Significance of Poorvarupa (Prodromal feature) of Prameha – A Review Article

Hukum Singh Dhakad; Reshma Shekh; Rajesh Kumar Jain

Prameha as well as diabetes is an important public health menace due to its high morbidity, mortality, economic impact, resource consumption, systemic complications, silent yet progressive nature, and less curative options. The prevalence of diabetes is also higher in urban areas than rural areas. In India over all 2.4% rural population and 4.6 – 11.6% urban population is suffering from diabetes. Systematic diagnosis of disease is well explained under the heading of Nidan Panchaka (Fivefold of examination) Viz. Nidan (Etiological factors), Poorvarupa (Prodromal features), Rupa (Specific sign and symptoms), Upasaya (Relieving factors) and Samprapti (Pathogenesis). Among the Nidan Panchaka, Poorvarupa (Prodromal features) are the symptoms which indicate the forthcoming disease. The long-term effects include progressive development of retinopathy with potential blindness, nephropathy that may lead to renal failure, neuropathy with risk of foot ulcers, amputation, Charcot joints and features of autonomic dysfunction including sexual dysfunction. People with diabetes are at increased risk of cardiovascular, peripheral vascular and cerebrovascular disease.

Corresponding Author

How to Cite this Article

To Browse

Hukum Singh Dhakad, Post Graduate Scholar, Department of Roga Nidan & Vikriti Vigyan, Pt. Khushilal Sharma Govt. Auto. Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email:

Hukum Singh Dhakad, Reshma Shekh, Rajesh Kumar Jain, Significance of Poorvarupa (Prodromal feature) of Prameha – A Review Article. J Ayu Int Med Sci. 2023;8(2):160-163.
Available From
https://jaims.in/jaims/article/view/2290

Manuscript Received

Review Round 1

Review Round 2

Review Round 3

Accepted

2022-12-29

2022-12-31

2023-01-07

2023-01-14

2023-01-21

Conflict of Interest

Funding

Ethical Approval

Plagiarism X-checker

Note

Nil

Yes

16%

Introduction

Prameha is a disease describe in ancient science, in which patient passes excess and copious urine with turbidity; i.e. Prabhut Avil Mutrata^[1] and it is defined as “Prakarshen Prabhutam Prachuram Barm Barm Wa Mehati Mutratyagm Karoti Yasmin Roge Sa Prameha” which means the condition in which frequent and excessive turbid urine is excreted.^[2] The most common Poorvarupa (Prodromal features) of Prameha are depicted as Dantadinam Maladhyatvam (dirt on the teeth), Karapada Daha (burning sensation in hands and feet), Chikkanta Deha (stickiness of the skin all over the body), Pipasa (thirst), Asya Madhurya (sweet taste in mouth),^[3]Mutre Abhidhavanti Pipeelikash (swarming of ants towards his urine).^[4]

Prameha is Tridoshaj Kapha predominant disease and classified into 3 types on the basis of dominancy of Dosha viz. Vataja, Pittaja and Kaphaja, which are further sub classified into 4, 6 and 10 types respectively, which acquires the color, taste touch and smell according to the respective Dosha.^[5] However increase frequency of micturition and turbidity of the urine are the cardinal symptoms of the 20 types of Prameha. The sweetness urine resembling with honey and turbid like characters resemblance with glycosuria, are two important cardinal clinical features of Prameha. Prameha commonly referred to as Diabetes, the most common endocrine disease, is characterized by metabolic abnormalities. Diabetes mellitus is a group of metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, Insulin action or both.^[6] The prevalence of diabetes has almost doubled among both women and men since 2005-06 (1% in 2005-06 to 2% in 2015-16). The prevalence of diabetes among women and men in the highest wealth quintile (3%) is higher than the prevalence among women and men in the lowest wealth quintile (1%). The prevalence of diabetes is also higher in urban areas than rural areas.^[7] The prevalence of diabetes and impaired glucose tolerance has been estimated to be 9.3% and 24.5%, respectively based on the nationally representative sample of adults aged 18–69-years in the National NCD Monitoring Survey.^[8]

Diabetes is found in every population in the world and in all regions, including rural parts of low- and middle-income countries. Today some diseases have

turn out to be burning problem of society, diabetes mellitus is one of them. Diabetes mellitus is the world leading disorder now a days. Metabolic disorder like Diabetes Mellitus is increasing like a rapid fire in the society as it affects all the age groups & all social economic groups.

Though numerous of work has been carried out on different aspect of Prameha, however the work on validation of its Poorvarupa (Prodromal Feature) is not conducted in scientific manner. Hence in this article attempt has been made to show clinical importance of Poorvarupa.

Aims and Objectives

To study clinical importance of Poorvarupa.

Materials and Methods

Review of Brihattrayi (Charak Samhita, Sushruta Samhita & Vagabhata), Laghutrayi. (Bhava Prakash, Madhav Nidan, Sharangadhara Samhita) have been carried out to elaborate the Poorvarupavastha of diseases.

Poorvarupa: Pragrupa are said to be those symptoms which are seen before the manifestation of the main disease (which they denote). Madhava Nidan defines Poorvarupa as 'Avyakta Lakshanas' i.e., feebly manifested symptoms or the hidden symptoms of the forthcoming disease. Madhava Nidan also says that only those symptoms which indicate a Bhavi Vyadhi or a forthcoming disease are called Poorvarupas.^[9] Acharya Vagbhata says that Poorvarupas (prodromal symptoms) are the symptoms of the forthcoming disease. They do not specify the particular Doshas taking part in the Samprapti (pathogenesis) of the disease. These symptoms are fewer and not clearly manifested (feebly manifested).

They are of 2 types:

Samanya Poorvarupa (Generalized premonitory symptoms)
Vishesha Poorvarupa (Dosha specific premonitory symptoms)

Importance of Poorvarupa
1. For prognosis

2. For diagnosis

3. For differential diagnosis

4. For treatment

Poorvarupa

Charak

Sushruta

Ashtang Hriday

Ashtang Sangrah

Sweda

Angagandha

Anga Shaithilya

Anga Sada

Shayya, Asana, Svapna Sukherati

Hridayopadeha

Netropadeha

Jihwopadeha

Shravanopadeha

Taluni, Danteshu Malotpathi

Kesha Ati Vriddhi

Nakha Ati Vriddhi

Kesha Jathilee Bhava

Sheeta Priyatvam

Gala, Talu Shosha

Asya Madhurya

Kara Pada Daha

Mutra Pipeelika Abhisarana

Madhura, Shukla Mutrata

Snigdha Gatrata

Picchila Gatrata

Ghana Gatrata

Pipasa

Shavas Dourgandhya

Tandra

Kara Pada Suptata

Anga Suptata

Alasya

Mukha Shosha

Kayachidropadeham

Sarvakale Nidra

Shatpada Abhisarana on Shareera

Shatpada Abhisarana on Mutra

Pipeelika Shareer Abhisharana

Discussion

According to Ayurvedic science, diseases occur due to imbalance of Dosha (Vata, Pitta, Kapha). This imbalance is created due to intake of Nidan. Nidansevan directly do not cause any disease but it causes Dosha Sanchay initially and then Prakopa and Prasara of Doshas if they continued further Nidansevan. The disease appears when complete pathogenesis takes place in body. In the course of disease (Samprapti) there is a stage of Sthana-Samshraya.

Conclusion

The Prodromal features of Prameha can be screened earlier and appropriate treatment will be given by holistic method as mentioned in Ayurveda. Diagnosis of disease in its Poorvarupa (Prodromal Feature) stage will helpful in prevention of disease as well as its complications. Poorvarupa (Prodromal Feature) of Prameha described in Ayurvedic classics are depicted as complication of diabetes mellitus in modern medicine. It could also be concluded that Poorvarupa along with the components of Nidan Panchaka holds great importance in Roga Pariksha (diagnosis of any disease).

Reference

1. Murthy Shrikant K. R., Astanga Hrdayam Vagbhata’s, Varanasi, Chowkhamba Krishndas Academy Reprint: 2018 Nidan Sthan, Chapter 10, Verse 6.

2. Sastri Sri Sudarsana, Upadhyaya Yadunandana, Madhava Nidanam of sri Madhavakara, Varanasi, Chaukhamba Sanskrit Sansthan, part 2, Reprint: 2055, 27th edition, Chapter 33, verse 1.

3. Sastri Sri Sudarsana, Upadhyaya Yadunandana, Madhava Nidanam of sri Madhavakara, Varanasi, Chaukhamba Sanskrit Sansthan, part 2, Reprint:2055, 27th edition, Chapter 33, verse 5.

4. Tripathi Ravi Dutta, Shukla Vidyadhar, Charaka Samhita, Chawkhamba Sanskrit Pratishthan, Delhi, Reprint: 2009 Vol I Nidan Sthan, chapter 4, verse 47.

5. Tripathi Ravi Dutta, Shukla Vidyadhar, Charaka Samhita, Chawkhamba Sanskrit Pratishthan, Delhi, Reprint: 2009 Vol II, chapter 6, verse 12.

6. Longo Dan.l. et al editors, Principle of internal medicine Harrison’s, volume 2, ISBN 978-0-07-174887-2 Library of congress cataloging in publication Data, 18th edition 2012, chapter 344, Pp2968.

Review Article

Poorvarupa

Journal of Ayurveda and Integrated Medical Sciences