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|description=Linga means characteristic feature. It includes clinical signs and symptoms

|description=Linga means characteristic feature. It includes clinical signs and symptoms

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The term linga (rupa) means clinical features i.e., signs (chinnha), and symptoms ([[lakshana]]) of a disease.(Code: SAT-D)<ref>National AYUSH Morbidity and Standardized Terminologies Electronic Portal by Ministry of AYUSH Available on http://namstp.ayush.gov.in/#/Ayurveda.</ref>The clinical features of the disease are vital predictors of the severity of the underlying pathogenesis of the disease. Linga is a crucial component in understanding disease prognosis and other aspects of nidanapanchaka (five factors necessary for understanding the severity, potency, pathology, and prognosis). [Cha.Sa.[[Nidana Sthana]] 1/6]

The term linga (rupa) means clinical features i.e., signs (chinnha), and symptoms ([[lakshana]]) of a disease.(Code: SAT-D)<ref>National AYUSH Morbidity and Standardized Terminologies Electronic Portal by Ministry of AYUSH Available on http://namstp.ayush.gov.in/#/Ayurveda.</ref>The clinical features of the disease are vital predictors of the severity of the underlying pathogenesis of the disease. Linga is a crucial component in understanding disease prognosis and other aspects of nidanapanchaka (five factors necessary for understanding the severity, potency, pathology, and prognosis). [Cha.Sa.[[Nidana Sthana]] 1/6]

Cardinal features are specific clinical features of a disease. Frequent defecation with variable consistency of stools (muhurbaddhammuhurdravam mala) is a cardinal feature of disorders of digestion and metabolism (grahanidosha).

Cardinal features are specific clinical features of a disease. Frequent defecation with variable consistency of stools (muhurbaddham muhurdravam mala) is a cardinal feature of disorders of digestion and metabolism (grahanidosha).

   

   

Linga is one of the three most essential aspects described in the Trisutra principle. [Cha.Sa.[[Sutra Sthana]] 1/24] of [[Ayurveda]] i.e., etiology ([[hetu]]), clinical features (linga), and intervention ([[aushadha]]). It is necessary for the precise knowledge and practice of Ayurvedic medicines and treatment techniques. The treatment should be prescribed only after thoroughly examining causative factors ([[hetu]]) and the signs and symptoms ([[lakshana]]) of the disease.<ref>Shukla DJ, Patel NC, Vyas H. Yogaśataka of pandita vararuci. Ancient Sci Life 2016;36:110-3.</ref>

Linga is one of the three most essential aspects described in the trisutra principle [Cha.Sa.[[Sutra Sthana]] 1/24] of [[Ayurveda]] i.e., etiology ([[hetu]]), clinical features (linga), and intervention ([[aushadha]]). It is necessary for the precise knowledge and practice of Ayurvedic medicines and treatment techniques. The treatment should be prescribed only after thoroughly examining causative factors ([[hetu]]) and the signs and symptoms ([[lakshana]]) of the disease.<ref>Shukla DJ, Patel NC, Vyas H. Yogaśataka of pandita vararuci. Ancient Sci Life 2016;36:110-3.</ref>

All systems of medicine rely primarily on the clinical features of the diseases to investigate, assess and plan the intervention accordingly. This article describes the etymology, synonyms, classification, identification methods, and importance of linga/rupa in medical practice.

All systems of medicine rely primarily on the clinical features of the diseases to investigate, assess and plan the intervention accordingly. This article describes the etymology, synonyms, classification, identification methods, and importance of linga/rupa in medical practice.

|label2 = Authors

|label2 = Authors

|data2 =Bhojani M.K.¹, Tanwar Ankur kumar¹

|data2 =Bhojani M.K.¹, Siddharth Kumar², Tanwar Ankur Kumar¹

|label3 = Reviewer  

|label3 = Reviewer  

|data3 =  Basisht G.²

|data3 =  Basisht G.³

|label4 = Editor  

|label4 = Editor  

|data4 = Deole Y.S.³

|data4 = Deole Y.S.⁴

|label5 = Affiliations

|label5 = Affiliations

|data5 = ¹ Department of Kriya Sharir, A.I.I.A., New Delhi, India,

|data5 = ¹ Department of Kriya Sharir, A.I.I.A., New Delhi, India  

² [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India,  

² Department of Roga Nidana Vikriti Vigyan, A.I.I.A.,New Delhi, India

³Department of Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India

³Rheumatologist, Orlando, Florida, U.S.A.

⁴ Department of Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India

|label6 = Correspondence email

|label6 = Correspondence email

|data6 = carakasamhita@gmail.com, meera.samhita@aiia.gov.in

|data6 = carakasamhita@gmail.com, meera.samhita@aiia.gov.in

|label7 = Date of first publication:

|label7 = Publisher

|data7 = April 28, 2022

|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = DOI

|label8 = Date of first publication:

|data8 = under process

 

|label9 = DOI

|data9 = 10.47468/CSNE.2022.e01.s09.095

}}

}}

==Etymology and derivation==

==Etymology and derivation==

Linga is derived from the Sanskrit root  "Linga" meaning "symbol" or "mark."<ref>Shabdakalpadruma, Radhakantdev R, editors.Delhi: Amar Publication; 2018.</ref>

Linga is derived from the Sanskrit root  "Linga" meaning "symbol" or "mark".<ref>Shabdakalpadruma, Radhakantdev R, editors.Delhi: Amar Publication; 2018.</ref>

==Synonyms==

==Synonyms==

==Classification==  

==Classification==  

===Three-fold classification===

 

'''Three-fold classification'''

1. [[Dosha]] specific features (dosha samashraya): The sign and symptoms of the disease that arise due to interactions of [[dosha]] with [[dushya]] (dosha-dushyasammurchana) are the [[dosha]] specific features of a disease. These are often exhibited in the early stages of disease and indicative of the commencement of pathogenesis of the disease.

1. [[Dosha]] specific features (dosha samashraya): The sign and symptoms of the disease that arise due to interactions of [[dosha]] with [[dushya]] (dosha-dushyasammurchana) are the [[dosha]] specific features of a disease. These are often exhibited in the early stages of disease and indicative of the commencement of pathogenesis of the disease.

2. Disease-specific features (roga samashraya): The sign and symptoms experienced by the subject physically or psychologically are disease-specific features. It represents a pathological event that surpassed the subjects’ body strength and immunity ([[bala]] & [[ojas]]) and led to the occurrence of the disease.

2. Disease-specific features (roga samashraya): The sign and symptoms experienced by the subject physically or psychologically are disease-specific features. It represents a pathological event that surpassed the subject's body strength and immunity ([[bala]] & [[ojas]]) and led to the occurrence of the disease.

3. Prodromal features ([[purvarupa]]): The sign and symptoms of a disease exhibited in an intermediated state of the occurrence of [[dosha]] specific and diseases specific features are called ‘Purvarupa’. These are the prodromal features that convert into the disease's cardinal features.  

3. Prodromal features ([[purvarupa]]): The sign and symptoms of a disease exhibited in an intermediated state of the occurrence of [[dosha]] specific and diseases specific features are called ‘Purvarupa’. These are the prodromal features that convert into the disease's cardinal features.  

[Su.Sa. Nidana Sthana 1/1]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

[Su.Sa. Nidana Sthana 1/1]<ref name=Susruta/>:

 

There are two types:

There are two types:

1. General features (samanya rupa): These are the general clinical features of the disease. For example, feverishness (santapa) is a prevailing clinical feature of fever ([[jwara]]); loose, watery stool (atisarana) is a general clinical feature of diarrhoea (atisara).

1. General features (samanya rupa): These are the general clinical features of the disease. For example, feverishness (santapa) is a prevailing clinical feature of fever ([[jwara]]); loose, watery stool (atisarana) is a general clinical feature of diarrhoea (atisara).

2. Specific features (vishistha rupa): These are the special clinical features of the disease. These indicate the specificity of the pathology. It is representative of the sub-variant of a disease occurring. The clinical features of [[vata]] dominant [[jwara]], [[pitta]] dominant [[jwara]], [[kapha]] dominant [[jvara]] etc. are specific features.

2. Specific features (vishistha rupa): These are the special clinical features of the disease. These indicate the specificity of the pathology. It is representative of the sub-variant of a disease occurring. The clinical features of [[vata]] dominant [[jwara]], [[pitta]] dominant [[jwara]], [[kapha]] dominant [[jwara]] etc. are specific features. [Su.Sa. Nidana Sthana 1/1]<ref name=Susruta/>

===Two-fold classification===

'''Two-fold classification'''

Another classification is based on the curability and severity of the disease.

Another classification is based on the curability and severity of the disease.

2. Signs of incurability (asadhyalinga)

2. Signs of incurability (asadhyalinga)

[Su.Sa. Nidana Sthana 1/1]<ref name=Susruta/>

[Su.Sa.Nidana Sthana 1/1]<ref name=Susruta/>:

 

 Recognized by the patient (symptoms)

# Recognized by the patient (symptoms)

 Recognized by the physician (signs)

# Recognized by the physician (signs)

===Understanding classification based on clinical applicability===

'''Understanding classification based on clinical applicability'''

# Disease ([[roga]]) specific

# Disease ([[roga]]) specific

# [[Dosha]]specific

# [[Dosha]] specific

# [[Dhatu]] specific

# [[Dhatu]] specific

# [[Srotas]] involvement specific

# [[Srotas]] involvement specific

# [[Vega]] (natural urge) specific

# [[Vega]] (natural urge) specific

# [[Panchakarma]] intervention specific

# [[Panchakarma]] intervention specific

# Sama and nirama specific

# Sama and nirama specific (along with and without [[ama]])

===Contemporary science-based classification===

'''Contemporary science-based classification'''

# Disease-specific features  

# Disease-specific features  

===Importance in prognosis and management of the diseases===

===Importance in prognosis and management of the diseases===

*The knowledge of the disease's clinical features (linga) is an essential component of the three fundamental elements (Trisutra) in [[Ayurveda]]. [Cha.Sa.[[Sutra Sthana]] 1/24]

*The knowledge of the disease's clinical features (linga) is an essential component of the three fundamental elements (trisutra) in [[Ayurveda]]. [Cha.Sa.[[Sutra Sthana]] 1/24]

*Diseases exhibiting the whole spectrum of the clinical features as mentioned in the classical books (apta) is potent and often indicative of incurability (asadhyata) or poor curability (kasthasadhyata) of the disease.

*Diseases exhibiting the whole spectrum of the clinical features as mentioned in the classical books (apta) is potent and often indicative of incurability (asadhyata) or poor curability (kasthasadhyata) of the disease.

*The conversion of all prodromal features ([[purvarupa]]) into clinical features ([[rupa]]) indicates sickness progression to severity or incurability.

*The conversion of all prodromal features ([[purvarupa]]) into clinical features ([[rupa]]) indicates sickness progression to severity or incurability.

*In case of diseases without the prodromal sign and symptoms like [[vatavyadhi]] and kshataksheena, the practitioner has to rely on the classical features of the disease to plan the treatment module for the subject.

*In case of diseases without the prodromal sign and symptoms like [[vatavyadhi]] and kshataksheena, the practitioner has to rely on the classical features of the disease to plan the treatment module for the subject.

*Linga is an essential component of the five tools for knowledge of diseases (nidanapanchaka). [Cha.Sa.[[Nidhan Sthana]] 1/6] It is used to diagnose the stages of progression of diseases ([[shatkriyakala]]).[Su.Sa.[[Sutra Sthana]] 22/34]<ref name=Susruta/>

*Linga is an essential component of the five tools for knowledge of diseases (nidanapanchaka). [Cha.Sa.[[Nidana Sthana]] 1/6] It is used to diagnose the stages of progression of diseases ([[shatkriyakala]]).[Su.Sa.[[Sutra Sthana]] 22/34]<ref name=Susruta/>

==Contemporary approach==

==Contemporary approach==

==Method of identification of linga==

==Method of identification of linga==

Different sorts of examinations were stated in [[Ayurveda]] for disease and patient examinations and for planning correct therapy based on [[prakriti]], vaya, and other factors. The method of identification of clinical features in [[Ayurveda]] is trividha pariksha.

Different sorts of examinations were stated in [[Ayurveda]] for disease and patient examinations and for planning correct therapy based on constitution ([[prakriti]]), age (vaya), and other factors. The method of identification of clinical features in [[Ayurveda]] is threefold examination for assessment (trividha pariksha).

   

   

*Darshana: Assessment through seeing or observation.

*Darshana: Assessment through seeing or observation.

*Saparshana: Assessment through touch.

*Saparshana: Assessment through touch.

*Prashana: Questioning or interrogation

*Prashana: Questioning or interrogation

'''Modern method of assessment of linga:'''

=== Contemporary method of assessment of linga ===

*History taking/Questioning

*History taking/Questioning

==Applicability of concept of linga (rupa)==

==Applicability of concept of linga (rupa)==

*The use of Ayurvedic concepts in modern scientific techniques such as proteomics, genomics, and technology is required to develop inexpensive and cost-effective healthcare solutions. It will be based on a blend of [[Ayurveda]] and modern scientific understanding. Ayurveda's Trisutra concept [Cha.Sa.[[Sutra Sthana]] 1/24] is the foundation for a predictive, personalized, and preventative approach to maintaining good health and management of the disease. The predictive (understanding of the future disease), personalized (individual-specific variability), preventive (utilization of the concept of dietary and lifestyle modification), and promotive (enhancement of the health) medicine, along with understanding the basic physiology and pathology is the key area of concept of linga (rupa/lakshana/clinical Features) applicability.  

*The use of Ayurvedic concepts in modern scientific techniques such as proteomics, genomics, and technology is required to develop inexpensive and cost-effective healthcare solutions. It will be based on a blend of [[Ayurveda]] and modern scientific understanding. Ayurveda's trisutra concept [Cha.Sa.[[Sutra Sthana]] 1/24] is the foundation for a predictive, personalized, and preventative approach to maintaining good health and management of the disease. The predictive (understanding of the future disease), personalized (individual-specific variability), preventive (utilization of the concept of dietary and lifestyle modification), and promotive (enhancement of the health) medicine, along with understanding the basic physiology and pathology is the key area of concept of linga (rupa/lakshana/clinical Features) applicability.  

*From a research perspective, the concept of linga plays a crucial role in finalizing the diagnosis criterion for different groups in the study. It is also used to determine the inclusion and exclusion criteria of the study. In this contemporary era, where every science depends mainly on the evidence-based approach toward treatment and maximized use of diagnostic investigations, linga (clinical features) still play a prime role of key importance in the diagnosis and management of the disease.

*From a research perspective, the concept of linga plays a crucial role in finalizing the diagnosis criterion for different groups in the study. It is also used to determine the inclusion and exclusion criteria of the study. In this contemporary era, where every science depends mainly on the evidence-based approach toward treatment and maximized use of diagnostic investigations, linga (clinical features) still play a prime role of key importance in the diagnosis and management of the disease.

==Current Researches==

==Current Researches==

'''Understanding evident fatal signs ([[arishta]] [[lakshana]]):''' For illness diagnosis and management, every science is dependent on the linga of the condition. Because there was no accessible instrument or diagnostic test in ancient times, the physician had to analyze, observe the linga, and finally conclude the diagnosis. The arishta lakshana can be linked to modern-day death signals [Cha.Sa.[[Indriya Sthana]]]. Murmure Rasika B et al. elaborated the concept of death signs mentioned in Charak Samhita with the impending indicators just before death and up to six months before death.<ref>Murmure Rasika B Et Al: CharkoktaArishtaLakshanas And Contemporary Signs Of Death. International Ayurvedic Medical Journal {online} 2017 {cited November, 2017}</ref>

=== Understanding evident fatal signs ([[arishta]] [[lakshana]]) ===

 

For illness diagnosis and management, every science is dependent on the linga of the condition. Because there was no accessible instrument or diagnostic test in ancient times, the physician had to analyze, observe the linga, and finally conclude the diagnosis. The arishta lakshana can be linked to modern-day death signals [Cha.Sa.[[Indriya Sthana]]]. Murmure Rasika B et al. elaborated the concept of death signs mentioned in Charak Samhita with the impending indicators just before death and up to six months before death.<ref>Murmure Rasika B Et Al: CharkoktaArishtaLakshanas And Contemporary Signs Of Death. International Ayurvedic Medical Journal {online} 2017 {cited November, 2017}</ref>

 

 

In [[Ayurveda]], the signs of equilibrium of body tissues (dhatusamya) can determine physical and mental well-being. T. Mahesh Raju B et. al. researched 250 seemingly healthy participants to develop, validate, and standardize a questionnaire to measure improvement in health status using Ayurvedic parameters. The final questionnaire measures health state according to Ayurvedic principles of dhatu samyata.<ref>Mahesh Raju. B, TB Tripathy, MB.Kavita. Development and Standardization of Health Status Assessment Tool Based on Ayurvedic Parameters w.s.r. to DathuSamyaLakshna. International Journal of Research in AYUSH and Pharmaceutical Sciences, 2017;1(1):92-96</ref>

'''Validation of tool of dhatu samyalakshana:''' In [[Ayurveda]], the signs of equilibrium of body tissues (dhatu samya) can determine physical and mental well-being. T. Mahesh Raju, B et al. researched 250 seemingly healthy participants to develop, validate, and standardize a questionnaire to measure improvement in health status using Ayurvedic parameters. The final questionnaire measures health state according to Ayurvedic principles of dhatu samyata.<ref>Mahesh Raju. B, TB Tripathy, MB.Kavita. Development and Standardization of Health Status Assessment Tool Based on Ayurvedic Parameters w.s.r. to DathuSamyaLakshna. International Journal of Research in AYUSH and Pharmaceutical Sciences, 2017;1(1):92-96</ref>

=== Cardinal features (pratyatma lakshana)===

'''Cardinal features (pratyatma lakshana):''' A diagnostic pathological report: The distinctive and peculiar clinical features of an illness are cardinal features. Mahamad Yunus S et al. concentrated on gaining a scientific grasp of cardinal features (pratyatma lakshana)'s distinctiveness and role as a diagnostic pathological report.<ref>MahamadYunus S. Nabooji, Amit K., Sandhya G.,  Komal R. PratyatmaLakshana: A Diagnostic Pathological Report. Indian Journal of Ancient Medicine and Yoga, 2019; 12(1):9-12.</ref>

A diagnostic pathological report: The distinctive and peculiar clinical features of an illness are cardinal features. Mahamad Yunus S et. al. concentrated on gaining a scientific grasp of cardinal features (pratyatma lakshana)'s distinctiveness and role as a diagnostic pathological report.<ref>MahamadYunus S. Nabooji, Amit K., Sandhya G.,  Komal R. PratyatmaLakshana: A Diagnostic Pathological Report. Indian Journal of Ancient Medicine and Yoga, 2019; 12(1):9-12.</ref>

'''Understanding proper oleation:''' An open-label clinical study studied the internal administration of ghee (snehapana). It was carried out on 30 psoriasis patients to evaluate the signs of proper oleation (samyaksnigdhalakshana) using a variety of clinical and biochemical markers. The study found that there were no significant changes in blood parameters. Substantial feces alterations in the presence of fat globules after snehapana were observed.<ref>Ramteke R, Vinodkumar G, Meharjan T. An open clinical trial to analyzeSamyakSnigdhaLakshana of ShodhanangaSnehapana with MahatikthakamGhritam in Psoriasis. Ayu. 2011;32(4):519-525. doi:10.4103/0974-8520.96126</ref>

=== Understanding proper oleation ===

==Research thesis==

 

== Research theses ==

   

   

#Sharma K. Sadashiv (1958): Samprapti – Lakshanyoh Sambandhah.  Department of Kayachikitsa and Panchakarma, I.P.G.T.& R.A., Gujarat.

#Sharma K. Sadashiv (1958): Samprapti – Lakshanyoh Sambandhah.  Department of Kayachikitsa and Panchakarma, I.P.G.T.& R.A., Gujarat.

#Reddy B.P.S. (1961): Panchanidana men upashaya.  Department of Kayachikitsa and Panchakarma, I.P.G.T.& R.A., Gujarat.

#Reddy B.P.S. (1961): Panchanidana men upashaya.  Department of Kayachikitsa and Panchakarma, I.P.G.T.& R.A., Gujarat.

#Grover Suman (1962): Lakshansammuchchatyavimarsha. Department of Kayachikitsa and Panchakarma, I.P.G.T.& R.A., Gujarat.

#Grover Suman (1962): Lakshansammuchchatyavimarsha. Department of Kayachikitsa and Panchakarma, I.P.G.T.& R.A., Gujarat.

#Sharma K.M. (1962): Lakshanavimarsha(kaphajalakshanavishishitavimarshasahita. Department of Kayachikitsa and Panchakarma, I.P.G.T. & R.A., Gujarat.

#Sharma K.M. (1962): Lakshanavimarsha (kaphajalakshana vishishitavimarshasahita. Department of Kayachikitsa and Panchakarma, I.P.G.T. & R.A., Gujarat.

#Mishra D.D. (1963): Pitta ki UshnaGunatah SantapaLakshana Vimarsha. Department of Kayachikitsa and Panchakarma, I.P.G.T. & R.A., Gujarat.

#Mishra D.D. (1963): Pitta ki Ushna Gunatah Santapa Lakshana Vimarsha. Department of Kayachikitsa and Panchakarma, I.P.G.T. & R.A., Gujarat.

#Tewari Jagdish (1963): KasaRoga evam lakshana vimarsha. Department of Kayachikitsa and Panchakarma, I.P.G.T. & R.A., Gujarat.

#Tewari Jagdish (1963): Kasa Roga evam lakshana vimarsha. Department of Kayachikitsa and Panchakarma, I.P.G.T. & R.A., Gujarat.

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==References==

==References==

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