What are the six stages of disease formation in Ayurveda?
When I hear someone say, “Suddenly, my father, brother, sister, mother, partner, or friend died of a heart attack,” I listen compassionately but don’t necessarily agree. When they are ready to listen, I remind that Ayurveda will tell you that most diseases don’t happen overnight. There are signs and symptoms that modern day living has conditioned us to ignore. Our body communicates what’s not sitting well, but we drown its wisdom with alcohol, noise, ignorance, and pills. For example, instead of investigating what causes heartburn when someone drinks wine, I know people who will pop a medication so they can drink at a party. Another example: instead of investigating the swelling and pain in their joints … taking painkillers to subside the pain.
How Diseases Formation Happens According to Ayurveda?
An important concept is shat kriyakala (six stages of pathogenesis). This is fundamental in understanding the pathological states and their progression (samprapti) of the doshas that result in disease. Having a dosha that is imbalanced doesn’t necessarily imply that an individual is gripped by a disease. Vitiated doshas alone can’t produce a disease in the absence of suitable ground i.e., abnormality or vitiation of srotas (channels). In the first two of the six stages, there are no symptoms. In the third stage there may be vague, non-specific symptoms, such as fatigue and general malaise, which become more pronounced in the fourth stage. Only in the fifth stage do symptoms manifest that are specific to a particular disease. That’s why the earlier the stage that the disorder can be detected, the easier it is to reverse the underlying imbalance, Ayurveda reiterates.
The Six Stages of Disease Formation:
Accumulation – Sanchaya— Disease begins with the accumulation of one or more doshas. In Stage One the dosha accumulates in its natural “seat” or “home.” Vata – Colon, Pitta – Small intestine, Kapha – Stomach. For example, Pitta Dosha might accumulate in the eyes, digestive tract, or skin. Symptoms are mild and/or irregular, but the disorder or condition can be detected and treated. It is easy to restore balance to the affected dosha(s) at this point.
Aggravation/Provocation of Doshas – Prakopa— While stage one involves a quantitativechange in the doshas, this stage involves a qualitativechange in the doshas. When a dosha continues to be aggravated it will do so in its main site. During this second stage symptoms will be more significant, but the aggravated dosha can still be removed via the gastro-intestinal tract (GI tract) relatively easily. The doshas are still in their own sites during these first two stages food cravings will be healthy and appropriate.
Dissemination or Spread– Prasara— Now the dosha moves out of its home seat and begins to circulate in the body and go to another site of that same dosha elsewhere in the body. There are still no specific symptoms. However, in stage three there can be vague, low-grade non-specific symptoms, such as transient aches and pains or mild malaise. The patient may complain of fatigue or mild depression or say, “I just don’t feel well.”
Localization – Sthana Samshraya— In this stage the dosha now localizes in a tissue outside of its main seat and begins to disrupt the function of that tissue (dhatu) or organ. There are several factors that determine where the disseminating dosha will localize. One is an abnormality in the microcirculatory channels (srotas) in that tissue. The second factor is the digestive toxins called ama. At this stage, early diagnosis and subsequent treatment can curb and resolve the disease itself.
Manifestation of Qualitative Changes – Vyakti— In this stage the disease manifests in its full-blown, clearly identifiable form. The functioning of the tissues is disrupted by the complex of ama mixed with the imbalanced dosha. For example, when Kapha dosha and ama localize in the head and neck, the scratchy throat and heaviness in the head are now experienced as the full-blown syndrome of congestion in the form of a common cold, sore throat, sinusitis, or an allergy attack.
Differentiation & Destruction of Tissue – Bheda— At this stage, the disease becomes so embedded in the tissues that the body’s natural repair mechanisms are not able to reverse it. Then the disruption of functioning becomes a long-term or permanent disorder. For example, the Kapha disorder could become chronic or perennial sinusitis or rhinitis.
The Importance of Early Detection
It is clear from this pattern that no chronic disease appears suddenly but is the sum of small and repeated imbalances that gradually set in over time. The sooner or earlier the diagnosis, the easier it is reverse the imbalance of the doshas. For Stages One and Two, simple dietary measures or even adjustments to dinacharya or seasonal routine are often sufficient to reverse the condition and prevent disease manifestation.
In Stages three and four of disease formation, cleansing therapies and Ayurvedic herbal procedures can help.
As the stages of disease progress, they get more difficult to treat. Stages five and six is when things get complicated and requires a multi-modality approach. Some of the diseases in this stage, Ayurveda would consider irreversible.
The Benefit of the Warning system
The great advantage of the Ayurvedic approach is to identify doshic imbalances before it leads to disease formation. This storytelling of the disease process isn’t meant to scare you; It’s an insight into the opportunities we have to keep our mind and bodies healthy.
The deranged doshas checked and subdued in the sanchaya [first] stage fail to exhibit any further or subsequent development but, if left unremedied, they gain in strength and intensity in the course of their further development.
Sushruta Samhita Sutra Sthana 21/36-37
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