Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

We have to consider many factors in treating diseases. Many Acharyas have given different sets of factors to be considered in treating diseases, in various chapters, according to the context and as and when appropriate.

Among such factors, Acharya Vagbhata has mentioned three main factors to be considered in treating the diseases effectively. They are –

1.    Samutthana Vishesha / Hetu Vishesha
2.    Adhistana Antarani and
3.    Vikara Prakriti

Reference – Ashtanga Hridaya Sutra Sthana, Chapter 12, verse 65-66 (A.Hr.Su.12/65, 66)

In this article, we will try to know more about these factors.

Three important factors to be considered to effectively treat diseases

स एव कुपितो दोषः समुत्थानविशेषतः।
स्थानान्तराणि च प्राप्य विकारान् कुरुते बहून्॥६५॥
तस्माद्विकारप्रकृतीरधिष्ठानान्तराणि च।
बुद्ध्वा हेतुविशेषश्च शीघ्रं कुर्यादुपक्रमम्॥६६॥
First, let us try to understand why so many diseases are manifested. Why do we have so many subtypes of each disease? The answers to these questions will also give a clarity about the understanding of the above mentioned three factors.

1. Samuttana / Karana / Hetu Vishesha –

First of all, all diseases are manifested after we get exposed to Nidanas i.e. causative or etiological factors of a disease. Each disease has a big list of etiological factors which would cause the disease. These etiological factors would cause disturbance of doshas in the body and thus the disease process or pathogenesis starts.

So, which etiological factor will influence and aggravate which dosha or doshas and to what proportions cannot be said. This mathematics varies from person to person. So, the nature of etiological factors cannot be understood nor the way they behave when they come in contact with the body. In the same person, the same etiological factor may disturb different dosha at different times and cause different sets of symptoms or diseases.

This gives us a clarity regarding the multiplicity of diseases caused due to specific natures of causative factors and how they influence the doshas and dhatus in the body.

So, a physician should have a precise knowledge of Hetu Visheshata to treat a disease properly.

2. Sthana / Adhistana Antarani –

The lodgment of aggravated dosha or doshas in the tissues and causing tissue damage is the next step in the pathogenesis of any disease.

As said above, the causative factors, due to their specific nature, would influence a dosha or doshas in many ways. These doshas travel in the body (as in the prasara stage of kriyakala). They would find a weak and susceptible place to lodge themselves, in the form of tissues and organs. Wherever they find a weak tissue or organ (which is also made up of tissues) or deformity of channels of transportation (kha vaigunya), the doshas get lodged or blocked therein respectively. This is called as sthana samshraya or dosha dushya sammurchana – amalgamation of vitiated dosha and weak dhatu or lodgment of powerful and aggravated dosha in weak and susceptible tissue. This is the fourth stage of kriya kala (cycle of pathogenesis) and is an important stage for the disease to form.

So, this sthana i.e. seat (tissue, organ) wherein the doshas would circulate get lodged are again of different types. These diseases would produce the disease depending on the nature of sthana, which is many. So, a particular dosha in circulation can cause a severe migraine getting lodged in the head or arthritis getting lodged in the joints depending on where they find the lodgment. So, the manifestation of the disease is also based on the nature of the sthana. So, it is important for a physician to know the Sthana Antarani to treat a disease effectively.

3. Vikara Prakriti –

The third and the most important factor to be considered is the main dosha causing the disease and its nature of aggravation, by which nidanas it has undergone aggravation and in which sthana it is lodged. This also involves understanding specific qualities of doshas which have undergone increase. This is called Vikalpa Samprapti i.e. fractional understanding of dosha involved in the pathogenesis of a disease.

So, a physician should have a thorough knowledge of the vikara prakriti i.e., the nature of dosha and the disease caused by it.

To sum up,

The aggravated doshas, depending on the nature of their causative factors, on reaching different parts of the body (and finding lodgment therein), will produce many kinds of diseases.

Therefore, a physician should know all these three factors and the relationship between them.

The treatment of the disease caused in such a way, by many kinds of causative factors and involving many seats of lodgment of doshas, should be done in quick time after properly understanding vikara prakriti, adhistana antarani and hetu vishesha.