Modern medicine recognizes two stages in disease formation. The first is the stage of detection, where clearly distinguishable symptoms have begun to manifest. Complication is the second stage, where disease is so advanced that it effects other areas of the body and is basically irreversible.
Ayurveda, however, elaborates a six-stage process of disease manifestation, called shat kriya kal, in which detection and complication comprise the last two phases. Knowledge of the first four stages is unique to Ayurveda and permits the recognition and elimination of disease long before it progresses into clearly differentiated clinical symptoms. Ama’s toxicity and the doshas’ mobility (dosha gati) constitute the key components in the disease process. We’ll now analyze the six-stage development of disease from the point of view of these two factors.
Sanchaya: The Stage of Accumulation
The first phase of disease formation is called sanchaya, meaning “stored.” It can be understood as the period of accumulation. At this time, ama, produced during improper prapaka digestion, collects in the gastrointestinal tract. This condition is primarily associated with weak digestive agni and an excess in one of the doshas. Ama associated with a kapha imbalance accumulates in the stomach.
When ama results from a pitta imbalance, it collects in the small intestine; and when connected to a vata dysfunction, it amasses in the colon. Ama’s presence disturbs the doshas’ functions, and creates mild symptoms which the individual can usually feel. We seldom act on these symptoms because they generally disappear by themselves in a few hours.
These symptoms signal physiological imbalance, and when we ignore or suppress them instead of recognizing and eliminating their causes, we invite the disease process to gain a foothold in our bodies. For example, suppose we go out to dinner with friends and drink or eat foods which are difficult to digest. Perhaps we eat too late at night when digestive agni is not strong.
That night indigestion disrupts our sleep. In the morning we feel heavy, lethargic and maybe even nauseous. Incompletely digested food sits in the stomach and nausea tells us the body wants to eliminate it. At this time we should fast and allow the digestive fire to rekindle so that the food remaining in the stomach can be fully metabolized. Instead, we drink coffee and take an antacid or some other over-the-counter medicine to mask the symptoms and make us feel better.
These symptoms alert us to an imbalance. If not properly addressed, the undigested food and toxic by-products of doshic malfunction stay in the body and move into the intestines. By the afternoon, the nausea is gone, but has been replaced by acidity, bloating or some unpleasant or sour taste in the mouth. This happens because the undigested food has now moved into the pitta zone. We may take another antacid or eat again, even though we don’t feel very hungry, further burdening the digestive fire. Our energy is low, but by the evening or the next morning, we start to feel better again.
Once the nausea, acidity and bloating disappear, we have missed an opportunity offered by the body to eliminate the cause of future disease. The symptoms do not leave because we are better, but because ama no longer burdens the digestive tract. Although we feel better, our body has started to sow the seeds of sickness.
Prakopa: The Stage of Aggravation
Prakopa, the second stage of the disease process, translates as “aggravation” or “provocation.” Once we feel better, we are not inclined to change those aspects of diet or lifestyle which brought the initial discomfort. As a result of not heeding the warnings arising from our digestive discomfort, we continue to make the same mistakes and ama continues to be produced. Eventually, ama amasses to such a degree that it begins to get active or provoked in the site of its production in the G-I tract, leading to the third phase of disease.
Though the prakopa phase does not manifest the clearly differentiated clinical symptoms which allopathic medicine can recognize, the Ayurvedic physician can confirm ama’s aggravated state through pulse diagnosis. He can then make dietary and behavioral recommendations to reverse the prakopa stage.
Prasara: The Stage of Migration
The third phase of disease formation, is referred to as prasara, which literally means “to leave and spread.” Ama accumulates to such a degree that it begins to overflow its site of origin in the G-I tract. Since it can no longer be contained here, the doshas transport it, along with essential nutrients, to the dhatus by virtue of dosha gati, the twice daily movement of the doshas from the body’s hollow structures to the deeper structures and back again.
The question then arises, if ama is carried to the dhatus, why isn’t it carried back again? The answer has to do with the sticky quality of ama. Once it lodges in the dhatus, its stickiness prevents it from being transported back to the G-I tract. The migration of ama from its site of origin occurs in the same sequence as dhatu development: First it is transported to rasa dhatu, then to rakta, mamsa, rneda and on into the deeper dhatus.
Sthana Samshraya: The Stage of Disease Augmentation
Sthana samshraya, or “taking shelter in a place,” comprises stage four. The ama which has migrated enters and lodges in a weak or defective dhatu. Once ama accumulates in an area of low immunity, its qualities overwhelm the dhatu and cause dysfunction and structural damage. This is the stage in which specific degenerative diseases and susceptibility to serious infection begin.
A number of factors determine which dhatus are predisposed to accept and be damaged by ama: congenital influences; effects from past diet and behavioral choices; effects from previous illnesses, stress, seasonal changes, chemical pollutants and radiation. Often a combination of these factors produces the weakness that opens certain tissues to disease.
Vyakta: Stage of Symptom Manifestation
Vyakta, or “that which can be seen,” is the fifth stage, and the one in which clearly differentiated symptoms first appear. The disease process overwhelms the body’s ability to maintain immunity and healthy functioning. Structural damage and dysfunction have progressed to the point where the illness activates. Here the disease process manifests the symptoms used by the Western system for classification and diagnosis.
Because modern medicine does not have an accurate or complete understanding of the origin of the disorder, its treatments often aim at suppressing or eliminating symptoms without removing their underlying causes. Even when symptomatic palliation is successful, sooner or later the specific disease process will recur or find another avenue to manifest in the body.
Bheda: Stage of Complications
The sixth and final phase of the disease process is called bheda, which means “differentiation.” Whereas stage five confirms general diagnosis, stage six confirms differential diagnosis. It offers such a detailed understanding of the group of symptoms which have surfaced, that all doubts about the nature of the disease are eliminated.
This phase is characterized by severe impairment of dhatu function, serious damage to the shrotas — the vessels within each dhatu — and, often, complications involving related dhatus. The disease process can be aggravated by the toxic side-effects of many of the drugs that are used to treat it. At this stage, many diseases become difficult to cure completely.
The consequences of a typical, Western teenager’s diet provide a perfect example of the six phases of disease development. Cars, sports, TV and learning about the opposite sex captivate the attention of many adolescents. Diet is not a major concern, particularly a healthy diet. Lunch might consist of pizza and a soft drink, finished off with a candy bar or a chocolate sundae. These heavy, kaphic, foods weaken the digestive fire and overwhelm the actions of the other doshas.
Afterwards, the teenager might experience some slight discomfort, indigestion or acidity, but later in the day he feels better. Perhaps he repeats this experience once or twice a week. Being young and healthy, he doesn’t give it a second thought. Teenagers tend to have a sense of invincibility; they believe that no matter what they put into their bodies, they will continue to grow healthy and vigorous. To a certain degree they are right. Pitta is now starting to dominate the body at this stage of life and pitta governs strength and resiliency.
Little by little, the ama that is burdening the teenager’s G-I tract gets unloaded onto the tissues of the body. As he grows into adulthood, the accumulating ama begins to settle in weaker parts of his physiology. Though no definite symptoms have yet appeared, the body’s vulnerable places begin to feel the strain and deterioration caused by ama, and for the first time, he senses some loss in vigor, strength and flexibility.
Several years down the line, he wakes up one morning to find that his knees or knuckles are a little swollen and painful. He can still ignore these symptoms and for a while they may go away.
Then one day the pain and swelling begins to interfere with his life to such an extent that he consults a doctor, and finds that he has arthritis. The disease process has reached the later stages. His doctor tells him that he can give him something to reduce the pain and swelling, but he will have to learn to live with the disease.
In reality, he has been living with the illness for a long time. Degenerative conditions and susceptibility to infectious diseases do not develop overnight. It often takes many years, or even decades, of sowing the seeds of dysfunction through inappropriate diet and lifestyle before disease symptoms show up. With proper knowledge of the foods and behaviors which are most appropriate for his particular doshic constitution, disease could have been prevented. Prevention is always easier than treatment.
It is, therefore, imperative that our educational system begin to teach children a preventative approach to health. They should be trained to recognize and understand what is taking place in their bodies and make the necessary adjustments.
Now that we have the knowledge of how illness originates and how it manifests step-by-step, in the body, let’s turn our attention to the procedures that Ayurveda uses to remove both the symptoms and causes of disease.