Ayurveda uses a system known in Sanskrit as shat kriya kala that translates as the six-fold progression of the disease. Shat kriya kala enables ayurvedic physicians to identify the cause, pathway, and reasoning for the various presentation of the disease. This breakdown of pathology provides insight for implementing effective strategies to restore health and harmony in both mind and body.

According to ayurvedic principles, disease begins with simple and seemingly insignificant disturbances in the body that affect the symbiotic relationship between mind (origin of most physical imbalances) and digestion (origin of manifestation of physical imbalance. Typically this happens in six stages.

1). ACCUMULATION/ sanchaya

Once we’ve become exposed to the above-mentioned causes of disease, Ayurveda explains that our digestive function becomes disrupted leading to an imbalanced production of phlegm, digestive acids, and enzymes or changes in gastric motility. This is known in Ayurveda as dosha imbalance.

As a result of disturbed digestion, the substance Ayurveda refers to as ama begins to form. Ama is described as a sticky, dense, morbid substance that is unable to build or repair bodily tissues or form waste products and causes obstruction in the channels of the body. At this stage, very mild symptoms may be perceived however they generally subside before long without causing any significant discomfort.

Quite often ama is described in western terms as toxin accumulation, however, the toxin in western terms is defined as a poisonous substance produced by microorganisms, plants, or animal species. There is no suitable equivalent to ama in western medical science as it is not limited to being a product of metabolism. Ama may be formed in the body as a result of undigested organic matter that hinders metabolic function for example heavy and difficult to digest foods. This process may facilitate the production of toxins forming in the body however may be more closely related to dosha imbalance. I assume this is why classical texts have defined ama by its quality and effect as opposed to its specific origin, perhaps due to this being more practical in clinical application.

2). AGGRAVATION/ prakopa

As ama continues to accumulate along with dosha imbalance, aggravation of specific areas of the gastrointestinal tract begins to present. This may be experienced as various signs and symptoms such as gas, wind, bloating, burning, hyperacidity, sluggish digestion, constipation, loose or irregular bowel movements depending on the specific site of aggravation. 


Eventually, ama and dosha imbalance will overflow from the areas where they have accumulated and pass through the intestinal wall into the channels of circulation. Ama and dosha imbalance during this stage may lead to a disturbance of beneficial gut-bacteria or conditions such as leaky gut allowing for increased permeability of the intestinal wall. This migratory stage may disturb various functions such as immunity, metabolism, and blood sugar regulation.

4). LOCALIZATION/ sthana samshraya

Eventually, the ama and dosha imbalance begins to deposit in the weaker tissue systems and over time accumulates. This is commonly experienced as pain, stiffness, inflammation, swelling, and mild impairment of tissue function. 

These symptoms are commonly known as signs of inflammation. Rheumatoid arthritis is a very good example of this stage. Often these signs and symptoms will be experienced over a long period of time before they trigger an auto-immune response. Auto-immune disease is considered in Ayurveda as a progressive response due to the localized accumulation of ama. The body is unable to be clear ama via its intrinsic detoxification pathways that may be compromised by genetic or environmental factors. The body then begins to aggressively attack the ama causing local tissue damage as a result.


Over time this impairment weakens the site of localization significantly disturbing the structure and function of the tissue or organ. At this stage, a clearly defined presentation with associated signs and symptoms can generally be diagnosed as a specific disease or illness.


If the manifestation stage of the disease is not treated the condition becomes more complex in its pathology and commonly leads to secondary conditions. At the 6th stage of disease, these conditions are usually very difficult to treat or manage and commonly lead to procedures like surgery or pharmaceutical drugs that may have potentially harmful side effects that cause complications in other tissues and organs.

Considering the origin of most common chronic diseases, it becomes more obvious how important it is to maintain a healthy mind. I find this model of disease very useful to share with my patients in clinical practice as it allows us to gain a better understanding of why its quite often the little manageable things that are so important in preserving health and longevity.

Sarve piroga mandagnihetavah

“Disease is caused by an imbalance of digestion, as a result of mental disturbance or inappropriate diet”.
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