Changes

In some acute diseases, the disease is presented directly with signs and symptoms. In these cases, the unmanifested form of the actual symptoms (''rupa'') described in the text should be treated as the ''poorvarupa'' of a disease [Chakrapani on Cha.Sa.Nidana Sthana 1/8].  

In some acute diseases, the disease is presented directly with signs and symptoms. In these cases, the unmanifested form of the actual symptoms (''rupa'') described in the text should be treated as the ''poorvarupa'' of a disease [Chakrapani on Cha.Sa.Nidana Sthana 1/8].  

Vagbhata opines that ''poorvarupa'' are signs and symptoms that appear earlier to the actual disease, not specifically assignable to the ''doshas'' as they are mild (not clearly recognizable) and few in number. (A. H. Ni. 1/) <ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/3, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 441 </ref>. This is also substantiated in the Ashtanga Sangraha (A S Ni 1/8)<ref>Vagbhata, Ashtang Sangraham, Nidanasthana Adhyaya 1/11, Edited by Dr D V Pandit Rao, First Edition, CCRAS, New Delhi, 1991, 554 </ref>

Vagbhata opines that ''poorvarupa'' are signs and symptoms that appear earlier to the actual disease, not specifically assignable to the ''doshas'' as they are mild (not clearly recognizable) and few in number. [A.H. Nidhana Sthana. 1/3] This is also substantiated in the Ashtanga Sangraha <ref>Vridha Vagbhata. Nidana Sthana, Cha.1 Sarvaroganidana Adhyaya verse 11. In: D V Pandit Rao, Editor. Ashtanga Sangraha. 1st ed. New Delhi: CCRAS;1991 </ref>

 

Gangadhara, commentator of [[Charak Samhita]], describes two types of ''Poorvarupa'':

Gangadhara, commentator of [[Charak Samhita]], describes two types of ''Poorvarupa'':

#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''doshas''.

#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''doshas''.

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Vagbhata defines upashaya as satmya (compatible). (A H Ni. 1/).<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/6, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 442 </ref>

Vagbhata defines upashaya as satmya (compatible). [A.H Nidana Sthana.1/6]

In nutshell, upashaya is the therapeutic test that is helpful in diagnosing the doubtful stages of different diseases. This is adopted during differential diagnoses of the disease. [10]

In nutshell, upashaya is the therapeutic test that is helpful in diagnosing the doubtful stages of different diseases. This is adopted during differential diagnoses of the disease. [10]

''Aagati'': Literally means the manifestation and remission of the disease. In this process of disease manifestation (''samprapti''), the physician gets the knowledge in the form of qualitative and quantitative progress of the disease.  

''Aagati'': Literally means the manifestation and remission of the disease. In this process of disease manifestation (''samprapti''), the physician gets the knowledge in the form of qualitative and quantitative progress of the disease.  

While the symptoms of a disease manifest completely after pathogenesis (''samprapti''), still for the purpose of diagnosis, the knowledge of ''samprapti'' is not as important as the knowledge of ''linga'' (symptoms). Hence ''samprapti'' is described at the end [Chakrapani on Cha.Sa.Nidana Sthana 1/11].

While the symptoms of a disease manifest completely after pathogenesis (''samprapti''), still for the purpose of diagnosis, the knowledge of ''samprapti'' is not as important as the knowledge of ''linga'' (symptoms). Hence ''samprapti'' is described at the end [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11].

Vagbhata has defined these synonyms as:  “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. (A H Ni. 1/8) <ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/8, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>[11]

Vagbhata has defined these synonyms as:  “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. [A.H Nidana Sthana 1/8] [11]

In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter[Chakrapani on Cha.Sa.Nidana Sthana 1/11].  

In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11].  

Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. (A H Ni. 1/9)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/10)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/10, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref> When a ''dosha'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''vata'' for example may mean aggravation of its coldness, lightness or ununctuousness.  

Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. [A.H Nidana Sthana 1/9] ''Pradhanya samprapti'' indicates the primacy of a ''samprapti''. [A.H Nidana Sthana 1/10] When a ''dosha'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''vata'' for example may mean aggravation of its coldness, lightness or ununctuousness.  

''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [[Ayurveda]] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds [Chakrapani on Cha.Sa.Nidana Sthana 1/11].  The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.

''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [[Ayurveda]] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds [Chakrapani on Cha.Sa.Nidana Sthana 1/11].  The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.

Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. (A H Ni. 1/)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/11, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>[12-5]

Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. [A.H Nidana Sthana 1/11] [12-5]

==== Significance of knowledge of ''nidana'' ====

==== Significance of knowledge of ''nidana'' ====

Sushruta described six stages of ''dosha'' vitiation and progression of disease known as ''shat kriyakala'' (periods of activity). They are as under:

Sushruta described six stages of ''dosha'' vitiation and progression of disease known as ''shat kriyakala'' (periods of activity). They are as under:

*''Sanchaya'' (accumulation): In this stage ''dosha'' undergo mild increase at their own site. This accumulation produces mild symptoms. If the person recognises these instincts and acts accordingly, the ''doshas'' can be brought to the normal condition without much effort. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/18, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,103.  </ref>

*''Sanchaya'' (accumulation): In this stage ''dosha'' undergo mild increase at their own site. This accumulation produces mild symptoms. If the person recognises these instincts and acts accordingly, the ''doshas'' can be brought to the normal condition without much effort. [Su.Sa.Sutra Sthana 21/18]

*''Prakopa'' (aggravation): In this stage, ''doshas'' gets vitiated further at their own site and exhibit some specific symptoms. By suitable changes in daily routine one can overcome these conditions. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/27, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,104. </ref>

*''Prakopa'' (aggravation): In this stage, ''doshas'' gets vitiated further at their own site and exhibit some specific symptoms. By suitable changes in daily routine one can overcome these conditions. [Su.Sa.Sutra Sthana 21/27]

*''Prasara'' (spreading): The status of ''doshas'' again increases further and ''doshas'' spread nearby sites and invade the sites of other ''doshas'' to produce symptoms. If the person continues to indulge in unhealthy food and regimen, then the disease progresses to the next stage. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/32, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,105. </ref>

*''Prasara'' (spreading): The status of ''doshas'' again increases further and ''doshas'' spread nearby sites and invade the sites of other ''doshas'' to produce symptoms. If the person continues to indulge in unhealthy food and regimen, then the disease progresses to the next stage. [Dalhana on Su.Sa.Sutra Sthana 21/32]

During the first three stages, the unhealthy food and activities increases the ''doshas'' and produces mild abnormalities. These three stages can be co-related with ''nidana'' (''hetu'') of ''nidanapanchaka''.

During the first three stages, the unhealthy food and activities increases the ''doshas'' and produces mild abnormalities. These three stages can be co-related with ''nidana'' (''hetu'') of ''nidanapanchaka''.

*''Sthanasanshraya'' (localisation): The increased ''doshas'' start accumulating at certain other places and lead to their abnormalities, especially in the ''srotasa''. It leads to four kinds of abnormal changes in ''srotasa''.<ref>Sushruta, Sushruta SamhitaSutrasthana Adhyaya 21/36, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>

*''Sthanasanshraya'' (localisation): The increased ''doshas'' start accumulating at certain other places and lead to their abnormalities, especially in the ''srotasa''. It leads to four kinds of abnormal changes in ''srotasa''. [Su.Sa.Sutra Sthana 21/36]

**''Atipravritti'' – Increased functioning of channels

**''Atipravritti'' – Increased functioning of channels

**''Sanga'' – Obstruction, blockage of channels

**''Sanga'' – Obstruction, blockage of channels

**''Vimargagamana'' – Movement of fluids in wrong direction

**''Vimargagamana'' – Movement of fluids in wrong direction

The site where these ''doshas'' lodge together to progress towards disease, is the site of origin of disease. This is the stage of actual commencement of the disease. It is characterized by manifestation of some moderate symptoms which indicate the forthcoming disease. These are known as ''poorvarupa''. This stage can be co-related with ''poorvarupa'' of ''nidanapanchaka''. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/33, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>

The site where these ''doshas'' lodge together to progress towards disease, is the site of origin of disease. This is the stage of actual commencement of the disease. It is characterized by manifestation of some moderate symptoms which indicate the forthcoming disease. These are known as ''poorvarupa''. This stage can be co-related with ''poorvarupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/33]

 

*''Vyakti'' (manifestation): This is the stage of full manifestation of the disease with all its characteristic sign and symptoms. These sign and symptoms are known as ''rupa''. This stage can be co-related with ''rupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/34]

*''Bheda'' (complication): In this stage, the abnormalities become more profound and irreversible in spite of the best treatment. Sometimes ''upadravas'' (complications) or ''arishta lakshanas'' (bad prognostic signs) can be seen in this stage. This stage also can be co-related with ''rupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/35]

*''Bheda'' (complication): In this stage, the abnormalities become more profound and irreversible in spite of the best treatment. Sometimes ''upadravas'' (complications) or ''arishta lakshanas'' (bad prognostic signs) can be seen in this stage. This stage also can be co-related with ''rupa'' of ''nidanapanchaka''.<ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/35, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>

The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.

The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.