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Introduction

Ayurveda, the Indian system of medicine has its own branch of speciality for understanding the disease process and proper diagnosis of disease. The art of understanding a disease and its stages of pathogenesis was probably explained for the first time in Ayurveda in a very comprehensive way.  It consists of many ways to diagnose a disease. One of them is Nidanpanchaka. The diagnosis of disease in Ayurveda depends upon the etiological factors of disease. These etiological factors are responsible for further signs and symptoms of the disease.  In Ayurveda, Nidanpanchaka is explained in Charaksamhita, Sushrutsamhita, Ashtanghridaya but it is moreover and widely explained in Madhavanidan[1]. Charaka[2] has stated that the Nidan(diagnosis) is very important and essential before proceeding for treatment. Ayurveda explained 2 basic components for diagnosis namely Rogpariksha and Rogipariksha[3] which refers to Examination of disease and Examinations of patients respectively. Among them Rogapariksha gives us the detailed knowledge about a disease starting from etiological aspects to actual manifestation of disease which is not mentioned in conventional modern science. The five basic components of Rogapariksha  are  Nidan[4] (etiological factors), Purvarupa[5] (premonitory symptoms), Rupa[6](signs and symptoms), Upashaya[7] (examination methods), Samprati[8 ](pathogenesis) which are collectively known as Nidanpanchaka[9]. Apart from diagnosing a disease, they also play a key role in planning the treatment of that disease. The Nidana (causative factor) are responsible for Dosha  imbalance. Nidan is the first component of Nidanpanchaka  which gives the knowledge of etiological factors of a disease also helps in treatment by avoiding them. Hetu(etiology), Linga(sign and symptoms), Aushadha(drug and therapy) are the three Sutra[10](principles) of Ayurveda. Without the knowledge of Hetu and Linga the implication of Aushadha is not possible. Purvrupa refers to premonitory symptoms and represents the 4th stage of disease formation which is Sthansanshraya part of Shatkriyakala[11] explained in Sushrutsamhita. Rupa   refers to signs of disease after manifestation of Purvroopa.   If physician is able to recognize   them as early as possible and treat accordingly then the further progression of disease is ceased. When above components are unable to diagnose a diseses then Upashaya (examination method) is the way to diagnose the disease. Last is the Samprapti which is process of manifestation of disease. In   this  way, every component of Nidanpanchaka  helps the physician for better understanding of the disease at an earliest possible stage. In the present era, many new diseases are emerging with varied   features; all of these were not mentioned in our science but on the basis of Nidanpanchaka we can make out the disease as well as management[12]. There are various methods of diagnosis of disease or diagnostic tools, investigations i.e. hematological, serological, radiological etc are mentioned in modern science but all these can be used only after manifestation of disease. But Nidanpanchaka is such a best diagnostic tool explained in Ayurveda which can be used in early stages of disease also prevent by avoiding Hetus. So, the study of these Nidanpanchaka is essential in today’s era for preventing disease and avoiding further complications.

Aim : To Study Importance of Nidanpanchaka in  various Ayurvedic Aspects

Objective: 1.To study importance of Nidanpanchaka.

                 2. Application of components of Nidanpanchaka in modern science.

Material and Methods:

It is conceptual study. For this study material related to  Rogpariksha, Nidanpanchaka i.e.  Hetu, Purvroopa, Roopa, Upashay, Samprati is collected from various literature like Charaksamhita, Sushrutsamhita, Madhavnida and various modern textbook  also from online publications and  articles.

Hetu (etiological factors)- The word  Hetu is used in two different context i.e.Vyadhiutpatti dhapti(diagnostic factor) and hetubhuta (causative factor). There are various types of classification of hetu describe in all the ancient literature as follows-

Table no .1 Classification [13]

Table no .2  Classification 2

Table no .3 Classification 3

 Classification 4

1. Bahya hetu (diet, lifestyle)

2. Abhyantar hetu (dosha)

Purvroop (Premonitory symptoms)- These are the symptoms which are produced in body before

manifestation of disease. This concept is given only in Ayurvedic text They are used to diagnose the disease. When there is accumulation of Dosha and Dushya in body they produce Purvroopa(premonitory symptoms in the body). There are 2 types of Purvroopa are as follows- 1.Samanya-(common) For example In Jwara vyadhi (fever) fatigue, weakness are samanya purvroopa

2.Vishishta- (according to doshas) For example Vatika jwar- jrimbha(yawing), pittaja jwar-Nayandah (burning sensation of eyes), Kaphaja jwar-anannabhilasha are the vishesh purvroopa.

Roopa (Signs)-These are the signs of disease which are important for diagnosis of disease. The signs of the disease are always seen after  the aggrevation of the Doshas and formation of the disease.

Upshaya (examination method)- The disease whose manifestation, symptoms, signs doesn’t clear the production of disease and from which Dosha and Dushya it has been produced in that diseases Upashya (examination methods) are used to rule out the disease. Treatment used drugs ,lifestyle, diet is also considered in Upashaya. There are 18 types of Upshaya are explained in Ayurveda. They are classified as 1.Hetuviparita 2.Vyadhiviparit 3.Hetu-Vyadhi ubhay viparit 4.Hetuviparitarthkari 5.Vyadhiviparitarthkari 6.Hetu-Vyadhi ubhyaviparitarthkari according to Aushadh(drugs), Anna(diet), Vihara(lifestyle).

For.example- In Sheetkaphaj Jwar(fever) Sunthi (ginger) is given as Aushadh is Hetuviparit.

Samprati (pathogenesis)- Samprapti is explained in Samhita as  Dosha Dushya get vitiated  and get  aggrevated and produce disease and that disease is known by Samprapti. The  process by which disease produce is known as Samprapti. This can be taken as stages through which disease evolve. In Samprati the evolution of the disease from the starting point as Nidan till the invesigations can be considered. It is mainly divided into 2 types:-

1. Samanya- a)Sanchyavastha- in which Dosha get accumulated

                   b)Prakopavasha- in which Dosha get aggrevated

                   c)Prasaravashta- in which Dosha goes to other places of the body other than their    

                       origin  place and get aggrevated 

                   d)Sthansanshraya- They get accumulated in Khavaigunya(vacant space)

                   e)Vyakti- Sign and symptoms will be seen in this stage

                   d)Bheda avastha- Stage of complication

     According to Sushruta, above types are the stages in Shatkriyakala. Actual manifestation of disease starts from 4th stage that is Sthansanshraya which shows Purvroopa(premonitory symptoms. 1st three stages can be prevented by avoiding Hetusevana as mentioned above.

2. Vishishta-a) Sankhya b)Pradhanya c)Vidhi d)Vikalpa e)Bala

Discussion

For diagnostic aspect Nidana-From above detailed explanation and classification of Hetu shows importance of Hetu in Vyadhi(disease). Some   diseases  like, Kushtha and Prameha having same Purvroopa so one should take the help of Nidana for proper diagnosis. For  differential diagnosis- example Udar roga and its type Yakrotodar. For treatment-Acharya Sushruta has explained that with the change of diet. Lifestyle that is Nidanparivarjan is the best way of treatment of disease. For prognosis- If the causative agent is less effective then the disease is sadhya(curable), if the causative agent is moderately effective then the disease is Krichhasadhya(may be curable) and if the causative agent is more effective the disease is Asadhya(incurable).Puravroop is also useful for diagnostic aspect –as Jwar (fever) and Gulma(tumor) has same nidana, for differential diagnosis- Kasa(cough), Hikka(hiccup), for treatment- in Jwara(fever) Langhana(fasting) is done seen after purvroopa. For prognosis- if the symptoms are less or more effective according to them they are curable or incurable.

Roopa- It is used to give a differential diagnosis of Raktapitta and Prameha signs.

Upashaya- It will help in the diagnosis and examination of Vatvyadhi as Urustambha.

Samprati- It will help to know the stages of formation of disease in which they can be cure.            They all have therapeutic importance as Nidan Parivarjan will stop the formation of disease, if treatment is started in Purvroopa it is easily curable, Roopa will give the information of disease to treat it, Upashya describe the disease which has no specific sign and symptoms and after knowledge of Samprati Dosha and Dushya can be dissociated and they will not produce a disease.

Conclusion

These are the main important diagnostic tools in Ayurveda. This study shows that if they are used in a proper method they will be useful in diagnostic, prognosis of disease. After the proper use of these Nidanpanchaka the disease manifestation can be stopped and can   be cure easily. Nidanpanchaka is very useful way of diagnosis given in Madhavanidana. By Nidanpanchaka the disease stages will be well known and by knowing the stages of disease the disease formation can be stopped in any stage. If Nidanpanchaka is used in a well manner Upadrava(complications) can be avoided. So proper knowledge of  Nidanpanchaka that is Rognidan approach is essential for diagnosis of disease.