A comprehensive outlook of Sannipata

Abstract

Nomenclature of the disease on the basis of vitiation of the body humors is stressed in ayurveda. Sannipatika, i.e., ‘conglomeration of vitiated tridosa’ is the final stage of process of manifestation of disease. In this specific state of pathogenesis, the disease becomes more advance and mostly irreversible. A detailed scientific study of Sannipatika-avastha has been documented in classics. Comprehensive analysis of sannipata-state and its ways of presentation is the main theme of the current article.

Introduction

The templates of the condensed diseases are well-demonstrated in the spectrum of pathology in the Ayurvedic compendium. The trisutra symbolize the categorical knowledge of the etiology and pathology in respect to disease in partial form and the fundamental approach of the management of those diseases in amplification respectively. The outstanding pathogenesis of the diseases is decorated in such a way that the justification of those sequences has also been commented in the texts. The subsequent knowledge of the pathogenesis of any disease is the interaction of the altered functions of the qualities of dosas and it magnifies different characteristics. The quashed form of diagnosis is definitely related to pathology and the knowledge of this subject is mandatory for the appropriate measures. The extensive aggravations of dosas are afflicted with the respective affected dhatus and produce the disease phenomena, but the specific degree of dosa prakopa results the different characteristics. Aggravation of tridosa at a time or in a consequence produces the complex phenomena where the prognosis is worse in comparison to other two varieties. This complex phenomenon of the disease is still valid in context to the pathogenesis of the different diseases as mentioned in modern Textbook of Pathology. In the present time, all the incurable diseases are required to be explored in the purview of the pathology of Sannipata.

Aims and Objectives

The specification of the disease is require to explore in the magnitude of corresponding relevant factors responsible for the production of the disease and as the Sannipatika state is a very complex phenomena. Therefore the current study is elicited with the following aims and objectives.

1. To find out the literal ambit of Sannipata.

2. To search the multidimensional aspect of Sannipata from the compendium.

Review of Concept

Vata, pitta and kapha are basic functional factors of the body and responsible to sustain the life in their homeostatic state.[1] The function of the above three fundamental factors are varied and manifested by certain characteristics.[2] The normalcy of the above three factors is termed as dhatusamya.[3] The implied term dosa is granted as dhatu in this state.

The abnormal physiological state is considered as pathology and no diseases can be occurred without the vitiation of vata, pitta and kapha either in singly, dually and triply.[4] The disease is occurred in due course of time with different interaction between the abnormal factors of dosa and dusya.[5] Dosa in specific or mutually interacts with each other but that does not produce the disease mandatory unless there is a strong affliction with the dusya and the presusceptible system with an extensive infiltration.[6] It is noteworthy to mention here that there are the subsequent stages for the procurement of the diseases.[7] The qualitative changes of the particular dosa or two dosas or all the three dosas may be manifested with different characteristics likely to be commenced in accumulation, aggravation and spreading stages.[8] The modulation of involvement of dosa is depended upon the extrinsic and intrinsic factors right from the accumulation up to the spreading stages.[9] The respective incompatible biofactors, if altered, in the single dosa termed as ekadosaja, two dosas termed as dvidosaja and three dosas termed as tridosaja abnormal state and manifested with the specific characteristic of the particular involvement of the specific dosa.[10] The abnormal state of dvidosa manifests with different sign and symptoms apart from the involvement with the characteristic of dosa, then those are termed as dvandvaja and sannipata states rather than to quote dvidosaja and tridosaja, respectively.[11] Hence sannipata is a state where qualitative changes of tridosa takes place but here the degree of the involvement of the dosa are examined and accordingly considering the dominant characteristic of specific dosa nomenclature are made.[12]

The aggravation, diminution and equilibrium are the three states of dosa[13] which are assessed through the respective manifested signs and symptoms. Although sannipata apparently is caused due to decrease and increase of tridosa[14] but the diminution state of dosa is incapable to vitiate the dhatu for the production of the disease on account of their less potency. Therefore sannipata is a state of synchronized fusion or combustion of the vitiated tridosa manifested with the resultant characteristics of the recessive qualities of the biological factors which are commonly unseen in tridosaja state.[15] Invariable competent outcome of the recessive states, as a result of sannipata, is encountered in the perspective of degree of involvement of dosa and accordingly considering the gravity with the administration of pacificatory or purificatory drug, the altered states of the biological factors are corrected.[16] Non arresting of aggravation of the dosa or dosas leads to affect the tissue elements and ultimately produce the disease with different or certain chemical reaction of the neglected sannipata states in its spreading phase crossing the immunological barriers produce the grave state of particular disease because of its metamorphic pathogenesis.[17]

Every disease is having its own pathogenesis and accordingly the treatment is advocated. Primary or secondary sannipata disease is basically caused due to the conversion of the sannipata state in a disease with specific pathogenesis and or conversion of any dosic disease (eka dosa, dvidosa) into sannipatic disorder in due course of time.[18] In the course of disease sannipatic state is considered under the stage of bheda.

The permutations and combinations of dosas which are most commonly manifested are 62 in number though it may varies because of their varied ratio.[19]

Sannipata is a classified state of different diseases and the vivid description of this classification is found in context to jvara roga.[20] In no other diseases such types of categorical description of sannipata are mentioned which signifies the acceptance of existence of the same multidimensional classification of the succeeding diseases as the preceding one. The importance of the disease jvara and its classification in different ways intensify the outlook of the classification of different disorders without a confirmed form.

The amplitude of the classification of the disease jvara may be implied in the classification of different disorders and likewise the sannipata state of different diseases.[21] Sannipata diseases signify the advanced stage.[22]

Genesis of the sannipata jvara predominated by characteristic of dosa is justified by the succeeding stalwarts with terminological variations in the purview of absolute and acute characteristic for the fruitful spot diagnosis and its treatment.[23] Such type of minute classification based on specific characteristics is also a variable form of altered functions of dosa and accordingly all the 13 types of sannipata jvara are metamorphically analyzed.[24]

The texture of the mutant sannipata jvara is a conglomeration of the dosaja variations in active and passive states on which the degree of the manifested characteristic are calculated and prototyped. The nano-quality of the vitiated dosa are exerted with a gratified matter either in similar or different manner and thereby the pathogenesis of the disease sannipata jvara is visualized with the involvement of the predominant dosa. Such type of quantified classification in qualitative aspects of dosa are so sensitized that the fascinated dosa is overwhelmed. The synthesized dosa in its migratory states are evolved with certain characteristic of the dominant, recessive and dormant states. These minute qualitative changes exhibit the complicated phenomena because of the nature of affliction. The affinity of the abnormal dosa is resulted through a postulated dimension. Specific characteristic of sannipata jvara are revealed by the extensities of morbid qualities of the dosa and trimmed by the specific terminology in place of dosaja nomenclature which ultimately incorporate primarily the dosaja involvement.[25]

In the process of study, it is found that the following diseases viz., udara, mutraghata, visarpa, atisara, gulma, plihadosa, chardi, bhaktasya-asanasthana, Siraroga, hridroga, pandu, unmada, apasmara, akshiroga, karnaroga, pratisyaya, mukharoga, grahani dosa, mada, murccha are classified in sannipatika variety and in the preceding, the above-said diseases are mentioned in sequence of classification without any variation.[26] Sannipatika raktapitta having triligga is incurable.[27] Sannipatika gulma termed as nicaya gulma, because of its vikrti-visama-samavaya causing vipratisiddha upakrama.[28] Consideration of the pathogenesis of prameha[29] and kustha,[30] indicates its sannipatika state. But specifically Kakanaka,[31] the tridosaja variety indicates its vikrti-visama-samavaya quality. Visamasanaja rajayaksma is tridosaja manifesting 11 types of features predominated by different dosas revealing prakrti-sama-samaveta character.[32] Ksata-ksina in terms of uraksata is tridosaja.[33] In the disease Sotha, the term sannipata or tridosaja variety has not been mentioned, where as the treatment of pitta-anilaja-Sotha (dvandaja) has been mentioned[34] denoting the ekadosaja Sotha has best prognosis.[35] Although arsa-roga has been classified on the basis of clinical manifestation, still the sannipatika state of arsa reveals the individual equal dominance of tridosa by the words ‘sannipatitaistribhih’.[36] In sannipatika udara, the aggravation of dosas occurred separately with specific etiology.[37] Grahani roga[38] and pandu roga[39] are stated because of its extrinsic intensity.

Sannipatika classification of hikka-svasa has not been made, but pathogenesis signifies the involvement of tridosa spuriously.[40] The aetiology of ksayaja kasa indicates the sannipata dosa involvent identical to visamasanaja rajayaksma.[41] The categorical etiology, pathogenesis and characteristics of sannipatika atisara signify the tridosa laksana due to vikrti-visama-samavaya.[42] In sannipatika atisara denotes the vikrti-visama-samavaya-lavdha-tridosaja feature with the magnification of different color of the stool in specific. Sannipatika chardi is manifested with the amapradosaja features and the causative factors in relation to the pathya and apathya for the aggravation of the tridosa has been emphasized.[43] In sannipatika visarpa, the causative factors, all extensive clinical features, involvement of all the seven tissue elements (along with tvak, rakta, mamsa and lasika), rapidly spreading and fatality resulting the poorest prognosis.[44] Although no specific clinical features have been mentioned, but the sannipatika state of visarpa categorically denotes the fatal prognosis. Sannipatika state of trisna is not found, may be because of the non entity of classification of kaphaja trisna, though the treatment of kaphaja trisna has been depicted.[45] Upasargaja trisna may be the indicative of sannipatika state of trisna as in almost all the sannipatika diseases trisna is a common features. In all types of madatyaya tridosa are involved, still predominance of the features of individual dosas differentiates the dosaja madatyaya, where as in sannipatika madatyaya is classified because of its acute fatal state.[46] Mutrakrcchra, hrdroga, pratisyaya, siraroga mukharoga, arocaka, karnaroga, netraroga have though their sannipatika varieties, because of the prakrtisama samavaya, those are not detailed in terms of hetu-linga-samprapti. The sannipatika classification of these diseases is specified on the basis of its specified treatment.[47] Urustambha and sannyasa are having only tridosaja classification[48] signifying the exclusive pathogenesis which is nowhere found in classics. Vatasonita is identical to that of madatyaya.[49] Tridosaja yonivyapat is characterized by daha, sula, sveta-picchila srava[50] significant of the concomitant pathological feature of the individual dosa.

In the preceding the comprehensive symptomatology of Sannipata dosa, Sannipata jvara and Sannipata rogas will be tabulated, respectively [Tables 1–3].

Table 1.

Symptomatology of Sannipata dosa

Table 3.

Symptomatology of Sannipata Jvara (Acc. to Trisati of Sarangadhara)

Table 2.

Clinical manifestation of different Sannipata roga

Discussion

The diseases are classified in different dimensions but the nija or dosaja type of diseases is having a classified sannipatika state which is manifested with the identical sign and symptoms of the aggravated dosas or non-identical features. In most of the diseases, sannipatika state is stated on the basis of its specialty of the causes, sign and symptoms and prognosis in particular and somewhere form therapeutic perspective. Although the basic classification of the jvara indicates two types specifying hypo and hyperthermic causes, but significant classification of Sannipatika Jvara magnify the multidimensional aspect of sannipatika state. But the theoretical approach of the sannipatika variety of different diseases in the classics enlightens the importance and gravity of the diseases in true aspect. In the present era, the dreadful diseases are also presented with different complex features because of its intricate pathogenesis. The viral or bacterial fevers, malignancy, auto immune diseases, etc. are to be related in accordance to the consideration of sannipatika state.

From the reference of Sotha, it may be revealed that sannipatika or tridosaja variety may not viable generally, but if found have the worst prognostic value.

In clinical practice evolution of the nomenclature of the diseases are seen on the basis of simple, effective, and justified form and its acceptance by the physician. The diseases are given nomenclature on the basis of dosaja variation[51] but these kinds of assessment are very difficult because of its inter-related manifestations. Considering the general pathogenesis of the disease, the diagnosis is made in an encapsulated form particularly in case of sannipata jvara and other sannipata diseases on the basis of cardinal characteristic with specific motor and sensory involvement and site of the disease and thoroughly understood by the physician for absolute measures.

Conclusion

In sannipatika state of the specific disease, intensified specific features apart from the features produced by the individual dosas in the specific disease regarded as the vikrti-visama-samavaya variety. In case of prakrti-sama-samaveta variety, these types of specific features are also found but which are not so much intensified in nature.

Agantuja varieties of any diseases can be turned into sannipatika state with grave prognosis.

The knowledge of ambit of the sannipatika Jvara may intensify the views of the physician to justify the sannipatika state of any diseases in any dimension. The symphony of the prelude sannipata states simultaneously in similar and different manner following the pathogenesis of the diseases camphor the resultant stupor and produce Sannipata Jvara.

The classical concept of the pathogenesis of urustambha and sannyasa are required to understand because of the single classification of these disease entities.

Sannipatika state is the complex phenomena having intricate pathogenesis and justified intensive therapeutic care.