Ayurveda has two basic functions, maintain health of the healthy and cure the disease of the unhealthy.
स्वस्थस्य स्वास्थ्य रक्षणम् आतुरस्य विकारप्रशमनम् च|(च. सू.३०/२६)
To cure the disease, first step is to diagnose the disease perfectly.
रोगमादौ परीक्षेत ….|
तत: कर्म भिषकपश्चात ज्ञानपूर्वंसमाचरेत| (च. सू.२०/२४)
Nidan Panchaka is method of examination of the disease (रोग परीक्षा) to gain knowledge of every aspect of the disease.
The word nidan panchaka comprises two words nidan and panchaka. Word nidan here denotes the diagnostic examination and Panchaka denotes the number five.
So, to define Nidan panchaka,
Five methods which are used to gain complete and detailed knowledge of the disease and confirm the diagnosis are called as nidan panchaka.
निदानं पूर्वरूपाणि रुपाणि उपशयस्तथा |
संप्राप्ती श्चेति विज्ञानं रोगानाम पंचधा स्मृतम ||. (मा. नि.१/४)
These five methods are
1. Nidan/ hetu(aetiology)
2. Purvarup(prodromal features)
4. Upashaya-anupashay (therapeutic testing)
1. NIDAN :–
सेतिकर्तव्यताक: रोगोत्पादक हेतु: निदानं| ( मा. नि. १/५ मधुकोष टीका)
The factor which has the ability to perform functions (इतिकर्तव्यता) which will undoubtedly give rise to disease through dosh-dushya samurchana, samprapti,etc. is called nidan.
For example – wrongful lifestyle practices have the ability to vitiate doshas which then through various pathologies give rise to diseases.
Synonyms of Nidan :-
निदानमाहु: पर्यायाई:…|| (मा. नि. १/५)
- Nimitta :- Initiator of the diseases
- Hetu :- Cause of the diseases
- Aayatan :- Dwelling of the diseases
- Pratyay :- One which is needed to form the disease( like pratyay needed to form the words in Sanskrit grammar)
- Utthan :- To give rise to disease
- Karan :- Cause of the diseases
Importance of Nidan :-
संक्षेपत: क्रियायोगो निदान परिवर्जनम|(सुश्रुत संहिता)
Aacharya Sushruta states that a disease can be cured by simply removing the cause of the disease. If Vaidya can identify the nidan of disease he can surely treat it by removal of the same.
Vice averse, if the cause could not be identified even if the treatment is done the disease will not be cured completely and will re occur.
Hence, it is very important to find out the aetiology when examining a disease.
Types of Nidan :-
Nidan is differentiated in various types depending on different perspectives. Detailed description of these types is found in Madhukosha commentary of Madhavanidan.
Purvarup/ prodromal symptoms
स्थान संश्रयिण: क्रुद्धा भावी व्याधि प्रबोधाकम|
दोषाः कुर्वन्ति यल्लिंगं पूर्वरूपम तदुच्यते||. (मधुकोष टीका)
Aacharya Vijay rakshit in his commentary on madhavnidan quotes above shloka from another treatise available in his era. It says that in the pathological process when vitiated doshas find foundation at particular space/dushya in body(sthansanshraya) and amalgamation process is started, few symptoms are experienced by the patient and these are purvarupa. These purvarupas give us an intimation of the upcoming disease in advance.
लिंगमव्यक्तमल्पत्वाद व्याधीनाम तद्यथा यथम||(अ.हृ. नि.१/३)
पूर्वरूपम प्रागुत्पत्तिलक्षणं व्याधे: | (चरकसंहिता निदान १/७)
Aacharya Charaka defines purvarupa as Signs and symptoms that are seen before the actual symptoms of a diseases are called as purvarupa.
Types of purvarupa :-
Importance of purvarup :-
- Purvarupas appear at the stage of amalgamation of doshas and dushyas. This gives vaidyas an opportunity to intervene the process even before the disease develops.
- Even after disease is developed if Vaidya examines the history to point out vishesh purvarupas , they help confirm the diagnosis and the dominant dosha. For example, haridra/ rakt (red coloured) urine without prameha purvarupas confirms the diagnosis of raktapitta.
- Purvarupas are also important in determining curability of the disease. For example, when all the textual purvarupas are present in jvara it is considered as incurable.
Rupa (symptomatology) :-
उत्पन्न व्याधीबोधकमेव लिंगम रूपं| (मधुकोष)
Signs and symptoms of a fully developed disease are called as rupa. after the samprapti (pathogenesis) is completed disease specific signs and symptoms can be observed which can confirm the diagnosis of that specific disease.
Synonyms of rupa
संस्थानं व्यंजनं लिंगं लक्षणं चिन्हमाकृति| (माधवनिदान १/७)
Types of Rupa :-
Symptoms of disease depend on the involved doshas, dushyas, sthan etc. aacharya charaka (vimanasthana)explains how the pathogenesis leads to appearance of symptoms. He has explained two possibilities.
1. prakruti sama samvet rupa :-
symptoms correspond to the qualities of involved doshas.
2. vikruti visham samvet rupa :-
symptoms do not correspond to the qualities of involved doshas
Importance of rupa :-
1. signs are confirmatory of the specific disease.
2. It is used as diagnostic tool to determine dominant doshas, dushyas.
3. appearance of all or few of the textual signs and symptoms guides Vaidya to curability of the disease.
4. Increase or decrease in intensity of signs and symptoms provides criteria to determine the right line of treatment.
Upashaya- Anupashaya (therapeutic testing) :-
विद्यात उपशयम व्याधे: सही सात्म्यं इति स्मृत: ||
विपरीतो नुपशयो व्याध्य सात्म्य इति स्मृत: | (अ.हृ. नि.१)
Upashay :– when a therapeutic test results in lowering the symptom it is called upashaya. For example, if hot fomentation is joint pain relieves pain it is upashay.
Anupashay :– when a therapeutic test results in increasing symptoms it is called as anupashay. For example, if oil massage(snehana) in joiunt pain increases pain it is anupashaya.
Types of upashay :-
Aacharya Charak has stated 6 types of upashay –
1. Hetu viparit – therapy with opposite qualities that of hetu
2. Vyadhi viparit – therapy with opposite qualities that of vyadhi/disease
3. Hetu-vyadhi viparit – therapy with qualities opposite of both hetu and vyadhi
4. Hetu viparitarthkari – therapy with similar qualities that of hetu
5. Vyadhi viparitarthkari – therapy with similar qualities that of vyadhi/disease
6. Hetu-vyadhi viparitarthkari – therapy with qualities similar to both hetu and vyadhi.
Aacharya chakrapani has again sundivided these types into 3 types each –
- Aushadh (medicine),
- aahar(diet) and
- vihar (lifestyle).
Taking into consideration these 3 subtypes to each type described by aacharya charak ,we have 18 types of upashay.
Importance of upshay-anupashaya :–
1. Therapeutic testing plays a very important role in determining doshas in doubtful cases where signs and symptoms don’t prove enough to confirm diagnosis.
2. Upashaya and anupashaya help in formulating pathya-pathya regime in treatment.
3. Therapeutic tests are often use to differentiate between to diseases with similar symptoms. For example, sandhigat vat and aamavat, vatvyadhi and urustambh.
Samprapti – (pathogenesis) :-
यथा दुष्टेन दोषेन यथा चानूविसर्पता|
निवृत्ति: आमयास्यासौ संप्राप्ती: जातिरागती||(अ.हृ. नि. १/)
व्याधीजनक दोष व्यापार विशेषयुक्तम व्याधिजन्मेह’संप्राप्ती
- Pathological process which explains development of disease from specific cause followed by dosha vitiation, dushya disruption and dosha-dushya amalgamation is called as samprapti.
- The series of manifestations in body after the cause which lead up to the appearance of signs and symptoms of disease is called samprapti.
- Jati and Aagati are used as synonyms of samprapti.
Acharya Sushruta describes 6 stages of samprapti –
1. sanchay (accumulation)
4. sthansanshray(amalgamation of doshas and dushyas)
5. vyakti (appearance of signs and symptoms)
6. bhed(manifestation of disease into chronic or complicated case)
Types of samprapti –
Samprapti does not have types. what is described as types are actually different aspects of samprapti(pathogenesis). they are as follows
- Sankhya – sankhya means number. It generally refers to types of same disease due to involvement of different doshas, dhatus, sthana etc for example, 8 types of jvara based on single dosha, dual doshas, tridoshaj and agntuj.
2. Pradhanya – word Pradhan indicates dominant. This explains dominance of doshas in a disease.
3. Vidhi – vidhi samprapti is similar to sankhya samprapti. When a samprapti is explained by diving it in different types based on different basis it is called as vidhi samprapti. For example, jvara has two types based on hetu – nija jvara and agantuj jvara. Raktpitta is of 2 types -urdhvag, adhoga
4. Vikalpa – explanation of fractions of involved doshas on the basis of their gunas. For example, night sleep deprivation increases vata by increasing dryness so vata dosha is increased but only with quality of dryness not other qualities of vata like Chanchal (hyper movments) or sheeta (cold).
5. Bal – vyadhi bala or strength of the disease depends on strength of the hetu, dosha and immunity of the patient(dhatu). It determines the curability and treatment.
6. Kal(काल) – kal means time. Pathogenesis in which time plays an important role in appearance of symptoms. For example, diseases due to kapha vitiation are most probably appear in vasant ritu or first pert of day or first part of the night.
Importance of samprapti :-
1. Ayurveda summarizes treatment or chikitsa as sampraptibhang. It means that interruption of pathological process, breaking amalgamation of dosh-dushya is treatment. Understanding samprapti is crucial to finalise the line of treatment.
2. Samprapti also indicates curability of disease through vidhi samprapti and bala samprapti.
3. Confirmation of diagnosis can be done with samprapti.
So, to conclude, Nidan panchak leads Vaidya to detailed information on all the aspects of disease and an unbiased diagnosis.
Written by :-
Vaidya Prajakta Apte
Author – Apta Ayurveda.