Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Nidana Panchakas are the tools of examination of a disease. Various aspects of the disease manifestation, causes, sequence of formation of the disease, its premonitory symptoms, symptoms etc can be known and analysed with the help of Nidana Panchakas. This further helps in knowing the details of the disease which in turn forms the foundation for planning a comprehensive treatment protocol.
Table of Contents
Nidana – Causative factors (etiological factors) of the disease
Poorvaroopa or Prakroopa – Premonitory symptoms of the disease
Roopa – Symptoms of the disease
Upashaya-Anupashaya – Pacifying and aggravating factors of a disease which helps in knowing the disease through application of trial and error method
Samprapti – Sequence or process of formation of a disease process, pathogenesis of a disease
Related Reading: Roga Rogi Pareeksha, Types
Meaning (derivation of the word) of Nidana
निदानं तु आदि कारणम्।(अमरकोष, १/४/२८)
आदिः मुख्यं कारणम् निदानं कारणे…(हेम ३/४१५)
निदानं तु आदि कारणम् इति आदि कारणम् आरम्भकं यथा बीजम् अंकुरस्य…निपूर्वधातो रूपं निदानम्।(गङ्गाधरः)
यत्तु न स्याद् विना येन तस्य तद् हेतुः उच्यते।(बृहत् योग तरङ्गिणी)
निदानं कारणम् इह उच्यते, तत् च इह व्याधि जनकं व्याधि बोधकं च सामान्येन उच्यते।(चक्रपाणि, च.नि.१/१)
Nidana is the fundamental cause – Adi Karana.
This term is used to describe the causative factors of a disease.
Chakrapani tells that Nidana is the beginning point for any disease.
He gives the following example in substantiation – ‘Beeja (seed) is the Nidana (cause) for ankura (sprout)’.No disease happens without Nidana.
- Mithya Ahara and Vihara (incompatible diet and lifestyle practices) cause nija rogas (many systemic diseases).
- Consumption of spicy foods (in excess) causes pitta vitiation and shoola (peptic ulcers).
- Excess smoking causes difficulty in breathing, bronchitis. Excess Consumption of alcohol causes liver disorders.
- Excessive consumption of Rooksha ahara (dry foods) causes Vata vitiation.
- Shoka (grief) and Krodha (anger) in excess cause mental disorders.
- Abhighata (injury) causes Vrana (wounds).
In these examples, mithya ahara and vihara, spicy foods, smoking, dry foods, grief, anger, injury are Nidanas.
Chakrapani tells that Nidana is a Karana (cause). It is used in 2 contexts i.e.
– Vyadhi Janaka – Nidana is a term used to explain the causes of a disease (Vyadhi=disease, Janaka=causing)
– Vyadhi Bodhaka – Nidana is a term which by itself indicates a disease, i.e. is Nidana helps in identifying or diagnosing a disease (Vyadhi=disease, Bodhaka=indicating, suggesting)
Synonyms of Nidaana
निदान पर्यायाः तु हेतुः निमित्तं आयतनं कारकः कर्ता कारणं प्रत्ययः समुत्थानं मूलं योनिः इति।(अ.सं.नि.१/१२)
निदानं कारणं हेतुः निमित्तं च निबन्धनम्।
मूलं आयतनं बीजं प्रत्ययः च अस्य वाचकाः।(बृहत् योग तरङ्गिणी)
The below mentioned terms are used to define Nidana and hence are its synonyms. These terms can be used interchangeably. Synonyms of Nidana are –
Hetu, Nimitta, Aayatana, Kaaraka, Kartaa, Kaarana,
Pratyaya, Samutthana, Moola, Yoni, Nibandhanam Beeja
a) Definitions which explain Nidana in the meaning of ‘causes of disease’
व्याधि जन्म हेतुः निदानम्। (मधुकोश)
व्याधि उत्पत्ति हेतुः निदानम्।(मधुकोश)
सेति कर्तव्यताको रोग उत्पादक हेतुः निदानम्।(मधुकोश, माधव निदान)
यद् द्रव्य गुण कर्म रूपं दोष प्रकोप द्वारेण व्याधि उत्पत्तेः निमित्तं भवति तद् इह निदानम् इति परिभाष्यते।(योगेद्रनाथ सेन)
येन आहार विहारेण रोगाणाम् उद्भवो भवेत्।
क्षयो वृद्धिः च दोषाणां निदानं हि तद् उच्यते।(वङ्गसेन)
बाह्य निमित्तं रोगाणां निदानं इति कीर्तितम्।
विधाय धातु वैषम्यं साक्षाद् वा रोगकारि तत्॥(मधुकोश, माधव निदानम्.१)
Nidana is defined in the following ways –
Nidana is a Vyadhi Janma Hetu or Vyadhi Utpatti Hetu – which is responsible for the origin or manifestation of a disease.
Nidanas are those causes which vitiate the doshas and in turn lead to causation of disease – Anything in the form of
Dravya (material, substances),
Guna (qualities) or
Karma (functions) which imbalance the doshas and lead to manifestation of disease are called Nidanas.
Nidanas are those foods and activites which cause diseases – Acharya Vangasena tells that Nidanas are:
– Roga Kaaraka Aaahara Vihaaras – Disease causing foods and lifestyle activities (practices)
– Kshayo Vriddhihi cha Doshaanaam – Qualitative and quantitative depletion or increase of doshas (pathological increase or decrease of doshas cause diseases)
Iti Kartavya – The series of events are called as ‘iti kartavya’. The below mentioned chain of events occur after the body comes into contact with Nidana or Nidanas.
- After intake of or exposure to nidanas, they create an initial disturbance in the body because they don’t belong to our system.
- This disturbs the doshas (singly or in combination).
- The vitiated doshas circulate all over the body through the channels (srotas).
- When they find a susceptible or weak tissue they get lodged therein (dosha dushya sammurchana).
- After getting lodged in the weak tissues, they damage the tissues, disturb cellular functions and cause accumulation of ama or amavisha or mala (tissue toxins or waste substances).
- This further leads to blockages at various junctures of the body.
- This leads to one or the more of atipravrutti (excessive discharge), sanga (obstruction), sira granthi (formation of extra tissues, cysts, tumors etc) and or vimargagamana (movement of doshas in untoward directions).
- The defense mechanism of the body gets altered and body gets weak.
- Over a period of time disease or diseases or syndrome is manifested with their characteristic signs and symptoms.
Nidanas are the external factors (bahya nimitta) causing diseases. External factors like incompatible foods, pollutants, allergens, dust, smoke, insects, microorganisms, bacteria, virus etc.
b) Definitions which explain Nidana in the meaning of ‘diagnosis of disease’
हेतु लक्षण निर्देशात् निदानानि।(सुश्रुत)
निर्दिश्यते व्याधिः अनेन इति निदानम्।(मधुकोश)
निश्चित्य दीयते प्रतिपाध्यते व्याधिः अनेन इति निदानम्।(मधुकोश)
व्याधि निश्चय करणं निदानम्।(मधुकोश)
According to Sushruta –
That which depicts hetu (causes of disease) and lakshana (symptoms of the disease) is called Nidana.
According to Madhukosha –
i) That which points towards or helps to know about or diagnose a disease is called Nidana
ii) That which helps in confirmatory diagnosis of a disease (without any doubt) is called Nidana
iii) That which helps in diagnosing a disease (tools of diagnosis of a disease) is called Nidana
In short – The tools of diagnosis of a disease are called Nidanas
Importance in clinical practice
Knowledge of Nidana, its importance in clinical practice
Knowledge of Nidana helps in identifying the causes of any disease –
If the Nidanas are not identified we cannot isolate them. If the causative factors are in contact with the body for a longer time, the disease caused by them keeps worsening with time.
Knowledge of Nidana helps in planning dosha pratyaneeka chikitsa (treatment antagonistic to vitiated dosha) –
All Nidanas do not vitiate all doshas. Particular doshas vitiate particular doshas. By seeing the signs and symptoms of dosha vitiation we can guess and track down the nidanas which might have disturbed that dosha and isolate them. Similarly we can provide treatment and medicines which are antagonistic for that particular dosha.
Example, in Kaphaja Kasa or cough with phlegm the physician makes a guess that the patient might have taken cold foods or exposed to cold conditions. The physician can guide the patient to keep away those causative factors. Simultaneously he can provide the treatment and medicines which mitigate kapha.
Knowledge of Nidana helps in speculation of outcomes – Knowledge of Nidana directs the physician
1. to speculate dosha that is going to get vitiated,
2. the nature of the disease that is going to be produced.
3. or the disease that has already been produced and
4. upadravas (complications of the disease) that may impend in future. By tracing the nature of unwholesome foods and regimen, the outcome can be predicted.
Example by seeing the person taking excess of pungent, hot, sour and salty foods the physician can speculate that pitta is going to get vitiated which may lead to gastritis, peptic ulcers, skin diseases, burning urination and defecation, inflammation of joints, muscles and other soft tissues, bowel inflammation etc.
Nidana gives a hint towards the chronicity of the disorder.
Example, if the patient having liver cirrhosis has a history of consumption of alcohol for long time, we can speculate that the disease is a chronic one and has got stubborn (depending on the periodicity of drinking alcohol).
On seeing a patient of chronic cough smoking regularly, one can speculate that the patient is surely bound to develop complications in the form of chronic bronchitis or tuberculosis in future.
Knowledge of Nidana helps in making diagnosis – In case of doubt regarding the diagnosis of any disease, analysis of Nidana or etiological factors will help to clarify the position of the disease.
Example, in case of Vata, it will be vitiated by one or more of the sheeta guna (cold quality), ruksha guna (dry quality), kashaya rasa (astringent taste), katu rasa (pungent taste), ati vyayama (excessive exercise), avarana (obstruction of activities of vata by other elements of the body) etc. The knowledge of each of these causative factors which vitiate Vata will help the physician to achieve good prognosis, make accurate diagnosis of the disease, correlate the causes with the effect (disease and its symptoms), help the patient to keep away the causative factors and plan an effective treatment protocol.
Knowledge of Nidana will help in planning accurate treatment in accordance to the causative factor – In each case, the treatment will differ and will depend on the cause.
Example, if Vata is vitiated by Sheeta Guna, the treatment and medicines should be antagonistic to sheeta i.e. ushna upashaya and chikitsa (comforts and treatments predominant in hot potency) should be preferred.
Similarly if Vata prakopa is caused due to excessive consumption of ruksha guna, its antagonistic approach i.e. snigdha upashaya and chikitsa (unctuous or oily measures and medicines) should be given.
When Vata is vitiated due to excessive consumption of Kashaya, Katu and Tikta rasa, Vata mitigating tastes should be administered i.e. Madhura (sweet), Amla (sour) and Lavana (salt).
Knowledge of Nidana helps in avoiding or isolating the causative factors causing the disease – ‘Sankshepataha Kriya Yogo Nidana Parivarjanam’.
The best and simplest form of the treatment is avoidance or isolation of causative factors. The knowledge of Nidanas or causative factors helps a physician to counsel the patient to keep away the factors, foods and activities which are incompatible to them. It will not only help in framing a good treatment protocol, it will also help in planning a good diet and lifestyle protocol wherein many diseases can be avoided while following the wholesome and good parts of life.
Knowledge of Nidanas will help in preventing and curing diseases (and complications) – When Nidanas are identified beforehand they can be kept away. This can be done depending on identification of known incompatible foods and life style practices, allergens etc which cause health disturbances in the said person on regular basis. By keeping the Nidanas away we would have prevented the impending doshic disturbances or aborted the diseases before they are manifested. Similarly, in a diseased person when the Nidanas are identified, they can be advised to keep away the causative factors. This would help in quick recovery from the disease / diseases and also in avoiding the complications.
Knowledge of Nidanas forms the basis of planning an effective treatment plan-up –
Identification of Nidanas helps in proper diagnosis and knowing the exact measure of morbidity (of doshas), the nature of insult occurring in the body and the status of the disease. This will not only help in isolating the causative factors (which is more than half the treatment) but also to plan anti-dosha and anti-vyadhi treatment protocols and selection of exact disease modifying medicines and diet.
Just Before Finishing –
‘Prevention is better than cure’ and to prevent diseases it is good to keep away the causative or etiological factors of the disease. For this one should have a comprehensive knowledge of Nidanas.
Click to Consult Dr Raghuram Y.S. MD (Ayu)