Stages of dosha disturbance (accumulation, aggravation, spread)

The doshas are said to be aggravated or calmed by unfavourable or favourable external and internal causes, by the rising (udaya) and premature ripening (udīraṇā) of the karma bringing discomfort or comfort, and by contrary or suitable substance, place, time and state.

An editorial note says that every result needs an external and an internal instrumental cause: for the cure of disease the external causes are medicine, nursing and treatment, and the internal cause is the rising of the comfort-bringing karma (sātāvedanīya) relating to that disease. It defines udaya as karma bearing fruit after completing its term and udīraṇā as karma bearing fruit and falling away before its term, and adds that suitable medicine, place, time and state calm the doshas while their opposites aggravate them.

The commentary says doshas reach accumulation and the later stages in two ways, through the nature of the season and through their own other causes; the instruction to treat at each of the six stages concerns doshas disturbed by their own causes, since for seasonally accumulated doshas the text prescribes elimination at aggravation rather than treatment at accumulation.

The introduction says Ayurvedic diagnosis mainly considers the vitiation of the doṣas, which arises from many different causes: the doṣas accumulate, become aggravated and spread (caya, prakopa, prasara), enter the various dūṣyas, doṣa and dūṣya unite, and the sites become vitiated because the doṣas lodge in them (sthāna-saṁśraya). Therefore the causes must be considered first in diagnosis.

Note: दोष दृष्टि in the conversion is read as दोष दुष्टि (vitiation of the doṣas).

Any single dosha, once aggravated, is said to aggravate all the doshas dwelling in its seat, from which a web of many diseases arises.

The verse says kapha accumulated in hemanta is aggravated in spring, vata accumulated in summer is aggravated in prāvṛṭ, and pitta, through the activity of the rain clouds, becomes intense in autumn.

Following the second season scheme, the editor gives pitta accumulating in Bhādrapada–Āśvayuja, kapha in Pauṣa–Māgha and vata in Vaiśākha–Jyeṣṭha, with pitta aggravated in Kārtika–Mārgaśīrṣa, kapha in Phālguna–Caitra and vata in Āṣāḍha–Śrāvaṇa.

Aggravated doshas are said to spread through the body singly, two together, all three together, sometimes along with blood, or all four together, giving fifteen kinds of spread (prasara).

Spreading through faulty channels, the doshas lodge in a body part and produce that part's diseases: in the abdomen gulma, diarrhoea, weak digestion, ānāha and viśūcikā; in the bladder prameha, dysuria, urinary obstruction and stone. The signs then show that it is fever, diarrhoea or vomiting, and later the type becomes clear, such as vata or pitta fever, or pitta or kapha diarrhoea. The six stages are accumulation, aggravation, spread, lodging (anyonyāśraya or sthānasaṃśraya), manifestation (vyakti) and differentiation (bheda).

The editor compares spread (prasara) to a full lake that receives more water, breaks its embankment and floods: aggravated doshas likewise overflow their own seat and spread through the body. He lists fifteen patterns (vata, pitta, kapha and blood singly; vata-pitta, vata-kapha, kapha-pitta; all three; the doshas with blood in single, double and triple combinations; and all four) and adds that fifteen is a rough count, finer analysis giving many more.

The editor calls the stage in which doshas settle in body parts anyonyāśraya or sthānasaṃśraya and says the prodromal signs (pūrvarūpa) appear as soon as it occurs; his following sentences naming this vyakti and bheda appear incomplete.

The commentary says accumulated doshas should be removed at the time of their aggravation, vata by enema (basti), pitta by purgation and kapha by emesis; otherwise many diseases of the respective doshas arise.

The editor says elimination should be done from the second month of the season in which a dosha is aggravated, otherwise it is not well controlled: vata in Śrāvaṇa, pitta in Mārgaśīrṣa and kapha in Caitra.

Elimination by enema and similar procedures is to be used only when a dosha is very strongly aggravated; moderate or slight aggravation should be overcome by digestives (pācana), fasting (laṅghana) and the like.

One who knows the whole course of the doshas through these six stages should apply elimination, fasting, digestives, pacification and the like as fits each stage, because treated in the early stages the doshas cannot advance and treatment is easy, while each later stage is harder.

Having understood the divisions of time, the physician should plan food, drink, conduct and medicine to suit each time; accumulated doshas should first be calmed before they are aggravated, and if they do become aggravated they should be carefully removed from the body by emesis and other eliminative measures, which the text calls the way to protect the health of the healthy.