Dosha Dushya Sammurchana – When Imbalanced Doshas Meet Weak Tissues

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Dosha Dushya Sammurchana is the amalgamation of vitiated doshas with weak and susceptible tissues. It is an important and mandatory event needed for the formation of disease. 

Dosha vitiation is an important contributory factor for the manifestation of diseases. Dosha dushti occurs in many ways.
Related reading – Role of Doshas in the causation of diseases

Dosha Dushya Sammurchana

Dosha Dushya Samurchana is mandatory for disease formation
The vitiated doshas can cause symptoms of vitiation (prakopa lakshanas or dushti lakshanas). But these vitiated Doshas cannot cause / initiate a disease process without invading the tissues (dhatus, dushyas) of the body.

The target of invasion – Dushyas also include the malas or waste products of metabolism (feces, urine and sweat).
The vitiated doshas not only contaminate the dhatus but also contaminate the malas to cause the diseases.

Thus, for a disease to be formed the vitiated doshas put into circulation should attack the weak and susceptible Doshas, cause damage therein and cause disease.

For this to happen, the vitiated doshas need to get lodged in the dushyas (mainly tissues of the body) and form a vicious combination (pathological admixture) with them.
This amalgamation of vitiated doshas and weak and susceptible tissues is called Dosha-Dushya Sammurchana. Unless dosha dushya samoorchana takes place, the disease is not formed.

Dosha Dushya Sammurchana Vighatana

Dosha Dushya Sammurchana Vighatana (breaking the amalgamation of dosha and dushya) is treatment (Chikitsa)

On the other hand, if dosha dushya sammurchana is not allowed to be formed or aborted with suitable interventions, pathogenesis of the disease does not take place and disease does not form.

Dosha Dushya Samurchana Vighatana i.e. breaking the bond of dosha and dushya  (tissues and waste products) and hence aborting the disease process is called Chikitsa or treatment.

Thus, effective treatment of a disease can be initiated by administering suitable interventions so as to break the amalgamation of dosha and dushya and hence bringing halt to the formation or progression of disease.

Dosha Dushya Sammurchana Vighatana  (breaking) is also called as Samprapti Vighatana.

Formation of Dosha Dushya Sammurchana

How does Dosha Dusya Sammurchana takes place?
After the dosha dushti i.e. vitiation of doshas due to consumption of Nidanas (etiological factors), the doshas go through different pathological states (kriya kala) causing the pathogenesis of a disease (samprapti).

Firstly the dosha chaya (sanchaya) takes place wherein the disturbed doshas increase and accumulate in their chief sites. Later the same doshas (when not attended) will progress to the stage of prakopa wherein the doshas vitiate in higher proportions, still in their chief sites.

When the dosha prakopa is addressed with suitable interventions or when the seasonal regimen (Ritucharya) is followed correctly, the doshas get pacified by themselves (prashama, shama) not progressing towards other pathological stages (explained ahead).

When not taken care of, the prakupita doshas (vitiated doshas) progress to stage of prasara wherein the vitiated doshas leave their places and travel in all directions, throughout the body.

Now these prasarita doshas (doshas put into circulation) are in search of weak and susceptible dushyas (dhatus and malas). When they find such dushyas, the vitiated doshas enter those dushyas and get lodged therein. This stage of pathogenesis is called Sthana Samshraya or lodgment of doshas or localization of doshas in dushyas (dhatus, malas).

When the vitiated doshas enter the dhatus (dushyas), a reaction sets in between the invading dosha and invaded dhatu. A pathological combination or amalgamation of doshas and dushyas sets in which sets in the disease pathology. This amalgamation of dosha and dushya is called dosha dushya sammurchana.

Note: For convenience of understanding, I would mention and consider dhatus as dushyas (I will use the word dhatus in place of dushyas) because when we speak of formation of diseases dosha dushya sammurchana often means dosha dhatu sammurchana.

Dosha Dushya Sammurchana marks the onset of disease process. Purvarupas or premonitory symptoms of a disease are formed as a result of sthana samshraya or dosha dushya sammurchana. Purvarupas indicate that a disease would be formed in future. Since purvarupas are formed, this stage of pathogenesis is also called as purvarupa avastha (stage of premonitory symptoms).

After formation of Dosha Dushya Sammurchana

What happens to dosha dushya sammurchana after its formation?
If the disease is diagnosed in its premonitory stage or sthana samshraya stage of kriya kala and treated promptly, the samprapti vighatana takes place i.e. the disease process is aborted. The vicious combination of dosha and dushya is broken and they are separated. Once the dosha and dushya are separated and the doshas expelled by administration of suitable medicines, the disease is not formed.

If the disease is either neglected or not treated in the sthana samshraya stage, the dosha dushya sammurchana gets stronger. The dosha dushya sammurchana progresses, so does the pathogenesis of the disease (samprapti). This leads to the formation of the disease proper with its clear cut signs and symptoms. This stage of pathogenesis is called Vyakta Avastha or stage of manifestation of disease. Since the Rupas or signs and symptoms of a disease are formed in this stage, this stage is also called as Rupa Avastha.

When the disease is diagnosed at this stage and treated promptly with suitable interventions in the form of ideal medicines, treatment, exercise and dietetic protocols, the dosha dushya sammurchana gets broken and the disease gets destroyed. If the disease is neglected or not treated even in this stage, the dosha dushya sammurchana worsens and damages the tissues and organs (in the site of lodgment of doshas) to a greater extent leading to the formation of complications of a disease i.e. upadravas. This stage is called Bheda Avastha or stage of complications. This stage is very difficult or impossible to treat. Since upadravas or complications are formed in this stage, it is also called as Upadrava Avastha or stage of complications.

Fate of Dosha Dushya Sammurchana

Dosha Dushya Sammurchana forms when a strongly vitiated dosha invades or gets lodged in a weak and susceptible dhatu or dushya. If the dhatu is strong enough the dosha dushya sammurchana will not occur because the strong dhatus will fight against the invading dosha and drive it out, not allowing the doshas to enter into them, thus denying the lodgment and amalgamation of dosha and dushya.

In the sthana samshraya stage of kriya kala, the dosha dushya sammurchana begins leading to the initiation of disease. Purvarupas are formed indicating that the disease is about to form in the future.

In the Vyakta stage of kriya kala, the dosha dushya sammurchana completes leading to the formation of disease with the manifestation of Rupas or signs and symptoms of the disease.

In the Bheda stage of kriya kala, the dosha dushya sammurchana further worsens leading to the formation of complications or upadravas of a disease.

The successive stages of disease are formed and dosha dushya sammurchana gets worsened if the previous stages are not treated properly.

Importance

Importance of having the knowledge of Dosha Dushya Sammurchana
For a clinician it is important to know in depth about the dosha dushya sammurchana, regarding its initiation, progression and worsening because at various stages of disease, dosha dushya sammurchana presents different faces and phases of a disease. Dosha dushya sammurchana, as discussed earlier is a mandatory event in the formation of a disease.

Without the understanding of dosha dushya sammurchana, the samprapti or pathogenesis of a disease cannot be understood.

If dosha dushya sammurchana is understood in a proper way strategies to break the amalgamation of dosha and dushyas can be charted out and the samprapti vighatana (destruction of pathogenesis of disease) be done properly by planning and administration of suitable interventions in the form of medicines, treatment and diet corrections.

Thus a physician would become capable of treating a disease comprehensively with a precise knowledge of dosha dushya sammurchana.

Just Before Finishing –
In this article we have discussed in detail about the pathological amalgamation of dosha and dushya, i.e. dosha dushya sammurchana, the knowledge of which is very essential to understand a disease process and progression and also to implement comprehensive treatment to cure the disease.
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