Assessment of Various Stages of Vatarakta in the Purview of Doshagati

Introduction

Ayurveda is a system of healing with time-honored doctrines. It explains various physiological phenomenons which form the base for understanding the normal functioning of the body. Altered physiology leads to pathogenesis. Thus, Ayurveda explains the pathological aspects in terms of deviation in the normal functional pathway. For the production of any disease, dosha are the primary internal factor [1]. They are constantly circulating all over the body. If there is any susceptible dushya (dhatu and mala), they conglomerate with them to evoke pathogenesis [2]. Doshagati is all about the internal movement of dosha according to situation. They form the tool to assess factual situation of the disease and probable future course. 

Doshagati – Prakrita And Vaikrita

Dosha are the primary governing principles of the body. They are in constant movement all over the body. Normal functioning of the body is dependent on the status of dosha while deviation from the same can lead to disease [3]. Technical terminology used for the movement or status of dosha is doshagati.  The commentators have interpreted the term ‘gati’ to ‘avastha’ or ‘prakara’ [4]. It has a role both in physiological as well as pathological state of the body.

The equilibrium of dosha, dhatu and mala is necessary in maintaining health [5]. Equilibrium may be considered in relative sense because the status of dosha vary in any person at a given time based on vaya, ahoratri kaala, bhuktavastha [6]. Therefore, health should be considered as a band of dynamic balance of dosha. This phase of dosha is considered under prakrita gati. The equilibrium will be disturbed whenever a person is involved in regular nidana sevana. Subsequently, the normal onward propagation of dosha is altered and the state is known as vikrita gati of dosha [7].

A disease can be assessed in two different ways based on the stage of doshagati. If prodromal symptoms of the disease are already manifested, then etiology and pathogenesis can be analyzed retrospectively while the clinical features and complications can be analyzed prospectively.  

Acarya Caraka has described three variants of doshagati [8] namely,

• Kshaya, vriddhi and sthana
• Urdhva, adhah and tiryak gati
• Rogamargae, bahya, abhyantara and marmasthisandi

Vatarakta In The Purview Of Doshagati–Retrospective Analysis

• Kshaya, vriddhi and sthana

‘Sthana’ refers to the physiological state of dosha [9]. The primary aim of a physician is to achieve dhatusamya [10]. This necessitates the assessment of status of vikrita dosha as they can be in either vriddhi or kshaya state. Further, vriddhi-kshaya of dosha can be of either gunatah, karmatah or pramanatah. Then, imbalanced dosha needs to be normalized by the principle of samanya-vishesha.

Vatarakta involves various nidana in terms of food and regimen. Each nidana has its own ability to vitiate specific dosha and increase the susceptibility of specific dushya. If the interaction of etiological factors, dosha and dushya are weak, then the disease process may delay or does not manifest and vice versa [11].  Thus, hereby, the relation of each nidana and their affinity to vitiate dosha and cause khavaigunyata are  are considered.

Table No. I Showing the relation between nidana, doshaprakopa and srotodushti

Thus, by analyzing nidana in each patient by prashna pareeksha, probable clinical symptomatology based on dosha–dushya involved maybe traced.

• Urdhva, adhah and tiryak gati.

Vata dosha has the property of motion while other dosha–dhatu–mala are lame [14]. They are dependent on vata dosha to move all over the body. Movement in the body can be in any direction like upwards (urdhva), downwards (adha) and lateral (tiryak). Based on the functions, respective subtype of dosha have gati.

• By physiological considerations, vata dosha gati can be taken as follows:
• Prana vata – Urdhva , adho
• Udana vata – Urdhva
• Vyana vata – Urdhva, adho, tiryak
• Apana vata – Adho

The above gati may get altered during the pathological state. Thus, treatment should be aimed at anulomana. If dushta dosha have taken tiryak gati, Pre-requisites like pacana, deepana, snehana, svedana should be administered before shodhana [15].

In case of vatarakta, aggravated vata dosha, particularly vyana vata, undergoes pratiloma gati,. Due to pratiloma gati of vata and margavarana by dushita rakta, it gets lodged in susceptible areas like joints. Thus, manifesting musculo-skeletal symptoms like arthralgia and joint deformities. Skin manifestations such as vaivarnya, kandu are seen as a result of raktadushti.

• Rogamargae, bahya, abhyantara and marmasthisandhi

Depending on the severity of etiology and vitiation of dosha, the pathway of pathogenesis varies. These pathways are termed as rogamarga. Knowledge of rogamarga involved in a disease helps in assessing the severity of the disease as well as in planning treatment. They are categorized into three, namely bahya rogamarga (shakha), Abhyantara rogamarga (koshtha) and Madhyama rogamarga.

            In case of vatarakta, all the three rogamarga can get involved presenting with respective features. If dosha gati is directed towards abhyantara rogamarga, then clinical features of altered functions of koshtha are seen like aruci, agnimandya. If doshagati involves bahya rogamarga, it manifests in two stages, namely uthana and gambhira vatarakta. Uthana avastha involves Rasa, Rakta and Mamsa dhatu characterized by Kandu, Daha, Ruk, Ayama, Toda, Sphurana, Kuncana, Tvak shyavata and Tvak tamrata. Gambhira avastha involves meda, asthi, majja producing symptoms like shvayathu, sthabdha, kathina, antarbhrisharti, toda, sphurana, daha, shyavata, tamrata, paaka. In the chronic stages of gambhira vatarakta, doshagati may involve structures like asthi, sandhi, snayu, sira producing features like khanja, pangu, angulivakrata [16].

Acarya Cakrapani considered gati as prakara or avastha. Thus, avastha of dosha can be considered in terms of presence of ama, based on kaala and avarana.

• Dosha gati based on the presence of ama

Dosha can be either in sama or nirama avastha. Amapacana and agnideepana are the initial measures to be taken before starting vyadhi pratyaneeka cikitsa. Features such as gauravata, anilamoodhata, agnisada, vedana, shotha and toda indicate the sama doshagati in a case of vatarakta. Once the dosha are brought to the state of nirama, vyadhi pratyaneeka cikitsa should beplanned.

• Doshagati based on different stages of the disease

Dosha maintain their normal state as long as there is no triggering factors called etiology. Once a person indulges in nidana, they lead to dosha vaishamya. Initially, dushta dosha accumulates in their own places, known as sancaya avastha. If they move out of their own abode, then they are said to be in prakopa and prasara avastha, where they circulate all over the body [17]. In these three phases namely sancaya, prakopa and prasara, only specific dosha features can be seen and categorical disease features are absent. Features of dosha involved depends on the etiology of each individual.

       In the fourth stage of doshagati, known as sthanasamshraya, aggravated dosha become localized in the susceptible dushya.  Premonitory signs and symptoms of the diseases, poorvaroopa, are seen [18]. Thus, poorvaroopa of vatarakta are as follows: Svedo atyartam na va, Karshnya, Sprashajnana, Kshate atiruk, Sandhishaithilya, Alasya, Sadana, Pidakodgama, Appearance of toda (pain) in the joints, Vaivarnya Mandalotpatti and Feeling of gurutva (heaviness), supti (numbness) and kandu (itching) in knee, thigh, waist, shoulder, hands, legs and other joints of the body [19].

       In the fifth stage of doshagati, known as vyakta, signs and symptoms of the disease manifest[1]. Features correspond to the dominant dosha involved in the pathogenesis.

• If vata dosha has predominant gati, clinical features manifested are, Sirayama, shoola, sphurana, toda, shothasya karshnya, roukshya, Shyavata vriddhi–hani, Sankoca of dhamani of fingers, Angagraha, Atiruk, Kuncana, Sthambhana,
• If pitta has predominant gati, features manifested are Vidaha, Moorcha, Sveda, Trishna, Mada, Bhrama, Raga, Bheda, Paka, Shosha.
• If kapha dosha has predominant gati, features manifested are staimitya, gourava, sneha, supti and mandaruk. When there is predominance of two dosha or all three dosha there will be combination of symptoms and etiological factors as well [20].

    In the sixth stage of doshagati, known as bheda avastha, doshagati can alter by traversing in all directions and affecting multiple structures causing upadrava.

Upadrava of vatarakta as a result of bheda avastha are asvapna, arocaka, shvasa, mamsakotha, shirograha, moorcha, mada, ruk, toda, trishna, jvara, moha, pravepaka, hikka, pangulya, visarpa, paka, bhrama, klama, angulivakrata, sphota, daha, marmagraha and arbuda [21].

Avarana as a doshagati of vata

Vata dosha is unique among tridosha as it has cala guna and thus, it has tendency to get obstructed, commonly known as avarana. Samprapti of vatarakta involves avarana. Here, vata dosha, being in vriddha avastha, gets obstructed due to rakta vriddhi [22].

Diagnosis of avarana, especially by kapha or meda is important for planning treatment as snehana is contraindicated. Instead kapha and meda subjugate with physical exercises, shodhana, virecana, intake of arishta and butter milk with abhaya should be planned [23].

Examples of doshagati in vatarakta: – prospective analysis:

1. I) Nidana such as excessive intake of virudha ahara, excess amla-lavana rasa, , ajirna bhojana, krodha

      Leads to vata–pitta prakopa

       Prasara in  sarva shareera

Sthamasamshraya in khavaigunyata – rasavaha, raktavaham svedavaha srotas

Producing symptoms like atiruk in sandhi, tvak rookshata, daha, svedadhikya

In this case, doshagati can be seen in the form of bahya rogamarga and tiryak gati

1. II) Nidana such as abhigata, divasvapna, plavana, acankramanasheelatam adhyashana

                                                            leads to vata–kapha prakopa

Prasara in sarva shareera

Sthamasamshraya in khavaigunyata – medovaha srotas, asthivaha srotas

Producing symptoms like shvayathu, stabdhata, asthitoda, sandhivakrata

In this case, doshagati can be seen in bahya and madhyama rogamarga, tiryak gati, saama doshavastha.

Discussion

Ayurveda considers multiple factors for planning line of treatment. A physician having many tools to examine a patient, aims at dhatusamya by planning the treatment. Avastha of the disease depends on the status of dosha in the disease process. Thus, assessment of dosha gati helps in determining the phase wise treatment plan required. Further pathogenesis also gets stopped preventing the complications. Vatarakta is considered in this work as it has multiple clinical symptomatologies due to different dosha gati. Thus, based on various permutations and combinations of etiology, dosha traverses in different pathway producing lakshana.

Conclusion

Examination of a disease involves five methods such as nidana, pragroopa, roopa, upashaya and samprapti[24]. This methodology is adopted while explaining any disease for easier understanding of the readers. Thus, it is the skill of the physician to apply the basic doctrines, such as doshagati, to understand pathogenesis and treatment. In this work, various stages of vatarakta are assessed in the purview of doshagati. Similarly, other diseases can be analyzed from both prospective and retrospective eye.

Acknowledgements: The authors are thankful to National Institute of Ayurveda for giving the platform to carry out the basic research.

Financial Support & Sponsership: Nil

Conflicts of Interest: Nil

References:

[1] Ashtangahridayam, Sutrasthana, Doshabhedeeyadhyaya, 12/32. Available from https://vedotpatti.in/samhita/Vag/ehrudayam

[2] Sushrutasamhita, Sutrasthana, Vyadhisamuddeshiyamadhyaya, 24/10. Available from http://niimh.nic.in/ebooks/esushruta/ (Accessed on 30/3/2024)

[3] Ashtangahridayam, Sutrasthana, Ayushkameeyadhyaya, 1/20. Available from https://vedotpatti.in/samhita/Vag/ehrudayam

[4] Cakrapani on Carakasamhita, Sutrasthana, Kiyantashirasiyamadhyaya, 17/112-113. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[5] Ashtangahridayam, Sutrasthana, Doshadivijnaneeyadhyaya, 11/1. Available from https://vedotpatti.in/samhita/Vag/ehrudayam [6] Ashtangahridayam, Sutrasthana, Ayushkameeyadhyaya, 1/8. Available from https://vedotpatti.in/samhita/Vag/ehrudayam

[7] Carakasamhita, Sutrasthana, Kiyantashirasiyamadhyaya, 17/115. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[8] Carakasamhita, Sutrasthana, Kiyantashirasiyamadhyaya, 17/112-113. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[9] Cakrapani on Carakasamhita, Sutrasthana, Kiyantashirasiyamadhyaya, 17/112-113. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[10] Carakasamhita, Vimanasthana, Rogabhishagjitiyavimana, 1/112-113. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[11] Carakasamhita, Nidanasthana, Pramehanidana, 4/4. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[12] Carakasamhita, Cikitsasthana, Vatashnoitacikitsa, 29/5-10. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[13] Carakasamhita, Vimanasthana, Srotovimana, 5/10-22. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[14] Sharangadhara. Sharangadharasamhita With the Commentaries Adhamalla’s ‘Dipika’ and Kashirama’s ‘Gudhartha-dipika’. Ed. Pt. Parashuram Shastri Vidyasagar. Varanasi: Chaukhamba Surbharati Prakashan, 2013.,PP.50.

[15] Ashtangahridayam, Sutrasthana, Doshopakramaneeyadhyaya, 13/29-30. Available from https://vedotpatti.in/samhita/Vag/ehrudayam [16] Carakasamhita, Cikitsasthana, Vatashnoitacikitsa, 29/19-23. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[17] Sushrutasamhita, Sutrasthana, Vranaprashnamadhyaya, 21/28. Available from http://niimh.nic.in/ebooks/esushruta/ (Accessed on 30/3/2024)

[18] Sushrutasamhita, Sutrasthana, Vranaprashnamadhyaya, 21/33. Available from http://niimh.nic.in/ebooks/esushruta/ (Accessed on 30/3/2024)

[19] Carakasamhita, Cikitsasthana, Vatashnoitacikitsa, 29/16-18. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[20] Carakasamhita, Cikitsasthana, Vatashnoitacikitsa, 29/24-29. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[21] Carakasamhita, Cikitsasthana, Vatashnoitacikitsa, 29/31-33. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[22] Carakasamhita, Cikitsasthana, Vatashnoitacikitsa, 29/10-11. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[23] Carakasamhita, Cikitsasthana, Vatashnoitacikitsa, 29/156-157. Available from http://niimh.nic.in/ebooks/ecaraka/ (Accessed on 30/3/2024)

[24] Ashtangahridayam, Sutrasthana, Ayushkameeyadhyaya, 1/22. Available from https://vedotpatti.in/samhita/Vag/ehrudayam