Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Samprapti is the story of the disease. Samprapti tells how a disease is formed including the entire process right from the exposure to causative factors to the initial disturbances produced by those causative factors in the physical body and mind to the production of premonitory symptoms and symptoms of the diseases which enable the disease to be identified, named and diagnosed.
The knowledge of Samprapthi is very important because it gives a précised and comprehensive picture of the nature of the disease. Thus the term Samprapthi can be correlated to the modern term ‘pathogenesis.
According to Ayurveda, Samprapti Vighatana or breaking the Samprapti by proper and timely treatment is called Chikitsa or treatment. Thus, knowing the Samprapti of a disease helps in drafting the blueprint for comprehensive treatment.
If the Samprapti is broken early, it doesn’t progress ahead to produce a disease in its full form nor would complications be produced.
Samprapti is one of the Nidana Panchakas
Nidana Panchakas are the ‘tools of examination of disease’.
The other four tools of Nidana Panchaka are
Nidana (causative factors of a disease),
Purvarupa (premonitory symptoms),
Rupa (signs and symptoms) and
Upashaya-Anupashaya (relieving and aggravating factors of the disease).
Definition (features and qualities) of Samprapti
The process in which the doshas which have undergone vitiation in many forms, due to the many etiological factors, travelling in different tracts (marga), having various kinds of movements (gatis) get lodged at various sites and organs of the body and produce the diseases pertaining to that particular organ, after getting the amalgamation with the Rasa etc dhatus (tissues) and causing their vitiation (i.e. after the completion of dosha dushya sammurchana or amalgamation of morbid doshas and weak, susceptible dhatus) is called as Samprapti.
Gati and Aagati are the synonyms of Samprapti.
According to Chakrapani, ‘The manifestation of a disease due to different pathological activities and the effects caused by the doshas (vyadhi janaka dosha vyapara) involved in the process of pathology is called samprapti’.
The aggravated doshas get lodged in the weakened dhatus vitiate them and produce deformity in them leading to disease. This is called Samprapti.
The Vyadhi Ghatakas (components are participants in disease formation) i.e. dosha, dushya (tissues), agnimandhya (debility of metabolic fire), ama (immature essence of digestive juices in circulation, tends to block the passages of the body) and srotorodha (obstruction to the micro-channels and passages of the body) contribute to the sthana samshraya of doshas and manifestation of disease.
Ayurvedic explanation of pathogenesis
How does the Samprapti of a disease form? (Ayurvedic explanation of pathogenesis)
The Samprapti forms in the below mentioned chronology (according to the above mentioned definition), keeping in rhythm with the Shat Kriya Kalas – 6 stages of formation of diseases.
Exposure to the etiological factors (Nidana) –
This is a mandatory step in the formation (rather initiation) of a disease process. These etiological factors will disturb the equilibrium of the doshas and cause their vitiation. At the same time, the agni (metabolic fire) will be disturbed and ama (intermediate products of digestions which go on to become cellular endo-toxins and circulating toxins) is formed.
Related Reading – Nidana
Vitiation of Doshas (Dosha Dushti) –
The doshas should be vitiated for the disease process to begin in the body. There are different forms of dosha vitiation. It can either be
Prakrita dushti (normal vitiation) or
Vaikruta dushti (abnormal vitiation) or
Anubandha Dushti (associated vitiation along with a main vitiated dosha) or
any other type of dushti. The disturbed doshas initially undergo two types of vitiation. They are:
Sanchaya or Chaya – Accumulation of doshas in their own seats is called Chaya. This also happens to be the first stage of disease formation or Kriya Kala.
Prakopa or Kopa – Aggravation of doshas in their own seats is called Prakopa. This is the second stage of disease formation (Kriya Kala).
Spread of Doshas (Dosha Gati) –
The vitiated doshas will tend to leave their places and spread to other parts of the body. These doshas can go in either direction i.e.
upward (urdhwa gati),
downward (adho gati) and
sideward or oblique movement (tiryak gati). This spread of Doshas is called Prasara which is the 3rd Kriya Kala.
Lodgment of doshas in the dhatus and beginning of the disease process (dosha dushya sammurchana) –
This is an important aspect of Samprapti. The Samprapti doesn’t happen without dosha-dushya sammurchana i.e. amalgamation of vitiated doshas and susceptible tissues (dushya, dhatu). This amalgamation happens when the vitiated doshas in circulation (prasara) finds weak and susceptible dhatus (tissues) and gets lodged in those tissues therein. This is the 4th Kriya Kala and is called Sthana Samshraya. The vitiated doshas damage the tissues and organs where they get lodged and initiate the disease process. The premonitory symptoms of a disease are formed in this stage of samprapti.
Related reading – Purvarupa
Formation of disease with its signs and symptoms (Vyadhi Utpatti ) –
When the disease is not treated promptly in the Sthanasamshraya stage of Samprapti (Kriya Kala), the vitiated doshas further damage the cells and organs in a severe way. This leads to the manifestation of disease with its signs and symptoms. This forms the 5th stage of Kriya Kala and is called as Vyakta Avastha (Vyakta=manifested, Avastha=stage) or Vyakti Bhava. In this stage, the signs and symptoms of the disease are formed.
Related Reading – Rupa or Lakshana
Complications (Upadrava Utapatti) –
When the Vyakta Avastha of Kriya Kala is not addressed with proper measures of treatment the disease progresses to a stage of incurability. This is the 6th Kriya Kala and is called Bheda Avastha since it is associated with lot of complications (upadravas).
All the above explained happenings are the subsequent steps of disease formation or Samprapti.
Thus, ‘All the stages from the very contact of the body with the nidanas to the development of the disease including all its stages (avasthas) are together called as the Samprapti of the disease’.
Outcome of Samprapti
The outcome of pathogenesis is the disease. This outcome i.e. disease is the resultant effect of the war between the factors which fight against the disease and those which produce the disease. When the factors like dosha,
desha (land, place of living),
kala (time period),
agni (digestive fire, metabolism),
sattva (status of mind),
ahara (dietetic patterns) and
vihara (lifestyle activities) are favorable to the health,
they fight against the disease and prevent or cure it. But when these factors are unfavorable to the health, they help in formation of the disease.
The occurrence of sthana samshraya followed by the dosha dushya sammurchana is the most important aspect of samprapti. Unless this stage is reached, the disease will not be manifested. Among the Kriya Kalas, the stages prior to the dosha dushya sammurchana i.e. Chaya, Prakopa and Prasara contribute to sthana samshraya and the stages occurring after the sammurchana like Vyakta, Bheda and Upadrava are its effect.
Types of Samprapti
Samprapti is of 5 types. They are as enlisted below –
- Sankhya Samprapti and its subtype Vidhi Samprapti
- Vikalpa Samprapti
- Pradhanya Samprapti
- Bala Samprapti
- Kala Samprapti
Samkhya Samprapti is all about understanding the pathogenesis (samprapti) of a disease based on the number of subtypes and types of a given disease. It is in fact a numbering system in the pathogenesis of a disease (any disease). This helps us to understand about the different forms in which a disease manifests as indicated by the number of the disease. Thus, Sankhya Samprapti helps in understanding the types and subtypes of diseases, which in turn will help in planning treatment according to the manifestation of diseases in various forms.
Sankhya Samprapti or the method of understanding pathogenesis of diseases on the basis of numbering of a disease is based on the below mentioned factors –
- Type of predominant dosha and their combinations involved in the formation of a disease
- Various types of symptoms (lakshanas) presented in the various types and subtypes of the disease
- Different tracts (vyadhi marga) in which the disease is manifested
- Different routes (gati of roga and doshas) in which the disease is manifested
- Peculiarities of manifestation of dushyas (tissues)
Examples of Sankhya Samprapti: Telling Kushta (skin diseases) is of 18 types, Hridroga (heart disorders) is of 5 types, Shwasa (breathing disorders) is of 5 types, Kasa (cough) is of 5 types etc is Sankhya Samprapti. This helps in understanding the different ways in which a given disease is manifested.
Related Reading – Sankhya Samprapti
Vidhi Samprapti is a variant (subtype) of Sankhya Samprapti as mentioned by Acharya Charaka. Vidhi Samprapti is a method of sub-grouping diseases based on the nature of prognosis (saadhya-asaadhyata). Example, listing the types of Raktapitta or bleeding disorders as – Urdhwaga Raktapitta (raktapitta manifested in the upward direction) is sukhasadhya (easily curable), Adhoga Raktapitta (raktapitta manifested in downward direction) is krichrasadhya (difficult to cure) and Tiryakgata Raktapitta (raktapitta manifested in oblique or sideward direction) as asaadhya (incurable).
Since counting and numbering the disease is included on the basis of prognosis (sadhya-asadhyata), Vidhi Samprapti is included under Sankhya Samprapti. The diseases are numbered or listed as Sukhasadhya (easily curable), Krichrasadhya (curable with difficulty), Yapya (manageable diseases) and Asadhya (incurable disease).
Understanding the fractional variations occurring in the dosha or doshas involved in the causation of a disease is called Vikalpa Samprapti.
When more than one dosha is combined in a disease, Vikalpa Samprapti helps us to understand which dosha is more disturbed than the other, i.e. which dosha is proportionally increased more and which is less (in terms of qualities and quantity).
Vikalpa Samprapti also helps us to understand the fractional variations occurring in the gunas or qualities of the dosha or doshas involved in the causation of the disease. Example, we can tell that in a given disease, the sheeta guna or cold quality of the Vata has increased or the ushna guna or hot nature of pitta has been increased or the manda guna or slowing down quality of kapha has been increased etc.
The method of fractional study of dosha or doshas is called Amshamsha Kalpana.
The knowledge of Vikalpa Samprapti helps in minute understanding of a disease pathology and also to comprehensively treat the disease.
Praadhaanya Samprapti is about understanding the Samprapti or pathogenesis of the disease on the basis of the strength of the doshas.
The samprapti produced by an independent or major dosha (swatantra dosha) is called Praadhaanya Samprapti. Similarly, the Samprapti produced by a minor or dependent dosha is called as Apradhaanya Samprapti.
In simultaneous vitiation of two doshas (Samsarga) or three doshas (Sannipata), the pradhana dosha (major dosha) is mentioned first and the apradhana dosha (minor dosha) is mentioned next.
While treating such conditions, the pradhaanya dosha should be primarily treated.
The samprapti or pathogenesis of an independently manifested disease (swatantra vyadhi) is called Praadhaanya Samprapti and that of a secondary disease (paratantra vyadhi) is called Apraadhaanya Samprapti.
This Samprapti helps in knowing the strength of the doshas involved in the disease, to understand the strength of major and minor disease and treat them accordingly.
Bala Samprapti helps us in understanding the overall strength of a disease based on the strength of the factors causing the disease and on the strength of the symptoms manifested in a given disease.
The bala or strength of a disease depends upon whether the causes, premonitory symptoms and symptoms of a given disease are partially manifested or completely manifested. When these are completely manifested, the bala or strength of a disease is greater. When these are partially manifested, the bala or strength of a disease is weak.
The knowledge of Bala Samprapti helps us to understand the strength of a disease and its pathogenesis and treat the disease accordingly.
Kala Samprapapti is about understanding the pathogenesis of a disease on the basis of the changes occurring in a dosha or doshas due to the effect of kala or time.
Kala Samprapti shows that the doshas which have produced the disease get increased in terms of their intensity with change in time like day and night, change in seasons and in accordance with the stages of digestion.
Example, the first, second and third parts of the night increase kapha, pitta and vata respectively.
The knowledge of Kala Samprapti will help us in treating a disease or dosha aggravation according to the time of their manifestation or aggravation.
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