A Disease Can Be Properly and Completely Understood Through

Nidāna pañcaka

Madhava nidāna 1: A disease can be properly and completely understood through 1. nidāna (hetu/ causative factors) 2. pūrva rūpa (precursor symptoms) 3. rūpa (lakṣaṇa/ symptoms) 4. samprāpti (process) 5. upaśaya (?relief) Importance of each of these: Hetu:  Knowledge of hetu helps in identifying disease/ disease type.  One of the most important parts of cikitsā is nidāna parivarjana – to stop/ give up the hetu.  One hetu (causative factor) can produce one disease or multiple diseases; one disease in a person and a different one in another. So knowledge of hetu alone is not sufficient for diagnosis. Pūrva rūpa:  Knowledge of pūrva rūpa helps better identification of disease/ disease type. For example, excessive yawning in vātaj jwara, burning in the eyes in pittaj jwara, loss of taste in kaphaj jwara.  Also useful for differential diagnosis. For example, dark yellow/reddish urine is a lakṣaṇa of adhoga raktapitta as well as pittaj prameha. If you are confused about what disease it is, you can remember the pūrva rūpa and try to identify with the disease then a differential diagnosis is possible. In this example, if pūrva rūpa of prameha like abnormally more mala in kaṇṭha (throat), tālu (upper palate), jihvā (tongue), burning of soles of hands and feet, tṛśā (thirst) etc are present it can be differentiated as prameha.  If all or most pūrva rūpa are present, it can imply that the disease will be very strong/ kaṣṭa sādhya (difficult to cure)/ asādhya (incurable) etc.  If a potential disease is identified right in the pūrva rūpa avasthā (stage/condition), then proper cikitsā can be started immediately, trying to establish balance of doṣa etc. Rupa (Signs and symptoms):  Definite and precisely observable, hence help to clarify the diagnosis, including subtype; eg. Vataj jwara/ pittaj jwara; vataj kāsa, kaphaj kāsa etc.  To define/ estimate the sādhāsādhyatva (the curability) of the disease. For example, in a pramehi patient, if you notice that he has just a few symptoms, say, excessive urination, feeling of heaviness then he becomes more easily curable than a patients showing excessive urination, frothy urine, heaviness, loss of libido, recurrent skin infections, non-healing wounds etc. Samprāpti:  This is understanding the complete process of disease formation. Here, there is identification of udbhava sthāna (site of origin), adhiṣṭhāna/ vyakti sthāna (site of expression) etc. For proper cikitsā, one has to just break this cycle by proper upakrama (procedure). So if one knows the whole route that is going to be run in disease formation, one can intervene timely at any juncture. This is called samprāpti bhanga (breaking the samprāpti). Upaśama:  Is the treatment that gives relief. When you notice that a certain type of treatment has given relief you can decide the line of treatment. This is also useful when there are multiple symptoms and therefore confusing possible diagnosis.  For example, if you have a patient of śwāsa. You give him medicines for kapha congestion in the chest and it gives him relief then it is upaśaya. If it doesn’t, it is called an-upaśaya. Then you have to search for other reasons of śwāsa. Perhaps the patient has a severe apāna avarodha leading to śwāsa. The perhaps you need to give him anulomana.  Another example of tamaka śwāsa – āsino labhate saukhyam…  Another example of snehan in joing pain – sandhivāta or āmavāta.