World Journal of Pharmaceutical Research

Vinod et al. World Journal of Pharmaceutical

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Volume 8, Issue 6, 247-254. Review Article ISSN 2277– 7105

1

CLINICAL IMPORTANCE OF VYADHI SANKARA- A REVIEW

Kumar Vinod*1, Patra Satyanarayan2, Singh Ashok Kr. Madan3 and Gujjarwar
Vidula4

1,2
P.G. Scholar, PG Dept. of Rog Nidan Evum Vikruti Vigyan, Ch. Brahm Prakash Ayurved
Charak Sansthan, Khera Dabar, Najafgarh, New Delhi-73.
3
Associate Professor, PG Dept. of Rog Nidan Evum Vikruti Vigyan, Ch. Brahm Prakash
Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi-73.
4
HOD and Professor, PG Dept. of Rog Nidan Evum Vikruti Vigyan, Ch. Brahm Prakash
Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi-73.

ABSTRACT
Article Received on
24 Feb. 2019, The main aim and objective of Ayurveda is to maintain the health of
Revised on 17 March 2019, Swastha Purusha and to eradicate the diseases of Atura Purusha. For
Accepted on 07 April 2019
DOI: 10.20959/wjpps20196-14739 this purpose, the diagnosis of diseases is very important and for this
purpose Nidana Panchak plays a vital role which has been explained
elaborately in Nidanasthana of Charaka Samhita. In the same section,
*Corresponding Author
Kumar Vinod there is mentioned about the concept of Sankara which is one of most
P.G. Scholar, PG Dept. of ignored, but is very useful tool for diagnosis of a diseased condition as
Rog Nidan Evum Vikruti per ayurvedic principles. The concept of Vyadhi Sankara which has
Vigyan, Ch. Brahm Prakash
been explained at the end of Nidanasthana of Charaka Samhita plays
Ayurved Charak Sansthan,
an important role for diagnostic approach for many diseases. The word
Khera Dabar, Najafgarh,
New Delhi-73. Sankara further explained as Hetu-Sankara, Linga-Sankara, Chikitsa-
Sankara & Vyadhi-Sankara. Here, out of these four types of Sankara,
Vyadhi Sankara has been explained to understand its importance for the differential diagnosis
of the various disease as per Ayurveda. Vyadhi Sankara is a group or collection of two or
more disease showing clinical presentations at a similar time.

KEYWORDS: Atura, purusha, Nidanpanchak, Vyadhi Sankara.

INTRODUCTION
In Ayurveda, the healthy as well as diseased state of a person is totally dependent on the
fundamental principle of trisutra[1] i.e. Hetu, Linga, and Aushadha as well explained by

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Acharya Charaka in his texts. For better understanding & treating the Atura Purusha,
Acharya Charaka has explained his concepts in different sthana (sections) of his text, like the
Nidanasthana, Chikitsasthana and Siddhisthana. In Nidanasthana he has mainly explained
the etiopathogenesis of eight diseases which form basic plateform for understanding & curing
all those diseased states as explained by Acharya Charaka in his texts. While explaining
nidana, poorvaka, samprapti (etiopathogenesis) of Apasmara in nidanasthana, Acharya
Charaka has also given the concept of Sankara[2] and highlighted the importance of it in
understanding and analysing the different diseases in Chikitsasthana, but ironically the
concept of sankara keeps less importance now a days. The word Sankara is used by Acharya
Charaka in different ways as Hetu-sankara, Linga-sankara, Vyadhi-sankara and Chikitsa-
sankara.[3] As per Acharya Charaka, Hetu-sankara helps in better understanding of different
aspects of nidana in causation of a disease, while Linga-sankara helps in analysing
differences between symptoms and a disease and how the same or different symptoms are
manifested in one or many diseases. Vyadhi-sankara has been found helpful in making
differential diagnosis when more than two presentations are seen at a time.

What is Vyadhi Sankara?

According to Acharya Chakkarpani, Vyadhisankara means Vyadhimelaka ( mixture or
combination or group of two or more diseases) and said as kricchratama (most difficult to
treat) which happens because of - (1) prayoga-aparishuddhatwat (improper treatment
strategies) which is seen as –“Amaatisaare sthambhanamkrutam dosham samsthabhya shoola
anaaha adhmaanaadi janayet”[3] & (2) second causative factor for Vyadhi Sankara is
Anyonyasambhavaat means parasparakaranaroopatwat (one causing another or caused from
pre-existing condition)[3] eg-pratishyaayohi swaroopena eva kaasa syakaaranamsa cha
rajkshmina.[3] As per Acharya Charaka, shuddhastushamyet-yonakopyet (treatment adopted,
should alleviate the present imbalance in doshas and dhatus and should never lead to
aggravation of another dosha or a new disease). So, we can say that if given treatment is not
shuddha(proper), it can lead Vyadhi Sankara. To understand Vyadhi Sankara, the knowledge
of nidanarthakararoga and the concept of Upadrava is very essential.

Understanding Nidanaarthakara Roga–according to Acharya Charaka when one disease

become the cause or Nidana for another disease i.e, act as vyadhijanaka of other disease then
it is known as nidanaarthakararoga the word nidanaarthkararoga as per chakrapani means

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nidanasyaarthamprayojanam, vyadhijananamtatkarotiitinidanarthkarah which can be seen

as follows- (ch.ni.8/16-19)
 Jwara→raktapitta→shosha
 Plihavrudhi→udararoga→shosha
 Arsha→udararoga→gulmaroga
 Pratishyaya→kasa→kshya→shosha

The above description also shows that nidana is the entity which is responsible for the
causation of a disease and when a disease itself becomes a causative factor for some other
disease, then it is called as nidanarthakararoga.

Concept of Ekaarthkari and Ubhayarthakari – the primary disease which now exists as
nidana or hetu may or may not continue to exist with the secondary disease. According to
Acharya Chakrapani, if the hetu which causes the vyadhi subsides after the onset of
secondary disease then it is known as Ekaarthkari and if it exists after the onset of secondary
disease then it is known as Ubhayarthakari.

Concept of Upadrava (complications) – the clinical presentations that are found in roga-
uttarkala (not along with the main disease) are called as upadrava. These presentations are
due to dosha-dushyassammurchhna of the primary disease only, so they also have similar
etiological factors as that of the primary disease.[4] According to madhavnidana, “tatra
upadravo rogaarambhka doshaprakopajanyo anyovikara”.

Also, upadrava is an episode which develops after the manifestation of main disease and
subsides by giving treatment to main disease. Treatment is not antagonistic to main disease,
but in certain cases, upadrava needs special attention towards treatment as upadrava are
much more difficult to treat as they appear in a diseased body severe upadrava require
immediate care.

Understanding “prayogaaparishuddhatwat” with examples

 In context of navajwara, sadyovamana (emesis) leads to hrudroga (heart disease) this is
because of doshaanutklishta stage i.e, dosha are not ready to be expelled out.
“Kaphapradhanaanutklishtaandoshaanamashayasthitaan”[5] these are the consequences
for performing sadyovamana, in case of navajwara, though there is dosha in amashaya if

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it is not utklishta and chalayamana, (ready to be expelled and movable), administration of

emesis would lead to hridroga, swasroga, anah etc.
 In Raktapitta, if stambhana is done in raktadusti then it will lead to galagraharoga.[6] In
the treatment of Raktapitta, langhana (fasting) is the first line of treatment[6] because the
initial stage of Raktapitta may be associated with Ama (intermediary component). If
stambhana is done without saamadoshapachana (metabolism), then it will lead to
Galagraha, pootinasa, moorcha, aruchijwara[6] and so on.
 In visarpa (erysepalis), intake of medicated ghee in bahudosha stage leads to suppuration
of twakmansarudhira. Andifghee is given without administering suitable purificatory
therapies like vamana/virechana (based on location and doshic dominance), then it will
also cause suppuration of twak and so on.[7]

Thus, above discussion reveals that if the given treatment is not suddha (proper), it will lead
to vyadhisankara.

Examples of Anyonyasambhavaat – due to some similarities in nidana/ dosha/

adhisthana(dushya) it is the tendency of a disease to cause another disease. E.g., pratishyaya
leads to many diseased conditions.[3]

Vyadhisankara is nothing but a presentation of two or more diseases together but these
presentations can be mistaken with nidanarthakararoga or upadrava so it is very essential to
differentiate among them, for doing this following points to be considered –
1. Co-existance of two or more diseases may be considered as nidanarthkararoga.
2. If primary disease subsides after causing a secondary disease then it is called as
nidanaarthkararoga.

Explainations of Nidanarthkararoga
1. Jwarasantapaatraktapittamudeeryate[8]– (i.e. jwara causes raktapitta) but how one can
differentiate it from uppadrava? The answer to this is, as nidanas for both of these
conditions are ushnaaaharaviharasewana and also if in jwara, the same nidanasewana
carried out excessively it also shows some affliction to other adhisthana of rakta and
causes vigunta making it more favourable for causing raktapitta. So, if a disease targets
another dushya or adhisthana then concept of nidanarthkararoga is to be considered.
2. Arshebhyojathara[8]– (i.e Arsha, causes jathararoga) as we know that Apanavayudushti
causes arsharoga which further causes apanadushti creating a viscious circle.[9]

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Apanadushti is an important component in samprapti (pathogenesis) in jathararoga.

Formation of Arsha causes a change or dushti in Apanapradesha (lower abdomen),
leading to manifestation of jathararoga and finally to udararoga (ascites). It is also
important to know that a disease can produce another disease only when there is the
presence of sakaharibhava (supportive/conductive factors) that is why nidanas are
specific for specific diseases. we have seen the co-existance of two or more diseases in
upadrava as well, due to continuation of nidanasewanaupadravas are caused by dosha-
dushya of primary roga only. This differentiates upadrava from nidanarthakararoga.
Nidanasewana if continued, affect dosha and dushya(upto deeper levels) of the disease
leading to complications in terms of severity and prognosis. For example – Upadrava of
vatarakta[10] – aswapnaarochakashwasamamsakothashirograha and so on, these
presentations are the offshoots of same dosha and dushya. So, by looking at,
1. Dushya (dhatu, the bodily constituents) involved in primary and secondary roga.
2. Nidanas (etiological factors) of the two diseases, one can decide whether the condition is
a nidanarthakararoga or an upadrava.

The importance of this differentiation is necessary as, the concept of nidanarthakararoga is

important to see the manifestation of the secondary disease.

If it is an upadrava, then separate line of treatment need not be planned, as upadravas are the
only offshoots of the primary disease and will get subside with the subsidence of primary
disease unless these are not severe, only worst and complicated forms of upadrava need
special attention and treatment first, and the primary disease to be attended their after.

Why is the concept of Sankara explained in nidanasthana?

This probably is based on trisutrasiddhanta.[1] i.e., Hetu, Linga and Aushadha and extended
and essential part of hetu (cause), linga (symptom) is Vyadhi And Acharya Charaka has
clearly mentioned that clear distinction between linga (symptom) and vyadhi (disease) has to
be made.[11,12] To differentiate symptoms and disease clearly Vyadhisankara has been
separately mentioned. In sutrasthana, trisutra has been explained as having importance in
healthy as well diseased person. But while dealing with Sankara it is exclusively for the
diseased conditions. This is the reason why it has been explained in nidanasthana.

Also the concept of nidanarthakararoga is described before vyadhisankara, as there is a thin

line of distinction between these two concepts and because of the closeness of these two

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concepts, nidadanarthakararoga is mentioned first and after that only the tools to understand
a disease i.e Hetu and Lingasankara have been explained.

Highlighting differences between Nidanarthakararoga and Vyadhisankara

This can be betterly explained by understanding the concept of Ekaarthakari/
Ubhayaarthakariroga, from above discussion, we have got the idea as if a disease leads to
another disease and self gets subsides, then it is nidanarthakararoga and if it i.e primary
disease exist with secondary disease then this condition is known as vyadhisankara.

If jwara is caused due to ushnanidanasevana, which in presence of supporting factors leads

to Raktapitta, then jwara becomes the Nidanarthakararoga of Raktapitta, here the
ushnanidanasevana (causative factors) are common to both diseases along with
sahakaribhava (supporting/conductive factors) which leads to the menifestations of
Raktapitta. But, if only ushna and jwaranidanas are continued without the sahakaribhava it
should have led to upadrava of jwara. The primary disease i.e, jwara affects almost every
adhisthana of its provocation and due to the presence of specific causative factors and in the
presence of sahakaribhava (supporting/conductive factors) lead to Raktapitta. Concept of
nidanarthakararoga, mainly helps in diagnosing the disease, thus with the help of concept of
nidanarthakararoga we can get the idea of present conditions without much bothering of past
history of the present disease. Due to the specific nidanasevana, moolavyadhi (primary
disease) will affect another adhishthana (nidana specific) leading to some other disease. As
mentioned earlier it helps in foreseeing the secondary disease.

For example, pleeha, arsha, grahani causing udararoga.[13,14] Differences between

nidanarthakararoga and vyadhisankara are depicted only because of aparishuddhachikitsa
and anyonyasambhavaat. Though mentioned specifically for vyadhisankara it is applicable to
nidanarthakararoga also, because pratishyayaatbhavetkaasa[8] is the examplefor
anonyasambhavat and jwarasantaapaatraktapittamudeeryate or stambhana in amatisaara
leads to shoola etc. is for aparishuddhachikitsa. By seeing these two conditions, if existence
of both diseases at one time happen then it will be vyadhisankara (ubhayarthakaari)[15,16] and
if primary one subsides after causing secondary then it is nidanarthakararoga. Hence
nidanarthakararoga can be considered as ekarthakaari[15,16] roga and vyadhisankara as
ubhayarthakaariroga.

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CONCLUSION
We have seen that Vyadhisankara is a collection of two/more presentations. This can be
mistaken with either upadrava or nidanarthakararoga. With the help of present article an
attempt has been made to understand the basic classical differences between vyadhisankara
and nidanarthakararoga and to use these concepts clinically, thus vyadhisankara can be
helpful in prognosis and planning treatment protocol. This vyadhisankara can happen due to
nidanarthakaratwa or as a result of upadrava differentiating these two concepts gives clarity
in planning right treatment stregies.

REFERENCES
1. Yaadavji Trikamji(editor). Charakasamhita of Agnivesha. Sutrasthana, chapter 1, verse
no. 24. Chaukhambasurbharatiprakashan: Varanasi, 2013; 7.
2. Yaadavji Trikamji(editor). Charakasamhita of Agnivesha. Nidanasthana, chapter 8, verse
no 22-29. Chaukhambasurbharatiprakashan: Varanasi, 2013; 228.
3. Yaadavji Trikamji(editor). Commentary: Ayurveda Dipika of Chakrapani on
Charaksamhita of Agnivesha, Nidanasthana, 2013; chapter 8: 22-32.
Chaukhambasurbharatiprakashan: Varanasi, 228.
4. Yaadavji Trikamji(editor). Charakasamhita of Agnivesha. Chikitsasthana, chapter 21,
verse no.40. Chaukhambasurbharatiprakashan: Varanasi, 2013; 561.
5. Dwivedi Lakshmidhar. Charaka Samhita of Mahrishi Agnivesha. Chikitsasthana chapter
3, verse no 146-147. 1st edition, Chaukhambakrishnadasacademy: Varanasi, 2013;
130-131.
6. Dwivedi Lakshmidhar. Charaka Samhita of Mahrishi Agnivesha. Chikitsasthana chapter
4, verse no 25-27. 1st edition, Chaukhambakrishnadasacademy: Varanasi, 2013; 204.
7. Dwivedi Lakshmidhar. Charaka Samhita of Mahrishi Agnivesha. Chikitsasthana chapter
21, verse no 48-49.1st edition Chaukhambakrishnadasacademy: Varanasi, 2013; 701.
8. Yaadavji Trikamji(editor). Charakasamhita of Agnivesha. Nidanasthana, chapter 8, verse
no 13-19. Chaukhambasurbharatiprakashan: Varanasi, 2013; 227.
9. Shastri Pt Haridas. Ashtanga Hridayam with sarvanasundara commentary of arunadatta
and Ayurveda rasayana commentary of Hemadri. Reprinted: Varanasi;
krishnadasacademy, 2000; 494.
10. Dwivedi Lakshmidhar. Charaka Samhita of Mahrishi Agnivesha. Chikitsasthana chapter
29, verse no 31-32. 1st edition Chaukhambakrishnadasacademy: Varanasi, 2013; 965.

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Vinod et al. World Journal of Pharmaceutical Research

11. Dwivedi Lakshmidhar. Charaka Samhita of Mahrishi Agnivesha. Nidanasthana chapter 8,

verse no 40. 1st edition Chaukhambakrishnadasacademy: Varanasi, 2008; 756.
12. Yaadavji Trikamji (editor). Charakasamhita of Agnivesha. Nidanasthana, chapter 8, verse
no 40. Chaukhambasurbharatiprakashan: Varanasi, 2013; 229.
13. Yaadavji Trikamji(editor). Charakasamhita of Charaka. Chikitsasthana, chapter 13, verse
no.13. Chaukhambasurbharatiprakashan: Varanasi, 2013; 491.
14. Dwivedi Lakshmidhar. Charakasamhita of Mahrishi Agnivesha. Chikitsasthana chapter
13, verse no 13. 1st edition, Chaukhambakrishnadasacademy: Varanasi, 2013; 433-434.
15. Yaadavji Trikamji(editor). Charakasamhita of Agnivesha. Nidanasthana, chapter 8, verse
no 20-21. Chaukhambasurbharatiprakashan: Varanasi, 2013; 228.
16. Dwivedi Lakshmidhar. Charakasamhita of Mahrishi Agnivesha. Nidanasthana chapter 8,
verse no 20-21. 1st edition Chaukhambakrishnadasacademy: Varanasi, 2008; 752-753.

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