Proper study and understanding of the details of nidana and samprapti
In Ayurveda, disease is studied in this way and order.
- Nidana or hetu – pathogenesis or reason
- Lakshanas – signs and symptoms
- Chikitsa – Management
- Apunarbhava – avoiding recurrence of same disease
If the person is following the same lifestyle and they do not change it, they will have a recurrence of disease. This must also take into account food, lifestyle, exercise etc.
Nidana and Lakshanas gives knowledge of the disease while Chikitsa and Apunarbhava give knowledge of the management of the disease.
Nidana and Hetu
Treating a disease without proper diagnosis, even though it may be cured it is an accidental cure. In treating the disease with full knowledge of diagnosis, and the doctor has good knowledge of all factors (desham, kalam, etc.) then the patient will get the positive benefit and it will not be accidental. We must be really aware of factors so we can be 100% sure of the treatment of the disease.
16 factors are described in Astanga Hrydaya. The first chapter describes sarva roga nidana. It has a comprehensive awareness of nidana, purvarupa, vyadhi etc. but no disease described.
2nd chapter – describes jwara (fever), it is the first disease to occur in the universe.
Very simple examples of hetu are given in it like excessive eating of anything can cause aama. This can be cured by a day of fasting or shunthi boiled with water to help to digest that aama.
Hetu alone is not sufficient to study a disease.
Nidana Panchakala – Causatives 5 times
Hetu, Nidana, Nimitha , Ayathanam, Karanam – all synonyms for Nidana meaning causative factors
Hetu is causative factors – if the causative factors are not addressed this can lead to more serious disease. Stopping the causative factor is a treatment itself. If you understand the causative factor in detail you can then understand what dosha is involved. Understanding the strength of the causative factors will help you understand what kind of strength of treatment is required. Going outside in the cold and starting to sneeze is an example of Shita and kapha vrudhi. It is not a strong hetu so it only needs a mild treatment. Hetu also determines potency of the drug required to treat, as well as how long it will take to treat. Example, arthritis: causative factor may be very longstanding, so treatment may also be longstanding. Bala (strength) of the Roga (disease) can be understood by…
Purvarupa – This is before the full manifestation of the disease. It is pre-signs and symptoms of the disease. There are always subtle premonitory signs and symptoms. They may be very difficult to assess which roga (disease) is going to be created because in this period people wont generally go for any medical management. It is always in the full blown disease when people go to get help. Premonitory signs and symptoms before onset of disease. If one can recognize the purvarupa, one can take some precautions so it doesn’t advance into the next stage of disease. It helps to identify the doshas and to know the strength of the disease. If the purvarupas are well known in the patient, the disease will be stronger. Knowing the bala (strength)of the vyadhi can be ascertained from the purvarupa. If one is able to cure it at the purvarupa stage, it wont advance to next stage.
Samyapurvarupa – general – described in detail in texts
Vishistapurvarupa – specific – understand dosha predominance of the disease yawning for jwara – vata. Burning sensation in eyes for jwara– pitta dosha. Indigestion is seen or no taste for disease – kaphajwara. One can determine the dosha combination of the disease.
Shatkriyakal – (stages of disease) at stanasanshrayam, purvarupa are seen, sanchayam, prakopama. Classical texts talk about vyakti bhava – at rupa full blown manifestation of disease is already there.
Khavaigunya/weakness place in body
Rupa – Ayurveda is science of lakshana (sign diagnosis). It is able to observe the lakshanas and then cure from that. There were no investigative sciences before then. It is actually pretty exacting as it is just understanding nature.
Synonyms of Rupa, akruti, lakshanas, chinam
If one doesn’t know lakshanas (signs) they can’t diagnose the disease. It is most important factor. One disease is differentiated from another because of Lakshanas. Each and every disease is distinguished by its lakshanas. One can understand the strength of the disease and the strength of the treatment. If all standard lakshanas are seen, one will have to use very strong drugs and long treatment. It can also tell us how long a patient will need treatment, what potency will be required, the frequency dosage and time of medication.
Signs – objective manifestations of the disease in patient observed by the doctor during the examination
Symptoms – subjective sensations experienced by the patients: I am having a headache, or a pain here or there. In pediatric conditions very difficult because the patient cant explain what is going on. One pediatric text talks about how pediatrics is like veterinary science.
Upasaya – therapeutic test or trial. Diseases may hide signs and symptoms and may be difficult to find out the disease. So at this point Ayurveda gives the patient some medicines to see if that is correct – 18 types of therapeutic tests or trials. One may not be able to diagnose appropriately, so this is another tool for diagnosis. In other words it is eliminatory methods. Even now the modern physicians use this technique. Actually, most modern doctors use this technique alone! It has importance today and we see it in examples like broad spectrum antibiotics being prescribed. They may or may not work when the doctor doesn’t know anything about this disease, they prescribe antibiotics. This is very dangerous because the drug is intended for limited restrictive use. Anupasaya – if patient doesn’t get any relief from a particular drug or food for their disease
Samprapti – the changes that are occurring within the body: the story of the disease from the doctor’s point of view. Ingestion of the nidana leads to the disease, after that signs and symptoms show up, after that before disease full blown, some pathological conditions are occurring in the body – this is the progression of the disease that is called the samprapti – collectively from hetu to lakshana/manifestation is known as samprapti. Why particular srotas are involved, etc.
Samprapti has 5 types:
- Samkya Samprapti – classification and enumeration of the disease- how many types of diseases are available. Up to a certain point has same samprapti – and then through samkya are able to enumerate which of the disease it is. The pathology is the same but the hetus are different – by dosha.
- Vikalpa Samprapti – some degree of involvement of every dosha is there, but qualitative analysis and detail of the vitiated doshas. This will help us to treat based on which doshas and gunas are out of balance. This defines vataj, pittaj or kaphaj. (there it will have unique lakshanas for each doshic type of disease)
- Pradhanya – importance. All diseases are either independent or nonindependent – Primary and Secondary diseases –In Rajakshma jwara is seen but that is not the primary disease. So we need to see which is the pradhanya to treat the primary disease not the secondary. Don’t need to treat the secondary disease independently they will subside when the important dsisease is treated.
Ex. Diabetes causes kidney disorders after a long time, but treat diabetes not the nephritic/kidney problems which are complications of the primary disease.
- Bala – the strength of the disease – if all the symptoms are there, we can understand the balava or strength of the disease.
- Kala – time – early daytime kapha, midday pitta, evening vata – so when we see when the disease is strongest we can see what dosha is affected. All diabetes starts as kapha prameha but if not treated eventually turns into vatajaprameha (chronic stage with all vital organs affected including neuropathy etc.) and yapya/incurable.
Satmya /Asatmya – curable/ incurable.
Sukhasatmya/easy to treat.
Krucasatmya/Difficult to cure
Yapya/incurable but manageable (diabetes mellitus)
Anupakrama/definitely incurable and not treatable.
Samanya Samprapti / General Samprapti of any disease – it all starts with hetu
So here we go. This is how Ayurveda works. At least partly.
- Hetu – so one must think of shad rasas – the improper use of these are the main cause of any disease. Think of the 6 tastes and then we can start to understand the hetu. Due to improper utilization of shad rasas, dosha dushti can occur and can cause aahara hetu (improper food cause) (also can be vihara hetu – excessive sedentary life causes kapha imbalance but excessive exercise is also a vihara hetu.)
- Dosha Dushti – vitiation of the doshas. At this time there are no signs or symptoms.
But this leads to
- Dhatu dushti – vitiation of dhatu. In each dhatu these doshas are seen and if they are vitiated the particular part of the dhatu where the dosha is, that is affected first – example. kapha in rakta dhatu would get vitiated first if kapha dosha is vitiated. Whichever dhatu has that dosha predominance is shown first. This is the stage where signs and symptoms are showing. If we don’t treat at this point dhatu vikruti happens – structural damage may be occurring. In diabetes, when the kidneys are damaged it is incurable. If signs and symptoms aren’t managed the disease may become incurable at this point.
This leads to
- Mala dushti – the excretion is affected – whole excretory process is affected. Incontinence of urine, constipation. Effects on excretory system may lead to another hetu. If proper interference is given at this stage, good. We can treat at all levels, but the strength of the disease will be different and the effectiveness of the treatment
If it leads to another hetu then.
Very complex and we cannot understand all of them. What is known is a handful, what is not known is as wide as the sea. This is why a doctor cannot say someone is incurable.
Good diagnosis leads to good treatment
Jwara – main cause is aama – but may be caused by all 3 doshas. At which point it will change into each
Which srotas is involved also affects the samprapti.
samprapti same up to aama
- Vatajwara –which blocks the channels and then
- Pitta loose bowel movements
- Kapha lack of appetite
For any disease there may be many
Duty of any doctor is to diagnose properly, treat properly, but don’t tell the patient their life expectancy or whether curable or incurable. Their duty is only to diagnose and treat. Modern doctors don’t know these factors, no one does.
So is anyone out there gonna argue anymore that Ayurveda is what is written in those Western books and what Dr. Oz has pushed on his show? Vata, Pitta, and Kapha diet plans huh? Really?
And if you are calling yourself an Ayurvedic Practitioner and do not know this stuff, what are you doing? This is basic Ayurveda.