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→Samprapti (pathogenesis)
In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter. [20]
In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter. [20]
Vagbhata has not described vidhi samprapti. He has described only five kinds of samprapti i.e. samkhya, vikalpa, pradhanya, bala and kala samprapti. (A H Ni. 1/)[21] [12]. Pradhanya samprapti indicates the primacy of a samprapti (A H Ni. 1/)[22] When a dosha gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of vata for example may mean aggravation of its coldness, lightness or ununctuousness.
Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. (A H Ni. 1/)[21] [12]. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/)[22] When a ''dosha'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''vata'' for example may mean aggravation of its coldness, lightness or ununctuousness.
Kala samprapti means the type that is governed by seasonal variations. Aggravation/ manifestation of shleshmika/kaphaja type of fever during winter season is the example of seasonal variation. Some Ayurveda practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define vidhi samprapti as an affliction attributed to such deeds. [23] The timing of disease manifestation shows variation in the samprapti or pathogenesis. This aspect of samprapti helps in clearly determining the specific characteristics of a disease.
Vagbhata describes that bala samprapti is important to assess the severity of disease. (A H Ni. 1/)[24] [12-5]
''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds. [23] The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.
Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. (A H Ni. 1/)[24] [12-5]
==== Significance of knowledge of ''nidana'' ====
#Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases. [26]
#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult. [27]
#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.
#To treat the newly originated diseases, a physician should have the knowledge of the involved ''doshas'', causative factors and the location of the disease.
==== Significance of knowledge of ''poorvarupa'' ====
#[[Charaka Samhita]] suggests specific modalities for treatment of a patient at this stage. E.g. Light food and ''apatarpana'' treatment should be give when premonitory signs of fever are seen.
#Manifestation of all the premonitory signs indicates bad prognosis of the disease.
#''Poorvarupa'' has significant role in the differential diagnosis of the disease.
==== Significance of knowledge of ''rupa'' ====
#It has the same importance as that of ''nidana'' and ''poorvarupa'' in the prognosis of diseases. Rise in number of ''rupa'' makes the disease difficult to cure.
#''Rupa'' denotes the complete manifestation of the disease along with its ''dosha'' predominance. The diseases can be treated in a proper way if one is having the knowledge of all the sign and symptoms and the ''dosha'' responsible for it.
==== Significance of knowledge of ''upashaya'' ====
#Knowledge of ''upashaya'' is helpful in differential diagnosis of diseases.
#It also helps in identifying the diseases which are not clearly manifested.
==== Significance of knowledge of ''samprapti'' ====
#''Samprapti'' provides the details of the diseases such as ''dosha'' predominance, predominance of one or the other fraction of the three ''doshas'', specific time of aggravation, and manifestation of diseases which plays a pivotal role in the management of diseases.
#The important role of a physician in the management of diseases is ''sampraptibhanga'' i.e. to break the association of vitiated ''dosha'' and ''dushya'' (tissue that gets vitiated). This is not possible without proper knowledge of ''samprapti''.
==== ''Nidanapanchaka'' and ''shat kriyakala'' ====
Sushruta described six stages of ''dosha'' vitiation and progression of disease known as ''shat kriyakala'' (periods of activity). They are as under:
*''Sanchaya'' (accumulation): In this stage ''dosha'' undergo mild increase at their own site. This accumulation produces mild symptoms. If the person recognises these instincts and acts accordingly, the ''doshas'' can be brought to the normal condition without much effort. [29]
*''Prakopa'' (aggravation): In this stage, ''doshas'' gets vitiated further at their own site and exhibit some specific symptoms. By suitable changes in daily routine one can overcome these conditions. [30]
*''Prasara'' (spreading): The status of ''doshas'' again increases further and ''doshas'' spread nearby sites and invade the sites of other ''doshas'' to produce symptoms. If the person continues to indulge in unhealthy food and regimen, then the disease progresses to the next stage. [31]
During the first three stages, the unhealthy food and activities increases the ''doshas'' and produces mild abnormalities. These three stages can be co-related with ''nidana'' (''hetu'') of ''nidanapanchaka''.
*''Sthanasanshraya'' (localisation): The increased ''doshas'' start accumulating at certain other places and lead to their abnormalities, especially in the ''srotasa''. It leads to four kinds of abnormal changes in ''srotasa''. [28]
**''Atipravritti'' – Increased functioning of channels
**''Sanga'' – Obstruction, blockage of channels
**''Sira-Granthi'' – Abnormal growths in the channels
**''Vimargagamana'' – Movement of fluids in wrong direction
The site where these ''doshas'' lodge together to progress towards disease, is the site of origin of disease. This is the stage of actual commencement of the disease. It is characterized by manifestation of some moderate symptoms which indicate the forthcoming disease. These are known as ''poorvarupa''. This stage can be co-related with ''poorvarupa'' of ''nidanapanchaka''. [32]
*''Vyakti'' (manifestation): This is the stage of full manifestation of the disease with all its characteristic sign and symptoms. These sign and symptoms are known as ''rupa''. This stage can be co-related with ''rupa'' of ''nidanapanchaka''. [33]
*''Bheda'' (complication): In this stage, the abnormalities become more profound and irreversible in spite of the best treatment. Sometimes ''upadravas'' (complications) or ''arishta lakshanas'' (bad prognostic signs) can be seen in this stage. This stage also can be co-related with ''rupa'' of ''nidanapanchaka''. [34]
The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.
====Interrelation between ''nidanapanchaka'' and ''shatkriyakala'' ====
Sr. No. Shatkriyakala Nidanapanchaka
Sr. No. Shatkriyakala Nidanapanchaka