KOSHTAGATI & SAKHAGATI

KOSHTHA TO SHAKHA GATI OF DOSHA (कोष्ठात् शाखां गतिः)

• Definition:

  • Movement of Doṣhas from Koṣṭha (gastrointestinal tract) to Śākhā (peripheral tissues) is called Koṣṭhāt Śākhā Gati.

  • It indicates the beginning of Dosha spread (Sañchāra) outside the GI tract.

• Cause / Nidāna:

  • Improper management of Sañchaya (accumulation) and Prakopa (aggravation) stages.

  • Factors that obstruct the natural downward movement of Doṣhas, such as:

    • Suppression of natural urges

    • Improper administration of purification therapies

    • Indulgence in causative factors even after symptoms start

• Mechanism:

  • When aggravated Doṣhas in the Koṣṭha are not expelled, they overflow and move to the Śākhā.

  • This movement marks the Prasara Avasthā (spreading stage) of disease development.

• Relevant Śloka (from Ashtanga Hridaya, Sutrasthana, Chapter 1):
  "संचयं च प्रकॊपं च प्रशमं चापि यॊऽन्विति।
  स रोगमक्षतं वेत्ति स च विज्ञेय भिषग्वरः॥"
  (AH Su.1/25)

• Pathophysiology:

  • Vāta pushes the aggravated Doṣhas into circulation.

  • These Doṣhas then lodge in Rasa, Rakta, Mamsa, Meda, etc.

  • Leads to prodromal symptoms (Pūrvarūpa) or localized disease manifestation.

• Clinical Examples:

  • Ama Vāta – Vāta takes Ama (toxins) to joints (Śākhā).

  • Vāta Rakta – Doṣhas reaching Rakta dhātu and small joints.

• Signs & Symptoms:

  • Discomfort shifts from GI tract to peripheral parts.

  • Symptoms become localized – e.g., joint pain, skin rashes, etc.

  • Sometimes, GI symptoms reduce while peripheral symptoms appear.

SHAKHA TO KOSHTHA GATI OF DOSHA (शाखात् कोष्ठं गतिः)

• Definition:

  • Movement of Doṣhas from Śākhā (periphery) back to Koṣṭha (gut) is called Śākhāt Koṣṭha Gati.

  • Also called Saṅghāta Mokṣa or Pāchana Mārga, depending on context.

• Purpose:

  • Makes Doṣhas ready for elimination (Shodhana).

  • Indicates a favorable shift in disease – sign of ripening of disease (Pakva Avasthā).

• Indications:

  • When Doṣhas return to GI tract, Shodhana therapies like Vamana, Virechana can be administered.

  • Return to Koṣṭha indicates accessibility of Doṣhas for expulsion.

• Mechanism:

  • Proper digestion (Agnibala), use of Deepana-Pāchana medicines and Langhana (fasting/light food) helps draw Doṣhas back to Koṣṭha.

• Relevant Śloka (Ashtanga Hridaya, Sutrasthana, Chapter 13):
  "शुद्धे कोष्ठे स्थितान् दोषान् संसृष्टानपि सात्म्यजः।
  निश्चिन्त्य बहिर्नयेत् स्वेदवमनविरैचनैः॥"
  (AH Su.13/26)

• Factors Supporting Return to Koṣṭha:

  • Use of Langhana (lightening therapy)

  • Administration of Deepana-Pāchana herbs (appetite and digestion-enhancers)

  • Improved Agni (digestive fire)

  • Cessation of aggravating factors

  • Restoration of proper Vāta function (Prāṇa, Apāna balance)

• Clinical Relevance:

  • Purgative Therapy becomes effective only after Doshas return to Koṣṭha.

  • Delayed Shodhana in stage of Śākhā gati is contraindicated.

  • Shodhana performed prematurely in Śākhā gati may worsen the disease.

• Signs of Doshas Having Returned to Koṣṭha:

  • Increase in GI symptoms again (nausea, heaviness, distension).

  • Reduction in peripheral symptoms.

  • Improved signs of appetite and elimination.

ILLUSTRATION: PATHWAY OF DOSHA GATI

      AGGRAVATION PHASE
       (सञ्चय + प्रकोप)
               ↓
       KOSHTHA (GI TRACT)
               ↓
    PRASARA – Overflow of Doshas
               ↓
    KOSHTHA → SHAKHA GATI
   (Symptoms move to tissues)
               ↓
     TREATMENT (Deepana-Pachana)
               ↓
    DOSHAS RETURN TO KOSHTHA
     (SHAKHA → KOSHTHA GATI)
               ↓
         SHODHANA (Elimination)