Aacharya Madhav explain the Nidan Panchak in his book ‘Madhav-nidan’. Nidan panchak is nothing but the way of diagnosis of disease by the consideration of their etiology,pathology,symptoms and prognosis. With the help of nidan panchak ,the vaidyas reach to correct diagnosis of disease ,hence vaidyas can done treatment of disease more easily.
The slow phasing movement of a normal physiology to a disease causing pathology is dealt in Nidan Panchak.
Diagnosis of a disease, knowledge of its origin, and tracing evolution can be done through Nidan in Ayurveda.
The five tools to identify diseases and the pathology are Hetu (Nidan), Poorvaroop, Roop, Upshaya, and Samprapti.
Hetu-Means the factor which is responsible for disease formation in body.It is of 2 types.
Nija means internal hetus and Agantuja means external hetus.
Equilibrium state of tridoshas (vata,pitta,kapha) is responsible for healthy life while any imbance in tridoshas leads to disease.The balance of the three doshas can be disturbed by many causative factors which are called as Hetu.
It is very important tool in nidan panchak.If we know the causative factors for particular disease then we can avoid the many disease and control the growth of disease.
In nidan panchak,hetu word is also known as nidan.Nidan means one which leads to vitiation of vatadi doshas due to intake of ahita ahar and vihar.
There are many types of hetus described in ancient literatures.they are-
A) Sannikrista-cause which is near for prakop of doshas.
Aggrevation of dosh according to day,night timingor age wise
B) Viprakrishta-Distant cause factor for production of disease.
Ex-shanchit kapha in hemant ritu get vitiated during vasanta ritu.
C) vyabhichari hetu-The causative factor which is weak in nature and does not cause the disease but it is carrier for that disease
D) Pradhanik-The powerful causative factor which produces disease instantly.
Other classification is
Asatmendriyarth Sanyoga– means atiyoga ,ayoga and mithyayoga of indriyas are called as Asatmendriyarth sanyoga.
Ex-watching excess TV
Pragnyaparadha-Doing all asubh karm due to vibhrama dhi.drati and smruti is called Pragnyaparadha.
Ex-subpression of natural urges like gases,urine ,stools etc
Parinaam or Kala-Atiyoga,ayoga and mithyayoga of kaal is cause for disease Ex-Extreame rainfall in rainy season.
Poorvarupa means predormal or preliminary signs of disease-
The signs and symptoms that are developed during the development of disease pathology.
The symptoms which appears before the onset of an disease.This are the warning signs that disease may manifest to you soon.Each and every disease has their specific predormal signs.o avoid the confusion related to disease diagnosis,poorvarupa is to be considered.
Ex- body pain is predormal sign of Fever
Poorvarupa is of two types-
Samanya Poorvaroopa-These are those which indicates the disease to some extent without giving any indications of dosha imbalance.Samanya poorvaroopa vanishes after appereance of disease.
Vishitha Poorvaroopa-These are those which give an idea of doshas also in addition to give some idea about disease.Vishista poorvaroopa has the probability of carring after disease commences.
Ex-excessive yawning indicates vata type of fevere..
If all mentioned poorvaroops in text appears in large extent in disease then this disease is said to be fatal in nature.And it is said to be that if all pporvarupas appeas and persist during the course of disease in large extent then such patient is likely to die.
The signs and symptoms that appear only after the disease development help in diagnosing the disease, There are various synonyms of Roopa.These are
Samsthana-means ,the symptoms through which a disease is surely known
Vyanjana-those signs ,which futher manifest in to disease.
Linga-the characteristics by which the disease is surely known
Lakshana-detones the symptoms od disease
Aakriti-a shape of substance
Chihna-a mak by which disease can be identify.
The signs and symptoms helps in diagnosis of disease.and vaidya starts the treatment and medicines accordindg to manifestation of doshas.
Samanya Roopa-ZThe general signs and symptoms of a disease is called as samanya roopa.
Exabsence of sweating,body pain ,rise in body temperature is features of Jwara Vishesh roopa-The specific signs and symptoms of different types of the disease is known as vishesh roopa.
Ex-Intensed pain in abdomen with obstraction in faeces and flatulence is typical feature of Vataj Gulma.
The technique through which investigation and eliminatination of the disease occur with the help of diet, herbal remidies or physical conducts .
When vaidya has doubt about the diagnosis even after thorough examination,then vaidy started symptomatic treatment. Sometimes subpression in disease or aggrevation in disease also helps in clear diagnosis of disease.
Ex-If there is knee pain and whether this knee pain is due to amavata or sandhivata is not confirm then sthanik tail prayoga as a upashaya will result in clarity of diagnosis.
The ahar,vihar and aushadh which relieves the lakshana of disease are considered as upashaya and the ahar,vihar and aushadh which worsen the disease is considered as anupashaya.
|Upas haya bheda||Aushadha||Aahaara||Vihaara|
|Hetuvipareeta||Sunthi siddha sheeta jvara||Maamsarasa in Vaataj jwar||To advise jaagrana to a patient who is suffering from kapha vriddhi due to diwaswap|
|Vyaadhivipareeta||Use of kutaj in Atisaara||Use of Masoora Kris haraa in Atisaara||Virechana in udavarta|
|Hetu-Vyaadhivipareeta||Use of Das hammoola Kvaatha in Vaataja shotha||Use
Of Takra in Kahaja Grahani
|To advise jaagrana to a patient who is suffering from tandra due to diwaswap & snigdha ahar|
|Hetuvipareetaarthakaaree||Upnaaha of pittakar ushna dravya in pittaj vrana shotha||Pittakara Aahaarain Pittaja Vran as hotha||Trasana chikitsa in vataj unmad|
|Vyaadhivipareetaarthakaaree||Use of Madanaphala in Chhardi||Use of Milk as purhative in Atisaara||Stimulating the root of tongue to creat vomiting sensation in chhardi|
|Hetu- Vyaadhivipareethakaaree||Use of Agaroo in burns||Use of paishtiks madya in madatyaya due to gaudika madya||To advise swimming to patient suffering from urusthambha due to ativyayam|
Samyak means “proper” and prapti is “to get.” The way through which we get proper knowledge abouth the disease manifestation.
It provide the detail knowledge abouth the disease progression,cause of disease,doshas and dusya involved in disease and site of accumulation of doshas in diseaseBody changes that occur from the exposure to causative factor to the manifestation of disease ,all comes under this catagery.In short it provide complete view of disease.It heps in judgement of sequence of disease and its pathogenesis.The accumulation,movement and exacerbation of doshas and the process in which the disease takes place are described in samprapti.
It is also known as Jaati or aagati.It also gives the idea about the stages of disease.Samprapti includes the main cause,precipitating factors,age.sex,time, pathology,diet and lifestyle within itself.
Sampraapti is subdivided into six categories-
Sankhaya or number-It includes the variety or prakar of diseases in numbers.
For an example, jwar (fever) can be eight types viz. vata, pitta, kapha, vatapitta, pittakapha, vatakapha, vatapittakapha and agantuj (external); kaas (cough)is of five types etc.
Pradhanya or dominant-It shows the predominance of a particular dosha or it confirms the causes of the disease is swatantra(primary or independent) or partantra (secondary or complication of primary disease).
Vidhi or Order- the disease cause is classified into two categories-nija (idiopathic or individual) or agantuja(traumatic). Or it can be classified into three categories i.e. saadhya (easily curable), aasadhya( incurable), krichsaadhya(difficult to cure) and yaapya(incurable disease but with judicious diet and conduct life can be prolonged).
Vikalpa-It is the measure in which the dosha is aggravated in the ‘doshic triad'(vata, pitta and kapha) or the measures in which the dosha or gunnas that excites the doshas that already exists.
Kala or Time- The time which makes the disease severe, moderate or mild . It depends on seasons, day and night, hour of eating etc.
Bala or Strength-Bala is the strength of the disease that is determined by the severity of the attack, presence or absence of all the symptoms etc.
Stages of Samprapti-
Sanchaya or the accumulation phase-This is the accumulation of the aggravated or attenuated vata, pitta or kapha in their respective places instead of circulating in the body freely.
Prakopa or the excited phase-In this phase the altered dosha is excited and gets swollen.
Prasara or spread- In this phase dosha spreads to various places of the body. Sthanasanshraya or specific locations- The abnormal doshas are accumulated in other sites causing the diseases in the part affected and constitute the fourth kriya kaal. In this phase the clinical manifestation of the disease takes place and in this phase it presents itself as Purva roopam (prodromal symptoms).
Vyakti or manifestation- This is the phase when all clinical features are completely manifested 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 takes place and might get chronic, or may be subsiding wholly or in extreme cases cause death. The result depends on the gravity of the condition and the treatment adopted.