Exclusiveness of Samprapti & Samkhya samprapti and their relevance as the tools to abstract and classify diseases by their etiopathogenic course
Anand P.K.V.,
Vaidyaratnam Ayurveda Collage,
Ollur - Thaikkattussery, Thrissur 680322
Abstract: The basis of disease classification in Ayurveda is simple numerical differentiation which groups diseases into any single category by their unique common factor and separates them internally by the unique differentiating factor. Enumeration (Samkhya) of etiopathogenic course (Samprapti) is
the foundation on which the classification of diseases in Ayurveda is built up. This system of classification is unique by its infallibility in an ever changing scenario of systems of classifications.
Introduction
Classifier reserves the right to categorize diseases in any plane according to his purpose of classification, says Charaka samhita in Roganeekam chapter of Vimanastanam. This gives rise to innumerable kinds of categorization of diseases which often creates confusion in the minds of scholars. The classification becomes relative and not self explanatory, affecting the scientific communication negatively. The multiplicity of basis of classifications and variations in understanding
of diseases in various systems of medicine makes it a highly complex problem. This gives rise to coining of new names for diseases in order to make parallel nomenclature in Ayurveda unscientifically, such as Arbudam for cancers, Vishucika for cholera, Amavatam or Raktavatam for rheumatoid arthritis etc. It affects poor performance in the treatments also. The original classification of 20 varieties of Prameham has no practical utility for physician in his clinic as he has conceived the English classification as superior and adopted their strategy to bring down the blood sugar levels as the principal objective in his Prameham treatment, hence poor results. Proper understanding of the foundation of absolute classification of Ayurveda, will help the scientific community to understand the basis of relative classifications with purpose in our system as well as other health systems. International classification of diseases is a numbering system at an international level which groups the diseases according to common characteristics and aims at better scientific communication and study of diseases. This can be useful in minimizing the variations existing in different countries in criteria and standards adopted for diagnosis of diseases and their notification. Even then it may be of minimum use for the Ayurveda community as basis of absolute classification since principles of Ayurveda is not at all a consideration in the international classifications. This makes a review of
foundation of classification of diseases in Ayurveda, essential and relevant.
The nature of Samprapti
The imbalance of Dhathus is momentary in character. Being defective by itself, it gives rise to another another imbalance. Such sequential momentary imbalances, gives rise to a series of activities which forms the entity of disease. Thus the disease is an all comprising word where Samprapthi discusses its Pathogenic events. Samprapthi tracks down the evolution of illness without missing any details and by using every special tool for it. Both causes & prodrome are discussions on diseases about a stage before its completion of existence. But Samprapthi is the biography of the disease. Visualizing the events in a manner that says, such vitiation, in such a location, accompanied by such and such factors, etc., in order to appreciate the disease as a whole is the procedure for it. Thus it explains the details of Dosha Vitiation and its spread in development of any disease. The Samprapthi should be capable of explaining the types of causes, the degree of involvement of each properties like
Dryness etc., gradation of the status of each Doshas, their mutual association etc. It should also clarify the track and direction of spread of Doshas and the emergence of illness. For instance, the Samprapthi of Jwara explains the sequence of events in such a way that the vitiated doshas, enter the seat of Ama, mixes up with heat, trails the first outcome of digestion named Rasadhathu, blocks the tracks of Rasa and Sweat, diminishes the Agni, displaces the digestive fire from its location and moves all over the body to emerge out as fever.
Those useful tools for treatment such as metering each Doshas, rating the power, period etc., will not be useful in the absence of Samprapthi, even if the disease is already identified by the emergence of prodrome etc. So Madhukosa reaffirms that all the five, such as the cause, prodrome, symptoms, positive responses and the life history of disease should be explained. Bhattaraharischandra explains it as the emergence of disease as seen through the determination of Doshas. It should be with affairs that end up in disease. It is not simply the emergence of disease only because some diseases are occurring by birth itself (eg. Jathaprameha)
The carefully traced out course of a disease is its Samprapthi. The core of Samprapthi is Sattha. The course of action in Samprapthi will be in accordance to the sattha. Sattha is that inherent cause of continuity of the status of inherent causation for those factors developing into manifestations. Thus the activities led by it will be proceeded to continuously permute and combine the healthy objects, in order to produce the manifestations out, coordinating all the causative factors for the purpose. Jathi is a synonym which means coming in to existence. It points to the source and development of diseases. Aagathi means the stretch of disease from the root cause to emergence of disease. Samprati is the most important one among the five modules of learning a disease. When it is known fully, understanding the disease becomes complete. Learning Samprati well, being the most useful tool for treatment, makes naming of diseases less important practically.
The base of Absolute differentiation
The difference in Samprapti (etiopathogenic course) makes each disease different from the other. Myriad of distinctiveness in each disorders are generated based on the variations in provocatory factors (Nidana) and the objects which gets provocated(Dooshya). Diseases differ each other by innumerable variations in the natural temparaments, locus or seat, causative factors, manifestations and afflictions making umpteen kinds of diseases3. Causative factors, manifestations and afflictions are discussed separately as Nidana & Lakshana. The remaining are the Prakruti & Adhishtana, the distinct versions of which is the Samprapti. Vikaraprakruti is described based on the kind provocation & the course of spread (Yadha dushtena doshena Yadha Caanuvisarpata). The outbreak of the disease is based on the locusor scope of the diseases (Adhishtantarani).
There are occasions when these Nidana etc., fail to explain the nature of diseases. We may fail to recognise a causative factor for being accustomed for long or by the fact that it is not making a disease in any other people (Sadharanatwa). We may not give due importance to his everyday complaint like fatigue as a symptom of that particular disease, which is expected in him being a hard worker. We may also mistake them as cause or symptoms of some other diseases (Vyamoha). Or by any other reason if we do not get the exact nature of illness, there the Samprapti becomes useful to understand diseases. Samprapti, whether an old textual description or a newly meditated one, should be capable of completely satisfying all enquiries regarding the manifestation. In fact, all other four, causative factors, prodrome, symptoms and favourable factors are important diagnostic tools by their utility in formulating the Samprapti.
Indeed Samprapti is completely dynamic in nature. That is why Vijayarakshita describes it as that origin of disease which is distinguished by the purposefulness of Doshas. Cakrapani also says 'that emergence of disease which has that distinct dynamic activity of Doshas associated with disease development. The synonym Aagati also hints on the nature of Samprapti. It describes the course of illness from its instigating factors to the manifestation of illness along with the interactions and reciprocation during the course. This differentiates Samprapti awarnesss from the Dosha-Dushya awarnes. Since the dynamic activity is inherently associated with the Samprapti, they cannot be separated each other. Dosa & Dooshya, which has no imbalance will not generate a disease. So the first dynamic event in the disease development is the Doshas loosing its normalcy. At this phase, Samprapti awareness means explaining the quality of aggravating factors like Rooksha or Seeta etc. In the next phase of spreading, Samprapti awarness means explaining the interrelations between those
aggravated and those spread. In the subsequent phases, Samprati awareness means explaining the strength and brunt of each factors involved, explanations in relation with time, explanations on the status of Dooshya, explaining the involvements of Srotas etc. When the Samprati awareness is complete, the understanding on the disease is also complete.
Samaanya samprati
When the aggravated Doshas enter into Aamaasaya, interact with the digestive fire, follow the course of those componants of Rasadhaatu which has just evolved from the food status to the Rasa status after digestion, blocking the channels of Rasa& Sweda, diminishing the digestive fire and displacing it, gets hold of the whole of the body to generate Fever. This Samprapti of fever is not Samkhya samprati being common for all the eight variants. It is not the discription of Vikalpa samprati since the Amsaamsakalpana is to be explained individually for each case. This does not explain Praadhaanya & Apraadhaanya. Bala is some thing to be explained by the physician in each cases. Kaala samprapti is better explained in terms of manifestations, again which varies fom case to case. So this kind of explanations on Samprapti stands separate as Saamanya samprapti.
This Samprapti is common for all variants of the disease. All the 8 types of the disease is named as Jwara because of a common Samprapthi they all have. That is why a set of manifestations are common to all types of Jwaram.
Visishta samprapti
This differs in each variants of the disease. The identity of each variant is their own individual Samprapti. Such individual identity may sometimes be contributed by extrinsic causes as in Abhighata jwara or Kshataja kaasa. It may be by the evolution of pathological events like in presence of fluid in Jalodara. It may be contributed also by the difference in gradation of Doshas as Udakameha is by white, clear, cold properties, Ikshumeha by sweet and cold properties, slimy and condensing properties make Sandrameha etc.
These two are two types of understanding on Samprapti. They exist in the same person in the same context simultaneously. The common Samprapti begins during the lodgment stage (Sthaana samsraya). This is the one which first gets shown out well in manifestation stage (Vyakti). Latter in this stage the symptoms gets specific and differentiated.
The importance of Samkhya samprapti
A description of Samprapti of a disease should have all of its six components in it for completion. The foremost among them is Samkhya samprapti, which describes the heterogeneous characters within a single Samprati. Diseases are innumerable. This is due to the countless varieties in temperaments like Vatha, basements like dooshyas, symptoms, multiplicity of extrinsic causative factors like food and activities, etc. They again turn countless by intermixing of Dosha-Dooshya further by their status of increase, diminution etc., further again by the finest permutation and combination in dooshyas in their continuous dividing activity, further again by the symptoms of the whole of the disease. Although by the causative factors and their variants they are fathomless, only
the deliberated ones are discussed in the scientific literature. When looked for their incidence and prevalence, we may find that only limited varieties of a particular Samprapti are physically existing in a given area during any era, as its development is totally dependent on exposure to causative factors in that area during those times. Although symptoms inform us about the details of internal derangement, their nature and peculiarities are known by Samprapti. When discussing Nidaana, Samkhya refers to those kinds as classified in Ashtodariya. This appear as simple divisions of diseases such as eight types of Jwara, five types of Gulma, seven types of Kushta etc. We may see that the classifications of Pradhaanya etc, are also numerically refered and differentiated.
This division is based on clear difference in causative factors and deeds of each of them. For instance such a separation obvious in the six types of Arsas i.e. Vata, Pitta, Kapha, Sonita, Sannipata and Sahaja. They are different each other in their causes like Vegarodha, manifestations like the dry appearance of the pile mass, its symptoms & complications like pain,etc., prognosis, and treatment. This does not make any overlapping (Ativyapti) or omission (Avyapti) of categories in Arsas in spite of the possibility of an Arsas developing by two Doshas (Samsarga) which can make another six varieties. Because a homogeneous combination (Prakruti Sama Samavaya)of duel combination (Samsarga) of Doshas or triple combination are treated in similar lines of individual Doshas. In addition to that, their treatments does not differ with those of their dominant Dosha. Hence such a differentiation is not necessary. So the explanations in the texts are detail only about the heterogeneous manifestations which needs discrimination for treatment. This argument makes Samkhya samprapti a classification very useful for practical applications.
Another example of the clear separation is in Kshudra rogas where the mix up of Doshas, Dhatus and Malas does not make different types in each Kshudra roga. Nyayachandrika focuses this feature as the reason for explaining them as each one of their kind. Madhukosa also explains the same as an important basis of differentiation to Kshudra rogas (Avanthara bheda viraho Kshudratwam). Diseases in this category, such as Ajagallika, there will not have a variant manifestation or further differentiation as in Vrana or Jwara.
Superficial discussions and understandings on the Samkhya samprapti makes it appear as random selection of numbers with a mandatory disposition without any specific reason or benefit. A closer look reveals that this is the principal postulation of disease studies that offers identity to diseases.
Samkhya samprapti & Vidhi samprapti
Differentiating them according to intentions of Dosha vitiation is Vidhi samprapti. All those classifications which are not under the purview of Samkhya samprati such as the differences in origin, prognosis, or any other which on the basis of the nature and impacts of the disease, are grouped under Vidhi samprapti.
Both Vagbhata and Madhavakara considers Vidhi samprapti as a variant of Samkhya samprati. Gananadha sena also prefers to be with the same opinion. When Samkhya samprapti differentiates groups with uniform features from mixed crowd, the Vidhi samprapti is a measure to classify them internally12 & 13. There is no contradiction, repetition or overlapping of Samkhya samprapti by having another classification such as Vidhi samprapti, rather it adds clarity. Because the former deals with basic differentiation of pathogenesis precisely and in the shortest way i.e., shows only the numbers. The diseases differentiated by Samkhya samprapti will have mutually dissimilar symptoms. But the latter differentiates the same numbers of pathogenesis based on different kinds of activities. They will not have dissimilar symptoms or pathogenesis. But the manner in which the pathogenic activity is proceded and manifested becomes different from each other. Unlike Samkhya samprapti, there will be no inherent variation among those classified. It is based on the conduct (Prakaara) of disease. Prakaara is that feature of Dosha vitiation which is aquired by virtue of the nature of causative factors. Experts in Nyaaya say that grouping based on similarity in business is termed as Vidhi. Experts in language & grammer also say that grouping based on their subsequent attitudes is termed as Prakaara, while in grouping under the term Bheda, the sub-sequences are not considered.
The three types of Raktapitta is Vidhi samprapti. The intrinsic & extrinsic diseases, differentiation based on Dosas as in Vatasonita, Swasa, etc., prognostic differentiation etc. are some other examples. It is the freedom of the classifier to classify diseases according to his basis for classification, which is selected to satisfy his specific intention. So it does not contradict any other type of classifications. Another example is a combination of both, as in a statement like "'three red, two white and five steel are the three types among the ten vessels". So Samkhya samprati is a more absolute differentiation while the other, Vidhi samprapti is rather relative classification.
The six modules of understanding Samprapti
Samkhya samprati is the number of natural variations in a disease. The number of types in a disease will be same as the number of kinds of Dosha vitiation based on the Satta of Samprapti. The variations in the activities of a disease according to difference in causative factors is known as Prakaara which makes the Vidhi samprapti The Prakaara of a disease mainly discusses the nature of Dosha vitiation in the disease. Inferring the accumulation and provocation of Doshas by the involved quantitative and qualitative aspects (Vikalpa samprapti), shows us the separate activities by the strength, time (Bala-kaala Samprapti) and Dosha factors. All these together make the six different perspectives of learning the Samprapti. The part and degree of Dosha vitiation during accumulation & provocation and their possibilities are the determinants in potency, time and the involvement of each Dosha. To Understand the umpteen possibilities in the context, they are moderated into modules according to number (Samkhya), independency (Praadhanya), intentions (Vidhi) variability (Vikalpa),
strength (Bala) and time (Kaala).
The summary of information received from Vikalpa and Samkhya samprapti are different. Even with all the information about the disease in hand, we require to check in which category it falls (the Samkhya ) in order to adopt the classical treatment principles corresponding to it. Bala-Kaala Samprapti explains the disease by the peak period of activity. The essence of classification of diseases is Samkhya samprapti, while others adjuncts. Samprapti, with all its details, right from the core differentiation of diseases, is the most fundamental understanding in study of any disease.
Conclusion
Samprapti is useful not only in diagnosis but in treatment also. It is impossible to finalize a treatment strategy without the information on Dosha & Dooshya along with their fractional involvement. Only then it will be possible to visualize measures to reverse that particular kind of changes which will in turn cure the disease. An intelligent physician can predict the symptoms of a concealed disease, if he could recognize Samprapti by the analysis of Dosha vitiation. Indu further adds that similarly if Samprapti is known it gives the physician sufficient freedom to use appropriate treatment techniques even though not described in texts.
Samprapti is the one and only basis of classification of diseases that can differentiate any disease through out its course without Avyapti, Ativyapti or Asamgata. This understanding helps practitioners of Ayurveda to face challenges raised by ever changing classifications and nomenclature of diseases in the modern era and to avoid the trend of searching for baseless parallels from our system. Samkhya samprapti is to be recognized as the most important understanding on Samprapti.
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