Samprapti Ghatakas – Components Of Manifestation Of Disease

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Samprapti is the story of a disease. Narration goes from intake of etiological factors to manifestation of disease. This includes many steps of disease manifestation. As in a story there needs to be certain characters, certain characters also participate in causation of disease. These characters form ghataka or components of pathogenesis of a disease. These components which participate as a group in formation of a disease are called Samprapthi Ghatakas.
Read –42 Different Criteria For Ayurvedic Prognosis – Charaka Sutrasthana 10

Pathogenisis

Samprapti Ghataka – components of a disease pathogenesis
Doshas – bodily humors
Dhatus – tissues
Agni – digestion and metabolism strength
Ama – product of altered digestion and metabolism
Srotas – body channels
Sroto Dushti Prakara – type of affliction of body channels
Udbhava sthana – site of origin of disease
Sanchara Sthana – places where Doshas / disease spreads
Vyakta sthana – places where symptoms appear
Dosha gati – movement of Doshas
Roga Marga – site of pathogenesis
Roga Avastha – stage of disease manifestation
Sadhya Asadhyata – prognosis

Doshas

Vata, Pitta and Kapha, either individually or in combinations of two and three are mandatory factors which contribute towards formation of a disease pathogenesis.
Doshas do not cause diseases when they are in a state of balance.

Diseases don’t occur until and unless vitiated doshas get localized in tissues and cause damage therein. This is called dosha dushya sammurchana.
Doshas get aggravated due to consumption of etiological factors responsible to disturb them. These vitiated doshas pass through various stages of pathogenesis before they cause disease. These stages are called kriya kalas.

Process of formation of kriya kalas is called samprapti. If earlier stages of kriya kala are treated, further stages are not formed. Thus we can arrest disease even before it is formed.
If immunity is good enough,  doshas which naturally get vitiated in their particular seasons would regress automatically. Such doshas settle down to a state of balance in their favorable seasons. This is called Shamana.

Involvement of subtypes of doshas too should be considered while enlisting samprapti ghataka.
It will give precise information of involvement of doshas and its subtypes.
This will make treatment more comprehensive and complete.
Read – Contributory Factors for a Disease – Ayurvedic View Point

Dhatus

Tissues of body form another half of mandatory components which participate in pathogenesis of a disease. Doshas and tissues form two sides of the same coin. Diseases don’t manifest until these tissues get weak.

Weak tissues become susceptible to invasion and subsequent damage by doshas.
Tissues invaded and damaged by doshas would cause various diseases pertaining to those tissues, sites or organs.
When tissues are healthy and strong they are immune against such attacks and damages. They resist attack from doshas and pathogenesis doesn’t take place.
Weak and susceptible tissues give an ideal platform for formation of a disease.
Read – Immunity In Ayurveda: Concept, Diet, Herbs, Medicines, Exercise

Agni

Weak digestive and tissue fires are essential components taking part in pathogenesis of disease.
A famous quote of Ayurveda tells – ‘Sarve api rogau mande agnau’. This means ‘all diseases are caused due to weakness of digestive fire’.
Read Understanding Agni: Concept, Definition, Functions, Types

Fire in belly is responsible for digestion of food. It provides rich nutrition for survival of entire system. It also contributes towards smooth running of all activities of body. Tissue fires and elemental fires are dependent on health and balance of this belly fire. When this fire gets weak,  tissue and elemental fires too will get weak. Thus entire metabolism of  body will be disturbed.

This leads to formation of ama which blocks and clogs channels and transport system of body.
Tissues are deprived of nutrition and lose their strength and defense. This will make them susceptible to be attacked by vitiated doshas. Subsequently disease pathogenesis occur leading to manifestation of diseases.
Read – Samprapti Meaning, Definition, Types, Examples

Ama

Ama is digestive toxin. It is a form of unprocessed or improperly processed food juices. This happens due to improper digestion of food due to weak digestion capacity.
Thus weak digestive fire causes weak digestion. Weak digestion leads to formation of immature food juices which are not compatible for body and health. This is called ama.

Ama is one of most important elements participating in pathogenesis of many diseases.
This ama is put into circulation. Owing to its sticky nature, ama sticks to the walls of channels and passages, including excretory pathways.
Due to this all pathways are blocked. The body doesn’t get proper nutrition. As a result tissues are damaged. Immunity of body will reduce. Toxins and excreta are not thrown out of body. As a result many diseases are formed.
Read – Qualities And Symptoms Of Ama – Ama Guna Lakshana

Srotas

Entire human body is an abode of multiple srotases i.e. channels. In every systemic disease there will be involvement of one or more of channels in pathogenesis. It is important for a physician to know which channel is involved in a given disease. This will enable him to decide quality and quantity of morbidity and block in a channel and also to determine the type of contamination of channels in a given disease.

This in turns helps in planning a comprehensive protocol for that disease. Cleansing channels and strengthening them is a key strategy in treating all diseases.
Example – in Dysuria and obstruction of urine, channels for carrying urine are contaminated. In  skin diseases, lymph or nutrition carrying, blood carrying, muscle tissue carrying and  water carrying channels are involved in pathogenesis of disease.
Related reading – Srotas

Sroto dushti prakara

Contamination of channels of body leading to subsequent obstruction in them is one of key factors responsible for formation of pathogenesis of any disease.

Contamination of channels of body takes place in four forms –
– Ati pravritti – excessive discharge or overflow of contents of body like blood, water etc leading to diseases like hemorrhoids, menorrhagia, diarrhea etc
– Sanga – obstruction leading to diseases like constipation, retention of urine, formation of stones in kidney and gall bladder etc
– Vimarga Gamana – reverse movement of body elements or flow of elements in abnormal pathways leading to diseases like skin diseases, upward movement of vayu etc
– Sira Granthi – formation of cyst like structures leading to formation of diseases like cysts, tumors and other growths
Read – Srotas: Body Channels and Duct systems – Easy Explanation

Udbhava Sthana

Udbhava sthana means site of origin of disease. It is very important to know about place of origin of disease. This is because effective treatment of some diseases depends on treatment of site from which disease takes its origin.
Vomiting starts from stomach, diarrhea starts from large intestine, irritable bowel syndrome starts from small intestine, heart disease starts from heart etc.

In these conditions, while treating disease and morbid doshas, organs or tissues from where disease origin should also be treated and strengthened.

For all diseases,  site of origin will be either stomach and small intestines (for pitta and kapha disorders) and large intestine (vata disorders).
Read Vata Disorders (Vatavyadhi): Definition, Causes, Symptoms

Sanchara Sthana

Sanchara sthana means places of body in which morbid doshas travel or disease spreads.
This helps physician to know stage and status of disease. This helps in understanding mode, quality and quantity of spread of diseases and doshas.

Example, anemia and jaundice have their origin in stomach and liver. Disease and morbid doshas move in channels responsible for transportation and formation of blood and their places of origin. Thus, anemia and jaundice have their origin in stomach and move in blood carrying channels and their place of origin of blood carrying channels i.e. liver and spleen.But symptoms of these diseases are seen all through body.
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Pallor of anemia and yellow discoloration of jaundice are seen in skin, eyes, nails, stools etc. thus  sanchara sthana of these diseases will be entire body. Doshas and disease pathology is moving through channels of blood transportation. Therefore raktavaha srotas also forms sanchara sthana for pandu and kamala.

Vyakta Sthana

Vyakta sthana means site of manifestation.
It is important to know site of manifestation of disease because many diseases need treatment to be provided at place of their manifestation, along with place of origin.

Example, jaundice and anemia are manifested as yellow discoloration and pallor respectively in eyes, nails and skin but we do not treat these parts of body. Liver and spleen being points of origin of blood carrying channels are also affected. They too are vyakta sthanas for jaundice and anemia. We only treat site of origin i.e. small intestine which is a site of pitta along with liver and spleen and blood carrying channels which are affected (vyakta sthana).
Read Fatty Liver: Symptoms, Ayurvedic Treatment, Remedies, Tips

But in case of disease like skin disorders, disease starts from stomach and small intestines, travels all over body through blood and lymph carrying channels, and also through channels transporting muscle tissue and water but mainly gets manifested over skin.
Here, we treat place of origin i.e. stomach, and pathological components participating in causation of disease i.e. nutrition carrying and blood, muscle tissue and water carrying channels. At same time treatment for site of manifestation is needed. Thus we treat skin too. We use medicated pastes, sprinkles, stream pouring treatments, medicated oils etc over skin to cure skin disease and also to restore skin health.

Similarly, diseases like hiccough and breathing diseases take their origin from pitta sites and manifest in lungs (vyakta sthanas). Apart from treating site of origin we also treat lungs by administration of medicines and treatments which get rid of morbid doshas from these sites and also strengthen lungs and heart.

Dosha Gati

Dosha gati shows direction in which morbid doshas are moving. It is of three categories –
– Kshaya – Sthana – Vriddhi i.e. decrease, balance and increase, here balance is not pathological but  other two conditions are
– Urdhwa – Adhah – Tiryak i.e. upwards, downwards and oblique
– Shakha – Koshta – Marmasthi Sandhi gati i.e. tissues, visceral organs and vital organs, bones and joints
These three categories denote direction of movement of doshas or development of pathology. They also denote pathway in which disease is located. This knowledge is needed for properly treating diseases.
Read –Koshta Shakha Marma-Asthi-Sandhi Gati Of Dosha – Doshas In Organs And Joints

Roga Marga

Vyadhi marga means pathway of disease.  When vitiated doshas travel in directions mentioned in dosha gati, they will produce diseases in same pathway.

The roga or vyadhi margas are –
– Bahya roga marga i.e. external disease pathways –  tissues, same as shakha gati
– Abhyantara roga marga i.e. internal disease pathways – visceral organs, same as koshta gati
– Madhyama roga marga i.e. intermediate disease pathways –  vital organs, bones and joints of  body, same as marmasthi sandhi gati

Knowledge of both dosha gati and vyadhi marga will give a precise idea of the direction and manifestation of disease along with its progression.
This will enable physician to target his treatment in a particular pathway and direction.
It will also help  physician to make diagnosis of disease in a correct way, seeing progression of disease and doshas in particular directions and localization in particular pathways accordingly.

Vyadhi Swabhava / Roga Avastha

Vyadhi Swabhava or Roga Avastha means nature of disease.
Disease may be acute or chronic.  Knowledge of acuteness and chronic nature of a disease will help in judging prognosis of disease and extent of damage caused in body.
This will also help physician to take a decision between method of treatment to be given in each condition and also about pace with which it should be addressed.

Sadhya Asadhyata

Sadhya Asadhyata means prognosis of a disease in terms of its curability.
Disease may be – easy to treat, difficult to treatincurable or manageable

Each category will have its own criteria on which disease can be classified.
Prognosis of a disease should be made in every disease before starting treatment.
It gives liberty for physician to choose diseases which are under control of his limitations and treat them.
He can refer difficult cases to experts and thus help patients.
It will also help physician to halt disease from progressing to complicated stages.
Read – Reasons Why Curable Diseases Become Incurable

Just Before Finishing –
All above said criteria and components of pathogenesis of any disease should be considered and documented before beginning treatment. This is most ancient method of case recording.
After documenting details physician will have blueprint of  disease and its status in his hands. This will help him in treating  diseases comprehensively.
Click to Consult Dr Raghuram Y.S. MD (Ayu) – Email / Skype