GENERAL PATHOGENESIS OF A DISEASE
(PATHOGENESIS OF A DISEASE WE CALL SAMPRAPTI IN AYURVEDA)
IT WILL HELP YOU UNDERSTAND HOW WE ACTUALLY GET SICK (IT IS OUR AYURVEDIC VIEW FOR HOW WE ARE AFFECTED WITH A DISEASE). FROM HERE YOU CAN UNDERSTAND EASILY THAT HOW DO WE GET AFFECTED WITH ANY DISEASE?
SAMPRAPTI IS MADE FROM TWO WORDS:
संप्राप्ति = सम्यक + प्राप्ति
Samyak means “proper” and prapti is “to get.”
SAMPRAPTI is to get the proper knowledge about the pathway of disease manifestation. This provides complete knowledge of the disease progression, starting from the cause, the doshas involved and the location where aggravated doshas are accumulated (dooshya).
All the bodily changes that occur from the time of exposure to the causative factor, to the actual onset of disease and manifestation of its symptoms are called SAMPRAPTI. Saṃprapti is A Sanskrit technical term translating to “onset”, referring to one of the “five characteristics of diagnosis (PANCH LAKSHAN NIDAANA). It is used throughout Ayurvedic literature such as THE CHARAKA-SAMHITĀ AND THE SUŚRUTA-SAMHITĀ.
THESE FIVE CHARACTERISTICS ARE REGARDED AS VERY IMPORTANT CLUES FOR DIAGNOSIS (NIDAANA) AND NIDAANA (REASONS) IS ALSO CALLED AS THE REASONS FOR CAUSING DISEASE.
संप्राप्ति : वह शारीरिक अवस्था जो शरीर में किसी रोग के रोगाणु पहुँचने, उस रोग के परिपक्व होने और बाह्य लक्षण के उपस्थित होने तक माना जाता है I
In Ayurveda, in contrary to modern medicine, there are various stages for each disease. We don’t get affected with any disease all of a sudden, there are some symptoms which body start possessing, but we usually ignore these until we are actually manifested with the symptoms. We overlook the problems. Our body tries to give us signs of cautions, but we usually ignore. We can say our immunity gets lowered with all these changes gradually and ultimately we possess a disease.
That is exactly why Ayurveda is a preventive medicine as, As It starts treatment from treating the root cause of the disease and not just the symptoms like the modern medicine. In Ayuveda when we diagnose a patient we seek for the resons which are responsible for the changes in the body and creating Diseases.
WE DIAGNOSE PATIENT WITH TEN FOLD EXANINATION OF PATIENT AND PANCH NIDAN FOR DISEASE, HERE EXPLAINING PANCH NIDAAN AND SAMPRAPTI OF A DISEASE AND WILL EXPALIN TEN FOLD EXAMINATION OF PATIENT IN NEXT CHAPTER.
According to Ayurveda there is always a reason (NIDAAN: CAUSE) for a disease; as Disease is DIS – EASE, WHICH HAS PUT YOUR BODY OUT OF EASE OR COMFORT)
According to Ayurveda, there are five stages of a disease and it takes a long time till the Dosha (disease) actually manifest their symptoms in any patient.
निदानं पूर्व रूपाणि रूपाणयुपशय तथाः I
सम्प्राप्तिश्चेति विज्ञानं रोगाणा पंचधा स्मृतम I I
EASY UNDERSTANDING OF PATHOGENESIS OF A DISEASE
HOW ARE WE AFFECTED WITH ANY DISEASES
NIDAAN (CAUSE, REASON FOR A PROBLEM /DISEASE)
PURVRUUP (PRELIMINARY SIGNS OF A DISEASE, HIDDEN SYMPTOMS OF PROBLEM /DISEASE)
RUUP (SYMPTOMS START APPEARING OF THE PROBLEM WE ARE GOING TO FACE / DISEASE)
UPSHAYA (EXPLORATORY METHODS, ADDITION / DELETION OF AGGREVATING FACTORS TO PROBLEMS /DISEASE)
SAMPRAPTI (DEVELOPMENT OF A DISEASE ACTUALLY, THE PROBLEMS /SYMPTOMS OF A DISEASE AGGREVATE)
The entire process of Pathogenesis (Saṃprāpti) has been analysed into the following six stages:
1. SACHAYA (ACCUMULATION)
2. PRAKOPA (AGGRAVATION)
3. PRASARA (DISSEMINATION)
4. STHĀNASANSHRAYA (LOCALIZATION)
5. VYAKTIA AWASTHA (MANIFESTATION)
6. BHEDA AWASTHA (EXPLOSION)
IN SAMPRAPTI THERE ARE:
SANCHYA : Dosha start accumulating at the weak place of the body /Problems affecting the weak persons.
PRAKOP : Dosha start aggravating if not treated at the site / Problems start aggravating.
PRASSAR : They start spreading to nearby organs and places as they get accumulated in abundance / They start affecting the other persons surrounding.
STHANASANSHRAYA (LOCALIZATION) : Dosha start accumulating at the place whichever is weak in the body.
VYAKTA AWASTHA : Appearance of symptoms / Problem actually occurs), if not treated.
BHEDA AWASTHA : Symptoms getting chronic if not treated / or problems start affecting everyone around if not treated or controlled).
In the fourth stage, the premonitory symptoms appear and in the next stage the disease is fully manifested. For example in the last stage the abscess bursts (in surgery) and the disease becomes chronic (in medicine). These stages are also known as Kriyākālas (stages for remedial measures).
THE PANCHA NIDAANA :
Defines a diagnosis in cases where a single causative factor (nidaana) may create a number of different diseases. For example, the aggravation of vata causes eighty different types of diseases. Generally, it is not sufficient to know only the cause of the disease, in this case the aggravation of vata dosha. Knowing the various types of vata, it is important to procure information about the dosha type, body channels (srotas), tissues (dhatus) and systems that are involved in the pathogenesis of the disease in question. Simply implementing an "anti vata" therapy may not permanently eradicate all vata related disorders, if the other affected factors have been overlooked.
NIDAANA IS THE DISEASE CAUSING FACTOR.
"निर्दिश्यते व्याधिरनेणति निदानम ” I
The symptoms which are useful to know the disease are called Nidaan.
“निमित्त हेत्वा यातन प्रत्ययो त्थान कारणैः निदानमाहुः पर्यायः” I
Also the reasons which are responsible for the onset of a disease are also Nidaan.
They are Pancha means "five", and nidana is "diagnostic methods" and Nidana is also called as reason for a disease. Diet, life style or external factors like environmental variations (excessive heat, cold or rain), injuries or any other factors that disturb the doshas are considered nidaana. If we know that certain foods or particular activities aggravate a dosha we can avoid those causative and triggering factors and prevent manifestation or recurrence of disease.
In Ayurveda, nidaana parivarjana or "avoiding the cause" is considered as the first line of treatment in most of the diseases. For example, avoiding heavy, sweet foodstuffs and sedentary lifestyle is the first step towards healing of diabetes.
PURVARUPA - THE PRELIMINARY INDICATIONS:
प्रागरूपं येन लक्ष्यते I
उत्पितसुरामयो दोष विशेषेणानाधिष्ठितः I
लिङ्ग मव्यक्तमल्पट्वाद व्याधीनांतद्यथायथम I I
Purvarupa are preliminary signs of disease. These symptoms appear before the actual onset of any illness, and are warning signs that disease may soon manifest. Each disease has specific preliminary signs. If there is any confusion about a specific diagnosis arising due to similar symptoms or causative factors, then purva rupas need to be considered. For example, in the case of epilepsy, the purva rupas include dimness of vision, particular odours or tastes becoming prominent and a throbbing pain all over the body.
RUPA - THE SYMPTOMS
तदेव व्यक्ततां यातं रूपमित्यभि धीयते I
संस्थानं व्यञ्जनं लिङ्ग लक्षणं चिन्हमाकृतिः I I
Rupa, or the symptoms of a disease, indicate the actual onset of the manifestation process. When rupa appear, the disease becomes more pronounced with obvious and clearly defined symptoms. The rupa can be considered the advanced form of the warning signs (purva rupa). The severity and number of symptoms present provide the doctor with indications of physical impacts, the possibility of cure and the length of time healing may take.
UPASHAYA - THE EXPLORATORY TREATMENT
हेतुव्याधि विपर्यस्तविपर्यस्तार्थ कारिणाम I
औषाधान्नविहारानामुपयोग सुखावहम I
विद्यादुपशयम व्याधेः स हि सात्म्यमिति स्मृतः I
There are certain diseases which have identical causes, preliminary signs, and symptoms. For example, fever may be a symptom of typhoid, malaria or pneumonia. In ancient times, when modern scientific testing techniques did not exist, a specific diagnosis was aided by upashaya. This involves investigating and eliminating particular diseases through diet, herbal remedies or physical therapies that can help to make an exact diagnosis. For example, in the case of fever, the doctor might try prescribing quinine to see if the symptoms are alleviated. If that reduces the severity of symptoms, it confirms that the patient has malaria. If quinine makes no difference, malaria can be eliminated as one of the potential diseases. Similarly, dietary changes may be recommended by a doctor to confirm an opinion about a suspected diagnosis.
SAMPRAPTI - DEVELOPMENT OF THE DISEASE
यथा दुष्टेन दोषेण यथा चानु विसर्पता I
निवृत्तिरामयस्यासौ सम्प्राप्तिर्जातिरागति I I
Samyak means "proper" and prapti is "to get." Samprapti is to get the proper knowledge about the pathway of disease manifestation. This provides complete knowledge of the disease progression, starting from the cause, the doshas involved and the location where aggravated doshas are accumulated (dooshya). All the bodily changes that occur from the time of exposure to the causative factor, to the actual onset of disease and its manifestation are placed under this category.
THE SIX STAGES OF SAMPRAPTI:
संचयं च प्रकोपं व् प्रसरं स्थानसश्रयम I
व्यक्तिभेदं च यो वेत्ति दोषणाम भवेत्भिषक I I
1. SANCHAYA – ACCUMULATION
साचितनाम खलू दोषाणाम स्तब्धपूर्णकोष्ठता पितावाभासता I
मंदोषमता चांगाणाम गौरवालस्यं चयकारण विद्वेषश्चेति लिङ्गानी भवन्ति I I
Each Dosha has a dwelling place. (Vata – Colon, Pitta – Small intestine, Kapha – Stomach). Vata Accumulation may be indicated by symptoms of constipation, abdominal distention or gases in the colon.
Pitta accumulation may be indicated by symptoms of heat around the belly button, yellowish discoloration of the eyes or urine.
During this stage the person feels healthy, and the body’s magnificent intelligence, makes one wants to eat the opposite tastes of the accumulated dosha.
2. PRAKOPA – PROVOCATION
तेषां प्रकोपात कोष्टतोद संचरणाम्लिका पिपासा I
परिदाहान्न द्वेष हृदयोतक्लेशे जायन्ते I I
When a dosha is aggravated, and continues to aggravate it does so in its own dwelling place. During this stage symptoms will be more significant.
Vata symptoms during this stage will be pain in the flanks or mid-back, hyperperistalsis, urgling and even breathlessness.
Pitta symptoms will be indigestion and heartburn.
Kapha symptoms will be cough, congestion, heaviness.
If one is listening to one’s body, one may reverse those symptoms during those early stages, by using the opposite qualities of the aggravated dosha. After those two stages, the disease is getting out of the GI tract, makes it harder to treat by oneself, and will need to consult an Ayurvedic doctor or practitioner.
3. PRASARA – SPREAD
पित्त पंगुः कफः पंगुः पंगवो मालघातवः I
वायुना यत्रातियन्ते तत्र गच्छन्ति मेधवत I I
Further aggravation of the dosha, will make it leave its dwelling place and go to another site of that dosha elsewhere in the body. Purva Rupa, prodromal symptoms and signs are happening during this stage.
In the junction between this stage and the fourth one (sthana Samshraya), purva rupa manifest but is still curable.
Vata will be always involved, as it is represent the factor of movement in the body.
Vata will move to the ears, skin, bones and thighs. Normally during this stage a person will crave dry, rough foods. If one will not go with this crave, one may reverse the progress of disease.
Pitta will move to the stomach, eyes, sweat glands, skin, heart and subcutaneous fat. During this stage a person will crave hot, spicy food. If one will not go with this crave and will eat the opposite tastes like sweet, bitter and cooling substances, one will arrest the further spread of pitta.
Kapha will move to the lungs, sinuses, lymphatic system, breast tissue, mouth and head. There will be craving towards heavy sweet food, and the choice should be spicy and light and hot.
Remember as long as the doshas are at the GI tract, which takes place in the first and second stages, they are still in the home of Agni. As long as this is happening, the doshas can do much harm, as Agni is there to protect, once the Agni is impaired the doshas will leave the GI tract and the disease will manifest further, and will be harder to cure.
4. STHANA SAMSHRAYA – DEPOSITION OR LOCALIZATION
कुपितानां हि दोषानां शरीरे परिधावतम I
यत्रसङ्गः ख वैगुण्यात व्याधिस्तत्रोपजायते I I
During this stage, the aggravated dosha will tend to move into a spot which has a weakness, this point is called Khaivaigunya. When the dosha enters this delicate spot, it changes the tissue and its qualities. When the dosha reaches the khaivaigunya, there is a ‘fight’ between the Agni of the dhatu and the aggravated dosha, if the agni is weak, the dosha will change the qualities of the asthay dhatu (immature form), which will further change the sthayi dhatu (mature form).
For example: Vata may bring coldness, dryness into the dhatu, Pitta may bring heat, oiliness and Kapha may bring stagnation, heaviness and congestion.
5. VYAKTA AWASTHA – MANIFESTATION
" व्याधेः प्रव्यक्तं रूप व्यक्तिः "
In this stage the dosha has overcome the dhatu, and changed its qualities, symptoms will be observed in this stage. One may see the pathological symptoms, and know exactly which guna (attribute) of the dosha is the most important part of this disease. The seeds of disease now sprout and begin to manifest in the area of the defective dhatu. Specific signs can be seen, like cracking of joints due to dryness of Vata entering the joints (a Kapha location). Inflammation is caused by Pitta entering the specific dhatu. Kapha will create congestion, swelling and the like.
6. BHEDA AAWASTHA – DIFFERENTIATION OF DISEASE
In this stage, structural changes manifest. Complication of other organs, tissues or systems becomes evident. It’s the final expression of the disease. In this stage the tissue is affected as well as its surrounding areas and their functions.
Vata during this stage can manifest as structural changes, severe dehydration, emaciation and so forth.
Pitta may create ulcers in the stomach, hemorrhage, bleeding disorders and the like. Kapha will create consolidation, tumor formation, as well as fibrocystic changes like lipoma, fibroma and the like.
When we don’t care about the disease and the problem become chronic then other side effects or complications start arising, we call them complications or updrava.
तत्र उपद्रवो रोगारंभक दोषप्रकोपजन्योअन्यविकारः I
In the last stage of the problem some symptoms start appearing indicating that the patient cannot be cured, in Ayurveda different SYMPTOMS /ARISHA LAAKSHANA are described for every Disease.
नियतमरणख्यापकं लिङ्गमरिष्टम I
BENEFITS OF PANCHA NIDAANA
In addition to identifying the nature, location and treatment of disease, pancha nidaana also help in the prevention of disease, as it provides an understanding of causes (nidaana). Avoiding or taking certain precautions prevents exposure to the specific factors that generate disease. Similarly, if we have knowledge about the preliminary signs and symptoms of a particular disease (purva rupa and rupa), steps to combat the disease can be implemented at that stage, before the disease has actually manifested. In the same way, the exploratory treatments (upashaya) and disease pathway (samprapti) allow a thorough understanding about specific aspects of the disease, and permit us to refine treatment regimes in order to ensure the cure is permanent.
The knowledge of pancha nidana is therefore valuable in diagnosis of diseases especially the ones with similar features. A thorough application of these diagnostic techniques assists in determining the right treatment to permanently cure the disease.
STAY HEALTHY AND STAY BLESSED
Dr. Inderjit Kaur
+91 - 92167 77272
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