Ayurvedic Vikriti (Doshic Imbalances)

A common source of confusion for Ayurvedic students is how to distinguish an individual's prakriti (normal constitutional tendencies) from vikriti (conditions which indicate an abnormal excess of a particular dosha). For example, if one is of a predominantly Vata prakriti, it is considered "normal" to have a somewhat restless, active mind and skin that tends to be dry. In small degrees, these signs are not considered as due to disturbed Vata dosha. However, if the same individual were to develop mental restlessness to the point of forgetfulness and lack of ability to concentrate, this would indicate the presence of excess Vata dosha. Likewise, if the skin becomes so dry that its integrity begins to break down and areas of skin are "flaking" away or becoming darker in color, this indicates a Vata imbalance.

Samprapti (The Pathological Course of the Disease)

Due to uncorrected exposure for a period of time to the causitive forces described above, the doshas can become aggravated and begin a sequence of pathological steps culminating in the creation of a disease state. The term "samprapti" refers to this sequence of doshic-related pathology triggered by one or more nidana (cause). Before we describe this sequence in detail let us consider a brief explanation of this sequence. First, one or more doshas begins to accumulate somewhere in the body and soon becomes vitiated (aggravated). Next, the aggravated dosha spills over and begins to spread. When it reaches a vulnerable or somewhat weakened area or organ of the body, it will stagnate there and begin to mix with and disturb the structure and function of the local tissues. The tissues of the body, when spoken of in their healthy state are of course called the dhatus; however when we speak of these same tissues with regard to their mixing with vitiated doshas, we always refer to the tissues as dushyas. This dosha-dushya sammurcchana is the actual disease process (sammurcchana means "interaction"). The interaction of the doshas and dushyas, together with the specific effect from the site or organ involved (adhisthana) leads to the development first of specific prodromal features, and then of the main symptomatology, of a disease. Left untreated the disease will evolve its unique set of complications and reach a stage where it is no longer curable by any means.

Ayurveda, in one of its seminal contributions to medical thought, precisely describes this sequence of pathogenesis in terms of six specific stages. This has become known as the satkriyakala. Literally, this translates to "six times for action" but is also more commonly referred to as "the six stages of disease". Either translation is suitable. The satkriyakala gives a view of the entire natural course of the disease from its early, reversible, pre-organic stages through its stage of manifestation and symptoms, to its late advanced stage with its irreversible complications. Knowledge of which stage of the satkriyakala a particular disease is in guides us toward the appropriate therapeutic intervention for that stage. The legacy left behind by this brilliant and profound set of observations into the nature of the disease process is the vital importance and practical relevance of the early identification of the incipient disease process, so that the disease can be precluded while in one of its early stages.

There are many internal and external causes of doshic vitiation. Once the doshas become vitiated (i.e. disturbed), the tissues (dhatus), digestive fire (agni), and channels (srotas) also become abnormal leading to illness and disease. At the earliest stage of doshic disturbance, changes are apparent only at a very subtle level; this can progress to biochemical disturbances, cellular disturbances, and finally tissue and organ system abnormalities. All of these when considered together are known as the vikriti, or "deviation from the original state of balance". The satkriyakala gives us knowledge concerning vikriti as it progresses along the entire spectrum of disease, from the earliest pre-organic stages to the late manifestations of disease.