Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
It is important to know anything beforehand, especially when the information is related to an impending disaster or a disease. This will help us to keep ourselves prepared for the situation and tackle it efficiently.
Purvaroopa – premonitory symptoms are indicators of the impending disease. They inform us that some chain of untoward events are occurring in the body and may in near future sum up into full blown diseases. Purvarupa is the earliest symptom of the disease.
When purvarupa get manifested, the disease is still in an unripe, developing form. This is the best time to intervene in the disease process by administration of comprehensive treatment. It is important to identify the disease at this stage, i.e. the stage of prodromata.
Read related: Nidana: Meaning, Word Derivation, Definition
Nidana Panchaka are the 5 tools of examination of nature, quality and quantity of a disease. The knowledge of Nidana Panchaka is mandatory if the nature of the disease needs to be understood in a comprehensive way. Poorvaroopa is one among these 5 tools of disease examination. The knowledge of Poorvaroopa helps in diagnosing and aborting the disease in its earlier stages of its manifestation. Knowledge of Purvarupa also helps in identifying the disease in its earliest form and also to prevent the disease process and progress. The knowledge of Purvarupa also helps in treating the disease at the earliest, even before we have a full blown disease at our disposal.
Read related – Roga, Rogi Pareeksha: Examination Of Disease And Patient
Definition of Purvarupa / Pragroopa –
Pragrupa are said to be those symptoms which are manifested before the manifestation of the main disease (which they denote).
Acharya Vagbhata further clarifies telling that Purvarupas (premonitory symptoms) are the symptoms of the forth coming disease. They do not denote the peculiarity of the dosha taking part in the samprapti (pathogenesis) of the disease. These symptoms are latent (hidden, not clear), fewer and not clearly manifested (feebly manifested).
Madhava Nidana defines Purvarupa as ‘Avyakta Lakshanas’ i.e. feebly manifested symptoms or the hidden symptoms of the forthcoming disease.
Madhava Nidana further stress on the definition of Purvarupa and defines it as ‘Only those symptoms which indicate a bhavi vyadhi or a forthcoming disease are called Purvarupas’. By using the word ‘only’, the author has eliminated or disapproved the inclusion of Nidana (causative factors), Rupa (symptoms of a manifested disease), Upashaya (relieving and aggravating factors of a disease) and Samprapti (pathogenesis of a disease) in the definition of Purvarupa.
A more appropriate definition of Purvarupa given by Madhava Nidana goes as – ‘During the process of Sthana Samshraya i.e. amalgamation of vitiated doshas and susceptible dhatus, the vitiated doshas produce certain unclear symptoms which indicate the forthcoming disease. These symptoms of the yet to be manifested disease are called Purvaroopas’.
2 Types of Purvarupa
- Samanya Purvarupa (Generalized premonitory symptoms)
- Vishesha Purvarupa (Dosha specific premonitory symptoms)
Another classification of Purvarupa as explained in Madhava Nidana is as below mentioned –
- Shareera Purvarupas – premonitory symptoms limited to physical plane
- Maanasa Poorvaroopas – premonitory symptoms limited only to the mental plane
- Shaareea-Maanasa Purvarupas – premonitory symptoms which occur both at physical and mental plane
Samanya Purvarupa (Generalized premonitory symptoms)
The premonitory symptoms which give a clue regarding the forthcoming disease without giving an idea of the doshas involved are called Samanya Purvarupas. This means to tell that the Samanya Purvarupas indicate the forthcoming disease but do not give us an idea of the dosha involved in the causation of disease or its types.
Example – Shrama (fatigue), Arati (discomfort, body pains) and Vivarnata (discoloration) etc are the purvarupas or premonitory symptoms of Jwara (fever). These symptoms suggest that the fever is going to be manifested after sometime. But these symptoms will not reveal whether the Jwara which is supposed to get manifested is Vataja (fever caused due to vitiated vata) or Pittaja (fever caused due to vitiated pitta) etc.
Vishesha Purvarupa (Dosha specific premonitory symptoms)
The symptoms which not only give a clue regarding the forthcoming disease but also give us an idea of the dosha taking part in the causation of the disease are called Vishesha Purvarupas or dosha specific premonitory symptoms.
Example – Sushruta has explained Yawning as a purvarupa of Vataja Jwara (fever caused by vitiated vata), burning eyes as the purvarupa of Pittaja Jwara (fever caused by vitiated pitta) and tastelessness as purvarupa of Kaphaja Jwara (fever caused by vitiated kapha).
2. Purvarupas are classified as – psychological, somatic, psycho-somatic –
Shareera Purvarupas Physical premonitory symptoms:
The premonitory symptoms of a disease occurring only at the physical level are called Shareera Purvarupas. Example – shrama, aruchi, jrimbha, netra daha etc are shaareerika purvarupas.
Maanasa Poorvaroopas – psychological prodromal symptoms:
The premonitory symptoms of a disease appearing only at the mental level are called Maasa purvarupas. Example – inclination to common desires, aversion to the elderly advices etc.
Shareera Manasa Purvaroopa
Shaareea-Maanasa Purvarupas – psycho-somatic –
These are the prodromal symptoms of a disease which occur both at physical and mental planes. Example – Desire for taking amla (sour) and lavana (salt) tastes or foods rich in these tastes and dislike of madhura rasa (sweet taste or foods rich in sweet taste are examples of sharira maanasa purvarupas. In this instance, desire and dislike (of tastes) are mental manifestations and requirements and non-requirements of these tastes of that particular person is physical manifestation.
Importance of Purvaroopa
Importance of having knowledge of Poorvaroopas
Purvarupa knowledge helps in diagnosing the disease early – The efforts of the physician should be to detect the pathology as early as possible and try to control and cure it. Purvarupas are the best early clues regarding the developing pathology – dosha dushya sammurchana. Hence the forthcoming disease, its nature, severity etc can be diagnosed at an early stage before the manifestation of the main disease with the help of knowledge of Poorvaroopa.
Knowledge of Purvarupas helps in aborting the disease process at the earliest – the knowledge of Poorvarupas helps in halting the disease process before its progression into the main disease and complications. This is because the poorvaroopas help in early recognition of the diseases, early understanding of the pathology and pathological elements, and nature of the impending disease.
Knowledge of Purvarupas help in stopping the next stages of disease formation of Kriya Kala – The physician can prevent the Vyakta (stage of manifestation of disease and manifestation of symptoms) and Bheda (stage of complications) of the disease when he has a precise knowledge of Purvarupa avastha.
Knowledge of Purvarupa helps in early start of treatment – With good knowledge of Purvarupa the physician can diagnose the disease at the earliest; this will help him to plan the treatment and medications at the earliest, before the disease gets manifested with its full blown symptoms. The treatment at this stage is also easier and doesn’t need an aggressive approach. Appropriate treatment planned and implemented at Purvarupa stage succeed in preventing the disease or in minimizing the severity of the disease. If the pathology is destroyed in Purvarupa avastha itself, the disease pathology doesn’t progress to its further stages.
Knowledge of Purvarupa helps in knowing the prognosis of a disease – The purvaroopas indicate the Sadhya Asadhyata (prognosis) of a disease. The greater the number of premonitory symptoms and more the severity of the nature of premonitory symptoms indicate the severity of vitiation (morbidity) of the doshas and severity of the nature of the disease. If the poorvaroopas of a given disease are more in number or if the purvarupas are severe in intensity, then the prognosis of the disease will be difficult to cure or impossible to cure.
Similarly the less number of purvaroopas of any disease or their feebleness indicate good prognosis of the disease (saadhya), i.e. that the disease can be easily curable.
Salient Features of Purvarupas
Purvarupas are the symptoms which occur before the manifestation of the disease – After the disease gets manifested, they may continue along with the course of the disease or disappear before the actual disease is manifested.
Purvarupas occur in the Sthanasamshraya stage of Kriya Kala – Purvarupas occur in the 4th stage of Shat Kriya Kala or Samprapti i.e. Sthana Samshraya stage. Shat Kriya Kalas are 6 stages of manifestation of the disease (pathogenesis) explained by Sushruta Acharya. The vitiated doshas which have left their chief sites in the third stage of pathogenesis i.e. Prasara avastha (stage of overflow of doshas), flow all through the body in search of a place for lodgment. When they find a susceptible dhatu or dushya (tissue), they invade those tissues and get lodged in the dhatus. This lodgement is called Sthana Samshraya. The amalgamation of vikrita dosha (vitiated dosha) and durbala dhatu (weak and susceptible tissue which cannot protect self) is called dosha dushya sammurchana. When dosha dushya sammurchana starts following sthanasamshraya of doshas, the prodromal symptoms are manifested. These symptoms indicate the initial damage of the tissues and demands attention in the form of prompt treatment.
Prodromal symptoms occur due to Dosha-Dushya Sammurchana – Purvarupas occur due to the amalgamation of vitiated (morbid) doshas and weak, susceptible dhatus in the sthana samshraya stage i.e. dosha dushya sammurchana. This occurs due to initial contact of doshas and dushyas and the reaction occurring therein. This occurs following the sthanasamshraya or lodgment of doshas in the dhatus.
In the stage of Purvarupa, the strength of dosha dhatu amalgamation and symptoms will be weak – In Purvarupas, the dosha dushya sammurchana will be in a primitive stage (weak); therefore the damage to the tissues also will be least. Since the damage of the tissues is less, early diagnosis of this condition and prompt treatment will prevent the disease progression and consequent formation of stage of manifestation of disease (Vyakta avastha, i.e. 5th stage of pathogenesis) and stage of manifestation of complications (Bheda avastha i.e. 6th stage of Kriya Kala).
The Purvarupas are fewer and weaker than Rupas – The prodromal symptoms will be fewer and weaker in comparison to the rupas (symptoms of a manifested disease). They are also unclear and latent. This by itself is characteristic feature of the Purvarupas. Since Purvarupas are fewer and feebler, the treatment of the disease at this stage i.e. stage of prodromata symptoms will be comparably easy.
Samanya Poorvaroopas will not reveal the dosha involvement in the formation of a disease – In the beginning of manifestation, the purvarupas (samanya purvarupas) might indicate an impending disease but will not reveal the doshas involved in the causation of the disease. In some cases or in later stages, the involvement of doshas too will be indicated (vishishta purvarupas).
The Purvarupa avastha can progress to Vyakta and Bheda Avastha when not treated promptly – When the purvarupas get matured and get clearly manifested in the 5th stage of pathogenesis (kriya kala), i.e. Vyakta avastha, they will denote the manifested diseases and will be called as Rupas (symptoms of a manifested disease). Further progression of the disease beyond stage of manifestation will lead to stage of complications (Bheda Avastha). These two stages are difficult to treat; the stage of complications is more difficult or impossible to treat. The purvarupas will lead to rupas and upadravas (complications) when the disease is not manifested while at the stage of manifestation of Purvarupas (sthana samshraya).
Some premonitory symptoms continue into the disease process – Some of the Purvarupas may continue to exist in the actual condition of the disease also (manifested disease). In this instance, the purvarupas have matured to form rupas or the purvarupas have been transformed into rupas and clearly manifested. Example, yawning which is a purvarupa of jwara, will also (may) continue to persist even in the acute condition of manifested jwara i.e. in the rupa avastha of the jwara.
Some Poorvaroopas progress, some disappear – All the Purvarupas do not progress to form the Rupas in the Vyakta Avastha. Some purvarupas disappear at the stage or during the process of becoming rupas.
Pragrupas contradictory to Rupas may also be formed – Very often, the purvarupas quite contradictory to the rupas may also occur. Example, instead of sensation of heat (santapa), rigors and chills occur before the onset of fever. Similarly constipation (vidsanga) occurs before manifestation of diarrhea in the purvarupa of atisara (diarrhea).
Prodromal symptoms occur at both mental and physical planes – Purvarupas may be limited to the body (shareera purvarupas), mind (manasa purvarupas) or both (shareera maanasa purvarupas).
Purvarupas may be generalized or dosha specific – Purvarupas are also Samanya Purvarupas (generalized purvarupas, do not specify the dosha involved in the pathogenesis of the disease) and Vishesha Purvarupas (premonitory symptoms indicating the dosha involved in the pathogenesis of the disease).
Premonitory symptoms form the keys for early diagnosis and treatment of a disease – Knowledge of Purvarupas helps in early diagnosis and early treatment of a disease. Knowledge of Purvarupas also may help in preventing the diseases and its complications.
The number and strength of the Purvarupas determine the prognosis of a disease – The prognosis of the disease will become asadhya (incurable) if there are more number of purvarupas in a disease or if the severity of purvarupas is more. On the contrary if there is less number of purvarupas, which are feeble and of low strength, the disease becomes easily curable (sadhya).
Appearance of Purvaroopa in Sthanasamshraya
Formation of Purvarupas in the Sthanasamshraya stage of KriyaKala
स्थान संश्रयिणः कृद्धात् भावी व्याधि प्रबोधकम्।
दोषाः कुर्वन्ति यत् लिङ्गं पूर्वरूपं तद् उच्यते॥(मा.नि)
Shat Kriya Kalas are the 6 stages of disease formation or 6 stages of pathogenesis explained by Acharya Sushruta.
Sthanasamshraya is the 4th stage of Shat Kriya Kala or 6 stages of formation of disease
Sthana = Place, site (tissues of the body in this instance)
Samshraya = Lodging, invade
Sthanasamshraya is the stage of pathogenesis in which the vitiated doshas lodge in the tissues causing damage therein.
In this stage, the vitiated doshas which are displaced from their places in the 3rd stage of Kriya Kala (Prasara, or stage of overflow) are circulating in the body in seek of a lodgment. When these vitiated and aggressive doshas find a weak and susceptible dhatus (tissues), they invade the dhatus and get lodged in them. This is called dosha dushya sammurchana (amalgamation of strong doshas and weak and susceptible dhatus).
Since the doshas get lodged (samshraya) in certain places i.e. tissues (sthana), this stage of kriyakala is called sthanasamshraya or stage of lodgement of doshas.
These doshas in the later part contaminate and damage the dhatus leading to the manifestation of various diseases (depending on the tissue and organ in which these vitiated doshas get lodged).
In this stage the amalgamation of doshas and dushyas (dhatus) is not complete (is immature) and the samprapti (pathogenesis) of the disease is not complete, therefore the disease is also not manifested.
The dosha dushya sammurchana can be halted and the further stages of kriya kala i.e. Vyaktha Avastha (stage of manifestation of disease) and Bheda Avastha (Stage of complications of the disease) can be prevented by early diagnosis and treatment, thus preventing the disease formation. (The disease is completely formed and named in the Vyakta Avastha (5th stage).
During the process of Sthana Samshraya (when the samprapti has not been completed and the disease has not yet manifested), the vitiated doshas produce certain unclear symptoms which indicate the forthcoming disease. These symptoms of an impending disease (yet to be manifested disease) are called Purvaroopas.
The symptoms which occur after the completion of dosha dushya sammurchana (complete contamination of dhatus by morbid dushyas or dhatus) are called Lakshanas (symptoms of a manifested disease).
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