Role of Doshas In the Causation of Disease

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Table of Contents

Introduction

Doshas are the inevitable, mandatory and the most important ones among the various contributory factors for a disease. No systemic disease or Nija Roga (diseases caused by vitiated doshas) is caused without the involvement of the vitiated doshas in the pathogenesis of the disease.

Likewise, no disease is caused without the initiation of the disease process provided by the vitiated doshas.

Vata, Pitta and Kapha are the three doshas in the body. These are chiefly responsible for producing the shaareerika diseases pertaining to the body when they get vitiated and contaminate the other elements of the body.

Similarly Raja and Tama are the Manasika Doshas. They are chiefly responsible for causing diseases pertaining to the mind.

Sushruta considers the Rakta – blood also as a dosha and calls it the fourth Dosha. He tells that just like the vata, pitta and kapha, rakta too takes care of the body when in normalcy and becomes responsible for the destruction of the body (by causing diseases) when it gets vitiated.

Dosha as contributory factor

Doshas – most important contributory factor for causation of disease
Doshas have a natural tendency of contaminating the other elements of the body and hence to produce disease.

When these doshas are in a condition of normalcy (equilibrium), they bestow beneficial effects on the body in terms of providing good health. When the same doshas get vitiated they trouble the body by producing many diseases.

Vata, Pitta and Kapha i.e. the three doshas move all through the body. These doshas while travelling throughout the body will benefit the body (shubhani kurvanti) when they are in normal and balanced state (akupita dosha), like nourishing and nurturing the body (upachaya), providing strength and immunity to the body (bala), providing color to the body (varna) etc. The same doshas harm the body (ahsubhani kurvanti) when they are in vitiated form (kupita dosha), produce wide array of diseases and trouble the body.

Acharya Vagbhata also tells the same – ‘Vikrita doshas i.e. vitiated doshas destroy the body and the Avikrita doshas i.e. normal doshas keeps the body healthy and stable’

Vata, pitta and kapha are the root causes of all the diseases. This is because –

Tat lingatvaat – manifestation of the symptoms pertaining to the doshas in all the diseases
Drushta phalatvaat – when the treatment is given to a disease on observing the symptoms caused by doshas, the treatment gets successful and fruitful in eliminating (destroying) that disease
Aagamaat – all the Ayurvedic treatises share the same opinion that doshas cause all diseases

Doshas participate in the all forms of the diseases, be it Nija Rogas (diseases initiated, caused and controlled by vitiated doshas), Agantu Rogas (diseases caused by injuries and other external causative agents) and mental disorders.
Read related: Shooka Dosha: Diseases Due To Artificial Sexual Stimulants, Size Enhancers

Doshas in Nija Rogas

All the Nija Rogas are essentially caused by the involvement of the three doshas. The nija vyadhis never occur without the involvement of the doshas.

In Nija Rogas, the disease process is initiated by the vitiated doshas. These doshas get vitiated by the exposure to Nidanas (causes). The doshas on getting vitiated go through 6 different pathological states called Kriya Kala.

Kriya Kalas are divided into 2 sections of three stages each.

A) Dosha Kriya Kala – This comprises of 3 stages of pathogenesis. They are:
Sanchaya or Chaya – In this stage, the doshas which get disturbed by exposure to Nidanas attain gradual accumulation over a period of time in their own sites.
Prakopa or Kopa – In this stage the doshas further get vitiated in their respective places. This happens when proper treatment is not given and doshas are not controlled in the Sanchaya stage.
Prasara – In this stage, the vitiated doshas tend to leave their seats and trespass into other parts of the body (tissues and organs) which do not belong to those doshas. This occurs when the dosha vitiation in prakopa stage is not addressed.

In the above said 3 stages only doshas are vitiated. These are warning signals of formation of disease, an alarm to the physician and patient to get the doshas into control and not to allow them to progress towards the next three stages of pathogenesis leading to the formation of disease and complications. Since these three stages are dominated with mischief caused by vitiated doshas in various proportions, they are collectively called Dosha Kriya Kala.

Prashama of doshas – If the doshas are taken care of in the first 2 stages, the stage of spread or prasara doesn’t occur. In fact as a natural process, the doshas pacify by themselves. This auto-pacification of doshas is called as Prashamana stage.

B) Vyadhi Kriya Kala – This comprises of 3 stages of pathogenesis, continues after Prasara stage. They are:
Sthana Samshraya – The doshas spreading all through the body in prasara stage on finding weak and susceptible tissues (dushyas, dhatus) get lodged therein and form a pathological amalgamation with the dhatus. This amalgamation is called dosha dushya sammurchana. As a result of this, the vitiated doshas damage the tissues and initiate the disease process. Here the premonitory symptoms are manifested. They reflect that the disease would be formed in future. This happens when the doshas which are in a mode of spread in prasara stage are not taken control of.
Vyakta – The doshas which get lodged in the dhatus in sthana samshraya stage further damage the tissues leading to the manifestation of disease. The signs and symptoms of that particular disease also are formed in this stage. This happens when the sthana samshraya stage is not diagnosed at proper time and when it is not meddled with proper interventions.
Bheda – Complications (upadravas) are manifested in the disease when the disease is not treated at right time with right interventions in the vyakta stage. This makes the clinical picture of the disease complicated and the disease becomes difficult to treat.

In the above mentioned three stages the disease manifests but in varied proportions. Therefore these three stages of pathogenesis are collectively called as Vyadhi Kriya Kala.
Read related: Shat Kriya Kala – ‘Stage-Wise Disease Management’

Doshas in Agantuja Rogas

Agantuja Rogas are those which are caused due to external factors like injuries, effect of poisons and toxins, witchcraft and black magic, etc. In these diseases the doshas are involved in the later context, i.e. after the manifestation of the disease.

Doshas in Manasa Rogas

Manasa Rogas means diseases of the mind. In Manasika Rogas the doshas of the mind i.e. Rajas (rajo guna) and or Tamas (tamo guna) qualities get vitiated, afflict the mind and senses and cause the disease process. Later in the context, i.e. after the manifestation of the mental diseases, the doshas governing the body i.e. Vata, Pitta and Kapha gets involved in the pathogenesis.
Read related: Classification of Vyadhi (diseases) according to Ayurveda

Dosha as vitiating factor

Doshas independently contaminate the other elements of the body
The vitiated doshas (prakupita doshas), as said above are the prime important factors for producing a disease because they are the only causative factors responsible for vitiation of the other body elements of the body including the dhatus (tissues of the body), malas (waste products) and srotases (channels and duct system of the body).

This means to tell that the doshas carry the privilege of ‘swatantra dushakatva’ or capability of independently vitiating the other elements in body, initiating the disease process and also causing the disease.

Pathological decrease of Doshas

Decreased doshas do not produce diseases
Another pathological state of the doshas apart from ‘dosha prakopa’ or dosha vitiation is called ‘dosha kshaya’ i.e. pathological decrease in the doshas.

The decreased doshas cannot produce a disease because the ksheena doshas (decreased doshas) will not be capable enough of progressing through the pathological states of the kriya kala i.e. sanchaya, prakopa etc. so as to produce pathogenesis (samprapti). But the kshaya of the doshas also should be addressed. When the doshas undergo decrease, they produce symptoms of decrease. When a particular dosha decreases there will be an increase of other dosha thus leading to functional imbalance and disturbance. Interventions in diet and lifestyle so as to bring the decreased doshas to normalcy and re-establish their functions should be promptly done. Many times this pathological state of the doshas will auto-correct and come back to normal business.

Thus the decreased doshas are weak and will be incapable of initiating a disease process (samprapti).

Understanding Doshas by Lakshanas

Involvement of doshas in the causation of disease can be known through their Atma Rupas (Lakshanas)
How do we know that a particular disease is caused by a particular dosha(s)? Well, when a particular dosha gets involved in a disease process they produce certain symptoms which are particular to only them. These symptoms are the indicators which tell us which particular dosha is involved in the causation of that particular pathological change. These symptoms which reveal the involvement of a particular dosha in disease pathology are called Aatma Lakshanas or Aatma Rupas of that particular dosha.

Forms of Dosha vitiation

The doshas undergo various forms of vitiation
We have discussed earlier that the vitiated doshas lead to the formation of disease. This dosha vitiation will be of various types. Since the dosha vitiation is of various types, the pathogenesis and manifestation of diseases also will be of various kinds.
Read related: Amshamsha Kalpana – Fractional Understanding Of Qualities Of Doshas In Disease

The different kinds of dosha vitiation are as below mentioned –

Prakrita dushti (dosha vitiation due to natural factors like change in seasonal factors etc) and Vaikruta Dushti (dosha vitiation in abnormal seasons not natural to its vitiation)
Swatantra Dushti (independent vitiation of doshas) and Paratantra Dushti (secondary vitiation of doshas)
Prakriti Dushti (vitiation of natural Dosha body constitution) and Vikriti Dushti (vitiation of dosha non-identical to one’s constitution)
Dosha dushti according to dosha gati (location, movement, direction and positioning of doshas) comprises of the below mentioned presentations of doshas –

Kshaya (decrease), Sthana (equilibrium) and Vriddhi (increase)
Urdhwa gati (upward movement), Adhah Gati (downward movement) and Tiryak Gati (oblique movement)
Koshta gati (movement towards visceral organs), Shakha Gati (movement towards tissues) and Marma-Asthi-Sandhi gati (movement into vital organs, bones and joints)
Chaya (accumulation), Prakopa (vitiation) and Prashamana (auto-pacification)
Prakriti (normalcy) and Vikriti (abnormality, morbidity)