Changes

== Introduction ==

== Introduction ==

<div style="text-align:justify;">

<div style="text-align:justify;">

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

A physician cannot treat a patient if he does not possess a complete understanding of a disease [Cha.Sa.[[Vimana Sthana]] 4/12]. Accurate diagnosis of a disease is important before initiating any treatment, and any understanding of a disease’s manifestation is incomplete without understanding its ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (actual sign and symptoms), ''upashaya'' (pacifying factors) and ''samprapti'' (pathogenesis) – or the ''Nidana Panchaka'' (literally, the five components of ''nidana'') [Cha.Sa.Nidana Sthana 1/6].

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

A disease’s lifecycle starts with certain premonitory symptoms and ends with its complete manifestation, or ''samprapti''. Between these two stages of the disease, the body shows various signs and symptoms that could be observed by any knowledgeable physician, using 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].

''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.   

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

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

If diseases are not properly known, one cannot start the treatment. Therefore, ''Nidanapanchaka'' (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease. <ref>Chakrapani, Commentator, Charak Samhita Nidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. </ref>

If diseases are not properly known, one cannot start the treatment. Therefore, ''Nidanapanchaka'' (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease [Cha.Sa.[[Nidhana Sthana 1/6].

Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]

Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]

#''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, Charak Samhita Nidanasthana 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 [Chakrapani on Cha.Sa.Nidhana 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. 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 [[Charak Samhita]], describes two types of ''Poorvarupa'':

Gangadhara, commentator of [[Charak Samhita]], describes two types of ''Poorvarupa'':

#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''doshas''.

#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''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, Charak Samhita Nidanasthana Adhyaya 1/5, Edited by Narendranath Sengupta, Reprint edition, Rashtriya Sanskrit Sansthana, Varanasi, 2002, 1213 </ref>

#'''''Vishesha Poorvarupa''''' (specific premonitory features): These are the general symptoms of disease which manifest before the manifestation of the disease and indicate involvement of ''doshas''[Gangadhar on Cha.Sa.Nidhana Sthana.1/5].

==== ''Rupa'' (clinical signs and symptoms) ====

==== ''Rupa'' (clinical signs and symptoms) ====

''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''doshas'', various stages viz., ''ama'' (immature), ''pakva'' (mature), etc. They however, do not include such other factors of diagnosis of the diseases like ''nidana, upashaya'' and ''samprapti''. <ref>Chakrapani, Commentator, Charak Samhita Nidanasthana Adhyaya 1/9, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 195. </ref>.  

''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''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.Nidhana Sthana 1/9].

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

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

Hence, all these above synonyms quoted are indicative of such symptomatology which is scattered in different diseases. Any one term is not sufficient to define the ''rupa'' or ''lakshana'' entirely therefore these different terms have been collectively described here. [9]

Hence, all these above synonyms quoted are indicative of such symptomatology which is scattered in different diseases. Any one term is not sufficient to define the ''rupa'' or ''lakshana'' entirely therefore these different terms have been collectively described here. [9]

''Upashaya'' (pacification):

===''Upashaya'' (pacification):===

''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups:<ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,195. </ref>

 

''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups:[Chakrapani on Cha.Nidhana Sthana 1/10]

#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.  

#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.  

#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.  

#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.  

#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)

#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)

#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)

#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)

#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref>

#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) [Chakrapani on Cha.Sa.Nidhana Sthana 1/10]

</div>

</div>

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

While the symptoms of a disease manifest completely after pathogenesis (''samprapti''), still for the purpose of diagnosis, the knowledge of ''samprapti'' is not as important as the knowledge of ''linga'' (symptoms). Hence ''samprapti'' is described at the end [Chakrapani on Cha.Sa.Nidhana Sthana 1/11].

Vagbhata has defined these synonyms as:  “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. (A H Ni. 1/8) <ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/8, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>[11]

Vagbhata has defined these synonyms as:  “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. (A H 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, Charak Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,197. </ref>

In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter[Chakrapani on Cha.Sa.Nidhana Sthana 1/11].  

Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. (A H Ni. 1/9)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/10)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/10, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref> When a ''dosha'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''vata'' for example may mean aggravation of its coldness, lightness or ununctuousness.  

Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. (A H Ni. 1/9)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>. ''Pradhanya samprapti'' indicates the primacy of a ''samprapti'' (A H Ni. 1/10)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/10, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref> When a ''dosha'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''vata'' for example may mean aggravation of its coldness, lightness or ununctuousness.  

''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [[Ayurveda]] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds. <ref>Chakrapani, Commentator, Charak Samhita Nidansthana Adhyaya 1/11, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. </ref> The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.

''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [[Ayurveda]] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds [Chakrapani on Cha.Sa.Nidhana Sthana 1/11]. The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.

Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. (A H Ni. 1/)<ref>Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/11, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 </ref>[12-5]

Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. (A H 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, Charak, Dridhabala, Charak Samhita Sutraasthana Adhyaya 10/14, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66 </ref>

#Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases [Cha.Sa.[[Sutra Sthana]] 10/14].

#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult.<ref>Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 7/30, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 261 </ref>

#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult [Cha.Sa.[[Vimana Sthana]] 7/30].

#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.

#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.

#To treat the newly originated diseases, a physician should have the knowledge of the involved ''doshas'', causative factors and the location of the disease.  

#To treat the newly originated diseases, a physician should have the knowledge of the involved ''doshas'', causative factors and the location of the disease.