Ayurvedic Pathogenesis: 6 stages of disease formation according to Ayurveda

There are six stages of disease production proliferation according to Ayurveda they are

Sanchay

Let us take the example of a metabolic pendulum with a certain weight, for example, 10 kg. Let us assume that when the pendulum is stable, there is no disease condition in the body. However, when the pendulum starts to move, the disease proliferates.
To be specific, let us suppose when the pendulum moves with a velocity of 1 km per hour, migraine occurs. Since the current velocity is zero, therefore, acceleration will be equal to the resultant velocity :). According to Physical calculations, we would need an approximate force of 10 N to move the pendulum from its normal position to a diseased position. Before the pendulum moves from its original state of rest, it needs a precise power to overcome its inertia of healthy metabolism. The accumulation of vitiated dosha generates this negative force. The collection of the dosha or generation of negative energy is the state of Sanchay. Ideal Ayurvedic treatment should prevent sanchay of any dosha in the body. According to Ayurveda, this is the perfect prevention.

It looks like the concept of the fighter immunity doesn’t work in case of Sanchay. The body does not fight back to prevent diseases. Instead, there is stable inertia in the healthy state that is difficult to imbalance. This stability of health is natural immunity.

Suppose if the body was to remain in a situation where there are no external seasonal changes, temperature fluctuations due to respiration and food intake, etc; if the body were to receive all the required energy in the form of electricity just like a mobile phone, then there will be hardly any aging in the body. Such a person will Age so slowly that he might look like an Immortal. According to Hindu mythology, six months of humans are equivalent to a half day of the Gods. I wonder if gods stay in a friction-free, fluctuations free environment! The mythology says that gods have a pure mind that is free from the mental vices of humans.

So, if we drive the body metabolism properly without introducing undesirable fluctuations unnecessarily in the body, the average health of a person will always remain stable. The stability of health is the basis of immunity in Ayurveda.

Disease-causing factors are all around us. Each one of us is facing the same pathogens. However, some of us fall sick, and some do not; in similar conditions. The health of a perfectly healthy person must be like an elephant; too heavy and tough to move. On the other hand, the health of a frail and weak person must be like a dry leaf. Even a mild breeze can blow it away in any direction.

Therefore sanchay is, in a way, a force that is required to move the body from its stable, healthy position into disease position. The pathogens or the external surroundings do not produce this force. The vehicle for this negative force are the doshas. In a way, Sanchay is a kind of disease incubation period.

Ritucharya focuses on prevention of sanchay of dosha during every season. If we can prevent the accumulation of dosha, we can avoid all the disorders in the body, even the minor ones like cough and cold.

Prasar

Prasar is like a Domino effect in the body. In a healthy condition, the metabolism of the entire work body works in close synchrony. Once the pendulum of disease starts to move, it disturbs the natural metabolism of the whole body and disrupts the normal functions of different systems. Prasar is the stage of discord in the metabolism. It is the stage where the body starts gets affected by the doshas.

The word Prasar means expansion or spread. In this stage, the imbalance of the Dosha spreads to other dosha, parts, or systems in the body.
There is a chance that a strong dhatu will stop the disease pathophysiology in the body. Dhatu is a metabolic station that sustains and promotes the anabolic activity in the body.
For example, suppose that kapha Dosha of a person gets imbalanced who is drenched in the rain and remains wet for a long time. This vitiated kapha dosha affects different parts of the body and stimulates excess mucus formation in the nasal cavity. This process might lead to a common cold eventually. However, if this person is a Pitta Prakriti individual and he consumes a warm soup after getting wet, then and the heat production through digestion will balance the kapha dosha and help to stop the proliferation of common cold. Besides, a good sleep after the soup will help to prevent the vitiation of another dosha like pitta,vata, or both. However, if the person were to stay awake entire night, vata dosha might get vitiated and take the disease to the next level!

However, if the individual does not receive proper treatment in the stage of Prasar, then pathophysiology moves to the next step of prakop.

Prakop

Prakop comes from the word “kop,” which means anger. Prakop is the stage where the symptoms of imbalance become visible. For example, in the above case, the drenched person starts to sneeze, feels itching in the nasal cavity, tiredness or mild headache, depending on his Prakriti body type and the current state of health.

In the stage of Prakop, accumulated doshas can no longer be contained in the primary disease incubation site and spread in rest of the body like the way a boiling milk spilled out of the pot and spreads all over.

ภาพโดย Myriam Zilles จาก Pixabay

If the person usually is healthy, then prakop will result in mild disorders like a common cold, headache, body pain, etc. However, in a weak and sick person, this slight internal destruction can result in dangerous disorders. For example, a person infected with fully blown HIV AIDS can die from even a flu infection.
Prakop is a condition in which body sends a signal for help through mild disorders like body pain, headache, common cold, heaviness in the body inflammation, acidity, constipation, etc. 80 types of vata disorders, 40 types of pitta disorders and 20 types of kapha disorders are found in the stage.

According to Ayurveda, a perfect physician will heal the body in the stage of sanchay, before even the mild symptoms of discomfort occur. An average physician will heal the body after the symptoms of the disease are visible. And foolish physician will cure a person only after the disease takes roots in the body. Buy this logic; most of us are foolish physicians. However, we should strive to move up The Ladder.

Prakop is another stage of pathophysiology which is more visible and therefore more actionable. At this stage, no specific disease establishes in the body. Only dosha imbalance is stabilized, as a precursor to disease formation. Mild symptoms of a probable illness are visible. If you can correct the doshas in this stage, there will be no disease formation in the body.

At this stage, symptoms are visible in the main spots of dosha, for example, chest and the head region is like a head office for kapha dosha. Any kapha imbalance will reflect as a disorder in this region, for instance running nose, heaviness in the head, drowsiness, et cetera. Therefore, it is possible to find out the exact imbalanced dosha and its intensity by looking at the symptoms and their site.

The Domino effect of this imbalance is not limited to the body parts. One imbalanced dosha can cause an imbalance in other doshas of the body as mentioned before. For example, increased kapha Dosha in the body as in the previous case, can block the normal pathway of vata dosha. We can understand this in the following manner – excess kapha Dosha in the body stimulates excess mucus formation and secretion. This excess mucus can block the normal respiratory pathway(vata system) and cause vitiation of vata dosha as well. Therefore, the stage of Prakop is not limited to a single dosha. One imbalanced dosha can extend its imbalance to all other doshas in the body.

Another critical point is the kind of treatment offered at the stage of Prakop.

One interesting concept is that we should allow our bodies to fight against the infections, without taking any medicines –

https://www.quora.com/How-many-of-you-agree-to-the-actual-fact-that-consumption-of-medicine-during-cold-cough-and-fever-will-hamper-detoxification-process/answer/Vd-Kanika-Verma

Dosha correction is one of the options of treatment in prakop. This treatment will erase all possibilities of disease incubation in the future.
Another option is symptomatic treatment. For example, in case of headache, you can pop in a painkiller in your mouth. The nerves will become numb, and you will not feel the pain. However, the pain causing factor still be there. This treatment is an ostrich approach towards treatment, which hinders the real healing process.

If the dosha/doshas remain vitiated in this stage, the pathophysiology will move to the next step of sthana sanshraya.
Therefore you do not treat this mild headache resulting from this common cold properly, and it will eventually lead to severe disorders like chronic cold, migraine, sinusitis, et cetera.

Sthana sanshraya

The word “sthana” means place.”sanshraya” refers to establishment, accumulation, or lodging.
Sthana sanshraya is the stage in which the accumulated dosha find a weak link in the body metabolism and settle down to form the disease. In this stage, a weak dhatu(tissue) attracts the vitiated dosha like the way dry wood attracts termite

In the stage of prakop, disease formation happens typically at the primary site of dosha, example vata imbalance symptoms are found mainly in the abdomen(bloating constipation), extremities(pain in hands and legs). With the pitta imbalance, signs mainly occur in the stomach(acidity), skin(inflammation).In the case of kapha dosha vitiation, symptoms will be found mostly in the chest and head region. For more information, visit the abode of dosha.

However, in the stage of sthana sanshraya, the disease can occur in any part of the body depending on the vulnerability of the body part, organ, or system. Considering the previous example of the drenched person, if respiratory system is the weakest in the body of this individual, then imbalanced doshas will accumulate in the body and cause-related disorders like asthma, pneumonia, tuberculosis, upper respiratory tract infection et cetera.

This development will not happen in a day. The stage of sthana sanshraya takes some time depending on the overall health, age, mental state, nutrition, and multiple other factors. It might take weeks or even years for the disease to occur depending on the rate of exposure to wrong food, lifestyle, and negative mental state.

Sthana sanshraya is the stage when doshas choose the best spot for disease occurrence. It all happens naturally according to the laws of nature. As this stage stabilizes, doshas prepare the selected body part or system for disease acceptance.

We often notice that we face symptoms which subside once a proper disease occurs. For example, a person might face initial difficulty in breathing regularly. However, after some time, the regular breathing normalizes to a certain extent, and a proper disease expresses itself in the form of asthmatic attacks.
Initial disharmony in the metabolism becomes stronger and establishes as a parallel bio-rhythm. In this case, the smaller symptoms might subside to produce regular and stronger syndrome.

Therefore it is essential to note that if a minor disorder subsides, it might not mean that core pathology inside the body subsides completely. Probably, the minor ailment is stabilizing into a more prominent disease.

The prime site of the disorder depends on various factors. Considering the same example, if kapha dosha gets vitiated in a vata dominant Prakriti person then, kapha can easily vitiate vata. In this case, doshas have a choice of disorders like migraine, urinary disorders, diabetes at et cetera. All these disorders require both kapha and vata dosha vitiation.

Now, if the person has frequently faced mild urinary infections in the past, a weakened urinary system becomes the natural choice for the doshas to settle down. If this person is obese, eats lots of sweets, follows wrong food and lifestyle practices regularly, the doshas can later aggravate the disorder into a severe urinary infection, bladder stones, and even diabetes.

Age of the individual also makes a lot of difference in pathogenesis. Youth is dominated by the pitta dosha dominates. If the concerned individual is a young person, then the above-vitiated dosha will form milder symptoms as pitta dosha has properties contrary to both vata and kapha. Because of the purifying nature of fiery Pitta dosha, most of the toxins in the body get burnt. Therefore youth is a phase when the person has maximum immunity towards diseases.

On the other hand, vata Dosha is the dominating factor in the old age. Vata dosha governs all movements in the body. Therefore, An older adult is highly vulnerable to diseases. Also, the range of possible disorders in the old age is much more extensive as compared to that in the other phases of life.

In the old age, the best site of sthana sanshraya are the main sites of vata Dosha- for example, abdomen, large intestine, limbs, skin, etc. For this reason, some of the diseases are more common in aged people like osteoarthritis, dementia, baldness, etc.
Abode of dosha.

If the imbalanced doshas are not treated or appeased in the stage of sthana sanshraya, then that this pathogenesis progresses to the next stage-vyakti.

Vyakti

The word vyakti refers to “expression,” “entity,” or “individual” in Sanskrit. In this stage of pathogenesis, the full expression of a specific disorder or syndrome is visible. This disorder is easily identifiable and distinguishable from others, for example, diabetes, rheumatoid arthritis, pneumonia, tuberculosis, vitiligo, et cetera. This disease has a specific name and exact manner in which it impacts the body. For example, a cataract affects the vision and can lead to blindness.

In this stage, the disease implants itself thoroughly in the body. The faulty metabolism becomes a part of the bio Rhythm and body adjust its functioning around it. The word vyakti forms another word, “vyaktitva” – personality. In this stage, you can see the whole character of the disease! All the primary symptoms of the disease are present in the stage of vyakti.
However, differential diagnosis is still applicable in this stage.

In this stage of pathophysiology, the disease is firmly established in the body and openly challenges healthy metabolism. The body responds with attempts to accommodate normal metabolic functions around the diseased system and generate enough resources to overthrow the disease.
Vyakti is the stage, where the enemy comes out of the trojan horse and attacks on the Achilles’ heel.
At this stage, the disease can cause significant permanent damage to the body if not appropriately treated.

All the disorders are easily treatable up to the early stage of vyakti. With a failure to provide proper treatment, the disease diversifies itself to create complications. In the next phase – bheda, the condition can become incurable yet manageable (diabetes, vitiligo), or fatal(cancer).

Bheda

The word bheda refers to “variety”, “diversification”,”hole”,or “secret” in Sanskrit. In this stage of pathophysiology, the disease differentiates into its varieties; for example, migraine with or without Aura, with or without headache.

Beda is also the stage of appearance of complications. For examples, the occurrence of diabetic neuropathy, nephropathy, retinopathy, etc. as the primary disorder diabetes broadens its impact on the body. Imagine, the British came to India as merchants and became the rulers. They made rules contrary to the ancient law of the land and forced the natives to follow them. In the stage of bheda, the body is almost under foreign control. Only a violent revolt can change the scene of power.

A person requires extensive treatment in the stage of bheda. Now the focus is not to cure the disease completely, as many diseases might convert to incurable due to the permanent damage to the body. However, at this stage, a vaidya should try to maintain the health by regular external intervention(perennial medication and preventive lifestyle) and elongate the lifespan of the patient.

Six stages in a story-form

If you try to understand the whole system of pathophysiology, according to Ayurveda, we can take the example of terrorists attempting to overthrow the government and capture a nation. Here the maligning factor is not pathogens or environment, but the doshas. Doshas are the dissatisfied population!

Initially, there has to be some malfunctioning at the end of the government that leads to dissatisfaction in a small section of the population. The growth of dissatisfaction is the stage of Sanchay in case of the body. This discontent population is the base for a more massive discord.

If the government tries to do no substantial correction in response to this dissatisfaction, gradually the discontent might spread to a larger section of the population. This spread is the kind of Domino’s effect that we talked about in the stage of Prasar.

As the discontent spreads to a larger population, the disgruntled group might get enough support and confidence to express it’s dissatisfaction to the government, in the form of rallies, strike, destruction of public property, non-cooperation et cetera. We can assume this to be the stage of prakop, where we can see mild symptoms in terms of the disorder; however, a proper disease is still not established.

If the dissatisfied group does not get a proper response from the government, it might lose hope and take things into their own hands. This group can form an organization to ensure the protection of its rights and to nullify the effect of government. The dissatisfied people start together in the incubation centers from where they can spread and become more powerful. Here is the stage of sthana sanshraya, where the disease finds a weak link in the metabolism and establishes itself in there.

As this group forms and grows inside the country, it shows its presence by openly opposing the government functioning and control. By this time, the disconcerted people are established and organized. At this stage, they are not to individuals but the whole body of people, running a parallel government inside the nation. This development can also is similar to the situation of a civil war inside a country where two opposing forces are trying to gain power over the entire nation. Such is the stage of vyakti when the opposite force comes into full expression.

One major organization of dissatisfied people can branch out into several other organizations with a similar purpose. For example, the same organization can form a youth wing, a women’s wing, educational Institutes to propagate their ideology, a personal army et cetera et cetera. It is possible that these baby-structures develop into full-fledged and independent organizations in the long run. In this manner, anti-government forces become more established and stronger than ever before. At this stage, it is very much possible for this force is to overthrow the central government and take complete control in their hands. Such is the stage of Bheda where the disease manifests with multiple Independent and robust complications. This stage of the disease can be even fatal.

These are the six stages of pathogenesis that every disease in the body goes through. The natural preventive mechanism of the body can prevent most of the disorders in the stage of prakop. The common cold, cough, headache, etc. are body’s attempts to eliminate the pathology.

With external help like frequent seasonal Detox(ritucharya), adjustment of food and Lifestyle according to seasonal changes and age, peaceful mental state, we can prevent the accumulation of the dosha and eliminate the foundation of disease formation – Sanchay.

Here lies the importance of knowing the six stages of disorders. This information can help us to prevent ailments and maintained a perfect state of health forever.


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