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<p style="text-align:justify;">‘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.<ref name="ref11">Chakradutta. Chakradutta. Translated from from Sanskrit by Pandit Jagannath Sharma Bajpayee. 3rd ed. Bombay: Lakshmi Venkateshwara Steam press;1863.pp-223-224.</ref></p>
<p style="text-align:justify;">‘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.<ref name="ref11">Chakradutta. Chakradutta. Translated from from Sanskrit by Pandit Jagannath Sharma Bajpayee. 3rd ed. Bombay: Lakshmi Venkateshwara Steam press;1863.pp-223-224.</ref></p>
== Differential diagnosis ==
<p style="text-align:justify;">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.</p>
== Difference between ashayapakarsha and avarana ==
<p style="text-align:justify;">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. <br/>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.</p>
== Importance of ashayapakarsha ==
<p style="text-align:justify;">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. <br/>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. </p>
== Principles of management ==
<p style="text-align:justify;">Usually, the palliative therapy (shamana chikitsa) is applicable in ashayapakarsha pathogenesis. Proper history-taking is very important in the diagnosis of ashayapakarsha. <br/>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. <br/>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. </p>
== Contemporary approach ==
<p style="text-align:justify;">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.<ref name="ref12">Roma Pahwa, Amandeep Goyal, Ishwarlal Jialal. Chronic Inflammation. Available from https://www.ncbi.nlm.nih.gov/books/NBK493173/#__NBK493173_ai__cited on 24 Jul. 23</ref> The phenomenon of ashayaparkarsha needs more research to understand the pathologies of unknown origin. </p>
== Thesis and research works ==
<p style="text-align:justify;">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.<ref name="ref13">Patel MV, Patel MM, Patel KB, Chhayani PV, Mittwede M, Scheidbach D, Gupta SN. A randomized placebo-compared study on the efficacy of classical ayurvedic pharmaceutical form versus aqueous alcoholic extracts of Phyllanthus niruri Linn. Plus Sida cordifolia Linn. in patients of diabetic sensory polyneuropathy. J Ayurveda Integr Med. 2022 Jul-Sep;13(3):100619. doi: 10.1016/j.jaim.2022.100619. Epub 2022 Aug 23. PMID: 36027804; PMCID: PMC9424570.</ref> <br/>Other research works are supportive to the concept of ashayapakarsha as mentioned above.
# Conceptual study of ashayapkarsha gati w.s.r.to Samprapti vivechan of ruddhpath kamala<ref name="ref14">Amale D, Chavan M. Conceptual study of ashayapkarsha gati w.s.r.to Samprapti vivechan of ruddhpath kamala.World journal of pharmaceutical and medical research. 2020;6(3), 01-04.</ref>
# Conceptual study of ashayapkarsha gati in shetapitta vyadhi<ref name="ref15">Gaikwad M. Chatre S. Amale D. Conceptual study of ashayapkarsha gati in shetapitta vyadhi. J. Bio. Innov 9(5b). pp: 148-154, 2020. </ref>
# Critical review on the concept of Ashayapakarsha and its application<ref name="ref16">Huddar A., Nuchhi M., Walikar M. Critical review on the concept of Ashayapakarsha and its application. Journal of Ayurveda and integrated medical sciences. May June 2020</ref>
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