(i) Accumulation: If the intake of food and adoption of lifestyle and seasonal changes are in accordance with the action, properties and effect of the corresponding dosa, then the affected dosas increase at its specific location. These dosas accumulate at those locations and are unable to circulate all over the body. This phase is said to be an accumulation phase. This is the root cause for disease genesis.
The accumulation period is the first opportunity provided for treatment. If in this phase accumulated dosas are expelled then further phases and disease will not occur.
(ii) Aggravation (Provocation): If dosas do not subside in the accumulation phase, then the aggravation phase starts. Just as butter melts with a little heat, in such a way availability of favourable food and lifestyle causes accumulated dosas to gets aggravated. Vata aggravation causes pain in the abdomen and flatulence. Provoked Pitta results in heartburn, acidity, increased thirst and a burning sensation. In provocation of Kapha, anorexia, nausea and other symptoms develop. It is the second chance of treatment or stage where treatment is possible.
(iii) Dissemination (Spreading): If treatment is not given in the provocation period, then the dissemination or spreading phase starts. Just as butter at high temperature not only melts but flows out from the vessel, in such a way dosas provoked by unfavourable food, lifestyle and season move away from their specific location and spread in other organs of the body. Pitta and Kapha themselves are inactive, but with the help of Vata, they also speed up and spread. When these aggravated dosas spread to different organs by induced Vata, diseases also originate in those organs. This way, disease can emerge all over the body or in any one organ or in any one part of that organ. Circulation of these dosas occur through lymphatics. Those dosas that are not much aggravated remain suppressed in the srota (channels) of the body, even if they are not treated.
(iv) Site of manifestation (Localization): If dosas are not treated in the spreading phase, then the manifestation phase starts. In this condition, dosas are disseminated throughout the body through lymphatics and locate at a particular place due to the blockage of channels and therefore localizing the dosa to one place. These disseminated dosas localize in those organs which have low immunity and are weak, and where these dispersed dosas get a positive or favourable environment.
These dosas pollute one or more than one tissue (plasma, blood and other tissues) and waste matter (feces, urine, sweat) at that particular site or organ, and along with them, produces the disease according to that place. This stage of combination of dosa and dusya (dhatus and malas) is called the manifestation phase or the site of manifestation. In this phase, preliminary signs and symptoms are developed. For example, if the tissues of the lungs, musculature of the bronchial tubes and synovial membranes are weak in a person, then Kapha disseminates from the stomach and accumulates in the lungs or respiratory channels. As a result, cough, cold and sneezing emerge as a preliminary sign which may be an indication of bronchial asthma. In a similar manner, when Vata dosa accumulates in the abdomen, it leads to abdominal swelling, abscess and distention in the abdomen; when it accumulates in the urinary bladder, it causes calculi, prameha (urinary abnormality) and obstruction in urination; and when it accumulates throughout the body, there develops preliminary signs and symptoms of Vata diseases, emaciation, anemia and so on. It requires the fourth phase of treatment.
(v) Symptom manifestation: If treatment is not given in the fourth phase, then clearly differentiated specific symptoms of a disease emerge. This phase is symptom manifestation. For example, high temperature during fever, watery and frequent passing of feces in diarrhea, difficulty in breathing in bronchial asthma, yellow colour in jaundice, acute abdominal pain in cholera and so on. It requires the fifth phase of treatment.
(vi) Differentiation or chronicity of a disease: It is the last and sixth stage of a disease cycle. If symptoms persist yet the disease is not treated, then fever, diarrhea and other manifestations become vicious and reach the chronic stage. In the case of edema and abscess, abscess bursts and develops into a wound or ulcer. It is the phase of differentiation. It is the sixth stage of treatment. If in this phase disease is not treated, then it becomes incurable.
In these phases, the first five phases come under the stage of pathogenesis of a disease, differentiation is a later stage. For a skilled physician, it is very essential to know these six stages, because if the dosas are treated at the very first stage of accumulation, then provocation and other stages of the disease cycle will not emerge.
(C) Astavidha Pariska: The Eight Ayurvedic Methods of Disease Examination
Other than the above-said examinations (on the basis of dosa, etc.), eight other types of examinations are conducted to know the bodily constitution (prakrti), curability and/or incurability of the diseases. These examinations are known as Astavidha pariksa. They are as follows:
(i) Nadi pariksa (Pulse examination)
(ii) Mutra pariksa (Urine examination)
(iii) Mala pariksa (Fecal examination)
(iv) Netra pariksa (Ophthalmic examination)
(v) Jihva pariksa (Tongue examination)
(vi) Svara pariksa (Voice examination)
(vii) Sparsa pariksa (Tactile examination)
(viii) Akrti pariksa (General appearance and nature examination)
All these examinations are based on the fundamental principles of Ayurveda. Apparently, Ayurveda Nadi Pariksa (pulse examination) does not resemble the pulse examination in the modern medical science. The former technique is absolutely different from the latter. The Sattvika feeling of a physician is very important to attain the deeper insight of pulse examination. Also proximity of a skillful teacher/ practioner is very important to teach this knowledge. Hence this knowledge can be gained by a worthy disciple from a skillful preceptor. Diagnosis through pulse examination is a blessing or divine knowledge provided by the Ayurvedic seers as a gift.