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=== Abstract ===

=== Abstract ===

 

[[Nidana Sthana]] deals with the etiology, symptomatology, and means of diagnosis of diseases. It begins with a generalized set of diseases and then progresses into specialized studies of diseases. This explains why the section begins with a study of etiological factors causing ''jwara'' (this chapter) – a generalized study of fever - and then proceeds onto the studies of vitiation of the various ''dhatus'', or tissues, that are addressed in the subsequent chapters.  

[[Nidana Sthana]] deals with the etiology, symptomatology, and means of diagnosis of diseases. It begins with a generalized set of diseases and then progresses into specialized studies of diseases. This explains why the section begins with a study of etiological factors causing ''jwara'' (this chapter) – a generalized study of fever - and then proceeds onto the studies of vitiation of the various ''dhatus'', or tissues, that are addressed in the subsequent chapters.  

The first part of this chapter deals with tools necessary for acquiring a comprehensive knowledge of any disease. ''Nidana Panchaka'', an important concept introduced in this chapter,  implies a set of five important tools/components - etiology, premonitory signs, clinical features, pacifying factors and pathogenesis – that help in understanding a disease thoroughly. Each of these tools has a specific significance in diagnosis and explores an important aspect of the disease. Etiology helps to ascertain the causative factors of the diseases and diagnosis helps in determining the nature of the disease by causative factors, premonitory signs, actual signs, exploratory signs, and pathogenesis. It is not possible to manage disease completely without knowing all aspects of the disease process.  

The first part of this chapter deals with tools necessary for acquiring a comprehensive knowledge of any disease. ''Nidana Panchaka'', an important concept introduced in this chapter,  implies a set of five important tools/components - etiology, premonitory signs, clinical features, pacifying factors and pathogenesis – that help in understanding a disease thoroughly. Each of these tools has a specific significance in diagnosis and explores an important aspect of the disease. Etiology helps to ascertain the causative factors of the diseases and diagnosis helps in determining the nature of the disease by causative factors, premonitory signs, actual signs, exploratory signs, and pathogenesis. It is not possible to manage disease completely without knowing all aspects of the disease process.  

'''Keywords''': Diagnosis, ''nidana'', etiology, ''poorvarupa'', premonitory signs, ''rupa'', clinical signs, ''upashaya'', pacifying factors, ''samprapti'', pathogenesis, ''jwara'', ''nija'', ''aagantu jwara'', ''ghrita'' (ghee), fever.

'''Keywords''': Diagnosis, ''nidana'', etiology, ''poorvarupa'', premonitory signs, ''rupa'', clinical signs, ''upashaya'', pacifying factors, ''samprapti'', pathogenesis, ''jwara'', ''nija'', ''aagantu jwara'', ''ghrita'' (ghee), fever.

 

=== Introduction ===

=== Introduction ===

 

Per Ayurvedic texts, a physician cannot treat a patient if he does not possess a complete understanding of a disease. [1] Accurate diagnosis of a disease is important before initiating any treatment, and any understanding of a disease’s manifestation is incomplete without understanding its ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (actual sign and symptoms), ''upashaya'' (pacifying factors) and ''samprapti'' (pathogenesis) – or the ''Nidana Panchaka'' (literally, the five components of ''nidana''). [2]  

Per Ayurvedic texts, a physician cannot treat a patient if he does not possess a complete understanding of a disease. [1] Accurate diagnosis of a disease is important before initiating any treatment, and any understanding of a disease’s manifestation is incomplete without understanding its ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (actual sign and symptoms), ''upashaya'' (pacifying factors) and ''samprapti'' (pathogenesis) – or the ''Nidana Panchaka'' (literally, the five components of ''nidana''). [2]  

A disease’s lifecycle starts with certain premonitory symptoms and ends with its complete manifestation, or ''samprapti''. Between these two stages of the disease, the body shows various sign and symptoms that could be observed by any knowledgeable physician, using the ''Nidana Panchaka'' . Naturally, any disease, if diagnosed very early, could be prevented from manifesting itself through a variety of interventions. [3] A proper understanding of the ''Nidana Panchaka'' helps the physician using various therapies, to establish an equilibrium among the patient’s ''doshas'', ''dhatus'', and ''mala'' – since it is the vitiation of these bodily features that cause a disease. A therapy is considered pure or correct (''vishuddha'') when it cures the disease without giving rise to another disease. [4] Curable diseases can progress to incurable if they are not properly treated. [5]

A disease’s lifecycle starts with certain premonitory symptoms and ends with its complete manifestation, or ''samprapti''. Between these two stages of the disease, the body shows various sign and symptoms that could be observed by any knowledgeable physician, using the ''Nidana Panchaka'' . Naturally, any disease, if diagnosed very early, could be prevented from manifesting itself through a variety of interventions. [3] A proper understanding of the ''Nidana Panchaka'' helps the physician using various therapies, to establish an equilibrium among the patient’s ''doshas'', ''dhatus'', and ''mala'' – since it is the vitiation of these bodily features that cause a disease. A therapy is considered pure or correct (''vishuddha'') when it cures the disease without giving rise to another disease. [4] Curable diseases can progress to incurable if they are not properly treated. [5]

Depending upon the etiological factors, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] prescribes one of two types of therapies – spiritual and rational. A specific rational treatment of ''jwara'' could involve the use of processed ghee (clarified butter) with suitable drugs in a chronic fever is to alleviate all the three ''doshas''.

Depending upon the etiological factors, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] prescribes one of two types of therapies – spiritual and rational. A specific rational treatment of ''jwara'' could involve the use of processed ghee (clarified butter) with suitable drugs in a chronic fever is to alleviate all the three ''doshas''.

 

===Sanskrit Text, Transliteration and English Translation===

===Sanskrit Text, Transliteration and English Translation===

sA sa~gkhyAprAdhAnyavidhivikalpabalakAlavisheShairbhidyate|12|

sA sa~gkhyAprAdhAnyavidhivikalpabalakAlavisheShairbhidyate|12|

 

''Samprapti'' can be further classified, depending upon certain specific characteristics, by ''sankhya'' (numerological classification), ''pradhanya'' (dominance of ''dosha''), ''vidhi'' (types of diseases), ''vikalpa'' (dominance of one or the other attributes of ''doshas''), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]

''Samprapti'' can be further classified, depending upon certain specific characteristics, by ''sankhya'' (numerological classification), ''pradhanya'' (dominance of ''dosha''), ''vidhi'' (types of diseases), ''vikalpa'' (dominance of one or the other attributes of ''doshas''), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]

 

सङ्ख्या तावद्यथा- अष्टौ ज्वराः, पञ्च गुल्माः, सप्त कुष्ठान्येवमादिः|१२|

सङ्ख्या तावद्यथा- अष्टौ ज्वराः, पञ्च गुल्माः, सप्त कुष्ठान्येवमादिः|१२|

prAdhAnyaM punardoShANAM taratamAbhyAmupalabhyate| tatra dvayostaraH,

prAdhAnyaM punardoShANAM taratamAbhyAmupalabhyate| tatra dvayostaraH,

triShu tama iti|12|

triShu tama iti|12|

 

''Pradhanya'' (classification of ''samprapti'', or pathogenesis) indicates the dominance or primacy of one particular ''dosha'' above other ''doshas''. If two ''doshas'' get vitiated, the comparative term ''tara'' is used to indicate the predominant one. If, all the three ''doshas'' get vitiated then the superlative term ''ttama'' is used to indicate the most predominant one. [12.2]

''Pradhanya'' (classification of ''samprapti'', or pathogenesis) indicates the dominance or primacy of one particular ''dosha'' above other ''doshas''. If two ''doshas'' get vitiated, the comparative term ''tara'' is used to indicate the predominant one. If, all the three ''doshas'' get vitiated then the superlative term ''ttama'' is used to indicate the most predominant one. [12.2]

 

विधिर्नाम- द्विविधा व्याधयो निजागन्तुभेदेन,त्रिविधास्त्रिदोषभेदेन, चतुर्विधाः साध्यासाध्यमृदुदारुणभेदेन|१२|

विधिर्नाम- द्विविधा व्याधयो निजागन्तुभेदेन,त्रिविधास्त्रिदोषभेदेन, चतुर्विधाः साध्यासाध्यमृदुदारुणभेदेन|१२|

==== ''Vidhi'' or types of diseases can be illustrated as follows ====

==== ''Vidhi'' or types of diseases can be illustrated as follows ====

 

Diseases are of two varieties - ''nija'' (endogenous) or ''agantu'' (exogenous). On the basis of vitiation of the ''doshas'', diseases could be of three types; they could also be of four varieties, viz. ''sadhya'' (curable), ''asadhya'' (incurable), ''mrudu'' (mild), and ''daruna'' (severe). [12.3]

Diseases are of two varieties - ''nija'' (endogenous) or ''agantu'' (exogenous). On the basis of vitiation of the ''doshas'', diseases could be of three types; they could also be of four varieties, viz. ''sadhya'' (curable), ''asadhya'' (incurable), ''mrudu'' (mild), and ''daruna'' (severe). [12.3]

 

समवेतानां  पुनर्दोषाणामंशांशबलविकल्पो विकल्पोऽस्मिन्नर्थे|१२|

समवेतानां  पुनर्दोषाणामंशांशबलविकल्पो विकल्पोऽस्मिन्नर्थे|१२|

rUkShalaghushItavamanavirecanAsthApanashirovirecanAtiyogavyAyAmavegasandhAraNAnashanAbhighAta-vyavAyodvegashokashoNitAtiShekajAgaraNaviShamasharIranyAsebhyo~atisevitebhyo vAyuH prakopamApadyate||19||

rUkShalaghushItavamanavirecanAsthApanashirovirecanAtiyogavyAyAmavegasandhAraNAnashanAbhighAta-vyavAyodvegashokashoNitAtiShekajAgaraNaviShamasharIranyAsebhyo~atisevitebhyo vAyuH prakopamApadyate||19||

 

Excess use of rough, light to digest, and cold (food), over administration of therapeutic emesis and therapeutic purgation, ''asthapana'' (non-unctuous enema), ''shirovirechana'' (head evacuation), overexertion, suppression of urges, ''anashana'' (fasting), injury, copulation, agitation, lamentation, excessive blood-letting, night vigils and improper/odd posture of body – cause vitiation of ''vayu'' [19]

Excess use of rough, light to digest, and cold (food), over administration of therapeutic emesis and therapeutic purgation, ''asthapana'' (non-unctuous enema), ''shirovirechana'' (head evacuation), overexertion, suppression of urges, ''anashana'' (fasting), injury, copulation, agitation, lamentation, excessive blood-letting, night vigils and improper/odd posture of body – cause vitiation of ''vayu'' [19]

स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य  केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२०||

स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य  केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२०||

sa yadA prakupitaH pravishyAmAshayamUShmaNA [2] saha mishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||20||  

sa yadA prakupitaH pravishyAmAshayamUShmaNA [2] saha mishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||20||  

 

This vitiated ''vayu'', when it gets into the ''amashaya'' (stomach), afflicts ''agni'' and vitiates the first ''dhatu'' (''rasa'') created through this vitiated digestion process. This (vitiated admixture of ''vayu'' and ''rasa'') blocks the channels associated with ''rasa'' and ''sweda'' (sweat), adversely affecting the digestive processes and moving that heat out of its locus into other parts of the body. This excess heat leads to ''jwara''. [20]

This vitiated ''vayu'', when it gets into the ''amashaya'' (stomach), afflicts ''agni'' and vitiates the first ''dhatu'' (''rasa'') created through this vitiated digestion process. This (vitiated admixture of ''vayu'' and ''rasa'') blocks the channels associated with ''rasa'' and ''sweda'' (sweat), adversely affecting the digestive processes and moving that heat out of its locus into other parts of the body. This excess heat leads to ''jwara''. [20]

 

==== Clinical features ====

==== Clinical features ====

==== Symptoms of ''vata''-dominant ''jwara'' ====

==== Symptoms of ''vata''-dominant ''jwara'' ====

 

The patient would experience abrupt  onset and remission (of fever), with variations in temperature and severity. ''Jwara'' would be particularly severe at the end of digestion and there would be temporal variations as well (i.e., day, night and in summer). The patient’s skin would appear rough, and there would be reddish discoloration of nails, eyes, face, urine, stool and skin. The patient would experience excessively reduced tendency to pass urine, feces, excessive tearing of nails, etc. Debilitating pain radiating from the toe up, with various sensations felt at various parts as the pain travels – numbness in feet, cramps in the calves, looseness in knee joints (and also in all other joints), weakness in thighs,  excruciating pain in the waist region, aching in the sides, pressure sensation in back, churning in shoulder, cutting in arms, extracting in scapular region and constricting feeling in chest, inability to move the jaws, tinnitus, and piercing pain (pricking pain) in the temple region. (Other symptoms include) astringent taste or lack of taste in the mouth (distaste), dryness of mouth, palate and throat, thirst, catching pain (grabbing pain) in the heart, dry vomiting, dry cough, loss of sneezing and eructation, aversion to the taste, salivation, anorexia, diminished digestive power, malaise, increased yawning, bending, shivering, exhaustion, giddiness, delirium, insomnia, horripilation, sensitivity in teeth, and the desire for hot. Factors mentioned in the etiology are alleviating and contrary to them are aggravating. [21]

The patient would experience abrupt  onset and remission (of fever), with variations in temperature and severity. ''Jwara'' would be particularly severe at the end of digestion and there would be temporal variations as well (i.e., day, night and in summer). The patient’s skin would appear rough, and there would be reddish discoloration of nails, eyes, face, urine, stool and skin. The patient would experience excessively reduced tendency to pass urine, feces, excessive tearing of nails, etc. Debilitating pain radiating from the toe up, with various sensations felt at various parts as the pain travels – numbness in feet, cramps in the calves, looseness in knee joints (and also in all other joints), weakness in thighs,  excruciating pain in the waist region, aching in the sides, pressure sensation in back, churning in shoulder, cutting in arms, extracting in scapular region and constricting feeling in chest, inability to move the jaws, tinnitus, and piercing pain (pricking pain) in the temple region. (Other symptoms include) astringent taste or lack of taste in the mouth (distaste), dryness of mouth, palate and throat, thirst, catching pain (grabbing pain) in the heart, dry vomiting, dry cough, loss of sneezing and eructation, aversion to the taste, salivation, anorexia, diminished digestive power, malaise, increased yawning, bending, shivering, exhaustion, giddiness, delirium, insomnia, horripilation, sensitivity in teeth, and the desire for hot. Factors mentioned in the etiology are alleviating and contrary to them are aggravating. [21]

 

===== ''Pitta'' dominant ''jwara'' =====

===== ''Pitta'' dominant ''jwara'' =====

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktasya vidAhakAle madhyandine~ardharAtre sharadivA visheSheNa, kaTukAsyatA, ghrANamukhakaNThauShThatAlupAkaH, tRuShNA, mado, bhramo, mUrcchA, pittacchardanam, atIsAraH, annadveShaH, sadanaM,khedaH, pralApaH, raktakoThAbhinirvRuttiH sharIre, haritahAridratvaM nakhanayanavadanamUtrapurIShatvacAm, atyarthamUShmaNastIvrabhAvaH, atimAtraMdAhaH, shItAbhiprAyatA, nidAnoktAnupashayo viparItopashayashceti pittajvarali~ggAni [3] bhavanti||24||

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktasya vidAhakAle madhyandine~ardharAtre sharadivA visheSheNa, kaTukAsyatA, ghrANamukhakaNThauShThatAlupAkaH, tRuShNA, mado, bhramo, mUrcchA, pittacchardanam, atIsAraH, annadveShaH, sadanaM,khedaH, pralApaH, raktakoThAbhinirvRuttiH sharIre, haritahAridratvaM nakhanayanavadanamUtrapurIShatvacAm, atyarthamUShmaNastIvrabhAvaH, atimAtraMdAhaH, shItAbhiprAyatA, nidAnoktAnupashayo viparItopashayashceti pittajvarali~ggAni [3] bhavanti||24||

 

Excess use of hot, sour, salty, alkali, pungent and bitter food and intake of meals before the digestion of the previous meal, contact with intense heat, fire, exhaustion due to excessive exercise, anger, untimely meals – vitiate ''pitta''. The vitiated ''pitta'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' causes sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. Due to blocked channels of sweat, heat dissipation is adversely affected, causing the temperature to rise all over the body and manifest as ''paittika jwara''.

Excess use of hot, sour, salty, alkali, pungent and bitter food and intake of meals before the digestion of the previous meal, contact with intense heat, fire, exhaustion due to excessive exercise, anger, untimely meals – vitiate ''pitta''. The vitiated ''pitta'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' causes sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. Due to blocked channels of sweat, heat dissipation is adversely affected, causing the temperature to rise all over the body and manifest as ''paittika jwara''.

The symptoms of this type of ''jwara'' include simultaneous high fever in the whole body, specially at the time during digestion of meals, midday, middle of the night or in the Autumn season. This type of fever leaves a pungent taste in the mouth, ''paka'' (ulceration or inflammation) of the nose, mouth, throat, lips and palate, unquenchable thirst, narcosis, giddiness, fainting, vomiting of ''pitta'' (bile), ''atisara'' (diarrhea), aversion to food, malaise, dejection, delirium, appearance of reddish patches in the body, green or yellow coloration in nails, eyes, mouth, urine, feces and skin, excessive migraine and burning sensation, desire for cold things, unsuitability of included factors in etiology and suitability of opposite ones – these symptoms are of ''pitta'' (or ''paittika'') ''jwara''. [22-24]

The symptoms of this type of ''jwara'' include simultaneous high fever in the whole body, specially at the time during digestion of meals, midday, middle of the night or in the Autumn season. This type of fever leaves a pungent taste in the mouth, ''paka'' (ulceration or inflammation) of the nose, mouth, throat, lips and palate, unquenchable thirst, narcosis, giddiness, fainting, vomiting of ''pitta'' (bile), ''atisara'' (diarrhea), aversion to food, malaise, dejection, delirium, appearance of reddish patches in the body, green or yellow coloration in nails, eyes, mouth, urine, feces and skin, excessive migraine and burning sensation, desire for cold things, unsuitability of included factors in etiology and suitability of opposite ones – these symptoms are of ''pitta'' (or ''paittika'') ''jwara''. [22-24]

 

===== ''Kapha''-dominant ''jwara'' =====

===== ''Kapha''-dominant ''jwara'' =====

sa yadA prakupitaH pravishyAmAshayamUShmaNA sahamishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya prapIDayan kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||26||  

sa yadA prakupitaH pravishyAmAshayamUShmaNA sahamishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya prapIDayan kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||26||  

 

Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle –vitiate ''sleshma'' or ''kapha''. [25] The vitiated ''kapha'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' cause sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. As channels of sweat are blocked and are unable to dissipate the heat, temperature rises all over the body, causing ''jwara''. [26]

Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle –vitiate ''sleshma'' or ''kapha''. [25] The vitiated ''kapha'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' cause sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. As channels of sweat are blocked and are unable to dissipate the heat, temperature rises all over the body, causing ''jwara''. [26]

 

तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तमात्रे पूर्वाह्णे पूर्वरात्रे वसन्तकाले वा विशेषेण, गुरुगात्रत्वम्, अनन्नाभिलाषः, श्लेष्मप्रसेकः, मुखमाधुर्यं, हृल्लासः, हृदयोपलेपः, स्तिमितत्वं, छर्दिः, मृद्वग्निता, निद्राधिक्यं, स्तम्भः,तन्द्रा, कासः, श्वासः, प्रतिश्यायः, शैत्यं, श्वैत्यं च नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थं च शीतपिडका भृशमङ्गेभ्य उत्तिष्ठन्ति, उष्णाभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्च; इति(श्लेष्मज्वरलिङ्गानि भवन्ति)||२७||

तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तमात्रे पूर्वाह्णे पूर्वरात्रे वसन्तकाले वा विशेषेण, गुरुगात्रत्वम्, अनन्नाभिलाषः, श्लेष्मप्रसेकः, मुखमाधुर्यं, हृल्लासः, हृदयोपलेपः, स्तिमितत्वं, छर्दिः, मृद्वग्निता, निद्राधिक्यं, स्तम्भः,तन्द्रा, कासः, श्वासः, प्रतिश्यायः, शैत्यं, श्वैत्यं च नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थं च शीतपिडका भृशमङ्गेभ्य उत्तिष्ठन्ति, उष्णाभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्च; इति(श्लेष्मज्वरलिङ्गानि भवन्ति)||२७||

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktamAtre pUrvAhNe pUrvarAtre vasantakAle vAvisheSheNa, gurugAtratvam, anannAbhilAShaH, shleShmaprasekaH, mukhamAdhuryaM, hRullAsaH, hRudayopalepaH, stimitatvaM, chardiH, mRudvagnitA,nidrAdhikyaM, stambhaH, tandrA, kAsaH, shvAsaH, pratishyAyaH, shaityaM, shvaityaM ca nakhanayanavadanamUtrapurIShatvacAm, atyarthaM ca shItapiDakAbhRushama~ggebhya [2] uttiShThanti, uShNAbhiprAyatA, nidAnoktAnupashayo viparItopashayashca; iti (shleShmajvarali~ggAni [3] bhavanti)||27||

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktamAtre pUrvAhNe pUrvarAtre vasantakAle vAvisheSheNa, gurugAtratvam, anannAbhilAShaH, shleShmaprasekaH, mukhamAdhuryaM, hRullAsaH, hRudayopalepaH, stimitatvaM, chardiH, mRudvagnitA,nidrAdhikyaM, stambhaH, tandrA, kAsaH, shvAsaH, pratishyAyaH, shaityaM, shvaityaM ca nakhanayanavadanamUtrapurIShatvacAm, atyarthaM ca shItapiDakAbhRushama~ggebhya [2] uttiShThanti, uShNAbhiprAyatA, nidAnoktAnupashayo viparItopashayashca; iti (shleShmajvarali~ggAni [3] bhavanti)||27||

 

The symptoms of ''shleshmaja'' (''kaphaja'') ''jwara'' include the simultaneous onset of mild fever in the whole body, specially just after meals, forenoon, early night or spring season. This type of fever causes heaviness in the body, less desire to eat, excess secretion of ''shleshma'' (phlegm), sweet taste in the mouth, nausea, coating in the heart (causing wheezing), vomiting, mild appetite, excessive sleep or narcolepsy, stiffness, drowsiness, cough, dyspnea, coryza, coldness, whiteness in nails, eyes, face, urine and skin, urticarial patches in the body, desire to be subjected to heat, unsuitability of the described etiological factors and suitability of opposite to them. [27]

The symptoms of ''shleshmaja'' (''kaphaja'') ''jwara'' include the simultaneous onset of mild fever in the whole body, specially just after meals, forenoon, early night or spring season. This type of fever causes heaviness in the body, less desire to eat, excess secretion of ''shleshma'' (phlegm), sweet taste in the mouth, nausea, coating in the heart (causing wheezing), vomiting, mild appetite, excessive sleep or narcolepsy, stiffness, drowsiness, cough, dyspnea, coryza, coldness, whiteness in nails, eyes, face, urine and skin, urticarial patches in the body, desire to be subjected to heat, unsuitability of the described etiological factors and suitability of opposite to them. [27]

 

विषमाशनादनशनादन्नपरिवर्तादृतुव्यापत्तेरसात्म्यगन्धोपघ्राणाद्विषोपहतस्य चोदकस्योपयोगाद्गरेभ्यो गिरीणां चोपश्लेषात् स्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावrयोगाrथ्यासंसर्जनाद्वा स्त्रीणां च विषमप्रजननात् प्रजातानां च मिथ्योपचाराद्यथोक्तानां च हेतूनां मिश्रीभावाद्यथानिदानं द्वन्द्वानामन्यतमः सर्वे वा त्रयो दोषा युगपrकोपमापद्यन्ते,ते प्रकुपितास्तयैवानुपूर्व्या ज्वरमभिनिर्वर्तयन्ति||२८||

विषमाशनादनशनादन्नपरिवर्तादृतुव्यापत्तेरसात्म्यगन्धोपघ्राणाद्विषोपहतस्य चोदकस्योपयोगाद्गरेभ्यो गिरीणां चोपश्लेषात् स्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावrयोगाrथ्यासंसर्जनाद्वा स्त्रीणां च विषमप्रजननात् प्रजातानां च मिथ्योपचाराद्यथोक्तानां च हेतूनां मिश्रीभावाद्यथानिदानं द्वन्द्वानामन्यतमः सर्वे वा त्रयो दोषा युगपrकोपमापद्यन्ते,ते प्रकुपितास्तयैवानुपूर्व्या ज्वरमभिनिर्वर्तयन्ति||२८||

viShamAshanAdanashanAdannaparivartAdRutuvyApatterasAtmyagandhopaghrANAdviShopahatasya codakasyopayogAdgarebhyo girINAM copashleShAtsnehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAt mithyAsaMsarjanAdvA strINAM ca viShamaprajananAt prajAtAnAM camithyopacArAd yathoktAnAM ca hetUnAM mishrIbhAvAdyathAnidAnaM dvandvAnAmanyatamaH sarve vA trayo doShA yugapat prakopamApadyante, teprakupitAstayaivAnupUrvyA jvaramabhinirvartayanti||28||

viShamAshanAdanashanAdannaparivartAdRutuvyApatterasAtmyagandhopaghrANAdviShopahatasya codakasyopayogAdgarebhyo girINAM copashleShAtsnehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAt mithyAsaMsarjanAdvA strINAM ca viShamaprajananAt prajAtAnAM camithyopacArAd yathoktAnAM ca hetUnAM mishrIbhAvAdyathAnidAnaM dvandvAnAmanyatamaH sarve vA trayo doShA yugapat prakopamApadyante, teprakupitAstayaivAnupUrvyA jvaramabhinirvartayanti||28||

 

Irregular diet, fasting, change in regular meals, seasonal derangement, unsuitable odors, use of hilly water full of poisonous sediments, improper medication by ghee, oils and fats, medical fomentations, emesis, purgation, oily or decoction enema, nasal instillations, faulty diets after purification therapies, women undergoing abnormal delivery and inappropriate post-partum management  - these are some of the etiological factors that have already been mentioned as causes of vitiation of ''doshas'', that cause fever. [28]

Irregular diet, fasting, change in regular meals, seasonal derangement, unsuitable odors, use of hilly water full of poisonous sediments, improper medication by ghee, oils and fats, medical fomentations, emesis, purgation, oily or decoction enema, nasal instillations, faulty diets after purification therapies, women undergoing abnormal delivery and inappropriate post-partum management  - these are some of the etiological factors that have already been mentioned as causes of vitiation of ''doshas'', that cause fever. [28]

 

===== ''Sannipatika jwara'' =====

===== ''Sannipatika jwara'' =====

sa ki~jcitkAlamAgantuH kevalo bhUtvA pashcAddoShairanubadhyate|  

sa ki~jcitkAlamAgantuH kevalo bhUtvA pashcAddoShairanubadhyate|  

tatrAbhighAtajo vAyunA duShTashoNitAdhiShThAnena, abhiSha~ggajaH punarvAtapittAbhyAm, abhicArAbhishApajau tu sannipAtenAnubadhyete||30||

tatrAbhighAtajo vAyunA duShTashoNitAdhiShThAnena, abhiSha~ggajaH punarvAtapittAbhyAm, abhicArAbhishApajau tu sannipAtenAnubadhyete||30||

 

''Agantuja jwara'' (''jwara'' caused due to exogenous factors) is the eighth type of fever. This fever is accompanied with pain and is often caused by trauma, association with evil, fascination, and wrath (of the wise and the elders). These causes directly manifest as fever without any prodromal symptoms for a transitional duration. Slowly, with the passage of time, ''doshas'' get vitiated and their effects manifest as above. Fevers caused due to trauma influence blood pathology, while association with evil afflicts ''vata'' and ''pitta'', and fascination and wrath causes ''sannipata'' (and therefore, leads to an incurable condition). [30]

''Agantuja jwara'' (''jwara'' caused due to exogenous factors) is the eighth type of fever. This fever is accompanied with pain and is often caused by trauma, association with evil, fascination, and wrath (of the wise and the elders). These causes directly manifest as fever without any prodromal symptoms for a transitional duration. Slowly, with the passage of time, ''doshas'' get vitiated and their effects manifest as above. Fevers caused due to trauma influence blood pathology, while association with evil afflicts ''vata'' and ''pitta'', and fascination and wrath causes ''sannipata'' (and therefore, leads to an incurable condition). [30]

 

स सप्तविधाज्ज्वराद्विशिष्टलिङ्गोपक्रमसमुत्थानत्वाद्विशिष्टो वेदितव्यः,कर्मणा साधारणेन चोपचर्यते इत्यष्टविधा ज्वरप्रकृतिरुक्ता||३१||

स सप्तविधाज्ज्वराद्विशिष्टलिङ्गोपक्रमसमुत्थानत्वाद्विशिष्टो वेदितव्यः,कर्मणा साधारणेन चोपचर्यते इत्यष्टविधा ज्वरप्रकृतिरुक्ता||३१||

sa saptavidhAjjvarAdvishiShTali~ggopakramasamutthAnatvAdvishiShTo veditavyaH, karmaNA sAdhAraNena copacaryate [1] |  

sa saptavidhAjjvarAdvishiShTali~ggopakramasamutthAnatvAdvishiShTo veditavyaH, karmaNA sAdhAraNena copacaryate [1] |  

ityaShTavidhA jvaraprakRutiruktA||31||

ityaShTavidhA jvaraprakRutiruktA||31||

 

All the seven doshic ''jwara'' have their own doshic specifications with respect to the onset, symptomatology, and treatment principles. The exception is the ''agantuja jwara'' (exogenous), which should be treated with appropriate consideration to the ''jwara''’s specific etiology. [31]

All the seven doshic ''jwara'' have their own doshic specifications with respect to the onset, symptomatology, and treatment principles. The exception is the ''agantuja jwara'' (exogenous), which should be treated with appropriate consideration to the ''jwara''’s specific etiology. [31]

 

ज्वरस्त्वेकएवसन्तापलक्षणः|तमेवाभिप्रायविशेषाद्द्विविधमाचक्षते,निजागन्तुविशेषाच्च|तत्र निजं द्विविधं त्रिविधं चiतुर्विधं सप्तविधं चाहुर्भिषजो वातादिविकल्पात्||३२||

ज्वरस्त्वेकएवसन्तापलक्षणः|तमेवाभिप्रायविशेषाद्द्विविधमाचक्षते,निजागन्तुविशेषाच्च|तत्र निजं द्विविधं त्रिविधं चiतुर्विधं सप्तविधं चाहुर्भिषजो वातादिविकल्पात्||३२||

tamevAbhiprAyavisheShAddvividhamAcakShate, nijAgantuvisheShAcca|  

tamevAbhiprAyavisheShAddvividhamAcakShate, nijAgantuvisheShAcca|  

tatra nijaM dvividhaM trividhaM caturvidhaM saptavidhaM cAhurbhiShajo vAtAdivikalpAt||32||

tatra nijaM dvividhaM trividhaM caturvidhaM saptavidhaM cAhurbhiShajo vAtAdivikalpAt||32||

 

Per doshic classification of ''jwara, santapa'' (excessively hot sensation) is of only one type common to all ''jwara''. But according to other classifications it is of two types - ''nija'' (endogenous) and ''agantuja'' (exogenous). ''Nija'' again could be classified into two types (''saumya'' or mild) and ''agneya'' (high grade fever)), three types (''vatika, paitika, shleshmika''), four types (''vatika, paittika'', ''sleshmika'' and ''agantuja''), or seven types (''vatika, paittika, shleshmika, vata-paittika, vata-shleshmika, pitta-shleshmika''). [32]

Per doshic classification of ''jwara, santapa'' (excessively hot sensation) is of only one type common to all ''jwara''. But according to other classifications it is of two types - ''nija'' (endogenous) and ''agantuja'' (exogenous). ''Nija'' again could be classified into two types (''saumya'' or mild) and ''agneya'' (high grade fever)), three types (''vatika, paitika, shleshmika''), four types (''vatika, paittika'', ''sleshmika'' and ''agantuja''), or seven types (''vatika, paittika, shleshmika, vata-paittika, vata-shleshmika, pitta-shleshmika''). [32]

==== General premonitory signs of all ''jwara'' ====

==== General premonitory signs of all ''jwara'' ====

tasyemAni pUrvarUpANi bhavanti; tadyathA- mukhavairasyaM, gurugAtratvam, anannAbhilAShaH, cakShuShorAkulatvam, ashrvAgamanaM, nidrAdhikyam, aratiH,jRumbhA, vinAmaH, vepathuH, shramabhramapralApajAgaraNaromaharShadantaharShAH, shabdashItavAtAtapasahatvAsahatvam, arocakAvipAkau, daurbalyam,a~ggamardaH, sadanam, alpaprANatA, dIrghasUtratA, Alasyam, ucitasya karmaNo hAniH, pratIpatA svakAryeShu, gurUNAM vAkyeShvabhyasUyA, bAlebhyaHpradveShaH, svadharmeShvacintA, mAlyAnulepanabhojanaparikleshanaM, madhurebhyashca bhakShebhyaH pradveShaH, amlalavaNakaTukapriyatA ca, iti jvarasyapUrvarUpANi bhavanti prAksantApAt; api cainaM santApArtamanubadhnanti||33||

tasyemAni pUrvarUpANi bhavanti; tadyathA- mukhavairasyaM, gurugAtratvam, anannAbhilAShaH, cakShuShorAkulatvam, ashrvAgamanaM, nidrAdhikyam, aratiH,jRumbhA, vinAmaH, vepathuH, shramabhramapralApajAgaraNaromaharShadantaharShAH, shabdashItavAtAtapasahatvAsahatvam, arocakAvipAkau, daurbalyam,a~ggamardaH, sadanam, alpaprANatA, dIrghasUtratA, Alasyam, ucitasya karmaNo hAniH, pratIpatA svakAryeShu, gurUNAM vAkyeShvabhyasUyA, bAlebhyaHpradveShaH, svadharmeShvacintA, mAlyAnulepanabhojanaparikleshanaM, madhurebhyashca bhakShebhyaH pradveShaH, amlalavaNakaTukapriyatA ca, iti jvarasyapUrvarUpANi bhavanti prAksantApAt; api cainaM santApArtamanubadhnanti||33||

 

Premonitory symptoms of ''jwara'' include abnormal taste in the mouth, heaviness in the body, aversion to food, restless eyes, lacrymation, excessive sleep, restlessness body, yawning, bending, shivering, exhaustion (without exercise), giddiness, delirium, sometimes sleeplessness, horripilation, oversensitive teeth, tolerance and intolerance to sound, cold, wind and heat, anorexia, indigestion, weakness, body-ache, malaise, reduced vitality, mental agitations, lethargic, idleness, lack of natural activities, apathy to daily regimen, disrespect to the words of elders, agitation with  children, aversion to doing work, uncomfortable with flowers and perfumes, aversion to sweet edibles, and desirous for sour, salty and pungent things. These premonitory symptoms rise before the onset of ''jwara'' and may continue through the course of the fever. [33]

Premonitory symptoms of ''jwara'' include abnormal taste in the mouth, heaviness in the body, aversion to food, restless eyes, lacrymation, excessive sleep, restlessness body, yawning, bending, shivering, exhaustion (without exercise), giddiness, delirium, sometimes sleeplessness, horripilation, oversensitive teeth, tolerance and intolerance to sound, cold, wind and heat, anorexia, indigestion, weakness, body-ache, malaise, reduced vitality, mental agitations, lethargic, idleness, lack of natural activities, apathy to daily regimen, disrespect to the words of elders, agitation with  children, aversion to doing work, uncomfortable with flowers and perfumes, aversion to sweet edibles, and desirous for sour, salty and pungent things. These premonitory symptoms rise before the onset of ''jwara'' and may continue through the course of the fever. [33]

 

इत्येतान्येकैकशो ज्वरलिङ्गानि व्याख्यातानि भवन्ति विस्तरसमासाभ्याम्||३४||

इत्येतान्येकैकशो ज्वरलिङ्गानि व्याख्यातानि भवन्ति विस्तरसमासाभ्याम्||३४||

sa sarvarogAdhipatiH, nAnAtiryagyoniShu ca bahuvidhaiH shabdairabhidhIyate|  

sa sarvarogAdhipatiH, nAnAtiryagyoniShu ca bahuvidhaiH shabdairabhidhIyate|  

sarve prANabhRutaH sajvarA eva jAyante sajvarA eva mriyante ca; sa mahAmohaH, tenAbhibhUtAH prAgdaihikaM dehinaH karma ki~jcidapi na smaranti,sarvaprANabhRutAM ca jvara evAnte prANAnAdatte||35||  

sarve prANabhRutaH sajvarA eva jAyante sajvarA eva mriyante ca; sa mahAmohaH, tenAbhibhUtAH prAgdaihikaM dehinaH karma ki~jcidapi na smaranti,sarvaprANabhRutAM ca jvara evAnte prANAnAdatte||35||  

 

''Jwara'' occurs due to the wrath of Maheshwara. It could take away the life of all creatures, causes ''santapa'' (grief) in body, sense organs and mind. It reduces intellect, strength, complexion, feeling of happiness and enthusiasm and produces tiredness, fatigue, confusion, aversion to food. In fact, it is called ''jwara'' because it produces unhealthy effect in the body. No other disease is as frightful, complicated and difficult in treatment as this. That is why it is considered the king of all diseases. It is considered a life-giving force, since all living beings are born with fever (body temperature) and die with fever. It causes delirium. Afflicted living beings lose their memory of any event of their previous lives. In the end fever takes away the life of all creatures. [35]

''Jwara'' occurs due to the wrath of Maheshwara. It could take away the life of all creatures, causes ''santapa'' (grief) in body, sense organs and mind. It reduces intellect, strength, complexion, feeling of happiness and enthusiasm and produces tiredness, fatigue, confusion, aversion to food. In fact, it is called ''jwara'' because it produces unhealthy effect in the body. No other disease is as frightful, complicated and difficult in treatment as this. That is why it is considered the king of all diseases. It is considered a life-giving force, since all living beings are born with fever (body temperature) and die with fever. It causes delirium. Afflicted living beings lose their memory of any event of their previous lives. In the end fever takes away the life of all creatures. [35]

 

==== Management of ''jwara'' ====

==== Management of ''jwara'' ====

tatra pUrvarUpadarshane jvarAdau vA hitaM laghvashanamapatarpaNaM vA, jvarasyAmAshayasamutthatvAt; tataHkaShAyapAnAbhya~ggasnehasvedapradehapariShekAnulepanavamanavirecanAsthApanAnuvAsanopashamana-nastaHkarmadhUpadhUmapAnA~jjanakShIrabhojanavidhAnaM ca yathAsvaM yuktyA prayojyam||36||  

tatra pUrvarUpadarshane jvarAdau vA hitaM laghvashanamapatarpaNaM vA, jvarasyAmAshayasamutthatvAt; tataHkaShAyapAnAbhya~ggasnehasvedapradehapariShekAnulepanavamanavirecanAsthApanAnuvAsanopashamana-nastaHkarmadhUpadhUmapAnA~jjanakShIrabhojanavidhAnaM ca yathAsvaM yuktyA prayojyam||36||  

 

When premonitory symptoms manifest or at the onset of the fever, dieting or fasting is useful because the disease originates from the ''amashaya''. In such a case, intake of ''kashaya'' (decoctions), massage, oleation, fomentation, ''pradeha'' (sprinkling), ''anulepana'' (anointing with pastes), emesis, purgation, decoction and oily enema, pacificatory measures, snuffing, fumigation, smoking, collyrium, medicated milk and a specific dietetic regimen should be indicated as per the condition. [36]

When premonitory symptoms manifest or at the onset of the fever, dieting or fasting is useful because the disease originates from the ''amashaya''. In such a case, intake of ''kashaya'' (decoctions), massage, oleation, fomentation, ''pradeha'' (sprinkling), ''anulepana'' (anointing with pastes), emesis, purgation, decoction and oily enema, pacificatory measures, snuffing, fumigation, smoking, collyrium, medicated milk and a specific dietetic regimen should be indicated as per the condition. [36]

 

==== Management of chronic ''jwara'' ====

==== Management of chronic ''jwara'' ====

nAnyaH snehastathA kashcit saMskAramanuvartate|  

nAnyaH snehastathA kashcit saMskAramanuvartate|  

yathA sarpirataH sarpiH sarvasnehottamaM matam||40||  

yathA sarpirataH sarpiH sarvasnehottamaM matam||40||  

 

In all types of ''jirna jwara'' (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies ''vata'' by its unctuousness, ''kapha'' by (ghee infused with) ''kapha'' pacifying drugs, and ''pitta'' by its coldness. Therefore, ghee is useful in all forms of ''jirna jwara'' like fire subsides with water. [37]

In all types of ''jirna jwara'' (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies ''vata'' by its unctuousness, ''kapha'' by (ghee infused with) ''kapha'' pacifying drugs, and ''pitta'' by its coldness. Therefore, ghee is useful in all forms of ''jirna jwara'' like fire subsides with water. [37]

As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other ''sneha'' (oil etc.) brings the refinement properties of ''sanskara'' (processing with drugs) as ghee and therefore it is said the best one of all the ''snehas''. [38-40]

As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other ''sneha'' (oil etc.) brings the refinement properties of ''sanskara'' (processing with drugs) as ghee and therefore it is said the best one of all the ''snehas''. [38-40]

 

गद्योक्तो यः पुनः श्लोकैरर्थः समनुगीयते|

गद्योक्तो यः पुनः श्लोकैरर्थः समनुगीयते|

तद्व्यक्तिव्यवसायार्थं द्विरुक्तं तन्न गर्ह्यते||४१||

तद्व्यक्तिव्यवसायार्थं द्विरुक्तं तन्न गर्ह्यते||४१||

   

   

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

 

*The causative factors, favorable conditions, dominant factors, and origins of ''jwara'' are important in the context of ''nidana''. [3]

*The causative factors, favorable conditions, dominant factors, and origins of ''jwara'' are important in the context of ''nidana''. [3]

*Somatic diseases could be caused due to ''soma'' (''kapha''), ''agni'' (''pitta''), and ''vayu'' (''vata'') – due to vitiation of single ''dosha'', two ''doshas'', or all three ''doshas''. Psychiatric diseases are attributed to vitiation of ''rajas'' and ''tamas''. [4]

*Somatic diseases could be caused due to ''soma'' (''kapha''), ''agni'' (''pitta''), and ''vayu'' (''vata'') – due to vitiation of single ''dosha'', two ''doshas'', or all three ''doshas''. Psychiatric diseases are attributed to vitiation of ''rajas'' and ''tamas''. [4]

#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)

#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)

#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) [16]

#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) [16]

 

=====Various examples of ''upashaya'':=====

=====Various examples of ''upashaya'':=====

==== ''Samprapti'' (pathogenesis) ====

==== ''Samprapti'' (pathogenesis) ====

 

''Samprapti'' is a compound word meaning ''samyak aapti''/ ''prapti'' i.e. complete manifestation of a disease or the stage where the disease could be understood well. This pathogenesis explains the pattern of disequilibrium of ''dosha'' interacting with body tissues and thus, gives a clearer picture of disease. This covers all the six stages (''chayaprakopadi'') of the disease as told by Sushruta and the physician gets a complete understanding of the ''nidanas'' (causes), ''poorvarupas, rupas'' and ''upashayanupashaya'' with the help of ''samprapti''. Mostly patients come to physician when the process of ''samprapti'' is completed and at that time there may not be any existence of ''nidanas'' or ''poorvarupas''.  

''Samprapti'' is a compound word meaning ''samyak aapti''/ ''prapti'' i.e. complete manifestation of a disease or the stage where the disease could be understood well. This pathogenesis explains the pattern of disequilibrium of ''dosha'' interacting with body tissues and thus, gives a clearer picture of disease. This covers all the six stages (''chayaprakopadi'') of the disease as told by Sushruta and the physician gets a complete understanding of the ''nidanas'' (causes), ''poorvarupas, rupas'' and ''upashayanupashaya'' with the help of ''samprapti''. Mostly patients come to physician when the process of ''samprapti'' is completed and at that time there may not be any existence of ''nidanas'' or ''poorvarupas''.  

The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.

The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.

 

====Interrelation between ''nidanapanchaka'' and ''shatkriyakala'' ====

====Interrelation between ''nidanapanchaka'' and ''shatkriyakala'' ====