Nidana Panchak

 

(Five Clues to Diagnose the Disease):

 

In Ayurveda, ‘Nidan’ is the tool to diagnose any particular disease, its origin and trace the evolution.Ayurveda describes the following five tools that help in identifying the diseases and its pathology:

  1. Nidan (Hetu)
  2. Poorvaroopa
  3. Roopa
  4. Upashaya
  5. Samprapthi

 

1. Nidan / Hetu (Causative Factors)

They are the factors or causes that lead to the disease causing pathology. These Hetu can be Internal (Nija) and External (Agantuja) and are capable of disturbing the balance of three doshas (i.e. Vata, Pitta and Kapha). In ayurveda Hetu has been classified into different branches that are as follows: 

1a) Sannikrishta Hetu (Close Factor)

These are the factors that bypass the Sanchay stage of the disease process to the next stage of disease process i.e. Prakopa (provocation) by disturbing the equilibrium of the three doshas (Vata, Pitta, Kapha) by the three following factors:

 

  • Stages of the day (morning, afternoon, evening)
  • Stages of night (early night, mid night, late night)
  • Stages of digestion (amawastha, pachyamanawastha, pakwawastha) An illustrating example of such a disease is Trauma (Sannikrishta).

 

1b) Viprikrishta Hetu (Distant Factor)

These are the factors that effect the equilibrium of doshas, which was developed earlier but was unable to develop disease. In this case as the disturbed equilibrium of dosha (Sanchay) already exists the onset of the ailment is quick due to other stimulating factors. 

An illustrating example is: during Shishira rutu (Winter) season equilibrium of kapha dosha is disturbed but it doesn't lead to disease as it is frozen due to extreme cold but as soon as the climate changes it melts due the warmth in Vasanth ritu (Autumn).

 

1c) Vyabhichari (Weak Factor)

 

This type of Hetu is weak and due to its weakness although it disturbs the equilibrium of the doshas it is unable to lead to disease. An illustrating example is that of our daily life where we resort to unhealthy practices but doesn't always fall sick.

1d) Pradhanik (String Factor)

Due to its strength these types of Hetu always lead to disease or death after disturbing the equilibrium of the doshas. An illustrating example is that of poison, snake bites, trauma etc.

2a) Asatmiya Indriyartha Samyoga

These types of factor are due to the unhealthy or improper use of the Indriya i.e. Gyan Indriya (Chakshu, Srotra, Ghran, Rashna, Sparsh) and Karmindriya (Hasta, Pada, Twak, Payu, Upastha ) that lead to disease. These Hetu are divided into the following categories:

 

  • Ati Yoga (Overuse)

 

This refers to the overuse of Indriya. Example: reading for hours together, watching T. V for long and working on computers for hours together develop disease related to eyes due to the overstrain or overuse of eyes.

 

  • Hina Yoga (Underuse)

 

This refers to the under use or less use of Indriya that lead to disease. Example: if we keep the eyes close for longer than the sleep hours or rest hours eyes may develop some disease.

 

  • Mithya Yoga (Misuse)

 

This refers to the wrong use or misuse of Indriya. Example: seeing towards bright light straight or reading in very dim light both are misuse of eyes that lead to diseases. 

2b) Pragyaparadha

This term comprises of two words i.e. Pragnya meaning Intellect and Apradha meaning Crime thus giving the whole term the meaning of doing wrong things inspite of knowing about their negative side effects or consequences that will lead to disease. In ayurveda it is said that Pragyapradha is the main cause of Janpadodhwansa (Epidemic Diseases). It is the crime performed by the intellect and is classified into three groups that are as follows:

 

  • Dhi (Intellectual)

 

It refers to the onset of any disease due to the action performed by his intellect, as he doesn't know what are the adverse effects of the action, lack of intellect.


Example: A person not knowing the bad effect of alcohol resorts to drinking does so because of lack of intellect.

 

  • Dhriti (Awareness)

 

This refers to the onset of any disease due to factors or actions performed by the person after knowing the adverse effects of the action i.e. In spite of the awareness when one does wrong things. 


Example: when a person knows that alcohol is bad for health but still is addicted to it and is not able to leave it due to liking it or weak will power.

 

  • Smruti (Memory)

 

It refers to the onset of ailment due to the loss of memory.

 

Example: A person who is aware of the bad effects of alcohol decides not to drink in future but drinks forgetting that he had resolved not to drink he is termed as Smruti Vibhramsha. 

2c) Parinama (Time)

Parinama refers to the prime factors that change the world and is classified under the following three categories:

 

  • Hinayoga : Less cold in winter is considered as hinayog of winter season, which affects our body and leads to disease.

  • Mithyayoga : If there is unexpected rain in winter is considered as mithyayog of it. It also affects our body and leads to disease.

  • Atiyoga : Extreme cold in winter is considered as atiyog of it. It affects our body, which leads to disease.

 

3a) Dosha Hetu

This refers to the Hetu that disturbs the equilibrium of any particular dosha but doesn't lead to particular disease.

 

Example: Intake of sugar causes disequilibria in kapha dosha but doesn't lead to any disease.

3b) Vyadhihetu (Diseased Factor)

This refers to the cause of disease that is direct and can be identified immediately as the cause.

 

Example: Eating soil always leads to anemia.

 

3c) Ubhayahetu (Combined Factor)

It is the situation when both the disease and disturbance of the doshas is identified with the same factor or cause. 

 

Example: Eating chilies or spicy food during travelling by any vehicle or any other means of transport leads to disease called Vataraktha (Gout). The dosha disturbed in this case is Vata
.
4a) Utpadaka Hetu (Predisposing Factor) 

This refers to the situation where the factor is responsible for disturbing the equilibrium of the dosha but May or may not be responsible for the disease. 

 

Example: Coldness of winter disturbs the equilibrium of kapha dosha in the body but it does not lead to any disease.

4b) Vyanjaka Hetu (Exciting Factor)

This refers to the factors, which are not responsible for disturbing the dosha but exciting them to lead to the disaaese.

 

Example: Warmth of Vasant (Autumn) does not disturb the equilibrium of kapha dosha directly but its warmth melts the disturbed kapha dosha, which leads to disease.

5a) Bahya Hetu (External Factor)

This refers to the disease causing factors that are present outside the body.

 

Example: Diet, Conduct, Time, Microorganism, Trauma, Insect bite, Lightening, poisons, etc.

5b) Abhyantara Hetu (Internal Factors)

This refers to the factors present inside the body.

 

Example: Dosha, Dhatu and Mala of the body.

 

2. Poorvaroopa (Pre- indicating signs and symptoms) 

During the development of pathology of the disease (samprapti) signs and symptoms develops on the body which can identify the disease are called Poorvaroop. These are classified into two:

1) Samanya Poorvaroopa (General Preindicating Signs And Symptoms)

By these signs and symptoms only the basic disease can be identified but not the subtype. Example: Shrama (Tiredness), Aarati (Uneasy feeling) is one of the sign of Pyrexia (Jwara).

2)  Vishesha Poorvaroopa (Special Preindicating Signs and Symptoms)

These not only help in identifying the disease but also the sub type of the ailment. Example: Burning sensation in the eye along with Shrama (Tiredness) is pre indicative sign of Pittaj Jwara (fever, developed due to Pitta dosha).

 

Importance of Poorva Roopa

 

  • Treatment : In Ayurveda some treatment can be given in Poorva roopa stage to prevent the disease. Example: In Pittaja Fever Ghrithpan (Taking Ghee) is the treatment at its Poorva roopa stage.

 

  • Severity of Disease : In Ayurveda it is said if developed disease show all its poorva roopa (Pre indicating Signs and Symptoms) and Roopa (Indicating Sign and Symptoms) then the disease is said to be Asadhya (Impossible to Treat) or Krichra Sadhaya (Dificult to Treat).

 

  • Diffrential Diagnosis : In Ayurveda there is same Roopa (Indicative Sign and Symptoms) mentioned for two different diseases but different Poorva roopa (Pre indicating Signs and Symptoms). This type of disease could be identified with the help of poorvaroop (pre indicating sign and symptoms) only. 

    3. Roopa (Indicative Signs and Symptoms) 

    Following are the synonyms for Roopa or Symptoms in Ayurveda:

 

  • Sansthana
  • Vyanjana
  • Linga
  • Lakshana
  • Chihnam
  • Akruti.

 

Signs and Symptoms developed by the completion of pathology leading to disease, which is indicative of the disease, is called the Roopa (Indicative Signs and Symptoms) of the disease.

Importance of the Roopa

 

  • Diagnosis : Roopa (Indicative Signs and Symptoms) is the main means of diagnosis of the disease.

 

  • Severity : The disease is severe if it presents all of its Roopa (Indicative Signs and Symptoms), which are indicative of the disease, is called the Roopa (Indicative Sign and Symptoms) of the disease. 

    4. Upshaya (Therapeutic Test) 

    It refers to the treatment of the ailment i.e. Oushadhi (Medicine), Anna (Diet) and Conduct, which help to cure the disease. The opposite of this is Anupashaya. Treatments are classified as follows:

    (1) Hetu Viparita (Anti Factor)

    This refers to the treatment that is opposite to the factor, which causes the disease and can be classified in three sub categories, namely:

 

  • Hetu Viparita Oushadhi : They are the medicines that control the ailment. Example: In Kapha Jwara dried Ginger is the medicine as it corrects the imbalance of Kapha dosha in the body, which cures Kapha Jwara. Here medicine i.e. Ginger is opposite of the factor i.e. Kapha dosha.

 

  • Hetu Viparita Anna : The diet opposite to the disease-causing factor is called Hetu Viparit Anna. Example: To have chicken soup as diet in shrama Jwara (ever due to Tablets). That is caused due to over exertion leads to imbalance of Vata dosha and chicken soup balances the Vata dosha in the body and removes tiredness.

 

  • Hetu Viparita Vihara : This refers to the type of conduct that controls the disease-causing factor. Example: Sleeping in day- time disturbs the Kapha dosha in the body which leads to Kapha (Cold and Cough), thus the treatment for this is to sleep at night, which controls the disturbed Kapha dosha, and ultimately cures the disease. 

    (2) Vyadhi Viparita (Anti Disease)

    This refers to specific means to cure certain disease.

 

  • Vyadhi Viparita Oushadhi : These are the medicines specifically for a certain disease. Example: Kutaja (Holarrhena antidysenterica) is the specific medicine for diarrhoea.

 

  • Vyadhi Viparita Anna : It refers to diet specific to the disease.  Example: In Diarrhoea Masoordal ( Pulse)is the specific diet.

 

  • Vyadhi Viparita Vihar : It refers to the conduct specific to the disease. Example: In Udhavartha (a kind of disease in which excreta comes out through mouth) Pravahana (make effort by abdomen to defecation) is the specific conduct (Vihar). 

    (3) Hetuvyadhi Viparita (Anti Factor & Anti Disease)

    This refers to treatment, which is specific to the disease and yet is an anti factor.

 

  • Hetuvyadhi Viparita Oushadhi : It is the medicine that controls the positive factor and cures the ailment. Example: The medicine Dashamool is specific for Vataja Shotha. Here Dashamool controls the disturbed Vata dosha in the body. It is also specific to control the Shotha (Edema).

 

  • Hetuvyadhi Viparita Anna : It is the diet specific to the disturbed doshas and is specific to the disease. Example: Takra (Buttermilk) is the specific diet for Vataja Grahani (a type of Indigestion). Here Takra controls the disturbed Vata dosha in the body. It also improves digestion.

 

  • Hetuvyadhi Viparita Vihar : This refers to the conduct that is specific to control the disturbed dosha and is specific to for controlling the ailment. Example: Tandra developed due to excessive use of fatty things and daytime sleep. Ruksha Vihar (conduct which reduces fat, such as running walking etc). Exercise like running walking etc controls the disturbed kapha dosha in the body. 

    (4) Hetu Viparitarthkari (Anti Causative Subjective)

    This refers to the factors that initially might be supporting the causative factor but helps in curing the ailment at the end.

 

  • Oushadhi (Medicine) : Example: The suppuration of boil is caused by disturbed Pitta dosha. When Upanaha (type of Poultice) is used for the treatment of boil it enhance the process of suppuration of boil by exciting Pitta dosha. Here the medication seems to enhancing the causative factor i.e. Pitta dosha. As after suppuration of boil puss is drained which support healing. This way upanaha, which seems to be a pro causative factor ultimately, cures the boil.

 

  • Anna (Diet) : To take Vidahi anna (the diet which imbalance the Pitta dosha ) as diet in boil. Here also the Vidahi anna excites the Pitta dosha, which enhance the suppuration of boil. After suppuration puss is drained out from the boil, which supports healing.

 

  • Vihar (Conduct) : According to Ayurveda the fear disturbs Vata dosha to treat Vatik Unmad (a form of Psychotic disorder) patient is feared and angry. Here anger and fear excite the Vata dosha, but the action of scolding and fear control the patient and ultimately he get cured. 

    (5) Vyadhi Viparitarthkari (Anti Disease Subjective)

    This refers to the means, which are supposed to be exaggerating the disease, but it cures it.

 

  • Oushadhi (Medicine) : Example: Madan phala (Randia dumetorum) exaggerate Vamana (Vomiting). In the treatment of Kaphaja Vamana it helps to remove unwanted cough by exaggerating Vamana (Vomiting).

 

  • Anna (Diet) : Example: Milk is a Mild Laxative, which may promote Diarrhoea. In Dysentery milk helps to remove mucous from the Gastro Intestinal Tract by promoting evacuation. Thus to take milk in dysentery helps in its cure.

 

  • Vihar (Conduct) : Example: To promote Vomiting (Vamana) in the disease Vamana (Vomiting) helps to remove polluted cough from the body but it relives patient and accurate it. 

    (6) Hetu- Vyadhi Viparitarthkari (Anti Factor & Anti Disease Subjective)

    This type of treatment seems to be anti causative factor and disease promoting but the ultimately it cures the disease.

 

  • Oushadhi (Medicine) : Example: According to Ayurveda Agaru (type of herb) promotes warmth in the skin. Agaru is applied on the burns and scalds as its treatment. Inspite of its warm nature it enhances the blood flow to the effected part, which helps in healing.

 

  • Anna (Diet) : Example: In a chronic alcoholic patient to avoid withdrawal syndrome, alcohol in small amount is provided.

 

  • Vihar (Conduct) : Example: According to Ayurveda Frozen Shoulder develops due to the disturbance in equilibrium of Vata dosha. As cold water and the conduct of swimming both may disturb Vata dosha. This conduct seems to be disease promoting but during swimming the heat produced by the action get trapped in the effected area (Frozen Shoulder). This warmth corrects the disturbed equilibrium of Vata dosha and ultimately the disease is cured. 

    5. Samprapti (Pathology) 

    Following are synonyms of samprapti:

 

  • Jati
  • Agati

This term is defined as the process of development of disease, which starts from the disturbance of the equilibrium of the doshas and after going through different stages causes disease. Following are the different stages of samprapti:

 

  • Sanchayam : At this stage the quantum of dosha increases within the dwelling place and signs and symptoms of the disease are seen and patient wishes to do activities that are opposite to the causative factor. Example: Increase in the quantum of Kapha dosha in Urapradesh (Thoracic region). The causative factor of Sanchaya stage is divided into following two types:

 

  • Prakruti (Natural) : It refers to the change of quantum of dosha according to the seasons.  Example: Sanchaya of Kapha dosha during Shishira (Winter Season).

 

  • Vikruti (Pathological) : It refers to the change in the quantum of dosha due to unhealthy diet and unhealthy conduct. Example: Excessive eating of ice-cream leads to increase in the quantum of Kapha dosha in the body.

 

  • Prakopam : This refers to further increase of the in the quantum of dosha, which tends to come out of its Ashaya (Dwelling Place). It is divided into two categories:

 

  • Direct : It refers to the movement of the dosha to its prakop stage without attending its stage of Sanchaya.

 

  • Indirect : In this type the quantum of dosha increases in sanchaya stage, which leads to its prakopa stage. It is also classified into two types:

 

  • Prakruti (Natural)
  • Vikruti (Pathological)

 

This stage has two directions one leads to disease and the other reverts the process to health. If the causative factor continues then it goes to the next stage of Samprapti i.e. Prasara which leads to disease and if the causative factor is removed then it reverses the process to Health (Prashamana), hence at this level of Samprapti it is not necessary that it will develop disease.

 

  • Prasaram : This refers to the stage where quantum of dosha increases unto its zenith. Due to which dosha comes out of its ashay and start circulating through out the body.

 

  • Sthana Samshrayam : At this stage the circulating dosha get deposited at particular place of the body where there is Kha-vaygunyath or Shroto-Rodh (Obstruction in Circulation) and disease developed according to the involvement of Srotas.  Example: if Pranavaha Srotas (Respiratory System) is involved then the disease like Cough, Pneumonia, Asthma, etc could develop.

 

  • Vyakti : This refers to the stage of Dosha dushya Sammurchhana (Mixing of Dosha and Dushya at the place of Sthansansraya). The Signsa & Symptoms developed on the body according to the involvement of dosha (Vata, Pitta, and Kapha) and dushya (Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Shukra). Example: if Dosha dushya Sammurchhana takes place between Pitta (dosh) and Rakta (dushya) then the Signs & Symptoms developed over the body are small furuncles over the skin which have burning sensation. The Signs & Symptoms developed at this stage is called Purva roopa of the disease.

 

  • Bheda : At this stage the process of Dosha-dushya-Sammurchhana is completed and most of the Signs and Symptoms develop on the body by the help of which disease could be diagnosed. The Signs & Symptoms developed at this stage are called Roopa of the disease. 

    Types of Samprapti
  • Sankhya (Numerical) : It denotes the number of subtypes of disease. Example: Jwara (Fever) has eight subtypes i.e. Vataja, Pittaja, Kaphaja etc.

 

  • Vikalpa (Proportional) : During alteration of dosha is caused by its causative factor its property gets exaggerated. This exaggeration may be of its single property, more than one property or all the properties. The alteration of dose according to alteration of property in proportional way is called Vikalpa Samprapti. Example: Vata has - Laghu, Ruksha, Sheetha, Chala.

 

  • Pradhanya (Main) : This refers to the situation where more then one dosha is involved in the development of disease.

 

  • Bala Samprapti (Severity) : It refers to the situation where it is important to know which dosha is the main and which is the subsidiary.

 

  • Kala Samprapti (Time) : This refers to the determination of the altered dosha by the exaggeration of the property of particular dosha at particular period i.e. exaggeration of Kapha dosha in the morning diet Kaphaja Vyadhi (disease caused by Kapha).

 

 

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