Intimate And Distant Causes Of Disease: Sannikrushta, Viprakrushta Nidan

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Sannikrushta = intimate, very close
Nidana = etiological factors of a disease

Sannikrusta Nidana

Sannikrushta Nidanas are nearby causative factors for a dosha or disease. These factors cause immediate aggravation of doshas or exacerbation of a disease.
Read – Nidana: Meaning, Word Derivation, Definition

Example

1. Different doshas get aggravated naturally at different parts of day and night. This happens even in healthy people, in fact everyone.

Kapha naturally tends to aggravate in the morning time, from sunrise to onset of noon. Cold environment and less heat favors kapha increase. At noon when Sun is at its peak and heat prevails, kapha naturally subsides.

Pitta tends to aggravate in noon time and persists till an hour or so till sunset. Its surge is at mid noon or at point of maximum heat because heat favors increase of pitta. By evening pitta naturally subsides since cold once again prevails, which favors increase of vata.

Vata tends to aggravate naturally at onset of evening and continues until night.
Read – Normal Vitiation of Doshas As Per Seasonal Variation

Same pattern of dosha aggravation takes place at night. In early part of night, kapha is predominant, pitta is predominant in middle part of night i.e. midnight and vata gets predominant towards dawn. Once again kapha takes over at early hours of morning. This is cyclic. There is variability from person to person in terms of quantum of dosha aggravation because everyone is made up of different body types. Variability is also seen during different seasons. But time of aggravation of dosha in everyone during day and night is same.

Food timing and Dosha

2. Doshas naturally aggravate during different food timings.

Kapha naturally increases immediately after consumption of food, in stomach, at onset of digestion. Here kapha increases due to sweetness of food. Kapha naturally subsides when second stage of digestion starts in small intestine, where pitta and its sourness take over.
Read – Normal Dosha Vitiation In Relation To Digestion

Pitta naturally increases during digestion of food, in small intestine. Here, food acquires sourness which is pitta increasing taste. This pitta naturally subsides in next stage of digestion when digested food is pushed into large intestine.

Vata naturally increases during end stage of digestion wherein food acquires pungent taste, a vata increasing taste. Vata also increases due to dryness caused in the intestine due to absorption of water contents from digested food rendering digested part of food i.e. stools dry.

This vata again subsides after consumption of food and once again kapha increases. This runs as a cyclic process. Pattern is same during breakfast, lunch or dinner.
Read – Formation Of Doshas In Avastha Paka

Important points

Important points to be noted about Sannikrishta Nidana

In above mentioned examples there is temporary aggravation of doshas during different parts of day, night or food timings. This temporary aggravation is a natural increase. Since it is natural increase, it doesn’t cause diseases in healthy people. Since parts of day and night and different timings of food are closer for dosha aggravation i.e. natural increase of doshas, they are considered to be sannikrishta nidanas for increase of doshas. We also need to note that increased doshas naturally taper down in following part of day or night or food timing.
Read – Dosha Chaya, Kopa, Shamana – Accumulation, Aggravation, Auto-pacification

These parts of day, night and food timings may also trigger a disease and its symptoms. This may be temporary and may subside in next phase of day, night and food timing. Sometime disease and its symptoms become very aggressive and may need interventions. This may not necessarily happen at all times and in everyone. Here parts of day, night and food timings triggering a disease process temporarily are sannikrishta nidanas for disease.

These types of dosha increase are not accompanied with dosha accumulation. When dosha undergoes phase-wise increase as explained in shat kriya kala, doshas first accumulate before getting aggravated. In these ‘nearby etiological factors’ there is an aggravation without accumulation.

Here, formation of pathogenesis is not essential. Even if pathogenesis is formed, it will be a weak one. If immunity of person is less, pathogenesis may get stronger and trouble him with severe signs and symptoms.
Read – Samprapti Ghatakas – Components Of Manifestation Of Disease

Examples

Few examples for Sannikrishta Nidana –

Increase of body heat, burning sensation, sour belching and trigger of an inflammation on intake of hot, pungent and sour foods caused by immediate vitiation of pitta. These symptoms may settle down after some time or with slight medication and might never come back until pitta aggravating foods or activities are consumed next time. On contrary, if person is having an inflammatory disease of chronic nature, symptoms may persist for long time and may need strong interventions.
Read – Abnormal Vitiation Of Doshas – Vaikruta Dosha Dushti

Immediate aggravation of an episode of asthma early in morning or after having consumed cold drinks or after a walk in cold climate caused due to disturbance of kapha which may be a temporary aggravation or a prolonged disturbance as said above.

Viprakrusta Nidana

Viprakrishta Nidana – Distant Causes of diseases

Viprakrishta = distant.

Viprakrishta Nidanas are distant causative factors for a vitiation of dosha or manifestation of a disease. These etiological factors of a given disease do not produce a disease immediately. In fact they take lot of time to cause a disease.
Read – Relationship Of Doshas With Nidana Panchakas 

Examples

1. Kapha accumulated in Hemanta / Shishira season i.e. winter will cause kapha diseases in next season, Vasanta season i.e. spring season.

According to Ayurveda there are six seasons and each season runs for a period of 2 months. In this example we can see that kapha accumulated in winter doesn’t produce disease immediately. It accumulates over a period of 2 months. In spring season, kapha melts due to heat of Sun, just like an iceberg melts due to heat of sun.

Kapha which has melted would overflow from its seats and spreads all over body and cause kapha disorders. Thus, kapha takes 2 months to produce disease. Here, kapha vitiation which takes place in spring season, 2 months after accumulation of kapha is far-off etiological factor for kapha diseases.
Read – Relationship Of Doshas With Seasons

Similarly, pitta accumulated in monsoon season causes pitta disorders 2 months later in autumn season. Vata accumulated in summer causes vata disorders 2 months later in monsoon season.

In all these cases we can observe that dosha vitiation and disease occurs long time after dosha accumulation. Therefore, seasons in which dosha vitiation occurs, leading to manifestation of diseases are considered as far-off causative factors for diseases.
Read – Normal Vitiation of Doshas As Per Seasonal Variation

2. Rudra kopa i.e. anger of Lord Rudra is said to be far-off etiological factor for causation of fever.

Excessive consumption of incompatible foods is nearby causes for manifestation of fever. When appropriate causes for fever are not found out, it is said that anger of Lord Rudra has caused fever.
Read – Charaka Jwara Nidana: 1st Chapter

In olden days, when any type of fever became an etiological factor for suffering of large masses of population and when suitable remedies for such fevers were not available, it was believed that Lord Rudra was angered and caused fever. Probably this was language used to define incurable, long-standing and stubborn fevers and other kinds of tough epidemic diseases, especially when proper causative factors could not be found out.
Read – Charaka – Jwara Chikitsa 3rd Chapter

Distance of time period between causation of chronic fevers and anger of Lord Rudra could not be predicted in real terms but seeing chronic nature of fevers it would be inferred that fevers occurred long time after anger of Lord. Thus it is a far-off etiological factor in causation of fever.
Read – Jwarahara Gana Of Charaka – Fever Relieving Group Of Herbs

Important points

Important points to note about Viprakrishta Nidana

Viprakrishta Nidanas cause diseases not immediately, but after a long duration.

When season to follow becomes far-off etiological factor for doshas accumulated in previous season, it is not essential that vitiated dosha should cause a disease. People having good immunity will escape disease.
Read – Main Cause For Diseases As Per Ayurveda

Infective conditions, of modern times follow a long time of incubation period. Disease may be manifested in 10-15 days as it happens in bacterial infections or after long periods as it takes a HIV infection to shape up into full blown AIDS. All these causative factors into category of viprakrishta nidanas.

Infections or organisms which cause disease after a long period after a person gets exposed to them are called far-off etiological factors of that disease. This happens because organisms take time to initiate damage in body, spread through body beating weak defences of body and cause disease. This varies from diseases to disease, organisms involved and immunity of person.
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