Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Acharya Sushruta, in the context of Vyadhi Pariksha – examination of diseases has touched upon the concepts of Upasarga, Prakkevala and Anya Lakshana types of diseases.
Ref – Sushruta Sutra Sthana Chapter 35, verses 18, 19 (Su.Su.35/18, 19)
In this article we will try to understand these three conditions.
Vyadhi pariksha: Examination of diseases
व्याधिविशेषास्तु प्रागभिहिताः; सर्व एवैते त्रिविधाः- साध्या, याप्याः प्रत्याख्येयाश्च । तत्रैतान् भूयस्त्रिधा, परीक्षेत-किमयमौपसर्गिकः; प्राक्केवलः, अन्यलक्षण इति। तत्र, औपसर्गिको नाम यः पूर्वोत्पन्नं व्याधिं जघन्यकालजातो व्याधिरुपसॄजति, स तन्मूल एवोपद्रवसंज्ञः, प्रक्केलमो नाम यः प्रगेवोत्पन्नो व्याधिरपूर्वरूपोऽनुपद्रवश्च; अन्यलक्षणो नाम यो भाविष्यद्वचाधिख्यापक:, स पूर्वरूपसंज्ञः । तत्र, सोपद्रवमन्योन्याविरोधेनोपक्रमेत, बलवन्तमुपद्रवं वा; प्राक्केवलं यथास्वं प्रति कुर्वीत; अन्यलक्षणे त्वादिव्याधौ प्रयतेत॥१८॥
According to Acharya Sushruta, all the diseases (which were detailed earlier through chapter 1 and 24) and each of these diseases are of three types. They are –
1. Sadhya Vyadhi – curable diseases
2. Yapya Vyadhi – diseases which are controllable / manageable but not totally curable
3. Pratyakhyeya Vyadhis – incurable / reject-able diseases
Examination of these three diseases – These three types of diseases should once again be examined. This is to determine to which among the below mentioned categories they belong to.
– Upasarga – secondary diseases
– Prak-kevala – primary diseases or
– Anya laksana – symptoms other than its own
This also means to tell that all the above said diseases i.e. Sadhya, Yapya for Pratyakhyeya type of diseases belong to one among the Upasarga, Prakkevala or Anya Lakshana categories.
Now, we will understand about these three categories of diseases.
1. Upasarga Vyadhi
Sometimes, a disease or condition manifests after the main disease has manifested. Such a disease which occurs after the main disease is called Upasarga. The Upasarga develops much later than the existing (already manifested) disease and after that it remains along with the main existing disease.
Since Upasarga branches out from the main disease or occurs as an effect of the main disease, it is also called as Upadrava i.e. complications of a disease or associated secondary disease.
2. Prakkevala Vyadhi
Prak-kevala Vyadhi is opposite of Upasarga. Sometimes, a disease or condition occurs earlier than the main disease i.e. the disease which manifests later.
So, Prak-kevala occurs first and after that the main disease gets manifested. This condition does not have Purvarupas i.e. premonitory symptoms. Prak-kevala will also not have Upadravas i.e. complications.
3. Anya Lakshana
Sometimes a disease or condition which indicates that a disease will be manifesting in the near future. They are called Anya Lakshanas. Anya Lakshanas are also known as Purvarupas – the premonitory symptoms of a disease.
From treatment perspective
When the main disease and its Upasarga / Upadrava i.e. complications coexist or when a complication is associated with the main disease, both these conditions shall be treated in such a way that there is no interference with each other.
On the other hand, if the complications are severe in nature, they should be addressed first. Later, the primary disease should be treated as required, appropriately.
In case of Anya Lakshana – the primary disease itself should be treated first.
Acharya Sushruta also says,
नास्ति रोगो विना दोषैर्यस्मात्तस्माद्विचक्षणः ।
अनुक्तमपि दोषाणं लिङ्गैर्व्याधिमुपाचरेत् ॥१९॥
All the diseases are caused by aggravated doshas, as a rule. No disease is manifested without the involvement of doshas. Therefore, a wise physician should identify the involved dosha or doshas involved in the pathogenesis of a disease, in spite of them not being mentioned and should treat them promptly.
