Roga Nidan Chapter 5: Upashaya Anupashaya

1. Introduction

In Ayurvedic diagnostics, Upashaya (उपशय) refers to any measure—be it a medicine (aushadha), diet (ahara), or regimen (vihara)—that relieves or alleviates the symptoms of a disease. Conversely, Anupashaya (अनुपशय) refers to measures that either fail to relieve or aggravate a disease.

Classical texts such as Charaka Samhita and Sushruta Samhita repeatedly emphasize observing how symptoms respond to specific interventions (upashaya–anupashaya pariksha). If symptoms improve with a particular approach, that intervention is considered upashaya for that condition (and helps confirm the suspected diagnosis). If they worsen or fail to improve, it becomes anupashaya (and helps rule out that line of thinking).

“तद्दोषविधमेवान्नं भवेदुपशयो मतः।”
(Charaka Samhita, Nidana Sthana)
“That food or regimen which opposes the morbid dosha is regarded as Upashaya.”


2. Eighteen Types of Upashaya

A classical way to categorize Upashaya yields eighteen (18) distinct types, usually by looking at three major dimensions (focusing on the cause, focusing on the disease, or on both) and then considering different modes of intervention (medicine, diet, regimen, etc.).

A simplified but common teaching format is:

  1. Hetu Viparita (Opposite to the Cause)
  2. Vyadhi Viparita (Opposite to the Disease)
  3. Hetu–Vyadhi Viparita (Opposite to Both Cause and Disease)
  4. Hetu Viparita Arthakari (Measures that remove the cause but also produce a certain intentional effect)
  5. Vyadhi Viparita Arthakari (Measures that counteract the disease in a more deliberately applied manner)
  6. Hetu–Vyadhi Viparita Arthakari (Measures that tackle both cause and disease with a specific purposeful effect)

Each of these six can be further subdivided based on medicine (aushadha), diet (ahara), or lifestyle/activity (vihara), totaling 18 distinct categories.

Below is an expanded table-like explanation, correlating each of the six main headings with three subtypes (medicine, diet, lifestyle) and examples to illustrate their application.


2.1 Hetu Viparita (Opposite to the Cause)

Here, the prime focus is on removing or counteracting the etiological factor (nidana). Regardless of the exact pathology, if we can negate the cause, the symptoms tend to subside.

SubtypeExplanationExample
(A) Medicine (Aushadha)Using medicines that counteract the cause of disease. If the cause is exposure to cold and damp (leading to Vata–Kapha aggravation), then prescribing warming, drying drugs helps remove that cause.In Vata–Kaphaja Jvara arising from cold, damp etiological factors, using Uṣṇa dravya (warm herbs) like Pippali (Piper longum), Sunthi (Zingiber officinale), or a warm fomentation.
(B) Diet (Ahara)Modifying diet opposite to the cause. If the cause is excessive dryness or fasting leading to Vata aggravation, giving a nourishing, unctuous diet addresses the cause.In Vataja Jvara caused by undernourishment or over-fasting, giving māṃsa-rasa (meat soup) or other nutrient-dense, warm soups.
(C) Lifestyle (Vihara)Changing lifestyle/regimen that directly opposes the cause. If over-exertion (shram) caused fever, then rest is the opposite measure.In śramaja jvara (fever due to overwork/exhaustion), prescribing viśrāma (rest), gentle massage, or stress reduction techniques.

2.2 Vyadhi Viparita (Opposite to the Disease)

Here, the measure specifically targets the manifest pathology or the samprapti (disease process), rather than focusing on the original cause.

SubtypeExplanationExample
(A) Medicine (Aushadha)Selecting medicines that are directly antagonistic to the disease process itself. For instance, a drug that breaks vata rakta pathology by improving blood circulation & pacifying Vata.In Vāta-rakta (gout/arthritis-like condition), using Raktapachaka or Vata-pacifying drugs such as Guggulu; or in Vāta-vyādhi, using Bala, Ashwagandha, etc.
(B) Diet (Ahara)A dietary intervention specifically opposing the disease pathology. For instance, in obesity (sthaulya), reduce heavy and oily foods.In Sthaulya, adopting Yava (barley) as staple—light, high-fiber, reduces kapha & medas.
(C) Lifestyle (Vihara)A lifestyle measure that counters hallmark features of the disease. For instance, in prameha (diabetes), one uses regular exercise.In Prameha, encouraging chankramaṇa (brisk walking) or regular physical activity to oppose lethargy & excessive kapha.

2.3 Hetu–Vyadhi Viparita (Opposite to Both Cause and Disease)

In certain disorders, you must remove the cause and simultaneously address the disease manifestation. This approach is common in chronic conditions where the cause is still ongoing and the pathology is well-established.

SubtypeExplanationExample
(A) Medicine (Aushadha)A herb or regimen that both negates the original cause (e.g., cold exposure) and pacifies the resultant condition (e.g., vata jvara).In Vātaja śīrṣa-śūla (headache due to Vata & cold exposure), using daśamūla preparations as śirodhārā or warm fomentation. This addresses the cause (excess cold) and the pathology (vata aggravation).
(B) Diet (Ahara)Dietary shift that removes continuing aggravating factors while also relieving the present symptom complex.In śīta-janita vāta-jvara (fever caused by cold exposure and leading to Vata vitiation), giving warm peya or light, hot soups eliminates the cold factor and pacifies Vata.
(C) Lifestyle (Vihara)Correcting the causative regimen and disease-specific regimen simultaneously.If tandrā (drowsiness) is caused by over-sleeping during the day and results in a kapha/vata disorder, prescribing rātri-jāgaraṇa (staying awake at night in moderation) or restricting daytime sleep.

2.4 Hetu Viparita Arthakari (Cause-Opposite with a Specific Intended Effect)

In this category, the intervention is primarily aimed at negating the cause, but with an added deliberate effect or action (arthakari) that helps break the pathology or produce a therapeutic outcome. Sometimes this is referred to as a more “purposeful” or “intensely directed” approach against the cause.

SubtypeExplanationExample
(A) Medicine (Aushadha)A treatment that removes the cause but also has a targeted effect—often a more potent or specifically applied therapy.In a pittaja granthi (inflammatory swelling) that arose from overexposure to cold dryness (initial cause for local congestion), using uṣṇa upanāha (warm poultice) to not only negate cold dryness but also actively reduce inflammation/swelling.
(B) Diet (Ahara)A purposeful dietary regimen that tackles the etiological factor but also has a strong secondary effect.Using uṣṇa & tīkṣṇa dravya in a condition that originated from excessive cold or kapha cause, thus removing the “cool cause” and actively “burning away” kapha accumulation.
(C) Lifestyle (Vihara)A regimen or behavioral approach that both counters the cause and intentionally produces a beneficial mental/physical shift. Sometimes it may seem paradoxical but is used deliberately.In vāta-ja unmāda (a type of psychosis/agitation due to Vata aggravation and an underlying cause like fear or shock), ironically, “developing a controlled sense of bhaya” or employing certain psychological stimuli may help “recenter” the mind. (This is a classical, nuanced example illustrating how arthakari can be intentionally deployed.)

Note: The above psychological example is sometimes cited in classical texts to illustrate how certain “shock therapies” or mental diversions can break a vicious cycle. Always apply such measures with careful clinical judgment.


2.5 Vyadhi Viparita Arthakari (Disease-Opposite with a Specific Intended Effect)

This category specifically aims to neutralize the pathology with an added “artful” or “purposeful” approach—often a more aggressive or specialized measure that goes beyond just generic disease-opposing.

SubtypeExplanationExample
(A) Medicine (Aushadha)A medication or procedure that not only opposes the disease but also creates a desired therapeutic “impact” that intensifies the healing process.In hṛd-roga or hṛllāsa (nausea/heartburn conditions), using strongly acting herb(s) like mattanphala (special classical references) to produce direct anti-disease action plus a cleansing or pacifying effect.
(B) Diet (Ahara)A dietary measure that is specifically harnessed to strongly correct the disease pathology—often quickly or powerfully.In atisara (diarrhea), prescribing a carefully chosen milk (dugdha) regimen can sometimes serve as a “soothing yet binding” therapy, provided it is used specifically for a certain pathology profile (e.g., pittaja atisara).
(C) Lifestyle (Vihara)A specially crafted activity or regimen that directly targets the disease manifestation and yields a purposeful additional effect.In severe indigestion or certain hṛd-roga manifestations, special protocols such as “mild emesis” or “controlled fasts” might be used short-term to break the pathological cycle. (Exact regimen must match the disease subtype.)

2.6 Hetu–Vyadhi Viparita Arthakari (Cause–Disease Opposite with a Specific Intended Effect)

Finally, in certain complex or chronic diseases where both the cause continues and the disease is firmly established, a combined approach is used. Moreover, the intervention is done in a precise, purposeful way (arthakari) so that it not only removes the cause and opposes the disease but also accelerates or directs healing more forcefully.

SubtypeExplanationExample
(A) Medicine (Aushadha)Medicines that remove the etiological factors and counter the doshic pathology, with an additional targeted effect—often used in stubborn or deep-seated conditions.In a chronic skin disorder (tvag-vyadhi) initiated by poor hygiene (the cause) and complicated by Kapha–Pitta pathology (the disease), using jāṅgala māṃsa-rasa (lean meat soup) plus specific external applications (e.g., medicated lepa) to remove the etiological factor (moist/unclean environment) and address the deep pathology.
(B) Diet (Ahara)A purposeful dietary approach that simultaneously eliminates aggravating dietary habits and corrects the advanced disease pattern.In malāsaya-gata vikāra (pathology in the large intestine) caused by faulty heavy diets plus chronic constipation, adopting madhuḥ sevana (honey-based or light, scraping diets) to remove old residues (cause) and correct the disease.
(C) Lifestyle (Vihara)A lifestyle practice that rectifies the etiological error (e.g., excessive daytime sleeping, poor hygiene, stress) while also having an active role in reversing the disease.For ūṣmasthāna disorders (e.g., certain conditions aggravated by dryness + inactivity), prescribing lavan (salt-water) swimming or mild steam therapy can shift both cause and pathology. Suitably chosen measures can break the cycle of dryness, inactivity, and local pathology.

3. Anupashaya

To complete the conceptual picture, recall that Anupashaya is any measure that:

  • Does not relieve the symptom/disease, or
  • Aggravates the symptom/disease.

Observing Anupashaya is equally valuable in Ayurveda because it helps rule out incorrect diagnoses. If a measure that should have been beneficial (for a certain suspected dosha involvement) actually worsens the situation, the physician reconsiders the diagnosis.

Synonyms:

  • Ahita (अहित) – harmful
  • Viparita (विपरीत) – contradictory or adverse
  • Pratikula (प्रतिकूल) – unfavorable

4. Importance in Clinical Practice

  1. Confirming Diagnosis:
    If a presumed Vata disorder improves with warm, unctuous therapy (upashaya), it reaffirms that Vata is indeed the culprit. If not, it might be an anupashaya scenario—suggesting a different dosha or pathology.
  2. Tailoring Treatment:
    By noting which interventions provide relief, the Ayurvedic practitioner tailors a patient-specific regimen, ensuring that both cause removal (nidana-parivarjana) and pathology removal (samprapti-vighatana) happen simultaneously.
  3. Prognosis & Follow-up:
    Continuous observation of upashaya helps measure ongoing improvement or detect early aggravations—crucial for refining the line of management.
  4. Teaching Tool:
    For students of Ayurveda, the 18-fold classification demonstrates how flexible and individualized interventions can be when factoring in hetu (cause), vyadhi (disease), and the patient’s environment (Desha, Kala, Vihara, etc.).

“न ह्यप्रतीकृतस्य रोगस्य निदानमुपलभ्यते”
(Charaka Samhita)
“Without testing the response (Upashaya–Anupashaya), the diagnosis of a disease cannot be conclusively established.”


5. Key Takeaways

  • Upashaya is central to Ayurvedic diagnostic logic: a valuable confirmatory tool in clinical settings.
  • There are 18 types when considering (1) whether the approach is primarily addressing the cause, disease, or both, and (2) whether it is a straightforward “opposite” or a more deliberately applied (arthakari) intervention, each with medicine, diet, or lifestyle subcategories.
  • Anupashaya is equally important for exclusion of wrong assumptions.
  • Always correlate the presenting symptoms and their response to aushadha, ahara, and vihara to refine both diagnosis and treatment.

Conclusion

A thorough understanding of the eighteen types of Upashaya ensures that a physician-in-training can analyze both the root cause and the symptomatology, choose appropriate interventions in a targeted manner, and confirm or refute their clinical suspicions through the patient’s response. This dynamic, feedback-oriented approach is what makes Ayurvedic diagnosis truly holistic and customized to the individual’s condition.

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