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Line 23: − + − <div style="text-align:justify;">[[Nidana Sthana]], the second section within [[Charak Samhita]], is about guidelines for diagnosing disease on the basis of detailed history and clinical examination. The five means to know a disease viz. ''hetu'' (causative factors), ''purva-rupa'' (premonitory signs and symptoms), ''rupa'' (clinical features),''upashaya'' (pacifying factors) and ''samprapti'' (etio-pathogenesis).The study is comprehensive and is different from modern medical system to guide a physician to diagnose and treat disease with minimal use of laboratory, imaging and other tools. − ===Two important aspects in Diagnosis=== − There are two important aspects while diagnosing a disease as per principles of Ayurveda. It always considers interaction between the individual and the affecting pathological entities. − ====Analysis of the individual==== − The first being an evaluation of the self-healing capacity of the body which depends upon equilibrium of five components, namely ''doshas'' (body humors), ''agni'' (digestive and metabolic capacity), ''dhatu'' (body tissues), ''mala'' (waste) and psycho-spiritual state. Health is a state of equilibrium, whereas disease is a state of dis-equilibrium of any of these factors. According to [[Chikitsaprabhritiya Adhyaya#Swabhavoparama vada (theory of natural destruction)|''swabhavoparam vada'' (theory of natural resolution)]], the resolution / destruction of the existing always happen naturally in the course of time. [[Chikitsaprabhritiya Adhyaya#Swabhavoparama vada (theory of natural destruction)|(Cha.Su.16/27)]] So the nature itself heals disequilibrium. This aspect of host defence mechanism is important to be assessed for knowing natural healing capacity of an individual. In the fourth chapter of [[Nidana Sthana]], [[Prameha Nidana]], [[Prameha Nidana#Process of Onset of Disease|the process of onset of disease]] through interaction between aggravating and pacifying factors to cause disease is described.[[Prameha Nidana#Process of Onset of Disease|(Cha.Ni.4/4)]] If the host defense factors are stronger than aggravating ones, then the disease will not occur and vice versa. Therefore, before making diagnosis of a disease, [[Rogabhishagjitiya Vimana#Examination of patient|examination of patient]] is important with emphasis on his ''prakriti'' (basic constitution), ''sara'' (quality of tissues) etc described in context of [[Rogabhishagjitiya Vimana#Examination of patient|ten fold examination of patient(Cha.Vi.8/94-131)]]. Every person has a unique constitution and hence the same biological investigations cannot be precise to assess his health status completely. Personalized assessment is important to diagnose normal and abnormal state of the individual. − + − + − Thus, this section on knowledge of diagnosis, points to two fold principles of management of disease in brief and to reverse the process by modifying the etiological, aggravating and pacifying factors of disease.+ + + + + + + + + + + + + + + + + + + + + − + − + − + − + − + − + − + − + + + + + + + + + + − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + − ===Guidelines to diagnose ''anukta vyadhi'' (untold diseases in text)=== − Any new disease, not mentioned in this text, should be studied with investigation of vitiated ''dosha'' and ''dushya'' (vitiated ''dhatu'' and other body components) first because all endogenous diseases start with vitiation of ''dosha''. The enlisted causative factors elucidated in the detailed history of a patient’s diet, lifestyle, psychological frame and others direct the vitiation of a specific ''dosha''. Then their status (increase or decrease) can be assessed based on the premonitory signs and clinical features, followed by evaluation of aggravating (''anupashaya'') and pacifying (''upashaya'') factors. The sequence of events in the pathogenesis of a disease is understood and accordingly treatment protocol is formulated. − ''Prajnaparadha'' (intellectual errors, or knowingly violating rules) is the chief responsible factor for causation of all endogenous and exogenous diseases. ''Asatmenriyarthasamyoga'' (improper union of senses with their objects) and ''parinama''(time) are other two causative factors . Therefore, this principle points that so called idiopathic diseases of unknown etiology have a definite cause,that needs to be searched and removed for its management.
→More information
The section Nidana Sthana deals with principles of diagnosis of diseases. The term Nidana is applied for knowing the origin of disease (vyadhijanaka) and comprehensive information of disease (vyadhibodhaka). <ref> Chakrapani commentary on [[Jwara Nidana]] Cha.Ni.1/2</ref>
{{Infobox
{{Infobox
|title = [[Charak Samhita]] Nidana Sthana
|title = [[Charak Samhita]] Nidana Sthana
|label4 = All Sections
|label4 = All Sections
|data4 = [[Sutra Sthana]],[[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data4 = [[Sutra Sthana]],[[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label4 = Total number of verses
|data4 = 247
|header5 = Chapters
|header5 = Chapters
}}
}}
== Preamble of [[Nidana Sthana]] (Section on Diagnosis) ==
== Preamble of Nidana Sthana (Section on Diagnosis) ==
===Fundamental principles of diagnosis===
===Fundamental principles of diagnosis===
====Analysis of disease====
<div style="text-align:justify;">[[Nidana Sthana]], the second section within [[Charak Samhita]], is about guidelines for diagnosing disease on the basis of detailed history and clinical examination. The word Nidana literally means primary cause and diagnosis.<ref> Available from http://spokensanskrit.org/index.php?mode=3&script=hk&tran_input=nidana&direct=au accessed on May 02,2019</ref> The five methods to know a disease viz. [[hetu]] (causative factors), [[purvarupa]] (premonitory signs and symptoms), [[rupa]] (clinical features),[[upashaya]] (pacifying factors) and [[samprapti]] (etio-pathogenesis).The comprehensive study guides a physician to diagnose and treat disease with minimal use of laboratory, imaging and other tools.
The second part provides for a comprehensive knowledge of disease with its causative factors, premonitory signs and symptoms, clinical features, complications, aggravating and pacifying factors. Complete cure in curable diseases and management of palliable diseases can only be achieved after ''Nidana Parivarjana'' (removal of the cause). If the cause is removed, then half the treatment is done, because it stops progression of disease as well as helps the host to return to the normal state. Modern science focuses more on disease management after its complete manifestation, while Ayurveda emphasizes on identification of abnormality when it is in a very primitive stage, so as to prevent its further progression. The journey of a disease from the initial stage of accumulation of vitiating factors to complete manifestation of its symptoms is to be studied well for its complete knowledge. A disease can cause another disease is described with reference to ''Nidanarthakara roga''. ''Upadrava'' (complications), ''Udarka'' (marks of disease after it is cured) are mentioned for knowing the cause-effect in relation to disease.
===Important aspects of knowledge of disease===
[[File:Aspects of Nidana Sthana .jpg|400px|Image 1:Aspects of Nidana Section]]
'''Image 1: Aspects of Nidana Section'''
Nidana section studies diagnostic principles in view of two important aspects like knowledge of roga (disease) and rugna (patient). It always considers interaction between the individual and the affecting pathological entities. It also considers the prognosis and inter-relation of different diseases or co-morbid conditions.
===Knowledge of the individual===
Before knowing disease, one need to know the self-healing capacity of the human being. This depends upon equilibrium of five components of health, namely [[dosha]] (regulatory functional factors of body and mind) , [[agni]] (digestive and metabolic capacity), [[dhatu]] (body tissues), [[mala]] (metabolic waste products) and psycho-spiritual state. Health is a state of equilibrium, whereas disease is a state of dis-equilibrium of any of these factors.
According to [[swabhavoparam vada]], the resolution / destruction of the existing always happen naturally in the course of time. So the nature itself heals disequilibrium.[[Chikitsaprabhritiya Adhyaya#Swabhavoparama vada (theory of natural destruction)|(Cha.Su.16/27)]] This aspect of host defence mechanism is important to be assessed for knowing natural healing capacity of an individual. In the fourth chapter,[[Prameha Nidana]], [[Prameha Nidana#Process of Onset of Disease|the process of onset of disease]] through interaction between aggravating and pacifying factors is described [[Prameha Nidana#Process of Onset of Disease|(Cha.Ni.4/4)]]. If the host defense factors are stronger than aggravating ones, then the disease will not occur and vice versa. Therefore, before making diagnosis of a disease, [[Rogabhishagjitiya Vimana#Examination of patient|examination of patient]] is important with emphasis on his [[prakriti]] (basic constitution), [[sara]] (quality of tissues) etc described in context of [[Rogabhishagjitiya Vimana#Examination of patient|ten fold examination of patient(Cha.Vi.8/94-131)]]. Every person has a unique constitution and hence the same biological investigations cannot be precise to assess his health status completely. Personalized assessment is important to diagnose normal and abnormal state of the individual.
===Knowledge of disease===
After thorough examination of an individual, one shall evaluate the disease. The second part of diagnostic protocol provides comprehensive knowledge of disease. This includes the methods to elucidate causative factors[[hetu]], observe premonitory signs and symptoms[[purvarupa]], clinical features[[rupa]], pathogenesis [[samprapti]], and pacifying factors [[upashaya]]. The set of these five diagnostic tools is called as 'Nidana Panchaka'. This is described and applied in clinical practice to know each disequilibrium condition.
The phenomena of a disease causing another disease is described as [[Nidanarthakara roga]]. [[Upadrava]] (complications), [[Udarka]] (marks of disease after it is cured) are applied for knowing the cause-effect relationship in pathogenesis of disease.
Principles of management of disease are mentioned in brief in each chapter to denote pacifying factors of disease. Each chapter of this section follows the same protocol for comprehensive knowledge of disease.
===Importance of eight chapters===
===Importance of eight chapters===
This section comprises eight different chapters enlisted as below:
* The first chapter, [[Jwara Nidana]] , introduces basic principles of diagnosis of a disease as well as the disease ''jwara'' with involvement of ''rasa dhatu'' as ''dushya''.
This section comprises eight different chapters as described below:
* The second chapter, [[Raktapitta Nidana]], deals with various pathologies related to ''rakta dhatu''
* The third chapter, [[Gulma Nidana]], deals with ''mamsa dhatu'' predominantly
* The first chapter, [[Jwara Nidana]] , introduces basic principles of diagnosis of a disease as well as the disease [[jwara]] with involvement of [[rasa]] [[dhatu]] as [[dushya]].The chapter discuss diagnosis of disorders of hyper-pyrexia and various types of fever.
* The fourth chapter, [[Prameha Nidana]], involves ''meda dhatu'' predominantly
* The fifth chapter, [[Kushtha Nidana]], involves seven ''dushyas''
* The second chapter, [[Raktapitta Nidana]], deals with various pathologies related to [[rakta]] [[dhatu]].This chapter details the diagnosis of bleeding disorders.
* The sixth chapter, [[Shosha Nidana]], deals with the pathology of emaciation
* The seventh chapter, [[Unmada Nidana]] explain insanity and psychotic disorders.
* The third chapter, [[Gulma Nidana]], deals with [[mamsa]] [[dhatu]](muscle tissue) predominantly. This chapter describes diagnosis of lumps in abdomen, tumors.
* The fourth chapter, [[Prameha Nidana]], involves [[meda]] [[dhatu]] (tissue fat) predominantly. This chapter describes the diagnosis of disorders of lipid metabolism, obstinate urinary disorders including diabetes.
* The fifth chapter, [[Kushtha Nidana]], involves seven [[dushyas]] (vitiated factors). This chapter deals with diagnosis of skin disorders.
* The sixth chapter, [[Shosha Nidana]], deals with the pathology of emaciation. This chapter describes diagnosis of degenerative disorders that involve depletion of body tissues.
* The seventh chapter, [[Unmada Nidana]] explain insanity and psychotic disorders.
* The eighth chapter, [[Apasmara Nidana]] deals with epilepsy and seizure disorders.
* The eighth chapter, [[Apasmara Nidana]] deals with epilepsy and seizure disorders.
These eight chapters represent major pathogenesis of diseases described in details in this section. The eight chapters of this section, focus upon eight disorders related with vitiated ''dosha'' acting on various ''dhatu'' to vitiate them.
These eight chapters represent pathogenesis of major diseases described in details in this section. Each chapter directs towards variety of pathogenic processes related interaction of vitiated [[dosha]] with [[dhatu]] to cause disease.
===Guidelines to diagnose [[anukta vyadhi]] (new or untold diseases in text)===
There are innumerable diseases. Major diseases are mentioned in this text. Therefore one may not find complete description of certain diseases seen in contemporary era. Any new or unknown disease should be studied by assessment of vitiated [[dosha]] and [[dushya]] (vitiated factors). The criteria like type of pain, appearance (color), etiology, site, symptoms and name shall be applied for identification.[[Trishothiya Adhyaya#Criteria for classification of diseases|(Cha.Su.18/42-43)]]
All endogenous diseases start with vitiation of [[dosha]]. The causative factors elucidated in the detailed history of a patient’s diet, lifestyle, psychological frame and others direct the vitiation of a specific [[dosha]]. Then their status (increase or decrease) can be assessed based on the premonitory signs and clinical features. Then after evaluation of aggravating ([[anupashaya]]) and pacifying ([[upashaya]]) factors is done. The sequence of events in the pathogenesis of a disease is understood and accordingly treatment protocol is formulated.
[[Prajnaparadha]] (intellectual errors, or knowingly violating rules) is one of the fundamental cause of all endogenous and exogenous diseases. [[Asatmendriyarthasamyoga]] (improper union of senses with their objects) and [[parinama]](time) are other two causative factors . These principles reveal that all idiopathic diseases of unknown etiology also have a definite cause,that needs to be searched and removed for its proper management.
In nutshell, one should initiate any treatment after acquiring complete knowledge of following:
* Inherent nature of the disease
* Its pathogenesis
* Origin or site of lesion and location of presentation
* Etiological factors. [[Trishothiya Adhyaya#Identification of new diseases|(Cha.Su. 18/44-47)]]
===Importance of studying Nidana section ===
* It is highly important to know the fundamental cause of any disease. Complete cure in curable diseases and management of palliable diseases can only be achieved after [[Nidana Parivarjana]] (removing the cause). If the cause is removed, then half the treatment is done. This stops progression of disease as well as helps the host to return to the normal state. The current healthcare system focus more on disease management after its complete manifestation; while [[Ayurveda]] emphasizes on identification of abnormality at an early stage, to prevent its further progression.
* The journey of a disease from the initial stage of accumulation of vitiating factors to complete manifestation of its symptoms shall be studied well for its complete knowledge.
* The knowledge of Nidana can be helpful in reducing healthcare cost by reducing use of invasive and non invasive medical diagnostic tools.
===Researches===
#A team of researchers compiled all Sanskrit texts of [[Nidana Sthana]] in a project report.<ref>Critical Edition of Charaka Nidana Sthana available from http://ayushportal.nic.in/EMR/LITERARY_FINAL_REPORT-1.pdf downloaded on 17/04/2019</ref>
#Shrirang S.G. have done a critical study on Nidana Sthana with special reference to [[Prameha Nidana]] <ref> Shrirang S.G. Thesis on Critical Study Of Caraka Nidana Sthana With Special Reference To Prameha . Department of Samhita . Institute for Post Graduate Teaching & Research in [[Ayurveda]], Gujarat Ayurved University, Jamnagar . 2000</ref>
#Shashirekha H. K. has studied [[Shosha Nidana]] described in [[Nidana Sthana]]. <ref>Shashirekha H K . A Study On Caraka Nidana Sthana With Special Reference To Shosha . Swasthavritta . Dr. Basavaraj Nagur Memorial Rural Ayurvedic Medical College And Hospital (Dr. B N M R), Bijapur .2010</ref>
=== More information ===
The following chapters in other sections deal with detail information about diagnostic principles and classification of disease.
* [[Mahachatushpada Adhyaya]]
* [[Tistraishaniya Adhyaya]]
* [[Kiyanta Shiraseeya Adhyaya]]
* [[Trishothiya Adhyaya]]
* [[Ashtodariya Adhyaya]]
* [[Maharoga Adhyaya]]
* [[Trividha Roga Vishesha Vijnaniya Vimana]]
* [[Roganika Vimana]]
* [[Vyadhita Rupiya Vimana]]
* [[Rogabhishagjitiya Vimana]]
Moreover each chapter of [[Chikitsa sthana]] described the five assessment tools (nidana panchaka) of respective diseases.
=== All Abstracts ===
The new learners of Nidana sthana can read all abstracts of chapters of this section on the [[Abstracts- Nidana Sthana]] page.
==References==
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