Pradhanya Samprapti – Understanding Pathogenesis Based On Dosha Strength
Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Pradhanya means predominant.
Samprapti is process of formation of disease right from the exposure to causes to the vitiation of doshas, the doshas getting lodged in the weak tissues with consequent damage of the tissues and formation of disease at the site of lodgment of vitiated doshas. In short, Samprapthi explains the pathogenesis of a disease.
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Pradhanya Samprapti
Praadhaanya Samprapthi is one of the 5 types of Samprapti.
For any disease to be formed it is invariable that doshas get disturbed. The vitiation of doshas progresses through a chain of events leading to the formation of disease of vyadhi.
This chain of events happens after exposure to etiological factors (nidanas). These events are called Kriya Kalas. There are 6 kriya kalas which happen in chronological order.
Dosha Kriya Kala – In the first 3 stages of Kriya Kala the doshas are disturbed, getting intense with each successive stage. In the first stage the doshas get vitiated in their primary seats (sanchaya), after this, the doshas get severely aggravated in their seats (prakopa) and in the 3rd stage they leave their seats and tend to overflow in different directions and trespass into the other tissues and organs where they do not belong to (prasara). When the doshas are taken control of through appropriate treatment measures in these three stages, they do not progress ahead and thus the disease is not formed.
Vyadhi Kriya Kala – In the next 3 stages of Kriya Kala the disease is formed. Firstly the mild form of disease is formed in the stage of sthanasamshraya wherein the vitiated doshas invade the weak and susceptible dhatus (tissues) and initiate the disease process. Here the premonitory symptoms which indicate that the disease will be formed within a short time are manifested. In the 5th stage i.e. in Vyakta Avastha, the purvarupas mature to form rupas (signs and symptoms) and thus the disease is borne. In the 6th stage the disease has progressed to form complications (upadravas) and here the disease becomes almost incurable. This stage is called Bheda stage.
When the disease is treated in the initial stages of pathogenesis, disease process is aborted at that stage itself and doesn’t progress to successive stages. Therefore sanchaya stage is the easiest and bheda stage is toughest to treat.
Doshas lead the script of formation and progression of diseases
But the entire story of the formation of the disease and its progression is dependent on various degrees of vitiation of doshas and the game they play at every stage of the disease formation. Thus the dosha involvement becomes inevitable factor for any disease to form and progress.
The pathogenesis of any disease depends on the strength of the doshas. In fact, the strength of the pathogenesis of a disease is directly proportional to the strength of the doshas. Stronger the vitiation of the doshas, stronger is the damage done to the tissues and stronger is the disease and thus stronger will be the samprapti of the disease.
In every disease at least one dosha will be predominantly vitiated and will take the lead in the formation of the disease process. In some diseases two doshas may be vitiated and in some all three doshas may be vitiated. Sometimes a predominantly vitiated dosha which tends to produce the samprapti of the disease may disturb the other doshas too in the later part of the disease process. In this condition, the other doshas will also get involved in the mischief work and produce their symptoms in the disease but may be of a lesser magnitude in comparison to the main vitiated dosha.
Praadhaanya Samprapti is about understanding the pathogenesis of the disease on the basis of strength of doshas. Pradhanya Samprapti also explains the involvement of a major dosha in the formation of a disease.
The samprapti produced by a major dosha (swatantra dosha or pradhana dosha) is called Praadhaanya Samprapti. Similarly, the Samprapti produced by a minor or dependent dosha is called as Apradhaanya Samprapti.
When 2 or 3 Doshas are involved, the major dosha is mentioned first and the minor dosha is mentioned afterwards.
Example, VataPittaja Jwara – here the fever or jwara is caused by simultaneous vitiation of two doshas. Here, since Vata has been mentioned first, it is the major dosha involved in the pathogenesis of fever, hence
Vata is the praadhanya dosha or predominant dosha causing jwara. Pitta is apraadhanya or secondary dosha. Pitta is vitiated in a smaller scale in comparison to Vata in Vata-Pittaja Jwara. Vitiated Pitta is associated with vitiated Vata, may be in later part (time) of pathogenesis or there is also a possibility that both are vitiated simultaneously but Vata is more vitiated than Pitta.
This also reflects that the etiological factors (nidana) for disturbance of Vata were more than those for pitta at the beginning of the Samprapti i.e. the person would have been exposed to more vata vitiating causes than Pitta. Or the contributory and trigger factors leading to vitiation of vata dosha might be more than the pitta vitiating ones.
Samprapti is formed both by Vata and Pitta in this condition but the samprapti formed by pitta (which is vitiated in a lesser scale and magnitude in comparison to vata) is a minor one.
Thus, the samprapti formed by a strong dosha or severely vitiated in comparison to the other doshas will be called as Pradhaanya Samprapti.
While treating such conditions, the pradhaanya dosha should be primarily treated. Later the apraadhanya dosha may also be addressed if there is need to do so. There is also a chance that the apradhaana dosha gets pacified when the pradhana dosha is dealt with. Thus in most conditions there may be no need of breaking the samprapti of an apradhaana dosha because the pathogenesis may be resolved by itself. But care should be taken to address the pradhana dosha and the samprapti caused by it i.e. praadhaanya samprapti.
As samprapti of swatantra vyadhi
Praadhanya Samprapti is also the pathogenesis of Swatantra Vyadhi or independently manifested disease
We should also remember that the pathogenesis of a swatantra vyadhi (independently manifested disease) is called Praadhaanya Samprapti and the samprapti of a paratantra vyadhi (secondary disease) is called Apraadhaanya Samprapti. The Samprapti of a Swatantra Vyadhi will have its own story. It will have its own set of causative factors, its own pattern of dosha aggravation following exposure to etiological factors, its specific set of tissues and organs wherein the vitiated doshas get lodged and cause damage, its own pattern of tissue contamination, its own way of formation of disease and its own set of signs and symptoms.
On the other hand, the samprapti of a Paratantra vyadhi will be dependent on the samprapti of the pradhana vyadhi i.e. praadhaanya samprapti.
The samprapti of the swatantra vyadhi will be complicated one in comparison to the paratantra vyadhi samprapti.
The samprapti of paratantra vyadhi or secondary disease will be resolved by itself (many times) once the samprapti of swatantra vyadhi is broken.
Sometimes the paratantra vyadhi may develop on the backdrop of swatantra vyadhi and manifest strongly as an independent disease and also stronger than swatantra vyadhi. In this case it might need special attention in terms of treatment.
Example, fever (pradhana vyadhi having pradhanya samprapti) might cause Raktapitta or bleeding disorders (paratantra vyadhi having apradhaanya samprapti, nidanarthakara vyadhi). Treating Jwara or breaking its samprapti will cure Raktapitta too. When Raktapitta is manifested independently (independent of Jwara), it will have its own Praadhanya Samprapti. When Jwara pacifies after giving rise to Raktapitta or when Raktapitta manifested as a secondary disease to Jwara supersedes Jwara and manifests in a stronger way pushing Jwara to its backdrop, Jwara will be called as Nidanarthakara of Raktapitta (Jwara acts as causative factor for Raktapitta).
Importance of Pradhanya Samprapti
Benefits of having knowledge of Pradhanya Samprapti
Pradhanya Samprapti helps in knowing the strength of the doshas involved in the disease pathogenesis. This will help in addressing the pradhana dosha and pradhana samprapti while treating that condition.
Praadhaanya Samprapti wil enable a physician to understand the strength of major and minor disease (dependent and independent disease) and treat them accordingly.
Pradhanya Samprapti will help the physician to be judicious of selecting and implementing the dosha pratyanika (dosha specific) and vyadhi pratyanika (disease specific) treatment after having analyzed and differentially understanding those conditions.
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