Disease Progression: Six Stage of Pathogenesis

Ayurveda describes health as a fine blend of Dosha, Dhatu (tissue) and Mala (wastes) along with the blissful state of senses, mind and soul. Any aberration in these health factors results in disease. The disease is not an instant process but a multistage process as conceptualized by Acharya Sushruta through a six stage of pathogenesis viz. Accumulation, Aggravation, Spread, Infiltration, Manifestation, and Complications. If Doshic changes can be detected in the early stage of disease pathogenesis, a corrective measure can be advised to arrest the disease in early stage and prevent disease pathogenesis.

Accumulation: The First Stage among Six Stage of Pathogenesis

Due to various causes like seasonal changes, diet, emotions and bad karma, the Doshas get accumulated in their respective sites. Vata in the colon, Pitta in intestine and Kapha in the chest. If Vata gets accumulated there is hardness and fullness of abdomen. Pitta accumulation produces a mild increase in body temperature. Kapha accumulation causes heaviness in body, lassitude, and sensation of cold. The body detects an early change in Dosha balance of the body and creates a fondness or aversion from certain food. Vata accumulation (let’s say due to cold weather) causes the body to become cold and dry, the body tips the brain towards craving of hot food and comfort.

Aggravation: The Second Stage among Six Stage of Pathogenesis

The dosha eventually builds up to an excess in their respective sites. Vata continues to build up in the colon, Pitta in the intestines and Kapha in the chest. This is due to the ignoring of the bodily signs during the Dosha accumulation stage. For example, when you have eaten Pitta foods, the Pitta starts to accumulate in the intestine; your body starts to heat up. However, a friend calls you over and you go on to eat spicier Indian food without you recognizing the bodily signs. The next morning you start having heartburn and nausea. This is the state of Pitta aggravation. Vata aggravation causes abdominal cramps or colic, Pitta causes heartburn and excessive thirst, while Kapha causes heaviness in chest.

Spread: Third Stage among Six Stage of Pathogenesis

The aggravated Dosha spillover from their respective sites of Aggravation. They get into the circulation and are on a lookout for other organs that they can encroach upon. Acharyas painted a visual picture in describing Accumulation, Aggravation and Spread. The Accumulated Dosha are like a solidified piece of butter, the Aggravated Dosha is like melted butter in a bowl – free to move around and finally the Dosha that starts spreading is the overflowing butter out of the bowl. Once the Dosha start spreading throughout the body, they can be put back into their site of actin their place only through the process Panchakarma.

Infiltration: Fourth Stage among Six Stage of Pathogenesis

The Dosha that has spread from their sites starts to infiltrate the tissue that is susceptible, weak or defective. This may be due to previous trauma, genetic predisposition. A good example is diabetes. A person who has a family history of diabetes, starts consuming excess of Kapha diet, the Kapha accumulates in the chest, aggravates, spreads and finally infiltrates the pancreas to create less insulin.

The result is misbalanced glucose level in the blood. Up to this point, the disease has not appeared on the surface, but it can be detected by a skilled physician or recognized by imbalances in the Doshas such as those mentioned above. An alert person can feel subtle changes in the body. If the condition is not interrupted at this stage, it will erupt as a full-blown disease.

Manifestation: Fifth Stage of among Six Stage of pathogenesis

In this stage, the disease becomes quite apparent. The disease sprouts and shows its sign and symptoms along the tissue that is affected. To continue with the above example, diabetes causes dryness of mouth, increased urination and excess of hunger.

Complication: Sixth Stage of among Six Stage of Pathogenesis

If no proper treatment is done in the fifth stage the Dosha will pass onto the stage of complications. Structural changes start appearing in the organ affected. In this stage, the disease is most difficult to cure. Kapha in the fifth stage causes diabetes while in this stage it causes diabetic ketoacidosis.

In organizing a disease in a stepwise fashion, Ayurveda sought to be more of a preventive science than a science of treatment. The disease is far easier to cure in the first to stage, than on the later four stages. The first two stage of disease promotes an intuitive approach to your own health. It tries to place a health in the hands of a common person – you. The key is awareness. The more you are alert to how your mind, body, and emotions are reacting to changing circumstances; the more you are aware of your constitution and the moment-to-moment choices you can make to maintain health, the less opportunity you create for becoming sick.