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The section Nidana Sthana deals with principles of diagnosis of diseases.

 

|description=The section Nidana Sthana deals with principles of diagnosis of diseases. The term Nidana is applied for knowing the origin of disease (vyadhijanaka) and comprehensive information of disease (vyadhibodhaka).

{{Infobox

{{Infobox

|title = [[Charak Samhita]] Nidana Sthana

|title = [[Charak Samhita]] Nidana Sthana-Preamble

|header1 = Sections

|label1 = Section/Chapter

 

|label2 = Prior Section

|label2 = Preceding section

|data2 = [[Sutra Sthana]]

|data2 = [[Sutra Sthana]]

 

|label3 = Succeeding section

|label3 = Next Section

|data3 = [[Vimana Sthana]]

|data3 = [[Vimana Sthana]]

|label4 = All Sections

|header11 = Chapters

 

|header5 = Chapters

|label6 =  

|label12 =  

|data6 = [[Jwara Nidana]], [[Raktapitta Nidana]], [[Gulma Nidana]], [[Prameha Nidana]], [[Kushtha Nidana]], [[Shosha Nidana]], [[Unmada Nidana]], [[Apasmara Nidana]]

|data12 = 1. [[Jwara Nidana]], 2.[[Raktapitta Nidana]], 3. [[Gulma Nidana]], 4. [[Prameha Nidana]], 5. [[Kushtha Nidana]], 6. [[Shosha Nidana]], 7. [[Unmada Nidana]], 8. [[Apasmara Nidana]]

}}

}}

== Preamble of [[Nidana Sthana]] (Section on Diagnosis) ==

'''<big>Preamble of Nidana Sthana (Section on Diagnosis)</big>'''

<p style="text-align:justify;">The section Nidana Sthana deals with principles of diagnosis of diseases. The term Nidana is applied for knowing the origin of disease (vyadhijanaka) and comprehensive information of disease (vyadhibodhaka). [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/1-2] </p>

===Fundamental principles of diagnosis===

===Fundamental principles of diagnosis===

===Important aspects of knowledge of disease===

===Important aspects of knowledge of disease===

[[File:Aspects of Nidana Sthana .jpg|400px|Image 1:Aspects of Nidana Section]]

[[File:Aspects of Nidana Sthana .jpg|400px|'''Image 1:Aspects of Nidana Section'''|thumb]]

 

Nidana section studies diagnostic principles in view of two important aspects like knowledge of roga (disease) and rugna (patient). It always considers interaction between the individual and the affecting pathological entities. It also considers the prognosis and inter-relation of different diseases or co-morbid conditions.[Image 1: Aspects of Nidana Section]

'''Image 1: Aspects of Nidana Section'''

===Knowledge of the individual===

Nidana section studies diagnostic principles in view of two important aspects like knowledge of roga (disease) and rugna (patient). It always considers interaction between the individual and the affecting pathological entities. It also considers the prognosis and inter-relation of different diseases or co-morbid conditions.

Before knowing disease, one needs to know the self-healing capacity of the human being. This depends upon equilibrium of five components of health, namely [[dosha]] (regulatory functional factors of body and mind) , [[agni]] (digestive and metabolic capacity), [[dhatu]] (body tissues), [[mala]] (metabolic waste products) and psycho-spiritual state. Health is a state of equilibrium, whereas disease is a state of dis-equilibrium of any of these factors.  

====Analysis of the individual====

According to [[swabhavoparam vada]], the resolution / destruction of the existing always happens naturally in the course of time. So the nature itself heals disequilibrium.[[Chikitsaprabhritiya Adhyaya#Swabhavoparama vada (theory of natural destruction)[Cha.Sa.[[Sutra Sthana]].16/27].This aspect of host defense mechanism is important to be assessed for knowing natural healing capacity of an individual. In the fourth chapter,[[Prameha Nidana]], [[Prameha Nidana#Process of Onset of Disease|the process of onset of disease]] through interaction between aggravating and pacifying factors is described [[Prameha Nidana#Process of Onset of Disease|[Cha.Sa. [[Nidana Sthana]] 4/4]. If the host defense factors are stronger than aggravating ones, then the disease will not occur and vice versa. Therefore, before making a diagnosis of a disease, [[Rogabhishagjitiya Vimana#Examination of patient|examination of patient]] is important with emphasis on his [[prakriti]] (basic constitution), [[sara]] (quality of tissues) etc described in context of [[Rogabhishagjitiya Vimana#Examination of patient|ten fold examination of the patient[Cha.Sa.[[Vimana Sthana]] 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.

The first being an evaluation of the self-healing capacity of the body which depends upon equilibrium of five components, namely [[dosha]] (regulatory functional factors of body and mind) , [[agni]] (digestive and metabolic capacity), [[dhatu]] (body tissues), [[mala]] (metabolic waste products) 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 [[swabhavoparam vada]], the resolution / destruction of the existing always happen naturally in the course of time. So the nature itself heals disequilibrium.[[Chikitsaprabhritiya Adhyaya#Swabhavoparama vada (theory of natural destruction)|(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]], [[Prameha Nidana#Process of Onset of Disease|the process of onset of disease]] through interaction between aggravating and pacifying factors is described [[Prameha Nidana#Process of Onset of Disease|(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, [[Rogabhishagjitiya Vimana#Examination of patient|examination of patient]] is important with emphasis on his [[prakriti]] (basic constitution), [[sara]] (quality of tissues) etc described in context of [[Rogabhishagjitiya Vimana#Examination of patient|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.

===Knowledge of disease===

====Analysis of disease====

After thorough examination of an individual, one shall evaluate the disease. The second part of diagnostic protocol provides comprehensive knowledge of disease. This includes the methods to elucidate causative factors ([[hetu]]), observe premonitory signs and symptoms ([[purvarupa]]), clinical features ([[rupa]]), pathogenesis ([[samprapti]]), and pacifying factors ([[upashaya]]). The set of these five diagnostic tools is called as 'Nidana Panchaka'. This is described and applied in clinical practice to know each disequilibrium condition. 

The second part provides 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. The current healthcare system focus more on disease management after its complete manifestation; while [[Ayurveda]] emphasizes on identification of abnormality at an early stage, 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 shall be studied well for its complete knowledge. The phenomena of a disease causing another disease is described as [[Nidanarthakara roga]]. [[Upadrava]] (complications), [[Udarka]] (marks of disease after it is cured) are applied for knowing the cause-effect relationship in pathogenesis of disease.

The phenomena of a disease causing another disease is described as [[Nidanarthakara roga]]. [[Upadrava]] (complications), [[Udarka]] (marks of disease after it is cured) are applied for knowing the cause-effect relationship in pathogenesis of 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.

Principles of management of disease are mentioned in brief in each chapter to denote pacifying factors of disease. Each chapter of this section follows the same protocol for comprehensive knowledge of disease.

===Importance of eight chapters===

===Importance of eight chapters===

* The third chapter, [[Gulma Nidana]], deals with [[mamsa]] [[dhatu]](muscle tissue) predominantly. This chapter describes diagnosis of lumps in abdomen, tumors.

* The third chapter, [[Gulma Nidana]], deals with [[mamsa]] [[dhatu]](muscle tissue) predominantly. This chapter describes diagnosis of lumps in abdomen, tumors.

   

   

* The fourth chapter, [[Prameha Nidana]], involves [[meda]] [[dhatu]] (tissue fat) predominantly. This chapter describes the diagnosis of disorders of lipid metabolism and diabetes.  

* The fourth chapter, [[Prameha Nidana]], involves [[Meda dhatu|meda]] [[dhatu]] (tissue fat) predominantly. This chapter describes the diagnosis of disorders of lipid metabolism, obstinate urinary disorders including diabetes.

   

   

* The fifth chapter, [[Kushtha Nidana]], involves seven [[dushyas]] (vitiated factors). This chapter deals with diagnosis of skin disorders.

* The fifth chapter, [[Kushtha Nidana]], involves seven [[dushya]] (vitiated factors). 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 sixth chapter, [[Shosha Nidana]], deals with the pathology of emaciation. This chapter describes diagnosis of degenerative disorders that involve depletion of body tissues.

* The eighth chapter, [[Apasmara Nidana]] deals with epilepsy and seizure 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 represent variety of pathogenic process related with vitiated [[dosha]] acting upon various [[dhatu]] to cause disease.

These eight chapters represent pathogenesis of major diseases described in detail in this section. Each chapter directs towards variety of pathogenic processes related interaction of vitiated [[dosha]] with [[dhatu]] to cause disease.

===Guidelines to diagnose [[anukta vyadhi]] (new or untold diseases in text)===

===Guidelines to diagnose [[anukta vyadhi]] (new or untold diseases in text)===

There are innumerable disease. Major diseases are mentioned in this text.[[Trishothiya Adhyaya#Criteria for classification of diseases|(Cha.Su.18/42-43)]] Therefore one may not find complete description of certain diseases seen in contemporary era. Any new or unknown disease should be studied by investigation of vitiated [[dosha]] and [[dushya]] (vitiated factors). All endogenous diseases start with vitiation of [[dosha]]. The 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. Then after evaluation of aggravating ([[anupashaya]]) and pacifying ([[upashaya]]) factors is done. The sequence of events in the pathogenesis of a disease is understood and accordingly treatment protocol is formulated.  

There are innumerable diseases. Major diseases are mentioned in this text. Therefore one may not find complete description of certain diseases seen in contemporary era. Any new or unknown disease should be studied by assessment of vitiated [[dosha]] and [[dushya]] (vitiated factors). The criteria like type of pain, appearance (color), etiology, site, symptoms and name shall be applied for identification.[[Trishothiya Adhyaya#Criteria for classification of diseases|(Cha.Su.18/42-43)]]

[[Prajnaparadha]] (intellectual errors, or knowingly violating rules) is one of the fundamental cause of all endogenous and exogenous diseases. [[Asatmendriyarthasamyoga]] (improper union of senses with their objects) and [[parinama]](time) are other two causative factors . These  principles reveal that all idiopathic diseases of unknown etiology also have a definite cause,that needs to be searched and removed for its proper management.

 

All endogenous diseases start with vitiation of [[dosha]]. The 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. Then after evaluation of aggravating ([[anupashaya]]) and pacifying ([[upashaya]]) factors is done, 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 one of the fundamental cause of all endogenous and exogenous diseases. [[Asatmendriyarthasamyoga]] (improper union of senses with their objects) and [[parinama]](time) are other two causative factors . These  principles reveal that all idiopathic diseases of unknown etiology also have a definite cause, that needs to be searched and removed for its proper management.

 

 

 

* The knowledge of Nidana can be helpful in reducing healthcare cost by reducing use of invasive and non invasive medical diagnostic tools.

===Researches===

===Researches===

#A team of researchers compiled all Sanskrit texts of [[Nidana Sthana]] in a project report.<ref>Critical Edition of Charaka Nidana Sthana available from http://ayushportal.nic.in/EMR/LITERARY_FINAL_REPORT-1.pdf downloaded on 17/04/2019</ref>

#A team of researchers compiled all Sanskrit texts of [[Nidana Sthana]] of Charak Samhita in a project report.<ref>Critical Edition of Charaka Nidana Sthana available from http://ayushportal.nic.in/EMR/LITERARY_FINAL_REPORT-1.pdf downloaded on 17/04/2019</ref>

#Shrirang S.G. have done a critical study on Nidana Sthana with special reference to [[Prameha Nidana]] <ref> Shrirang S.G. Thesis on Critical Study Of Caraka Nidana Sthana With Special Reference To Prameha . Department of Samhita . Institute for Post Graduate Teaching & Research in [[Ayurveda]], Gujarat Ayurved University, Jamnagar . 2000</ref>

#Shrirang S.G. have done a critical study on Nidana Sthana with special reference to [[Prameha Nidana]] <ref> Shrirang S.G. Thesis on Critical Study Of Caraka Nidana Sthana With Special Reference To Prameha . Department of Samhita . Institute for Post Graduate Teaching & Research in [[Ayurveda]], Gujarat Ayurved University, Jamnagar . 2000</ref>

#Shashirekha H. K. has studied [[Shosha Nidana]] described in [[Nidana Sthana]]. <ref>Shashirekha H K . A Study On Caraka Nidana Sthana With Special Reference To Shosha . Swasthavritta . Dr. Basavaraj Nagur Memorial Rural Ayurvedic Medical College And Hospital (Dr. B N M R), Bijapur .2010</ref>

#Shashirekha H. K. has studied [[Shosha Nidana]] described in [[Nidana Sthana]]. <ref>Shashirekha H K . A Study On Caraka Nidana Sthana With Special Reference To Shosha . Swasthavritta . Dr. Basavaraj Nagur Memorial Rural Ayurvedic Medical College And Hospital (Dr. B N M R), Bijapur .2010</ref>

=== All Abstracts ===

=== All Abstracts ===

The new learners of Nidana sthana can read all abstracts of chapters of this section on the [[Abstracts- Nidana Sthana]] page.

The new learners of Nidana sthana can read all abstracts of chapters of this section on the [[Abstracts- Nidana Sthana]] page.

==References==   

==References==   

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