Six stages of manifestation of the disease

Introduction

When the vital energies of the human body are imbalanced for a long period, the diseases is origin and spread. According to the Ayurveda, factors resulting imbalance of the three biological humours, normally results in the accumulation of toxic or products, known as ama in Ayurvedic system of medicine. Along with the time factor, the ama moves to parts of the human body where genetic weaknesses exist. Once ama accumulates in that part, it cane described as origin of the diseases.

Definition

In Ayurveda there are six chief stages of manifestation of the disease. These six stages are known as Kriya Kal.

Kriya Kal has great significance as they are helpful in the thorough cause or aetiology of the disease much before clinical manifestations are evident. Each stage of the Kriya Kal (stages of disease formation) provides a way to stop and most-probably to reverse the further spread of the disease (vyadhi in Ayurveda). Obviously, if a disease is detected earlier, it is easier to control it.

The six stages are

1. Sanchaya (accumulation),
2. Prakopa (aggravation),
3. Prasara (dissemination),
4. Sthana Samsraya (relocation),
5. Vyakti (manifestation),
6. Bheda (disruption).

Sanchaya (accumulation)

Sanchaya represents as the stage of accumulation. Sanchaya is the first stage of the kriya kal and ama production resulting from improper digestion, starts accumulating in the gut or intestine. Sanchaya is primarily associated with the imbalance of the biological water, Kapha which accumulates in the amasya (stomach). According to the Ayurveda, when ama is product of the imbalance of the biological fire, Pitta, it accumulates in the ksudrantra (small intestine) and in the colon ama gets connected to the dysfunction of the biological air, Vata. Aama disturbs the smooth functioning of the three biological humours resulting in mild symptoms which can be easily detected, which is a signal of physiological imbalance.

Prakopa (aggravation)

Prakopa (aggravation) is the 2nd stage of the kriya kal. Prakopa (aggravation) is generally translated as aggravation or provocation. Although the prakopa phase of the kriya kal do not manifest the differentiated clinical signs and symptoms that modern system of medicine is not in a position to recognize. This stage is confirmed by nadi prakisha or pulse diagnosis whether it is aggravated biological humours or ama. According to ayurveda some behavioural and dietary changes in order to reverse stage of the prakopa.

Prasara (dissemination)

Prasara (dissemination) is the third stage of kriya kal as per Ayurveda. Prasara (dissemination) means to leave and spread. In Prasara (dissemination), aggravated doshas or ama had accumulates to such an extent that it creates influx in the gastrointestinal tract. The three biological humours travel along with the micronutrients to the tissues (dhatus).

Sthana Samshraya (relocation)

Sthana Samsraya (relocation) is the 4th phase of kriya kal. It is also known as the stage of disease relocation or augmentation. Sthana samshraya refers to taking shelter in some place. The dosha or ama from the prasra stage enters in a feeble and defective tissue. Dosha or Ama is responsible for the structural and functional damage of the human-body. This is the stage which can invite some degenerative disorder or infective disease. An array of factors determines dosha or ama shall damage which specific dhatus.

Vyakta (manifestation)

Vyakta (manifestation) is the 5th stage of kriya kal. Vyatka means which can be visualised. In this stage, well differentiated symptoms appear on first basis. Vyakta can be defined as the stage of symptom manifestation. The process of the disease overpowers the capability of the human-body to maintain immunity. At this juncture, structural and functional dysfunctions progress to such a stage where the illness has actual start. The process of the disease results in the manifestation of the clinical symptoms which are generally used for diagnosis of the disease.

Bheda (disruption)

Bheda (disruption) is the final and 6th stage of kriya kal according to Ayurveda. Bheda is also defied as the stage of updrava or complications Vyakta (manifestation) the 5th stage of kriya kal gives or rather confirms the general diagnosis and the sixth stage i.e. bheda stands for the differential diagnosis. Bheda (disruption) provides a detailed information and understanding of the group of clinical symptoms. Bheda (disruption) is characterized by severe depletion of the tissue function, serious damage to the channels of circulation or srotas, and the updrava which involves the related tissue. The whole disease cycle is aggravated by the unpleasant and toxic (sometimes) side- effects of the medicines that are employed to care the disease.

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Ayurvedic approach of treatment

Ayurvedic approach of treatment is as below...

1. Nidan Parivarjana
   
       Avoiding the etiology


2. General Treatment

- Santarpana
        Means strengthing, nourishment. It is the therapy that accelerates the normal functions of the doshas and dhatus in the body. It gives strength to weak and emaciated.

- Apatarpana
        The absence of food intake seen in the case of diseased condition. Lack of nourishment, is known as apatarpana. Loss of desire for food, lack of tripti or its absence is called as apatarpana.

- Shodhana
        Shodhana itself means to purify. In shodhana purification is regarding expelling out the aggravated Doshas from the body.

- Shamana
Shamana is a palliative approach that, rather than expel the Doshas, merely normalizes them. 



3.   Pathya & Apathya
          The aahar(food) & vihar (activity) which is beneficial and nutritional to the body and also give the happiness to the mind is known as Pathya and opposite to that is known as Apathya.

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Aam

          Aam is a peculiar concept in Ayurveda (for which modern chemistry has no correlate). It is an important factor in a cause of disease and in modification of disease process.
           Aam literally means undigested or unripe. It is the toxic by product of impaired digestion. Due to the weak digestive power chyle- Ras Dhatu (A milky liquid formed in the small intestine as a result of digestion of ingested fats and joins lymphatic vessels) is not properly formed and chyme- Annarasa ( A semi liquid substance formed in the stomach and small intestine during digestion of the digested food) undergoes fermentation yielding Aam- A toxic substance.

Properties of AAM

It is always in the form of incompletely digested substance.

Hence it is non-homogenous, has a very bad or foul odor which can be experienced only when it is combined with excretory products such as sweat, urine, and feces, or when products such as sputum, vomit, etc., are expelled from the body.

It is very sticky.

It produces lethargy in the body.

Symptoms of AAM

                  Srotorodhan- Obstruction of circulatory channels - This can occur in any large, small, or minute channel, when it is indicated by stagnation and disturbance in transport, and metabolism can occur even at the cellular level. The commonly observed obstructions are in the liver [affecting the passage of bile], the urinary tract, the fallopian tubes, the blood vessels, the respiratory tract, etc.
Weakness or reduced working power in any part or organ is due to the difficulty produced by AAM in the contraction and relaxation of the musculature of the part, even when the organic structure of the muscle is normal.
                Obstruction of the movement of Vaata - AAM on one side causes disturbance in the action of the musculature of the part or organ, and on the other side it causes disturbances in the conduction of nerve impulses, and ultimately the activity of the concerned part becomes reduced or stopped. It will create lack mental clarity and energy and feel weary and unenthusiastic Heaviness and Lethargy.
Tongue is coated especially upon awaking in the morning. Metabolic disturbance Due to various diseases such as obesity, diabetes, etc., metabolic disturbance is produced.

Signs of AAM

           Feeling heavy, muzzy headed, unclear thinking, aches and pains, bloating, gas, skin blemishes, fever, lack of energy, stickiness, foul smells (breath, sweat, urine, stools, phlegm), sinking stool, mucous in stool, turbid urine, lack of appetite or taste, indigestion, sticky/sweet taste in the mouth, copious phlegm. Pulse; deep, dull, slippery, Tongue thick, greasy coating.
            High triglycerides, atherosclerosis, late-onset diabetes, high blood sugar levels, some forms of depression, rheumatoid factor, the presence of H. pylori bacteria, leukocytosis or leukocytopenia (deficient and excess white blood cells), excess anti-bodies, Candida albicans in the gut and uterus, blood urea, gout, excess platelet count, excess red blood cells, gall stones as a sign of excess bile, kidney stones as a sign of un-metabolized calcium and oxalates, high liver enzymes (ALT, AST), intra-ocular pressure [glaucoma], bacterial infection, high temperature, tumors.

Effects of AAM

         When Aam come in contact with Dosh, tissues, or waste product, it produces SAAM DOSH, SAAM DHATU and SAAM MALA. (SAAM mean mix with Aam, NIRAM mean not mixed with Aam)
        Ayurveda attributes cause of any disease to an imbalance in one or all of the Dosh and for successful treatment of a particular disease physician has to determine, weather the imbalanced Dosh is 'SAAM' or 'NIRAM' .
       Thus, according to this concept, indigestion is the causes for AAM, this indigestion is even not able to digest drugs. Hence, in Saam condition of the patient drugs are unable to give its proper effects and will not be able to cure diseases. After creating Niram status drugs will give miraculous results.

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Types of tridosha, seats & their functions

Vata Dosha

Type	Seat	Function
Pran	Head, chest, ears, tongue, mouth, nose	Spitting, sneezing, belching, respiration and swallowing. Responsible for enthusiasm and happiness. Responsible for emotions, behavior etc. all the functions of mind, heart and maintain coordination between sense organs and their functions.
Udaan	Naval , chest, throat	Responsible for initiation of speech, efforts and memory.
Samaan	Digestive tract in stomach and intestines.	Helps in digestion of food . Formation of faeces and absorption of essence of food by helping the bowel movements and carrying the enzymes to their place of action.
Vyaan	Heart and moves in the whole body.	Responsible for all activities e.g. walking, blinking etc. , blood circulation, sweat formation and its excretion.
Apaan	Testes, urinary bladder, urethra, naval, thighs, pelvis, anus and intestines.	Responsible for elimination of waste products such as faeces, urine, flatus, menstrual fluid etc. and semen from the body. For pushing out the baby during its birth.

Pitta Dosha

Type	Seat	Function
Ranjak	Liver and spleen (Sushrut) Stomach (Vagbhat)	It helps in the formation of the blood.
Pachak	Small intestine	Digestion of food, its separation into essence and waste
Alochak	Eyes	Vision
Sadhak	Heart	It is responsible for intelligence , self respect and self consciousness
Bhrajak	Skin	Responsible for complexion and body temperature

Kapha Dosha

Type	Seat	Function
Kledak	Stomach (Amashay)	Helps in digestion of food , it lubricates the food
Avlambak	Chest	Provides Energy
Bodhak	Tongue and throat	Responsible for perception of taste
Tarpak	Head, brain	Responsible for nourishment of the brain. Responsible for the normal function of brain
Shleshak	Joints	Responsible for lubrication of joints and their smooth movements

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