Sankhya Samprapti – Understanding Pathogenesis On The Basis Of Types

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Sankhya Samprapti is one of the types of Samprapti (study of pathogenesis of a disease). It is a method of studying and understanding the process of formation of a disease with the help of the types of a disease. Every disease will have certain number of types based on the peculiarities of the involved doshas, dushyas (tissues), specialty of manifestation of symptoms of a disease, route of the disease (gati) and location of a disease (vyadhi marga).

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Sankhya Samprapti

Sankhya Samprapti explains the numbering system in the pathogenesis of diseases. It is the system of numbering the different types of diseases. Thus Sankhya Samprapti helps us in understanding the types (subtypes) of the diseases.

The number of types of a disease can be said on the basis of many factors. Sankhya Samprapti is based not only on the pridominant Doshas, but also on the type of symptoms of disease, the different tracts in which the disease is manifested (vyadhi marga) and the different routes in which the disease travels (roga marga).

The Sankhya Samprapti is sometimes based on the reactivity and peculiarity of dushyas (dhatus). Below mentioned are some examples.

Based on Dosha involvement

Sankhya Samprapti on the basis of dosha involvement (doshas involved in the causation of the disease)

Example, Jwara is of 8 types depending on the predominant doshas causing the jwara (fever). Three types of jwara are caused due to involvement of vitiation of single dosha (Vataja, Pittaja and Kaphaja Jwara), three types of jwara are caused due to the involvement of vitiation of dual doshas (Vata-Pittaja, Pitta-Kaphaja and Kapha-Vataja Jwaras), one type of Jwara is caused due to simultaneous vitiation of all the doshas (tridoshaja jwara) and the last type is caused by external factors (Agantuja Jwara).

Based on symptoms

Sankhya Samprapti based on the type of symptoms
Many diseases present with symptoms which may not be necessarily in accordance to the vitiated doshas. This means to tell that sometimes in some diseases the presented symptoms will be such that they cannot be strictly categorized under any dosha vitiation, rather they will be special symptoms which define and describe that particular disease.

Example, Shwasa, a disease characterized by ‘difficulty in breathing’ is of 5 types. They are

Maha Shwasa – characterized by strenuous, painful inspiration with loud noises.

Urdhwa Shwasa – is characterized by an imbalance in the output and input of air i.e. expiration and inspiration. It presents with deep and prolonged inspiration with difficulty in expiration (throwing the air out).

Chinna Shwasa – is characterized by obstruction of breathing which is severely distressing and painful. The person breathes interruptedly in splits and parcels.

Kshudra Shwasa – is characterized by short spells of dyspnoea which is not troublesome. It generally accompanies strenuous exercise and will settle down after rest.

Tamaka Shwasa – is a type of shwasa in which the abnormally vitiated vayu haphazardly moving upwards occupies all the channels of the body. On reaching the head, the vayu provokes kapha which causes cold and congestion. The kapha being blocked in these channels produces sounds. As the disease progresses, the kapha blocks the channels and causes serious dyspnoea of life taking proportions.

In these types of Shwasa, though there is involvement of doshas, the names have been given and the number of subtypes has been given on the basis of peculiarity of presentation of symptoms.

Similar types of Sankhya Samprapti can be seen explained in diseases like 18 types of Kushta (skin disorders), 5 types of Hikka (hiccough), 18 types of Mutraghata (obstruction of urine) etc are explained on this basis.

Some types of Sankhya Samprapti also have mixed presentations. Example, cough is of 5 subtypes. Three of them are due to doshic aggravation and two others have been named on the basis of special type of presentation of symptoms. The 5 types of Kasa are Vataja (caused due to vitiated vata), Pittaja (caused due to vitiated pitta), Kaphaja (caused due to vitiated kapha), Kshataja (caused due to injury to chest and chest organs) and Kshayaja (caused due to depletion of tissues).

Sankhya Samprapti of 7 types of Visarpa (herpes), Hridroga (heart diseases), Shiroroga (diseases of head) etc are explained in the same pattern.

Based on vyadhi marga

Sankhya Samprapti on the basis of the vyadhi marga – disease tract

Certain diseases will have different tracts i.e. will be manifested in certain tracts or organs. The Vyadhi marga may be either in
shakha (tissues),
koshta (visceral organs) or
marma-asthi-sandhi (vital organs, bones and bony joints).

When located in one of these vyadhi margas, the diseases are numbered and named accordingly.

Example, we have Shakhashrita and Koshta-Shakhashrita Kamala, i.e. two types of Jaundice located in tissues and both in tissues and visceral organs respectively. But a clear explanation of the symptoms of kamala located in each tissue is not given. But numbering Kamala as two types and giving these names explains the peculiarity of this disease and also the need of specific and special treatment approaches to handle it, quite different from handling other diseases. No disease occurs without the involvement of tissues but conditions like Shakhashrita Kamala may denote the maximum damage of the tissues caused in the disease and the grave requirement to address it with priority.

Based on Dosha Gati

Sankhya Samprapti on the basis of the gati or direction of Dosha movement
Certain diseases will have certain directions in which they tend to move or manifest. This we call as gati. The subtypes of those diseases will also be named and numbered according to the direction in which they are moving and getting manifested.

Example, Raktapitta (bleeding disorders) will have
urdhwa gati (movement in upward direction, having upper tract or passage),
adho gati (movement in downward direction, having downward tract or passage) and
tiryak gati (sideward direction or oblique direction, tract or passage).

Thus Raktapitta is of 3 types i.e
Urdhwaga Raktapitta,
Adhoga Raktapitta and Tiryak Raktapitta.
Similarly Amlapitta (gastritis, acid reflux disease) will have 2 types i.e. Urdhwaga and Adhoga types.

Based on Dushyas

Sankhya Samprapti on the basis of the peculiarities of the dushyas or tissues

We have more than one classification in certain diseases, one on the predominance of the doshas and the other on the peculiarity of the tissues and tissue response to the disease (may also include the extent of damage of the tissues).

Example, In skin diseases, apart from the classification on the peculiarity of symptoms and prognosis, including the involvement of doshas (as 7 types of Maha Kushta and 11 types of Kshudra Kushta), the dhatugata avastha of the disease (manifestation of disease or location of disease in particular tissues, including their symptoms).

Not all diseases have such classification and numbering.

When all diseases occur with involvement of one or the other dosha, then what is the need of mentioning dhatugata avastha?

Vidhi Samprapti

As already explained in the above aspect, this may point towards the depth of understanding of a disease in terms of tissue involvement as derived by the wisdom of ancient Ayurveda teachers. Dhatugata stage (disease seated in the tissues) explains a condition different from dosha dushya sammurchana (amalgamation of morbid doshas and tissues) which is mandatory for a disease formation. Dhatugata stage indicates the extent of damage of tissues and the need of looking and understanding a disease in this perspective which forms guideline for comprehensive treatment approach when conventional treatments of a disease fails. This also helps in knowing the chronic nature of a disease.

Vidhi Samprapti is a subtype of Sankhya Samprapti. According to Acharya Charaka, Vidhi Samprapti is a system of sub-grouping diseases such as listing 3 types of Raktapitta or any other disease based on the nature of prognosis.

Since counting and numbering the disease is included on the basis of prognosis (sadhya-asadhyata), Vidhi Samprapti is included under Sankya Samprapti. The diseases are numbered as Sukhasadhya (easily curable), Krichrasadhya (curable with difficulty), Yapya (manageable diseases) and Asadhya (incurable disease).

Importance of Sankhya Samprapti

Importance of having the knowledge of Sankhya Samprapti
Sankha Samprapti helps us to understand the components and different presentations of a disease. The numbers tell the different types of presentation of a disease, which also denotes the subtypes of a disease.

Sankya Samprapthi helps us to plan treatment in a precise way according to peculiarities of involved doshas or dhatus, according to the location and movement of the disease or doshas and on peculiarities of special symptoms of a disease.

Vidhi Samprapti, a sub-classification of Sankhya Samprapthi helps us in knowing the prognosis of the disease types apart from knowing the subtypes of the same.

Just Before Finishing
In this article we have tried to touch upon an important aspect of understanding the subtle nature and variant presentations of a disease while studying the samprapti (pathogenesis) of a disease i.e. Sankhya Samprapti which will help in understanding the numerology and number of types of presentation of a disease, will help in understanding the prognosis of a disease and also forms the basis for planning a comprehensive treatment protocol for any disease.
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