Samprāpti: The Six Steps of Disease (Satkriyākāla)
There are numerous causes of dosha aggravation or vitiation. These can be both external and internal. If the doshas become vitiated enough, the dhātus and their agni will be abnormally affected, causing illness and disease (vyādhi). The early stages of aggravation may be quite subtle and it may take further aggravation before it 'grabs the attention'. This can then lead to a progression that causes a change in cellular intelligence, abnormal changes in the quality of a dhātu, and changes in organs and srotamsi.
Āyurveda classifies this progression of disease in six steps, called the Satkriyākala. Understanding these steps is vital for a doctor or practitioner of Āyurveda. It allows for a 'view of pathogenesis' and helps greatly in deciding how treatment is administered. A brief overview is presented here.
Sanchaya – Accumulation
In this stage the aggravated dosha begins to accumulate in its respective main site: Vata – Colon, Pitta – Small intestine, Kapha – Stomach. Symptoms are mild and/or irregular, but the disorder or condition can be detected and treated. It is easy to restore balance to the affected dosha(s) at this point.
Prakopa – Provocation
When a dosha continues to be aggravated it will do so in its main site. During this second stage symptoms will be more significant, but the aggravated dosha can still be removed via the gastro-intestinal tract (GI tract) relatively easily. The doshas are still in their own sites during these first two stages food cravings will be healthy and appropriate.
After those two stages, the disease is moving out of the GI tract, makes it harder to treat by yourself, and you should consult an Ayurvedic doctor or practitioner.
Prasara – Spread
If the dosha is still being aggravated it will leave its main site or 'home' in the GI tract and go to another site of that same dosha elsewhere in the body. Pūrva Rupa, prodromal symptoms and signs, present themselves during this stage. Food and other cravings will begin to be abnormally affected. However, the condition is still curable.
The doshas are in the GI tract at the first and second stages, the 'home' of Agni. As long as this is happening, there is the possibility of harm, with the Agni becoming impaired by further aggravation. Once impaired the dosha(s) will leave the GI tract and the disease or disorder will manifest further, making it more difficult to alleviate and harder to cure.
Sthana Samshraya – Localization
Vyakti – Manifestation
Bheda – Differentiation or Destruction
Please see chart below for more detail.
Disease is also caused by or within the mind. The mind has its two doshas, Rajas and Tamas, two of the māha gunas. The third māha guna, Sattva, is considered the very nature of the mind and is not a causative factor. There are two types of diseases that involve the mind:
Manasaja (mental): Any disease that arises in the mental faculty, such as depression, schizophrenia, and other psychiatric issues. There is a disturbance of rajas and tamas, then the three doshas (vāta, pitta and kapha) are disturbed. Therefore, the dhātus may become involved later.
- Sharīra Manasaja (psychosomatic): Any disease that originates as Manasaja and then progresses to increase the doshas and dhātus; or a disease that begins in the physical body and then goes on to disturb the gunas of the mind.