Nidana Sthana

Charak Samhita Nidana Sthana
Sections
Prior Section	Sutra Sthana
Next Section	Vimana Sthana
All Sections	Sutra Sthana,Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Chapters
	Jwara Nidana, Raktapitta Nidana, Gulma Nidana, Prameha Nidana, Kushtha Nidana, Shosha Nidana, Unmada Nidana, Apasmara Nidana

Preamble of Nidana Sthana (Section on Diagnosis)

Fundamental principles of diagnosis

Nidana Sthana, the second section within Charak Samhita, is about guidelines for diagnosing disease on the basis of detailed history and clinical examination. The word Nidana literally means primary cause and diagnosis.^[1] The five methods to know a disease viz. hetu (causative factors), purva-rupa (premonitory signs and symptoms), rupa (clinical features),upashaya (pacifying factors) and samprapti (etio-pathogenesis).The study is comprehensive and is different from modern medical system to guide a physician to diagnose and treat disease with minimal use of laboratory, imaging and other tools.

Two important aspects in Diagnosis

There are two important aspects while diagnosing a disease as per principles of Ayurveda. It always considers interaction between the individual and the affecting pathological entities.

Analysis of the individual

The first being an evaluation of the self-healing capacity of the body which depends upon equilibrium of five components, namely doshas (body humors), agni (digestive and metabolic capacity), dhatu (body tissues), mala (waste) and psycho-spiritual state. Health is a state of equilibrium, whereas disease is a state of dis-equilibrium of any of these factors. According to theory of natural destruction and theory of natural resolution (swabhavoparam vada), the resolution / destruction of the existing always happen naturally in the course of time. So the nature itself heals disequilibrium.(Cha.Su.16/27) This aspect of host defence mechanism is important to be assessed for knowing natural healing capacity of an individual. In the fourth chapter,Prameha Nidana, the process of onset of disease through interaction between aggravating and pacifying factors is described (Cha.Ni.4/4). If the host defense factors are stronger than aggravating ones, then the disease will not occur and vice versa. Therefore, before making diagnosis of a disease, examination of patient is important with emphasis on his prakriti (basic constitution), sara (quality of tissues) etc described in context of ten fold examination of patient(Cha.Vi.8/94-131). Every person has a unique constitution and hence the same biological investigations cannot be precise to assess his health status completely. Personalized assessment is important to diagnose normal and abnormal state of the individual.

Analysis of disease

The second part provides for a comprehensive knowledge of disease with its causative factors, premonitory signs and symptoms, clinical features, complications, aggravating and pacifying factors. Complete cure in curable diseases and management of palliable diseases can only be achieved after Nidana Parivarjana (avoiding the cause). If the cause is removed, then half the treatment is done, because it stops progression of disease as well as helps the host to return to the normal state. Modern science focuses more on disease management after its complete manifestation, while Ayurveda emphasizes on identification of abnormality when it is in a very early stage, so as to prevent its further progression. The journey of a disease from the initial stage of accumulation of vitiating factors to complete manifestation of its symptoms is to be studied well for its complete knowledge. A disease can cause another disease is described with reference to Nidanarthakara roga. Upadrava (complications), Udarka (marks of disease after it is cured) are mentioned for knowing the cause-effect in relation to disease. Thus, this section on knowledge of diagnosis, points to two fold principles of management of disease in brief and to reverse the process by modifying the etiological, aggravating and pacifying factors of disease.

Importance of eight chapters

This section comprises eight different chapters enlisted as below:

The first chapter, Jwara Nidana , introduces basic principles of diagnosis of a disease as well as the disease jwara with involvement of rasa dhatu as dushya.The chapter discuss diagnosis of disorders of hyper-pyrexia and various types of fever
The second chapter, Raktapitta Nidana, deals with various pathologies related to rakta dhatu.This chapter details the diagnosis of bleeding disorders.
The third chapter, Gulma Nidana, deals with mamsa dhatu(muscle tissue) predominantly. This chapter describes diagnosis of lumps in abdomen
The fourth chapter, Prameha Nidana, involves meda dhatu (tissue fat) predominantly. This chapter describes the diagnosis of disorders of lipid metabolism and diabetes.
The fifth chapter, Kushtha Nidana, involves seven dushyas (vitiated dhatu). This chapter deals with diagnosis of skin disorders.
The sixth chapter, Shosha Nidana, deals with the pathology of emaciation. This chapter describes diagnosis of degenerative disorders that involve depletion of body tissues.
The seventh chapter, Unmada Nidana explain insanity and psychotic disorders.
The eighth chapter, Apasmara Nidana deals with epilepsy and seizure disorders.

These eight chapters represent major pathogenesis of diseases described in details in this section. The eight chapters of this section, focus upon eight disorders related with vitiated dosha acting on various dhatu to vitiate them.

Guidelines to diagnose anukta vyadhi (untold diseases in text)

Any new disease, not mentioned in this text, should be studied with investigation of vitiated dosha and dushya (vitiated dhatu and other body components) first because all endogenous diseases start with vitiation of dosha. The enlisted causative factors elucidated in the detailed history of a patient’s diet, lifestyle, psychological frame and others direct the vitiation of a specific dosha. Then their status (increase or decrease) can be assessed based on the premonitory signs and clinical features, followed by evaluation of aggravating (anupashaya) and pacifying (upashaya) factors. The sequence of events in the pathogenesis of a disease is understood and accordingly treatment protocol is formulated. Prajnaparadha (intellectual errors, or knowingly violating rules) is the chief responsible factor for causation of all endogenous and exogenous diseases. Asatmenriyarthasamyoga (improper union of senses with their objects) and parinama(time) are other two causative factors . Therefore, this principle points that so called idiopathic diseases of unknown etiology have a definite cause,that needs to be searched and removed for its management.

Researches

A team of researchers compiled all Sanskrit texts of Nidana Sthana in a project report.^[2]
Shrirang S.G. have done a critical study on Nidana Sthana with special reference to Prameha Nidana ^[3]
Shashirekha H. K. has studied Shosha Nidana described in Nidana Sthana. ^[4]