Pathogenesis – Stage of dissemination, Localisation of Doshas and Premonitory symptoms
Ayurveda for a healthy life ! – 37/2024 on 1.10.2024
3. Prasara : Stage of dissemination of doshas
Prasara stage means stage of dissemination of doshas. When one or more factors responsible for a particular disease continue to further excite the doshas, which are already in the prakopa stage the doshas disseminate in the body. This is termed as prasara stage. The dissemination of the doshas of prasara stage is compared to the over flow from a vessel full of flour, which is undergoing fermentation. Vata dhatu that is responsible for all the movements of the body including movements of body fluids is also responsible for the dissemination of the accumulated vata, pitta and kapha doshas from the local sites. Depending on the aetiological factors, the three doshas may accumulate singly or in various combination and get disseminated through body fluids or blood.
A. Clinical manifestations
एवं प्रकुपितानां प्रसरतां वायोर्विमार्गगमनाटोपौ ओषचोषपरिदाहधूमायनानि पित्तस्य अरोचकाविपाकाङ्गसादाश्छर्दिश्चेति श्लेष्मणो लिङ्गानि भवन्ति ।। – सु. सू. २१.३२
Pain due to movements of vata in the abnormal direction and gurgling noise in abdomen are symptoms of vata prasara Localised burning pain stimulating that due to sucking, burning sensation all over the body and sensation as if body is full of smoke are the symptoms of pitta prasara. Kapha prasara gives rise to anorexia, vomiting, indigestion and a state of exhaustion.
Compared to the previous two stages, the symptoms are more generalised during this stage. The person will develop desires, which will try to neutralise the disseminated doshas in all possible manners.
B. Course
As in the stage of prakopa, the disseminated doshas may subside or remain dormant for some time and get reactivated again or increase further and lead to the next stage of sthana sanshraya.
C. Treatment
The treatment consists of neutralising the increased or vitiated dosha or doshas by all possible means.
Until this stage, the body tissues or organs are not involved & the treatment is directed towards normalisation of affected dosha or doshas.
4. Sthanasanshraya : Stage of localisation of doshas
This is a stage of localisation of disseminated doshas in a particular site or stage of prodromal symptoms.
यत्र सङ्गः खवैगुण्याद्व्याधिस्तत्रोपजायते ।। – सु. सू. २४.१९
The disseminated doshas get localised in a tissue or organ whose defence mechanism is weak. The poor local defence mechanism may be genetic or acquired. The acquired cause may be dietetic, environmental, traumatic or sequelae of previous illness etc. Though, in the disseminated stage of prasara, the doshas are present all over the body, their concentration in any tissue / organ is not much. In addition, the doshas in prasara stage, though in superficial contact, do not enter or affect the individual cells of any organ. On the other hand, in the stage of sthanasanshraya, the concentration of doshas in a particular organ is much more. At this stage, doshas enter the individual cells of the tissue or organ & cause their slight dysfunction.
Vata, pitta and kapha are the three basic biological elements, which constitute the bodies of all the living creatures. Each cell and organ though composed of all the three elements has one dominant biological element example Pitta dominates in small intestine, kapha in lungs and vata in ears. When the causative dosha gets localised and enters the cells of the organ, it disturbs the balance of vata, pitta and kapha in that organ.
The dominant biological element in particular organ naturally is offended to the maximum extent and now becomes local dosha that is local vata, pitta and kapha dosha. This results in dysfunction of organ involved. In generalised diseases like fever (septicaemias) there is no specific localisation of causative doshas in a particular organ but they get localised in & affect all cells & tissues of the body.
A. Clinical manifestations
During the stage of chaya, prakopa and prasara, the manifestations are non-specific and are related to the increased or vitiated dosha.
स्थानसंश्रयिणः क्रुद्धा भाविव्याधिप्रबोधकम् ।
दोषाः कुर्वन्ति यल्लिङ्गं पूर्वरूपं तदुच्यते ।।
In the stage of sthanasanshraya one gets premonitory or prodromal symptoms of a disease which depend on slight affection of the involved organ or tissue as well as the causative dosha. These premonitory symptoms are usually described under individual diseases. During this stage, the patient develops aversion for substances and factors which would further increase or vitiate the local as well as the causative dosha.
B. Course
In this stage, doshas may damage the tissue or organ further till the disease manifests that is Vyakta stage, or the tissue might recover completely from the local imbalance of the doshas.
C. Treatment
The principle of treatment consists of treating the local dosha simultaneously keeping in mind that the causative dosha is not aggravated example in sthansashraya stage of cough caused by pitta dosha, one should treat the local kapha dosha, simultaneously seeing that at the same time the causative pitta dosha does not increase. Occasionally if the causative dosha is very powerful, one should treat the causative dosha simultaneously seeing that the local dosha does not increase.
4A. Poorva-roopa (Premonitory symptoms)
Premonitory symptoms represent all the signs and symptoms, which are observed before the manifestations of the disease appear. These symptoms may appear during the stage of accumulation (Chaya), increase (Prakopa), spread (Prasara) or localisation of the doshas in the tissue or organ (Sthanasanshraya). The premonitory symptoms represent the resistance offered by the tissue or the organs to the attacking doshas. Whereas the manifestations of the disease means that, the diseased tissue or the organs are now overpowered by the doshas.
Premonitory symptoms are classified as general and specific premonitory symptoms. They are related to dosha, which is increased in that disease. If all the prodromal symptoms described in a disease are present, it takes a fatal course.
It is important to start the treatment in prodromal stage, as given in the chapter on stages of the disease that is chaya, prakopa etc., example during prodromal stage of fever, fasting or light diet is advised. However during prodromal stage of vataja fever, administration of ghee is indicated, so that the disease is either subdued or takes a milder form, if it becomes manifest.