Principles of Upadrava Siddhānta: Understanding and Managing Complications in Ayurveda

REVIEW ARTICLE

Dr. Mayank Kumar Gupta

Post-Graduate Scholar, Department of Saṁhitā and Maulika Siddhānta, National Institute of Ayurveda (DU), Jaipur, ORCID : https://orcid.org/0009-0008-7122-2045

Dr. Abhijeet Kumbhar

Assistant Professor, Department of Saṁhitā and Maulika Siddhānta, National Institute of Ayurveda (DU), Jaipur

Dr. Rajendra Soni

Assistant Professor, Department of Shālākyatantra, National Institute of Ayurveda (DU), Jaipur, https://orcid.org/0000-0001-5436-8853

**Principles of Upadrava Siddhānta: Understanding and Managing Complications in Ayurveda**

International Journal of Ayurveda360 | Volume 1 | Issue 4|

Journal Details:

ISSN (ONLINE) : 3048-7390
ISSN (PRINT) : 3048-7382
Bimonthly Journal

How to cite this article:

Gupta, M. K., Kumbhar, A., & Soni, R. (2025). Principles of Upadrava Siddhānta: Understanding and Managing Complications in Ayurveda. International Journal of Ayurveda360. 2025; 1(4): 218-229. https://doi.org/ 10.5281/zenodo.14879214

Important Dates:

Submitted: 04-12-2024 Revised: 08-01-2025

Accepted: 14-02-2025 Published: 15-12-2024

DOI Link: https://doi.org/10.5281/zenodo.14880941

DOI: 10.5281/zenodo.14880941

Address for Correspondence:

Dr. Mayank Kumar Gupta, P.G. Scholar, Department of Samhita & Maulik Siddhanta, National Institute of Ayurveda (DU), Jaipur. Email id: mayankgupta22796@gmail.com

Licensing & Distribution

This work is licensed under a Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/) You are free to share, copy, redistribute, remix, transform, and build upon this work for any purpose, even commercially, provided that appropriate credit is given to the original author(s) and source, a link to the license is provided, and any changes made are indicated.

ABSTRACT

Introduction:

Ayurveda, a holistic system of medicine, emphasizes the importance of maintaining health and addressing diseases through a balanced approach. Upadrava Siddhānta, which refers to complications arising during the progression of a primary disease, is a key concept in Ayurvedic pathology. Understanding Upadrava is crucial for accurate diagnosis, prognosis, and treatment in Ayurveda. This study aims to analyze the principles of Upadrava Siddhānta and its clinical relevance in managing complications.

Methods:

This conceptual review analyzes Ayurvedic classical texts, such as Caraka Saṁhitā, Sushruta Saṁhitā, and Aṣṭāṅga Hṛdaya, alongside modern literature. The review focuses on the classification of Upadrava, its connection to primary diseases (Vyadhi), and the Ayurvedic treatment methods for managing complications.

Results:

Upadrava is classified into Sthula (major complications) and Anu (minor complications). Both share the same dosha imbalance as the primary disease. Treatment should either target the Upadrava first if severe, or complement the primary disease treatment if the Upadrava is weak. Clinical examples from Madhavanidana illustrate complications in diseases like Ajeerna, Raktapitta, and Prameha.

Discussion:

Timely identification and management of Upadrava are essential for preventing further complications. By addressing both the primary disease and its complications, Ayurvedic principles offer a holistic framework for treatment. Integrating Ayurvedic and modern practices could enhance the management of complications, and future clinical studies could validate these approaches in contemporary settings.

Keywords: Siddhānta, Ayurveda, Complications, Primary Disease, Nidanarthakararog, Upadrava

FULL PAPER

Introduction

Ayurveda, an ancient system of medicine, emphasizes holistic health through the balance of the Atma (soul), Indriya (senses), and Manas (mind), in harmony with the Vata, Pitta, and Kapha doshas. Health is defined as a state of equilibrium in these fundamental aspects, while disease emerges from imbalances in these doshas. According to Acharya Carakaa, one of the founding authorities of Ayurvedic medicine, a Swastha Purusha (healthy individual) is one whose physical, mental, and spiritual states are in harmony, while any deviation from these characteristics indicates a Vyadhita Purusha (diseased individual).

A core aspect of Ayurvedic pathology involves understanding the progression of disease through its various stages. One key concept in this regard is Upadrava, which refers to secondary complications or diseases that arise as a result of an existing condition. These complications are driven by the same doshic imbalances responsible for the primary disease (Vyadhi) and often signify the disease’s advancement. Failure to identify and manage these complications can lead to further deterioration of the patient’s condition, highlighting the need for timely recognition and intervention by Ayurvedic practitioners.

In Ayurveda, the concept of Upadrava is crucial for accurate diagnosis, prognosis, and treatment. This article aims to explore and clarify the concept of Upadrava as described in Ayurvedic classics, with particular focus on its relation to the significance of Vyadhi (disease), and its impact on Chikitsa (treatment).

Aims & Objectives

To compile and critically analyze the concept of Upadrava Siddhānta (principles of managing complications) as described in classical Ayurvedic texts.

To understand the clinical relevance of Upadrava Siddhānta in managing complications and its applicability in contemporary medical practice.

Materials and Methods

This review is based on an extensive study of relevant Ayurvedic literature. The following sources were utilized: Bṛhattrayī (including Acharya Carakaa Saṁhitā, Suśruta Saṁhitā, and Aṣṭāṅga Hṛdaya), Madhav Nidana, and other classical Ayurvedic texts. Related Contemporary texts, journals, and research papers related to the concept of Upadrava.

Type of Study: Conceptual study.

Understanding of Upadrava

Acharya Carakaa’s Classification of Diseases-Acharya Carakaa classifies diseases into two broad categories .They may be swatantra or partantra as per their pradhanta. [1] “Swatantryapartantrabhyam vyadheh pradhanyamadishet” [2] -To signify a disease as primary or secondary is Pradhaanyasamprapti.Swatantra Vyadhi (Anubandhya Vyadhi) –”Swatantro vyaktalingo yathokta samutthanprashmo bhawatyanubandhyah।।“[3].These diseases arise from their own specific causative factors, exhibit distinct cardinal symptoms, and can be effectively treated using their prescribed therapeutic approaches. It manifests the symptoms as per the dosha vitiation — Ekdoshaja, sansargaja and sannipataja. After vitiation they produce innumerable different disorders due to different vitiating factors and the dooshya. Paratantra Vyadhi (Anubandha Vyadhi)– tadviparitalakshanastwanubandhah”[4].It means lakshanas opposite to Anubandhya i.e, it is dependent. It’s symptoms, etiology and treatment basically depends on Anubandhya or Pradhana vyadhi. These conditions do not originate from independent causative factors, lack clear manifestations, and typically do not subside with treatments directed at the primary disease. Paratantra Vyadhi is further categorized into purvaroopa and upadrava:[5] Purvarupa – Early signs or premonitory symptoms indicating the likelihood of an impending disease.Upadrava – Complications that arise as a distinct disease state due to the progression of an existing condition.Poorvaja vyadhi may also be identified as “Poorvaroopa” of pradhana vyadhis. For ex. Shrama, arati, vivarnta, vairagya are the poorvaroopa of jwara. Pashchataja vyadhi may include Upadrava, Arishta, Aupsargika Vyadh.. Acharya Sushruta classifies Vyadhi into the following types:[6]Aupāsargika or Upadrava refers to a disease that emerges after the primary Vyadhi, merges with it, and originates from the same root cause, making it a secondary or complicating condition.Prakkevala Vyadhi is an independent disease that neither acts as a precursor (Purvarupa) nor develops as a complication (Upadrava).Anya-lakshana Vyadhi signifies the likelihood of a future disease and is described as Purvarupa (early or premonitory symptoms).

Acharya Caraka mentioned “vyādhērupari yō vyādhir bhavatyuttara kālajaḥ| upakramāvirōdhī ca sa upadrava ucyatē|” [7]. “That which arises above a disease in the later stages, and does not contradict the initiation (of treatment), is called a Upadrava.” Upadrava (complications) sometimes go unnoticed and do not cause pain remain hidden and unnoticed. However, when they become gross (sthula), they start causing discomfort and require separate treatment. Based on this the classification of Upadravas into Sthula (major complications) and Anu (minor complications) highlights their varying severity and impact on patient health. Sthula Upadravas are characterized by significant pathological effects requiring urgent medical attention, while Anu Upadravas may present milder symptoms but still necessitate careful management.

Classification of Upadravas [8]

Upadravas (complications) are classified into two categories: Sthula Upadrava and Anu Upadrava .Sthula Upadrava (Major Complications) are severe conditions with significant pathological impacts that can result in serious symptoms, often necessitating immediate medical intervention. These complications involve multiple pathological factors and typically affect deeper tissues (Dhatus). If left untreated, they may become life-threatening. For instance, Pandu (anemia) can lead to complications such as Shotha (swelling), Daurbalya (weakness), and Murcha (fainting). Likewise, Rajayakshma (tuberculosis) may arise following Kasa (cough), while Atisara (diarrhea) can develop as a consequence of Jwara (fever).Conversely, Anu Upadrava (Minor Complications) are comparatively milder and do not pose an immediate life threat. These complications are fewer, less severe, and generally do not impact deeper tissues. In most cases, they resolve once the primary disease is treated. Examples include Jwara (fever), Moha (confusion), or Kshaya (depletion) resulting from Trishna (thirst). Similarly, symptoms like Bhrama (dizziness) or Klama (fatigue) may accompany Hrudroga (heart disease).Understanding these classifications helps in determining the severity of complications and implementing appropriate treatment strategies.

Table 1: Types of Upadrava as per severity

Type	Severity	Characteristics	Examples
Sthula	Major	Severe, involves deeper tissues	Pandu complications, Rajayakshma, Atisara
Anu	Minor	Milder, fewer complications	Jwara from Trishna, Bhrama from Hrudroga

Clinical Relevance

Upadrava signify the progression of a disease and highlight the need for timely therapeutic intervention.Their emergence often indicates incomplete treatment or aggravation of the underlying dosha. Vyadhi, as described in the phrase ādadhāti śarīrē manasi cēti-vyādhiḥ, refers to any form of distress affecting both the body and mind. Rogamadhyakalaja [10] refers to Upadravas that arise during the progression of a disease, following the onset of its primary symptoms. A clear distinction exists between Lakshanas and Upadravas. Lakshanas are the initial symptoms characteristic of a disease, whereas Upadravas develop later as complications. Therefore, Upadravas are also termed Rogottarakalaja, signifying their emergence after the primary disease symptoms appear. Upadrava is termed Rogasraya because its manifestation depends on the same Doshas that contribute to the onset of the primary disease. In other words, both the Upadrava and the main Vyadhi share the same underlying cause.

Differentiation of Upadrava from Others

It is important to distinguish Upadrava (complications) from related concepts like Lakshana (symptoms), Arishta (signs of impending death), and Nidanarthakari Roga (secondary diseases caused by primary disorders) to better understand disease progression and prognosis. Arishta refers to specific signs that indicate imminent death, as described in the principle “Niyata Maran Khyapakam Lingam Arishtam.” These signs manifest spontaneously, without any apparent cause, affecting aspects such as body form, sensory perception, voice, shadow, reflection, and natural behaviors. Their occurrence is considered an ominous indication of an unavoidable fatal outcome. In contrast, Nidanarthakari Roga refers to diseases that arise as a result of pre-existing conditions, in line with the principle “Nidanarthakaro Rogo Rogasyapyuplabhyate.” Here, an initial disorder not only affects the body but also acts as a causative factor for another disease. For example, excessive Santapa(heat) due to Jwara (fever) may lead to Raktapitta (bleeding disorders). Notably, the primary disease does not necessarily persist in the body after causing the secondary condition.Within Nidanarthakari Vyadhi, there are two primary types of disease progression: Ekarthakari Vyadhi – In this scenario, a disease gives rise to another condition before subsiding. It serves both as an active disease and as a causative factor simultaneously. For instance, Pandu Roga (anemia) may progress to Kamala (jaundice), or Atisara (diarrhea) may lead to Grahani Roga (malabsorption syndrome). Ubhayarthakari Vyadhi – Here, the original disease continues to persist even after triggering a secondary disorder. Both conditions coexist in the body. For example, Arsha (hemorrhoids) may cause Gulma (abdominal lump), or Pratishyaya (common cold) may lead to Kasa (cough), with both diseases affecting the patient simultaneously.

When a disease causes another disorder and then disappears, it is classified as Nidanarthakari Vyadhi. However, if both the primary and secondary diseases persist together, the condition is known as Vyadhi Sankara. Vyadhi Sankara refers to a complex pathological state where multiple diseases coexist due to improper treatment or the emergence of one disease from another. Unlike Nidanarthakari Vyadhi, where diseases share a similar doshic imbalance, affected bodily channels (Srotas), and disease mechanisms, Vyadhi Sankara involves conditions with distinct pathogenesis, making treatment more complicated. For example, excessive night awakening (Ratrijagaran) leads to Vata Prakopa, resulting in Sandhigata Vata (rheumatoid arthritis), while an irregular diet causes Pitta Prakopa, leading to Amlapitta (acidity). Additionally, improper treatment (Prayog Aparishuddhi) can contribute to Vyadhi Sankara. For instance, using obstructive therapy (Stambhana) in Aamatisara (sticky stool) can further aggravate imbalanced doshas, leading to conditions like Aadhman (flatulence) and Shool (abdominal pain).

A clear understanding of these distinctions is crucial for accurate diagnosis and effective treatment, helping to manage complications and prevent further disease progression.

Table 2 : Conceptual Analysis of Upadrava

Aspect	*Upadrava*	*Vyadhi*
Dependence	Depends on the *Vyadhi* (primary disease) for its manifestation.	Can develop independently of other conditions.
Nidana Samprapti	Does not have its own *Nidana Samprapti* (causative factors) and treatment.	Has its own *Nidana Samprapti* and specific treatment protocols.
Treatment	Treatment of the *Moola Vyadhi* (primary disease) often alleviates the *Upadrava*; may require additional specific treatment.	Requires *Vyadhipratyaneek* (disease-specific) or *Dosha Pratyaneek* (dosha-specific) treatment, or a combination of both.

Table 3: Conceptual Differentiation of Upadrava

Aspect	*Upadrava*	*Arishta*	*Nidanarthakar Roga*
Definition	Secondary complication of a primary disease	Indicative signs of impending death	A new disease caused by an existing one
Etiological Basis	Same doshic imbalance as the primary disease	Not related to doshic imbalance	Distinct causative factors
Treatment Approach	Treat the primary disease and specific Upadrava	Often considered incurable	Focused on the new disease

Different Upadravas as per Acharya Madhava

Certain diseases are associated with specific complications, and only the most significant ones are emphasized. Given the vast number of possible symptoms, listing them all would be impractical. Instead, only the most commonly occurring Vyapads (complications) have been highlighted by various Acharyas.

An analysis of Madhavanidana reveals the diverse range of Upadravas linked to different diseases, underscoring their clinical importance. Madhavacharya stresses that the principles of Roga Nidana (disease diagnosis) extremely subtle and intricate. Due to the vast expanse of Ayurvedic knowledge, it is impossible to grasp everything at once—much like the unfathomable depths of an ocean. Thus, excessive elaboration and unnecessary details should be avoided. Acharya Carakaa reinforces this idea, stating, “Na chaiva hyasti sutaram āyurvedasya pāram,” which means Ayurveda is infinite and has no ultimate boundary.

Table 4: Upadravas as per Acharya Madhava

S. No.	Vyadhi	Various Upadravas
1.	Ajeerna	mūrchā pralāpō vamathuḥ prasēkaḥ sadanaṁ bhramaḥ \| upadravā bhavantyētē maraṇaṁ cāpyajīrṇataḥ [10]
2.	Visuchika	nidrānāśō’ratiḥ kampō mūtrāghātō visañjñatā \| amī hyupadravā ghōrā visūcyāṁ pañca dāruṇāḥ [11]
3.	Raktapitta	daurbalyaśvāsakāsajvaravamathumadāḥ pāṇḍutādāhamūrchā, bhuktē ghōrō vidāhastvadhr̥tirapi sadā hr̥dyatulyā ca pīḍā \| tr̥ṣṇā kōṣṭhasya bhēdaḥ śirasi ca tapanaṁ pūtiniṣṭhīvanatvaṁ, bhaktadvēṣāvipākau vikr̥tirapi bhavēdraktapittōpasargāḥ [12]
4.	Chardi	kāsaḥ śvāsō jvarō hikkā tr̥ṣṇā vaicittyamēva ca \| hr̥drōgastamakaścaiva jñēyāśchardērupadravāḥ[13]
5.	Paansya-parmada-panaajeerna -paanavibhrama nidanam	hikkājvarau vamathuvēpathupārśvaśūlāḥ kāsabhramāvapi ca pānahataṁ bhajantē [14]
6.	Vatavyadhinidanam	visarpadāharuksaṅgamūrchārucyagnimārdavaiḥ kṣīṇamāṁsabalaṁ vātā ghnanti pakṣavadhādayaḥ \| śūnaṁ suptatvacaṁ bhagnaṁ kampādhmānanipīḍitam \| rujārtimantaṁ ca naraṁ vātavyādhirvināśayēt [15]
7.	Hridroganidanam	klamaḥ sādō bhramaḥ śōṣō jñēyāstēṣāmupadravāḥ \| krimijē krimijātīnāṁ ślaiṣmikāṇāṁ ca yē matāḥ [16]
8.	Mutrakricchra nidanam	hr̥tpīḍā vēpathuḥ śūlaṁ kukṣāvagniśca durbalaḥ \| tayā bhavati mūrchā ca mūtrakr̥cchraṁ ca dāruṇam [17]
9.	Pramehanidanam	avipākō’ruciśchardirnidrā kāsaḥ sapīnasaḥ \| upadravāḥ prajāyantē mēhānāṁ kaphajanmanām [18]
10.	Sadyovrana Nidanam	visarpaḥ pakṣaghātaśca sirāstambhō’patānakaḥ \| mōhōnmādavraṇarujō jvarastr̥ṣṇā hanugrahaḥ kāsaśchardiratīsārō hikkā śvāsaḥ savēpathuḥ \| ṣōḍaśōpadravāḥ prōktā vraṇānāṁ vraṇacintakaiḥ [19]
11.	Masurika nidanam	masūrikāntē śōthaḥ syāt kūrparē maṇibandhakē \| tathāṁ’saphalakē cāpi duścikitsyaḥ sudāruṇaḥ [20]
12.	Nasa roga nidanam	bādhiryamāndhyamaghratvaṁ ghōrāṁśca nayanāmayān \| śōthāgnisādakāsāṁśca vr̥ddhāḥ kurvanti pīnasāḥ [21]
13.	Pradar roga nidanam	tasyātivr̥ttau daurbalyaṁ bhramō mūrchā madastr̥ṣā \| dāhaḥ pralāpaḥ pāṇḍutvaṁ tandrā rōgāśca vātajāḥ [22]
14.	Mudagrabha nidanam	yōnisaṁvaraṇaṁ saṅgaḥ kukṣau makkalla ēva ca \| hanyuḥ striyaṁ mūḍhagarbhāṁ yathōktāścāpyupadravāḥ [23]

Discussion

Variations in primary (Pradhana) and secondary (Apradhana) characteristics lead to diverse classifications of Doshas and diseases. Physicians categorize ailments based on multiple factors. For instance, in Rajyakshma (tuberculosis), symptoms like Jwara (fever), Kasa (cough), and Ishtheevan (expectoration) naturally subside once the root disease is effectively treated. During Sharada Ritu (autumn season), Pitta Dosha becomes predominantly vitiated due to intense solar heat and Amla Vipaka, making it Pradhana (dominant). A minor imbalance in Kapha may also occur due to the heat, but it remains Apradhana (secondary). Treating the aggravated Pitta using Tikta Ghrita (bitter medicated ghee) simultaneously corrects the Kapha disturbance. Therefore, a physician should always focus on addressing the dominant disease (Pradhana Vyadhi) first. A clear differentiation between Upadrava (complications) and Vyadhi (disease) is crucial for accurate diagnosis. Upadrava refers to secondary complications that arise due to the aggravated Doshas responsible for the primary condition.For a symptom to be classified as Upadrava, it must meet specific criteria: It should either appear independently or in association with other symptoms,It must manifest at a particular stage of the disease ,It should be distinct from the primary disease’s pathogenesis.For example, Atipravrutti (excessive bleeding) can be a symptom of both Asrigdara (menorrhagia) and Pittavrita Apana (Pitta obstructing Apana Vata). Whether it is classified as Upadrava or just a symptom depends on its correlation with the primary disorder.

If Upadrava (complication) is mild, treating the Moola Vyadhi (primary disease) is usually sufficient for resolution. However, in severe cases, the complication must be addressed first without disrupting the management of the primary condition. The treatment of Upadrava follows three main approaches. Vyadhi Chikitsa focuses on curing the root disease, leading to the natural resolution of complications. Upadrava Chikitsa prioritizes treating the complication first, especially in critical conditions like Atisara (diarrhea) with Ambhuvahasrotokshaya (fluid loss), where rehydration is essential. The third approach, Vyadhi and Upadrava Chikitsa, treats both simultaneously, as seen in Prameha (diabetes) and Prameha Pidaka (diabetes-related skin lesions), ensuring comprehensive disease management.

Conclusion

The occurrence and severity of Upasargas (secondary afflictions) in a disease are often unpredictable. When all the symptoms (Sarvalinga) mentioned in classical texts appear, the disease may become incurable, as the extent of Upasarga depends on the patient’s overall condition. Accurate diagnosis requires appropriate tools, as no single symptom alone defines a disease. Nidāna represents the causative factor, while Liṅga (symptoms) indicate the presence of a disease. Recognizing Ariṣṭa Lakṣaṇas (ominous signs of impending death) enables Vaidyas to assess prognosis effectively.

This study underscores the importance of Upadrava Siddhānta in Ayurvedic diagnosis and treatment. Early identification of Upadrava (complications) is crucial in preventing disease progression and improving patient outcomes. Ayurveda’s approach, which considers both disease-specific and Dosha-specific factors, ensures a comprehensive and holistic healthcare system.

In diseases accompanied by Upadrava, treatment should be planned carefully to prevent conflicts between the primary disease (Moola Vyadhi) and its complications. Severe Upadrava should be treated first (Tvaritam va balavantam upadravam pradhanavirodhena), while mild complications often resolve naturally with the treatment of the primary disease (Tasya prayah pradhanaprasame prasamo bhavati). In cases of Prakkevala Vyadhi (primary disease without complications), treatment should primarily focus on balancing the aggravated Doshas. For Anyalakshana Vyadhi (early-stage diseases), preventive measures should be implemented to halt further progression.

Funding and Conflicts of Interest:
No external funding was received for this study. The authors declare no conflicts of interest.

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