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Ashayapakarsha (view source)

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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|dosha]] (gati). In this context, primarily the commentary of Bhattarharishchandra on kiyantah shirasiya adhyaya of Charak Samhita has been referred.[Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/45-46]<ref name="ref1">Goyal M.,Singh G.. Kiyanta Shiraseeya Adhyaya verse 45-46. In: Kar A., Rai S., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Kiyanta_Shiraseeya_Adhyaya&oldid=41147. Accessed December 31, 2022. </ref> [[Dosha|Dosha]] are primary regulatory principles of physiology. They move from their own seats to other places in the [[Sharira|body]] for performing various functions and come back to their own abodes. This movement of [[Dosha|dosha]] in the [[Sharira|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|doshas]] in [[Sharira|body]] physiology. The factors which are responsible for the causation of diseases are named ~~‘hetu~~ or ~~nidana’~~. [[Dosha|Dosha]] are important causative factors in disease pathology.<ref name="ref2">Sri Vijayrakshit and shrikantdutta,Madhavnidan of sri madhavkar with madhukosh Sanskrit commentary,Vidyotini hindi commentary,2018 edition,Panchnidan lakshana,verse 1-5,Choukhamba prakashan,Varanasi,volume 1,Page no.5</ref> In vriddhi state, [[Dosha|doshas]] are increased quantitatively and qualitatively. In sthana state, [[Dosha|doshas]] are in the state of equilibrium. Whereas in kshaya state, [[Dosha|doshas]] are decreased qualitatively and quantitatively. They are unable to perform their normal functions. Vriddhi and kshaya are pathological states of [[Dosha|doshas]], whereas sthana is indicative of its physiological state. However, in some instances even though [[Dosha|doshas]] are in their abodes, it may lead to pathological symptoms due to ashayapakarsha phenomenon. In ashayapakarsha, the increased [[Dosha|dosha]] forcibly takes out normal [[Dosha|dosha]] from its own place. Thereafter it moves to other places resulting in various symptomatology, wherever it lodges in the [[Sharira|body]]. Sometimes even [[Dosha|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 [[Dosha|doshas]] involved in the pathogenesis (vikriti vishama samavaya), a physician needs to think of ashayapakarsha. [[Vata dosha|Vata dosha]] is responsible for all types of movements in the [[Sharira|body]]. [[Vata dosha|Vata dosha]] has the capacity to move or take away other [[Dosha|dosha]] and dushya from their own abodes to others places. This produces various inconsistent symptoms, due to the mobility (chala guna) of [[Vata dosha|vata dosha]]. A proper understanding of ashayapakarsha opens many dimensions of treatment, where one cannot get results after routine treatment.

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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|dosha]] (gati). In this context, primarily the commentary of Bhattarharishchandra on kiyantah shirasiya adhyaya of Charak Samhita has been referred.[Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/45-46]<ref name="ref1">Goyal M.,Singh G.. Kiyanta Shiraseeya Adhyaya verse 45-46. In: Kar A., Rai S., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Kiyanta_Shiraseeya_Adhyaya&oldid=41147. Accessed December 31, 2022. </ref> [[Dosha|Dosha]] are primary regulatory principles of physiology. They move from their own seats to other places in the [[Sharira|body]] for performing various functions and come back to their own abodes. This movement of [[Dosha|dosha]] in the [[Sharira|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|doshas]] in [[Sharira|body]] physiology. The factors which are responsible for the causation of [[Vyadhi|diseases]] are named ‘[[Hetu|hetu]] or [[Nidana|nidana]]’. [[Dosha|Dosha]] are important causative factors in disease pathology.<ref name="ref2">Sri Vijayrakshit and shrikantdutta,Madhavnidan of sri madhavkar with madhukosh Sanskrit commentary,Vidyotini hindi commentary,2018 edition,Panchnidan lakshana,verse 1-5,Choukhamba prakashan,Varanasi,volume 1,Page no.5</ref> In vriddhi state, [[Dosha|doshas]] are increased quantitatively and qualitatively. In sthana state, [[Dosha|doshas]] are in the state of equilibrium. Whereas in kshaya state, [[Dosha|doshas]] are decreased qualitatively and quantitatively. They are unable to perform their normal functions. Vriddhi and kshaya are pathological states of [[Dosha|doshas]], whereas sthana is indicative of its physiological state. However, in some instances even though [[Dosha|doshas]] are in their abodes, it may lead to pathological symptoms due to ashayapakarsha phenomenon. In ashayapakarsha, the increased [[Dosha|dosha]] forcibly takes out normal [[Dosha|dosha]] from its own place. Thereafter it moves to other places resulting in various symptomatology, wherever it lodges in the [[Sharira|body]]. Sometimes even [[Dosha|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 [[Dosha|doshas]] involved in the pathogenesis (vikriti vishama samavaya), a physician needs to think of ashayapakarsha. [[Vata dosha|Vata dosha]] is responsible for all types of movements in the [[Sharira|body]]. [[Vata dosha|Vata dosha]] has the capacity to move or take away other [[Dosha|dosha]] and dushya from their own abodes to others places. This produces various inconsistent symptoms, due to the mobility (chala guna) of [[Vata dosha|vata dosha]]. A proper understanding of ashayapakarsha opens many dimensions of treatment, where one cannot get results after routine treatment.

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== Pathogenesis ==

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[[Vata dosha|Vata dosha]] is responsible for the initiation of pathogenesis in ashayapakarsha phenomenon. [[Kapha dosha|Kapha]] or [[Pitta dosha|pitta doshas]] are generally in the state of equilibrium. They are dragged by [[Vata dosha|vata dosha]] from their seats which leads to various symptoms in the [[Sharira|body]]. Primarily [[Vata dosha|vata dosha]] is vitiated by its own causes. In a few conditions, [[Vata dosha|vata]] may be vitiated due to the reduction (kshaya) of [[Kapha dosha|kapha dosha]]. In such conditions, vitiated [[Vata dosha|vata]] then takes out normal [[Pitta dosha|pitta]] from its own abode and manifests symptoms of aggravation of [[Pitta dosha|pitta]] (pitta vriddhi) wherever it goes along with [[Pitta dosha|pitta]]. [[Pitta dosha|Pitta dosha]] causes burning (daha), cracking (bheda) sensation etc. in different parts of the [[Sharira|body]] with fatigue and weakness. [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/47] It occurs due to an increase in [[Pitta dosha|pitta dosha]] which gets increased after assimilation with [[Pitta dosha|pitta dosha]] of that place (sthanantara). Similarly, in a conditions, where [[Pitta dosha|pitta]] is decreased, the increased vata that takes out normal [[Kapha dosha|kapha]] from its site and spreads it within the [[Sharira|body]]. Wherever this [[Kapha dosha|kapha]] is lodged, it manifests symptoms like colic pain, coldness, stiffness, and heaviness etc.<ref name="ref4"> </ref> The prerequisite for ashayapakarsha is aggravated state of [[Vata dosha|vata]] dragging the normal [[Dosha|doshas]] from its site. Therefore, causes of [[Vata dosha|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|vata dosha]]. These are a few examples of ashayapakarsha phenomenon. A wise physician must find out such different pathologies. [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/45]

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[[Vata dosha|Vata dosha]] is responsible for the initiation of pathogenesis in ashayapakarsha phenomenon. [[Kapha dosha|Kapha]] or [[Pitta dosha|pitta doshas]] are generally in the state of equilibrium. They are dragged by [[Vata dosha|vata dosha]] from their seats which leads to various symptoms in the [[Sharira|body]]. Primarily [[Vata dosha|vata dosha]] is vitiated by its own causes. In a few conditions, [[Vata dosha|vata]] may be vitiated due to the reduction (kshaya) of [[Kapha dosha|kapha dosha]]. In such conditions, vitiated [[Vata dosha|vata]] then takes out normal [[Pitta dosha|pitta]] from its own abode and manifests symptoms of aggravation of [[Pitta dosha|pitta]] (pitta vriddhi) wherever it goes along with [[Pitta dosha|pitta]]. [[Pitta dosha|Pitta dosha]] causes burning (daha), cracking (bheda) sensation etc. in different parts of the [[Sharira|body]] with fatigue and weakness. [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/47] It occurs due to an increase in [[Pitta dosha|pitta dosha]] which gets increased after assimilation with [[Pitta dosha|pitta dosha]] of that place (sthanantara). Similarly, in a conditions, where [[Pitta dosha|pitta]] is decreased, the increased [[Vata dosha|vata]] that takes out normal [[Kapha dosha|kapha]] from its site and spreads it within the [[Sharira|body]]. Wherever this [[Kapha dosha|kapha]] is lodged, it manifests symptoms like colic pain, coldness, stiffness, and heaviness etc.<ref name="ref4"> </ref> The prerequisite for ashayapakarsha is aggravated state of [[Vata dosha|vata]] dragging the normal [[Dosha|doshas]] from its site. Therefore, causes of [[Vata dosha|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|vata dosha]]. These are a few examples of ashayapakarsha phenomenon. A wise physician must find out such different pathologies. [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/45]

== Ashayapakarsha pathogenesis in different diseases ==

=== Vata dominant atisara (diarrhea) ===

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In the pathogenesis of [[Vata dosha|vata]] dominant atisara, the aggravated [[Vata dosha|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.<ref name="ref5">Byadgi P.S.,Dube N.. Atisara Chikitsa Adhyaya verse, 5. In: Singh G., Goyal M., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Atisara_Chikitsa&oldid=41216. Accessed January 2, 2023. </ref> Here, [[Vata dosha|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.

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In the pathogenesis of [[Vata dosha|vata]] dominant [[Atisara Chikitsa|atisara]], the aggravated [[Vata dosha|vata dosha]] afflicts the power of digestion (by reducing the [[Agni|agni]]). With the deterioration of [[Agni|agni]], the aggravated [[Vata dosha|vata]] forces urine and sweat to the colon (purishashaya), liquefying the stool and manifesting vataja [[Atisara Chikitsa|atisara]].<ref name="ref5">Byadgi P.S.,Dube N.. Atisara Chikitsa Adhyaya verse, 5. In: Singh G., Goyal M., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Atisara_Chikitsa&oldid=41216. Accessed January 2, 2023. </ref> Here, [[Vata dosha|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 [[Purisha|stools (purisha)]] in the colon (pakwashaya) causing liquefication of stool. This results in vata-dominant [[Atisara Chikitsa|atisara]].

=== Shakhashrita kamala (type of jaundice) ===

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In shakhashrita kamala, the inherent pathogenesis of aggravation of [[Pitta dosha|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 dosha|kapha]] and [[Vata dosha|vata dosha]]. Aggravated [[Vata dosha|vata]] further infiltrated with [[Kapha dosha|kapha]] takes out normal [[Pitta dosha|pitta]] from its abode and throws it out into the [[Sharira|body]] tissues (shakha) leading to an increase of [[Pitta dosha|pitta]] at shakha level and causing jaundice (kamala). Due to this phenomenon, [[Pitta dosha|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 dosha|pitta]]. Since [[Pitta dosha|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 dosha|pitta]] in the peripheral tissues (shakha), there is a diminution in the flow of [[Pitta dosha|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).<ref name="ref6">Kar A.C.,Rai S., Aladoriya N., Deole Y. S.. Pandu Chikitsa Adhyaya verse,124-126. In: Singh G., Goyal M., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Pandu_Chikitsa&oldid=41213. Accessed January 2, 2023. </ref>

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In shakhashrita [[Kamala|kamala]], the inherent pathogenesis of aggravation of [[Pitta dosha|pitta dosha]] is different. Consumption of a diet having a predominance of dry (ruksha), [[Sheeta|cold (sheeta)]], heavy to digest (guru), and [[Madhura|sweet (madhura)]] properties, excess physical exercise, etc. factors cause aggravation of [[Kapha dosha|kapha]] and [[Vata dosha|vata dosha]]. Aggravated [[Vata dosha|vata]] further infiltrated with [[Kapha dosha|kapha]] takes out normal [[Pitta dosha|pitta]] from its abode and throws it out into the [[Sharira|body]] tissues (shakha) leading to an increase of [[Pitta dosha|pitta]] at shakha level and causing [[Kamala|jaundice (kamala)]]. Due to this phenomenon, [[Pitta dosha|pitta]] cannot reach the gut ([[Koshtha|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 dosha|pitta]]. Since [[Pitta dosha|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 dosha|pitta]] in the peripheral tissues (shakha), there is a diminution in the flow of [[Pitta dosha|pitta]] (to the gastrointestinal tract) resulting in the gradual development of weakness, low digestion (agnimandya), pain in the sides of chest (parshva), [[Hikka Shwasa Chikitsa|hiccups (hikka)]], dyspnea (shvasa), anorexia (aruchi) and [[Jwara|fever (jwara)]].<ref name="ref6">Kar A.C.,Rai S., Aladoriya N., Deole Y. S.. Pandu Chikitsa Adhyaya verse,124-126. In: Singh G., Goyal M., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Pandu_Chikitsa&oldid=41213. Accessed January 2, 2023. </ref>

=== Post herpetic neuralgia ===

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=== Madhumeha ===

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In the pathogenesis of obstinate urinary diseases with diabetes mellitus (madhumeha), [[Vata dosha|vata]] is aggravated due to obstruction (avarana) of [[Kapha dosha|kapha]], [[Pitta dosha|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 dosha|vata]], [[Pitta dosha|pitta]] and [[Kapha dosha|kapha]] are frequently manifested. The symptoms subside for some time, but again reappear later. [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/78-81] The pathogenesis of madhumeha is explained differently in nidana sthana. [[Vata dosha|Vata]] gets aggravated due to its own etiological factors; this aggravated [[Vata dosha|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 dosha|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 dosha|vata]] converts it into an astringent-tasting element. This vata-afflicted ojas when drags to the basti, causes madhumeha.<ref name="ref7">Chandola H.M., Kajaria D.. Prameha Nidana Adhyaya,verse 36-37. In: Khandel S.K., Godatwar P., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Prameha_Nidana&oldid=41165. Accessed January 2, 2023. </ref> In both pathogenesis, vayu by its own power drags out ojas from its own place to basti. This is ashayapakarsha phenomenon in the pathogenesis.

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In the pathogenesis of obstinate urinary [[Vyadhi|diseases]] with diabetes mellitus ([[Prameha Chikitsa|madhumeha]]), [[Vata dosha|vata]] is aggravated due to obstruction ([[Avarana|avarana]]) of [[Kapha dosha|kapha]], [[Pitta dosha|pitta]], [[Mamsa dhatu|mamsa]] and [[Meda|meda]]. It drags [[Ojas|ojas]] from its own place and brings them to bladder ([[Basti|basti]]) causing [[Prameha Chikitsa|madhumeha]]. This condition is difficult to treat. In this condition, symptoms of [[Vata dosha|vata]], [[Pitta dosha|pitta]] and [[Kapha dosha|kapha]] are frequently manifested. The symptoms subside for some time, but again reappear later. [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 17/78-81] The pathogenesis of [[Prameha Chikitsa|madhumeha]] is explained differently in [[Nidana Sthana|nidana sthana]]. [[Vata dosha|Vata]] gets aggravated due to its own etiological factors; this aggravated [[Vata dosha|vata]] drags vasa (muscle fat) from its abode and enters the bladder ([[Basti|basti]]) leading to the manifestation of vasameha. When it carries marrow to the [[Basti|basti]], it results in majjameha. Due to the large quantity of [[Lasika|lasika (lymph)]] and due to the property of [[Vata dosha|vata]] to dissipate things, [[Lasika|lasika]] entering the [[Basti|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|Ojas]] by nature have a sweet taste. However, the roughness of [[Vata dosha|vata]] converts it into an astringent-tasting element. This vata-afflicted [[Ojas|ojas]] when drags to the [[Basti|basti]], causes [[Prameha Chikitsa|madhumeha]].<ref name="ref7">Chandola H.M., Kajaria D.. Prameha Nidana Adhyaya,verse 36-37. In: Khandel S.K., Godatwar P., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Prameha_Nidana&oldid=41165. Accessed January 2, 2023. </ref> In both pathogenesis, [[Vayu mahabhuta|vayu]] by its own power drags out [[Ojas|ojas]] from its own place to [[Basti|basti]]. This is ashayapakarsha phenomenon in the pathogenesis.

=== Jwara (fever) ===

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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 [[Sharira|body]]. This excess heat leads to jwara. The same phenomenon occurs in the pathogenesis of pittaja and kaphaja jwara.<ref name="ref8">Dwivedi R.B.,Dubey S.D., Gujarathi R.,Singh A.Khandel S.K., Rai S.. Jwara Nidana Adhyaya,verse 20. In: Khandel S.K., Godatwar P., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Jwara_Nidana&oldid=41162. Accessed January 2, 2023. </ref> Here ashayapakarsha of heat in the [[Sharira|body]] (kosthastha ushma) to all over the [[Sharira|body]] takes place due to vitiated [[Dosha|dosha]].

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In the pathogenesis of [[Jwara|jwara]], [[Vayu mahabhuta|vayu]] gets aggravated by its own etiological factors and this vitiated [[Vayu mahabhuta|vayu]], when it reaches [[Amashaya|amashaya (stomach)]], afflicts [[Agni|agni]]. It vitiates the first [[Dhatu|dhatu]] (rasa). This (vitiated admixture of [[Vayu mahabhuta|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 [[Sharira|body]]. This excess heat leads to [[Jwara|jwara]]. The same phenomenon occurs in the pathogenesis of pittaja and kaphaja jwara.<ref name="ref8">Dwivedi R.B.,Dubey S.D., Gujarathi R.,Singh A.Khandel S.K., Rai S.. Jwara Nidana Adhyaya,verse 20. In: Khandel S.K., Godatwar P., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Jwara_Nidana&oldid=41162. Accessed January 2, 2023. </ref> Here ashayapakarsha of heat in the [[Sharira|body]] (kosthastha ushma) to all over the [[Sharira|body]] takes place due to vitiated [[Dosha|dosha]].

=== Shosha (emaciation) ===

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In the pathogenesis of shosha (emaciation) due to excess adventures (sahasaja shosha), [[Vata dosha|vata dosha]] gets aggravated. This aggravated [[Vata dosha|vata]] with [[Kapha dosha|kapha]] residing in the lungs further afflicts [[Pitta dosha|pitta dosha]]. This causes the vitiated [[Dosha|doshas]] to spread upwards, downwards, and obliquely. A portion of this afflicted [[Dosha|dosha]] system that gets lodged in joints causes yawning, [[Sharira|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 [[Dosha|doshas]] are carried away by [[Vata dosha|vata dosha]]. [Cha. Sa. Nidana Sthana 6/4]<ref name="ref9">Singh R.H., Sodhi J.S. Shosha Nidana Adhyaya,verse 4. In: Khandel S.K., Godatwar P., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Shosha_Nidana&oldid=41167. Accessed January 2, 2023. </ref> In shosha due to suppression of natural urges (vegavarodhaja shosha), the same pathogenesis occurs. When a portion gets into specific parts of the [[Sharira|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|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, [[Sharira|body]] weakens further and vayu gets vitiated. The vitiated vayu spreads in the [[Sharira|body]] deficient of semen and blood. The [[Vata dosha|vata]] vitiates [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] and dries up the muscles and blood. Further, the vitiated vayu expels [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] as symptoms of kasa, causing pain in the sides of the chest and shoulders, irritation of the throat. The vitiated [[Vata dosha|vata]] by aggravating [[Kapha dosha|kapha]] in the head region and replacing it with the vitiated [[Kapha dosha|kapha]] expelled from their natural locations, causes pain in joints, [[Sharira|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.<ref name="ref10"> </ref> In the above pathogenesis of shosha, [[Vata dosha|vata]] drags other [[Dosha|doshas]] from their abodes and takes them out to different parts of the [[Sharira|body]] due to ashayapakarsha phenomenon.

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In the pathogenesis of shosha (emaciation) due to excess adventures (sahasaja shosha), [[Vata dosha|vata dosha]] gets aggravated. This aggravated [[Vata dosha|vata]] with [[Kapha dosha|kapha]] residing in the lungs further afflicts [[Pitta dosha|pitta dosha]]. This causes the vitiated [[Dosha|doshas]] to spread upwards, downwards, and obliquely. A portion of this afflicted [[Dosha|dosha]] system that gets lodged in joints causes yawning, [[Sharira|body]] ache, and fever; which gets into the [[Amashaya|amashaya]] to cause [[Vyadhi|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 mahabhuta|vayu]] causes a variety of [[Vyadhi|diseases]] depending upon the organs where [[Dosha|doshas]] are carried away by [[Vata dosha|vata dosha]]. [Cha. Sa. [[Nidana Sthana|Nidana Sthana]] 6/4]<ref name="ref9">Singh R.H., Sodhi J.S. Shosha Nidana Adhyaya,verse 4. In: Khandel S.K., Godatwar P., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/index.php?title=Shosha_Nidana&oldid=41167. Accessed January 2, 2023. </ref> In shosha due to suppression of natural urges (vegavarodhaja shosha), the same pathogenesis occurs. When a portion gets into specific parts of the [[Sharira|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|Nidana Sthana]] 6/7-8] Under the pathogenesis of kshayaja shosha, due to excessive sexual indulgence, shukra kshaya results in aggravation of [[Vata dosha|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, [[Sharira|body]] weakens further and [[Vayu mahabhuta|vayu]] gets vitiated. The vitiated [[Vayu mahabhuta|vayu]] spreads in the [[Sharira|body]] deficient of semen and blood. The [[Vata dosha|vata]] vitiates [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] and dries up the muscles and blood. Further, the vitiated [[Vayu mahabhuta|vayu]] expels [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] as symptoms of kasa, causing pain in the sides of the chest and shoulders, irritation of the throat. The vitiated [[Vata dosha|vata]] by aggravating [[Kapha dosha|kapha]] in the head region and replacing it with the vitiated [[Kapha dosha|kapha]] expelled from their natural locations, causes pain in joints, [[Sharira|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.<ref name="ref10"> </ref> In the above pathogenesis of shosha, [[Vata dosha|vata]] drags other [[Dosha|doshas]] from their abodes and takes them out to different parts of the [[Sharira|body]] due to ashayapakarsha phenomenon.

=== Shwasa (respiratory disorders or dyspnea) ===

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In the pathogenesis of shwasa, [[Vata dosha|vata]] gets aggravated by its own etiological factors. This vitiated [[Vata dosha|vata]] enters channels carrying vitality (pranavaha srotas) and takes out [[Kapha dosha|kapha]] from thorax (urasthana) causing obstruction to the movement of prana vayu, leading to shwasa.<ref name="ref8"/> Here vayu causes ashayapakarsha of [[Kapha dosha|kapha]], which is present in its own ashaya i.e. urasthana.

+

In the pathogenesis of shwasa, [[Vata dosha|vata]] gets aggravated by its own etiological factors. This vitiated [[Vata dosha|vata]] enters channels carrying vitality (pranavaha srotas) and takes out [[Kapha dosha|kapha]] from thorax (urasthana) causing obstruction to the movement of prana [[Vayu mahabhuta|vayu]], leading to shwasa.<ref name="ref8"/> Here [[Vayu mahabhuta|vayu]] causes ashayapakarsha of [[Kapha dosha|kapha]], which is present in its own ashaya i.e. urasthana.

=== Sheetapitta - udarda – pathogenesis ===

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‘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 dosha|Kapha]] and [[Vata dosha|vata dosha]] is aggravated specially due to exposure to cold wind (sheeta vata sevan). [[Pitta dosha|Pitta]] is also vitiated due to own causes in its abode. These vitiated dosha drag [[Pitta dosha|pitta dosha]] from its abode and traverse towards shakha (at rasa and rakta dhatu level). In this pathogenesis [[Pitta dosha|pitta dosha]] is dragged by [[Vata dosha|vata]] and [[Kapha dosha|kapha dosha]]. It traverse to periphery (shakha- bahya roga marga). Hence it is considered as ashaya- apakarsha. Looking into the treatment principle, [[Sharira|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>

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‘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 dosha|Kapha]] and [[Vata dosha|vata dosha]] is aggravated specially due to exposure to cold wind (sheeta vata sevan). [[Pitta dosha|Pitta]] is also vitiated due to own causes in its abode. These vitiated dosha drag [[Pitta dosha|pitta dosha]] from its abode and traverse towards shakha (at rasa and [[Rakta dhatu|rakta dhatu]] level). In this pathogenesis [[Pitta dosha|pitta dosha]] is dragged by [[Vata dosha|vata]] and [[Kapha dosha|kapha dosha]]. It traverse to periphery (shakha- bahya [[Rogamarga|roga marga]]). Hence it is considered as ashaya- apakarsha. Looking into the treatment principle, [[Sharira|body]] message by use of oils medicated with pungent medicines ([[Katu|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>

== Differential diagnosis ==

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Whenever one can find vikriti visham samveta lakshana sammuchaya (symptoms of the disease are not in accordance with the [[Dosha|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.

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Whenever one can find [[Vikriti|vikriti]] visham samveta lakshana sammuchaya (symptoms of the disease are not in accordance with the [[Dosha|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 ==

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In the process of avarana, [[Vata dosha|vata dosha]] is the primary unit with amurta nature (formless). Due to different etiological factors, other [[Dosha|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|dosha]] or dushya , but later, the symptoms of vitiated [[Vata dosha|vata]] are observed. During its management, the removal of avarana of [[Vata dosha|vata]] is the first and foremost thing. In ashayapakarsha, symptoms are produced due to displacement of [[Dosha|dosha]] or dushya from their own abodes due to vitiated [[Vata dosha|vata dosha]]. During treatment also, [[Vata dosha|vata dosha]] management is important among all other [[Dosha|doshas]] and dushyas.

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

== Importance of ashayapakarsha ==

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== Principles of management ==

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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|vata dosha]], which is dragging [[Pitta dosha|pitta]] from its abode is to be treated instead of [[Pitta dosha|pitta]]. If a physician is unaware of this phenomenon, by observing the aggravated symptoms of [[Pitta dosha|pitta dosha]], and by adopting a [[Pitta dosha|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 dosha|pitta]] kshaya. The predominant role of [[Vata dosha|vata dosha]] needs attention in treating these pathologies. Management of shakhashrita kamala is focused on removing obstruction of [[Kapha dosha|kapha]] and vatanulomana (restoring [[Vata dosha|vata]] Direction) and bringing back the [[Pitta dosha|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 dosha|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 dosha|pitta]], if someone follows the [[Pitta dosha|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.

+

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|vata dosha]], which is dragging [[Pitta dosha|pitta]] from its abode is to be treated instead of [[Pitta dosha|pitta]]. If a physician is unaware of this phenomenon, by observing the aggravated symptoms of [[Pitta dosha|pitta dosha]], and by adopting a [[Pitta dosha|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 dosha|pitta]] kshaya. The predominant role of [[Vata dosha|vata dosha]] needs attention in treating these pathologies. Management of shakhashrita [[Kamala|kamala]] is focused on removing obstruction of [[Kapha dosha|kapha]] and vatanulomana (restoring [[Vata dosha|vata]] Direction) and bringing back the [[Pitta dosha|pitta]] to its own abode. Until then, hot (ushna), [[Katu|pungent (katu)]], [[Tikta|bitter (tikta)]] and [[Amla|sour (amla)]] dravyas and food are used for the said purpose. Once the [[Pitta dosha|pitta]] restores its own abode, then the treatment of kostha shakhashrita [[Kamala|kamala]] is applied for further course. By observing the symptoms of aggravation of [[Pitta dosha|pitta]], if someone follows the [[Pitta dosha|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 ==

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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.

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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 [[Vyadhi|diseases]], autoimmune [[Vyadhi|diseases]], recurrent episodes of acute inflammation. These [[Vyadhi|diseases]] include diabetes, arthritis, allergies, chronic obstructive pulmonary [[Vyadhi|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.

== 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|pitta dosha]] by [[Vata dosha|vata dosha]]. The condition is treated with S. cordifolia Linn. (bala) and Phyllanthus niruri Linn. (bhumyamalaki) which help in pacifying [[Vata dosha|vata]] and [[Pitta dosha|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> Other research works are supportive to the concept of ashayapakarsha as mentioned above.

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# 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>

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# Conceptual study of ashayapkarsha gati w.s.r.to Samprapti vivechan of ruddhpath [[Kamala|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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