Importace of focusing on the aspect of Dhatu Dushti in a disease:-

In Ayurveda Dhatu (Structural unit of body) represent strength and immunity. Though Dosha (The vitiating entity) is the doer(Karta)-basic unit for onset of pathogenesis they unavoidably need the (Karma- on which the Dosha manifest) for expressing themselves. The combination and execution of Nidana (cause), Dosha (Vitiating entity) and Dushya (Sufferer) in a precise framework, actually decides the diverseness in disease pathogenesis.⁽²⁾ The disarranged Doşawhen comes in contact with different Dhātu and Mala    together with different  location  and  etiological  factors give rise to different form of disease⁽⁵⁾. This pathogenesis process comprises of two basic events as described in the following Sutra.⁽³⁾

a)       Yatha dushtena doshena -Nidana(causative factors), directing the Dosha Dushti & triggering the disease pathogenesis, which is responsible for DhatuDaurbalya(weakening of Dhatu )

b)       Yathacha anuvisarpita - Anusarpan (spreading of the DushtaDosha), through the Rogamargas. In this process RaktaDhatu has a major role to play.

Each Dhatu has its typical embedded structural and functional qualities. Transformation during pathogenesis brings some structural and functional disturbances in a normal constitution of a Dhatu and reflects specific characters. Ex-GramyaAhara⁽⁴⁾ causes

This process can be evaluated on the basis of Ayurvedic principles based on DoshaGunas(properties).

This typical abnormal condition of a Dhatu is referred as DhatuDushti (vitiated Dhatu).This DhatuDushti is represented by various DhatuAwastha(deranged condition of Dhatu)⁽⁶⁾

These Awastha are found at various stages of the disease, as the disease progresses.Grasping and treating these Awastha in right time can check a disease pathogenesis and even prognosis. A vitiated DhatuAwastha as found in texts are classified as -1) Kshaya 2) Vriddhi 3) DushtiAwasthas. Ex- Visarpa- Twak, Rakta, Mamsa,Lasika-Dushti.^(7).The DushtiAwastha of Dhatu can be explored from the following terms found in texts indicating DhatuDushti. Ex- In Raktapitta-SaptaDhatu- Swinnatwa(perspiration) is described.⁽⁸⁾. In Kushtha-Twak, Rakta, Mamsa, Lasika,Sirā –Shaithilya(to let pass) is described⁽⁹⁾.In Visarpa-Twak, Rakta, Mamsa, Lasika-Klinnatva(Accumulation of unduemoisture), Shirnatva(Perishable)^(10). Development of DhatuAwasthas in different disease can be analyzed through the Ayurvedic principles such as –

·         Amshamshakalpana (Action of-properties of Dosha on Dhatu in a typical manner-. i.e permutations & combination of properties of one or more Dosha).

Vata	Rūkşa, Cala, Sūkşma, Laghu	Stanya, Rakta, Twak - Twak,Mamsa------	Phenilatva (froathy) Tanutva (Emaciation) Shosha (decication)(33)
Pitta	Uşņa, Drava, Snigdha ,             / + Tikşhņa	Rasa, Rakta, Māmsa	Klinnatva.(30) Paka,(Ripening)(34)(35) Kotha.(Gangrene)(16)
Kapha	Guru, Manda, Sthira (in diffrringproportios)	Rakta, Māmsa	Grathitava,( Knotted)(32) Ghana (Copious)(31) Bahalatva .
Pitta, Kapha	Drava , Snigdha, + ushna	Māmsa, Twak, Rakta	Śaithilya ,Abaddha(11)
Vata  Pitta	Rūkşa,Khara,Sūkşma+Uşņa,/ + Tikşhņa,Laghu,Sara	Māmsa , Twak	Śīrņatva , Śātanaa (Causing to fall)

By knowing the factors involved in pathogenesis, sometimes the successive Awasthas can be predictable. As these are found to have affinity to proceed towards particular tracks of progression. These are readily quoted in CharakSamhitaNidanaSthana as- Agneya (towards warmth- can be wet or dry), Vayaviya (dry-cold), Saumya(wet-unctous-cold)⁽¹²⁾.

Ex- Awasthas found successively in Vatavyadhi- with the responsible properties (Amshamshakalpana)⁽¹³⁾

Rūkşatva-Drying	Rūkşa
Parūşatva- increased dryness	Rūkşa,Khara+++
Śoşaņa	Rūkşa+, Khara(++),Uşņa
Sankocana(Atrophy)	Rūkşa++,Khara++ , Kathiņa
Akshepa(Tremors)	Rūkşa, Khara, Kathiņa,Sheeta

These successive Awasthas occurring in one or more Dhatus, from initial to final stages of disease, have tendency to lead a Dhatu towards deterioration. Also the disease prognosis becomes bad due to it⁽¹⁴⁾. Ex-

Visarpa,Kushtha	Mamsa,Twak,Rakta	Stage-1 Shaithilya,Tanutva(15)	Stage-2 Shirnatva(10)	Stage-3 Shatana—PakaKotha(16)
Vatavyadhi	Asthi	Bheda (breaking pain)(17)	Souśirya(hollowness)(18)	Śoşa(18)

·         Ashrayashrayibhava-(Substrate & Substratum relation of Dosha&Dhatu)-

The concept of (Substrate & Substratum relation of Dosha&Dhatu)-  is pacified prominently in case of RaktaDhātu, being the substrate of Pitta is more prone to DhātuAvasthās due to Pitta i.e more than 50% of them..Ex-Askanditatva(Not coagulating) Pāka, Vidāha, Swinnatva, Utsanna(raised), Udrikta-Predominant, Ulbaņa- comparatively increased.^{(19)(20)(21)(22).}

·         Panchamahabhautik constitution (dominant element amongst the 5 elements)-

The proneness of a Dhatu towards a particular Awastha depends on the Mahabhautik constitution (dominant element amongst the 5 elements) of that Dhatu. Ex-Phenila, PicchillaAvasthās are only found in Drava Dhātus. - Śātana, Dāraņa is separation of a portion of Dhātu structure which requires Ghana, Sthira, SthoolaDhātu like Māmsa, Sirā, Twak etc. - Askanditatva in Rakta it’s particularly due to Śītoşņa, Sara, Drava etcGuņas in RaktaDhātu ,Saumyāgneya nature,(Jala+Agni)constitution.

v  The concept of Anusarpan (spreading of the DushtaDosha)-

In the Ayurveda system of medicine RaktaDhatu has a remarkable position in our body. It is considered as the symbol of life, one of the 10 dwelling spots of Prana(liveliness) in our body. It is the basic nutritional currency of all other Dhatus and hence is said to highly protected. Body’s vital competence i.e strength, complexion happiness and wellbeing depends on Rakta.⁽²³⁾Spreading of vitiated Dosha is the root cause of onset of a pathogenesis along with Nidana. Though Dosha are the triggering factors for pathogenesis  ,stillRakta amongst the 7 Dhatus is considered to be equally potent for execution of it by the Acharyas⁽²⁴⁾.-

Sushruta- Prasara(Spreading of  Dosha).one of the Shatkriyakala (6 stages of Dosha manifestation  in pathogenesis ).Among the 15 ways of  DoshaPrasara, 8 ways are with the help of Rakta. (Rakta= Agni+ JalaMahabhuta/elements-capable of stimulating and travelling).⁽²⁵⁾

Charaka- Dravatva(Liquidity) and Saratva(stimulating) qualities of Rakta are acknowledged as the key factors that act correspondingly to Vata(the only,moving entity among Dosha) in execution of a disease pathogenesis.⁽²⁶⁾

Thus vitiated Rakta carries the foundation of various pathogenesis.Hence when a disease is not found to get cured with its defined line of treatment, addition of Rakta treatment to it is advised to achieve success in its treatment.⁽²⁷⁾Rakta can lead the path of pathogenesis as seen from evidence of Rakta properties in successively deteriorating Awasthas.^(9)(28)

It can also be seen in Kushtha Vyadhi in context of Mamsa Dhatu

Mamsa Dhatu

·         Śaithilya - Snigdha + Drava + Sara ·         Klinnatva - Snigdha + Uşņa + Drava ·         Pāka – Snigdha + Uşņa +++ , ·         Kotha - Snigdha +Drava+ Tikşhņa ·         Śātana -Uşņa +Laghu+ Sara +Tikşhņa +++

Hence it can be summarized that -

·         Steps in Pathogenesis bring disturbances in normal Dhatu constitution and reflect specific characters in it,referred as (Dushti)vitiated DhatuAwastha .

·         DushtiAwastha of Dhatu, found scatterred in various disease pathogensis can be logically explored and classified on basis of Principles of Ayurved.

·         One or more Doşa produce different Avasthās in a Dhātu by Amśāmśakalpanā.

·         Awasthas of Dhatu proceed towards particular tracks of progression. Agneya ,Vayaviya ,  Saumya.

·         Successive Awasthas can lead a Dhatu towards deterioration.

·         The proneness of a Dhatu towards a particular Awastha depends on the Mahabhautik constitution  of that Dhatu  and Ashrayashrayibhava(of Dosha and Dhatu)

·         Vitiated RaktaDhatu, acting significantly in execution of Prasara(spreading of Doshas) carries the foundation of various pathogenesis.

Thus by being aware of the underlying nature of Dhātu condition, the onset and progress of pathogenesis can be grasped which can ensure an increased success rate of treatment as demanded in the NaimittikRasayan concept.⁽²⁹⁾