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Introduction

Since ancient times, Ayurveda is regarded as the ultimate panacea to obtain a healthy and happy life.[1] The pivotal idea for achieving the same is non-occurrence of diseases of both psychological and somatic origin. When the body and mind are free from any ailments, one is able to pursue the higher aims of life such as prosperity, progenesis as well as spiritual upliftment. [2] In order to achieve this, Ayurveda advocates a balanced life regimen in tune with nature and one’s body constitution. If these regulations to balance the body and mind activities are not followed properly, diseases manifest. [3] Also, certain unavoidable factors like ageing, natural calamities etc. also give rise to them. In such scenarios, the prime focus of a physician remains to restore the normalcy of body mechanisms and the Tridosha. [4] According to Ayurveda, our body is the abode of Dosha, viz. Vata, Pitta and Kapha. They carry out all bodily functions seamlessly when in unperturbed state. Their vitiation happens in a variety of combinations and at any of the sites in body. [5] Thus, innumerable diseases can possibly happen. The most revered treatise of Ayurveda, i.e., Charaka Samhita, elaborates the treatment of all such conditions. It is considered as the best reference to learn the Ayurveda therapeutics. It also gives due diligence towards the ‘Nidana’ aspects of diseases. The Nidana Sthana of Charaka Samhita is a brief yet knowledge-packed section elaborating the etiological aspects of diseases.

As per Charaka Samhita, treatment of a disease is nothing but breaking the chain of causative mechanism, i.e., ‘Samprapti Vighata’. Samprapti denotes the pathway of disease causation and manifestation. Its clear knowledge certainly helps in determining the customized treatment as per principles of Ayurveda. In the present work, an effort has been made to compile and discuss various aspects of concept of ‘Samprapti’ described in Charaka Samhita.

MATERIALS AND METHODS-

The scope of present work is primarily Charaka Samhita. Thus, Charaka Samhita supplemented by Ayurveda Deepika and other Hindi commentary was studied in detail. The references regarding concepts of disease development and especially ‘Samprapti’ were studied as per their relevance with the topic. For a comprehensive understanding, other sources such as scholarly articles, books etc. were also referred when required.

Discussion

The second section of Charak Samhita, Nidana Sthana, describes the guidelines for diagnosing diseases. The word Nidana actually denotes ‘Hetu’, i.e., primary cause and diagnosis.[6] The Nidana Panchaka (five methods to know a disease) consists of Hetu (causative factors), Poorvaroopa (premonitory signs and symptoms), Roopa (clinical manifestations), Upashaya (pacifying factors) and Samprapti (etiopathogenesis). This diagnostic protocol provides a complete picture essential for understanding a disease in order to cure it and also prevent its recurrence. Of these, Samprapti provides a complete narration as to why and how the disease has manifested. It also provides important clues regarding its pacification and also treatment. Thus, knowledge of Samprapti is of paramount importance. Also, earlier the Samprapti pathway is interrupted, quicker and easier the disease treatment is! Samprapti is relatable to the concept of pathogenesis in modern medicine. [7] The process of Samprapti starts with Dosha aggravation due to various factors. If this aggravation is intense enough, Dosha leaves their original site and travel throughout the body. They get lodged in the sites that are weakened and provide a nurturing atmosphere for disease formation. There, they vitiate respective organs, weak Dhatu etc. and full manifestation of disease happens. Thus, a number of components are involved in this whole process. These components viz., Dosha, Dhatu, Agni, Ama, Srotas etc. are termed as ‘Samprapti Ghataka’. If Chikitsa of Charaka Samhita is critically observed, it provides us means to tackle anomalies in either or all of these components and thus, disrupting the Samprapti process. Thus, synonyms such as ‘Jati’ and ‘Agati’ are listed in Charaka Samhita for Samprapti. [8]

Samprapti is classified by Charaka Samhita, as- Samkhya (numerical classification), Pradhanya (dominance of Dosha), Vidhi (types of diseases), Vikalpa (dominance of one or the other attributes of Dosha), and Bala-Kala Vishesha (the time of manifestation or aggravation of the disease). [9] They are elaborated as follows-

• Samkhya Samprapti- Samkhya is a number. Samkhya Samprapti helps to understand a disease based on its types and subtypes. For instances, types and combinations of Dosha involved, Types of signs and symptoms forming types and subtypes of diseases, Different tracts and routes involved in manifestation, etc. are elaborations of Samkya Samprapti. The Charaka Samhita is filled with examples of Samkhya Samprapti, e.g., eighteen Kushtha, five Kasa etc.
• Pradhanya Samprapti- It involves understanding disease basis of strength of Dosha involved. The Samprapti produced by a mighty, independent Dosha is Pradhanya Samprapti. If it is produced by dependent or less strong Dosha, it is Apradhanya Samprapti. In Sansarga vitiation, where two Dosha are vitiated at once, first to mention is Pradhana and other is Apradhana. Similarly, in Sannipata vitiation, where all three Dosha vitiate, first mentioned is Pradhana and next two are Apradhana. Also, Samprapti of independently manifested (Swatantra) disease is Pradhanya Samprapti and vice-versa. This knowledge basically provides idea of Dosha strength to draft the treatment protocol. It helps to determine use of Dosha Pratyanika and Vyadhi Pratyanika treatments judiciously.
• Vidhi Samprapti- Vidhi Samprapti is presenting the classification of diseases based on their prognosis, i.e., Sadhyata and Asadhyata. As this also involves numbering classification, sometimes Vidhi Samprapti is considered as a part of Samkhya Samprapti. The example of Raktapitta classification is according to Vidhi Samprapti. The Urdhwaga Amlapitta is listed as Sukhasadhya (easily treatable), Adhoga Amlapitta is Kricchrasashya (hard to treat), and Tiryagga Amlapitta is Asadhya (incurable). [10]
• Vikalpa Samprapti- It takes into account the fractional variations in Dosha vitiation resulting into disease manifestation. When more than one Dosha is involved in a disease pathway, Vikalpa Samprapti clarifies the state of Dosha disturbances. It gives an idea about which Dosha is perturbed in what extent, both qualitatively and quantitatively. This knowledge helps in deciding priority for Dosha management and choice of medicines to pacify them.
• Bala-Kala Vishesh Samprapti- Bala Vishesh Samprapti helps to understand overall strength of disease based on factors that causes it and strength of signs manifested. If all the signs and symptoms are clearly manifested, the disease is considered stronger and otherwise.  Kala Vishesh Samprapti takes into account the vitiation of Dosha and manifestation of disease due to effect of Kala i.e., time. The time of symptom aggravation and pacification are elaborated by Kala Vishesh Samprapti. It helps in time-wise management of certain disease conditions.

Conclusion

Charaka Samhita is like a lighthouse for seekers of Ayurveda. It provides a complete and scientific knowledge of any topic related to it. It has stressed the importance of thorough knowledge of disease prior to starting its treatment. This treatment does not start and end with eradication of signs and symptoms of diseases. It involves a deep understanding of causes and various events that occurred before disease manifested. Samprapti provides that blueprint as to how this manifestation occurred. The Samprapti Ghataka are the primary factors like Dosha along with situational factors like Srotas.

A comprehensive knowledge of these provides a concrete guidance on how to break this chain of events and stop disease progression. Also, it gives some ideas on how to prevent occurrence of similar conditions in other patients too. Thus, detailed knowledge of various aspects of Samprapti alone and along with other factors of ‘Nidana Panchaka’ are very crucial in treatment of diseases.