Samprapti Vijnyanam (Pathogenesis)

Ayurveda for a healthy life ! – 36/2024 on 16.9.2024

रोगस्तु दोषवैषम्यं दोषसाम्यमरोगता । – वा. सू. १.२०

Health is defined as a balanced state, while disease represents un­balanced state of doshas (Vata, Pitta and Kapha), dhatus (tissues) and mala (waste products). The deviation from robust health to diseased state is brought about by the etiological factors, which increase, decrease or vitiate the doshas, dhatus and mala. Hereditary factors like constitution etc. predispose one to a particular group of disease, which become manifest by the action of environ­mental, seasonal and dietary factors, weak digestive power etc. as well as other unknown factors, which give rise to imbalance in the state of doshas. It is this imbalanced state of doshas, which give rise to diseased state. Person with good defence mechanism of the body (Vyadhisahatva) with good quality of digestive and tissue enzymes may be able to digest the doshas and ward off further increase and accumulation of doshas by following appropriate do’s and don’ts as far as diet and activities are concerned.

Quality of mind depends on the dominance of particles of raja, tama or satva or their balance state. As far as mind is concerned, rajasik and tamasik personalities are considered to be diseased ones, where as satvik is considered to be healthy and highly evolved mental state, which is superseded only by trigunateet personality. Details of these are described in the first part of basic principles of Ayurveda. As described there, their qualities are dependent on the fine raja, tama and satva qualities.

Pathogenesis gives us the insight into the development of the disease. It gives us an exact idea as to how the aetiological factors gives rise to increased formation of doshas, how the doshas travel to different sites setting in the disease process. Utilising knowledge of pathogenesis, we can arrive at the cause of a disease and also understand the events in the development of a disease. Treatment means breaking the chain of these events that lead to the disease. If we carefully consider the pathogenesis of disease before treating it, success is assured in the treatment. The development of the disease is described under six stages viz. chaya, prakopa, prasara, sthanasanshraya, vyakti and bheda.

1.     Chaya : Stage of accumulation of doshas

When the aetiological factors are not powerful, the doshas accumulate slowly and in small amounts

चीयते लघुरूक्षाभिः ओषधीभिः समीरणः ।

तद्विधः तद्विधे देहे कालस्यौष्ण्यान्न कुप्यति ।। – वा. सू. १२.२५

Example : The increased Vata dosha produced by the dryness and lightness of the air in greeshma that is summer is partially subdued by the heat of greeshma. Hence, the Vata-dosha accumulates only to a limited extent that is in small amount in the body and is termed as Vata-chaya. Similarly, accumulation to a limited extent of Pitta and Kapha dosha that is Pitta chaya and Kapha chaya occurs in varsha that is rainy season and shishir that is winter season respectively.

The doshas tend to collect locally depending on the aetiological factors example dietetic indiscretion, excessive activity and breathing moist air would result in accumulation of doshas in gastro-intestinal tract, muscles and lungs respectively. Doshas also collect in their specific sites example doshas due to dietetic indiscretion tend to collect in colon, small intestine and stomach in Vata, Pitta & Kapha chayas respectively.

तत्र संचितानां खलु दोषाणां स्तब्धपूर्णकोष्ठता पीतावभासता मन्दोष्मता चाङ्गानां गौरवं चयकारणविद्वेषः चेति लिङ्गानि भवन्ति । – सु. सू. २१.१८

A.    Clinical manifestations

The clinical manifestations are fullness of stomach in Vata chaya, yellowish discoloration of skin in Pitta chaya & weak digestive power, heaviness of body and laziness in Kapha chaya. In addition, one develops aversion to the aetiological factor example if one takes excess of cold drinks and Vata chaya occurs, one develops aversion to cold drinks. If Vata chaya occurs due to eating in excess dry food items, one develops aversion to dry food items.

B.    Course

The accumulated doshas may come back to normal level or may increase & lead to second stage of prakopa. Sometimes doshas lie dormant in one stage for a long time till additional causative or precipitating factors stimulate them when they progress to next stage.

C.    Natural cure for the accumulated doshas

The diurnal variations which lead to accumulation of doshas tend to correct increased doshas themselves example increased Kapha in the morning comes to normal level by heat in the afternoon.

Development of aversions to the aetiological factors in chaya stage also tends to correct the increased dosha example eating excess of sweets leads to accu­mulation of Kapha dosha. This gives rise to aversion to sweets, which in turn results in natural cure.

The accumulated dosha may remain dormant for some time and later lead to prakopa stage when triggered by
dietetic or environmental factors example Vata chaya in greeshma season results in Vata prakopa in varsha season due to cold environment.

Chaya stage will quickly lead to prakopa stage, if aetiological factors are powerful or one does not pay attention to the natural caution signal that is aversion to the aetiological factors.

D.    Treatment

It is important to treat the doshas in chaya stage, as they constitute the seeds of disease, which should not be allowed to germinate.

The treatment consists of avoiding aetiological factors, which would be indicated by development of natural aversion to them.

तत्राल्पे लङ्घनं पथ्यं मध्ये लङ्घनपाचनम् ।।

प्रभूते शोधनं तद्धि मूलादुन्मूलयेन्मलान् । – वा. सू. ८.२१

In addition, one should neutralise the increased dosha by appropriate treatment that is by ‘langhana’, if dosha is in small amounts; by ‘deepana’ and ‘pachana’, if doshas are in moderate quantity and getting rid of doshas by emesis, purgatives or enemas if doshas are in large quantity.

2.     Prakopa : Stage of accumulation of doshas in excess

When aetiological factors are not controlled and continue to act for long the doshas continue to increase further and accumulate in excess until they reach the prakopa stage.

A.    Clinical manifestations 

तेषां प्रकोपात् कोष्ठतोदसञ्चरणाम्लिकापिपासापरिदाहान्नद्वेषहृदयोत्क्लेदाश्च जायन्ते । – सु. सू. २१.२७

Pain in abdomen and awareness of movements of gases in abdomen occur in Vata prakopa. Pitta prakopa gives rise to thirst, regurgitation with sour taste and burning sensation. Nausea and disgust for food are the symptoms of Vata prakopa. In addition, one develops a desire for factors and substances having properties opposite to the causative agents. This desire is obvious, when a single powerful factor is acting for quite sometime and may not be seen when multiple factors are operating.

B.    Course

As in chaya stage, the doshas in prakopa stage may subside naturally, when the season changes. If ppropriate action is taken the doshas will subside quickly. The doshas may remain dormant for sometime and are reactivated, when aetiological or precipitating factors trigger them. When the aetiological factors are powerful and or continue to act for quite sometime, the doshas will further increase and may lead to 3^rd stage of prasara.

C.    Treatment

Treatment consists of administering substances having properties opposite to those of aetiological factors.