mridu Koshtha is aggravated by the lifestyle which increases Pitta dosha. This includes:
- Excessive consumption of salty, sour, hot and pungent foods.
- Intake of acidic corrosive foods in excess (Vidaahi).
- Fermented and alcoholic drinks and foods
- Frequent starvation
- Excessive exposure to sunlight
- Excess anger
- Excessive usage of Til or Sesame in food
- Excessive indulgence in sexual activity (Vyavaya).
- Summer season and during autumn.
- Midnight and afternoon times are the most prone to attract Pitta energies and so above activities should be avoided during these times.
How To Cure or Avoid Mridu Koshtha?
In order to avoid Mridu, take following measures that help tame the excess of Pitta dosha:
- Intake of sweet and bitter foods and medications.
- Application of ointments made from Camphor, Sandalwood and Vettiver (Vetiveria zizanioides) all of which have cooling properties.
- Good intake of Ghee in foods.
- Listening to soothing music.
- Consuming ice and cold foods.
- Regularly drinking milk.
- Exposure to moonlight.
- Wearing necklaces made of gems (Manihara).
- Using fragrance around home.
- Activities and foods that pleases heart.
- Spending happy times with quality relations in life.
- Walking in lush green grass lands with naked feet.
- Spending time in water-bodies like lakes and beaches.
- Taking regular Therapeutic purgatives on expert consultation.
Madhyama meaning “Medium” in relevance to the bowel nature of such individuals. It is seen when Kapha dosha is dominant. Kapha is responsible for formation of soft, solidly formed ideal texture of stools. If Kapha is present in adequate amounts in alimentary canal, motion would be like an ideal one. But if there is an excess of Kapha, mucous is also passed out with stool. Hence characteristics of Madhyama koshtha are:
- Daily passage of motion, once a day.
- Stools are formed and not loose.
- Episodes or constipation and diarrhoea are rare.
- Requires minimal effort to pass and is easy.
- Quick to evacuate but takes a little longer than Mridu koshtha.
- Satisfaction of good evacuation is achieved after defecation.
How Madhyama Koshtha Is aggravated?
Madhyama Koshtha can manifest mainly due to either aggravation of Kapha or presence of Kapha constitution since birth. So the factors that aggravate Kapha will automatically vitiate Madhyama Koshtha which are:
- Intake of excess of sweet, oily, fatty, hard to digest foods
- Sleeping in excess in daytime
- If exercise is very less or nil, sedentary lifestyle
- Excessive intake of Ghee
- Spring season
- High calorie foods
- Excessive intake of water or fluids
- Excess intake of milk or milk products
- Kapha has a tendency to increase just after taking food or early in the morning too. So avoid doing above activities in conjunction with these timings.
How To Relieve Excessive Kapha To Maintain Madhyama Koshtha?
In order to keep Kapha dosha in a balanced in a Kapha constitution person and to lessen aggravated Kapha dosha in other individuals, following measures are helpful:
- Inducing strong emesis or purgation. This can be done under the guidance of a qualified Ayurvedic practitioner.
- Taking dry, hot and intensely flavoured foods
- Taking less quantity of food (Alpaharam) or even consider some fasting.
- Staying awake late night.
- Taking long duration fermentation foods or alcoholic beverages.
- Dry massages.
- Eating honey
- Increasing sexual activities
- Taking medicated smokes
- Mental strain
- Staying away from bodily comforts
- Exercising regularly
Ayurvedic Importance of Koshtha Pareeksha:
- Koshtha pareeksha helps to gather knowledge to judge Shareera Rachana (Body constitution) of any individual. This is the basis of diagnosis and treatment of disease processes.
- Koshthas (Cavities), most importantly, contains organs and understanding their function is very crucial to determine the site of disease or predict the chances/ possibilities of certain diseases. Many Organs act as a root for Srotas (channels or transport system) where movement of energy occurs. Srotodushti or any blockage in a particular srota leads to particular disease. Human body is said to have hundreds of Srotas that originate from different sites on different organs or vessels.
- Koshtha examination is helpful while treating constipation and deciding the right dose of medicines (Snehana) required. Krura koshtha requires treatment with Snehana for 7 days which is 5 days for Madhyama and 3 days for Mridu Koshtha.
- Ayurveda stresses immensely on the importance of a clean gut (Koshtha shuddhi) to achieve optimal well-being throughout the body because what we eat is what we become. In order to be in this state of perfect equilibrium of all doshas and elements, one needs a clean gut and healthy bowel movement. Otherwise the faecal matter that stays inside the system for long produces toxins that harm all organs and create diseases eventually. This makes the study of Koshthas (Koshta Pareeksha) most important.
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