KAMALA – HETU, SAMPRAPTI, TYPES, DIFFERENTIAL DIAGNOSIS, UPADRAVA, PROGNOSIS AND CLASSIFICATIONS

KAMALA – DEFINITION, HETU, SAMPRAPTI, TYPES, DIFFERENTIAL DIAGNOSIS, UPADRAVA, PROGNOSIS AND CLASSIFICATIONS

DEFINITION OF KAMALA

Kamala is a Pitta-dominant disorder primarily involving Yakrit (liver), manifesting with Haridra-netra-twak-nakha (yellow discoloration of eyes, skin, and nails), and is generally a sequelae of Pandu roga or other Pittaja disorders.

सन्धारणाद् दोषाणां विकारप्रदोषाज्ज्वरात् ।
कामलं जायते रोगं पाण्डुत्वात् परमं स्मृतम् ॥
— Aṣṭāṅgahṛdaya, Niḍānasthāna 12/13

Kamala is considered a Pitta-nānātmaka-vyādhi with predominance of Ranjaka Pitta dushti involving Raktavaha and Annavaha srotas, primarily affecting Yakrit and Pliha.

HETU (ETIOLOGY) OF KAMALA

• Ati-sevana of ushna, amla, lavana rasa

• Madya sevana (alcohol)

• Excessive exposure to sun/heat

• Dushita anna-pāna

• Krodha, vyayama, kshaya

• Continuation of nidana of Pandu roga

• Agni-mandya and Dushti of Ranjaka pitta

स्निग्धोष्णाम्ललवणैः क्षारमद्यमधूनि च ।
तैः सहोष्णं रुचिं चापि प्रीणनं च प्रयोजयेत् ॥
तेषां युक्तिविरुद्धानां सेवनाच्च विशेषतः ।
कामलं सञ्जयत्येव दोषैः पित्तप्रकोपितैः ॥
— Aṣṭāṅgahṛdaya, Niḍānasthāna 12/6-8

SAMPRAPTI (PATHOGENESIS) OF KAMALA

• Vitiated Pitta especially Ranjaka Pitta affects the liver (Yakrit) and spleen (Pliha).

• Due to impaired agni, the Rakta is improperly formed, leading to accumulation of vitiated Pitta and Rakta.

• The Rakta and Pitta are expelled through external dhatus like Twak (skin), leading to yellow discoloration.

PITTASYA PRADHANYENA → RANJAKA PITTA DUSHTI → YAKRIT/PLIHA DUSHTI → AVARNATA/ASAMYAK RASA-RASA DHATU → KAMALA LAKSHANA

CLASSIFICATION OF KAMALA BASED ON VIDHI SAMPRAPTI

1. KOSTHA SHAKHASHRITA KAMALA

   • Originates in Kostha (GI tract)

   • Associated with Mandagni and Ama

   • Symptoms like Arochaka, Aruchi, Vibandha

   • Easily curable with deepana, pachana chikitsa

2. SHAKHASHRITA KAMALA

   • Migration of vitiated Pitta to shakha

   • Involves dhatus like Rasa, Rakta

   • Dushti in Yakrit & Pliha

   • More chronic, dushta, difficult to treat

3. HALIMAKA / LOHITAKAMALA

   • Severe form, occurs when Kamala persists without proper treatment

   • Mixed vitiation of Kapha and Pitta

   • Presents with daha, moha, tamah pravesha, etc.

4. KUMBHAKAMALA

   • Most chronic and difficult form

   • Granthibhoota pitta dushti

   • Associated with gall bladder obstruction or chronic hepatitis in modern correlation

DIFFERENCE BETWEEN KOSTHA SHAKHASHRITA AND SHAKHASHRITA KAMALA

UPADRAVA (COMPLICATIONS) OF KAMALA

• Udara (Ascites)

• Pandu (Anaemia)

• Shotha (Edema)

• Hrudroga (Cardiac involvement)

• Jwara (Fever)

• Mrityu (Death – in Kumbhakamala)

कामलात् कुम्भकामलं ततोऽन्नवहस्रोतसां क्षयात्।
उदरं भृशमुत्पन्नं ततः कालान्तकं भवेत्॥
— Aṣṭāṅgahṛdaya, Niḍānasthāna 12/29

SADHYA-ASADHYATA (PROGNOSIS) OF KAMALA

• Sadhya: Kosthagata Kamala, recent onset, mild symptoms

• Kricchrasadhya: Shakhagata Kamala

• Asadhya: Kumbhakamala, Halimaka, Kamala with Udara, Pandu, Jwara, or Mrityu lakshana

कामला नवजा साध्या कर्षति स्फुटदर्शनात्।
सदा कृच्छ्रातिशूलार्ता कृच्छ्रसाध्या प्रकीर्तिता॥
— Aṣṭāṅgahṛdaya, Niḍānasthāna 12/30

SWATANTRA AND PARATANTRA KAMALA

• Swatantra Kamala: Arises independently due to direct Pitta prakopa

• Paratantra Kamala: Secondary to other diseases like Pandu, Jwara, etc.

स्वतन्त्रं पित्ताद्वा रोगं पाण्ड्वादीनां च हेतुकम्।
परतन्त्रं तदुक्तं स्यात् लक्षणाभेदतो विदुः॥

ALPAPITTA KAMALA AND BAHUPITTA KAMALA

• Alpapitta Kamala:

  • Mild pitta dushti

  • Lesser discoloration, manageable symptoms

  • Easier to treat

• Bahupitta Kamala:

  • Excessive pitta dushti

  • Intense yellow discoloration

  • Daha, jwara, moha prominent

  • Difficult to treat

MODERN CORRELATION OF KAMALA (Jaundice)

Kamala can be correlated with Jaundice, a clinical condition characterized by yellow discoloration of sclera, mucous membrane and skin due to elevated bilirubin in the blood.

Types of Jaundice (Modern):

• Pre-hepatic (Hemolytic): Excessive RBC destruction

• Hepatic (Hepatocellular): Hepatitis, cirrhosis

• Post-hepatic (Obstructive): Gallstones, tumor, strictures

Clinical Features (Modern):

• Yellow sclera

• Dark urine

• Pale stools

• Fatigue

• Pruritus

• Hepatomegaly

Common Causes (Modern):

• Viral hepatitis (A, B, C)

• Alcoholic liver disease

• Drug-induced hepatitis

• Gallstones

• Hemolytic anemias

• Cirrhosis

Investigations:

• Serum bilirubin (total, direct, indirect)

• Liver function tests (ALT, AST, ALP, GGT)

• Ultrasound abdomen

• Viral markers

• Peripheral smear (for hemolysis)