Skip to main content

For naturopathic practitioners, who aim to treat the root cause of disease and reverse its spread, it is vitally important to have a thorough understanding of how disease starts, spreads and develops across different sites in the body. This process was understood thousands of years ago in Ayurveda, the ancient medicine of India, and named Samprapti.

Are you looking to understand how to reverse your ill health? As a naturopathic practitioner, I specialise in helping people with these problems. Learn more about my programs here.

Samprapti: The Course of Disease

Samprapti is broken down into six phases which cover the full process from the initiation of the disease to the full manifestation of its potential in the physical body. Those six phases are given by Lad (2007) as the following:

  1. Accumulation;
  2. Provocation;
  3. Spread;
  4. Deposition;
  5. Manifestation; and
  6. Destruction of tissues with complications.

In the following paragraphs, I examine these stages in greater detail, with reference to Lad (2007) and Sharma (2019).

Stages of Sampapti

The first stage, accumulation (sanchaya), is where any of the three doshas start to increase and accumulate. This takes place within the “seat” of each dosha, being the large intestine for vata, the small intestine and stomach for pitta and the lungs and stomach for kapha. This happens naturally during different times of the day and seasons that are resonant with each dosha. Doshas can also fall out of balance due to the diet and/or lifestyle choices. When the body is functioning well, and the body’s intelligence is being listened to, accumulation is not an issue because it will be balanced as the seasons change and/or by changes in the diet and lifestyle of the person. When the person does not act in accordance with signals from the body to balance the accumulated dosha, the disease process continues into the second stage. Examples of stage one symptoms include constipation, gas or lower bowel distention for vata, yellow eyes or urine or intense hunger for pitta and low appetite, lethargy or a feeling of a full stomach for kapha.

In the second stage, provocation (prakopa), the accumulating dosha(s) continue to accumulate and start to rise towards the limit of that person’s tolerance. Each individual’s prakruti will dictate how much the doshas can be provoked before stage three is initiated. If the person is very kapha dominated, their body would not be able to handle much of a further increase in that dosha before the disease would begin to move onto the next stage in the process. However, if there were very little vata dosha, for example, in that person’s prakruti, a much larger accumulation could be tolerated without more serious symptoms manifesting. Examples of stage two symptoms include general bowel distention, pressure under the diaphragm or breathlessness for vata, heartburn, nausea or indigestion for pitta and congestion, mucus or coughing for kapha.

The third stage is called spread (prasara). By this point, the tolerance for accumulation of the dosha in question has been exceeded and the normal site of that dosha can no longer contain it. Therefore, the increasing dosha begins to spread from its seat into other tissues. It will naturally move into other parts of the body with which is it resonant. These are usually secondary sites of the dosha such as the skin, ears and bones for vata, the eyes, sweat glands, skin and heart for pitta or the sinuses, lymphatic system and breast tissue for kapha. The displaced doshas will begin to generate symptoms of disease in those tissues, although at this stage these will be fairly minor and may not even be paid attention to. However, once the third stage is reached, things can start to get worse more quickly. Ayurveda understands the doshas to be managed by Agni while they remain in their seats within the intestinal tract; here they fulfil their normal functions and are self-adjusting. Once they leave the intestines, in the third stage of Samprapti, they begin to spiral out of control and generate cravings to perpetuate their spread (Lad, 2007). Examples of stage three symptoms include dry skin, heart palpitations or tinnitus for vata, hot flashes, hives/rash, burning sensations for pitta and water retention, sinus and lymphatic congestion for kapha.

In the fourth stage, deposition (sthana samshraya), the dosha moves into a tissue or organ that has a pre-existing weakness. In this stage, the possible symptoms for each dosha can be quite varied as they depend on the tissues affected. However, symptoms will manifest in the affected tissue in accordance with the qualities of that dosha. These are typically more prominent symptoms and easier for the person realise that something is not as it should be than those in the third stage. However, they have not yet developed into a full-blown disease. This comes in the next stage.

The fifth stage is called manifestation (vyakti) and this is where the techniques of modern Western medicine would be able to easily identify that there is a problem. At this point, the dosha has overcome any resistance from the tissues it is afflicting. Like the previous stage, the possible symptoms are quite varied but diseases will now become manifest in accordance with the qualities of the dosha concerned in the site of the tissues or organ affected. Examples of stage four or five symptoms include muscle pain, cracking joints or tooth cavities for vata, tendonitis, cystitis or hyperthyroidism for pitta and joint swelling, diabetes or hypothyroidism for kapha.

The sixth and final stage of Samprapti is called destruction and degeneration (bheda). In this stage, physical, structural changes occur in the affected tissues. When a disease reaches this stage it is difficult to treat. Examples of stage six disease include osteoporosis, emaciation and degenerative diseases for vata, gangrene, abscesses and ulcerations for pitta and edema, tumours and hardening of tissues for kapha.

Pathways of Disease

While the aggravated doshas are progressing through these six stages, there are specific pathways in which they travel through the body. Once the dosha leaves its main site in the intestinal tract in stage three, it passes through these three pathways as the disease progresses to affect deeper tissues. These pathways reflect the different depths of the tissues in the body and thus the seriousness and progression of the disease. The pathways correspond to the three layers in which a fertilised ovum grows (the endoderm, mesoderm and ectoderm) whereby the deepest tissues and organs like the intestinal tract, respiratory system and liver form first, followed by the musculoskeletal system, circulatory and lymphatic systems and shallower organs like the kidneys and finally by the nervous and sensory system. The pathways and their corresponding tissues and organ systems are as follows (Sharma, 2019):

  1. The External Pathway (rasa and rakta dhatus) – corresponds with the Ectoderm
  2. The Middle Pathway (mamsa, meda, asthi, majja and shukra dhatus) – corresponds with the Mesoderm (primarily the musculoskeletal system); and
  3. The Deep Pathway – corresponds with the Endoderm (the deeper organs like the liver and lungs and deeper digestive issues).

The Law of Cure

This concept of disease spreading through different depths of the body was also proposed by the homeopath Constantine Hering and his Law has since become well-known in naturopathic circles. It is referred to simply as the “Law of Cure” and is as follows:

“Cure proceeds from above downward, from within outward, from the most important organs to the least important organs and in the reverse order of appearance of symptoms”.

Constantine Hering

While Hering’s Law of Cure describes the process of Samprapti in reverse, how cure develops as opposed to how disease progresses, the following idea was put forward by Dr Lawrence Plaskett to describe the process of disease and might be referred to as Plaskett’s Law:

“The progression of chronic disease proceeds from the bottom upward, from without to within, from the least important to the most important organs and in a pattern of increasing severity of the symptoms or labelled conditions leading onward towards more under-function, loss of function and death.”

Dr Lawrence Plaskett, year unknown

As stated in the introduction, these concepts are essential for naturopathic practitioners to understand if they want to be successful in reversing the course of a disease to achieve a real “cure” as opposed to simply plastering over symptoms of the latest manifestation of the disease. Unfortunately, mainstream medical doctors do not appear to have a grasp of the concept of Samprapti or the Law of Cure. If they did, one might expect them to cease their attempts to suppress the localised manifestation of symptoms, knowing that this would simply lead to (at best) the relocation of the imbalance and do nothing to avert further progress through the disease process. An understanding of these concepts can help naturopathic practitioners to clearly identify the state of progression of disease in their clients and avoid confusion when presented with a complex and wide-ranging symptom picture. By examining the qualities of the presenting symptoms and comparing these with the doshic qualities, one can identify the cause of the imbalance and thereby determine a suitable course of treatment as well as on which location in the body this treatment should be focussed, even when symptoms present in multiple sites.

Are you looking to understand how to reverse your ill health? As a naturopathic practitioner, I specialise in helping people with these problems. Learn more about my programs here.


Lad, V, 2007, Textbook of Ayurveda Volume 2: A Complete Guide to Clinical Assessment, pages 24-30 The Ayurvedic Press, Albuquerque, NM, USA.

Plaskett, L, Diploma in Nutritional Medicine Course Notes, Part One: Folder One, The Holistic Model of Healthcare, page B22.

Sharma, M, 2019, School of Health Naturopathy Course Notes, Ayurveda Module, pages 171-175 The School of Health, Stroud, UK

One Comment

Leave a Reply

Powered by ProofFactor - Social Proof Notifications