Understanding the Six Stages of Disease
Consider the following scenario. A middle-aged woman complains to her doctor that she "just doesn't feel well." She's says she's more tired than usual, a little depressed. The doctor does a physical exam, but doesn't find anything unusual. She also orders blood tests, but these too come back normal. The doctor reassures the patient that she is well, and perhaps encourages her to get more exercise and to "come again in six months." A year later the patient is diagnosed with Type II diabetes.
Unfortunately, this is a common experience in conventional medicine — that the disease cannot be diagnosed until the patient complains of specific symptoms or lab tests demonstrate specific findings. And by the time the findings are manifest, it's too late to prevent the disease.
"The great advantage of the ayurvedic approach is to identify imbalances before they actually manifest as a disease," says Stuart Rothenberg, M.D., Director of Maharishi Ayurveda Association of America. "This can allow the ayurvedic practitioner to take remedial action and reverse the imbalances at an earlier stage of development, thus preventing the emergence of the full-blown disease."
Prevention is the Key
Prevention has always been the first and major goal of ayurveda. According to the most ancient ayurvedic text, Charaka Samhita, only when the physician has failed in that first goal does he or she need to resort to the second goal — which is cure.
"How disease develops, the field called pathogenesis, is an important area of Maharishi Ayurveda," says Dr. Rothenberg. "Maharishi Ayurveda identifies six stages in the development of disease. In the first two of the six stages, there are no symptoms. In the third stage there may be vague, non-specific symptoms, such as fatigue and general malaise, which become more pronounced in the fourth stage. Only in the fifth stage do symptoms manifest that are specific to a particular disease."
While conventional medicine uses valuable diagnostic tools to detect disease in an early stage, such as blood tests and X-rays, they are able to detect disease only after it has become physically manifest — for example, a small tumor or an elevated blood sugar. According to Maharishi Ayurveda, this would be in the fourth or fifth stage of pathogenesis. Maharishi Ayurveda aims to detect disease at an earlier stage, before it becomes clinically manifest, when the disease process is easier to reverse.
The Six Stages of Disease
Stage One: Accumulation
Disease begins with the accumulation of one or more doshas. The three doshas, Vata, Pitta, and Kapha, are three mind-body operators that govern the body's functioning. Though at the basis of the physical body, the doshas themselves are not physical — they are principles of intelligence. When the three doshas are in balance, the person enjoys good health. However, through imbalanced diet, lifestyle, and exposure to stress and environmental factors, one or more of the doshas can begin to become imbalanced. The first stage of this imbalance is that the dosha increases in quantity, or "accumulates."
In Stage One, the dosha accumulates in its natural "seat" or "home." For example, Vata dosha may accumulate in the colon, nerves, or in empty spaces and channels of the body. Pitta dosha may accumulate in the digestive tract, eyes or skin. Kapha may accumulate in the chest and the fluid substances of the body, such as the joint fluids and circulatory system.
Stage Two: Aggravation
While Stage One involves a quantitative change in the doshas, this stage involves a qualitative change in the doshas. In Stage Two the dosha acquires the tendency to spread beyond its normal seat. This internal, qualitative change is sometimes called "vitiation," which can be translated as "becoming abnormal" or "spoiled."
Stage Three: Dissemination
Now the dosha moves out of its home seat and begins to circulate in the body. There are still no specific symptoms. However, in Stage Three there can be vague, low-grade non-specific symptoms, such as transient aches and pains or mild malaise. The patient may complain of fatigue or mild depression, or say "I just don't feel well."
Stage Four: Localization
In this stage the dosha now localizes in a tissue outside of its main seat and begins to disrupt the function of that tissue (dhatu) or organ.
There are several factors that determine where the disseminating dosha will localize. One is an abnormality in the microcirculatory channels (srotas) in that tissue. For example, if there is a narrowing of the blood vessels or lymph channels in an area of the body, the dosha may settle there and begin to disrupt the functioning of the surrounding tissues.
The second factor is the digestive toxins called ama. In Maharishi Ayurveda, it is understood that imbalanced digestion is almost always associated with chronic disease. Ama is the product of imbalanced digestion, and is described as a sticky substance which can easily clog the microcirculatory channels of the body. The disseminating dosha carries ama along with it, and the sticky ama becomes "stuck" at a site where the srotas are narrowed. Then that sticky ama, together with the vitiated dosha, becomes a breeding ground for disease in that area.
For example, if Kapha dosha, which is heavy and cold, has accumulated and disseminated, it may localize, together with ama, in the channels of the head and neck. In Stage Four, this will start to be experienced as a scratchy throat or a feeling of heaviness in the head.
Stage Five: Manifestation
In this stage the disease manifests in its full-blown, clearly identifiable form. The functioning of the tissues is disrupted by the complex of ama mixed with the imbalanced dosha. In the example of Kapha dosha and ama localizing in the head and neck, the scratchy throat and heaviness in the head is now experienced as the full-blown syndrome of congestion in the form of a common cold, sore throat, sinusitis, or an allergy attack.
Stage Six: Chronicity (also called Disruption)
At this stage, the disease becomes so embedded in the tissues that the body's natural repair mechanisms are not able to reverse it. Then the disruption of functioning becomes a long-term or permanent disorder. For example, the Kapha disorder could become chronic or perennial sinusitis or rhinitis.
Diagnosing the Patient, Not Just the Disease
Dr. Rothenberg notes that Maharishi Ayurveda supplements the diagnostic approach of conventional medicine by emphasizing two phases of diagnosis: diagnosis of the patient (rogi pariksha) and diagnosis of the disease (roga pariksha).
"Before attempting to diagnose the disease, the first step is to determine the patient's "nature" or prakriti — the constitutional type of the patient," says Dr. Rothenberg.
Constitutional type provides a diagnostic framework completely overlooked in modern medicine. It includes attention to details such as complexion and quality of skin, prominence and shape of joints, body build, shape of the eyes, color undertones of the whites of the eyes and tongue, prominence of tendons and veins, the patient's speed of walking and talking, personality traits, preferences for weather, types of dreams, and many other features.
"The constitutional type tells the ayurvedic expert the kinds of diseases and risk factors that the patient would likely be vulnerable to," says Dr. Rothenberg. "For example, if we diagnose the individual as a Pitta prakriti, which is the constitutional type that is characterized by more heat in the body, we know that individual will be more likely to develop diseases involving excessive heat. These kinds of diseases might include inflammatory conditions, such as gastritis, colitis, ulcers, acid reflux, and inflammation of joints, eyes, and other organs."
Dr. Rothenberg explains that the common root cause of these seemingly different diseases is excessive heat, or Pitta. He says, "By knowing this, it allows us to prescribe preventive measures to cool Pitta, to prevent the manifestation of these inflammatory conditions. These preventive measures would include a Pitta-balancing diet, cooling herbal preparations, mind-body techniques including the Transcendental Meditation® program, and daily and seasonal behavioral routines to balance Pitta."
Pulse diagnosis (nadi vigyan) is another special feature of the diagnostic repertoire of the Maharishi Ayurveda practitioner. The ayurvedic expert places his or her fingers on the radial pulse of the patient (the pulse at the wrist) and, through this technique, is able to detect imbalances in the doshas, the tissues (dhatus), and the microcirculatory channels of the body (srotas).
"This sophisticated procedure is a remarkable tool in detecting imbalances in the first stages of disease, before clinical signs and symptoms occur, when the disease can still be prevented," says Dr. Rothenberg.
The Importance of Early Detection
"The earlier the stage that the disorder can be diagnosed, the easier it is to reverse the underlying imbalance," says Dr. Rothenberg. "For example, in Stages One and Two, simple dietary measures or adjustments to the daily and seasonal routine are often sufficient to reverse the imbalances and prevent the manifestation of disease."
In Stage Three and Four, additional approaches, such as herbal therapies and cleansing procedures, can help. By purifying the toxins and accumulated doshas from the body at each season, the build-up of the doshas can be avoided.
"In Stages Five and Six, typically multi-modality approaches are needed, including physical, mental and environmental approaches," says Dr. Rothenberg. "These could include intensive in-residence physiological purification therapies (Panchakarma), herbal therapeutics, Maharishi Vedic Vibration Technology and Vedic Sound therapy, Vedic exercise, therapeutic aroma therapy, Ayurvedic light therapy, and environmental therapies."
"And of course if anyone is suffering from significant symptoms, they should see their family physician for conventional diagnosis as well," says Dr. Rothenberg. "Maharishi Ayurveda is complementary to conventional medicine and is not a replacement for it, especially in the case of serious diseases."
The sole purpose of these articles is to provide information about the tradition of ayurveda. This information is not intended for use in the diagnosis, treatment, cure or prevention of any disease. If you have any serious acute or chronic health concern, please consult a trained health professional who can fully assess your needs and address them effectively. If you are seeking the medical advice of a trained ayurvedic expert, call or e-mail us for the number of a physician in your area. Check with your doctor before taking herbs or using essential oils when pregnant or nursing.