Bull.lnd. Inst. Hist.Med. Vol. XXIX - 1999 pp. I to 14

DEFINITION OF NIDANA PANCAKA(FIRST CHAPTER OF MADilA V ANIDANA)

MOMIN ALI*

ABSTRACT

This is in continuation of the previous article published in this Bulletin of theIndian Institute of History of Medicine, Volume, XXVII, No.2. July 1997. P.Nos163 to 171, under the title of "Definition of Nidana Panchaka (First Chapter ofMadhava Nidana"). It deals with Nidana, Purvarupa. Rupa, lJpashaya andSamprapti as described in the first Chapter of Madhavanidana.

The dosas sometimes move into thevital organs, bones and joints and causePaksavadha, Apatanaka and Ardita etc.This is called "Madhyarna Roga Marga(Intermediate path of diseases)."

(g) The vitiated dosas should also beknown with regard to their beingaccompanied by or being devoid ofamadosa (immature matter). As it has beensaid "The adya rasadhatu (First element ofthe body) not being brought to a maturestate because the agni (heat of thetransforming fire) is ofa slight force beingcorrupted and staying in the arnasaya(receptacle of undigested food), is calledama (immature nutrient fluid). The dosasand the dusyas (corruptible constituents)which have come into contact with thatamadosa and have been corrupted (by it),are taught to be sarna (accompanied byamadosa) and so are the diseases arisingfrom them are called sarna roga, sarnajvaraand sarnatisara etc. Obstruction of thechannels, subsidence of bodily force,heaviness, a confused state of the Vata,

inertia, absence of maturative processes,ejection of saliva, retention of impurematter, the inability to eat and wearinessare the signs of the dosas accompanied byama, when they are devoid of amadosa,the opposite (signs are present)."

(A.H.Sut. 13/23-27)The dosas, intimately connected with

each other are of sixty two types asmentioned in susruta sarnhita "These threedosas allow of three individualcombinations (with aggravation of one dosaonly, i.e. aggravated Vata - with normalpitta and Kapha; aggravated Pitta - withnormal Vata and Kapha; and aggravatedKapha - with normal Vata and Pitta). Takendoubly at a time, both of them aggravatedequally or one more (aggravated) than tlother, the number of combinations wouk,be nine. Taken three at a time - all oftheinaggravated, either equally ordisproportionately - the number ofcombinations would be thirteen (a total of25 combinations of aggravation i.e. 3singles, 9 doubles and 13 triads). Thereare thus fifty combinations in all, when

* Assistant Director I/c .• Indian Institute of History of Medicine (CCRAS), 0.1\1.c. Buildings,Putl ibowli. Hyderahad (India)

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counted with an equal number ofcombinations of diminution (a similar totalof25 combinations of diminution of dosas)of the dosas (taken one, two or three at atime).

The number of combinations (Takenone, two and three at a time), with theaggravated and diminished dosasjuxtaposed, would be twelve only thus theyall are compiled to be sixty two in number(Uttara tantra Chapter 66, 10-12/1).Concerning more and most (seriousdegrees of excitement) etc., as Caraka says''the predominance of the dosas is describedin terms of the comparative and superlativedegrees. The comparative (a more seriousdegree) is used with reference to(excitement of) two and with reference to(excitement of) all the three dosas thesuperlative (most serious degree) is used(Nidana, Chapter-1I12(3).

Thus, the above mentioned distinctionswith regard to to hetus (causes) anddosabhedas have been summarized asfollows:

"The following distinctions withregard to the cause have been described :four (types) as to its being subordinate,distant, near or predominant ; three typeswith regard to (its subdivision into)inadequate junction of the senses with theirobjects, transformation (bytime) and errorsin judgement; also (three) with regard to(its being a ) cause of a disease, a morbificentity or both; two (types with regard tothe distinction of) a (cause) of manifestation

Bull.Ind.Inst.Hist.Med. Vol.XXIX - /999

and a (cause), bringing about theproduction and also (two) with regard tothe distinction of an external and an internal(cause).

Distinctions of the dosas (are made)with regard to their being natural ordeviated, chief or adjunctory, with regardto their being correlated WIth (the morbificentity dominating in) the prakrti(constitution) or with another (morbificentity) with regard to their receptacle ortheir being dragged away (from it) and withregard to their mode of being Sarna andNirama."

Thus, the object of studying Nidana(Etiology) is primarily to know the causeor causes of a particular disease. Itfacilitates treatment if the cause or causesof the diseases are definitely traced out.Further, in most cases, when the cause ofthe disease is removed, the disease subsidesnaturally. According to Ayurveda the bestmethod of curing disease is to avoid allthose things that act as causes of thatdisease, as Susruta says - "In brief, themanagement essentially consists in theavoidance of the etiological factors; andspecifically, in detail, it imp liescounteracting the increased Vata and otherdosas.""

I, 5d - 6: Purvanipa (a group of premonitorysymptoms or the symptom complex) is that bywhich an impending illness, not (yet)assignable to the specific (characteristics of a)dosa (morbific entity) is characterised. It is amild (an undeveloped) sign on account of the

8 - The Madhava Nidana and its chief commentary (Chapters 1-10) by G.1an.Meulenbeld (1974)P.Nos. 37 & 43. ,

9 - Ophthalmic & otorhinolaryngological considerations in Ancient Indian Surgery (based on Salakya TantraPortion of Uttara Tantra of Susruta Samhita, Chapter '1/25, by G,D, Singhal & K.R. Sharma (1976),Published by Dr,G.D, Singhal, Singhal Publisations, 14, Sammelan Marg. Allahabad - 211003, India,PNo 10

Definition Of Nidana Panchaka - Momin AU

slightness of the ailment, in accordance witheach (particular disease).

(A.H.Nid. I, 3d - 4)The Piirvariipas have been given just

after the N idana because, they immediatelyfollow upon it. To put it shortly thecharacteristic (of a prodrome) is (asfollows): "A prodrome is a sign that onlymakes (one) aware of an impendingillness." And the prodromes are verily thesigns of an illness though it is not (yet)present, in the same way as the coming upof specific clouds of rain.!? Such as theremay be symptoms of impending rain Viz.,a black cloud, a cool breeze and lighting.These three may be taken as Pilrvariipas orpremonitory indications of impending rain.But, at this stage one cannot be certain thatthis rain is sure to come. So, it can be saidthat, the Piirvanipas are the Premonitorysigns and symptoms which appear beforean illness being about to arise. ThesePiirvariipas may give a clue to the diseasebut, at this stage one cannot be certainwhether any disease will manifest itself orwhether the disease may subside. Thesesigns and symptoms may be few and maynot be very pronounced but an intelligentphysician may be able to guess the adventof the disease very often. Although theprodromal symptoms should not beconsidered as actual symptoms of thedisease as study of these symptoms is' ofgreat value in detecting the onset of aparticular disease well before hand andeven in preventing it by taking thenecessary steps.

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The Piirvariipas are of two kinds, Viz.Samanya (general) and Visista (special).Samanya Porvarnpas are tliose whichindicate the disease to some extent withoutgiving any indication of the Dosaderangement, Visista Porvampas are thosewhich give an idea of the Dosa also inaddition to some idea about the disease. Itis from the Rupa (signs and symptoms)That, we can have a clear and definite ideaof the disease and of the Dosas, e.g.excessive yaning occurring before fevermay be taken as Visi~ta Piirvariipa of Vat atype offever; burning sensation in the eyesas a Visi~ta Purvariipa of pitta type offeverand disgust for food as V isista Piirvariipaof Kapha type of fever.

Another point of distinction pointedout between samanya and VisistaPiirvariipas is that the Sarnanya Piirvariipasgenerally disappear before the onset of thedisease whereas Visista Piirvarupas arelikely to continue after the diseasecommences. It is further stated that if alarge number of premonitory symptomsmentioned in the case of a disease, persistalso after the disease manifests itself, theprognosis is considered to be grave. As itis mentioned in Caraka Sarnhita "If all thepiirvariipas of fever as have already beenspoken of, are seen in a man with excessiveintensity death makes it entry in to himpreceeded by fever. If all the premonitorysymptoms of any other disease find a placein a man, similarly with excessive intensity,death is certain to be fall him consequetupon that particular disease (Indriya sthana,5/4-5) .:

10 - The Madhava Nidiina and its chief commentary by G.lan Meulenbeld (1974) P.Nos. 43 & 47.

II.~~yurveda ~iksha (A Text - Book of Ayurveda) Volume IV~Section L "Principles of Diagnosis" (RogaVIJnanam), edited by Dr.A.Lakshmipathi (1945) Circus Maidan, Governorpet Bezwada, P.Nos.35-J8.

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I: 7: When this same (Phenomenon. i.e. thegroup of premonitory symptoms) has reached adeveloped state then it is called Riipa (signs andsymptoms), Samstbjina (Shape), Vyanjana(manifestation), Liriga (signs), Laks.a,!a(charactertisctics), Cinha (indication) and Akrti(form)

(A.H.Nid. 1,5)When the Piirvariipas, are manifested

in the disease, then they are called Riipas,As'mentioned in Caraka Sarnhita "Thesymptoms are characteristic manifestationswhich develop during the course of thedisease. Here liriga, Akrti, Laksana Cinha,Samsthana, Vyanja~a and' Riipa aresynonymous (Nidana, 1/9).12 All thesesynonyms of the word Riipa indicate thesigns and symptoms by which a disease isidentified: In this definition, it is intendedto state definitely that Piirvariipas, whichexisted before the onset of disease, are notRiipas and only those tokens that indicatea disease are called Riipas. The questionnow arises whether the sum total of Riipasis in itself a disease or not,? Ordinarilywhen we speak of Jvafa (fever) we intendby that term Jvara, all the signs andsymptoms by which the jvara is expressedor manifested. Here, Jvara is taken as adisease and not as a symptoms. In othercases, i.e. in pravahika (Dysentery) orKustha (Leprosy), Jvara may exist alongwith other predominant symptoms ofDysentary or Leprosy, then we considerjvara as one of the symptoms of the diseaseand not the disease itself. Arocaka(anorexia) may be one of the symptoms ofjvara but, Arocaka may sometimes exist

Bull.Ind.Inst.Hist.Med. Vol.XXIX - 1999

without any jvara at all and may be the onlysymptoms, then it (Arocaka) is consideredas a disease.

It is said that, the symptoms are not thedisease but the abnormal condition of thebody which causes these symptoms, is thedisease. A name given to the group ofsymptoms, or to one symptom alone, isaccepted as the name of the disease. Carakahimselfhas given his consent for using suchnomenclature for purposes of corveniencein the identification and treatment of adisease, such as "In this epitome ofdescription and treatment of a disease, suchas "In this epitome of description of thediseases, some of those that have beenmentioned as the symptoms of diseasesappear as independent diseases; as long asthey exist secondarily, they are calledsymptoms and not diseases" (Nidana, 8/40).

It often happens that, for the sake ofeasy understanding, symptoms bythemselves are spoken of as disease in thesection on Nidana, This was done for thesake of convenience but the symptoms areonly symptoms and they can never bediseases. The purpose oftreatrnent shouldbe to break the Dosa Diishya Samrniirchana(the abnormal interaction - between dosasand dusyas). Although, for purposes ofconvenience symptomatic treatment issometimes given, the original object of thetreatment should never be forgotten. Forthis purpose a knowledge of minute detailsof Riipas (Signs and symptoms) becomesessential. 13.

12 - The Miidhava Nidana & its chief Commentary (Chapters 1-10), by GJan. Meulenbeld (1974),1st Chapter, P.No. 48.

Definition Of Nidana Panchaka - Momin Ali 5

1,8-9: The use of medicines, foods and rules and rules of conduct having oppositeof conduct, opposite to cause and disease or both, qualities of the country (the habitat of theproviding the result of that which is opposite (to individuals) arid the causative factors of thecause and disease or both) and conducive to well ailments prevalent there" (Surra, 6/50).being should be known as Upasya (therapeutic Upasya is divided into two broaddiagnosis) of ~ disease, which is traditionally called groups such as (i) the remedial agents etc,Satmya i.e. adequate (treatment). The opposite (of which are actually antagonistic to the causeit), Anupasya (adverse therapeutic diagnosis), is of the disease and / or disease itself and.technically called Asatmya i.e. inadequate (ii) the remedial agents etc., which are(treatment) with regard to the disease actually not antagonistic either to the cause

(A.H.Nid. 1,6-7). of the disease or to the disease itself butNext is order comes, what is termed when employed, they actually alleviate the

as Upasaya, which is really a form of condition by counteracting either thediagnosis by applied therapeutics. As it has disease and/or the cause of it.been mentioned in Caraka Sarnhita that. Upasaya provides diagnostic aid for"Such of the medicines, foods and: rules of ailments which are otherwise difficult forconduct as bring about happiness either by diagnosis, as it has been stated in Carakaacting directly against the cause of the Sarnhita :disease, and or the disease itself or by "The following among others are theproducing such effects indirectly are called factors to be observed by inference .Upasya." "In other words: "The diseases with latent symptoms by thehomologatory signs are those which administration of such therapies as wouldindicate what kinds of medicine, food and alleviate or aggravate the condition "behaviour are antagonistic directly or in (Vimana, 4/8). For example as given ineffect to disease and its causative factors the Caraka Samhita, that: "The edemaand what are agreeable to the patient's which is reddish in appear, which issystem" (Nidana, III 0). lessened at night due to rest and which

Thus, the use of a medicine, a diet or disappears when massaged with unctuousthe hygienic conduct, which has given relief and hot substances is also due to vatais called Upasaya. Its synonym is Satmya, (Siitra, 18/ I0).14i.e. adequate (treatment), when otherwise Following are the various types ofit is Asatmya, i.e. inadequate (treatment) Upasaya: 1- Hetuviparita (Those thingsor adverse therapeutic diagnosis with which are contrary to cause of the disease:regard to the ailment. In this case it is said, (a) Medicines: The administration ofmedicines, foods and rules of conduct Medicines having usnatva quality heatingconstitute an implicative expression effect) like sunthi (Zingiber officinaleincluding place and time also, as it is given Rosc.) in fever caused by cold regimen andin Caraka Sarnhita that: "The knowers of also by the vitiation of Kaphadosa. As itthe principles of homologation advise has been given in the Caraka Sarnhita that,habitual use of such foods (including drugs) "The intelligent physicians administer13· Ayurveda Siksha, Vol.IV - Section - I, "Principles of Diagnosis, edited by DrA.Lakshmipathi (1945),

Circus Maidan Governor Pet, Bezawada (Vijayawada), P.No. 39-41.

14 - The Madhava Nidana & its chief Commentary (Chapters 1-10\ by Jan Meulenbeld (1974), I SI chapter,P.Nos. )2-53.

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cold things to cure diseases caused by hotthings; and for those diseases that arecaused by cold things, hot medicines areuseful" (Vimana, 3/41)

(b) Foods: The administration of riceboild in meat-broth (a form offood) in afever caused by fatigue and also by theVitiation of'vata, to remove the fatigue, thecause of fever, i.e. Vata.

(c) Rules of Conduct: The act ofremaining awake in the night in a diseaseof Kapha to counter act the Kapha whichis caused by excessive sleep in the daytime.

As it is mentioned in Caraka Sarnhitathat, "sleeping during the day time in theseasons other than summer is notadvisableas it causes vitiation of Kapha and. Pitta"(Siitra, 21144). _

2. Vyadhiviparita (those things whichare contrary to the disease):-

(a) Medicines: The administration ofPiltha (Cissampe/os pareira Linn.) andKutaja (Holrrhana antidysenterica wall.)as ~tringents in diarrhoea; in the same waysirisa (Albizzia lebbeck Benth.) in Visa(poison) (a specific like) to destroy itKhadira (Acaciacatechu willed.) In Kustha(Skjn disease) and Haridra (Curcuma longaLinn.) in Prameha (Urinary diseases) areadministered. Here the medicine is givenas a specific in the particular disease in aroutine manner irrespective of the natureof the deranged dosas,

(b) Foods: Intake of bowel bindingfoods like Masiira (Lens Culinaris Medic.)in diarrhoea.

(c). Rules of conduct: Pravahana(Strained evacuation by causing downwardpressure in abdomen) in Udavarta (aretentive disease with pain in abdomen-dueto misperistalsis) as a therapeutic measure.

Bull. Ind. Inst. Hist,Med. Vo/.XXIX - 1999

3. Hetuvyadhiviparita (those thingswhich are contrary to both the disease andits causative factors) :-

(a) Medicines : In Vatika sotha(swelling caused by' the Vitiation of Vat a)administration of the Dasmula (roots ofAegle marmelos corr, Oroxylum indicumvent., Gmelina arborea Linn;Stereospermum suaveolens D.C.,Cleroden-drum phlomidis Linn. f.ofDesmodium caneticum D.C.,-Uraria gictaDesv., So/annum indicum Linn., So/anumxanthocarpum Schrad. wendl., andTribulus terrestris Linn., which eliminateboth the Vata as well as the swelling.

(b) Foods: The administration ofTakra(buttermilk) in grahani (disorder) arisenfrom Vata and Kapha. Here Takra checksVata kapha and it is also a specific forGraham, and the administration of a hot andantipyretic peya (a thin gruel) in vatikafever caused by the cold things for itdestroys Vata by its hot potency and feverby its special faculty.

As it is stated in the Caraka Sarnhitathat " , and being wholesome in fever,they act as febriguge. Therefore, the wisephysician should treat the fever-patientwith gruels from the very beginning exceptin case where the fever is due toalcoholism" (Cikitsa, 31153.)

(b) Rules of Conduct: Remainingawake during night which causesroughness, for the treatment of drowsinesscaused by the sleep during day time, whichis unctuous. Thus it is the opposite to boththe cause and disease.

4. Hetuviparitarthakari (those thingswhich work against the causative factorsof disease; even though they are notantagonistic) :-

(a) Medicines: Application of upanaha

Definition Of Nidana Panchaka - Momin Ali

sweda (hot poultics) which normallyaggravates pitta. for the treatment ofoedema dominated by the vitiated pitta.

(b) Foods: Intake offoods which causeburning sensation, by a patient sufferingfrom oedema dominated by vitiated pitta.Here the disease is caused by pitta, theagents employed to effect the cure alsopromote pitta.

(c) Rules of Conduct: Terrorising apatient suffering from Vatika Unmada(insanity caused by the vitiated vata). Fear,which is one of the causes of promotinginsanity, increases Vata, but, here, it helpsthe patient as anamliorative measure.

5. Vyadhiviparitarthakaritthose thingswhich work against the disease; eventhough they are not antagonistic):-

(a) Medicines: Administration of theMadan phala (Randia-dumetorum Lam),which itself is an emetic for the treatmentof vomiting.

(b) Foods: Intake of milk (as) apurgative in diarrhoea.

(c) Rules of: Tickling (of the throat)for bringing about upward pressure inabdomen in order to (provoke) vomitingfor the treatment of vomiting.

6- Hetuvyadhiviparitarthakari (thosethings which work against the disease andits causative factors; even though they arenot antagonistic): -

(a) Medicines: Application of ointmentprepared of aguru (Aquilaria agallochaRoxb.) etc. for the cure of burns caused byfire, both the disease and its causativefactors are hot and the medicine applied

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over it, is also hot. In this way, theadministration of ooison to cure a case ofpoisoning also.

(b) Foods : Administration ofintoxicating alcohol for the treatment ofalcoholism caused by the intake of alcohol.

(c) Rules of conduct: Physicalexercise, in the form of swimming, for thetreatment ofSandhigata vata (gout) causedby excessive physical exercise - swimminghere is recommended as an ameliorativemeasure.

In this way, each of the six type ofUpasya is divided into three classesaccording to .the use of Medicines, Foodsand Rules of conduct thus, making eighteenvarieties 'Of the Upasaya as mentionedabove.

Anupasaya, which also helps indiagnosing a disease by its negative effectis included under etiological factors, hence,not to be mentioned separately.

1, 10: The process of manifastation of anailment by a do~a (morbific entity), in accordancewith the (particular manner of its) corruption andthe (particular manner of its) spreading is calledSamprapti (pathogenesis) or jiiti (emersion) or Agati(origination). (A.H.Nid. 1,8) u a. 16

Samprapti means the description of thepathology of the dosas, dhatus and malasetc., orin other words,it is the description,in detail of all the morbid processes thattake place in different diseases or indifferent stages of the same disease. Theaccumulation of the dosas, theirmovements and the particular form whichthe disease takes, are included in sarnprapti,

15. Caraka Samhija, with English Translation and critical exposition by Dr. R.K. Sharma & Vol. BhagwanDash (1985) Vol. II. Published by Chowkhamba Sanskrit series office, Varanasi - 221001 (India),P.Nos.9-1l.

16. The Madhava Nidana & its Chief Commentary, (Chapters 1-10) by G.Jan Meulenbeld (1974)P.Nos. 53-58

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-The words Jati and Agati are itssynonyms."

Some scholars are of the opinion that,the factor which finally determines themanifestation of a disease is Sarnprapti.According to them, like Nidana etc.,Samprapti is not indicative of theunmanifested disease but of the manifestedon. Some other scholars do not agree withthis view because in that case Sampraptidoes not materially help in the diagnosisof the disease. It is also not necessary,according to them that a disease should bediagnosed only when it is fully manifestedbecause even in unmanifested stage.disease are diagnosed by the help of'Nidanaand Purvariipa, Therefore, the genesis ofthe disease by the specific action of vitiateddosas responsible for its causation is calledSamprapti. Thus, the synonym Agati whichmeans the course of a disease right fromthe affection by the causative factors up toits manifestation, is justified. ThisSamprapti helps in the comprehension ofthe specific feature of a disease. Forexample, the Samprapti of Jvara (fever)indicates that, the dosas vitiated by variouscauses enter into Amasaya (Stomachincluding Small intestines) and expellingthe Jatharagni out of its place (suppressionof the power of digestion as well asmetabolism) extend themselves into theRasa Dhatu (Plasma and other fluidcontents of the body) an_dcause Jvara. Nodoubt, afflication of Arnasaya etc. aremanifested due to the dosas and as suchshould be comprehended by the mention

Bull.Ind.Inst.Hist.Med. Vol.XXIX - 1999

of causative factors. But in view of thespecific purpose served by thesemanifestations of causative factors, they arementioned separately under Samprapti.Similarly piirvarupa, which forms a part ofRupa has been stated separately because ithelps in the diagnosis of a disease beforeits manifestation. II

1.11 : This (Samprapti) is distinguished (intovarious kinds) on the basis of specification regardingSankhya (number) Vikalpa (discrimination),Pradhinya (Predominance), Bala (force) and kala(time), in a way as in this very (book) it will be said"there arc eight (types of) fever" (This is calledSankhya samprapti),

1.12 : Vikalpa (discrimination) (Samprapti), isthe settling of each component of the united morbificentities, responsible for the manifestation of adisease; the pradhinya (pre-dominance) of a diseasewill be indicated by its independence or dependence.

1.13 : Bala (the specific force or weakness of adisease) is known by the completeness of the(presence of) sub-divisions of the (series consistingof the cause etc.,) Kala (the time) of a disease (willbe determind) by the component parts of night, day,season and the (digestive process ofthe ) ingestedfood, in accordance with the (particular) dosa(impurity-involved). 19.

(A.H.Nid. 1,9-11).On the basis of certain specific

characteristics the srnaprapti has beensubdivided here into following five kinds:

I. Sankhya sarnprapti :- It is thenumber of varieties or types in whichdiseases may manifest themselves e.g.,there are eight types of fever, As it has beenalso mentioned in Caraka Samhita that :

17. "Ayurveda Siksha" Volume IV - Section I, principles of Diagnosis (Roga Vijnan), edited andpublished by Dr.A Lakshmipathi (1945) P.No. 47.

18. "Caraka Sarnhita" with English Translation and Critical Exposition by Dr. R.K. Sharma andVd.Bhagwan Dash, Vol. II, Published by Choukhamba Sanskrit Series office, Varanasi - 221001 (India),P.No.II-I2.

19. "The Madhava Nidana and its chief commentary; (chapters 1-10,) by GJ. Meulenbeld (1974) P.No.60.

Definition Of Nidana Panchaka - Momin Ali

"The number of the (Type of the disease isresponsible for the variation of thesamprapti., e.g. eight kinds ofjvara (Fever),five kinds of gulma (Abdominal tumour),seven varieties of Kustha (Dermatosis) andso on" (Nidana, 1112 (2)

2. V ikalpa Sarnprapti : VikaJpa ordiscrimination is the settling of one or theother component (dryness, etc of the Vataetc.) of the united morbific entities. It canalso be expresed as, the measure in whichthe dosas are excited in the dosic triad orthe measure in which the dosa gU':las thatexcite the dosas, exist. As it has also beenmentioned in Car ak a Sam h ita that:"Vikalpa in this context is used to signifyprecise minute pathological changes ofeach of the three dosas "(Nidana. 1112 (5).

3. Pradhanya Sarnprapti :- Thepredominance ofa particular dosa or dosasor the aiscertainment whether a disease isindependent (primary) or dependent(secondary to or complicating the primarydisease) is the Pradhanya sarnprapti. Thepredominance results from independenceand non-predominance from dependence,moreover non-predominance should alsobe understood, here which is not explainedbecause it it easily understood.

In Caraka sarnhita also it is said that"The Predominance of morbid humorsdescribed in terms of the comparative andsuperlative degrees. If two out of the threedosas get vitiated, the comparative term"tara" is used to indicate the predominantone. If, however, all the three dosas getvitiated then superlative term "Tam a" isused to indicate the most predominant one(Nidana, 1/12 (3»

4. Bala Samprapti ;- It is the specificforce or weakness of a disease. The forceof a disease is known by the completness

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of the presence of the cause, prodromataand symptoms, its weakness results fromthe presence of subdivisions i.e., fragmentsof these (cause etc.) Thus, Bala Sarnpraptiis the strength of a disease, known by itsseverity or mildness depending uponpresence or absence of all the cause,prodromes and symptoms.

Kala Samprapti ;- It is to signify that adisease is severe, moderate or mild duringa particular time factor, i.e., the night, day,season and the (digestive process of the)ingested food, in accordance with theparticular dosa involved. As it has beensaid in Astanga hrdaya that, "Though beingpervasive, they (Vata, Pitta Kapha) areresiding under, between and above theCardiac and umblical regions, they belongto the end, middle part and beginning oflife, day, night and (the digestive processof) the ingested food in due order" (Sut. II

7cd-8 ab).In Caraka Sarnhita Bala Sarnprapti has

not been given separately, but, it isdescribed along with the kala sarnprapti,and one Vidhi (mode) samprapti has alsobeen described. Thus according to Carakathe Samprapti is of five types only. InMadhava Nidana the Vidhi Samprapti hasnot been described, for which Vijayaraksitasays, that, the term Sankhya includes theVidhi because the latter is invariablyconnected with Sankhya (number)

That are the characteristics of theSamprapti.

I, 14 a b: Thus has been proclaimed what is

meant by nidana; it will be elaborated later.

(A.H.Nid. I, 12 ab)

In this way a general description oftheNidana etc. (the five means of gettingknowledge about a disease) has been givenuo till now. Hereafter, the Nidana etc.,

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belonging to each particular diseasetogether with the specific particulars ofeach of the disease have been describedelaborately.

I, 14 cd - 15 ab : The excited dosas arc reallythe root cause of all disease and the cause of theexcitement of the dosas again is proclaimed to bethe indulgence in different kinds of unwholesomefoods or activities in several ways.

(A.H.Nid.l, 12 cd -I3ab)Generally, the causes of diseases are

twofold, viz. Viprakrsta (distant) andSannikrsta (near), and with regard to thisdistinction, unwholesome foods etc. (i.e.inadequate conjunction of the senses withtheir objects, errors in judgement andtransformation by time) are Viprakrsta andvitiated Viita etc. are the Sanniknta causes.All diseases are invariably caused by thevitiated dosas, as it is mentioned in Susrutasamhiti that, "As a disease cannot occurwithout involvement of dosas, hence evenif the disease is not (specifically)mentioned, the intelligent physician shouldtreat the disease as manifested by the signsand symptoms of vitiated dosas" (siitra, 35119).

Although excitement of a dosa doesnot occur in the production of adventitiousillness, nevertheless this excitement willnecessarily come about immediately afterthe production, in the same way as theconnection with its qualities in a medicalsubstance which has been produced .. As itis given in Caraka Samhita that, "Theexogenous one (disease) begins with painand later on leads to the discordance ofVata, Pitta and Kapha" (Siitra, 20 7(1).

Diseases as causative factors for otherdiseases:

I, 15 cd : Diseases also. act as the causativefactors of other diseases,

Bull.lnd.lnst.Hist,Med. Vol.XXIX - 1999

1,16 : For example. Raktapitta (hemothcrmia)is produced as theresult of the general glowing heatof Jvara (Fever) arid'Jvara is also produced byRaktapitta; from both these (Jvara and Raktapitta)sosa (consumption) also arises;

1,17 : Jathara (abdominal affections ascitis)may result from the enlargement of spleen and from

/ /

Jathara, certainly sotha (edema); from arsa(Haemorrhoids) there may result abdominalsuffering and also gulma (abdominal Tumor)

/

Pratisyaya (coryza) results from morbific factorssuch as sleeping at day time etc):

I, 18 : Kasa (caugh) may result from corryzaand Ksaya (wasting) from Kasa: and the Ksaya actingas a causative factor may lead to the disease (called)sosa.

(C.N. 8,16 cd-19).Though, a disease sometimes becames

a cause for another disease. But thecausative factors of the primary diseaseshould be considered as the etiologicalfactors for the secondary disease also.Caraka has summarily described theetiological factors of all the primarydiseases as being threefold as••................ isknown as the unholesome conjunction. Theobjects of sense faculties which are of fivekinds are further subdivided into three each(Viz. non-utlisation, excessive utilisationand wrong utilisation" (sut 11,38). The useof thererm Nidanarthakara implies that,there is no further category of causativefactors. Further, a disease bringing aboutanother disease, can do so only when itsforce has been augmented by another cause.For example, the Jvara, as mentioned abovedoes not start Raktapitta, as long as its forceis not augmented by the unwholesomeconjuction of the senses with their objectsetc., such as, Jvara is caused by substanceshaving heating property and if suchsubstances are excessively used or other

Definition OJNidana Panchaka - Momin Ali

substances having properties conducive tothe production of Raktapitta aresimultaneously used then it results in theproduction ofraktapitta. Thus, with regardto the production ofa disease the cause istherefore, threefold, directly or indirectly.Casuative factors as diseases in stages:I, 19 a b: They exist first as isolated diseases, andlater on act as causative factors of other diseases.

(C. N.8,20 a b)These primary diseases in initial stage

are existing as such alone, and later on,being augmented by another cause, theybring about another disease, as for exampleJvara generates raktapitta.Nature of disease and difficulty in cure:I, 19 cd : Sometimes one disease gets subsided, aftergiving rise to another disease,1,20 : Whereas, there are other diseases which evenafter causing another disease do not subside.Such admixtures of diseases in human beings areregarded as being those which are the most difficultfor treatment.

(C.N.8, 21-22 ab)Some diseases get subsided after

causing another disease, but there are other

11

diseases which produce yet other diseaseswithout themselves subsiding. For examplecoryya may continue to exist along withkasa after causing to latter, and at timesafter causing kasa, coryza itself may getsubsided. In the former case coryya isconsidered both as a disease as well as acausative factors, in the latter case it actsonly as a causative factor.

The examples of admixures ofdiseases, i.e. combinations of diseases are:when coryza does not cease and cough isproduced, haemorrhoids do not cease andabdominal affection and visceral swellingoccur. They are most difficut to cure dueto the combination of diseases, as theygenerate suffering of many kinds andusually are obstructive to treatment.

1,21 : So, the accomplished physicians desirousof outstanding success; in the field of treatment haveto learn, exerting themselves, this very ascertainmentof Jvara(fever), etc., which will be described further.

Therefore, the physicians desirous ofsuccess have to strive hard to understandthe diagnosis of diseases like jvara (fever)etc. as being described hereafter, 20& 21

Thus ends the chapter called Panca Laksana Nidana.

20. Caraka Samhita (Text with English translation & critical exposition based on Cakrapani Datta'sAyurveda Dipika commentary) by Dr. R.K. Sharma and Vol. Bhagwan Dash, Vol. II, 2nd Edn. (1985),Pub. by Chowkhamba Sanskrit series office, Varanasi - I, P.Nos. 105 & 106.

21. The Madhava Nidana & its Chief Commentary (chapters 1-10) by GJan Meulenbeld (1974),P.Nos.66-68.

12

1. Lakshmipathi, A.

2. Meulenbeld, GJ.

3. Sharma, R.K. & Bhagwan Dash

4. Singhal, G.D. & Sharma, K.R.

Bull.Ind.Inst.Hist.Med. Vol.XXIX - 1999

REFERENCES1945

1974

1985

1976

"Ayurveda Siksha" ( A Text - Book of Ayurveda)Volume IV - Section -1, "PrinciplesofDiagnosis"(Roga vijnanam) edited by Dr. A. Lakshmipathi,Circus Maidan, Governorpet, Bezwada (Vijaya-wad a (India).

The Madhavanidana and its Chief Commentary( Chapters 1-10). Printed with financial support ofthe Netherlands Qrganization for the Advancementof - Pure Research (Z.W.O.), Leiden, E.J. Brill.

Caraka Samhita (Text with English translation& critical exposition based on Cakrapani Datta'sAyurvcda Dipika commentary) by DrR.K. Sharma and Vd. I3hagwan Dash, Vol. II,2nd Edn. Pub. by Chowkharnba Sanskrit seriesoffice, Varanasi - I (India).

Ophthalmic & otorhinolaryngological consider-rations in Ancient Indian Surgery (based onSalakya Tantra Portion of Uttara Tantra ofSusruta Samhita, Published by Dr. G.D. Singhal,Singhal Publications, 14, SammelanMarg, Allahabad- 211003 (India).

Defination of Nidana Panchaka - Momin AU 13

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