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Jwara Nidana (view source)

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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>

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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.

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''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.

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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).

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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).

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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.

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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.

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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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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]].

</div>

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# Asatmyendriyarthasamyoga (unsuitable contact of sense organs with their objects)

# [[Prajnaparadha]] (intellectual errors or knowingly engaging in harmful activities), and

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# Kala (time, seasonal, temporal factors). [3]

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# [[Kala]] (time, seasonal, temporal factors). [3]

==== Types of diseases ====

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</div></div>

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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].

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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].

====== Pradhanya samprapti (Classification on dominance) ======

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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]

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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]

</div>

====== Vikalpa samprapti (pathogenesis on fraction of [[dosha]]) ======

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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]

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== Knowledge of Jwara (fever) ==

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== Knowledge of [[Jwara]] (fever) ==

==== Origin ====

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</div></div>

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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]

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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]

==== Types ====

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</div></div>

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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]

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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]

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</div></div>

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Now I shall expound the specific ''nidana'' (etiology), ''poorvarupa'' (prodromal symptoms), ''rupa'' (symptoms) and ''upashaya'' (pacifying factors) of ''jwara''. [18]

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Now I shall expound the specific ''nidana'' (etiology), ''poorvarupa'' (prodromal symptoms), ''rupa'' (symptoms) and ''upashaya'' (pacifying factors) of ''[[jwara]]''. [18]

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==== [[Vata]] dominant jwara ====

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==== [[Vata]] dominant [[jwara]] ====

===== 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]

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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]

</div>

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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]

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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]

</div>

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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]

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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]

</div>

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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]

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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]

</div>

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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]

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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]

</div>

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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]

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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]

</div>

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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]

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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]

</div>

=====Clinical features =====

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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]

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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 ''[[dosha]]s'', that cause fever. [28]

</div>

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</div></div>

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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]

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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) ====

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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]

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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, ''[[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]

</div>

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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]

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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]

Here are (the verses) –

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

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*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]

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*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]

*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]

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*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:

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

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**Vitiated ''[[dosha]]s'' get accumulated in the ''amashaya'' i.e. site of first phase of digestion

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**Next, these ''~~doshas~~'' mix with the undigested food material, in that heated environment, in the ''amashaya'', vitiating the ''ahara rasa'' (just digested food)

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**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.

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]

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*Exogenous factors may cause ''jwara'' by vitiating ''rakta'' (blood), and/or ''dosha''. [30]

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*Exogenous factors may cause ''jwara'' by vitiating ''[[rakta]]'' (blood), and/or ''[[dosha]]''. [30]

*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]

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

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

== Vidhi Vimarsha (Applied Inferences) ==

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#'''''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.

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#'''''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.

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#'''''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.

#'''''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''.

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#'''''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''.

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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).

−

#'''''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 ====

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#'''''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 ====

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#'''''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 ====

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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, Chap.1, Pancha Nidanalakshanam, Verse 8. In: Prof. Yadunandana Upadhyaya, Editor. Madhava Nidanam. 30th ed. Varanasi: Chaukhambha Sanskrit Sansthana; 2000.p.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) ====

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There are two types of ''Poorvarupa'':

#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 ''~~doshas~~'' 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>

+

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'':

−

#'''''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~~''.[Gangadhar on Cha.Sa.[[Nidana Sthana]].1/5]

+

#'''''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'' 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''.[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/9]

+

''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:

#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 arise due to the complication of the diseases indicating their incurability.

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! 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

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| 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.

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==== ''Samprapti'' (pathogenesis) ====

−

''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.

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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 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.

+

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. [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.

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#''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.

−

#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'' ====

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#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'' ====

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==== 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'' ====

−

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. [Su.Sa.Sutra Sthana 21/18]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</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. [Su.Sa.Sutra Sthana 21/27]<ref name=Susruta/>

+

*''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. [Dalhana on Su.Sa.Sutra Sthana 21/32]<ref name=Susruta/>

+

*''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''. [Su.Sa.Sutra Sthana 21/36]

+

*''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

**''Sanga'' – Obstruction, blockage of channels

Line 1,009: Line 1,009:

**''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''. [Dalhana on Su. Sa. Sutra Sthana 21/33]<ref name=Susruta/>

+

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''. [Dalhana on Su. Sa. Sutra Sthana 21/34]<ref name=Susruta/>

Line 1,048: Line 1,048:

! 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.

|| 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.

|-

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| || 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.

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| || 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.

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| || 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.

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| || 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.

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| || 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.

Eganeesh

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Jwara Nidana (view source)

Revision as of 07:08, 10 July 2021

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