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==== ''Rupa'' (clinical signs and symptoms) ====

==== ''Rupa'' (clinical signs and symptoms) ====

''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''doshas'', various stages viz., ''ama'' (immature), ''pakva'' (mature), etc. They however, do not include such other factors of diagnosis of the diseases like ''nidana, upashaya'' and ''samprapti''. [14].  

''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''doshas'', various stages viz., ''ama'' (immature), ''pakva'' (mature), etc. They however, do not include such other factors of diagnosis of the diseases like ''nidana, upashaya'' and ''samprapti''. <ref>Chakrapani, Commentator, Charaka SamhitaNidanasthana Adhyaya 1/9, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 195. </ref>.  

''Rupa'' includes the following signs and symptoms:

''Rupa'' includes the following signs and symptoms:

''Upashaya'' (pacification):

''Upashaya'' (pacification):

''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups: [15]

''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups:<ref>Chakrapani, Commentator, Charaka SamhitaNidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,195. </ref>

#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.  

#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.  

#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.  

#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.  

#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)

#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)

#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)

#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)

#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) [16]

#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) <ref>Chakrapani, Commentator, Charaka SamhitaNidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref>

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=====Various examples of ''upashaya'':=====

=====Various examples of ''upashaya'':=====

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Vagbhata defines upashaya as satmya (compatible). (A H Ni. 1/).[17]

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>

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. [18]

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. <ref>Chakrapani, Commentator, Charaka SamhitaNidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref>

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) [19][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]

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. [20]

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. <ref>Chakrapani, Commentator, Charaka SamhitaNidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,197. </ref>

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/)[21] [12]. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/)[22] 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 Ni. 1/)</ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref> [12]. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/)<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.  

''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 [https://en.wikipedia.org/wiki/Ayurveda 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. [23] 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 [https://en.wikipedia.org/wiki/Ayurveda 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. <ref>Chakrapani, Commentator, Charaka SamhitaNidansthana Adhyaya 1/11, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref> 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/)[24] [12-5]

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]

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

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

#Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases. [26]

#Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases. <ref>Agnivesha, Charaka, Dridhabala, Charaka SamhitaSutraasthana Adhyaya 10/14, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66 </ref>

#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult. [27]

#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult.<ref>Agnivesha, Charaka, Dridhabala, Charaka SamhitaVimanasthana Adhyaya 7/30, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 261 </ref>

#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.

#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.

#To treat the newly originated diseases, a physician should have the knowledge of the involved ''doshas'', causative factors and the location of the disease.  

#To treat the newly originated diseases, a physician should have the knowledge of the involved ''doshas'', causative factors and the location of the disease.  

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. [29]

*''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>

*''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. [30]

*''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>

*''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. [31]

*''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>

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''. [28]

*''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>

**''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''. [32]

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>

*''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''. [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''.<ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/34, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>

*''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''. [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''.<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''.