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== Introduction ==

== Introduction ==

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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 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. [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 ''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. [Cha.Sa.[[Nidana Sthana]] 8/23] Curable diseases can progress to incurable if they are not properly treated. [Cha.Sa.[[Nidana Sthana]] 8/35]

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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# 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]

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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 ''doshas''), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]

[[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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''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) ======

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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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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 ====

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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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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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*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 ''doshas'' get accumulated in the ''amashaya'' i.e. site of first phase of digestion  

#'''''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 ''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).

==== D.Fourth classification ====

==== D. Fourth classification ====

This classification describes ''nidana'' to be of two types:

This classification describes ''nidana'' to be of two types: