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<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

<div style="text-align:justify;">Nidana Sthana deals with the etiology, symptomatology, and means of diagnosis of diseases. It begins with a generalized set of fundamental principles of diagnosis and then proceeds to specialized studies of diseases. The first part of this chapter deals with necessary tools for acquiring a comprehensive knowledge of any disease. A set of five important tools/components - etiology, premonitory signs, clinical features, pacifying factors and pathogenesis termed as ‘Nidana Panchaka’ helps in understanding a disease thoroughly. Each of these tools has a specific significance in diagnosis and explores an important aspect of the disease. Etiology helps to ascertain the causative factors of the diseases and diagnosis helps in determining the nature of the disease by causative factors, premonitory signs, actual signs, exploratory signs, and pathogenesis. Comprehensive management of disease and restoration of health is not possible without complete knowledge of all aspects of the disease process. The second part of the chapter uses these tools to explain fever (jwara) and its types (endogenous and exogenous), as well as methods to manage it. Jwara is caused by the accumulation of vitiated dosha at the site of digestion and further affliction of digestion and thermal regulation in the body. Considering the basic tools for comprehensive understanding of disease, it is regarded as an important chapter. </div>

<div style="text-align:justify;">Nidana Sthana deals with the etiology, symptomatology, and means of diagnosis of diseases. It begins with a generalized set of fundamental principles of diagnosis and then proceeds to specialized studies of diseases. The first part of this chapter deals with necessary tools for acquiring a comprehensive knowledge of any disease. A set of five important tools/components - etiology, premonitory signs, clinical features, pacifying factors and pathogenesis termed as ‘Nidana Panchaka’ helps in understanding a disease thoroughly. Each of these tools has a specific significance in diagnosis and explores an important aspect of the disease. Etiology helps to ascertain the causative factors of the disease and diagnosis helps in determining the nature of the disease by causative factors, premonitory signs, actual signs, exploratory signs, and pathogenesis. Comprehensive management of disease and restoration of health is not possible without complete knowledge of all aspects of the disease process. The second part of the chapter uses these tools to explain fever (jwara) and its types (endogenous and exogenous), as well as methods to manage it. Jwara is caused by the accumulation of vitiated dosha at the site of digestion and further affliction of digestion and thermal regulation in the body. Considering the basic tools for comprehensive understanding of disease, it is regarded as an important chapter. </div>

'''Keywords''': Diagnosis, ''nidana'', etiology, ''poorvarupa'', premonitory signs, ''rupa'', clinical signs, ''upashaya'', pacifying factors, ''samprapti'', pathogenesis, ''jwara'', ''nija'', ''aagantu jwara'', ''ghrita'' ,ghee , fever.

'''Keywords''': Diagnosis, ''nidana'', etiology, ''poorvarupa'', premonitory signs, ''rupa'', clinical signs, ''upashaya'', pacifying factors, ''samprapti'', pathogenesis, ''jwara'', ''nija'', ''aagantu jwara'', ''ghrita'' ,ghee , fever.

=== Introduction ===

=== Introduction ===

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Per Ayurvedic texts, a physician cannot treat a patient if he does not possess a complete understanding of a disease. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/12, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 249. </ref> Accurate diagnosis of a disease is important before initiating any treatment, and any understanding of a disease’s manifestation is incomplete without understanding its ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (actual sign and symptoms), ''upashaya'' (pacifying factors) and ''samprapti'' (pathogenesis) – or the ''Nidana Panchaka'' (literally, the five components of ''nidana''). <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Nidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. </ref>

A physician cannot treat a patient if he does not possess a complete understanding of a disease. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/12, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 249. </ref> Accurate diagnosis of a disease is important before initiating any treatment, and any understanding of a disease’s manifestation is incomplete without understanding its ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (actual sign and symptoms), ''upashaya'' (pacifying factors) and ''samprapti'' (pathogenesis) – or the ''Nidana Panchaka'' (literally, the five components of ''nidana''). <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Nidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. </ref>

A disease’s lifecycle starts with certain premonitory symptoms and ends with its complete manifestation, or ''samprapti''. Between these two stages of the disease, the body shows various sign and symptoms that could be observed by any knowledgeable physician, using the ''Nidana Panchaka'' . Naturally, any disease, if diagnosed very early, could be prevented from manifesting itself through a variety of interventions. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Sutrasthana Adhyaya 10/7, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66. </ref> A proper understanding of the ''Nidana Panchaka'' helps the physician using various therapies, to establish an equilibrium among the patient’s ''doshas'', ''dhatus'', and ''mala'' – since it is the vitiation of these bodily features that cause a disease. A therapy is considered pure or correct (''vishuddha'') when it cures the disease without giving rise to another disease. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Nidanasthana Adhyaya 8/23, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 228. </ref> Curable diseases can progress to incurable if they are not properly treated. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Sutrasthana Adhyaya 8/35, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 229. </ref>

A disease’s lifecycle starts with certain premonitory symptoms and ends with its complete manifestation, or ''samprapti''. Between these two stages of the disease, the body shows various signs and symptoms that could be observed by any knowledgeable physician, using the ''Nidana Panchaka'' . Naturally, any disease, if diagnosed very early, could be prevented from manifesting itself through a variety of interventions. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Sutrasthana Adhyaya 10/7, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66. </ref> A proper understanding of the ''Nidana Panchaka'' helps the physician using various therapies, to establish an equilibrium among the patient’s ''doshas'', ''dhatus'', and ''mala'' – since it is the vitiation of these bodiy features that cause a disease. A therapy is considered pure or correct (''vishuddha'') when it cures the disease without giving rise to another disease. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Nidanasthana Adhyaya 8/23, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 228. </ref> Curable diseases can progress to incurable if they are not properly treated. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Sutrasthana Adhyaya 8/35, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 229. </ref>

Today, physicians use diagnostic tests and medical investigations to study a condition. These tests could be supplemented with tools like the ''Nidana Panchaka'' described here. For example, access to complete knowledge of dietary and lifestyle activities of a person, specific disease provoking factors, clinical history or health records of past diseases or conditions, and a thorough clinical examination of all bodily systems would help provide a complete view of a patient’s condition.   

''Nidana Panchaka'' described here can be supplemented with diagnostic tests and medical investigations to study a condition. Access to complete knowledge of dietary and lifestyle activities of a person, specific disease provoking factors, clinical history or health records of past diseases or conditions, and a thorough clinical examination of all bodily systems would help provide a complete view of a patient’s condition.   

Thus, the first part of the chapter deals with the ''Nidana Panchaka''. The second part, then, takes this important concept and applies it on the most generic of conditions afflicting patients – ''jwara''. This also reveals how the [[Nidana Sthana]] section of the [[Charak Samhita]] is structured – it starts with the generic or the foundational condition (that, in many cases, acts as a causative factor itself), and then moves on to discussing the vitiation of the ''dhatus'' that are causes of all somatic diseases – by the order of their importance (i.e., starting with ''rasa dhatus'') – and ends with a study of vitiation of ''Rajas'' and ''Tamas'' (i.e., causes of mental diseases).  

Thus, the first part of the chapter deals with the ''Nidana Panchaka''. The second part, then, takes this important concept and applies it on the most generic of conditions afflicting patients – ''jwara''. This also reveals how the [[Nidana Sthana]] section of the [[Charak Samhita]] is structured – it starts with the generic or the foundational condition (that, in many cases, acts as a causative factor itself), and then moves on to discussing the vitiation of the ''dhatus'' that are causes of all somatic diseases – by the order of their importance (i.e., starting with ''rasa dhatus'') – and ends with a study of vitiation of ''Rajas'' and ''Tamas'' (i.e., causes of mental diseases).  

Thus ends the first chapter on diagnosis of fever in [[Nidana Sthana]] in the treatise composed by Agnivesha and reducted by Charak. (1)

Thus ends the first chapter on diagnosis of fever in [[Nidana Sthana]] in the treatise composed by Agnivesha and reducted by Charak. (1)

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' / Founding Principles ===

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*The causative factors, favorable conditions, dominant factors, and origins of ''jwara'' are important in the context of ''nidana''. [3]

*The causative factors, favorable conditions, dominant factors, and origins of ''jwara'' are important in the context of ''nidana''. [3]

*The best advocated medicine for chronic ''jwara'' is Ghee due to its therapeutic efficacy of pacifying all three ''dosha''. [37]

*The best advocated medicine for chronic ''jwara'' is Ghee due to its therapeutic efficacy of pacifying all three ''dosha''. [37]

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha''/ Applied Inferences===

Treatment of any disease is possible only after the proper knowledge of causative factors and sign and symptoms. Treatment principles described in [[Nidana Sthana]] should be incorporated in the ''upashaya'' (pacification factors). ''Nidana'' means the causative factor of the diseases. The term ''vyadhibodhakam'' means the diagnosis of diseases with the help of ''nidana, poorvarupa, rupa, upashaya'' and ''samprapti''. 1-2 [6]

Treatment of any disease is possible only after the proper knowledge of causative factors and sign and symptoms. Treatment principles described in [[Nidana Sthana]] should be incorporated in the ''upashaya'' (pacification factors). ''Nidana'' means the causative factor of the diseases. The term ''vyadhibodhakam'' means the diagnosis of diseases with the help of ''nidana, poorvarupa, rupa, upashaya'' and ''samprapti''. 1-2 [6]