Changes

=== Introduction ===

=== Introduction ===

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Per Ayurvedic texts, a physician cannot treat a patient if he does not possess a complete understanding of a disease. <ref>Agnivesha, Charaka, Dridhabala, Charaka SamhitaVimanasthana 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, Charaka, Dridhabala, Charaka SamhitaNidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. </ref>

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

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

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

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

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 [[Charaka Samhita]] is structured – it starts with the generic or the foundational condition (that, in many cases, acts as a causative factor itself), and then moves on to discussing the vitiation of the ''dhatus'' that are causes of all somatic diseases – by the order of their importance (i.e., starting with ''rasa dhatus'') – and ends with a study of vitiation of ''Rajas'' and ''Tamas'' (i.e., causes of mental diseases).  

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

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 ''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.  

Three types of ''nidana'' of ''jwara'', along with their synonyms, five types of diseases, symptoms and synonyms of diseases, five means to know the diseases, eight types of fever, its distant and immediate causes, premonitory symptoms, symptoms and medicament in short – all these were expounded by Lord Punarvasu (Atreya) to Agnivesha in this first chapter on the diagnosis of ''jwara''. [42-44]

Three types of ''nidana'' of ''jwara'', along with their synonyms, five types of diseases, symptoms and synonyms of diseases, five means to know the diseases, eight types of fever, its distant and immediate causes, premonitory symptoms, symptoms and medicament in short – all these were expounded by Lord Punarvasu (Atreya) to Agnivesha in this first chapter on the diagnosis of ''jwara''. [42-44]

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

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

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

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

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, Charaka SamhitaNidanasthana 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. <ref>Chakrapani, Commentator, Charak Samhita Nidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. </ref>

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]

#''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. <ref>Chakrapani, Commentator, Charaka SamhitaNidanasthana Adhyaya 1/8, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 195. </ref>

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>

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>

Gangadhara, commentator of [[Charaka 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 ''doshas''.

#'''''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, Charaka SamhitaNidansthana 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 ''doshas''. <ref>Gangadhar, Commentator, Charak Samhita Nidanasthana Adhyaya 1/5, Edited by Narendranath Sengupta, Reprint edition, Rashtriya Sanskrit Sansthana, Varanasi, 2002, 1213 </ref>

==== ''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, Charaka SamhitaNidanasthana 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 ''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'' includes the following signs and symptoms:

''Rupa'' includes the following signs and symptoms:

''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, Charaka SamhitaNidansthana 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:<ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,195. </ref>

#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, Charaka SamhitaNidansthana 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.) <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref>

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=====Various examples of ''upashaya'':=====

=====Various examples of ''upashaya'':=====

''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, Charaka SamhitaNidansthana 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. <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref>

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 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]

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, Charaka SamhitaNidansthana 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. <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,197. </ref>

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/)</ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref> [12]. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/)<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 Ni. 1/)</ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref> [12]. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/)<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.  

''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, Charaka SamhitaNidansthana 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. <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.

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 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]

==== 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, Charaka, Dridhabala, Charaka SamhitaSutraasthana 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. <ref>Agnivesha, Charak, Dridhabala, Charak Samhita Sutraasthana Adhyaya 10/14, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66 </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.<ref>Agnivesha, Charaka, Dridhabala, Charaka SamhitaVimanasthana 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.<ref>Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 7/30, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 261 </ref>

#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 ''doshas'', causative factors and the location of the disease.  

==== Significance of knowledge of ''poorvarupa'' ====

==== Significance of knowledge of ''poorvarupa'' ====

#[[Charaka Samhita]] suggests specific modalities for treatment of a patient at this stage. E.g. Light food and ''apatarpana'' treatment should be give when premonitory signs of fever are seen.

#[[Charak Samhita]] suggests specific modalities for treatment of a patient at this stage. E.g. Light food and ''apatarpana'' treatment should be give when premonitory signs of fever are seen.

#Manifestation of all the premonitory signs indicates bad prognosis of the disease.  

#Manifestation of all the premonitory signs indicates bad prognosis of the disease.  

#''Poorvarupa'' has significant role in the differential diagnosis of the disease.

#''Poorvarupa'' has significant role in the differential diagnosis of the disease.