THE SIX STAGES OF DISEASE ~ by Scott Gerson

THE SIX STAGES OF DISEASE
by Scott Gerson M.D., Ph.D. (Ayurveda)

  

SATKRIYAKALA (THE SIX STAGES OF DISEASE)

·  1. Sancaya (Accumulation)

·  2. Prakopa (Aggravation)

·  3. Prasara (Spread)

·  4. Sthanasamsraya (Localization)

·  5. Vyakti (Manifestation)

·  6. Bheda (Permanent Change and Complications) 

There is one additional Stage which is now recognized in this sequence in addition to the classical ones enumerated above and that is the Prasama (Remission) Stage 3a. It occurs after Prakopa (Stage 2--Aggravation). At this point the aggravated dosha can take two courses. If simple remedial measures are taken at this time, the aggravated dosha can easily recede; this is prashama. If not, the aggravated doshas will instead begin to overflow and spread Prasara (Spread) Stage 3b. Depending on the dosha and the constitution of the person, the spread can be relatively localized or, if the doshas reach the bloodstream, nervous system and other channels, quite widespread. Based on this refinement, the revised satkriyakala looks like this: 

Satkriyakala (The Six Stages of Disease)

• 1. Sancaya (Accumulation)
• 2. Prakopa (Aggravation)
• 3a. Prasama (Remission)
• 3b. Prasara (Spread)
• 4. Sthanasamsraya (Localization)
• 5. Vyakti (Manifestation)
• 6. Bheda (Permanent Change and Complications)

1. SANCAYA (ACCUMULATION)

This procession of six stages gives us an understanding of how the doshas undergo increase as a result of aggravating factors (diet, life-style, exercise, climate, emotional stress, seasons, etc.). Each dosha initially accumulates in areas of the body which are their respective normal sites (i.e. Vata = colon, mind, heart; Pitta = small intestines, blood, liver, skin; Kapha = stomach, lungs, joints.) If the body cannot eliminate the increasing dosha(s) and maintain homeostasis, it will begin to accumulate (Stage 1: Sanchaya) slowly and in small quantity. The usual reason that accumulation begins is that agni becomes low (mandagni) and ama begins to form in the body. Ama causes the metabolism to become inefficient and also creates an obstruction of the srotas (channels). This interferes with the normal processes of elimination of the doshas and initiates the sancaya stage. This is the earliest stage of vikriti.

The classic manifestations with respect to the various doshas are as follows.

Vata Sancaya:

·  frequent sensation of fullness below the navel

·  constant or frequent fullness of the stomach

·  perception of the breathing becoming shallow, especially the inspiratory phase

·  volatility of mood, especially envy and dissatisfaction

·  interrupted, changing thoughts

·  late afternoon fatigue

·  interrupted sleep

·  unrestful sleep

Pitta Sancaya:

·  perception of a slight rise in body temperature

·  increase in the quantity of food consumed at normal meal times

·  occassional, fleeting perception of burning sensation in the eyes, stomach, or  face

·  increased impatience and aggravation

·  concentration which exceeds "well-focused" and becomes obsessive

·  increased concern about finances

Kapha Sancaya:

·  heaviness of the stomach

·  heaviness of the hips and legs

·  increased laziness

·  disinterest in work

·  difficulty becoming active upon awakening from a night's sleep

·  craving for sweet, fattening foods  

2. PRAKOPA (AGGRAVATION)

If no measures are taken to correct the situation, the process continues into the next stage in which the accumulated doshas provoke and irritate the local tissues (Stage 2: Prakopa). During this stage the doshas not only increase and become abnormal in quantity, but also with regard to quality, as vitiation begins. During prakopa, the aggravated doshas remain in their usual and normal sites and have not yet spread. There are subtle physical and mental pre-symptoms but no recognizable features of any specific disease, and this is a fully reversible stage. 

Vata Prakopa:

·  an increase in intensity of sancaya signs, plus:

·  stiffness in one or more areas of the body

·  occassional tingling of the hands or feet

·  talking excessively; talking too fast; interrupting others

·  tenseness of the facial muscles

·  increased sensitivity to sound

·  aversion toward cold drinks and foods

·  gurgling or uneasiness in the epigastric (stomach)  region

·  pain occurring in sites of old injuries

·  bone or muscle pain which is fleeting in nature

·  bowel movements: less frequent, smaller pieces, darker in color, formed with many cracks, harder than usual, drier than usual (any of these signs)

Pitta Prakopa:

·  an increase in intensity of sancaya signs, plus:

·  sour taste in the mouth

·  sour fragrance of the perspiration

·  increased dryness causing increased thirst

·  slight burning in the throat, stomach, esophagus

·  mind turning to business matters after 10:00 pm

·  obsession with completing tasks which are not high priority

·  speech which is judgmental, criticizing of others, angry

·  slight burning during urination

·  yellowing of the eyes (sclerae) and/or skin

·  increased desire for alcoholic beverages/cold beverages

Kapha Prakopa:

·  an increase in intensity of sancaya signs, plus:

·  noticeable loss of appetite

·  increased nasal, eye, ear, mouth secretions

·  stickiness of the oral cavity and skin

·  mental lethargy

·  greediness, collecting, acquiring, hoarding

·  spending proportionately more time eating and sleeping

·  thick, whitish coating on posterior 1/3 of the tongue

·  generalized heaviness  

3A. PRASAMA (REMISSION)

As we have stated above, if at this stage the causative factors (diet, life-style, stress, etc.) are removed the doshas will recede back to a state of balance and normal proportion. For this to occur, usually all the precipitating factors must be removed and at least some appropriate remedial measures must be instituted--although at this stage they may be gentle and non-radical in nature and still be quite effective.

3B. PRASARA (SPREAD)

If the process is allowed to proceed, the doshas will fill to capacity in the region of accumulation and finally begin to overflow and spread (Stage 3a: Prasara) throughout the body. Initially, this extention follows a recognizable and predictable pattern however when advanced no particular pattern can be discerned. There are two forces which may drive the overflow and spread of the doshas. One is the force created by the accelerating increase in quantity of the dosha, like water bursting through a dam. The other force is a consequence of a change in the quality of the dosha, analagous to a mildly dysplastic cell becoming overtly anaplastic and metastasizing to the surrounding tissues.

In the prasara stage the patient still does not manifest the classical symptoms (rupas) of a specific disease. In addition, due to the spreading nature of this stage, the symptoms are also not localized and can appear and disappear in different areas of the body. Once firmly engaged in the prasara stage, prasama (spontaneous remission) is no longer possible. However, if the propagating doγa does not entrench itself in a tissue predisposed to morbidity and, simultaneously, the causative factors are removed the kriyakala can still be reversed and the disease cured.

Vata Prasara

·  Vata dosha manifesting at an abnormal site (twitching of the eyelids, dry patches of skin, cramping of a muscle, etc)

·  increased gurgling of the intestines

·  irregular appetite (sometimes not hungry at regular mealtimes)

·  mild constipation

·  noticeable decrease in stamina during normal daily activities

·  indecisiveness, insecurity, or fearfulness

·  frequent forgetfulness

·  abdominal bloating

Pitta Prasara

·  burning sensation of increased intensity and frequency

·  burning associated with pain

·  itching (may be subtle)

·  appearance of red vesicles in parts of the body

·  muscle fatigue

·  excessive perspiration

·  greenish or yellowish discoloration of the stool or urine

·  mounting frustration and dissatisfaction

Kapha Prasara

·  nausea

·  drowsiness

·  anorexia

·  slow digestion

·  excessive saliva production

·  excessive mucous production, especially in the throat and stools

·  pallor

·  loss of strength

It should also be noted that of the three doshas, only Vata has the capacity to move. Pitta and Kapha doshas do not have the inherent capability to move and spread by themselves; their movement requires Vata dosha to be present. The clinical manifestations noted above are seen in many patients. However, vikriti can take many other forms depending on the site of dispersion, quantity and quality of the aggravated dosha, previous injury or illness, strength of the dhatus, and other factors.

4. STHANASAMSRAYA (LOCALIZATION)

Eventually, the disseminating dosha(s) relocate in one or more different sites where they begin to manifest symptoms of disease (Stage 4: Sthanasamsraya). Usually the site of relocation is determined by the existence of some previous weakness or insult at that site which may have compromised the defense mechanisms. So, for example, we know that cigarette smokers are more prone to bronchitis than non-smokers. The weak site of the an individual's physiology may be determined by some genetic condition or be acquired as a result of a previous illness or trauma which resulted in a residual weakness despite apparent full clinical recovery. It is this individual-specific weakness which determines where the doshas will localize in a given patient. Thus the exact same doshic vitiation will manifest as a headache in one person, a kidney stone in another, and arthritic joints in a third person. These differences are influenced by differences in prakriti it is true--but also by distinct preexisting conditions of each individual which gives rise to sthanasamsraya in different locations.

At this stage the relocated doshas rapidly become more concentrated at the cellular and organ levels than in earlier stages. The vitiated doshas also cease their rapid phase of movement and mix with the tissues (dhatus) at the new location causing them to now become vitiated tissues (dushyas). This pathological process is known as dosha- dushya-sammurcchana (sammurcchana means "interaction"). It is this interaction of dosha and dushya in relation to a specific tissue or organ site (adhisthana) which produces the symptoms and physical signs of a disease. The fourth stage of the kriyakala is indeed the first stage in which the symptoms of the disease begin to appear, although not fully developed. We in fact regard the symptoms which appear at this stage as the purvarupa, or prodromal symptoms. These prodomal symptoms can either be replaced by the actual classical symptoms which are quite different or simply intensify to produce the true symptoms of the disease. Knowledge of these prodromal symptoms will help you further differentiate between prakriti-based "normal" tendencies and abnormal symptoms due to vitiated doshas. 

Vata Purvarupa

·  Generalized, persistent bodily weakness

·  Pain

·  Severe Pain anywhere in the body

·  Cutting pain anywhere in the body

·  Pain with associated pressure anywhere in the body

·  Spasmodic pain anywhere in the body

·  Tearing pain anywhere in the body

·  Gnawing pain anywhere in the body

·  Pain associated with cold sensations

·  Squeezing pain anywhere in the body

·  Splitting pain anywhere in the body

·  Poking pain anywhere in the body

·  Hypothesia (loss of feeling)

·  Loosening of the joints

·  Obstruction to flow (wastes, breath, secretions, thoughts, energies)

·  Tissue destruction, early signs of atrophy (muscle flattening)

·  Intermittent memory loss

·  Abnormal body movements

·  Constriction

·  Tremors

·  Tremulousness of the limbs

·  Weakness of all or some limbs

·  Swelling

·  Lameness

·  Kyphoscoliosis (poor posture)

·  Difficulty/inability to stand still and erect

·  Joint stiffness/destruction/deformity

·  Joint pain

·  Joint "cracking"

·  Bone pain

·  Ringing in the ears

·  Hoarseness

·  Bitter taste

·  Excessive yawning

·  Flatulence

·  Abdominal distention

·  Difficulty, even mild, in passing stool (or urine)

·  Strong desire for hot foods

·  Weakness of ejaculation

·  Loss of libido (men and women)

·  Insomnia

·  Excessive crying

·  Irrelevant talk

·  Underlying sense of fear, anxiety, or insecurity

Pitta Purvarupa

·  Yellow discoloration of the eyes, skin, nails, teeth, urine, stool, or nose

·  Appearance of more than usual of the following colors: red or green

·  Itching

·  Urticaria

·  Excess discharges from the eyes, mouth, nose, penis, or vagina

·  Ulcerations

·  Acne

·  Rashes

·  Increased thirst

·  Giddiness

·  Faintness/lightheadedness

·  Sour or salty taste in the mouth

·  Desire for cold substances

·  Jealousy

·  Anger

·  Aggravation

·  Impatience

·  Lack of compassion

·  Foul language

·  Disregard for the environment

·  Unhappiness/discontent

·  Blurred vision

·  Eye fatigue

·  Increased temperature of the feet

Kapha Purvarupa

·  Coldness

·  Oily skin (excess)

·  Oily hair (excess)

·  Swelling

·  Edema

·  Resistance to movement

·  Excessive nasal discharge

·  Whitish mucous mixed with stools

·  Sweet taste in the mouth

·  Weakness of the joints

·  Excessive desire for sleep

·  Desire for daytime sleep

·  General lack of interest in life

·  Loss of mental focus and intensity

·  Resistance to change

·  Excessive sexual fantasies

·  Weight gain

·  Procrastination  

5. VYAKTI (MANIFESTATION)

 When the dosha-dushya-sammurcchana is complete the characteristic symptoms of the disease finally appears; these characteristics are known as rupas. This is normally the point at which people realize something is wrong and seek medical attention. At this stage we can often recognize and name the disease: asthma, arthritis, overweight, etc.. Sometimes during the disease process, if it is not too intense, it is possible to distinguish the dosha and dushya components of the disease and identify the disease as vataja, pittaja, kaphaja, rasaja, raktaja, etc. In contrast, if the disease process is too intense and the interaction of dosha and dushya is too extensive, neither the tridoshika nor the dushyic character of the disease can be ascertained. In these cases disease are named according to the location in the body or the organs affected. 

6. BHEDA (PERMANENT CHANGE AND COMPLICATIONS)

The word bheda derives from the Sanskrit root bhid which means breaking, tearing, splitting, piercing; it also means to reveal a hidden secret. This description accurately foretells what occurs at this final stage of the kriyakala. At this stage the unique complications of the disease, which were never apparent earlier, are revealed. For example, a diabetic will discover the peripheral nerve, retinal, and renal complications of this disease or the individual suffering from chronic Lyme Disease will develop its characteristic neurological complications. At this stage the disease is no longer curable by any means, although palliation is possible. Diseases which reach this stage also have the potential to give rise to other diseases. A person with any disease of this stage is said to be permanently changed in profound ways.

Αccording to the Ayurvedic concept, it is always easier to treat the excess doshas while they are still in their original sites (Stages 1 and 2). The stage of spread (Stage3) is the transitional stage. As the doshas first relocate (Stage 4), there is still strong defensive energy available, so treatment is still very effective. In the final two stages, where the disease manifests and matures (stages 5 and 6), treatment becomes extremely difficult but palliation is still possible. If progression is permitted to the latter stages of Stage 6, the disease is incurable and even palliation is unlikely.