Disease State and various stages of pathogenesis

Ayurveda for a healthy life ! – 38/2024 on 16.10.2024

5. Vyakti : Disease state

When the causative doshas accumulate in excess and cause significant damage to the tissues or organ, the disease manifests itself. The classical symptoms and signs of the disease now become apparent. The clinical manifestation depends on the organ involved as well as the causative dosha. They are described under individual diseases in standard text books.

A. Roopa that is clinical manifestations of disease

संस्थानं व्यञ्जनं लिङ्गं लक्षणं चिह्नमाकृतिः ।। – मा. नि. १.७

Roopa, Linga, Lakshana, Chinnha, Akruti, Vyanjana and Sansthana are equivalents and are used synonymously. These are related to the affected doshas as well as the organ or the tissue. The symptoms arise as a result of increase, decrease or vitiation of dosha. The same symptoms are termed as clinical manifestation of disease, if it arises as a result of damage to a tissue or organ by dosha. A person with good resisting power, even when afflicted with a major disease, appear to be suffering from a minor disease and vice versa.

The clinical manifestations as well as prodromal symptoms indicates the doshas, tissue or organ affected in a disease example colicky pain, burning sensation and sensation of heaviness indicate increase in Vata, Pitta and Kapha respectively. Pallor, cramps in muscles, emaciation and pain in the bones indicate affection of blood, muscular tissue, fatty tissue and bony tissue respectively. Cough, diarrhoea and unconsciousness indicate the affection of respiratory, gastro-intestinal and nervous system respectively.

The clinical manifestations give us an important clue to the diagnosis, the stage of the disease, differential diagnosis, prognosis and treatment in every case. In Ayurveda, diseases are often named after the most important or the main symptom example kasa that is cough can be a symptom of many disease or it may be a disease entity itself example cough is a symptom of heart disease or hysteria, while when one talks of kasa as a disease entity, one has tracheobronchitis in the mind.

In practice, majority of the patients seek the advice of physician for one or two symptoms like headache, burning sensation etc. In many of these cases, one does not find any evidence of affection of tissues or organs. Hence, these persons cannot be labelled as suffering from a particular disease. Detection and correction of the root cause and treatment to correct the unbalanced state of doshas is enough to cure the symptom. On the other hand, when a person suffers from disease entity, apart from correcting the causative factors and doshas, one has to protect and increase the resistance of the tissue and organ attacked by doshas. Hence, symptoms can be easily controlled, while the disease entity takes longer time to settle. In addition, it is important to follow do’s & don’ts during convalescence and afterwards till normal state of tissues and organs is restored.

6. Bheda

It is the stage of differentiation of the type of disease. During this stage, if the disease is localised superficially as in an abscess, the pus comes out by rupture of the abscess and the body gets rid of the doshas and the damaged tissues. In diseases like fever, the body cannot get rid off the doshas quickly. Hence such diseasestend to become chronic. During this stage, these differentiate further depending on the particular doshas affected example vataja fever, pittaja fever, kaphaja fever etc. If not treated properly and in time, they may become chronic or incurable.

The various stages of pathogenesis have been summarised in the table on next page.

A. Upadrava that is complication

उपद्रवस्तु खलु रोगोत्तरकालजो रोगाश्रयो रोग एव स्थूलोऽणुर्वा रोगात् पश्चाज्जायत इत्युपद्रवसंज्ञः ।। – च. चि. २१.४०

Complication is a separate disease, which arises during or immediately after the course of an existing disease and which is dependant on the existence of the original or main disease. The original disease acts as one of the important cause of the complication. The lowered resistance of the patient during the course of the original disease acts as a predisposing factor for the development of its complication

Causes of complications

1. Aetiological factors continue to act and lead to formation, accumulation and spread of doshas which affect and settle in other organs of the body giving rise to complication, example germs of pneumonia settling in brain and giving rise to brain abscess.

2. Increased doshas that act as aetiological factors of original disease are further increased because if the patient does not follow the instructions regarding diet and activity example a patient with pneumonia develops empyema because he takes cold drinks and ice-cream and uses air-conditioned room.

3. In addition, when different aetiological factors operate during the course of existing disease, they can also lead to development of complication. Here the doshas responsible for the original disease and its complication are not identical. In some cases, the patient is cured of original disease, while its complication persists after it, example a patient with measles develops broncho-pneumonia due to germs of pneumonia settling in the lungs. Here the raw area in the lungs caused by measles virus acts as a predisposing factor.

When a patient develops new symptoms or clinical manifestations, it is important to differentiate between development of a complication and occurrence of new disease entity. The aetiological factors, causative doshas and pathogenesis are same as those of the original disease or the original disease is related to the complication, as it acts as a predisposing factor for the development of the complications. On the other hand the aetiological factors, causative doshas and pathogenesis are different when a new disease is super-imposed on the first disease. In addition, two diseases are in no way related to each other example patient with measles develops chicken-pox or mumps.

B. Pathogenesis

	Chaya stage	Prakopa	Prasara	Sthanasanshraya	Vyakta	Bheda
Dosha	+ (Local)	+ + (Local)	Dissemination +++	Localisation Damage to +	Damage to the organ+ +	Damage to theorgan+ + +
Vata	Fullness of stomach	Pain in abdomen, consciousness of gaseous movements with in abdomen	Pain all over the body, gurgling noises in abdomen	Vary with disease or organ involved	Clinical manifestation of disease	Further differentiation of type of dosha e.g. Vataja, Pittaja
Pitta	Yellowish discolour-ation of skin	Thirst, acid regur gitation, burning sensation	Burning and smoky sensation all over body	–	–	–
Kapha	Heaviness of body and laziness	Nausea, disgust	Anorexia, vomiting, exhaustion	–	–	–
General	Aversion to aetiological factors, e.g. cold drinks	Desire for factors and substances having opposite properties e.g. hot drinks	Aversion for casuative factors and desire for opposite factors	–	–	–
Phase in modern medicine	Incubation period	Incubation period	Dissemination	Prodromal phase with premonitory symptoms	Clinical manifestations	Type of disease or stage of disease well-differentiated
			A. Rapid. e.g. septicaemia
			B. Slow