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===Fundamental principles of diagnosis===

===Fundamental principles of diagnosis===

<div style="text-align:justify;">[[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.<ref> Available from http://spokensanskrit.org/index.php?mode=3&script=hk&tran_input=nidana&direct=au accessed on May 02,2019</ref> 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.

<div style="text-align:justify;">[[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.<ref> Available from http://spokensanskrit.org/index.php?mode=3&script=hk&tran_input=nidana&direct=au accessed on May 02,2019</ref> 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===

===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.

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====

====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 [[Chikitsaprabhritiya Adhyaya#Swabhavoparama vada (theory of natural destruction)|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.[[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.

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 [[Chikitsaprabhritiya Adhyaya#Swabhavoparama vada (theory of natural destruction)|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.[[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.

====Analysis of disease====

====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.  

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.

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===

===Importance of eight chapters===

This section comprises eight different chapters enlisted as below:  

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 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   

===Guidelines to diagnose ''anukta vyadhi'' (untold diseases in text)===

===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.  

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.

''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===

===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]] 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>

==References==   

==References==   

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