Nidan-Diagnosis with Ayurveda
Diagnosis in (Panch Lakshnam Nidanam)
The popular meaning of the term nidanam is diagnosis which also includes prognosis. Generally speaking the word nidanam is applied to the collective ayurvedic name for etiology, pathology, prodromata and symptomatology etc., although in a restricted sense the word nidanam refers specially to the cause that brings about diseases.
Method of investigation of disease in ayurveda is usually described in five heads. Nidanam or hetu- the cause, which probably started the disease. They very often give a clue to diagnose. First comes the investigation of nidanam or the root cause of disease: that is to say, of the particular causative indiscretion, such as bad food, bad water, indulgence, excesses and the like. This gives us a clue to diagnosis and prognosis. But, as one nidanam may possible be at the root of more than one disease, nidanam alone can not help us to diagnose disease.
Purva roopam- prodromata, predisposing symptoms and signs. Next in the sequence comes the purva roopam the prodromata. This investigation helps the physician to correlate particular doshic derangement with a particular group of prodromata and also gives him some clue to prognosis.
Roopam- means symptoms by which a disease exhibits itself. The group of symptoms-complex, which constitute the disease definitely in roopa samudaya. The roopa samudaya may be taken as a syndrome. Roopam or symptomatology by means of which the physician is enabled to judge the special feature of the developed stage of disease of dosha, dushya etc. which indicates whether we have to deal with morbidity of one dosha, two dosha (dwanda) or all the three (sannipatha) whether it is an affection of rasa, rakta mamsa, asthi, orany other dhatu or dushya and so on. The study of signs and symptoms was apparently pursed by ayurvedist with remarkable diligence and skill. The richness of material available in this field is so vast that it is a thousand pities awe do not know more about it. When one goes through some of the ancient medical classics which are happily still extant, one cannot but feel that they are obliviously the works of the master minds gifted with marvelous power of observation and expression.
Upashya- upashya is a form of diagnosis in which a disease is ascertained by the experimental use of particular conduct, diet or drugs. Next is the upashya which is really a form of diagnosis by applied therapeutics, a measure not unknown to western medicine. Let us say the question is whether a particular ailment is due to the derangement of vata. We are in doubt. We then prescribe a diet, exercise or any other remedial measure known to cure this suspected derangement, which is then either ameliorated or aggravated. If it is ameliorated, then the hypotheticateds proposition is confirmed. If not , it is rejected.
Sampraapti - the observation of the course of the disease. It is the term generally used as pathogenesis in modern science. It is the complete sketch of the disease. We follow the tract of the disease and gain the information about its advent and stages. By this we can judge the sequence of the disease and its pathogenesis.
Purva roopam is a new thing according to medical sciences. These are the prodromal symptoms which a disease presents during incubation period. These can be said the mild symptoms which can be seen in people before the actual presentation of ant disease. The knowledge of purva roopam may give us the hints regarding the disease but at this stage it can not be diagnosed that the disease may manifest by itself or may be subsided. As mentioned earlier also that these indications of the of the future diseases can only be understood by attentive patient and a good physician. If we take an example of rain, cool breeze, black clouds, thunder and lightening may be considered as the purva roopam of or the premonitory symptoms of rains. But after all these symptoms one can never be sure that it will rain in future or not.
Utility of Purva Roopam
There are two types of purva roopam.
1. Samanya
2. Visishta
Roopa Roopa can be defined as the purva roopam which manifests it self into a disease is called roopa. In modern terminology roopa is known as sign and symptoms of the disease. There are various synonyms given of roopa these are:
1. Samsthaana- It means that the symptoms by which a disease is surely known. Or the symptoms that establishes to form a disease.
2. Vyanjana- those signs that manifest into a disease. The word means “Vyanjana” the root of the disease.
3. Linga- these are the characteristics by which a disease is known surely.
4. Lakhsnam- it denotes the symptoms of a disease.
5. Chinnh- a mark or the spot by which a thing or a disease can be identified
6. Aakrity- a shape of a substance
All above mentioned six words relates to roopa. These all indicated the sign and symptoms of a disease. Only roopa signifies that symptoms that are being presented, is actually the establishment of the disease. As an example of jwar (fever) it is intended that all the signs and symptoms of the fever is expressed or manifested. More over fever is taken as the disease not the symptoms as in contrast considered by modern sciences. In other diseases say dysentery or leprosy, fever may present up itself, there it may considered as a symptom not the disease. Arochakam (anorexia) may be one of the symptoms of the fever but anorexia may sometimes exist without any presentation of fever and may be the only symptom. In such cases anorexia should be considered as a disease not the symptom. This is illustrated with number of examples in which a collection of symptoms or a symptom complex or syndrome is often considered and then administered as a disease, where as, the disease which have all these symptoms is all together different.
According to ayurveda disease or roga is defined as the abnormality in the interaction between dosha and dushya (a part which is affected). This kind of interaction between these is called as dosha-dushya-samurchanam. When this interaction takes place, certain symptoms are produced according to the nature of abnormality. As an example consider a case of Rajyakshma (tuberculosis), the interaction between doshas and dushya, produces a symptom complex of kaas (cough), skandh dah (burning sensation near shoulder), swar bhang (hoarseness of voice), jwar (fever), Shankhak shirh shool (pain in sides of head), spitting of sputum and blood, dyspnoea, atisaar (diarrhoea)etc. another type of abnormal interaction between dosha and dushya causes insensibility of feeling, profuse sweating or absence of sweat, discoloration of the skin, eruptions or elevation of skin patches. Shooting pains, numbness etc. which when assembled, form the symptom complex or disease known as leprosy.
But now a query arises in mind that, are these collection symptoms are able to get into the shape of a disease. As we know that the symptoms are not the disease themselves but are the imbalanced normal condition of the body that contributes to there cause and origination.
Upashya (Diagnosis by experimental method)
Upashya is a form of diagnosis method by applying the therapeutic method. After making a detailed investigation through all the methods of diagnosis discussed above i.e. nidanam, purva roopam, roopa, and sampraapti, a physician may still have a doubt regarding sure diagnosing a disease. The doubt may arise in exactly telling the nature of the disease i.e. the vitiated dosha etc. in such a condition upashya comes to play. As an example, we can say that, if there is any doubt regarding the disease presentation about its dosha aggravation .i.e. does it has vata dominance or pitta dominance or kapha dominance. So to get it confirmed, we suppose things like we assume that the disease is vata in nature or has occurred due to imbalance in vata, the physician administer anti- vata measures like he will be giving the patient with the anti vata medicine or snigdh (slimy) diet or advice him a panchkarma treatment like snigdh swed etc. if the disease is ameliorated thereby, his tentative diagnosis is confirmed; and this is called upashya. He is then enabled to pursue the treatment by anti vata measures in proper vigorous manner. Thus the medicine, food, panchkarma therapy or the modification in the life style which ahs given relief is called upashya. If the patient’s problem gets aggravated then by following this, it is then sure that it is not the cause or the aggravated dosha, then it is terms d as anupshya. It should be immediately stopped. Thus by knowing the anupshya, the physician is able to take an entire different course. This type of experimentation should be performed by a well qualified person and not by everyone as this involves complete knowledge of the subject. As mentioned by the ancient Maharishi Chakrapani, this sort of diagnostic method should be the last option of the intelligent physician for the purpose of diagnosis of a disease with hidden symptoms.
Upashya thus can be defined as the unbroken sequence of relief from the disease obtained by the use of Aushadh (medicine) or aahar (food) or vihar (lifestyle). It is to be noted that upashya gives the permanent cure not the temporary relief. Take an example of ahifen (opium), it can give a temporary relief say from headache but it is the solution of a problem and does not resolve the cause by which headache is caused.
Upashya is also called vyadhisatmya, i.e. which is conductive to the welfare of the patient by giving relief from the disease.
Six types of Upashya 1. Hetuvipareetha
2. Vyadhivipareetha
3. Hetu vyadhivipareetha
4. Hetuvipareetthaarthakari
5. Vayadhivipareetharthakari
6. Hetuvyadhivipareetharthkari
Sampraapti
Sampraapti means sequential description of the pathogenesis that occurs in our body due to advent of a disease. The details of morbid processes i.e. Vata, pitta, kapha, sapt dhatus (seven dhatus), three malas (mutra, purish and swed) that takes place in different diseases or in different stages of the same disease. The accumulation, movements and aggravation of doshas and the process in which the disease take place are a part of sampraapti. Sampraapti can make us understood by the knowledge of intake of cause, the degree of its affect, and how it affects the constitution and the physiology of the body and then resides in which part of the body. Sampraapti includes main cause, precipitating factors, sex, age, time, pathology, diet and lifestyle and all the changes that comes under sequence known as sampraapti.
Synonyms of sampraapti are jaati and aagati.
Take an example that the doshas gets aggravated due to any reason or cause which enters into the amashya (stomach) and then disturbs (jatharagni) and expels it out from its place of action i.e. Amashya (stomach) and entering into the rasa dhatu causing jwar (fever). Such a description or morbid processes are included in sampraapti or the pathogenesis.
Sampraapti is subdivided into six types.
1. Sankhaya or number – it id the number of varieties or types in which disesase may manifest itself. Take an example of types of jwar (fever) , it is of eight types i.e. vata, pitta, kapha, vatapitta, pittakapha, vatakapha, vatapittakapha and agantuj (external)., five types of kaas (cough) etc.
2. Pradhanya or dominant - it is the predominance of a particular dosha or doshas or it confirms that the disease caused is swatantra (primary or independent) or partantra (secondary or complication of primary disease).
3. Vidhi or order - classifying the disease with reference to either the two-fold caused as nija (idiopathic or individual) or agantuj (traumatic) or to the three fold classification of saadhya (easily curable), aasadhya (incurable), krichsaadhya (difficult to cure) and yaapya (incurable disease but judicious diet and conduct, life can be prolonged).
4. Vikalpa –it is the measure in which the dosha are excited in the doshic triad (vata, pitta and kapha) or the measure in which the dosha gunnas that excite the doshas exist.
5. kala or time – the time factor which makes the disease severe, moderate or mild, i.e. the seasons, day night, hour of eating etc.
6. Bala or strength – bala is the strength of a disease, known by severity of the attack, presence or absence of all the symptoms etc and so on.
Sampraapti can be still divided into six stages or path by which the action occurs in the body. These are the six stages by which a disease occurs. It is very essential for any physician to have the knowledge of these stages as one can get an idea in which the disease can be cured. If the imbalance in dosha is checked at the first stage, disease can be prevented. If the derangement of there dosha is not recognized and if prompt treatment is not given then damage continues and proceeds to the next stage. Similarly when each of the successive stages is neglected the disease takes a definite shape and nay sometimes become yaapya (incurable disease but judicious diet and conduct, life can be prolonged) or aasadhya (incurable).
Following are the six stages known as shad kriya kaal are described in the doshic changes during the course of a disease: -
· Sanchaya or the accumulation phase – it is accumulation or stagnation of the aggravated, attenuated or vitiated vata, pitta or kapha in their respective places, instead of circulating in the body freely.
· Prakopa or excited phase – in this phase, the altered dosha then gets swollen up or excited.
· Prasara or spread– when the prakopa occurs in body then precedes the stage of prasara. In this after the excited dosha spreads to various places.
· Sthanasanshraya or specific locations – the abnormal doshas gets located or placed in other sites causing certain diseases in the parts affected constituting the fourth kriya kaal. This time is the manifestation of the disease clinically and presents it self as purva roopam or the prodromal symptoms.
· Vyakti or manifestation – in this all the clinical feature come to the picture completely and represents the roopa (sign and symptoms) in the body.
· Bheda or variation – it is the last stage of the shad kriya kaal where the disease runs its course, either subsiding wholly or getting chronic or causing the death of the patient according to the gravity of the condition and the treatment adopted.
Nidanam, also known as hetu or kaaran in ayurvedic terminology, is the cause or factor by which pathogenesis occurs in the body. Firstly we may say that there is only one cause of the disease. Viz., vitiation of three doshas. This is caused due to consumption of unsuitable objects which are unable in maintaing the homeostasis of the body. But in order to make a closer study of the cause of the disease we have to take into consideration all the possible ways in which the doshas may be deranged and all the possible way in which unsuitable objects may indulge in by man by the improper use of his mind and his sensory receptors.
Types of Nidanam Nidanam is of four types (Categories 1).
These are
· Sannikrista nidanam
· Viprakrista nidanam
· Vyabbhicharika nidanam
· Pradhanika nidanam.
Nidanam may again be classified into three categories (Categories 2)
1. Asatmyendriyardha samyoga
2. Pragyapradh
3. Parinama
There is another category of nidanam.In this category it is divided into three (Categories 3)
1. Dosha nidanam
2. Vyadhi nidanam
3. Ubhaya nidanam
Nidanam can again be divided into two categories (Categories 4)
1. Utpaadaka
2. Vyanjaka
Again it can be classified into two categories.(Categories 5)
1. Baahya hetu (external cause)
2. Abhayantar hetu (internal cause)
The vitiated doshas are again classified into 2 categories.(Categories 6)
· Anubandha (the subordinate dosha)
· Anubandhya (the main dosha)
This distinction of dosha that it is main or subordinate is to be analyzed as the cure or remedy is generally directed to ward the main dosha. But there are some exceptions like upadrava (complication) which is an anubandha dosha, also goes away when the main disease is treated. But due to some dangers upadrava or the complications are to be treated first and then the main disease.
Nidanam is also classified into three more types more types which are mentioned under gati (movements).(Categories 7)
These are
1. Kshaya i.e. decrease
2. Sthaanam i.e. normal
3. Vriddi i.e. increase
There is other classification by which involvement of ama is to be considered. (Categories 8)
Theses are
1. Saam
2. Niraam
Nidanam is still classified into tow kinds (Categories 9)
These are:
1. Nija
2. Agantuka
The popular meaning of the term nidanam is diagnosis which also includes prognosis. Generally speaking the word nidanam is applied to the collective ayurvedic name for etiology, pathology, prodromata and symptomatology etc., although in a restricted sense the word nidanam refers specially to the cause that brings about diseases.
Method of investigation of disease in ayurveda is usually described in five heads. Nidanam or hetu- the cause, which probably started the disease. They very often give a clue to diagnose. First comes the investigation of nidanam or the root cause of disease: that is to say, of the particular causative indiscretion, such as bad food, bad water, indulgence, excesses and the like. This gives us a clue to diagnosis and prognosis. But, as one nidanam may possible be at the root of more than one disease, nidanam alone can not help us to diagnose disease.
Purva roopam- prodromata, predisposing symptoms and signs. Next in the sequence comes the purva roopam the prodromata. This investigation helps the physician to correlate particular doshic derangement with a particular group of prodromata and also gives him some clue to prognosis.
Roopam- means symptoms by which a disease exhibits itself. The group of symptoms-complex, which constitute the disease definitely in roopa samudaya. The roopa samudaya may be taken as a syndrome. Roopam or symptomatology by means of which the physician is enabled to judge the special feature of the developed stage of disease of dosha, dushya etc. which indicates whether we have to deal with morbidity of one dosha, two dosha (dwanda) or all the three (sannipatha) whether it is an affection of rasa, rakta mamsa, asthi, orany other dhatu or dushya and so on. The study of signs and symptoms was apparently pursed by ayurvedist with remarkable diligence and skill. The richness of material available in this field is so vast that it is a thousand pities awe do not know more about it. When one goes through some of the ancient medical classics which are happily still extant, one cannot but feel that they are obliviously the works of the master minds gifted with marvelous power of observation and expression.
Upashya- upashya is a form of diagnosis in which a disease is ascertained by the experimental use of particular conduct, diet or drugs. Next is the upashya which is really a form of diagnosis by applied therapeutics, a measure not unknown to western medicine. Let us say the question is whether a particular ailment is due to the derangement of vata. We are in doubt. We then prescribe a diet, exercise or any other remedial measure known to cure this suspected derangement, which is then either ameliorated or aggravated. If it is ameliorated, then the hypotheticateds proposition is confirmed. If not , it is rejected.
Sampraapti - the observation of the course of the disease. It is the term generally used as pathogenesis in modern science. It is the complete sketch of the disease. We follow the tract of the disease and gain the information about its advent and stages. By this we can judge the sequence of the disease and its pathogenesis.
Purva roopam is a new thing according to medical sciences. These are the prodromal symptoms which a disease presents during incubation period. These can be said the mild symptoms which can be seen in people before the actual presentation of ant disease. The knowledge of purva roopam may give us the hints regarding the disease but at this stage it can not be diagnosed that the disease may manifest by itself or may be subsided. As mentioned earlier also that these indications of the of the future diseases can only be understood by attentive patient and a good physician. If we take an example of rain, cool breeze, black clouds, thunder and lightening may be considered as the purva roopam of or the premonitory symptoms of rains. But after all these symptoms one can never be sure that it will rain in future or not.
Utility of Purva Roopam
There are two types of purva roopam.
1. Samanya
2. Visishta
Roopa Roopa can be defined as the purva roopam which manifests it self into a disease is called roopa. In modern terminology roopa is known as sign and symptoms of the disease. There are various synonyms given of roopa these are:
1. Samsthaana- It means that the symptoms by which a disease is surely known. Or the symptoms that establishes to form a disease.
2. Vyanjana- those signs that manifest into a disease. The word means “Vyanjana” the root of the disease.
3. Linga- these are the characteristics by which a disease is known surely.
4. Lakhsnam- it denotes the symptoms of a disease.
5. Chinnh- a mark or the spot by which a thing or a disease can be identified
6. Aakrity- a shape of a substance
All above mentioned six words relates to roopa. These all indicated the sign and symptoms of a disease. Only roopa signifies that symptoms that are being presented, is actually the establishment of the disease. As an example of jwar (fever) it is intended that all the signs and symptoms of the fever is expressed or manifested. More over fever is taken as the disease not the symptoms as in contrast considered by modern sciences. In other diseases say dysentery or leprosy, fever may present up itself, there it may considered as a symptom not the disease. Arochakam (anorexia) may be one of the symptoms of the fever but anorexia may sometimes exist without any presentation of fever and may be the only symptom. In such cases anorexia should be considered as a disease not the symptom. This is illustrated with number of examples in which a collection of symptoms or a symptom complex or syndrome is often considered and then administered as a disease, where as, the disease which have all these symptoms is all together different.
According to ayurveda disease or roga is defined as the abnormality in the interaction between dosha and dushya (a part which is affected). This kind of interaction between these is called as dosha-dushya-samurchanam. When this interaction takes place, certain symptoms are produced according to the nature of abnormality. As an example consider a case of Rajyakshma (tuberculosis), the interaction between doshas and dushya, produces a symptom complex of kaas (cough), skandh dah (burning sensation near shoulder), swar bhang (hoarseness of voice), jwar (fever), Shankhak shirh shool (pain in sides of head), spitting of sputum and blood, dyspnoea, atisaar (diarrhoea)etc. another type of abnormal interaction between dosha and dushya causes insensibility of feeling, profuse sweating or absence of sweat, discoloration of the skin, eruptions or elevation of skin patches. Shooting pains, numbness etc. which when assembled, form the symptom complex or disease known as leprosy.
But now a query arises in mind that, are these collection symptoms are able to get into the shape of a disease. As we know that the symptoms are not the disease themselves but are the imbalanced normal condition of the body that contributes to there cause and origination.
Upashya (Diagnosis by experimental method)
Upashya is a form of diagnosis method by applying the therapeutic method. After making a detailed investigation through all the methods of diagnosis discussed above i.e. nidanam, purva roopam, roopa, and sampraapti, a physician may still have a doubt regarding sure diagnosing a disease. The doubt may arise in exactly telling the nature of the disease i.e. the vitiated dosha etc. in such a condition upashya comes to play. As an example, we can say that, if there is any doubt regarding the disease presentation about its dosha aggravation .i.e. does it has vata dominance or pitta dominance or kapha dominance. So to get it confirmed, we suppose things like we assume that the disease is vata in nature or has occurred due to imbalance in vata, the physician administer anti- vata measures like he will be giving the patient with the anti vata medicine or snigdh (slimy) diet or advice him a panchkarma treatment like snigdh swed etc. if the disease is ameliorated thereby, his tentative diagnosis is confirmed; and this is called upashya. He is then enabled to pursue the treatment by anti vata measures in proper vigorous manner. Thus the medicine, food, panchkarma therapy or the modification in the life style which ahs given relief is called upashya. If the patient’s problem gets aggravated then by following this, it is then sure that it is not the cause or the aggravated dosha, then it is terms d as anupshya. It should be immediately stopped. Thus by knowing the anupshya, the physician is able to take an entire different course. This type of experimentation should be performed by a well qualified person and not by everyone as this involves complete knowledge of the subject. As mentioned by the ancient Maharishi Chakrapani, this sort of diagnostic method should be the last option of the intelligent physician for the purpose of diagnosis of a disease with hidden symptoms.
Upashya thus can be defined as the unbroken sequence of relief from the disease obtained by the use of Aushadh (medicine) or aahar (food) or vihar (lifestyle). It is to be noted that upashya gives the permanent cure not the temporary relief. Take an example of ahifen (opium), it can give a temporary relief say from headache but it is the solution of a problem and does not resolve the cause by which headache is caused.
Upashya is also called vyadhisatmya, i.e. which is conductive to the welfare of the patient by giving relief from the disease.
Six types of Upashya 1. Hetuvipareetha
2. Vyadhivipareetha
3. Hetu vyadhivipareetha
4. Hetuvipareetthaarthakari
5. Vayadhivipareetharthakari
6. Hetuvyadhivipareetharthkari
Sampraapti
Sampraapti means sequential description of the pathogenesis that occurs in our body due to advent of a disease. The details of morbid processes i.e. Vata, pitta, kapha, sapt dhatus (seven dhatus), three malas (mutra, purish and swed) that takes place in different diseases or in different stages of the same disease. The accumulation, movements and aggravation of doshas and the process in which the disease take place are a part of sampraapti. Sampraapti can make us understood by the knowledge of intake of cause, the degree of its affect, and how it affects the constitution and the physiology of the body and then resides in which part of the body. Sampraapti includes main cause, precipitating factors, sex, age, time, pathology, diet and lifestyle and all the changes that comes under sequence known as sampraapti.
Synonyms of sampraapti are jaati and aagati.
Take an example that the doshas gets aggravated due to any reason or cause which enters into the amashya (stomach) and then disturbs (jatharagni) and expels it out from its place of action i.e. Amashya (stomach) and entering into the rasa dhatu causing jwar (fever). Such a description or morbid processes are included in sampraapti or the pathogenesis.
Sampraapti is subdivided into six types.
1. Sankhaya or number – it id the number of varieties or types in which disesase may manifest itself. Take an example of types of jwar (fever) , it is of eight types i.e. vata, pitta, kapha, vatapitta, pittakapha, vatakapha, vatapittakapha and agantuj (external)., five types of kaas (cough) etc.
2. Pradhanya or dominant - it is the predominance of a particular dosha or doshas or it confirms that the disease caused is swatantra (primary or independent) or partantra (secondary or complication of primary disease).
3. Vidhi or order - classifying the disease with reference to either the two-fold caused as nija (idiopathic or individual) or agantuj (traumatic) or to the three fold classification of saadhya (easily curable), aasadhya (incurable), krichsaadhya (difficult to cure) and yaapya (incurable disease but judicious diet and conduct, life can be prolonged).
4. Vikalpa –it is the measure in which the dosha are excited in the doshic triad (vata, pitta and kapha) or the measure in which the dosha gunnas that excite the doshas exist.
5. kala or time – the time factor which makes the disease severe, moderate or mild, i.e. the seasons, day night, hour of eating etc.
6. Bala or strength – bala is the strength of a disease, known by severity of the attack, presence or absence of all the symptoms etc and so on.
Sampraapti can be still divided into six stages or path by which the action occurs in the body. These are the six stages by which a disease occurs. It is very essential for any physician to have the knowledge of these stages as one can get an idea in which the disease can be cured. If the imbalance in dosha is checked at the first stage, disease can be prevented. If the derangement of there dosha is not recognized and if prompt treatment is not given then damage continues and proceeds to the next stage. Similarly when each of the successive stages is neglected the disease takes a definite shape and nay sometimes become yaapya (incurable disease but judicious diet and conduct, life can be prolonged) or aasadhya (incurable).
Following are the six stages known as shad kriya kaal are described in the doshic changes during the course of a disease: -
· Sanchaya or the accumulation phase – it is accumulation or stagnation of the aggravated, attenuated or vitiated vata, pitta or kapha in their respective places, instead of circulating in the body freely.
· Prakopa or excited phase – in this phase, the altered dosha then gets swollen up or excited.
· Prasara or spread– when the prakopa occurs in body then precedes the stage of prasara. In this after the excited dosha spreads to various places.
· Sthanasanshraya or specific locations – the abnormal doshas gets located or placed in other sites causing certain diseases in the parts affected constituting the fourth kriya kaal. This time is the manifestation of the disease clinically and presents it self as purva roopam or the prodromal symptoms.
· Vyakti or manifestation – in this all the clinical feature come to the picture completely and represents the roopa (sign and symptoms) in the body.
· Bheda or variation – it is the last stage of the shad kriya kaal where the disease runs its course, either subsiding wholly or getting chronic or causing the death of the patient according to the gravity of the condition and the treatment adopted.
Nidanam, also known as hetu or kaaran in ayurvedic terminology, is the cause or factor by which pathogenesis occurs in the body. Firstly we may say that there is only one cause of the disease. Viz., vitiation of three doshas. This is caused due to consumption of unsuitable objects which are unable in maintaing the homeostasis of the body. But in order to make a closer study of the cause of the disease we have to take into consideration all the possible ways in which the doshas may be deranged and all the possible way in which unsuitable objects may indulge in by man by the improper use of his mind and his sensory receptors.
Types of Nidanam Nidanam is of four types (Categories 1).
These are
· Sannikrista nidanam
· Viprakrista nidanam
· Vyabbhicharika nidanam
· Pradhanika nidanam.
Nidanam may again be classified into three categories (Categories 2)
1. Asatmyendriyardha samyoga
2. Pragyapradh
3. Parinama
There is another category of nidanam.In this category it is divided into three (Categories 3)
1. Dosha nidanam
2. Vyadhi nidanam
3. Ubhaya nidanam
Nidanam can again be divided into two categories (Categories 4)
1. Utpaadaka
2. Vyanjaka
Again it can be classified into two categories.(Categories 5)
1. Baahya hetu (external cause)
2. Abhayantar hetu (internal cause)
The vitiated doshas are again classified into 2 categories.(Categories 6)
· Anubandha (the subordinate dosha)
· Anubandhya (the main dosha)
This distinction of dosha that it is main or subordinate is to be analyzed as the cure or remedy is generally directed to ward the main dosha. But there are some exceptions like upadrava (complication) which is an anubandha dosha, also goes away when the main disease is treated. But due to some dangers upadrava or the complications are to be treated first and then the main disease.
Nidanam is also classified into three more types more types which are mentioned under gati (movements).(Categories 7)
These are
1. Kshaya i.e. decrease
2. Sthaanam i.e. normal
3. Vriddi i.e. increase
There is other classification by which involvement of ama is to be considered. (Categories 8)
Theses are
1. Saam
2. Niraam
Nidanam is still classified into tow kinds (Categories 9)
These are:
1. Nija
2. Agantuka
