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Line 2: − + − + + + + − + − − <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 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. − </div> − − Line 26:
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Line 227: − ''Samprapti'' can be further classified, depending upon certain specific characteristics, by ''sankhya'' (numerical classification), ''pradhanya'' (dominance of ''dosha''), ''vidhi'' (types of diseases), ''vikalpa'' (dominance of one or the other attributes of ''doshas''), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]+ Line 224:
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Line 860: − + − − In some acute diseases, the disease is presented directly with signs and symptoms. In these cases, the unmanifested form of the actual symptoms (''rupa'') described in the text should be treated as the ''poorvarupa'' of a disease. <ref>Chakrapani, Commentator, Charak Samhita Nidanasthana Adhyaya 1/8, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 195. </ref> − Vagbhata opines that ''poorvarupa'' are signs and symptoms that appear earlier to the actual disease, not specifically assignable to the ''doshas'' as they are mild (not clearly recognizable) and few in number. (A. H. Ni. 1/) <ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/3, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 441 </ref>. This is also substantiated in the Ashtanga Sangraha (A S Ni 1/8)<ref>Vagbhata, Ashtang Sangraham, Nidanasthana Adhyaya 1/11, Edited by Dr D V Pandit Rao, First Edition, CCRAS, New Delhi, 1991, 554 </ref>+ + − + − + − + − + Line 873:
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→Related Chapters
|title=Jwara Nidana
|title=Jwara Nidana
|titlemode=append
|titlemode=append
|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, Ayurveda, Indian system of medicine, charak samhita.
|description=Nidana Sthana Chapter 1. Chapter on Fundamental Principles of Diagnosis and Fever
|description=Nidana Sthana Chapter 1. Fundamental Principles of Diagnosis and Fever
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
}}
}}
<big>'''Nidana Sthana Chapter 1. Chapter on Fundamental Principles of Diagnosis and Fever '''</big>
<big>'''Nidana Sthana Chapter 1. Fundamental Principles of Diagnosis and Jwara '''</big>
{{Infobox
{{Infobox
|title = Jwara Nidana
|title = Jwara Nidana
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|data6 = Dwivedi R.B.,Dubey S.D., Gujarathi R.,Singh A.Khandel S.K., Rai S.
|label7 = Reviewer
|data7 = Kar A.C.
|label8 = Editors
|data8 = Khandel S.K., Godatwar P., Deole Y.S., Basisht G.
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s02.002 10.47468/CSNE.2020.e01.s02.002]
}}
<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 the 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]], [[hetu]], etiology, [[poorvarupa]], premonitory signs, [[rupa]], clinical signs, [[upashaya]], pacifying factors, [[samprapti]], pathogenesis, [[jwara]], [[nija]], [[aagantu]] [[jwara]], [[ghrita]] ,ghee, endogenous causes, exogenous causes, fever.
</div>
== Introduction ==
<div style="text-align:justify;">
<div style="text-align:justify;">
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. [Cha.Sa.[[Vimana Sthana]] 4/12] 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]]). [Cha.Sa.[[Nidana Sthana ]]1/6]
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>
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 ''Nidana Panchaka'' . Naturally, any disease, if diagnosed very early, could be prevented from manifesting itself through a variety of interventions. [Cha.Sa.[[Sutra Sthana]] 10/7] A proper understanding of the ''Nidana Panchaka'' helps the physician using various therapies, to establish an equilibrium among the patient’s [[dosha]], [[dhatu]], and [[mala]] – since it is the vitiation of these body features that cause a disease. A therapy is considered pure or correct (''vishuddha'') when it cures the disease without giving rise to another disease. [Cha.Sa.[[Nidana Sthana]] 8/23] Curable diseases can progress to incurable if they are not properly treated. [Cha.Sa.[[Nidana Sthana]] 8/35]
''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.
''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 [[dhatu]] that are causes of all somatic diseases – by the order of their importance (i.e., starting with [[rasa dhatu]]) – and ends with a study of vitiation of [[Rajas]] and [[Tamas]] (i.e., causes of mental diseases).
It is important to note here that ''jwara'' is an independent ailment, per [[Ayurveda]], but also a secondary condition of other diseases, and also an etiology responsible for various diseases. For example, ''jwara'' gives rise to ''raktapitta'' (haemorrhagic disease), which in turn causes ''jwara'', and both cause ''shotha'' (phthisis). Thus, ''jwara'' is an etiology in this context, or a ''nidanarthakara''. Sushruta describes ''jwara'' at first as a complication of a wound in an afflicted person because it is the chief among diseases and has emerged “from the fiery wrath of Lord Rudra”, per Vedic mythology. Explaining its nature, he says that it influences an individual particularly at the time of his birth and death. But in this chapter, ''jwara'' is described as an independent disease which acts upon ''vata, pitta,'' and ''kapha'' as an immediate etiological factor to cause fever. Besides this (as a cause), various indirect causes have also been described to explain the vitiation of each ''dosha'', along with their pathogenesis and symptoms separately. However, it is important to note that while there could be any number or types of causes, ''amashaya'' (stomach) is common to all types of ''jwara''. Pathogenetic ''doshas'' combined with heat located in ''amashaya'' and accompanying the first ''dhatu'' created with the digestion of food (also known as ''rasa'') obstructs the passage of ''rasa'' and ''sweda'', causing them to spread all over the body in various ways raising the body temperature of a person. This rising temperature is the manifestation of fever.
It is important to note here that ''[[jwara]]'' is an independent ailment, per [[Ayurveda]], but also a secondary condition of other diseases, and also an etiology responsible for various diseases. For example, ''[[jwara]]'' gives rise to ''raktapitta'' (haemorrhagic disease), which in turn causes ''[[jwara]]'', and both cause ''shotha'' (phthisis). Thus, ''[[jwara]]'' is an etiology in this context, or a ''nidanarthakara''. Sushruta describes ''[[jwara]]'' at first as a complication of a wound in an afflicted person because it is the chief among diseases and has emerged “from the fiery wrath of Lord Rudra”, per Vedic mythology. Explaining its nature, he says that it influences an individual particularly at the time of his birth and death. But in this chapter, ''[[jwara]]'' is described as an independent disease which acts upon ''[[vata]], [[pitta]],'' and ''[[kapha]]'' as an immediate etiological factor to cause fever. Besides this (as a cause), various indirect causes have also been described to explain the vitiation of each [[dosha]], along with their pathogenesis and symptoms separately. However, it is important to note that while there could be any number or types of causes, ''amashaya'' (stomach) is common to all types of ''[[jwara]]''. Pathogenetic [[dosha]] combined with heat located in ''amashaya'' and accompanying the first [[dhatu]] created with the digestion of food (also known as ''[[rasa]]'') obstructs the passage of ''[[rasa]]'' and ''sweda'', causing them to spread all over the body in various ways raising the body temperature of a person. This rising temperature is the manifestation of fever.
Depending upon the etiological factors, [[Ayurveda]] prescribes one of two types of therapies – spiritual and rational. A specific rational treatment of ''jwara'' could involve the use of processed ghee (clarified butter) with suitable drugs in a chronic fever is to alleviate all the three ''doshas''.
Depending upon the etiological factors, [[Ayurveda]] prescribes one of two types of therapies – spiritual and rational. A specific rational treatment of ''[[jwara]]'' could involve the use of processed ghee (clarified butter) with suitable drugs in a chronic fever is to alleviate all the three [[dosha]].
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</div></div>
Now I shall expound upon the chapter on the “Diagnosis of ''Jwara'' (Fever).”
Now we shall expound the chapter "Jwara Nidana"(Fundamental Principles of Diagnosis and Fever). Thus said Lord Atreya. [1-2]
Thus said Lord Atreya. [1-2]
=== Principles of knowledge of disease ===
=== Principles of knowledge of disease ===
==== Synonyms of Nidana (causative factors) and its types ====
==== Synonyms of [[Nidana]] (causative factors) and its types ====
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Hetu, nimitta, ayatana, karta, karana, pratyaya and samutthana are synonyms of nidana (causative factors). ''Nidana'' could be of three types:
*[[Hetu]], [[nimitta]], [[ayatana]], [[karta]], [[karana]], [[pratyaya]] and [[samutthana]] are synonyms of [[nidana]] (causative factors).
[[Nidana]] is of three types:
#''Asatmyendriyarthasamyoga'' (unsuitable contact of sense organs with their objects)
# Asatmyendriyarthasamyoga (unsuitable contact of sense organs with their objects)
#''Pragyaparadha'' (intellectual errors or knowingly engaging in harmful activities), and
# [[Prajnaparadha]] (intellectual errors or knowingly engaging in harmful activities), and
#''Kala'' (time, seasonal, temporal factors). [3]
# [[Kala]] (time, seasonal, temporal factors). [3]
==== Types of diseases ====
==== Types of diseases ====
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(Physical) diseases caused are of three types, viz., ''agneya'' (''pitta''-predominant diseases), ''saumya'' (''kapha''-predominant diseases) and ''vayavya'' (''vata''-predominant diseases). Others (mental) are of two types viz. ''rajas'' and ''tamas''. [4]
The (Somatic) diseases manifest in three types, viz.
#Agneya ([[pitta]] [[dosha]] dominant diseases)
#Saumya ([[kapha]] [[dosha]] dominant diseases)
#Vayavya ([[vata]] [[dosha]] dominant diseases).
Others (psychic) are of two types viz.
#Rajas([[Rajas]] [[dosha]] dominant diseases)
#Tamas ([[Tamas]] [[dosha]] dominant diseases). [4]
==== Synonyms of disease ====
==== Synonyms of disease ====
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Vyadhi, amaya, gada, atanka, yakshma, jwara, vikara and roga are synonyms of disease. [5]
==== Means for knowledge of disease ====
==== Means for knowledge of disease ====
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Diseases could be diagnosed by studying their ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (sign and symptoms), ''upashaya'' (exploratory therapy) and ''samprapti'' (pathogenesis).[6]
Diseases could be diagnosed by studying their [[nidana]] (etiology), [[poorvarupa]] (premonitory symptoms), [[linga]] (sign and symptoms), [[upashaya]] (pacifying factors) and [[samprapti]] (pathogenesis).[6]
==== Definition of Nidana ====
==== Definition of [[Nidana]] ====
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Symptoms that manifest themselves before the appearance of the disease are known as ''poorvarupa''. [8]
Symptoms that manifest themselves before the appearance of the disease are known as [[poorvarupa]]. [8]
==== Definition of [[Linga]] (sign) and its synonyms ====
==== Definition of [[Linga]] (sign) and its synonyms ====
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Sign and symptoms when fully manifested are called as ''linga''. ''Linga, akruti, lakshana, chihna, samsthana, vyanjana'' and ''rupa'' are synonyms of ''linga''. [9]
Sign and symptoms when fully manifested are called as [[linga]]. ''Linga, akruti, lakshana, chihna, samsthana, vyanjana'' and ''rupa'' are synonyms of [[linga]]. [9]
==== Definition of [[Upashaya]] (pacifying factors) ====
==== Definition of [[Upashaya]] (pacifying factors) ====
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Medicines, diets and regimens that bring about relief either by acting directly on the cause of a disease or the disease itself or by producing such effects indirectly are termed ''upashaya'' (pacifying agents or factors).[10]
Medicines, diets and regimens that bring about relief either by acting directly on the cause of a disease or the disease itself or by producing such effects indirectly are termed [[upashaya]] (pacifying factors).[10]
====[[Samprapti]] (pathogenesis)====
====[[Samprapti]] (pathogenesis)====
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''Samprapti, jati'' and ''agati'' are synonyms of pathogenesis of the disease.
''Jati'' and ''agati'' are synonyms of [[Samprapti]] (pathogenesis) of the disease.
Like ''nidana'' and ''rupa, samprapti'' has been described here with its synonyms which are indicative of its definition. [11]
Like [[nidana]] and [[rupa]], [[samprapti]] has been described here with its synonyms which are indicative of its definition. [11]
===== Types of samprapti (pathogenesis) =====
===== Types of [[samprapti]] (pathogenesis) =====
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[[Samprapti]] can be further classified, depending upon certain specific characteristics, by ''sankhya'' (numerical classification), ''pradhanya'' (dominance of [[dosha]]), ''vidhi'' (types of diseases), ''vikalpa'' (dominance of one or the other attributes of [[dosha]]), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]
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''Sankhya'' type of classification of ''samprapti'' numerically groups diseases by their pathogenesis, such as, eight types of ''jwara''(fever), five types of ''gulma'' (abdominal lump), seven types of ''kushtha'' (skin diseases), etc. [12.1].
''Sankhya'' type of classification of ''samprapti'' numerically groups diseases by their pathogenesis, such as, eight types of ''[[jwara]]''(fever), five types of ''gulma'' (abdominal lump), seven types of ''kushtha'' (skin diseases), etc. [12.1].
====== Pradhanya samprapti (Classification on dominance) ======
====== Pradhanya samprapti (Classification on dominance) ======
<div style="text-align:justify;">
<div style="text-align:justify;">
''Pradhanya'' (dominance) indicates the dominance or primacy of one particular ''dosha'' above other ''doshas''. If two ''doshas'' get vitiated, the comparative term ''tara'' is used to indicate the predominant one. If, all the three ''doshas'' get vitiated then the superlative term ''ttama'' is used to indicate the most predominant one. [12.2]
''Pradhanya'' (dominance) indicates the dominance or primacy of one particular [[dosha]] above other [[dosha]]. If two [[dosha]] get vitiated, the comparative term ''tara'' is used to indicate the predominant one. If, all the three [[dosha]] get vitiated then the superlative term ''tama'' is used to indicate the most predominant one. [12.2]
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====== Vidhi samprapti (Classification on prognosis) ======
====== Vidhi samprapti (Classification on prognosis) ======
<div style="text-align:justify;">
<div style="text-align:justify;">
Diseases are of two varieties - ''nija'' (endogenous) or ''agantu'' (exogenous). On the basis of vitiation of the ''doshas'', diseases could be of three types; they could also be of four varieties, viz. ''sadhya'' (curable), ''asadhya'' (incurable), ''mrudu'' (mild), and ''daruna'' (severe). [12.3]
Diseases are of two varieties - ''nija'' (endogenous) or ''agantu'' (exogenous). On the basis of vitiation of the ''[[dosha]]s'', diseases could be of three types; they could also be of four varieties, viz. ''sadhya'' (curable), ''asadhya'' (incurable), ''mrudu'' (mild), and ''daruna'' (severe). [12.3]
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====== Vikalpa samprapti (pathogenesis on fraction of [[dosha]]) ======
====== Vikalpa samprapti (pathogenesis on fraction of [[dosha]]) ======
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Predominance of one or the other attribute of the three ''doshas'' (in the manifestation of the disease) is known as ''vikalpa'' here. [12.4]
Predominance of one or the other attribute of the three [[dosha]] (in the manifestation of the disease) is known as ''vikalpa'' here. [12.4]
======Bala Kala (time of aggravation) samprapti======
======Bala Kala (time of aggravation) [[samprapti]]======
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In brief, the above topics are the objectives of this section ‘Diagnosis of diseases’ ([[Nidana Sthana]]). They will again be discussed in detail later in this chapter. [14]
In brief, the above topics are the objectives of this section ‘Diagnosis of diseases’ ([[Nidana Sthana]]). They will again be discussed in detail later in this chapter. [14]
== Knowledge of [[Jwara]] (fever) ==
==== Origin ====
==== Origin ====
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''Jwara'' (fever) is described first among disorders because temperature (or body heat) is a life-sustaining force, and is the first condition (afflicting patients of somatic conditions). [16]
''[[Jwara]]'' (fever) is described first among disorders because temperature (or body heat) is a life-sustaining force, and is the first condition (afflicting patients of somatic conditions). [16]
==== Types ====
==== Types ====
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''Jwara'' occurs in humans due to eight causative factors, - ''vata, pitta, kapha, vata-pitta, vata-kapha, pitta-kapha, vata-pitta-kapha,'' and ''agantu'' (exogenous causes). [17]
''[[Jwara]]'' occurs in humans due to eight causative factors, - ''[[vata]], [[pitta]], [[kapha]], vata-pitta, vata-kapha, pitta-kapha, vata-pitta-kapha,'' and ''agantu'' (exogenous causes). [17]
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Now I shall expound the specific ''nidana'' (etiology), ''poorvarupa'' (prodromal symptoms), ''rupa'' (symptoms) and ''upashaya'' (suitable uses) of ''jwara''. [18]
Now I shall expound the specific ''nidana'' (etiology), ''poorvarupa'' (prodromal symptoms), ''rupa'' (symptoms) and ''upashaya'' (pacifying factors) of ''[[jwara]]''. [18]
==== [[Vata]] dominant jwara ====
==== [[Vata]] dominant [[jwara]] ====
===== Causes =====
===== Causes =====
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This vitiated ''vayu'', when it gets into the ''amashaya'' (stomach), afflicts ''agni'' and vitiates the first ''dhatu'' (''rasa'') created through this vitiated digestion process. This (vitiated admixture of ''vayu'' and ''rasa'') blocks the channels associated with ''rasa'' and ''sweda'' (sweat), adversely affecting the digestive processes and moving that heat out of its locus into other parts of the body. This excess heat leads to ''jwara''. [20]
This vitiated ''vayu'', when it gets into the ''amashaya'' (stomach), afflicts ''agni'' and vitiates the first ''[[dhatu]]'' (''[[rasa]]'') created through this vitiated digestion process. This (vitiated admixture of ''vayu'' and ''[[rasa]]'') blocks the channels associated with ''[[rasa]]'' and ''sweda'' (sweat), adversely affecting the digestive processes and moving that heat out of its locus into other parts of the body. This excess heat leads to ''[[jwara]]''. [20]
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The patient would experience abrupt onset and remission (of fever), with variations in temperature and severity. ''Jwara'' would be particularly severe at the end of digestion and there would be temporal variations as well (i.e., day, night and in summer). The patient’s skin would appear rough, and there would be reddish discoloration of nails, eyes, face, urine, stool and skin. The patient would experience excessively reduced tendency to pass urine, feces, excessive tearing of nails, etc. Debilitating pain radiating from the toe up, with various sensations felt at various parts as the pain travels – numbness in feet, cramps in the calves, looseness in knee joints (and also in all other joints), weakness in thighs, excruciating pain in the waist region, aching in the sides, pressure sensation in back, churning in shoulder, cutting in arms, extracting in scapular region and constricting feeling in chest, inability to move the jaws, tinnitus, and piercing pain (pricking pain) in the temple region. (Other symptoms include) astringent taste or lack of taste in the mouth (distaste), dryness of mouth, palate and throat, thirst, catching pain (grabbing pain) in the heart, dry vomiting, dry cough, loss of sneezing and eructation, aversion to the taste, salivation, anorexia, diminished digestive power, malaise, increased yawning, bending, shivering, exhaustion, giddiness, delirium, insomnia, horripilation, sensitivity in teeth, and the desire for hot. Factors mentioned in the etiology are alleviating and contrary to them are aggravating. [21]
The patient would experience abrupt onset and remission (of fever), with variations in temperature and severity. ''[[Jwara]]'' would be particularly severe at the end of digestion and there would be temporal variations as well (i.e., day, night and in summer). The patient’s skin would appear rough, and there would be reddish discoloration of nails, eyes, face, urine, stool and skin. The patient would experience excessively reduced tendency to pass urine, feces, excessive tearing of nails, etc. Debilitating pain radiating from the toe up, with various sensations felt at various parts as the pain travels – numbness in feet, cramps in the calves, looseness in knee joints (and also in all other joints), weakness in thighs, excruciating pain in the waist region, aching in the sides, pressure sensation in back, churning in shoulder, cutting in arms, extracting in scapular region and constricting feeling in chest, inability to move the jaws, tinnitus, and piercing pain (pricking pain) in the temple region. (Other symptoms include) astringent taste or lack of taste in the mouth (distaste), dryness of mouth, palate and throat, thirst, catching pain (grabbing pain) in the heart, dry vomiting, dry cough, loss of sneezing and eructation, aversion to the taste, salivation, anorexia, diminished digestive power, malaise, increased yawning, bending, shivering, exhaustion, giddiness, delirium, insomnia, horripilation, sensitivity in teeth, and the desire for hot. Factors mentioned in the etiology are alleviating and contrary to them are aggravating. [21]
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==== Pitta dominant jwara ====
==== [[Pitta]] dominant jwara ====
===== Causes =====
===== Causes =====
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Excess use of hot, sour, salty, alkali, pungent and bitter food and intake of meals before the digestion of the previous meal, contact with intense heat, fire, exhaustion due to excessive exercise, anger, untimely meals – vitiate ''pitta''.[22]
Excess use of hot, sour, salty, alkali, pungent and bitter food and intake of meals before the digestion of the previous meal, contact with intense heat, fire, exhaustion due to excessive exercise, anger, untimely meals – vitiate ''[[pitta]]''.[22]
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The vitiated ''pitta'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' causes sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. Due to blocked channels of sweat, heat dissipation is adversely affected, causing the temperature to rise all over the body and manifest as ''paittika jwara''.[23]
The vitiated ''[[pitta]]'' enters the ''amashaya'' and gets mixed with the initial ''[[dhatu]]'' formed in the process, ''[[rasa]]'', along with the digested food. This improperly formed ''[[rasa]]'' causes sluggish circulation and further block the micro channels of ''[[rasa]]'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. Due to blocked channels of sweat, heat dissipation is adversely affected, causing the temperature to rise all over the body and manifest as ''paittika jwara''.[23]
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The symptoms of this type of ''jwara'' include simultaneous high fever in the whole body, specially at the time during digestion of meals, midday, middle of the night or in the Autumn season. This type of fever leaves a pungent taste in the mouth, ''paka'' (ulceration or inflammation) of the nose, mouth, throat, lips and palate, unquenchable thirst, narcosis, giddiness, fainting, vomiting of ''pitta'' (bile), ''atisara'' (diarrhea), aversion to food, malaise, dejection, delirium, appearance of reddish patches in the body, green or yellow coloration in nails, eyes, mouth, urine, feces and skin, excessive migraine and burning sensation, desire for cold things, unsuitability of included factors in etiology and suitability of opposite ones – these symptoms are of ''pitta'' (or ''paittika'') ''jwara''. [22-24]
The symptoms of this type of ''[[jwara]]'' include simultaneous high fever in the whole body, specially at the time during digestion of meals, midday, middle of the night or in the Autumn season. This type of fever leaves a pungent taste in the mouth, ''paka'' (ulceration or inflammation) of the nose, mouth, throat, lips and palate, unquenchable thirst, narcosis, giddiness, fainting, vomiting of ''[[pitta]]'' (bile), ''atisara'' (diarrhea), aversion to food, malaise, dejection, delirium, appearance of reddish patches in the body, green or yellow coloration in nails, eyes, mouth, urine, feces and skin, excessive migraine and burning sensation, desire for cold things, unsuitability of included factors in etiology and suitability of opposite ones – these symptoms are of ''[[pitta]]'' (or ''paittika'') ''[[jwara]]''. [22-24]
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==== [[Kapha]]-dominant jwara ====
==== [[Kapha]] dominant jwara ====
=====Causes=====
=====Causes=====
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Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle –vitiate ''sleshma'' or ''kapha''. [25]
Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle –vitiate ''sleshma'' or ''[[kapha]]''. [25]
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The vitiated ''kapha'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' cause sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. As channels of sweat are blocked and are unable to dissipate the heat, temperature rises all over the body, causing ''jwara''. [26]
The vitiated ''[[kapha]]'' enters the ''amashaya'' and gets mixed with the initial ''[[dhatu]]'' formed in the process, ''[[rasa]]'', along with the digested food. This improperly formed ''[[rasa]]'' cause sluggish circulation and further block the micro channels of ''[[rasa]]'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. As channels of sweat are blocked and are unable to dissipate the heat, temperature rises all over the body, causing ''[[jwara]]''. [26]
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=====Clinical features =====
=====Clinical features =====
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==== ''Sannipatika jwara'' ====
==== Sannipatika jwara ====
===== Causes =====
===== Causes =====
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विषमाशनादनशनादन्नपरिवर्तादृतुव्यापत्तेरसात्म्यगन्धोपघ्राणाद्विषोपहतस्य चोदकस्योपयोगाद्गरेभ्यो गिरीणां चोपश्लेषात् स्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावrयोगाrथ्यासंसर्जनाद्वा स्त्रीणां च विषमप्रजननात् प्रजातानां च मिथ्योपचाराद्यथोक्तानां च हेतूनां मिश्रीभावाद्यथानिदानं द्वन्द्वानामन्यतमः सर्वे वा त्रयो दोषा युगपrकोपमापद्यन्ते,ते प्रकुपितास्तयैवानुपूर्व्या ज्वरमभिनिर्वर्तयन्ति||२८||
विषमाशनादनशनादन्नपरिवर्तादृतुव्यापत्तेरसात्म्यगन्धोपघ्राणाद्विषोपहतस्य चोदकस्योपयोगाद्गरेभ्यो गिरीणां चोपश्लेषात् स्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावत्प्रयोगात् मिथ्यासंसर्जनाद्वा स्त्रीणां च विषमप्रजननात् प्रजातानां च मिथ्योपचाराद्यथोक्तानां च हेतूनां मिश्रीभावाद्यथानिदानं द्वन्द्वानामन्यतमः सर्वे वा त्रयो दोषा युगपत् प्रकोपमापद्यन्ते,ते प्रकुपितास्तयैवानुपूर्व्या ज्वरमभिनिर्वर्तयन्ति||२८||
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Irregular diet, fasting, change in regular meals, seasonal derangement, unsuitable odors, use of hilly water full of poisonous sediments, improper medication by ghee, oils and fats, medical fomentations, emesis, purgation, oily or decoction enema, nasal instillations, faulty diets after purification therapies, women undergoing abnormal delivery and inappropriate post-partum management - these are some of the etiological factors that have already been mentioned as causes of vitiation of ''doshas'', that cause fever. [28]
Irregular diet, fasting, change in regular meals, seasonal derangement, unsuitable odors, use of hilly water full of poisonous sediments, improper medication by ghee, oils and fats, medical fomentations, emesis, purgation, oily or decoction enema, nasal instillations, faulty diets after purification therapies, women undergoing abnormal delivery and inappropriate post-partum management - these are some of the etiological factors that have already been mentioned as causes of vitiation of ''[[dosha]]s'', that cause fever. [28]
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When the symptoms exhibit the dominance of two ''doshas'', it is called ''sansrishta'' (''dwandaja'') ''jwara'' and in case all three ''doshas'' are vitiated, it is called ''sannipatika jwara'' (tridoshic fever). [29]
When the symptoms exhibit the dominance of two ''[[dosha]]s'', it is called ''sansrishta'' (''dwandaja'') ''jwara'' and in case all three ''[[dosha]]s'' are vitiated, it is called ''sannipatika jwara'' (tridoshic fever). [29]
==== ''Agantu jwara'' (Exogenous fever) ====
==== [[Agantu]] jwara (Exogenous fever) ====
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''Agantuja jwara'' (''jwara'' caused due to exogenous factors) is the eighth type of fever. This fever is accompanied with pain and is often caused by trauma, association with evil, fascination, and wrath (of the wise and the elders). These causes directly manifest as fever without any prodromal symptoms for a transitional duration. Slowly, with the passage of time, ''doshas'' get vitiated and their effects manifest as above. Fevers caused due to trauma influence blood pathology, while association with evil afflicts ''vata'' and ''pitta'', and fascination and wrath causes ''sannipata'' (and therefore, leads to an incurable condition). [30]
''Agantuja jwara'' (''jwara'' caused due to exogenous factors) is the eighth type of fever. This fever is accompanied with pain and is often caused by trauma, association with evil, fascination, and wrath (of the wise and the elders). These causes directly manifest as fever without any prodromal symptoms for a transitional duration. Slowly, with the passage of time, ''[[dosha]]s'' get vitiated and their effects manifest as above. Fevers caused due to trauma influence blood pathology, while association with evil afflicts ''[[vata]]'' and ''[[pitta]]'', and fascination and wrath causes ''sannipata'' (and therefore, leads to an incurable condition). [30]
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ज्वरस्त्वेकएवसन्तापलक्षणः|तमेवाभिप्रायविशेषाद्द्विविधमाचक्षते,निजागन्तुविशेषाच्च|तत्र निजं द्विविधं त्रिविधं चiतुर्विधं सप्तविधं चाहुर्भिषजो वातादिविकल्पात्||३२||
ज्वरस्त्वेकएवसन्तापलक्षणः| तमेवाभिप्रायविशेषाद्द्विविधमाचक्षते,निजागन्तुविशेषाच्च|तत्र निजं द्विविधं त्रिविधं चतुर्विधं सप्तविधं चाहुर्भिषजो वातादिविकल्पात्||३२||
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==== General premonitory features of all ''jwara'' ====
==== General premonitory features of all jwara ====
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Thus the symptoms of separate single doshic ''jwara'' are described in details and double and triple doshic ''jwara'' are described in brief [34].
Thus the symptoms of separate single doshic ''jwara'' are described in details and double and triple doshic ''jwara'' are described in brief [34].
==== Consequences of ''jwara'' ====
==== Consequences of jwara ====
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==== Principles of management of ''jwara'' ====
==== Principles of management of jwara ====
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==== Management principles of '' jeerna jwara''(chronic fever) ====
==== Management principles of jeerna jwara (chronic fever) ====
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In all types of ''jirna jwara'' (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies ''vata'' by its unctuousness, ''kapha'' by (ghee infused with) ''kapha'' pacifying drugs, and ''pitta'' by its coldness. Therefore, ghee is useful in all forms of ''jirna jwara'' like fire subsides with water. [37]
In all types of ''jirna jwara'' (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies ''[[vata]]'' by its unctuousness, ''[[kapha]]'' by (ghee infused with) ''[[kapha]]'' pacifying drugs, and ''[[pitta]]'' by its coldness. Therefore, ghee is useful in all forms of ''jirna jwara'' like fire subsides with water. [37]
Here are (the verses) –
Here are (the verses) –
As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other ''sneha'' (oil etc.) brings the refinement properties of ''sanskara'' (processing with drugs) as ghee and therefore it is said the best one of all the ''snehas''. [38-40]
As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other ''sneha'' (oil etc.) brings the refinement properties of ''sanskara'' (processing with drugs) as ghee and therefore it is said the best one of all the ''snehas''. [38-40]
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====Rule of exception for repetition of text====
====Rule of exception for repetition of text====
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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'' / Founding Principles ===
== Tattva Vimarsha (Fundamental 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]
*Somatic diseases could be caused due to ''soma'' (''kapha''), ''agni'' (''pitta''), and ''vayu'' (''vata'') – due to vitiation of single ''dosha'', two ''doshas'', or all three ''doshas''. Psychiatric diseases are attributed to vitiation of ''rajas'' and ''tamas''. [4]
*Somatic diseases could be caused due to ''soma'' (''[[kapha]]''), ''agni'' (''[[pitta]]''), and ''vayu'' (''[[vata]]'') – due to vitiation of single ''[[dosha]]'', two ''[[dosha]]s'', or all three ''[[dosha]]s''. Psychiatric diseases are attributed to vitiation of ''rajas'' and ''tamas''. [4]
*A disease can be seen clinically as a consequence of toxins inside the body, and could be defined as that which inflicts fear, hampers quality of life, manifests with many signs, decreases life, affects the senses, cause pain, and makes life hard. [5]
*A disease can be seen clinically as a consequence of toxins inside the body, and could be defined as that which inflicts fear, hampers quality of life, manifests with many signs, decreases life, affects the senses, cause pain, and makes life hard. [5]
*The five key factors of ''jwara nidana'' that provide a complete view of a disease are etiology, premonitory signs, clinical features, pacifying factors, and pathogenesis. [6]
*The five key factors of ''jwara nidana'' that provide a complete view of a disease are etiology, premonitory signs, clinical features, pacifying factors, and pathogenesis. [6]
*The pathogenesis of a disease includes numerical classification, types of diseases, knowledge of a dominant factor, and temporal factors (aggravation time and season).
*The pathogenesis of a disease includes numerical classification, types of diseases, knowledge of a dominant factor, and temporal factors (aggravation time and season).
*''Jwara'' is the primary change observed in body that initiates a disease process. [16]
*''Jwara'' is the primary change observed in body that initiates a disease process. [16]
*All forms of ''jwara'' are caused due to vitiation of ''doshas'', which in turn have various causative factors (for their vitiation). [17]
*All forms of ''jwara'' are caused due to vitiation of [[dosha]], which in turn have various causative factors (for their vitiation). [17]
*The important pathological events in process of ''jwara'' are as below:
*The important pathological events in process of ''jwara'' are as below:
**Vitiated ''doshas'' get accumulated in the ''amashaya'' i.e. site of first phase of digestion
**Vitiated ''[[dosha]]s'' get accumulated in the ''amashaya'' i.e. site of first phase of digestion
**Next, these ''doshas'' mix with the undigested food material, in that heated environment, in the ''amashaya'', vitiating the ''ahara rasa'' (just digested food)
**Next, these ''[[dosha]]s'' mix with the undigested food material, in that heated environment, in the ''amashaya'', vitiating the ''ahara rasa'' (just digested food)
**This vitiated ''rasa'' blocks the ''rasavaha'' and ''swedavaha strotas'' (channels) that regulate body heat.
**This vitiated ''rasa'' blocks the ''rasavaha'' and ''swedavaha strotas'' (channels) that regulate body heat.
Consequently, there is an affliction of the digestion process and spreading of heat outside its natural location, causing a rise in body temperature [19-28]
Consequently, there is an affliction of the digestion process and spreading of heat outside its natural location, causing a rise in body temperature [19-28]
*Exogenous factors may cause ''jwara'' by vitiating ''rakta'' (blood), and/or ''dosha''. [30]
*Exogenous factors may cause ''jwara'' by vitiating ''[[rakta]]'' (blood), and/or ''[[dosha]]''. [30]
*Rise in temperature is a confirmative sign of ''jwara''. [32]
*Rise in temperature is a confirmative sign of ''jwara''. [32]
*The light to digest diet and reduction therapy shall be started as soon as premonitory signs of ''jwara'' are observed. [36]
*The light to digest diet and reduction therapy shall be started as soon as premonitory signs of ''jwara'' are observed. [36]
*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'' / Applied Inferences===
== 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]
If diseases are not properly known, one cannot start the treatment. Therefore, ''Nidanapanchaka'' (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease. <ref>Chakrapani, Commentator, Charak Samhita Nidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. </ref>
If diseases are not properly known, one cannot start the treatment. Therefore, ''Nidanapanchaka'' (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease. [Cha.Sa.[[Nidhana Sthana]] 1/6]
Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]
Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]
#'''''Sannikrishta''''' (immediate causative factor): Immediate factors that cause afflication of a disease in a short span of time and do not require to wait for the different stages of ''doshaprakopa'' like ''chaya'' etc., are known as ''sannikrishta''. Such factors do not require any help of other causative factors to produce the disease, though it is not an independent agent either.
#'''''Sannikrishta''''' (immediate causative factor): Immediate factors that cause afflication of a disease in a short span of time and do not require to wait for the different stages of ''doshaprakopa'' like ''chaya'' etc., are known as ''sannikrishta''. Such factors do not require any help of other causative factors to produce the disease, though it is not an independent agent either.
#'''''Viprakrishta''''' (delayed/ chronic causative factor): These factors do not cause the disease in a short span of time. These causative factors have to wait for increased, gradual accumulation of ''doshas'' to get strength. A threshold, once reached, triggers the onset of the disease. The example of this is the accumulation of ''kapha dosha'' during ''Hemanta ritu'' (early winter season), causing diseases seen in ''Vasanta ritu''(spring season). ''Sannikrishta'' factors tend to use this foundation prepared by ''viprakrishta'' factors. As the diseases are immediately seen after the consumption of ''Sannikrishta'' factors, it gives the impression that the disease is caused only due to ''Sannikrishta'' factors. Thus, a disease cannot manifest independently by either ''Viprakrishta'' or ''Sannikrishta'' factors – it would require both.
#'''''Viprakrishta''''' (delayed/ chronic causative factor): These factors do not cause the disease in a short span of time. These causative factors have to wait for increased, gradual accumulation of ''[[dosha]]s'' to get strength. A threshold, once reached, triggers the onset of the disease. The example of this is the accumulation of ''[[kapha dosha]]'' during ''Hemanta ritu'' (early winter season), causing diseases seen in ''Vasanta ritu''(spring season). ''Sannikrishta'' factors tend to use this foundation prepared by ''viprakrishta'' factors. As the diseases are immediately seen after the consumption of ''Sannikrishta'' factors, it gives the impression that the disease is caused only due to ''Sannikrishta'' factors. Thus, a disease cannot manifest independently by either ''Viprakrishta'' or ''Sannikrishta'' factors – it would require both.
#'''''Vyabhichari''''' (weak causative factors or doubtful causative factors): These types of causative factors are weak and they may or may not be the etiological factors responsible for the disease. These could be secondary factors that require some other factor to afflict the patient, or could become a primary factor if the time is favorable.
#'''''Vyabhichari''''' (weak causative factors or doubtful causative factors): These types of causative factors are weak and they may or may not be the etiological factors responsible for the disease. These could be secondary factors that require some other factor to afflict the patient, or could become a primary factor if the time is favorable.
#'''''Pradhanika''''' (primary causative factor): These types of causes are the definite causes of disease due to their own strength. For example, poisons, severe trauma, etc. are considered as ''pradhanika hetu''.
#'''''Pradhanika''''' (primary causative factor): These types of causes are the definite causes of disease due to their own strength. For example, poisons, severe trauma, etc. are considered as ''pradhanika hetu''.
#'''''Asatmyendriyartha Samyoga''''' (Abnormal contact of the ''Indriyas'', i.e., sensory and motor organs): Excessive utilization, underutilization or improper utilization of sensory and motor organs with their objects is called as ''Asatmyendriyarth Samyoga''.
#'''''Asatmyendriyartha Samyoga''''' (Abnormal contact of the ''Indriyas'', i.e., sensory and motor organs): Excessive utilization, underutilization or improper utilization of sensory and motor organs with their objects is called as ''Asatmyendriyarth Samyoga''.
#'''''Pragyaparadha''''' (intellectual errors): The errors in one’s ''dhee'' (intellect), ''dhriti'' (restraint) and ''smriti'' (memory) lead to improper activitites. These result in improper activities of body, mind and speech leading to vitiation of ''dosha''.
#'''''[[Prajnaparadha]]''''' (intellectual errors): The errors in one’s ''dhee'' (intellect), ''dhriti'' (restraint) and ''[[smriti]]'' (memory) lead to improper activitites. These result in improper activities of body, mind and speech leading to vitiation of ''[[dosha]]''.
#'''''Parinama''''' (changes in the timings and in age): Changes in weather conditions or climate could lead to changes in environment that cause disease. Also, as one ages, exposure to environmental elements could afflict a person adversely. These are collectively termed ''parinama''.
#'''''Parinama''''' (changes in the timings and in age): Changes in weather conditions or climate could lead to changes in environment that cause disease. Also, as one ages, exposure to environmental elements could afflict a person adversely. These are collectively termed ''parinama''.
Another classification is as follows:
Another classification is as follows:
#'''''Doshahetu''''' – These causes are directly responsible for the vitiation of ''doshas'' and that particular vitiated ''dosha'' becomes the cause of the disease.
#'''''Doshahetu''''' – These causes are directly responsible for the vitiation of ''[[dosha]]s'' and that particular vitiated ''[[dosha]]'' becomes the cause of the disease.
#'''''Vyadhihetu''''' – Such specific causative factors are directly responsible for the specific type of diseases. E.g., the use of ''sheetoshnaviparyaya'' (using hot and cold things at same time repeatedly) is a specific cause of ''kushtha'' (skin disease).
#'''''Vyadhihetu''''' – Such specific causative factors are directly responsible for the specific type of diseases. E.g., the use of ''sheetoshnaviparyaya'' (using hot and cold things at same time repeatedly) is a specific cause of ''kushtha'' (skin disease).
#'''''Ubhayahetu''''' – These causes are responsible for the vitiation of ''doshas'' as well as specific diseases e.g. continuous intake of sweets, unctuous and heavy diet is the cause of ''kaphadushti'' (''doshahetu''), as well as for ''kapha dosha'' dominant disorders (''vyadhihetu'') like ''sthaulya'' (obesity) and ''madhumeha'' (diabetes).
#'''''Ubhayahetu''''' – These causes are responsible for the vitiation of ''[[dosha]]s'' as well as specific diseases e.g. continuous intake of sweets, unctuous and heavy diet is the cause of ''[[kapha]] dushti'' (''doshahetu''), as well as for ''[[kapha dosha]]'' dominant disorders (''vyadhihetu'') like ''sthaulya'' (obesity) and ''madhumeha'' (diabetes).
==== D.Fourth classification ====
==== D. Fourth classification ====
This classification describes ''nidana'' to be of two types:
This classification describes ''nidana'' to be of two types:
#'''''Utpadakahetu''''': These are the direct and primary causes of diseases which do not require the support of any other causes like dietetic, behavioral, psychological, accident, poisons etc.
#'''''Utpadakahetu''''': These are the direct and primary causes of diseases which do not require the support of any other causes like dietetic, behavioral, psychological, accident, poisons etc.
#'''''Vyanjakahetu''''' – (The supportive causes of the diseases): These are the indirect causes of the diseases and become supportive to the ''utpadaka hetu''. For example, the seasons, or time of the day (early morning, midday, evening, midnight) are the ''vyanjakahetu'' for various diseases.
#'''''Vyanjakahetu''''' – (The supportive causes of the diseases): These are the indirect causes of the diseases and become supportive to the ''utpadaka [[hetu]]''. For example, the seasons, or time of the day (early morning, midday, evening, midnight) are the ''vyanjakahetu'' for various diseases.
==== E.Fifth Classification ====
==== E.Fifth Classification ====
#'''''Bahyahetu''''' (external causative factors): The causative factors like abnormal diet, activities and seasonal effects which create the disease are termed as ''bahyahetu''.
#'''''Bahyahetu''''' (external causative factors): The causative factors like abnormal diet, activities and seasonal effects which create the disease are termed as ''bahyahetu''.
#'''''Abhyantarahetu''''' (Internal causative factors): Imbalance of the ''dosha, dhatu'' and ''mala'' along with psycho-sensory dysfunctions as well malfunctions of ''agni'' are termed as ''abhyantarahetu''.
#'''''Abhyantarahetu''''' (Internal causative factors): Imbalance of the ''[[dosha]], [[dhatu]]'' and ''[[mala]]'' along with psycho-sensory dysfunctions as well malfunctions of ''agni'' are termed as ''abhyantarahetu''.
==== F.Sixth Classification ====
==== F.Sixth Classification ====
This classifies ''nidana'' into the following types:
This classifies ''nidana'' into the following types:
#'''''Prakritahetu''''': Natural aggravation of ''doshas'' in the respective seasons and age is called as ''prakritahetu'' which does not cause the disease alone but with the help of other aggravating factors may cause the disease.
#'''''Prakritahetu''''': Natural aggravation of ''[[dosha]]s'' in the respective seasons and age is called as ''prakritahetu'' which does not cause the disease alone but with the help of other aggravating factors may cause the disease.
#'''''Vaikritahetu''''': If ''doshas'' are aggravated in the seasons other than their natural aggravation time and create the disease then they are termed as ''vaikritahetu''. E.g. Aggravation of ''pitta dosha'' in ''Vasanta'' (spring) season. (natural aggravation time of ''pitta dosha'' is ''Sharada ritu''.)(7) <ref>Madhavakar, Madhava Nidanam, Pancha Nidanalakshanam, Edited by Prof. Yadunandana Upadhyaya, Thirtyth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2000, 196. </ref>
#'''''Vaikritahetu''''': If ''[[dosha]]s'' are aggravated in the seasons other than their natural aggravation time and create the disease then they are termed as ''vaikritahetu''. E.g. Aggravation of ''[[pitta dosha]]'' in ''Vasanta'' (spring) season. (natural aggravation time of ''[[pitta dosha]]'' is ''Sharada ritu''.)(7) <ref>Madhavakar, Madhava Nidanam, Chap.1, Pancha Nidanalakshanam, Verse 8. In: Prof. Yadunandana Upadhyaya, Editor. Madhava Nidanam. 30th ed. Varanasi: Chaukhambha Sanskrit Sansthana; 2000.p.196. </ref>
==== ''Poorvarupa'' (premonitory signs) ====
==== ''Poorvarupa'' (premonitory signs) ====
There are two types of ''Poorvarupa'':
There are two types of ''Poorvarupa'':
#Incomplete manifestation of the symptoms before the appearance of the disease.
#Incomplete manifestation of the symptoms before the appearance of the disease.
#''Poorvarupa'' caused due to ''doshadushyasammurchana'' (interaction of vitiated ''dosha'' and ''dushya'') that are different from the previous ones. e.g. feeling of hatred towards children or horripilation seen in ''jwara''. These types of ''poorvarupas'' are not seen when the ''jwara'' is manifested completely. But if they are seen then the prognosis of the disease is ''asadhyata'' (incurable). These signs are symptomatic of the diseases to be seen in the near future and do not indicate ''dosha'' predominance in that disease.
#''Poorvarupa'' caused due to ''doshadushyasammurchana'' (interaction of vitiated ''[[dosha]]'' and ''[[dushya]]'') that are different from the previous ones. e.g. feeling of hatred towards children or horripilation seen in ''[[jwara]]''. These types of ''poorvarupas'' are not seen when the ''[[jwara]]'' is manifested completely. But if they are seen then the prognosis of the disease is ''asadhyata'' (incurable). These signs are symptomatic of the diseases to be seen in the near future and do not indicate ''[[dosha]]'' predominance in that disease.
In some acute diseases, the disease is presented directly with signs and symptoms. In these cases, the unmanifested form of the actual symptoms (''rupa'') described in the text should be treated as the ''poorvarupa'' of a disease. [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/8]
Vagbhata opines that ''poorvarupa'' are signs and symptoms that appear earlier to the actual disease, not specifically assignable to the ''[[dosha]]s'' as they are mild (not clearly recognizable) and few in number. [A.H. Nidhana Sthana. 1/3] This is also substantiated in the Ashtanga Sangraha <ref>Vridha Vagbhata. Nidana Sthana, Cha.1 Sarvaroganidana Adhyaya verse 11. In: D V Pandit Rao, Editor. Ashtanga Sangraha. 1st ed. New Delhi: CCRAS;1991 </ref>
Gangadhara, commentator of [[Charak Samhita]], describes two types of ''Poorvarupa'':
Gangadhara, commentator of [[Charak Samhita]], describes two types of ''Poorvarupa'':
#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''doshas''.
#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''[[dosha]]s''.
#'''''Vishesha Poorvarupa''''' (specific premonitory features): These are the general symptoms of disease which manifest before the manifestation of the disease and indicate involvement of ''doshas''. <ref>Gangadhar, Commentator, Charak Samhita Nidanasthana Adhyaya 1/5, Edited by Narendranath Sengupta, Reprint edition, Rashtriya Sanskrit Sansthana, Varanasi, 2002, 1213 </ref>
#'''''Vishesha Poorvarupa''''' (specific premonitory features): These are the general symptoms of disease which manifest before the manifestation of the disease and indicate involvement of ''[[dosha]]s''.[Gangadhar on Cha.Sa.[[Nidana Sthana]].1/5]
==== ''Rupa'' (clinical signs and symptoms) ====
==== ''Rupa'' (clinical signs and symptoms) ====
''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''doshas'', various stages viz., ''ama'' (immature), ''pakva'' (mature), etc. They however, do not include such other factors of diagnosis of the diseases like ''nidana, upashaya'' and ''samprapti''. <ref>Chakrapani, Commentator, Charak Samhita Nidanasthana Adhyaya 1/9, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 195. </ref>.
''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''[[dosha]]s'', various stages viz., ''ama'' (immature), ''pakva'' (mature), etc. They however, do not include such other factors of diagnosis of the diseases like ''nidana, upashaya'' and ''samprapti''.[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/9]
''Rupa'' includes the following signs and symptoms:
''Rupa'' includes the following signs and symptoms:
#Invariable symptoms of the diseases like hyperpyrexia.
#Invariable symptoms of the diseases like hyperpyrexia.
#Symptoms caused by the vitiation of ''doshas'' like irregularity in onset and relief of attacks which is characteristic feature of fever caused by the vitiation of ''vata dosha''.
#Symptoms caused by the vitiation of ''[[dosha]]s'' like irregularity in onset and relief of attacks which is characteristic feature of fever caused by the vitiation of ''[[vata dosha]]''.
#Symptoms indicative of specific stages of the diseases like those observed during ''ama'' (immature), ''pakva'' (mature), and ''jeerna'' (chronic) stage.
#Symptoms indicative of specific stages of the diseases like those observed during ''ama'' (immature), ''pakva'' (mature), and ''jeerna'' (chronic) stage.
#Symptoms arise due to the complication of the diseases indicating their incurability.
#Symptoms arise due to the complication of the diseases indicating their incurability.
Hence, all these above synonyms quoted are indicative of such symptomatology which is scattered in different diseases. Any one term is not sufficient to define the ''rupa'' or ''lakshana'' entirely therefore these different terms have been collectively described here. [9]
Hence, all these above synonyms quoted are indicative of such symptomatology which is scattered in different diseases. Any one term is not sufficient to define the ''rupa'' or ''lakshana'' entirely therefore these different terms have been collectively described here. [9]
''Upashaya'' (pacification):
===''Upashaya'' (pacification):===
''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups:<ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,195. </ref>
''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups:[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/10]
#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.
#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.
#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.
#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.
#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)
#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)
#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)
#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)
#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref>
#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/10]
</div>
</div>
=====Various examples of ''upashaya'':=====
=====Various examples of ''upashaya'':=====
! rowspan="1"| Vihar
! rowspan="1"| Vihar
|-
|-
| Hetu viparita || Usage of shunthi in sheeta kaphaja jwara due to its hotness. || Intake of meat juice in case of vata jwara and fatigue ||Remaining awake at night in aggravation of kapha dosha due to day sleeping
| Hetu viparita || Usage of shunthi in sheeta kaphaja jwara due to its hotness. || Intake of meat juice in case of [[vata]] [[jwara]] and fatigue ||Remaining awake at night in aggravation of kapha dosha due to day sleeping
|-
|-
| Vyadhi viparita || Use of antidiarrheal drugs like Patha etc. in diarrhea || Intake of food like masur etc. in diarrhoea due to its antidiarrheal property. || Pravahana improving downwards peristalsis is the treatment for udavarta rogi
| Vyadhi viparita || Use of antidiarrheal drugs like Patha etc. in diarrhea || Intake of food like masur etc. in diarrhoea due to its antidiarrheal property. || Pravahana improving downwards peristalsis is the treatment for udavarta rogi
| Hetu-vyadhi viparita || Usage of dashmoola qwath in case of vataja jwara due to its vatahara and shothhara property || Usage of hot substances and antipyretic gruel against sheetotthajwara, which subsides cold and fever. ||Night awakening etc. which brings roughness in case of tandra, which is the result of consumption of Slimy substances followed by day sleeping.
| Hetu-vyadhi viparita || Usage of dashmoola qwath in case of vataja jwara due to its vatahara and shothhara property || Usage of hot substances and antipyretic gruel against sheetotthajwara, which subsides cold and fever. ||Night awakening etc. which brings roughness in case of tandra, which is the result of consumption of Slimy substances followed by day sleeping.
|-
|-
| Hetu viparitarthakari || Usage of vrishya drugs like pippali, shunthi etc. in case of shukrakshaya due to intake of excess pungent substances. || Usage of food substances which are hot in pachyamana shoth caused due to pitta dosha. || Inducing fear to the patients who are suffering from vataja unmada.
| Hetu viparitarthakari || Usage of vrishya drugs like pippali, shunthi etc. in case of shukrakshaya due to intake of excess pungent substances. || Usage of food substances which are hot in pachyamana shoth caused due to [[pitta dosha]]. || Inducing fear to the patients who are suffering from vataja unmada.
|-
|-
| Vyadhi viparitarthakari || Usage of emetic drugs like madanaphala in case of chardi (vomitting) || Intake of milk in case of atisar, which induces purgation. || Inducing vomiting by external support in case of chardi.
| Vyadhi viparitarthakari || Usage of emetic drugs like madanaphala in case of chardi (vomitting) || Intake of milk in case of atisar, which induces purgation. || Inducing vomiting by external support in case of chardi.
|}
|}
Vagbhata defines upashaya as satmya (compatible). (A H Ni. 1/).<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/6, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 442 </ref>
Vagbhata defines upashaya as satmya (compatible). [A.H Nidana Sthana.1/6]
In nutshell, upashaya is the therapeutic test that is helpful in diagnosing the doubtful stages of different diseases. This is adopted during differential diagnoses of the disease. [10]
In nutshell, upashaya is the therapeutic test that is helpful in diagnosing the doubtful stages of different diseases. This is adopted during differential diagnoses of the disease. [10]
==== ''Samprapti'' (pathogenesis) ====
==== ''Samprapti'' (pathogenesis) ====
<div style="text-align:justify;">
<div style="text-align:justify;">
''Samprapti'' is a compound word meaning ''samyak aapti''/ ''prapti'' i.e. complete manifestation of a disease or the stage where the disease could be understood well. This pathogenesis explains the pattern of disequilibrium of ''dosha'' interacting with body tissues and thus, gives a clearer picture of disease. This covers all the six stages (''chayaprakopadi'') of the disease as told by Sushruta and the physician gets a complete understanding of the ''nidanas'' (causes), ''poorvarupas, rupas'' and ''upashayanupashaya'' with the help of ''samprapti''. Mostly patients come to physician when the process of ''samprapti'' is completed and at that time there may not be any existence of ''nidanas'' or ''poorvarupas''.
''Samprapti'' is a compound word meaning ''samyak aapti''/ ''prapti'' i.e. complete manifestation of a disease or the stage where the disease could be understood well. This pathogenesis explains the pattern of disequilibrium of ''[[dosha]]'' interacting with body tissues and thus, gives a clearer picture of disease. This covers all the six stages (''chayaprakopadi'') of the disease as told by Sushruta and the physician gets a complete understanding of the ''nidanas'' (causes), ''poorvarupas, rupas'' and ''upashayanupashaya'' with the help of ''samprapti''. Mostly patients come to physician when the process of ''samprapti'' is completed and at that time there may not be any existence of ''nidanas'' or ''poorvarupas''.
''Jati'' is a synonym of ''samprapti'' that indicates the ''janan'' (genesis) of the disease as explained above.
''Jati'' is a synonym of ''samprapti'' that indicates the ''janan'' (genesis) of the disease as explained above.
''Aagati'': Literally means the manifestation and remission of the disease. In this process of disease manifestation (''samprapti''), the physician gets the knowledge in the form of qualitative and quantitative progress of the disease.
''Aagati'': Literally means the manifestation and remission of the disease. In this process of disease manifestation (''samprapti''), the physician gets the knowledge in the form of qualitative and quantitative progress of the disease.
While the symptoms of a disease manifest completely after pathogenesis (''samprapti''), still for the purpose of diagnosis, the knowledge of ''samprapti'' is not as important as the knowledge of ''linga'' (symptoms). Hence ''samprapti'' is described at the end. <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref>
While the symptoms of a disease manifest completely after pathogenesis (''samprapti''), still for the purpose of diagnosis, the knowledge of ''samprapti'' is not as important as the knowledge of ''linga'' (symptoms). Hence ''samprapti'' is described at the end. [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11]
Vagbhata has defined these synonyms as: “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. (A H Ni. 1/8) <ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/8, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>[11]
Vagbhata has defined these synonyms as: “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. [A.H Nidana Sthana 1/8]<ref name=Hridaya>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> [11]
In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter. <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,197. </ref>
In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter.[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11]
Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. (A H Ni. 1/9)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/10)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/10, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref> When a ''dosha'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''vata'' for example may mean aggravation of its coldness, lightness or ununctuousness.
Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. [A.H Nidana Sthana 1/9]<ref name=Hridaya/> ''Pradhanya samprapti'' indicates the primacy of a ''samprapti''. [A.H Nidana Sthana 1/10]<ref name=Hridaya/> When a ''[[dosha]]'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''[[vata]]'' for example may mean aggravation of its coldness, lightness or ununctuousness.
''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [[Ayurveda]] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds. <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/11, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref> The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.
''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [[Ayurveda]] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds. [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11] The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.
Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. (A H Ni. 1/)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/11, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>[12-5]
Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. [A.H Nidana Sthana 1/11]<ref name=Hridaya/> [12-5]
==== Significance of knowledge of ''nidana'' ====
==== Significance of knowledge of ''nidana'' ====
#Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Sutraasthana Adhyaya 10/14, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66 </ref>
#Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases. [Cha.Sa.[[Sutra Sthana]] 10/14]
#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult.<ref>Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 7/30, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 261 </ref>
#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult. [Cha.Sa.[[Vimana Sthana]] 7/30]
#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.
#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.
#To treat the newly originated diseases, a physician should have the knowledge of the involved ''doshas'', causative factors and the location of the disease.
#To treat the newly originated diseases, a physician should have the knowledge of the involved ''[[dosha]]s'', causative factors and the location of the disease.
==== Significance of knowledge of ''poorvarupa'' ====
==== Significance of knowledge of ''poorvarupa'' ====
#It has the same importance as that of ''nidana'' and ''poorvarupa'' in the prognosis of diseases. Rise in number of ''rupa'' makes the disease difficult to cure.
#It has the same importance as that of ''nidana'' and ''poorvarupa'' in the prognosis of diseases. Rise in number of ''rupa'' makes the disease difficult to cure.
#''Rupa'' denotes the complete manifestation of the disease along with its ''dosha'' predominance. The diseases can be treated in a proper way if one is having the knowledge of all the sign and symptoms and the ''dosha'' responsible for it.
#''Rupa'' denotes the complete manifestation of the disease along with its ''[[dosha]]'' predominance. The diseases can be treated in a proper way if one is having the knowledge of all the sign and symptoms and the ''[[dosha]]'' responsible for it.
==== Significance of knowledge of ''upashaya'' ====
==== Significance of knowledge of ''upashaya'' ====
==== Significance of knowledge of ''samprapti'' ====
==== Significance of knowledge of ''samprapti'' ====
#''Samprapti'' provides the details of the diseases such as ''dosha'' predominance, predominance of one or the other fraction of the three ''doshas'', specific time of aggravation, and manifestation of diseases which plays a pivotal role in the management of diseases.
#''Samprapti'' provides the details of the diseases such as ''[[dosha]]'' predominance, predominance of one or the other fraction of the three ''[[dosha]]s'', specific time of aggravation, and manifestation of diseases which plays a pivotal role in the management of diseases.
#The important role of a physician in the management of diseases is ''sampraptibhanga'' i.e. to break the association of vitiated ''dosha'' and ''dushya'' (tissue that gets vitiated). This is not possible without proper knowledge of ''samprapti''.
#The important role of a physician in the management of diseases is ''sampraptibhanga'' i.e. to break the association of vitiated ''[[dosha]]'' and ''[[dushya]]'' (tissue that gets vitiated). This is not possible without proper knowledge of ''samprapti''.
==== ''Nidanapanchaka'' and ''shat kriyakala'' ====
==== ''Nidanapanchaka'' and ''shat kriyakala'' ====
Sushruta described six stages of ''dosha'' vitiation and progression of disease known as ''shat kriyakala'' (periods of activity). They are as under:
Sushruta described six stages of ''[[dosha]]'' vitiation and progression of disease known as ''shat kriyakala'' (periods of activity). They are as under:
*''Sanchaya'' (accumulation): In this stage ''dosha'' undergo mild increase at their own site. This accumulation produces mild symptoms. If the person recognises these instincts and acts accordingly, the ''doshas'' can be brought to the normal condition without much effort. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/18, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,103. </ref>
*''Sanchaya'' (accumulation): In this stage ''[[dosha]]'' undergo mild increase at their own site. This accumulation produces mild symptoms. If the person recognises these instincts and acts accordingly, the ''[[dosha]]s'' can be brought to the normal condition without much effort. [Su.Sa.Sutra Sthana 21/18]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>
*''Prakopa'' (aggravation): In this stage, ''doshas'' gets vitiated further at their own site and exhibit some specific symptoms. By suitable changes in daily routine one can overcome these conditions. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/27, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,104. </ref>
*''Prakopa'' (aggravation): In this stage, ''[[dosha]]s'' gets vitiated further at their own site and exhibit some specific symptoms. By suitable changes in daily routine one can overcome these conditions. [Su.Sa.Sutra Sthana 21/27]<ref name=Susruta/>
*''Prasara'' (spreading): The status of ''doshas'' again increases further and ''doshas'' spread nearby sites and invade the sites of other ''doshas'' to produce symptoms. If the person continues to indulge in unhealthy food and regimen, then the disease progresses to the next stage. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/32, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,105. </ref>
*''Prasara'' (spreading): The status of ''[[dosha]]s'' again increases further and ''[[dosha]]s'' spread nearby sites and invade the sites of other ''[[dosha]]s'' to produce symptoms. If the person continues to indulge in unhealthy food and regimen, then the disease progresses to the next stage. [Dalhana on Su.Sa.Sutra Sthana 21/32]<ref name=Susruta/>
During the first three stages, the unhealthy food and activities increases the ''doshas'' and produces mild abnormalities. These three stages can be co-related with ''nidana'' (''hetu'') of ''nidanapanchaka''.
During the first three stages, the unhealthy food and activities increases the ''[[dosha]]s'' and produces mild abnormalities. These three stages can be co-related with ''nidana'' (''hetu'') of ''nidanapanchaka''.
*''Sthanasanshraya'' (localisation): The increased ''doshas'' start accumulating at certain other places and lead to their abnormalities, especially in the ''srotasa''. It leads to four kinds of abnormal changes in ''srotasa''.<ref>Sushruta, Sushruta SamhitaSutrasthana Adhyaya 21/36, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>
*''Sthanasanshraya'' (localisation): The increased ''[[dosha]]s'' start accumulating at certain other places and lead to their abnormalities, especially in the ''srotasa''. It leads to four kinds of abnormal changes in ''srotasa''. [Su.Sa.Sutra Sthana 21/36]
**''Atipravritti'' – Increased functioning of channels
**''Atipravritti'' – Increased functioning of channels
**''Sanga'' – Obstruction, blockage of channels
**''Sanga'' – Obstruction, blockage of channels
**''Vimargagamana'' – Movement of fluids in wrong direction
**''Vimargagamana'' – Movement of fluids in wrong direction
The site where these ''doshas'' lodge together to progress towards disease, is the site of origin of disease. This is the stage of actual commencement of the disease. It is characterized by manifestation of some moderate symptoms which indicate the forthcoming disease. These are known as ''poorvarupa''. This stage can be co-related with ''poorvarupa'' of ''nidanapanchaka''. <ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/33, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>
The site where these ''[[dosha]]s'' lodge together to progress towards disease, is the site of origin of disease. This is the stage of actual commencement of the disease. It is characterized by manifestation of some moderate symptoms which indicate the forthcoming disease. These are known as ''poorvarupa''. This stage can be co-related with ''poorvarupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/33]<ref name=Susruta/>
*''Vyakti'' (manifestation): This is the stage of full manifestation of the disease with all its characteristic sign and symptoms. These sign and symptoms are known as ''rupa''. This stage can be co-related with ''rupa'' of ''nidanapanchaka''.<ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/34, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>
*''Vyakti'' (manifestation): This is the stage of full manifestation of the disease with all its characteristic sign and symptoms. These sign and symptoms are known as ''rupa''. This stage can be co-related with ''rupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/34]<ref name=Susruta/>
*''Bheda'' (complication): In this stage, the abnormalities become more profound and irreversible in spite of the best treatment. Sometimes ''upadravas'' (complications) or ''arishta lakshanas'' (bad prognostic signs) can be seen in this stage. This stage also can be co-related with ''rupa'' of ''nidanapanchaka''.<ref>Dalhana, Commentator, Sushruta SamhitaSutrasthana Adhyaya 21/35, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. </ref>
*''Bheda'' (complication): In this stage, the abnormalities become more profound and irreversible in spite of the best treatment. Sometimes ''upadravas'' (complications) or ''arishta lakshanas'' (bad prognostic signs) can be seen in this stage. This stage also can be co-related with ''rupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/35]<ref name=Susruta/>
The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.
The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.
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==== Shatkriyakala of ''Jwara'' as compared with pathogenesis of fever ====
==== Shatkriyakala of ''Jwara'' as compared with pathogenesis of fever ====
<div style="text-align:justify;">
{| class="wikitable"
{| class="wikitable"
! rowspan="1"| In Fever
! rowspan="1"| In Fever
|-
|-
| || Sanchaya || it is the stage of accumulation or the stage which represents the inceptive phase of the disease wherein the dosha are stated to have accumulated and stagnated in its own place
| || Sanchaya || it is the stage of accumulation or the stage which represents the inceptive phase of the disease wherein the [[dosha]] are stated to have accumulated and stagnated in its own place
instead of freely circulating as in its normal avastha or phase.
instead of freely circulating as in its normal avastha or phase.
|| it is the pyrogen which may be exogenous (bacterial substance lipopolysaccharide (LPS) present on bacterial cell wall) or endogenous (cytokines, Interleukin-1 and Interleukin-6 etc). These pyrogens enter the body and activate the immune cells (antigen presenting cell) for the formation of cytokines and other factors or due to endogenous cause too activation of immune system takes place.
|| it is the pyrogen which may be exogenous (bacterial substance lipopolysaccharide (LPS) present on bacterial cell wall) or endogenous (cytokines, Interleukin-1 and Interleukin-6 etc). These pyrogens enter the body and activate the immune cells (antigen presenting cell) for the formation of cytokines and other factors or due to endogenous cause too activation of immune system takes place.
|-
|-
| || Prakopa || In this stage dosha gets vitiated or aggravated or the dosha previously accumulated/ stagnated get swollen and excited Vilayana here means bonding (samhata) is loss and dosha gets released. || Exogenous factors contain immunological protein called lipo-polysaccharide binding protein (LBP) which binds to LPS. The LBP-LPS complex then binds to the CD14 receptors of a nearby macrophage. It causes synthesis and release of various endogenous cytokines factors such as IL-1, IL-6, Tumour Necrosing Factor alpha (TNFα).
| || Prakopa || In this stage [[dosha]] gets vitiated or aggravated or the [[dosha]] previously accumulated/ stagnated get swollen and excited Vilayana here means bonding (samhata) is loss and [[dosha]] gets released. || Exogenous factors contain immunological protein called lipo-polysaccharide binding protein (LBP) which binds to LPS. The LBP-LPS complex then binds to the CD14 receptors of a nearby macrophage. It causes synthesis and release of various endogenous cytokines factors such as IL-1, IL-6, Tumour Necrosing Factor alpha (TNFα).
|-
|-
| || Prasara || The third phase signifies to spread which generally takes place with help of vata and rakta. Dosha are stated to spread over and extend to other parts of the body. || the cytokine factors are released into general circulation, where they migrate to the cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood–brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated. Prostaglandin E2 (PGE2) is released which is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase.
| || Prasara || The third phase signifies to spread which generally takes place with help of [[vata]] and [[rakta]]. [[Dosha]] are stated to spread over and extend to other parts of the body. || the cytokine factors are released into general circulation, where they migrate to the cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood–brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated. Prostaglandin E2 (PGE2) is released which is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase.
|-
|-
| || sthanasansrayam || It is prodromal phase or the phase of poorvarupa wherein disease is yet to be manifested fully. The excited dosha having extended to other parts of the body become localized and it marks the beginning of specific diseases pertaining to those sthan/ structures. It is also known as the stage of disease augmentation. Sthana samshraya means taking shelter in a place. || PGE2 is the ultimate mediator of the febrile response. PGE2 acts on neurons in the preoptic area (POA) through the prostaglandin E receptor 3 (EP3). EP3-expressing neurons in the POA innervate the dorsomedial hypothalamus (DMH), the rostral raphe pallidus nucleus in the medulla oblongata (rRPa), and the paraventricular nucleus (PVN) of the hypothalamus. Fever signals sent to the DMH and rRPa lead to stimulation of the sympathetic output system, which evokes non-shivering thermo-genesis to produce body heat and skin vasoconstriction to decrease heat loss from the body surface. It is presumed that the innervations from the POA to the PVN mediates the neuroendocrine effects of fever through the pathway involving pituitary gland and various endocrine organs.
| || sthanasanshrayam || It is prodromal phase or the phase of poorvarupa wherein disease is yet to be manifested fully. The excited [[dosha]] having extended to other parts of the body become localized and it marks the beginning of specific diseases pertaining to those sthan/ structures. It is also known as the stage of disease augmentation. Sthana samshraya means taking shelter in a place. || PGE2 is the ultimate mediator of the febrile response. PGE2 acts on neurons in the preoptic area (POA) through the prostaglandin E receptor 3 (EP3). EP3-expressing neurons in the POA innervate the dorsomedial hypothalamus (DMH), the rostral raphe pallidus nucleus in the medulla oblongata (rRPa), and the paraventricular nucleus (PVN) of the hypothalamus. Fever signals sent to the DMH and rRPa lead to stimulation of the sympathetic output system, which evokes non-shivering thermo-genesis to produce body heat and skin vasoconstriction to decrease heat loss from the body surface. It is presumed that the innervations from the POA to the PVN mediates the neuroendocrine effects of fever through the pathway involving pituitary gland and various endocrine organs.
|-
|-
| || Vyakti || This stage may be stated to be that of manifestation of the fully developed disease- the resultant dosha dushya samurchana || the brain ultimately orchestrates heat effector mechanisms via the autonomic nervous system. It causes increased heat production by increased muscle tone, shivering and hormones like epinephrine (adrenaline) and also prevents heat loss by way of vasoconstriction.
| || Vyakti || This stage may be stated to be that of manifestation of the fully developed disease- the resultant [[dosha]] [[dushya]] samurchana || the brain ultimately orchestrates heat effector mechanisms via the autonomic nervous system. It causes increased heat production by increased muscle tone, shivering and hormones like epinephrine (adrenaline) and also prevents heat loss by way of vasoconstriction.
|-
|-
| || Bheda || It is the stage in which the disease may become sub-acute and chronic or incurable. Different types or variant of disease gets manifested. || In case of fever signs like increased blood pressure, neck stiffness, headache, giddiness, unconsciousness etc are seen in this phase.
| || Bheda || It is the stage in which the disease may become sub-acute and chronic or incurable. Different types or variant of disease gets manifested. || In case of fever signs like increased blood pressure, neck stiffness, headache, giddiness, unconsciousness etc are seen in this phase.
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|}
</div>
=== Related Chapters ===
=== Related Chapters ===
*[[Jwara Chikitsa]]
*[[Jwara Chikitsa]]
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=== References ===
=== References ===