The 7th chapter of Charaka Samhitha Vimana Sthana is Vyadhita Rupiya Vimana. It deals with the determination of the specific types of patients, different types of parasites and their treatment through Panchakarma and oral medicines. Let us explore the chapter on the “Vyadhita Rupeeya Viaman – Determination of the specific different types of Patients”. Thus said Lord Atreya [1-2]
Two types of patients
इह खलु द्वौ पुरुषौ व्याधितरूपौ भवतः- गुरुव्याधितः, लघुव्याधितश्च|
तत्र- गुरुव्याधित एकः सत्त्व बल शरीर सम्पदुपेतत्वाल्लघुव्याधित इव दृश्यते, लघु व्याधितोऽपरः सत्त्वादीनामधमत्वाद्गुरु व्याधित इव दृश्यते|
तयोरकुशलाः केवलं चक्षुषैव रूपं दृष्ट्वाऽध्यवस्यन्तो व्याधि गुरु लाघवे विप्रतिपद्यन्ते||३||
iha khalu dvau puruṣau vyādhitarūpau bhavataḥ- guruvyādhitaḥ, laghuvyādhitaśca|
tatra- guruvyādhita ekaḥ sattva bala śarīra sampadupetatvāllaghuvyādhita iva dṛśyate, laghu vyādhito’paraḥ sattvādīnāmadhamatvādguru vyādhita iva dṛśyate|
tayorakuśalāḥ kevalaṃ cakṣuṣaiva rūpaṃ dṛṣṭvā’dhyavasyanto vyādhi guru lāghave vipratipadyante||3||
Patients can be classified into two groups, viz,
Guru Vyadhita – those suffering from serious diseases and
Laghu Vyadhita – those suffering from mild diseases.
The patient suffering from a Guru Vyadhi (serious disease) may appear to be suffering from a mild disease due to
Good Satva – good tolerance capacity
Bala – immunity of the patient
Shareera Sampath – physical strength.
Due to bad tolerance capacity, weak immunity and weak physical strength, a Laghu Vyadhi can look like a Guru Vyadhi in some patients.
Unskilled physicians, who try to diagnose just by seeking, commit mistakes in determining Laghu and Guru Vyadhis. 
Need for careful examination
One cannot perceive a thing in its entirety with partial knowledge. In the absence of the correct knowledge of the disease, one commits mistakes in deciding the rationale behind the line of treatment. When the doctor mistakes a patient suffering from a serious disease (Guru Vyadhita) for Laghu Vyadhita, he would administer Mrudu Samshodhana – soft treatment, leading to further aggravation of Doshas and diseases. (Dosha Udeerana).
Similarly, if the doctor mis-diagnoses a weak disease as Guru Vyadhita, then he may administer Teekshna Shodhana – very strong purification procedures, leading to depletion of body tissues and health – Shareera Kshaya.
Physicians, who diagnose diseases accurately, by comprehensive patient examination, seldom err in deciding about Guruvyadhita or Laghu Vyadhita. and achieve cure of the disease. 
Thus it is said:
Because of the variation in
Satva – patient’s mental tolerance capacity toward treatment,
Bala – physical strength and immunity of the patient etc., an ignorant doctor may commit mistakes in deciding the seriousness or mildness of the disease, leading to selection of wrong therapies. This results in aggravation of the disease.
Physicians well versed in the science, ascertain all aspects of the disease and examine it by employing all the methods; they seldom err in administering correct therapies. [5-7]
Agnivesha’s query about Parasites
Thus, the classification of patients, cause of incorrect diagnosis along with its bad consequences, factors responsible for correct diagnosis and good results born out it- these topics are elaborately described.
Having listened to all this, Agnivesha fell at the feet of Lord Atreya and inquired about the specific cause, habit, from color, name, effect and treatment of all parasites (Krumi) having human body. 
Four groups of Krumi
Lord Atreya replied to Agnivesha,
“There are twenty types of Krumi, which can be grouped into four, on the basis of their source,
Malaja born of external excreta
Pureeshaja Krumi – born of feces,
Sleshmaja – born of Phlegm
Shonitaja – born of blood 
Pureeshaja Krumi (Malaja Krimi) – Yuka, Pipeelika
Shonitaja Krumi – Keshada, Lomada, Lomadvipa, Saurasa, Audumbara, Jantumata
Shleshmaja Krumi – Antrada, Udarada, Hrudayachara, Churava, Darbhapushpa, Saugandhika, Mahaguda
Purishaja – Kakeruka, Makeruka, Leliha, Sashulaka, Sausurada
Waste products are of two types – external and internal. Malaja Krumi are considered to be born of external waste products.
Cause for Malaja Krimi – lack of cleanliness
Samutthana – Habitat: hair on the head, face and other parts of the body, eye lashes and dresses.
Shape and size – minute, Millipede and having the shape of seasme grains.
Color: Black and while
Effects: Itching, production of urticaria and pimples
Apakarshana – killing of these Krumis
Malopaghata – removal of waste products
removal of these of such regimens which produce the excreta. 
Read related: Ayurvedic Treatment For Worm Infestation
Shonitaja Krumi – Parasites of blood:
Cause: the same as for Kushta – skin diseases
Samutthana – Raktavahi Dhamani – blood vessels
Samsthana – Form: minute, round and having no pedicle (Apada). Because of minuteness some of them are not visible to the naked eye.
Keshada(which eat away hair of the head)
Lomada (which eat-away the small hair of the body), Lomadvikpa,
Saurasa, Audumbara and Jantumatara.
Read related: Krimighna Gana: Parasites Relieving Herbs: Review, Benefits, Formulations
Prabhava of Shonitaja Krumi –
Destruction of the hair from the head, face, other parts of the body, eye-lashes and nails.
When a wound is affected, it causes
Harsha – hyperesthesia,
Kandu – itching,
Toda – pain and
Samsarpana – creeping sensation in the ulcerated area are caused;
When excessively grown they eat away the skin, vessels, ligaments, muscles tissue and cartilages;
Treatment: same as that of Kushta, which is described in 7th chapter of Chikitsa sthana of Charaka Samhita. 
Causes for Sleshmaj Krumi:
Intake of milk, Sugar-candy, excess sesame seeds, fish, meat of animals inhabiting marshy land (Anupa Mamsa),
Pishtanna – Pastries,
Paramanna – milk preparations,
Kusumabha taila ( Carthamus tinctorious Linn). Uncooked, putrefied and softened food, food mixed with despicable articles like feces, food having mutually contradictory properties and unwholesome food.
Habitat: Amashaya; when excessively grown, they move upwards, or to both the sides.
Form and color: some are big and fat (tape like) in shape and white in color; some are round in shape like earth worm and white in color with a coppery tinge; some are minute and long in shape like a thread and white in color.
Names of Shleshmaja Krumi:
Antrada (which eats away the intestine)
Udarada (which disturbs stomach)
Hrdayacara (lit. which move in the heart), Guru, Darbhapuspa (which is like the flower of Darbha), saugandhika (Mahagruda (Lit having a big anus).
Effects: Nausea, salivation, anorexia, indigestion, fever, fainting, yawning, sneezing, constipation, malaise, vomiting, emaciation and dryness of the body. 
Pureeshaja Krumi: Parasites of feces:
Causes of Pureeshaja Krumi: Same as Shleshmaja Krumi
Habitat: Pakvashaya or colon; when excessively grown they move downwards; when they move towards Amasaya or stomach, then the eructation and breath of the patient produce fecal odour.
Form and color: some of them are minute, cylindrical and long, they appear like the fibers of wool and they are white in color; some others are thick, cylindrical and their color are gray, blue, green or yellow.
Names of Purishaja Krumi: Kakeruka, Makeruka, Leliha, Sasulaka (which cause colic pain) and Sausurada.
Effects: diarrhoea, emaciation, dryness and horrification they inhabit the oral region and cause irritation and itching there; when excited they frequently come out of the anus.
Thus the cause etc., of parasites born of phlegm and feces as described. 
Krimi Chikitsa Sutra
Krumi Chikitsa Suthra – Line of treatment:
तत्र सर्वक्रिमीणामपकर्षणमेवादितः कार्यं, ततः प्रकृतिविघातः, अनन्तरं निदानोक्तानां भावानामनुपसेवनमिति||१४||
tatra sarvakrimīṇāmapakarṣaṇamevāditaḥ kāryaṃ, tataḥ prakṛtivighātaḥ, anantaraṃ nidānoktānāṃ bhāvānāmanupasevanamiti||14||
Line of treatment of Krumi in brief:
Apararshana – extraction of Krumi- by hand and by Shodhana
Prakruti Vighata – acting against the nature of the Krumi. Eg: Shleshmahara procedures in Shleshmaja Krumi.
Nidana Anupasevana – avoiding causative factors factors 
Krumi Apakarshana – Procedure to be followed for parasite extraction –
Parasites may be extracted by hand with or without the help of instruments (forceps etc). Parasites residing inside the body can be extracted by the Shodhana therapies –
Virechana and Asthapana Basti.
Prakruti Vighata treatment for Krumi –
Counter-acting the factors responsible for the production of parasites.
Drugs and diets which are pungent, bitter and astringent tastes, Kshara, Ushna medicines, in nature are given, along with other Kaphahara Pureesha hara medicines are administered.
Factors which produce these parasites and similar other substances are to be avoided. 
Preparatory treatment for Krimi treatment:
The patient afflicted is given Snehana, Swedana for 6 – 7 days,
Next day (a day before the administration of elimination therapy) during morning and evening meals he is given food consisting of milk, sugar candy, curd, sesame, fish, Anupa mamsa, Pishtanna, milk preparation and oil of Kusumbha (Carthamus tinctorius Linn). with a view to arousing the parasites and impelling them to migrate to the alimentary tract.
If the patient passes the night comfortably and the food taken by him in the previous day is fully digested, he is given Asthapana Basti, Vamana, Virechana – all on the same day, provided the patient is found fit for all these therapies. 
Radish, mustard, garlic, Karanja, Moringa leaves and seed, Kharapushpa, Bhutruna, Sumuka, Srasa, Kuteraka, Gandiraka, Alamala, Parnasa, Kshavaka, Phaninjaka – all these herbs or whichever are available, are taken, washed well, cut into small pieces, taken in a vessel, added with cow urine and half part of water, boiled till Gatarasa (herbs leave their taste), – filtered. While they are Sukhoshna – lukewarm, Madanaphala pippali, Vidanga Kalka, sesame oil, Swarjika Lavana are added as prakshepa and administered as Asthapana Basti.
Or, Basti prepared with Decoction of these – Arka, Alarka, Kutaja, Adhaki, Kushta, Kaidarya + madanaphala pippali etc. herbs Or
Basti with Decoction of Amalaki, ginger, Daruharidra, Pichumardha + Madanapippali etc Prakshepa are administered as Asthapana basti for 3 0r 7 days.
After Basti treatment, Ubhayato Bhagahara Samshodana is adminsitered. (Vamana and Virechana)
For this, Madanapahala pippali Kashaya – half anjali, along with Trivrit Kalpa – 12 grams is mixed and administered. This will induce vomiting and purgation.
After the patient is well-purged, in the afternoon, he is sponged with the lukewarm decoction of Vidanga (Embelia ribes).
He should use Vidanga Kashaya for washing and drinking. in place of water. If this decoction is not available then the decoction of drugs having pungent, bitter and astringent tastes or Kshara or prepared of urine may be used for sponging over the patient.
After getting sprinkled with the decoction etc. the patient should enter into a closed room (a room which is not windy) and be gradually be given with Panchakola Yavagu.
When the patient comes to the stage of being given Vilepi (thin gruel) then he is administered two to three Anuvasana Basti with Vidanga taila on alternate days. [18-19]
Administration of nasya
If it is observed that these parasites have invade the head because of their excessive growth, thereby causing injury to the head, the of patient is oleated and fomented and Doshas from the head is purged by the administration of earthiness prepared with the de-husked seeds of Apamarga (Achyaranthes aspera) as described in the second chapter of Sutra section 
Antidotes for production of parasites
We shall now explore the measures to be adopted for counter-acting the factors responsible for the production of parasites.
Mulakaparni (Moringa oleifera Lam) along with its roots and branches is collected, cut into pieces, crushed in a mortar and its juice is extracted by manual pressure. Juice and made to Pupalikas (a type of cake) which are again to be fried with smokeless fire- brands.
The patient suffering from parasitic infection is given this cake to take to take along with the salt and the oil of Vidanga (Embelia ribes Burm f)
Then, he is made to drink sour Kanji ( sour gruel) or Udashvit ( a mixture of water and buttermilk in equal quantity) along with salt and the powder of
Pippali – Long pepper fruit – Piper longum (Piper longum Linn),
root of Pippali – Long pepper fruit – Piper longum,
Chavya (Piper chaba hunter),
Chitraka (Plumbago zeylanica Linn) and
Shringavera – Ginger.
On the same way, Pupalika type of cake may be prepared by the juice of any of the following plants;
Markava (Eclipta alba Hassk), Arka – Calotropis gigantea R. Br. Ex Ait), Sahacara (Barleria critata Linn),
NIpa (Anthocephalus indicus A. Rich., (Nirgundi (Vitex negundo), various types of Basils, Viz, Sumukka, Surasa, Kutheraka, Gandira, Kalamalaka, Parnasa, ksavaka, and Phnijjhaka, Bakula (Minusopas elengi Linn), Kutaja – Connessi bark, Suvarnaksriri .Kinihi (Achyranthes aspera Linn),
Kriratatikta (Swertia chirata Buch_Ham), Suvaha– Operculina turpethum, Amalaka (Emblica officinalis Gaern), Haritaki (Terminalia chebula Linn) and Bibhitaka (Terminalia bellirica Roxb).
The patient may be given the juice of all these plants or one or two of them mixed with honey in the morning in empty stomach. 
Another recipe for counter action:
Another recipe for counteracting the factors responsible for the production of parasites is also follows: horse-dung is collected, spread over a tray and kept exposed to sun till it gets dried up. This should thereafter be crushed in a motor and again pounded in a stone slab so as to make it a fine powder.
The powder is well impregnated in the sun, with the decoction of Vidanga or Triphala – eight or ten times. This again is made to a fine powder over a stone slab and stored in an air tight new earthen jar carefully so as to avoid any infection.
This powder, in the dose of one Panitala (12 g) or in another suitable dose mixed with honey and in the form of a linctus is given to the patient suffering from the parasitic infection. 
Third recipe for Counter-action:
Another recipe for counteracting the factors responsible for the production of parasites is as below:
One Kalasa 912. 288 Kg) of the stones of Bhallataka (Semecarpus anacardium Linn.) is collected , crushed and kept in an earthen jar having many fine a lid and wrapped well (except over the bottom portion of it) with clay.
This jar is placed over another jar which is strong, smeared inside with oil and buried under ground up to its neck. Cow-dung cakes is piled “all around the jar and ignited.
When the cow dung cakes are well burst and the stones of Bhallataka (Semecarpus anacardium Linn.) have been drained of their oil contents, then the upper jar is removed and the oil from the lower jar is collected. This oil mixed with halt of its quantity of the de-husked seeds of Vidanga is kept in the sun for the whole day.
This potion, given to the patient in a proper dose will cause purgation. Follow- up measures to be adopted after purgation have already been described. Similarly the oil extracted from the wood of Bhadradaru (Cedrus deodara Loud) and Sarala ( Pinnus roxburghii) may be administered.
There after, in appropriate time, the patient is given Anuvasana (oleation) type of enema [23-24]
Fourth recipe for counter action:
Another recipe for counter acting the factors responsible for the production of parasites is as follows:-
Fresh sesame seeds of good quantity; harvested in the autumn is collected, separated from dirt particles, washed well and kept in the dirt particles , washed well and kept in the lukewarm decoction of Vidanga (Embelia ribes burm f) till all the dirt particles are removed.
Then the decoction is drained out. When the Taila is free from impurities, it is de-husked, cleaned well again, washed well, impregnated well for twenty one times in the decoction of Vidanga, dried in sun, crushed in a mortar and made to a fine powder over a stone slab, keeping this fine powder in a container, it is rubbed well with hands again and again, sprinkling frequently the decoction of Vidanga. The oil which comes out of it by the application of presence is collected by hand and kept in a safe place in a clean and strong earthen jar. 
Fifth recipe for counter action:-
Another therapy for counter acting the factors responsible for the production of parasites is as follows:-
Tilvaka (symplocos Racemosa Roxb) and Uddalaka – one Bilva (48 g) of each is collected, Made to a fine paste by the addition of the decoction of Vidanga (Emabelia ribes Burm. f) and kept in bolus form.
Similarly half Bilva (24g) each of Syama (black variety of Operculina turpethum R.B), one fourth Bilva (12 g) each of Danti (Balispermum montannum Muell-Arg) and Dravanti (Gatropha glundulifera Roxb) and one eight Bilva (6g) each of Chavya (Piper chaba Hunter) and Citraka(Plumbago zeylanica Linn) is collected. The above mentioned ingredients is mixed with half Adhaka – 3.072 kg (1.53 liter) of the decoction of Vidanga and one Prastha – 768 ml(0.768 liter)( of oil. all of them is mixed well in a sufficiently big vessel and kept over fire.
This oil is constantly stirred through a ladle over very mild fire by a person comfortably sitting near the hearth and carefully watching the oil from all sides. the time of removing the oil- pan out of fire is determined by the following criteria:-
Stoppage of the budding sound
Subsidence of the foam
Appearance of clarity in the oil
Manifestation of the desired smell; color and taste
When a portion of the pasted drugs mixed with the oil, is rubbed with the fingers then it takes the shape of a wick, it does not adhere to the finger and it is neither very hard nor very soft to touch.
When it cools after having been taken out of fire, it is filtered with a new cloth and kept in a clean and strong earthen jar. this jar is closed with a lid and covered with a piece of white cloth, tied well with rope and kept in a safe place. this oil, given to the patient in proper dose to drink will cause Virechana. when all the impurities are removed from the body, follow up measures as already described (in para- 19 of this chapter) is adopted. in proper time he is given Anuvasana (oil enema) also.
Following the same method, oil is prepared with drugs like Sarsapa ( Brassica nigra Koch), Atasi ( Linum usitatissimum Linn), Karanja (Pongamia pinnata Merr) and Kosataki (Luffa acutangula) and after having examined all aspects, the patient is administered this therapy. This cures the patient of his disease. 
Thus the specific cause, shape, color, names, effects and treatment of parasites with origin both from phlegm and feces are generally explained. Difference in the treatment of these two types of parasites is as follows:- for the feces- born parasites, the treatment involves the administration of the above mentioned drugs in small quantity, mostly in the form of Asthapana (corrective) and Anuvasana (oleation) types of enema and purgative.
For phlegm- born parasites, however, the drug is in large quantity and mostly having the property of eliminating Doshas from the head (errhines), emesis and sedation. Thus the ant parasitic therapies are explained. While administering these therapies, efforts is made to avoid such of the causative factors which are responsible for the production of these parasites. Thus the treatment of parasites of the alimentary tract as was suggested in paragraph 14 is explained. 
Thus it is said:-
The treatment of Krumis involves
Apakarshana – removal in the beginning.
Prakruti Vighanta – Then the causative factors for their production of parasites is countered and
Nidana Tyaga – avoiding causes.
These three principles of treatment described for curing the parasitic infestation are also applicable for the cure of all diseases in general. Elimination therapy, alleviation therapy and avoidance of causative factor- these three principles along with their proper procedure is adopted for treatment each and every disease by the physician. [28-30]
To sum up:-
Two types of patients, ignorant and wise physicians, need for correct determination, twenty types of parasites, seven aspects, viz., etiology etc., of these parasites- all these topics are described by Lord Atreya in this chapter – Vyadhita Rupiya with a view to proper understanding of the disciples and curing the disease. [31- 32]
Thus ends the seventh chapter on the “Determination of the specific characteristics of Different Types of Patients” of the Vimana section of Agnivesha’s work as redacted by Master Charaka.