Article by Dr Raghuram Y.S. MD (Ay)
Ashayapakarsha means displacement from original place. In this, the vitiated Vata Dosha displaces normal pitta or kapha from its place. This displacement of pitta and kapha from its place causes various disorders due to imbalance of pitta and kapha.
The sites of pitta and kapha become vacant, thus producing deficiency symptoms therein.
In Ashayapakarsha, it is important to note that the pitta and kapha are normal and not vitiated. It is the vitiated vata that displaces normal pitta and kapha out of their places.
Generally ashayapakarsha is initiated by vitiated Vata Dosha. Vata aggravated due to the depletion of kapha pulls or pushes normal pitta from its normal site. This pitta produces inflammatory
effect wherever it goes being motivated by pitta.
Ashayapakarsha is made up of two terms –
Ashaya + Apakarsha
We will study both terms individually and then understand them as a unit, collectively.
Ashaya means residence. Each dosha will have its assigned and designed place from where it operates. The places for subtypes of doshas also have been mentioned in Ayurveda. The allotment of ashaya simply means that a dosha is normally and naturally bound to stay and render its functions in the limits of its assigned territory.
Example, Pachaka Pitta stays in stomach and intestines, Tarpaka Kapha stays in head, Apana Vayu stays in the lower portion of the body and operates from there etc.
Even while thinking grossly, each dosha is assigned a primary site and few other places where it stays. The primary seat will be the seat of governance of that particular dosha. Example, the Vayu may be everywhere in the body but operates from pakwashaya or colon, which is its primary seat. It controls the other subtypes of vayu from here. Similarly Nabhi (navel) and Uras (chest) are primary operation centers for pitta and kapha respectively.
Even with respect to dhatus (tissues), specific doshas are having a confined relationship (ashraya ashrayi bhava) with particular tissues. Vayu lives in bones, Pitta in sweat and blood and Kapha in plasma, muscle, fat, bone marrow, semen, urine and feces.
Apakarsha means being pulled out or forcibly displaced from its place. So, apakarsha simply means displacement. When a particular dosha, mainly pitta or kapha is displaced from its normal seat of confinement by vitiated vata Dosha, the condition is called Ashaya Apakarsha.
Thus, Ashayapakarsha means displacement of a particular dosha (normal pitta or normal kapha) which is in a state of normalcy (balance, prakrita) from its original seat, caused by vitiated vayu.
The dislodged dosha is called ashayakakrushta dosha.
The ashayapakrushta dosha will cause disturbances in the place where it gets lodged (new place where it reaches and gets settled) after having been displaced by vitiated vayu. Ayapakrushta dosha is either a displaced normal pitta (prakrita pitta) or displaced normal kapha (prakrita kapha).
Example of Ashayapakarsha:
Vata getting aggravated following the depletion of kapha pulls the prakrita pitta (pitta in a state of normalcy) from its site and carries it all through the body. This pitta in spite of being normal will cause inflammation and corrosion due to its hot nature wherever it goes. Though pitta is normal, it becomes a foreign substance while travelling and reaching the other places.
Read related: Avarana Janya Vata Vikara: Vata Disorders Due To Blockage Of Channels
This leads to bheda (splitting pain) and daha (burning sensation) at those places of the body which come into the contact of the circulating pitta. This further leads to shrama (fatigue) and dourbalya (weakness) of the body parts which get afflicted. Such pitta which gets pulled from its place is called ashayapakrishta pitta (the pitta displaced from its normal site) and the whole pathological process is called Ashayapakarsha.
Though pitta is producing the symptoms in this condition, the treatment strategy lay in controlling the vitiated vata (which is displacing the pitta) rather than giving treatment to expel pitta.
Along with vata controlling measures, attempts should be done to restore the pathologically circulating pitta back to its place. This naturally occurs once vata has been brought under control.
Example given by Charaka –
The vata dosha undergoes aggravation following kapha depletion. This aggravated dosha will pull the normal pitta from its seats and carry it to (displaces to) different places of the body. This displaced pitta owing due to its hot nature causes daha (burning sensation) and bheda (splitting pain) wherever they come in contact with, in spite of pitta being normal (prakrita). Later shrama (fatigue) and dourbalya (weakness) are manifested. This condition is called ashayapakarsha.
Dealing with Ashayapakarsha and Ashayapakrishta dosha
Let us see how we can treat ashayapakarsha with the same example give by Charaka (explained above).
Here, though it is pitta which is producing the symptoms in ashayapakarsha, pitta alleviating or pitta expelling treatments (virechana i.e. therapeutic purgation which is specific treatment for increased pitta) or medicines should not be given. This is because we should not treat a dosha which is in a state of normalcy.
The mischief maker in ashayapakarsha is vitiated vata. Therefore the treatment of ashayapakarsha should be oriented towards controlling vitiated vata. (The reasoning for this approach has already been discussed above).
Therefore the key strategies of intervention as far as ashayapakarsha is concerned is –
- Vata prashamana – Controlling vayu by vata alleviating treatments, medicines and diet is the prime strategy.
- Ashayapakrushta dosha sthapana – Enabling the dislodged pitta and kapha to be replaced at their normal seats, i.e. restoring the dislodged doshas back to their normal places is a key strategy. This naturally occurs once the vata has been taken into control.
Importance of having the knowledge of Asayapakarsham
The physician should have a thorough knowledge of ashayapakarsha and should clearly know the difference between dosha vriddhi and ashayapakrushta dosha.
The physician ignorant about the ashayapakarsha when administers pitta expelling or alleviating treatments considering it as dosha vriddhi (pitta vriddhi), will cause serious complications because he will be treating the normal doshas and expelling them (which should not be done) rather than dealing with pathological dosha.
Thus, the knowledge of ashayapakarsha will help the physician in understanding the pathological states of doshas (dosha dushti) in a proper way, to differentially diagnose the conditions and to implement comprehensive treatments.
Mechanism of Ashayapakarsha
The concept of ashyapakarsha as a dosha dushti type causing pathology has been described in Madhava Nidana, oMadhukosha teeka, chapter 1.
The mechanism of Ashayapakarsha takes place thus –
Vitiated Vata, the trouble maker – The vitiated vata dosha is the initiator of the pathological process of ashayapakarsha. It disturbs and displaces pitta or kapha which are otherwise normal and balanced.
Vata pulls other doshas out of their sites – The vitiated vata pulls the normal pitta or normal kapha from their normal seats (prakrita sthanas) and displaces them.
The vata pulls either pitta or kapha from their seats and displaces them so that they are pushed to abnormal sites which do not belong to them (not natural to them). Pitta and Kapha are pangu (dependent) doshas, they cannot move all by themselves. They can be pulled or pushed to different parts of the body only by a vitiated vata because the normal vata doesn’t displace other doshas or other elements of the body since prakrita vata participates in maintaining harmony, equilibrium and health of the body.
Example, nabhi (navel) or amashaya (stomach, small intestine) is the seat of pitta. If normal pitta is displaced from amashaya by vitiated vata and pulls it into pakwashaya (colon) which is its place (place of vata), pakwashaya becomes an abnormal seat for pitta because it is not designed to be there. For pakwashaya, pitta is agantu dosha (alien dosha) whereas vata is sthanika dosha (resident dosha which is designed and assigned to be in pakwashaya).
The displaced doshas reach other places of the body – As already said, the doshas (pitta or kapha) which are displaced by vitiated vata travel in the body and reach other seats of the body which generally do not belong to them.
The displaced doshas become troublemakers in the new places – Displaced vata or pitta cause trouble in the new places of the body where they reach or pushed to by vitiated vata.
Effect of ashayapakarsha – When kapha or pitta is pulled from their seats, it obviously causes a vacancy in their seats. Therefore the functions of pitta and kapha will get reduced in the displaced seats, i.e. symptoms of dosha kshaya and karma kshaya (deficiency in normal activities and functions) of the displaced doshas may be demonstrated in the organs and tissues which have lost pitta or kapha. Meanwhile the displaced doshas, in spite of being normal will tend to cause symptoms of vitiation in the place where they reach, in spite of being normal because they are alien to the new places.
The vata dosha which undergoes aggravation following kapha kshaya (depletion of kapha), will pull the prakruta pitta (normal pitta) from the normal seats of pitta. Later vata propels and carries this displaced prakrita pitta all through the body.
This displaced pitta will cause inflammation and corrosion due to its hot nature (ushna guna) wherever it reaches; in spite of it being normal because it is a foreign element in the visiting place (new place which it has reached) as it is not a natural resident of the new place.
The ashayapakrushta pitta (displaced pitta) caused bheda (splitting pain or discomfort) and daha (burning sensation) at those new places of the body where it has reached after being displaced by vitiated vata. This further leads to the manifestation of shrama (fatigue) and dourbalya (weakness) of those sites and tissues wherein the ashayapakrushta pitta has gone.
This pathological condition caused by displaced doshas is called Ashayapakarsha.
Pathological symptoms by normal Doshas
How can normal doshas cause pathological symptoms?
Now the question is how do the displaced doshas cause disturbances where they reach, in spite of being normal?
As already said, Vata displaces normal pitta or kapha. Also we know that the normal doshas do not cause signs of disturbance or pathology.
Commentator Bhattara Harishchandra tells that though the displaced doshas are alien to the new places of the body they may cause disturbances. Since the visiting (displaced dosha) is a new component to the new place to which it has been displaced, the dosha causes disturbance at that new place.
Other authors explain dushti lakshanas of ashayapakarsha in the below mentioned way –
The normal doshas which gets dislodged in ashayapakarsha do not cause disease or pathology all by themselves since they are normal. But when they get added up to the doshas of their type (similar dosha) located in the new place, naturally the dosha gains increase in quality and quantity and sets in imbalance (all doshas are present everywhere in the body with predominance of one dosha in one particular region, as a rule). This causes signs of dosha vitiation.
Example, when pitta is pulled into pakwashaya the pitta being normal should not cause disease or disturbance as a rule but since this pitta gets added to the sthanika pitta i.e. pitta already present in pakwashaya (though pakwashaya is the seat of vata), the quantity of pitta gets increased and hence is considered as dosha vriddhi. Since it is dosha vriddhi, the invading pitta should be tackled first and expelled, i.e. ashayapakarsha should be dealt on the basis of dosha vriddhi, pitta vriddhi in this instance.
But Bhattara Harishchandra tells that this is a wrong concept. Charaka has already mentioned kshaya (decrease of doshas), sthana (normalcy of doshas) and vriddhi (increase of doshas) as dosha gatis i.e. different states of doshas. If ashayapakarsha should be dealt in the lines of dosha vriddhi (pitta vridhhi in Charaka’s example), then there is no need of explaining a separate pathological entity called Ashayapakrasha.
He is of the opinion that if ashayapakarsha is treated on lines of pitta vriddhi, obviously pitta alleviating medicines or virechana (purgation) will be the choice of treatments. By administering this we will be removing the normal doshas (pitta here) and cause symptoms of severe depletion which may lead to serious consequences including death due to severe impairment of normal functions of the expelled doshas.
Therefore in ashayapakarsha it is vitiated vata which should be treated (since it is causing ashayapakarsha) and not the ashayapakrishta dosha (i.e. displaced pitta or kapha).
The concept of explaining ashayapakarsha is to tell that the displaced or dislodged doshas can also cause pathological conditions (dosha dushti) in spite of being normal. This differentiates this condition from vriddhi of pitta or kapha wherein these doshas tend to increase in their own seats whereas the symptoms of ashayapakarsha occur in the place where the displaced doshas come into contact.
Treatment principles of Ashayapakarsha
Two key strategies should be followed while treating ashayapakarsha –
- Control vata
- Replace the dislodged doshas in their normal seats