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)