Roopa – Symptoms: Definition, Types, Benefits of its knowledge

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Roopa are the signs and symptoms of a disease. They are the indicators that explain the nature of a disease. They are also accompaniments of the disease and stay with the disease like the branches of the tree. When the disease is cured, the signs and symptoms of the disease too vanish away.

Synonyms of Roopa

Rupa, Linga, Lakshana
Lakshanas are manifested during the 5th stage of Shat Kriya Kala.

Shat Kriya Kalas are the 6 stages of disease formation explained by Sushruta Acharya.

When the 4th stage of pathogenesis – Sthana Samshraya Avastha (stage of lodgment of vitiated doshas in the weak and susceptible dhatus) advances to the 5th stage of pathogenesis i.e. Vyakta Avastha (stage of manifestation of disease with its signs and symptoms), the dosha dushya sammurchana (amalgamation of doshas and dhatus) which was incomplete and immature in the 4th stage, matures and gets completed in the 5th stage. In the process, the premonitory symptoms progress from the 4th to 5th stage and attain the form of Rupas- signs and symptoms.

The signs and symptoms of a disease may change from time to time according to the progress or retrogress of the disease. Certain symptoms may newly appear while some may disappear in the course of the disease.
Read related: Purvaroopa Definition, Types, Benefits Of Its Knowledge, Features

Definition

Only those signs and symptoms which denote a manifested disease (utpanna vyadhi) are called Linga. The word ‘only’ removes the nidana (causative factors), purvarupa (premonitory symptoms), upashaya-anupashaya (relieving and aggravating factors of a disease) and samprapti (pathogenesis) from the definition of Roopa.

Madhava Nidana also explains and defines Roopa as – ‘The same symptoms of the Purvarupa (premonitory symptoms) when get clearly manifested will be called as Roopas (symptoms)’. This definition explains that the roopas are transformed and matured forms of purvaroopas.

Charaka also defines Linga (signs and symptoms) as Pradurbhoota Lakshanas (clear cut symptoms of the disease).

Types

Types of Lakshana

  • Pratiniyata Lakshana – Disease specific symptoms
  • Doshaja Lakshanas – Dosha specific symptoms
  • Avasthika Lakshanas – stage wise symptoms of a disease
  • Atura Samvedhya Lakshanas – Symptoms recognized and expressed by the patient, Subjective symptoms, Symptoms of a disease
  • Vaidhya Samvedhya Lakshanas or Samsthana – Symptoms recognized and diagnosed by the physician, Objective symptoms, Signs of a disease

Importance

Importance of knowledge of Rupa
Symptoms give us the precise information about the vitiated dosha and also the qualities of vitiation.

Example – Shula (colic pain) suggests the vitiation of Vata Dosha along with imbalance of its ruksha (dryness) and sheeta (cold) qualities, which are the causes of the symptom (shula in this instance). Similarly, Daha (burning sensation) indicates the increase of ushna guna (heat quality) of Pitta and Bheda (splitting pain) indicates the increase of Teekshna guna (intense nature) of Pitta.

Similarly if the symptoms of 2 or 3 doshas are simultaneously observed, it suggests samsarga (vitiation of 2 doshas) and sannipata (vitiation of 3 doshas) respectively.

Rupa indicates the site of actual pathology in the body.

Example – Shira Shula (headache) indicates that the pain is in the head (shira). Udara Shula (abdominal colic pain) indicates that the pain is present in the abdomen.

Lakshanas help in conformation of a disease and its types.
Example – If kasa (cough), amsa parshwa abhitapa (rise in heat in the scapular region and flanks), jwara (fever), swarabheda (hoarseness of voice), parshwashula (pain in the sides of the chest and tummy), shirashula (headache), chardi (vomiting), rakta shteevana (spitting of blood), shwasa (dyspnea, breathlessness), aruchi (tastelessness) and varcha bheda (diarrhea) all these symptoms are collectively present in a disease, the disease can be definitely named and diagnosed as Rajayakshma. For this reason alone a group of symptoms taken collectively can be regarded as a disease.

Rupa also helps in making differential diagnosis as well as deciding the prognosis of the disease. When all the symptoms of a disease are collectively present in their full strength in a disease, the prognosis of a disease is said to be asadhya (incurable).

As Rupas indicate the vitiation of doshas indirectly, they also indicate the causes of vitiation of doshas.

Example, In Kaphaja Kasa (cough caused by vitiated kapha), sa kapha kasa (cough with expectoration) is the predominant rupa. This indirectly suggests that the kapha has been vitiated in this type of Kasa. This also suggests that the patient might have taken kapha aggravating foods and lifestyle activities. Hence the physicians can advice the patient to avoid kapha vitiating foods and lifestyle activities.

Rupa or Lakshana helps in deciding the line of treatment of a disease or Vyahdi.
Example, when there are symptoms of Pittaja Jwara or Fever caused by vitiation of Pitta, the medicines like Sutashekara Ras, Parpata, Tiktaka Kashayam etc can be prescribed. These medicines will be antagonistic to the causative dosha (i.e. pitta) and also the disease (jwara or fever). Similarly if it is Kaphaja Jwara (fever caused by vitiated kapha), medicines like Tribhuvana Kirti Ras etc shall be prescribed.

Salient features

Salient Features of Lakshanas, Signs and Symptoms of a Disease
They are the symptoms of a manifested disease – Lakshanas are the symptoms and signs of a disease. They get manifested after the disease gets manifested and stay along with the disease. They are the indicators and determinants of a disease. They define and describe a disease. The disease or vyadhi is identified by its name only when it has the signs and symptoms which are specific to it.

Rupas or Lakshanas occur in the Vyakta Avastha of Kriya Kala – Lakshanas (signs and symptoms of a fully manifested disease) are manifested in the 5th stage of Shat Kriya Kala or Samprapti i.e. Vyakta stage. Shat Kriya Kalas are the 6 chronologically occurring stages of a disease formation right from its onset to manifestation as explained by Acharya Sushruta. Vyakta Avastha is a continued stage of Sthana Samshraya stage. In the sthana samshraya stage the strongly vitiated doshas get lodged in the weak and susceptible tissues. The amalgamation of dosha and dhatus is called dosha dushya sammurchana. This amalgamation leads to certain reactions which leads to the manifestation of certain symptoms reflecting the initial insult caused to the tissues. These symptoms are called premonitory symptoms of a disease. These symptoms indicate the impending disease. If the disease is not treated in this condition, the next stage i.e. Vyakta Avastha is manifested in which the purvarupas attain the form of signs and symptoms. These Lakshanas denote a fully manifested disease.

Rupas occur due to completion of Dosha-Dushya Sammurchana – In the Sthana Samshraya stage of pathogenesis (kriya kala), the dosha dushya sammurchana begins and hence the signs and symptoms of a ‘yet to be manifested disease’ are manifested. They are called Purvarupaas. In the next stage of pathogenesis, i.e. Vyakta Avastha (stage of manifestation of a disease) the dosha dushya sammurchana which was immature and incomplete in the previous stage, will get matured and completed. When the dosha dushya sammurchana completes in the vyakta avastha, the purvarupas get matured into symptoms. The appearance of signs and symptoms is pointers which indicate that the disease has been formed. A disease is named only after its signs and symptoms i.e. lakshanas are manifested.

In the stage of Lakshanas, the strength of dosha dhatu amalgamation and symptoms will be comparatively stronger – In the Vyaktavastha, the dosha dushya sammurchana will be completed and the disease will be formed in its full and strong form. The damage formed to the tissues also will be more in comparison to the Sthanasamshraya avastha (in which the Purvarupas are formed). As a result when the symptoms of the disease are formed, they too will be stronger than their predecessors, i.e. Purvarupas. Prompt treatment of this condition will lead to the cure of the disease and consequentially the symptoms of the disease also will disappear at the end of the treatment. If proper treatment is not given in this condition, the Vyakta Avastha will progress to the Bheda Avastha (6th stage of Kriya Kala or Pathogenesis). Meanwhile the Lakshanas also will mature and become intense. In the Bheda Avastha as the disease progresses to an incurable level, the Rupas will take the form of complications of the disease.

The Rupas are clearly manifested in comparison to the Purvarupas – It is not that all the  premonitory symptoms progress to form the rupas, few purvarupas disappear in the process of transformation of the disease from the Sthana Samshraya to Vyakta stage. Those Purvarupas which progress to become Rupas are strongly and clearly manifested in comparison to the Purvarupas.

The Rupa Avastha (Vyakta stage of the disease) will progress to the Bheda Avastha or stage of complications when not treated properly – When the Vyakta Avastha or stage of disease formation is not well managed by proper treatment and dietetic corrections, it will progress to Bheda Avastha or stage of complications. The rupas in the Vyakta Avastha will gain strength and become the complications of the disease or vyadhi in the 6th stage of pathogenesis. All symptoms may not become the complications; few will progress to become upadravas (complications) while few symptoms may disappear in the process of transformation of the disease. Few new symptoms in the form of complications can add up in the Bheda Avastha making the clinical picture of the disease complicated and incurable.

Rupas coexist with the disease – Signs and symptoms of the disease will continue existing with their mother disease and the disease of which they are part and parcel. They exist in the form of inseparable relationship. When the disease is cured by proper administration of medicines and treatment, the symptoms too disappear. When the disease progresses to the stage of complications or Bheda Avastha, the symptoms too will progress into the next stage and remain with the disease in a stronger form, in the form of complications.

Some Rupas progress, some disappear – When the disease progress from the Vyakta Avastha to Bheda Avastha, some lakshanas too progress into Bheda stage and continue to stay along with the disease in the form of complications. Some symptoms may disappear in the pathway of transformation of the disease into the stage of complications.

Symptoms have varied presentations – They are either
disease specific (vyadhi pratyaneeka) or
Dosha specific (dosha pratyaneeka)
or stage specific (avasthanusara lakshanas).
The symptoms explained by patient are called Atura Samvedhya Lakshanas and the signs elicited and diagnosed by the physician are called as Vaidya Samvedhya Lakshanas.

Rupas occur at both mental and physical planes – Symptoms occur both at physical and mental planes. Example – Shula (pain), Raga (redness), Shotha (inflammation) etc are the symptoms occurring at the physical plane (shaareerika lakshanas). Similarly the symptoms like chinta (excessive thinking, anxiety), deenata (feel of helplessness), krodha (anger), bhaya (fear, panic), moha (confusion), vishaada (depression) etc are the symptoms which occur at the mental plane (manasika lakshanas). When these symptoms occur at both physical and mental plane, they are regarded as shareera-maanasa lakshanas (psychosomatic symptoms).

Rupas may be generalized or dosha specific – They may either be disease specific (roga pratyaneeka) or dosha specific (dosha pratyaneeka, depending on the chief causative dosha).

Roopas help in diagnosis of the disease and also in prompt treatment of diseases – They are the branches, fruits and leaves of a tree called disease. They cannot exist without each other. The Lakshanas define and describe a disease and the disease is a compilation of symptoms. When the disease exists, the symptoms exist and when the disease is destroyed, the symptoms are also destroyed. Thus the presence of the symptoms of a disease makes it easy to diagnose a disease. Similarly when the disease is diagnosed properly on the basis of availability of its r, a correct line of treatment can be drafted and the disease can be comprehensively treated on the basis of diagnosis of that disease.

The number and strength of the Rupas determine the prognosis of a disease – The prognosis of the disease will become asadhya (incurable) if there is more number of rupas in a disease. Similarly, if the severity of the lakshanas is more, the disease becomes incurable.  On the contrary if there is less number of rupas, which are feeble and of low strength, the disease becomes easily curable (sadhya).

In some cases, the predominant lakshana of a disease will itself be the disease – In few conditions, the predominant lakshana of a disease (pratyatma or pratineeyata lakshana) of a disease will be the characteristic feature

of the disease, i.e. the main lakshana will itself be the vyadhi (lakshana and vyadhi are one and the same). Or the vyadhi itself is its main lakshana. Example, Atisara (drava mala pravritti, loose stools) is the predominant symptom (lakshana) of Atisara Vyadhi (Atisara disease, diarrhea), Similarly Chardi (vomiting) is the predominant lakshana of Chardi Disease (vomiting disease) etc.

Types

Types of Roopa or Lakshana

Pratiniyata Lakshana (Disease specific symptoms)
Doshaja Lakshanas (Dosha specific symptoms)
Avasthika Lakshanas (stage wise symptoms of a disease)
Atura Samvedhya Lakshanas (Symptoms recognized and expressed by the patient, Subjective symptoms, Symptoms of a disease)
Vaidya Samvedhya Lakshanas or Samsthana (Symptoms recognized and diagnosed by the physician, Objective symptoms, Signs of a disease)

Pratiniyata Lakshana

Pratiniyata Lakshana (Disease specific symptoms)

The specific symptoms of a manifested disease are called Pratiniyata Lakshanas. These lakshanas define the disease of which they are a part. They are specific to only that disease. These lakshanas are also called by the names Pratyatmaka Lakshanas or Avyabhichari Lakshanas. These symptoms help in the diagnosis of a disease i.e. just by looking at these signs and symptoms, we can recognize the disease because those set of symptoms are present only in that disease and not in other diseases.

Example – Sweda Avarodha (obstruction to perspiration or absence of sweating), Santapa (rise in temperature in the body, mind and senses) and Sarva Anga Grahana (heaviness or gripping discomfort in the entire body) together constitute the Pratiniyata or Pratyatmaka Lakshanas of Jwara (fever). These set of symptoms define and describe Jwara and helps in diagnosing and naming the disease as Jwara. The same set of symptoms is not present in any other disease. Similarly Drava Mala Pravritti or loose stools is the pratiniyata lakshana or specific symptoms of Atisara (diarrhea).

Doshaja Lakshanas

Doshaja Lakshanas (Dosha specific symptoms)

The symptoms of the disease specifically produced by the vitiated doshas are called Doshaja Lakshanas. These symptoms and signs are caused by the vitiated dosha or doshas causing the disease.

Example – Rukshata (dryness), Khara (roughness), Toda bahula (pricking sensation) are dosha specific symptoms of Vataja Kushta (skin disease caused by vitiation of Vata) while Ati Sweda (excessive sweating) and Raga (reddish discoloration) are the dosha specific symptoms of Pittaja Kushta (Pitta predominant skin disorders).

Avasthika Lakshanas

Avasthika Lakshanas (stage wise symptoms of a disease)

The signs and symptoms which develop according to the stage or state of a disease are called Avasthika Lakshanas. These symptoms vary from stage to stage.

Examples –

  • Signs and symptoms of a disease occurring during the Vegavastha (stage of bouts of a disease, active phase) and Avegavastha (bout free stage of a disease, inactive or rest phase of a disease) of a disease,
  • Symptoms manifesting in the Samavastha (stage of disease associated with ama or immature essence of improperly digested food, formed in stomach and is put into circulation, which tends to block the channels of the body and cause many diseases due to its stickiness) and Niramavastha (stage of disease devoid of ama),
  • Symptoms occurring in different stages of Kriyakala,
  • Symptoms occurring in the Dhatugata Avasthas of a disease (disease lodged in the tissues) etc.

Atura Samvedhya Lakshanas

Atura Samvedhya Lakshanas (Symptoms recognized and expressed by the patient, Subjective symptoms, Symptoms of a disease)

The symptoms felt and expressed by the patient are called Atura Samvedhya Lakshanas. The physician comes to know about these symptoms only if and when the patient tells him about them.

Example – Vedana (pain), Klama (fatigue), Rukshata (dryness), Daha (burning sensation) etc.

Vaidya Samvedhya Lakshanas

Vaidya Samvedhya Lakshanas or Samsthana (Symptoms recognized and diagnosed by the physician, Objective symptoms, Signs of a disease)

The symptoms of the disease which are only identified and diagnosed by the physician are called Vaidya Samvedhya Lakshanas. The physician finds out these signs after conducting a thorough Pareeksha (examination of the patient) of the patient.

Example – Shotha (swelling), Raga (redness), Ushnata (rise in temperature) etc.
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