Ashayapakarsha

The Sanskrit word ‘ashayapakarsha’ includes two words: ‘ashaya’ meaning a space or site and ‘apakarsha’ meaning to draw off or take away. Thus, the word ‘ashayapakarsha’ means taking away from one’s site. Ashayapakarsha is explained in detail in Madhukosha commentary in the context of the movement of dosha (gati). In this context, primarily the commentary of Bhattar Harishchandra on Kiyantah shirasiya adhyaya of Charak Samhita has been referred.[Cha.Sa. Sutra Sthana 17/45-46] Dosha are primary regulatory principles of physiology. They move from their own seats to other places in the body for performing various functions and come back to their own abodes. This movement of dosha in the body is called 'dosha gati’. Decrease (kshaya), normalcy (sthana), and increase (vriddhi) are the three types of dosha-gati. It represents various states of dosha in body physiology. The factors which are responsible for the causation of diseases are named ‘hetu or nidana’. Dosha are important causative factors in disease pathology. In vriddhi state, doshas are increased quantitatively and qualitatively. In sthana state, doshas are in the state of equilibrium. Whereas in kshaya state, doshas are decreased qualitatively and quantitatively. They are unable to perform their normal functions. Vriddhi and kshaya are pathological states of doshas, whereas sthana is indicative of its physiological state. However, in some instances even though doshas are in their abodes, it may lead to pathological symptoms due to ashayapakarsha phenomenon. In ashayapakarsha, the increased dosha forcibly takes out normal dosha from its own place. Thereafter it moves to other places resulting in various symptomatology, wherever it lodges in the body. Sometimes even doshas are not vitiated by their own etiological factors, but features of their vitiation are observed clinically. In many disorders, where clinical symptoms are not in accordance with the doshas involved in the pathogenesis (vikriti vishama samavaya), a physician needs to think of ashayapakarsha. Vata dosha is responsible for all types of movements in the body. Vata dosha has the capacity to move or take away other dosha and dushya from their own abodes to others places. This produces various inconsistent symptoms, due to the mobility (chala guna) of vata dosha. A proper understanding of ashayapakarsha opens many dimensions of treatment, where one cannot get results after routine treatment.

Contributors

Section/Chapter/topic	Concepts/Ashayapakarsha
Authors	Mali Pavan 1, Deole Y.S. 2
Reviewer & Editor	Basisht G.3,
Affiliations	1 Chief Medical Officer, NFSG, Directorate of Ayush, Delhi Govt., Delhi, India 2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India 3 Rheumatologist, Orlando, Florida, U.S.A.
Correspondence emails	rigvedvp7@gmail.com, dryogeshdeole@gmail.com, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	July 31, 2023
DOI	10.47468/CSNE.2023.e01.s09.142

Etymological derivation

• Gati is derived from root verb ‘gam’ meaning going away, deportment, passage, procedure, progress, movement, path, way, course, manner or power of going, state, condition, situation, proportion, mode of existence, motion. [Monnier Williams Dictionary pg.347]
• Ashaya means place, seat, abode, resting place, receptacle, reservoir; any recipient or containing vessel or viscus of the body, any recipient.[Monnier Williams Dictionary pg.157]
• Apakarsha means drawing or dragging off or down, detraction, diminution, decay, decline, destruction, pulling down, bringing low, lowering, depressing.
  2. Inferiority, infamy, degradation, sinking, drawing away, taking off, diminution.[Monnier Williams Dictionary pg.48]

Pathogenesis

Vata dosha is responsible for the initiation of pathogenesis in ashayapakarsha phenomenon. Kapha or pitta doshas are generally in the state of equilibrium. They are dragged by vata dosha from their seats which leads to various symptoms in the body. Primarily vata dosha is vitiated by its own causes. In a few conditions, vata may be vitiated due to the reduction (kshaya) of kapha dosha. In such conditions, vitiated vata then takes out normal pitta from its own abode and manifests symptoms of aggravation of pitta (pitta vriddhi) wherever it goes along with pitta. Pitta dosha causes burning (daha), cracking (bheda) sensation etc. in different parts of the body with fatigue and weakness. [Cha.Sa. Sutra Sthana 17/47] It occurs due to an increase in pitta dosha which gets increased after assimilation with pitta dosha of that place (sthanantara). Similarly, in a conditions, where pitta is decreased, the increased vata that takes out normal kapha from its site and spreads it within the body. Wherever this kapha is lodged, it manifests symptoms like colic pain, coldness, stiffness, and heaviness etc.
The prerequisite for ashayapakarsha is aggravated state of vata dragging the normal doshas from its site. Therefore, causes of vata dosha are observed in every phenomenon and treatment antagonistic to the cause of the disease (hetu viparita chikitsa) is useful to control vitiated vata dosha. These are a few examples of ashayapakarsha phenomenon. A wise physician must find out such different pathologies. [Cha.Sa. Sutra Sthana 17/45]

Ashayapakarsha pathogenesis in different diseases

Vata dominant atisara (diarrhea)

In the pathogenesis of vata dominant atisara, the aggravated vata dosha afflicts the power of digestion (by reducing the agni). With the deterioration of agni, the aggravated vata forces urine and sweat to the colon (purishashaya), liquefying the stool and manifesting vataja atisara. Here, vata by virtue of its power takes out urine and sweat from its place (ashaya) causing ashayapakarsha phenomenon. The urine and sweat (both in liquid form) assimilate with stools (purisha) in the colon (pakwashaya) causing liquefication of stool. This results in vata-dominant atisara.

Shakhashrita kamala (type of jaundice)

In shakhashrita kamala, the inherent pathogenesis of aggravation of pitta dosha is different. Consumption of a diet having a predominance of dry (ruksha), cold (sheeta), heavy to digest (guru), and sweet (madhura) properties, excess physical exercise, etc. factors cause aggravation of kapha and vata dosha. Aggravated vata further infiltrated with kapha takes out normal pitta from its abode and throws it out into the body tissues (shakha) leading to an increase of pitta at shakha level and causing jaundice (kamala). Due to this phenomenon, pitta cannot reach the gut (koshtha) and is unable to color the stools (purisharanjana karma). This results in the pale whitish-colored stool (tilapishta vat means sesame cake like stools). Skin, eyes, and urine are yellowish in color due to increased pitta. Since pitta cannot reach the gut, it decreases the digestive capacity (agnimandya) leading to gurgling sound in abdomen (atopa), constipation associated with flatulence (vishtambha), and heaviness in the cardiac region. Due to the displacement of pitta in the peripheral tissues (shakha), there is a diminution in the flow of pitta (to the gastrointestinal tract) resulting in the gradual development of weakness, low digestion (agnimandya), pain in the sides of chest (parshva), hiccups (hikka), dyspnea (shvasa), anorexia (aruchi) and fever (jwara).

Post herpetic neuralgia

In the neuropathy and post herpetic neuralgia cases, patients complain of tingling sensation, burning pain etc. which mimics with symptoms of pitta dosha. But symptoms occur due to aggravated vata, vitiated due to depleted state of kapha dosha (myelin sheath damage) resulting in burning sensation (daha) etc. In such cases, patients get relief from vata dosha pacifying treatment and not from pitta pacifying remedies.

Madhumeha

In the pathogenesis of obstinate urinary diseases with diabetes mellitus (madhumeha), vata is aggravated due to obstruction (avarana) of kapha, pitta, mamsa and meda. It drags ojas from its own place and brings them to bladder (basti) causing madhumeha. This condition is difficult to treat. In this condition, symptoms of vata, pitta and kapha are frequently manifested. The symptoms subside for some time, but again reappear later. [Cha.Sa. Sutra Sthana 17/78-81]
The pathogenesis of madhumeha is explained differently in nidana sthana. Vata gets aggravated due to its own etiological factors; this aggravated vata drags vasa (muscle fat) from its abode and enters the bladder (basti) leading to the manifestation of vasameha. When it carries marrow to the basti, it results in majjameha. Due to the large quantity of lasika (lymph) and due to the property of vata to dissipate things, lasika entering the basti to produces a large quantity of urine. This causes a continuous urge for micturition. Passing copious amounts of urine continuously (even) without any pressure is like an elephant (hasti) gone amuck, this is known as hastimeha. Ojas by nature have a sweet taste. However, the roughness of vata converts it into an astringent-tasting element. This vata-afflicted ojas when drags to the basti, causes madhumeha. In both pathogenesis, vayu by its own power drags out ojas from its own place to basti. This is ashayapakarsha phenomenon in the pathogenesis.

Jwara (fever)

In the pathogenesis of jwara, vayu gets aggravated by its own etiological factors and this vitiated vayu, when it reaches amashaya (stomach), afflicts agni. It vitiates the first dhatu (rasa). This (vitiated admixture of vayu and rasa) blocks the channels associated with rasa and sweda (sweat). The process adversely affecting the digestive processes and moving that heat out of its locus into other parts of the body. This excess heat leads to jwara. The same phenomenon occurs in the pathogenesis of pittaja and kaphaja jwara. Here ashayapakarsha of heat in the body (kosthastha ushma) to all over the body takes place due to vitiated dosha.

Shosha (emaciation)

In the pathogenesis of shosha (emaciation) due to excess adventures (sahasaja shosha), vata dosha gets aggravated. This aggravated vata with kapha residing in the lungs further afflicts pitta dosha. This causes the vitiated doshas to spread upwards, downwards, and obliquely. A portion of this afflicted dosha system that gets lodged in joints causes yawning, body ache, and fever; which gets into the amashaya to cause diseases of lungs and anorexia; that which gets into the throat causes irritation of the throat and hoarseness of voice; that which gets into the channels carrying vital breath (bronchial channels) causes dyspnea and coryza; that which gets into the head produces distress in the head. Further, a manifestation of a wound at the lung level and irregular movement of vayu causes a variety of diseases depending upon the organs where doshas are carried away by vata dosha. [Cha. Sa. Nidana Sthana 6/4] In shosha due to suppression of natural urges (vegavarodhaja shosha), the same pathogenesis occurs. When a portion gets into specific parts of the body, it causes pain, diarrhea or drying up of feces, excessive pain in sides of the chest, pain in the shoulders, irritation in throat, lungs, headache, cough, dyspnea, fever, hoarseness of voice and coryza. Thereafter, having been afflicted with these wasting complications, the patient gradually gets afflicted with shosha. [Cha. Sa. Nidana Sthana 6/7-8]
Under the pathogenesis of kshayaja shosha, due to excessive sexual indulgence, shukra kshaya results in aggravation of vata dosha. It further enters the related blood vessels and blood gets discharged from the seminal passage. Due to loss of semen and hemorrhage, joints loosen, the skin becomes rough or scaly, body weakens further and vayu gets vitiated. The vitiated vayu spreads in the body deficient of semen and blood. The vata vitiates kapha and pitta and dries up the muscles and blood. Further, the vitiated vayu expels kapha and pitta as symptoms of kasa, causing pain in the sides of the chest and shoulders, irritation of the throat. The vitiated vata by aggravating kapha in the head region and replacing it with the vitiated kapha expelled from their natural locations, causes pain in joints, body ache, anorexia and indigestion. Due to frequent cough, the lungs get damaged and hemoptysis ensues, debilitating the patient further and afflicting him with wasting complications. If untreated, the patient gradually gets afflicted with phthisis. In the above pathogenesis of shosha, vata drags other doshas from their abodes and takes them out to different parts of the body due to ashayapakarsha phenomenon.

Shwasa (respiratory disorders or dyspnea)

In the pathogenesis of shwasa, vata gets aggravated by its own etiological factors. This vitiated vata enters channels carrying vitality (pranavaha srotas) and takes out kapha from thorax (urasthana) causing obstruction to the movement of prana vayu, leading to shwasa. Here vayu causes ashayapakarsha of kapha, which is present in its own ashaya i.e. urasthana.

Sheetapitta - udarda – pathogenesis

‘Sheetapitta’ has ‘vata dominancy’, while ‘udarda’ has ‘kapha Dominancy’. [M. N. 50/4] It has been described as different entities, but they can be considered as different types of urticarias. They all have same cardinal symptom i.e. ‘itchy red rashes on the skin’. Kapha and vata dosha is aggravated specially due to exposure to cold wind (sheeta vata sevan). Pitta is also vitiated due to own causes in its abode. These vitiated dosha drag pitta dosha from its abode and traverse towards shakha (at rasa and rakta dhatu level). In this pathogenesis pitta dosha is dragged by vata and kapha dosha. It traverse to periphery (shakha- bahya roga marga). Hence it is considered as ashaya- apakarsha. Looking into the treatment principle, body message by use of oils medicated with pungent medicines (katu rasa dravyas like mustard oil (katu-taila abhyanga)) and fomentation by hot water is useful. By observing the movement of dosha (gati), hot treatment (ushna chikitsa) or cold treatment (sheeta chikitsa) is to be given.

Differential diagnosis

Whenever one can find vikriti visham samveta lakshana sammuchaya (symptoms of the disease are not in accordance with the doshas causing that disease) or when a patient is not responding as per conventional treatment of clinical pathogenesis (lakshan-samprapti-chikitsa), we need to think of the principle of ashayaapakarsha. It is a unique process, where symptoms can occur directly in the absence of that causative factor. In the diagnosis of ashayapakarsha, upashaya-anupashaya plays a vital role in the absence of causes of occurring symptoms.

Difference between ashayapakarsha and avarana

In the process of avarana, vata dosha is the primary unit with amurta nature (formless). Due to different etiological factors, other dosha, dhatu, and malas aggravates. These increased dushyas cause obstruction in the route of vayu leading to its aggravation (avaranajanya vata prakopa). This initially causes symptoms of obstructing dosha or dushya, but later, the symptoms of vitiated vata are observed. During its management, the removal of avarana of vata is the first and foremost thing.
In ashayapakarsha, symptoms are produced due to displacement of dosha or dushya from their own abodes due to vitiated vata dosha. During treatment also, vata dosha management is important among all other doshas and dushyas.

Importance of ashayapakarsha

It is one of the core concepts mentioned under sansargaja vikara (pathogensis due to two doshas). It doesn't follow shatkriyakala in its sequential occurrence. Aashay vikshep (Normal Doshas are deflected from their abode) and movement of deflected doshas or dushyas with Prerak (urging) dosha are prerequisites in this phenomenon. Upashay -anupashy (whether given medicine is beneficial or non-beneficial for treating condition) is the important key for the diagnosis of ashayapakarsha.
It is one of the important diagnostic tool in the management of exceptional pathologies. Often, symptoms of ashayapakarsha are localized in a specific area and not having a systemic presentation of the disease. In such cases, it is an acute phenomenon.

Principles of management

Usually, the palliative therapy (shamana chikitsa) is applicable in ashayapakarsha pathogenesis. Proper history-taking is very important in the diagnosis of ashayapakarsha.
During management, vata dosha, which is dragging pitta from its abode is to be treated instead of pitta. If a physician is unaware of this phenomenon, by observing the aggravated symptoms of pitta dosha, and by adopting a pitta pacifying management will result in the reduction of pitta. This may manifest new disease and cause harm to the patient’s life due to pitta kshaya. The predominant role of vata dosha needs attention in treating these pathologies.
Management of shakhashrita kamala is focused on removing obstruction of kapha and vatanulomana (restoring vata Direction) and bringing back the pitta to its own abode. Until then, hot (ushna), pungent (katu), bitter (tikta) and sour (amla) dravyas and food are used for the said purpose. Once the pitta restores its own abode, then the treatment of kostha shakhashrita kamala is applied for further course. By observing the symptoms of aggravation of pitta, if someone follows the pitta pacifying treatment, it will not give the proper results and cause harm to the patient. Hence, the wise physician must think about other aspects of pathogenesis like ashayapakarsha in such cases.

Contemporary approach

The ashayapakarsha phenomenon can be studied in view of contemporary pathophysiological approach. The inflammatory chemicals or messengers are circulated and produce clinical features at a different site. This is observed in case of chronic inflammatory diseases, autoimmune diseases, recurrent episodes of acute inflammation. These diseases include diabetes, arthritis, allergies, chronic obstructive pulmonary diseases. The phenomenon of ashayaparkarsha needs more research to understand the pathologies of unknown origin.

Thesis and research works

In a clinical study, the burning sensation in condition of diabetic poly neuropathy is observed due to ashayapakarsha phenomenon of pitta dosha by vata dosha. The condition is treated with S. cordifolia Linn. (bala) and Phyllanthus niruri Linn. (bhumyamalaki) which help in pacifying vata and pitta dosha.
Other research works are supportive to the concept of ashayapakarsha as mentioned above.

1. Conceptual study of ashayapkarsha gati w.s.r.to Samprapti vivechan of ruddhpath kamala
2. Conceptual study of ashayapkarsha gati in shetapitta vyadhi
3. Critical review on the concept of Ashayapakarsha and its application

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