Abstracts- Nidana Sthana

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The abstracts of all eight chapters of Nidana Sthana are presented here for introductory knowledge about its chapters. For more knowledge, the readers can go to the individual chapters.

Chapter 1. Chapter on Fundamental Principles of Diagnosis and Fever – Jwara Nidana

Nidana Sthana deals with the etiology, symptomatology, and means of diagnosis of diseases. It begins with a generalized set of fundamental principles of diagnosis and then proceeds to specialized studies of diseases. The first part of this chapter deals with necessary tools for acquiring a comprehensive knowledge of any disease. A set of five important tools/components - etiology, premonitory signs, clinical features, pacifying factors and pathogenesis termed as ‘Nidana Panchaka’ helps in understanding a disease thoroughly. Each of these tools has a specific significance in diagnosis and explores an important aspect of the disease. Etiology helps to ascertain the causative factors of the diseases 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.

Chapter 2. Diagnosis and etiopathogenesis of Bleeding Disorders – Raktapitta Nidana

This chapter deals with diagnosis of bleeding disorders (raktapitta) caused by an excess of pitta dosha vitiating blood (rakta dhatu) in the body. This leads to capillary break-down causing hemorrhage from external openings like mouth, per rectum, nose, eyes, ears, urethra. Contributing factors that increase the probability of raktapitta include consumption of incompatible food substances, consuming certain meats with alcohol, butter milk with meat of animals etc. The regular exposure to dietary and lifestyle factors with hot (ushna) properties vitiates pitta. This pitta has the same color and smell as rakta, and blends seamlessly with it. Vitiated pitta and increased rakta circulate in the channels and the resultant increased volume of the blood overflows from the bodily orifices. The pathogenesis, if associated with vitiated kapha, leads to bleeding from upper orifices, whereas if it is associated with vitiated vata, leads to bleeding from the lower orifices. The first condition is curable, and later is difficult to cure. If both kapha and vata are involved in the pathogenesis, then the complications arise and such conditions are incurable. Avoiding etiological factors enlisted in this chapter can delay the progression of hemorrhagic disorders. Therapeutic measures of emesis and purgation, along with useful medicinal formulations and attention can improve the condition of patients of hemorrhagic disorders in varying degrees. Prodromal symptoms and complications have been described in this chapter.

Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps – Gulma Nidana

The third chapter describes the etiology, pathogenesis, clinical features and therapeutics of lumps in abdomen. Gulma, a (stable or transitory) growth that could occur anywhere in the body is primarily caused by a vitiated vata. The description given in the text cannot be correlated with any single entity of conventional medicine, but denotes localized intra-abdominal swellings of multiple origin in terms of their cause, site, features etc. In patients weakened by or recuperating from diseases or cleansing therapies (vamana, etc.), or suffering from very stressful conditions, vata gets vitiated and enters the mahasrotas (gastrointestinal tract) causing the formation of gulma. Amongst the five types of gulma, sannipatika gulma is incurable whereas remaining can be managed according to dosha involvement.

Chapter 4. Diagnosis and etiopatheogenesis of Obstinate Urinary Disorders including diabetes – Prameha Nidana

This chapter describes the disease prameha (group of obstinate urinary disorders including diabetes) as well as its etiopathogenesis, types, clinical features, prognosis, prodromal symptoms, complications, and a line of treatment. Though it is predominantly a kapha dosha disorder, there are variants involving all three doshas and ten dushya (body tissues and other elements). Excessive and turbid urination are the cardinal signs of all prameha. All those urinary and systemic diseases that cause copious quantities, as well as the abnormal (including turbid) quality of urination, come under the umbrella of prameha. This chapter briefly explains the importance of interaction of exogenous factors, endogenous and tissue response factors in the manifestation of the disease. The concept of genetic susceptibility to disease and effect of chronic disease on genes is also incorporated in this chapter.

Chapter 5. Diagnosis and etiopathogenesis of Skin diseases – Kushtha Nidana

This chapter deals with diagnosis of skin disease termed as Kushtha. The disease has variable manifestations on skin depending upon degree of involvement of three vitiated dosha and their effect on four vitiated factors i.e. rasa, rakta, mamsa and lasika (lymphatic system). On the basis of clinical manifestations and severity, kushtha is classified into seven major types, eleven minor types or innumerable types due to the permutation and combination of dosha predominance and involvement of particular quality of a dhatu and accretion of dosha at different sites. The etiopathology, prodromal symptoms (purvarupa), symptomatology of seven major types of kushtha (maha-kushtha), their dosha predominance, prognosis, complications and significance of early treatment are described in this chapter.

Chapter 6. Diagnosis and etiopatheogenesis of Progressive wasting disease- Shosha Nidana

This chapter describes the basics of etiopathogenesis of progressive wasting disease termed as shosha roga and its culmination in rajayakshma vis-à-vis pulmonary tuberculosis. Shosha is characterized by severe depletion of tissues (also called phthisis) which could be a precursor of tuberculosis as known today which occurs due to tubercular infection, phthisis and immune-compromised state. Over exertion (sahasa), suppression of natural urges (vegavidharana), pre-existing emaciation (kshaya), and wrong dietary habits (vishamashana) are the four primary causes of shosha. These four basic factors lead to progressive loss of strength (including immunity), vitiating the three doshas and culminating in rajayakshma, a major organic disease that seems to be similar to various similar progressively wasting diseases presenting characteristically with signs and symptoms of Pulmonary Tuberculosis as seen today and has been described in great clinical and therapeutic detail in Rajayakshma Chikitsa .

Chapter 7. Diagnosis and etiopathogenesis of psychosis disorders – Unmada Nidana

This chapter describes the detailed etiopathogenesis and types of a large class of major mental disorders or psychoses named as Unmada. The word Unmada, literally means frenzy, madness or mental derangement. Unmada is characterized by a disordered mental state in the faculties of mind and intellect. This leads to perverted presentation of thought processes, decision making, intellectual functioning, orientation and responsiveness, memory, desires, habits, character, psychomotor activity, conduct and behaviour. The clinical diagnosis of unmada, its etiology, psychopathogenesis, and prodromal features have been elaborately described in this chapter.

Chapter 8. Diagnosis and etiopathogenesis of seizure disorders- Apasmara Nidana

This chapter deals with another psychiatric disorder leading to transient loss of consciousness termed as Apasmara. It describes causative factors, predisposing conditions, pathogenesis, signs, types, and prognosis of apasmara. The clinical presentation of this disease simulates the seizure disorders described in conventional medical literature. Apasmara is a common neuropsychiatric disorder characterized by intermittent loss of consciousness, memory, abnormal movements and blackouts. This chapter explores the basic principles of psychiatric disorders involving memory, mind, consciousness and intellect. These disorders are marked by major pathological obstacles in perception, impaired intellectual functioning, orientation, co-ordination and consciousness. Their management includes avoidance of etiological factors as well as pharmacological and non-pharmacological treatment (including psychological and spiritual therapies). The basic principles described in the present chapter can be helpful in preventing and managing neuro-psychiatric disorders like apasmara in a better way. This chapter also deals with some important aspects of diagnosis. It explains how one disease can trigger another disease i.e. Nidanarthakara roga, leading to the presence of two or more diseases at the same time. This chapter lays down some principles of diagnosis to manage such conditions as well.