Upashaya Anupashaya – Pacifying And Non-Pacifying Factors Of Disease

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
The concealed symptoms of a disease are examined with the help of upashaya and anupashaya. It is trial and error methods in diagnosing a disease when the signs and symptoms of the disease are concealed making it difficult to diagnose a given condition.

Upashaya and Anupashaya are the part of five tools of diagnosing a disease. Pancha Nidanas – The five important Ayurveda tools for diagnosing any disease are –

• Nidana – the causative factors of a disease
• Purvarupas – the premonitory symptoms of a disease
• Rupa – signs and symptoms of a disease
• Samprapti – pathogenesis of a disease and
• Upashay Anupashay – determining pacifying and non-pacifying factors of a disease
  Read – Relationship Of Doshas With Nidana Panchakas

Introduction

Upashaya means relieving factors of a disease.
Anupashaya is non-relieving factors of a disease. Sometimes anupashaya may also play the role of ‘aggravating factor’.

Example – when you give cold foods to a person having excess body heat and if the symptoms pacify, it is called as upashaya. In the same person if the cold things do not pacify the heat it is called anupasaya.

In some rare instances, the cold things may aggravate heat and inflammatory reactions in the body in an unusual and unexpected way. For example, in fever with cold, if cold treatment is given, it may further increase body heat.
This gives us a clue that the condition needs to be handled in a different way. Thus upashaya-anupasaya serves three purposes.
Read – Ayurvedic Medicine: Introduction, Importance, Types and Myths

• It serves as a diagnostic tool
• It helps in differential diagnosis of a disease &
• It helps in therapeutics – to plan and implement proper diet and lifestyle practices ideal for combating a disease, on the basis of trial and error method.
• Read – When To Stop Taking Ayurveda Medicines And Treatment?

Definition, Meaning

Definition and word meaning of Upashaya

A judicious application of medicines, diet and lifestyle, prescribed –

1. Hetu Viparita – opposite to the cause of the disease
2. Vyadhi Viparita – opposite to the disease itself
3. Hetu Vyadhi Viparita – opposite to both cause of the disease and also the disease or
4. Hetu Viparitarthakari – similar to the cause of the disease
5. Vyadhi Viparitarthakari – similar to the disease itself or
6. Hetu Vyadhi Viparitarthakari – similar to both the cause of the disease and the disease itself constitutes upasaya when they produce relief in the symptoms of the disease and anupashaya when it aggravates the symptoms of the disease.
   Read – Vital And Weak Causes Of Disease – Pradhanika And Vyabhichari Nidana

Sanskrit verse

How this is done?
Firstly, a disease is suspected.

Herbs and diet are administered in two forms.

1. The administered medicine may be against the cause of the disease, only the disease or both. If they give relief, then it is considered as upasaya. Generally when the medicine with opposite qualities to disease is administered, we expect them to relieve the symptoms. But they can also aggravate the symptoms of a given disease. When the medicines, in spite of being opposite to the disease qualities, do not pacify the disease or if they aggravate the symptoms they would be considered as anupashaya.
2. On the other hand, the medicines, similar to the disease, if they produce relief of the symptoms of the disease, we consider them to be upashaya. Generally when the medicines having similar qualities of disease is administered, we expect them to aggravate the disease. But in some conditions they can also relieve the symptoms. It is still called upashaya. But when the same factors aggravate the symptoms of the disease, they will be called as anupashaya.
   Read – Importance Of Diet (Pathya) For Specific Diseases

Outcomes

Possible outcomes of upashaya anupashaya

Thus, the administration of upashaya and anupashaya in any disease may have the below outcomes –

• They may pacify the disease symptoms being antagonistic to the disease. This shows that our approach towards diagnosing the disease, planning and implementation of treatment was absolutely correct.
• They may aggravate or not pacify the disease in spite of being antagonistic to the disease – an unexpected outcome which compels us to change our approach towards diagnosis and treatment.
• They may pacify the disease symptoms being similar to the disease – still considered as Upashaya, forcing a change in treatment strategy.
• They may aggravate the disease being similar to the disease – an expected outcome if it was done as a diagnostic test. This confirms that the disease-opposing treatment should be adopted.
  Read – Bad Prognosis Based On Premonitory Symptoms Of Disease – Purvarupiya Arishta

Classification

Classification of Upashaya
There are 18 types of upashaya.

1. Medicines antagonistic to the cause of the disease
2. Food antagonistic to the cause of the disease
3. Activities antagonistic to the cause of the disease
4. Medicines antagonistic to the disease
5. Foods antagonistic to the disease
6. Activities antagonistic to the disease
7. Medicines antagonistic to the cause and disease
8. Foods antagonistic to the cause and disease
9. Activities antagonistic to the cause and disease
10. Medicines similar to the cause of the disease
11. Foods similar to the cause of the disease
12. Activities similar to the cause of the disease
13. Medicines similar to the disease
14. Foods similar to the disease
15. Activities similar to the disease
16. Medicines similar to the cause and disease
17. Foods similar to the cause and disease
18. Activities similar to the cause and disease
Read – Lifestyle Tips For Healthy People And Patients In Ayurveda

A. Hetu Viparita Upashaya – opposite to the cause of the disease (three types)

1. Hetu viparita aushadha i.e. medicines antagonistic to the cause of the disease. Example – use of ginger in fever caused due to excessive cold. Here ginger is the remedy for relieving cold, i.e. the cause for fever.
Read – Ginger Benefits, Research, Home Remedies, Side Effects

2. Hetu viparita anna i.e. the foods antagonistic to the cause of the disease. Example – use of meat soup in fever caused by vitiated vata. Here meat soup is the remedy for vitiated vata i.e. cause of the fever.

3. Hetu viparita vihara i.e. the activities which are opposite to the cause of the disease. Example – when kapha is increased due to excessive day-sleeping, keeping awake in the night is recommended. Here day sleeping is the cause for kapha aggravation. Being awake is the opposite activity of this cause. This balances kapha.
Read – Mutton Akhni – Qualities, Health Benefits, Ayurvedic Method

B. Vyadhi Viparita Upashaya – opposite to the disease (three types)

4. Vyadhi viparita aushadha i.e. medicines antagonistic to the disease. Example – administering of Holarrhena antidysenterica and Cissampelos pareira as remedies for diarrhea.
Another example is the use of Acacia catechu for treating skin diseases and turmeric in treating urinary diseases and diabetes. Here, the mentioned herbs act against the diseases and cure them.

5. Vyadhi viparita anna – Food antagonistic to the disease. Example – administering lentils to stop loose motions in diarrhea.

6. Vyadhi viparita vihara – activities opposite to the disease. Example – straining (pravahana) to expel feces and fart in udavarta i.e. disease caused due to upward movement of vata.
Read – Udavarta – Reverse Movement Of Vata Dosha Causing Disease

C. Hetu Vyadhi Viparita Upashaya – opposite to both the cause and disease (three types)

7. Hetu vyadhi viparita aushadha – medicines antagonistic to both cause and disease. Example – administering dashamula decoction in swelling caused due to vitiation of vata. Here dashamula is a remedy for both the cause i.e. vitiated vata and also the disease – swelling.
Read – Dashamula Kashayam With Castor Oil For Low Back Pain

8. Hetu vyadhi viparita anna – food antagonistic to both cause and disease. Example – administration of buttermilk in grahani i.e. disease of small intestine caused by vitiation of vata and kapha. Here, the buttermilk is a remedy for both the cause i.e. vitiated vata and kapha doshas and also for the disease i.e. bowel disease.
Read – Buttermilk Benefits, Side Effects, Usage, Home Remedies

9. Hetu vyadhi viparita vihara – Activities antagonistic to both cause and disease. Example – advocating wakeful nights, a drying activity in case of excessive day sleep and consumption of fatty foods. Staying awake at night, being drying, is opposite to the unctuous nature of fatty foods. Here, wakeful night is a remedy for excess day sleep.
Read – Day Sleep – Sleeping In The Day: Rules, Benefits, Contra Indications

D. Hetu Viparitarthakari Upashaya – similar to cause of the disease (three types)

10. Hetu viparitarthakari aushadha – medicines similar to the cause of the disease. Example – administration of poultice and pitta increasing hot potency herbs in the treatment of inflammatory swelling caused by vitiated pitta. Here hot poultice and pitta causing herbs, as a rule should worsen the inflammation and swelling caused by pitta, but they help in reliving the symptoms.

11. Hetu viparitarthakari anna – diet similar to the cause of the disease. Example – foods which tend to produce heat and corrosion in the body is administered in the treatment of inflammatory swelling of wounds caused by vitiated pitta. Here hot and corrosive foods, as a rule should worsen the inflammation and swelling caused by pitta, but they help in relieving the symptoms.

12. Hetu viparitarthakari vihara – activities which are similar to the cause of the disease. Example – causing fear in the patient suffering from insanity. Actually causing fear should aggravate the symptoms of insanity but it is used as a remedy in this instance.
Read – Unmada-Insanity: Ayurvedic Understanding And Management

E. Vyadhi Viparitarthakari Upashaya – similar to the disease (three types)

13. Vyadhi viparitarthakari aushadha – medicines which are similar to the nature of the disease. Example – administering Randia dumetorum in treating vomiting. The mentioned herb is an emetic and in real sense should worsen the vomiting episodes. But here it is used as a remedy for the disease, to induce vomiting. In some cases of acute indigestion with nausea, inducing vomiting gets rid of all the undigested food material from stomach, thus the patient gets relief.
Read – Chardi Roga – Vomiting: Ayurveda Explanation, Types, Symptoms

14. Vyadhi viparitarthakari anna – food which are similar to the nature of the disease. Example – administering milk as a purgative in diarrhea i.e. as a remedy for diarrhea. Milk is known to have laxative property but the milk, in this instance is used as a remedy for diarrhea. It cleanses the colon and thus brings relief.
Read – 37 Ayurveda Home Remedies For Diarrhea And Dysentery

15. Vyadhi viparitarthakari vihara – activities which are similar to the nature of the disease. Example – stimulating the root of the tongue to create vomiting sensation in the vomiting disease. This helps to vomit out the undigested food in stomach, bringing relief to the patient.

F. Vyadhi Viparitarthakari Upashaya – similar to the disease (three types)

16. Hetu vyadhi viparitarthakari aushadha – medicines similar to the cause and disease. Example – administering of Aquilaria agallocha which is hot in nature and potency for the treatment of burns. The mentioned herb should in actual sense have worsened the burns but it is used as a remedy in this instance.

17. Hetu vyadhi viparitarthakari anna – food similar to the cause and disease. Example – administering paishtika madya i.e. wines / alcohol prepared from flours for treating intoxication caused by alcohol prepared by using jaggery. Here wine is used in the treatment of intoxication caused by another wine. Actually the jaggery wine should worsen the symptoms of alcoholic intoxication but it is used as a remedy in this case, to the cause i.e. flour wine and also to relieve symptoms of intoxication.
Read – Jaggery (Gur) Health Benefits, Usage, Side Effects – Full Ayurveda Details

18. Hetu vyadhi viparitarthakari vihara – activities which are similar to the cause and disease. Example – advocating swimming as an exercise in the treatment of urustambha disease i.e. stiffness of the thigh produced by exertion. Here swimming is an activity and it should have worsen the symptoms of stiffness of the thigh which is caused by another activity i.e. exertion. Here swimming is used as a remedy for both the cause i.e. exertion and disease i.e. stiffness of the thighs.
Read – Charaka Urusthambha Chikitsa – 27th Chapter

Benefits

Benefits of knowledge of upashaya anupashaya

Upashaya and Anupashaya are not treatment methods. They are diagnostic tools. They are useful when the symptoms are hidden or not completely manifested. They are useful when the doctor is unsure about the diagnosis.
Read – Classification of Vyadhi (diseases) according to Ayurveda

2. Knowledge of upashaya helps in differential diagnosis. Sometimes more than one disease will be having similar set of signs and symptoms.

3. Knowledge of upashaya helps in therapeutics – Upashaya is also known as satmya. Satmya means compatible, wholesome and conducive things – medicines, foods and activities which are beneficial to us. Upashaya is also said to be equivalent to the term chikitsa – treatment. When the upashaya becomes successful and when the symptoms of the disease get relieved, the same upashaya shall be continued in the form of treatment.

Difference Between Upashaya And Chikitsa

The terms upashaya and chikitsa are often considered similar and used interchangeably, but they have some conceptual differences.
Read – Chikitsa: Treatment Types, Ayurvedic classification

Difference, Meaning, Derivation

Differences between upashaya and chikitsa

1. Word meaning and derivation

Upashaya is primarily administered to diagnose the disease. It is the trial and error method to know the exact nature of the disease. The Upashaya administration leads to relief of symptoms. The doctor gets clear direction about the line of treatment to be adopted further.
If the same interventions do not give relief, then it is called Anupashaya and opposing treatment is adopted.
Read – Importance Of Diet (Pathya) For Specific Diseases

Chikitsa – Chikitsa means treatment of the disease. Treatment is adopted when the diagnosis is finalized.
Read – Ayurvedic Hospital Management – Chikitsa Chatushpada

2. From point of view of diagnosis and differential diagnosis

Upashaya & Anupashaya – These are diagnostic tools and are part of nidana panchaka i.e. five tools of examination of a disease. They are also useful in differential diagnosis of a disease. When it is difficult in diagnosing a disease due to subtle manifestation and masked nature of its signs and symptoms (latent symptoms – Goodha linga) these are used as tools to diagnose.
Read – How To Make Prognosis Of Disease According To Ayurveda?

Chikitsa – The treatment is not used as a diagnostic tool. It is also not used for differential diagnosis. This is because treatment is not done on trial and error basis. It is administered only after proper diagnosis of the disease.

3. From point of view of classification of upashaya and chikitsa

Upashaya – Upashayas i.e. advantageous therapeutic measures are classified into only 18 types whereas treatment is classified in multiple ways.

Surety and un-surety of providing a cure to the disease

By the above given description of definitions and dimensions of upashaya and chikitsa, we can come to this conclusion about the surety of cure expected from each.

Upashaya – Upashaya is unsure of providing results in a given disease or in relieving the signs and symptoms of the disease in question. There is a possibility that the measures used here in the form of medicines, food and activities may fail in providing the desired or expected results.

On the other hand there is also a possibility of the symptoms getting aggravated. In this condition it will be considered as anupashaya i.e. non-advantageous measures as already said. Therefore upashaya is a chance medicine, on the basis of trial and error method of approach.
Read – Main Cause For Diseases As Per Ayurveda

Chikitsa – On the other hand, treatment is not done on ifs and buts. It is not about taking chances. The treatment plan-up which also includes planned implementation of medicines, diet and activities will be done to perfection since the disease for which it is being administered is clearly known and diagnosed. The outcomes of treatment are also expected to be positive.

But is the treatment always successful?
In this context we should discuss a reference given by master Sushruta.

Meaning – ‘The treatment is said to be the best and comprehensive when it subsides or pacifies the disease for which it is being administered but doesn’t cause yet another disease. On the contrary, any chikitsa which subsides or pacifies a particular disease but produces another disease in the process is not to be a good treatment’.

This definition of ‘the ideal treatment’ looks like and resembles the definition of upashaya. Here also it is said that the treatment shall be considered a bad one if it produces complications. In case of upashaya, if the strategies fail we name it as anupashaya. Therefore there is also a chance that the treatment too fails, just like upashaya but the chances are rare because treatment is done on a diagnosed disease but upashaya is done on a suspected disease.
Read – Upadrava: Complications of diseases, Definition, Examples

Upashaya and Chikitsa inter-changeable?

Can the terms upashaya and chikitsa be used interchangeably?

Upashaya is a diagnostic tool. Chikitsa is a term used for treatments, medicines and therapies. Upashaya is applicable when the disease is not properly diagnosed.
Since medicines, food and activities are used in upashaya, even though to make a diagnosis or prognosis of a disease, it can be considered as chikitsa if they are beneficial and advantageous, as already discussed.

Upashaya can be a treatment if the symptoms of the diseases pacify. On the other hand, the same medicines, food and activities are used for destroying a disease in chikitsa, after the disease has been properly diagnosed. Since the chikitsa is beneficial to the patient, it can be considered as upashaya.

Since it also cures the disease it is called chikitsa. We have also seen that the 18 types of upashay are considered as types of treatment. Going by the description and the points of difference that we have discussed above, in the earlier part of the article, they should not be used interchangeably. But as also discussed, upashaya can be a chikitsa and chikitsa can be an upashaya as per situation and as per their utility in a given condition.
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