A A M J Anveshana Ayurveda Medical Journal

Transcription

1 A A M J Anveshana Ayurveda Medical Journal ISSN: Review Article Concept of Nidāna and its Clinical Importance Shailaja 1 R. Shylaja Kumari 2 A b s t r a c t The aim of Ayurveda is swasthasya swāsthya rakṣaṇam, āturasya vikāra praśamanam. It gives first preference to maintenance of health. Nidāna is one of the rōgaparīkṣa mentioned by our acharyas. It is the first step to diagnose the disease as kārya(rōga) will not occur without kāraṇa(nidāna). Here, an effort made to understand the concept of Nidāna as etiological factor of diseases as it is said nidāna parivarjanameva chikitsa, there by fulfilling the main motto of Ayurveda i.e prevention and cure of the diseases. Key words: nidāna, hētu, nidāna panchaka, prevention, cure 1 PG Scholar, 2 Professor & Head, Department of PG studies in Rōga nidāna, Government Ayurvedic Medical College, Bengaluru. CORRESPONDING AUTHOR Dr. Shailaja PG Scholar, Department of PG studies in Rōga nidāna, Government Ayurvedic Medical College, Bengaluru, Karnataka, (India). drshailveer@gmail.com sue2/aamj_1230_1234.pdf AAMJ / Vol. 3 / Issue 2 / March April 2017

2 INTRODUCTION Hētu (aetiology), Liṇga (sign and symptoms), Auṣadha (drug and therapy) are the three sūtra of Ᾱyurveda. Without the knowledge of Hētu (cause of a disease) and Liṇga (sign and symptoms), the implication of Auṣadha (drug and therapy) is not possible. Treatment of diseases will be effective only with good knowledge of Nidāna. The term Nidāna stands for both Vyādhijanak (cause of disease) and Vyādhibodhak (knowledge of disease) [i]. Vyādhijanak nidāna, called as Hētu and Vyādhibodhak nidāna comprises of Nidāna, Pūrvarūpa, rūpa, Upaśaya and Samprāpti. A particular factor can be called as nidāna only when it will develop a complete disease process in the body either immediately or after a certain period, because Nidāna produces disorder through aggravation of doṣas. Doṣas aggravated by respective etiology give rise to disorder. [i] Synonyms - Nidāna (Etiology) has many synonyms like nimitta, hētu, kāraṇa, yoni, āyatana, pratyaya, utthāna, karta and mūla. Nidāna considers the disease causing factors like; diet, lifestyle, environment factors and injuries as source of any disease, which leads to imbalance of doṣas. Nirukti: Nidāna is napumsaka shabdha. It mean ni nischitya diyate anena iti. Dictionary meaning is first or primary cause Pāribhāṣa: 1. Factor that which manifests disease is known as nidāna. 2. Nidāna means one which aggrevates vātadi doṣas due to intake of ahita āhāra and vihara. 3. Nidāna is one which describes causative factors of the diseases 4. A factor which is capable of manifesting the development of the disease either quickly or after a certain period is called as hētu. Hētu Bheda: 4 types of Hētu: 1. Sannikrista: Cause which is near for the Prakopa of the doṣas. For example: Diurnal variation of doṣas take place routinely i.e. during night, day and during digestion. For this, sanchaya of doṣa is not essential. Aggravation of doṣa as per age, day, night, during digestion is common and it is a physiological process. For example: Rukshadi Bhojana and Vihara manifest Jwara. 2. Viprakrista: It is the distant cause for the production of disease. Sanchaya of doṣa is very much essential. It is also accepted that Jwara manifest due to wrath of the God Rudra. 3. Vyabhichari: The cause which is weak and unable to produce the disease but it acts as a carrier when favourable situation arises for the manifestation of diseases. When the Nidāna, Doṣas, Dūṣyās are unfavourable moderately or strongly with each other then it will not result in disease, if manifested disease will be simple, with alpa lakṣaṇa, alpa bala yukta 4. Pradhanika: It is the powerful cause, which produces diseases instantaneously like poison. Three types of āyatana: 1. Asātmēndriyārtha saṁyōga: Atiyōga, Ayōga and Mityāyōga of Indriya with Viṣaya are called as Asātmēndriyārtha saṁyōga. Indriya Ayōga Atiyōga Mithyāyōga Chakṣurindriya Śravaṇēndriya Ġhrāṇēndriya Rasanēndriya Sparṣanēndriya Not at all seeing any objects Not at all hearing Not at all smelling Not at all consuming food Not at all touching Excessive gazing at luminous objects Hearing up loud noise from thunder bolt, drums etc. Excessive exposure to exceedingly sharp, intense and intoxicating odours etc. Excessive consumption of food Excessive exposure to hot and cold things Seeing objects which are too near or far Hearing harsh words, news about death of close relative, insulting etc. Excessive abnormal exposure to smell of the exceedingly putrid, unpleasant, impure, poisonous gas etc. Not following the Aṣṭha vidha āhāra viśēṣāyatana Touching unhygienic things etc. AAMJ / Vol. 3 / Issue 2 / March April

3 Each sense organ is subdivided into three varieties based on their Atiyōga, Ayōga and mithyayōga of Indriya with Viṣaya is called Asātmēndriyārtha saṁyōga. On the contrary, wholesome conjunction with sense organs is called as sātmya. 2. Prajnāparādha: Indulging in Aśubha karma due to vibhraṁśa of Dhi, Dhruti and Smruti is called as Prajnāparādha. Prajnāparādha means Mithyayōga of Shareera, Vāk and Mana. 3. Pariṇāma: Kāla is known as Pariṇāma i.e. transforming or consequence. Kāla is the unit of time comprises of Hemant Ṟitu, Grīṣma Ṟitu, and Varṣa Ṟitu characterized by Śīta, Uṣṇa and Varṣadharana respectively. Atiyōga, Ayōga and Mithyayōga of Kāla is cause for the disease. 1. Doṣa hētu: Normal accumulation, aggravation and pacification of doṣas takes place in respective seasons is called Doṣa hētu. 2. Vyādhi hētu: Vyādhi hētus are those, which are responsible for the development of specific disease by specific aetiology. Eg. Regular consumption of mud/sand will manifest mṟudbhakṣaṇajanya pāṇḍurōga, Excess intake of kalāya manifests kalāya khanja. 3. Ubhaya Hētu: specific factors, which aggravates vāta and rakta and simultaneously manifest vātarakta vyādhi. Here causative factors aggravates doṣa and simultaneously manifest diseases. Two types of hētu 1. Utpādaka: Utpādaka Hētu is one, which favours accumulation of respective doṣas with respect to Ṟitu due to changes in Ṟitu. For example: In Hemanta Ṟitu due to madhuradi dravya Sanchaya of Kapha observed. 2. Vyanjaka: Vyanjaka Hētu is one, which stimulates the development of diseases. For example: Sanchita Kapha during Hemanta Ṟitu manifests disorders of Kapha in Vasanta Ṟitu due to the effect of the Sun. 1. Bāhya: Disease manifests due to consumption of Ahita Āhāra, vihāra and due to effect of Ṟitu, and such other internal factors which are responsible for the development of disease are called Bāhya Hētus. Vātādi doṣa Prakopaka Hētus are included under bāhya Hētu. 2. Ābhyantara: Shareerashrita doṣa and dūṣyās is called Ābhyantara Hētu. 1. Prākṟita: Prakrita hētus are those who manifest naturally due to variation in Ṟitu and accordingly Prakopa of doṣa results. For example: Kapha prakopa in Vasant Ṟitu Pitta Prakopa in Sharad Ṟitu, Vāta prakopa in Varṣa Ṟitu. 2. Vaikṟita: Vaikṟita Hētus are those which manifest unnaturally due to abnormal Ṟitu, where prakopa of Doṣa is irrespective of Ṟitu. For example:in Vasanta Ṟitu Pitta and Vāyu prakopa. In Varṣa Ṟitu Kapha and Pitta prakopa. In Sharad Ṟitu Kapha and Vāta prakopa. Understanding of normal and abnormal aggravation of doṣas as per influence of Ṟitu is essential to understand the prognosis of disease. 1. Anubandhya: It is the prime cause, which is having Swatantra vyakta Lakṣaṇa and Shastrokta upakrama. 2. Anubandha: It is the secondary cause, means that is not having Swatantra Lakṣaṇa and Upakrama. For example: In Kapha pradhana Vātakaphaja Jwara Here Kapha is Anubandhya and Vāta is Anubandha Ashayapakarsha hētu: prākṟita or sama doṣa moves from its own place by influence of vāta and produces diseases. For eg.if prākṟita doṣa moves to different places other than its normal path, there it becomes the apakrusta because that place is not conductive to that particular disease. Hētusankara: Hētusankara means mingling of hētu with respect to manifestation of diseases.one hētu manifests much disease, one disease has one hētu and other disease has many hētus. Eg.intake of ruksha āhāra manifests jwara, bhrama, pralapa, sometimes only jwara. Many hētus like ruksha, śīta, uṣṇa, lavana and viruddhāhāra manifest only jwara. But in some people the same hētus may manifest jwara, gulma, raktapitta etc depending upon the vyādhikshamatwa of the individual. Nidānarthakara rōga: These are the rōgas, where one rōga serves as nidāna for another rōga. For example: Santapa of jwara leads to manifestation of Raktapitta. Raktapitta and jwara leads to manifestation of of shosha Pratishyaya develops into kasa Kasa manifests kshaya Kshaya manifests shosha rōga. Initially nidānarthakara rōga manifest independently and later serves as a nidāna for another disease, sometimes they serve both purposes i.e. rōga as well as nidāna and sometimes become either nidāna or rōga. Nidānarthakara rōga divided into two types Ekarthakari: some diseases subside after manifesting another disease is called Ekarthakari AAMJ / Vol. 3 / Issue 2 / March April

4 Ubhayarthakari: Initial disease will persist after manifesting another disease and acts as nidāna for later disease. DISCUSSION The main motto of Ayurveda is swāsthya paripalana and rōga chikitsa. Doṣas become vitiated by ahitakara āhāra and vihara, which is the main cause of the disease nothing but the nidāna. In present era, people are leading sedentary life style, over eating and exposed to stress to earn more money and luxurious facilities. These are the main nidānas of present diseases. In clinical practice,obtaining etiological factors concerning to each disease is very difficult due to many hinderances like non co-operation of patients etc. factors. Importance of nidāna: Preventive aspect: Dinacharya, Rutucharya and Achara rasayana which are explained and followed by our ancestors, thereby avoiding the nidānas is the preventive measure to rogotpattti. Diagnostic aspect: For diagnosis of disease, one should know the exact reason for the manifestation of disease. For e.g. The Nidāna of Prameha are idle sitting, oversleep, excessive use of curd, meat soup of the domestic, aquatic and marshy animals and milk, new cereals and drinks, products of jaggery and all other kapha -vardhaka regimens [ii]. In Kusta alternatively taking śīta-uṣṇa, snigdha-ruksha āhāra, viruddhāhāra etc. are the nidāna of the disease. Some disease like Krimijanya shirorōga, kustha, switra, Udararōga, the cause is papajanya. Some of the diseases like vātarakta and Kustha are having a few same poorvaroopas like swedasysa atipravrutti or Abhava, Vaivarnya etc. so here one should take the help of Nidāna for proper diagnosis. By avoiding such factors, one can prevent the disease. In differential diagnosis: When the signs and symptoms of two or more diseases are identical, a precise diagnosis becomes very difficult. In such conditions if we are able to trace out the exact etiological factors, then a definite diagnosis becomes possible. It is because the etiological factors are different for various diseases, which have similar symptomatology. For example, there are eight types of Udaravyādhies in which ascites develops in the advanced stage [iii]. When the patient reaches this stage, a diagnosis of the specific type of disease becomes difficult as an examination of the abdomen is found to be impossible owing to the presence of ascitic fluid. But if the patient reveals his addiction to drinking alcohol and traces its history, the disease can be definitely diagnosed as Yakrutodara. Similarly, many skin diseases show some similar characters. If a patient is having rashes, pustules etc. reveals the history of abnormal sexual contacts or exposure, then a diagnosis of syphilis can be arrived at diagnosis of syphilitic arthritis also can be arrived at based on facts, which differentiate it from rheumatic and other types of arthritis. Limitations Though a knowledge of etiology becomes helpful in differential diagnosis, there are certain limitations of its own. Charaka has expressed his opinion on this matter. Certain diseases have a single specific etiological factor; but that is not always the case. Certain factors are such that any one of them is capable of producing more than one disease; for e.g. over eating of may produce diarrhoea, loss of appetite or pain in the abdomen. On the other hand, certain diseases are caused by the combination of various causes; eg. General weakness, under nutrition, unhygienic surroundings etc. accompanied by the infection of M.Tuberculosis will cause Rajayakshma. Hence in such condition, where the etiological factor is not definite and specific, such factors are not much help in differential diagnosis.sometimes a recent etiological factor remains dormant and the disease develops owing to a factor with which the patient came into contact long ago. In such a condition, if we consider the recent factor as being responsible for the disease we shall be misguided. Hence, Vapyachandra, a commentator, has warned us not to rely solely upon etiological factors for a confirmed diagnosis and suggested that the physician should take into account all the factors which come under Nidāna panchaka, like the prodromal symptoms, signs and symptoms. Treatment aspect: Knowledge of nidāna is of prime importance in the prevention as well as the cure of diseases. As Acharya Susruta told i.e., In short, Avoiding the Nidāna is the simple form of chikitsa [iv]. E.g. for treatment of Hikka and Śwāsa, it is told as if patient of Hikka and śwāsa desiring freedom from disease should avoid the etiological factors (Nidāna) said for these disorders. Acharya charaka told in Prameha, the respective etiological factors should not be used. The treatment of disease starts with abstinence from etiological factors. Apathya are the things, which should be avoided after manifestation of disease. It is nothing but aggravating factor for disease or in nutshell, the cause of disease. For e.g., in vatika jwara the factors wasting, fear, anger, passion, anxiety, and exertion will AAMJ / Vol. 3 / Issue 2 / March April

5 vitiate the Vāta further & will aggravate the disease. Upaśaya is nothing but sātmya i.e. Opposite to nidāna. Upaśayatmaka chikitsa is of eighteen types, according to chakrapani. Among that Hētu viparita and Hētu viparitartha both depends upon the knowledge of Nidāna. For e.g. In Vāta rōga, Rasona is Uṣṇa, teekshna (Hētu viparita), uṣṇa upanaha in pittaja vidradhi (Hētu viparitartha) and shadadharana churna without sneha in Urusthambha. In our treatise, it is said that success of physician depends on the skill of diagnosing a disease correctly and treatment should be given according to that. Nidāna panchaka is a process or sequential way of diagnosing a disease at various stages. The equilibrium state of dhātus is not disturbed, imbalanced state is brought to normalcy without some causative factors, that cause (either balanced or imbalanced) determine the equilibrium or imbalanced state of dhātu. Nidāna is the foremost step of nidāna panchaka. In short, Nidāna(cause of disease) is to be avoid for treatment. ΛΛΛΛ Prognostic aspect: In charaka nidāna,acharya charaka told disease manifestation or severity depends on the extent of nidāna taken ie. disease may not manifest, may manifest late,may manifest with less symptoms and may be with full presentation of symptoms [v].acharya also told about prognosis of disease is sadhya if nidāna is having Alpabala & kricchrasadhya if with moderate bala and yapya if nimitta is of poornabala. Conclusively, while treating diseases the highest importance should be attached to avoidance of causes responsible for the vitiation of doṣas because it will be helpful in breaking the samprāpti of the diseases. All these things will become possible only if there is a perfect knowledge about the etiological factors Even with all its limitations, Nidāna i.e., knowledge of etiological factors, is extremely helpful to the physician as well as to the patient. It also help people in general in preventing diseases. REFERENCES i. 1.Madhava nidana with madhukosha commentary by sudarshana shastri,varanasi;chaukhamba Sanskrit samsthan:2000 p.20 ii. Yadavji Trikakamji Charak Samhita of Agnivesha. Varanasi; Chaukhamba Surabharti Prakashana; 2013.p.217 iii. Yadavji Trikakamji Charak Samhita of Agnivesha. Varanasi; Chaukhamba Surabharti Prakashana; 2013.p.298 iv. 4.Yadavji Trikamji Susruta samhita of Susruta.Varanasi; Chaukhamba Surabharti Prakashana; 2013.p.597 v. Yadavji Trikakamji Charak Samhita of Agnivesha. Varanasi; Chaukhamba Surabharti Prakashana; 2013.p.539 CONCLUSION Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Shailaja & Shylaja: Concept of Nidāna and its Clinical Importance. AAMJ 2017; 2: ΛΛΛΛ AAMJ / Vol. 3 / Issue 2 / March April