Shat Kriyakala: Understanding 6 Stage of Disease Progression in Ayurveda and Its Modern Relevance
Introduction Shat Kriyakala, derived from the Sanskrit terms “Shat” (six), “Kriya” (action), and “Kala” (time), represents the six stages of disease progression as described in Ayurveda. This concept serves as a comprehensive diagnostic and preventive tool, illustrating how diseases develop, manifest, and can be intercepted. In the context of modern healthcare, integrating Shat Kriyakala with contemporary research can deepen our understanding of early diagnosis, prevention, and personalized medicine. To cure the disease completely knowledge of shatkriya kala or samprapti is essential. Shat means six and kriyakala means stages. Samprapti has six stages from the accumulation of doshas till the disease is completely manifested. Sushruta has described these stages in the following way. ‘सञ्चयं च प्रकोपं च प्रसरं स्थानसंश्रयम् । व्यक्तिं भेदं च यो वेत्ति दोषाणां स भवेद् भिषक्’ ।। (S.Su. 21:36) This article explores the six stages of Shat Kriyakala, their practical applications, and their correlation with modern medical science. 1) Stage of Accumulation (Chaya or Sanchaya) Definition : The initial stage where one or more Doshas accumulate due to improper diet, lifestyle, or seasonal changes. Symptoms are mild and often ignored.Symptoms : – Vata: Dryness, constipation – Pitta: Mild acidity, heat sensation – Kapha: Heaviness, lethargy Ayurvedic Perspective : Accumulation begins in the respective primary sites of Doshas (Vata in the colon, Pitta in the stomach, and Kapha in the chest). If unaddressed, it progresses to the next stage. In this stage mild symptoms are seen. Thus it is very beneficial to cure the person in this 1″ stage itself. ‘एनानि खलु दोषस्थानानि एषु सञ्चीयते दोषाः । तत्र सञ्चितानां खलु दोषाणां स्तब्धपूर्णकोष्ठता पीतावभासता मन्दोष्मता च अङ्गानां गौरवमालस्यं चयकारण- विद्वेषश्चेति लिङ्गानि भवन्ति’ । ‘ (S.Su. 21:18) चयो वृद्धिः स्वाधाम्न्यैव प्रद्वेषो वृद्धिहेतुषु । विपरीतगुणेच्छा च’ । (A.H.Su. 12:22) Modern Correlation : This stage can be compared to subclinical disease conditions, such as prediabetes or prehypertension, where physiological changes start without overt symptoms. Example : A study on early inflammation markers highlights how low-grade inflammation (akin to Sanchaya) can indicate the onset of chronic diseases like cardiovascular disorders. Early detection through blood tests for CRP (C-reactive protein) may correspond to identifying this stage in modern diagnostics. 2) Stage of Aggravation (Prakopa ) Definition : The accumulated Doshas begin to aggravate, exceeding their natural limits, leading to noticeable symptoms.Symptoms : Vata: Bloating, joint pain Pitta: Heartburn, irritability Kapha: Mucus production, dull appetite Ayurvedic Perspective : This stage marks the tipping point where the body starts signaling discomfort. Ayurvedic interventions like fasting, detoxification, or pacifying treatments (Shamana) are recommended. ‘तेषां प्रकोपात् कोष्ठतोदसञ्चरणाम्लिकापिपासापरिदाहान्नद्वेषहृदयोत्क्लेदश्च जायन्ते । तत्र द्वितीयः क्रियाकालः’ । (S.Su. 21:27) Modern Correlation : This stage aligns with early pathological changes detectable through imaging or lab tests. For instance, elevated blood glucose levels before diabetes diagnosis can reflect Dosha aggravation. Research Insight : Studies on oxidative stress reveal its role in cell damage and chronic diseases. Elevated oxidative markers might reflect the Prakopa stage, emphasizing the importance of lifestyle changes to curb disease progression. 3) Stage of Spread (Prasara) Definition : The aggravated Doshas begin to overflow from their original sites and spread throughout the body.Symptoms : Vata: Randomized pain, fatigue Pitta: Burning sensation in multiple areas Kapha: Fluid retention, swelling In this stage the doshas are hyper activated and they leave their site and start spreading throughout the body. Ayurvedic Perspective : Doshas become mobile, potentially affecting other tissues (Dhatus). If unchecked, they move to weak or predisposed areas, triggering disease manifestation. Modern Correlation : This stage parallels systemic inflammation or disease markers traveling through the bloodstream. For example, metastasis in cancer reflects the spreading nature of imbalances. Example : Research on chronic inflammation, such as elevated interleukin-6 (IL-6) levels, highlights how inflammatory mediators travel and initiate damage in distant organs, mirroring Prasara. How prasara stage is formed? If milk is kept for boiling in a vessel, after some time it comes up to the brim and then if not removed spills out. Similarly doshas leave their place and spread through out the body. When water and kodrava (type of cereal) are mixed and kept in closed vessel for some time, then fermentation takes place and this mixture spreads rapidly everywhere. Similarly doshas spread rapidly throughout the body. When water starts accumulating in a lake beyond its capacity then the extra water overflows. Similarly doshas spread rapidly throughout the body. 4. Sthana Samshraya (Localization) Definition : The overflowing Doshas settle in a weak or predisposed tissue, leading to the formation of specific diseases.Symptoms Vata: Arthritis, neuropathy Pitta: Gastritis, ulcers Kapha: Asthma, diabetes Ayurvedic Perspective : At this stage, the imbalanced Doshas interact with Dhatus, resulting in localized pathological changes. Treatment becomes more specific, targeting both the Doshas and the affected Dhatus. ‘स्थानसंश्रयिणा क्रुद्धाः भाविव्याधि प्रबोधकम् । दोषाः कुर्वन्ति यत् लिङ्ग पूर्वरूपं तदुच्यते’ ।। Μ.Ν. 1:7 In this stage the disease starts progressing. The type of disease depends on where the doshas have accumulated. Depending on the type of channel these doshas attack, various diseases like diarrhea, kidney stone, fever etc. occurs. To prevent this stage rasayana treatment is very beneficial. Modern Correlation This stage is akin to the localization of disease processes, such as plaque formation in arteries leading to atherosclerosis or the specific organ damage seen in autoimmune diseases. Research Insight : Advances in epigenetics reveal how environmental factors and genetic predisposition determine the localization of diseases. This scientific understanding complements Ayurveda’s emphasis on individual constitution (Prakriti) and vulnerable tissues. 5. Vyakti (Manifestation) Definition : The disease becomes clinically evident with clear signs and symptoms.Symptoms : Vary based on the affected Dosha and tissue. For instance: Diabetes (Kapha): Excessive thirst, frequent urination Peptic ulcers (Pitta): Severe abdominal pain, bleeding Osteoarthritis (Vata): Joint degeneration, stiffness Ayurvedic Perspective Disease-specific therapies, including Panchakarma (detoxification), herbal formulations, and dietary modifications, are essential at this stage. Modern Correlation : Vyakti represents the diagnosis of a disease based on clinical symptoms, imaging, and lab tests. Modern diagnostic techniques, like MRI or biomarker analysis, often identify conditions at this stage. Example : Research on diagnostic biomarkers, such as