The progressive stages of each disease are laid out in great detail. The health of the system is optimized when the dosa are flowing out of the body and the dhatu are nourished. The stages enumerated below describe how this healthy process becomes imbalanced:
1. Accumulation (caya)
Any of the causes of disease listed above can cause the dosa to accumulate at their site: Kapha gathers in the stomach with signs of sluggish digestion, lethargy, paleness, heavy limbs and heavy head. Pitta accumulates in the small intestine with signs of acidity in the stomach, yellowing of the eyes, urine and stool, sensations of heat, irritability, bitter taste in the mouth and loose and smelly stools. Vata collects in the large intestine with signs of bloating, gas, constipation, pebble-like stool, dryness, cramps, coldness, anxiety and insomnia. At this stage the disease is relatively easy to remove.
2. Aggravation (prakopa)
Prakopa is further aggravation of the symptoms mentioned above. The increased severity of doshic irritation starts to aggravate the viscera (amas´aya) that are containing the dosa. The aggravated dosa is still relatively easy to remove via the digestive pathway.
3. Spreading (prasara)
Having reached maximum capacity in their respective sites the accumulated and aggravated dosa now cross their threshold and spill over into other parts of the body. They rebel in any direction that they can force themselves. Via the rasa and rakta tissues they spread to other associated locations. Kapha spreads to the lungs causing a wet cough, breathing difficulties and vomiting, to the joints causing swelling and the bowel causing mucus in the stool. Pitta spreads to the skin causing inflammatory skin problems, eyes causing redness, stomach causing nausea and bowels causing burning diarrhoea. Vata spreads to the skin causing dryness, joints causing cracking and pain, air passages causing a dry cough and the intestines causing further pain and obstructed motions. The dosas are still relatively easy to clear from the system evenat this stage.
4. Relocation (sthana samsraya)
The irritated dosa now fixes in a set location, usually associated with an area of weakness or one of the areas of the body that the particular dosa is associated with, e.g. kapha in the lungs, stomach, joints, mucous membranes and fluid parts of the body; pitta in the liver, eyes, skin, intestinal lining or glands; vata in the ears, joints, bones, skin or colon. This is when the premonitory signs of disease start; the weak cough and slight wheeze that can develop to full-blown asthma. The dosas are now difficult to clear and require deep cleansing techniques and pancakarma tobe removed.
5. Manifestation (vyakti)
The disease now manifests as an identifiable disease such as diabetes, asthma or diverticulosis. The disease is set and cure is often difficult.
6. Expression of unique characteristics of the disease (bheda)
Once a disease is fixed at a site it takes on a life of its own and its dominant features are reflected by the primary causative dosa. For example eczema caused by vata is dry, fissured and itchy; by pitta is red, inflamed, bleeding and hot; and that caused by kapha is wet, suppurating, itchy and oedematous.
The disease is now chronic and may have become incurable. By understanding where a disease is in its evolution it allows you to direct the treatment at the right level as well as to give insight as to the progress of the disease. One of Ayurveda’s strengths is its prognostic ability. It classifies diseases as:
- Easy to cure (sadhya)
- Difficult to cure (krcchra sadhya)
- Incurable but can be alleviated (yapya)
- Incurable (asadhya)
Caraka goes to great lengths to describe various prognostic signs that indicate imminent death, how to promote the birth of a boy or a girl, when fetal death may have occurred and how to enhance general health (Caraka Samhita Indriyasthana). This ability to predict the progression and pathology of a disease is mirrored by Ayurveda’s inspirational ability to remove ill health and promote wellbeing.