In Sarvaroga nidana modes of diagnosis of diseases; we will see,
Nidana Panchaka,Nidana,Purvarupa,Rupa – Clinical features and symptoms,Samprapti – pathogenesis,Sarvaroga karana – causes of all diseases / aetiology,Vatavriddhi Karana – causes of increase of vata,Pittavriddhi Karana – causes of increase of pitta,Kaphavriddhi Karana – causes of increase of kapha, Sarvadosa vrddhi karana – causes for the increase of all the dosas,Vriddha dosa gati – the fate of increased dosas
अथातः सर्वरोगनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
Roga Paryayah – Synonyms of the term disease
रोगः पाप्मा ज्वरो व्याधिर्विकारो दुःखमामयः ।
यक्ष्मातङ्कगदाबाधाः शब्दाः पर्यायवाचिनः ॥ १ ॥
Roga, papma, jvara, vyadhi, vikara, duhkha, amaya, yaksma, atanka, gada and abadha-these terms are synonyms. 1.
Notes: Each of these terms indicates a certain aspect of the disease. The disease is called ‘roga’ because it gives to pain, it is ‘papma’ because it is born from sinful acts, ‘jvara’ because it torments, vyadhi for it brings in different kinds of abnormalities, ‘duhkha’ as it causes various kinds of unhappiness, ‘amaya’ because it is caused by ama (undigested, improperly processed metobolites), ‘yaksma’ as it is a group of diseases (symptom complex, syndrome), ‘atanka’ for it makes life miserable, gada because it is produced by multiple causes, ‘abadha’ for, it produces constant discomfort (to the body, mind and or sense organs). In addition to these, even the term ‘dosa’ is also used as a synonym to indicate the disease.
निदानं पूर्वरूपाणि रूपाण्युपशयस्तथा ।
सम्प्राप्तिश्चेति विज्ञानं रोगाणां पञ्चधा स्मृतम् ॥२॥
The five means of diagnosis-Nidana (cause). Purvarupa (premonitory symptoms), Rupa (signs and symptoms charactorestic of the diseases), Upasaya (diagnostic test) and Samprapti (mode of manifestation of the disease) are the five means of obtaining full knowledge (diagnosis) of disease. 2.
Notes Knowledge of all these five is not essential for the diagnosis of every disease. Many can be diagnosed by knowing any one or two, some times all the five are neccessary.
निमित्तहेत्वायतनप्रत्ययोत्थानकारणैः निदानमाहुः पर्यायैः
Nidana (cause) is indicated by synonyms such as nimitta, hetu, ayatana, pratyaya, utthana and karana. 3.
Notes: A few more synonyms which are used rather rarely are mula, mukha, prakrti, ayatana and yoni. The term ‘nidana’ has two meanings
(1) that which furnishes definite information. In this sense it is applied to diagnosis of disease and also to the section of the text which furnishes definite information about diseases. (nidana sthana).
(2) the ’cause’ of anything. In the context of disease it refers to the cause of the desease. It is this second usage which is more common.
Purvarupa – Premonitory symptoms/prodromal symptoms
प्राग्रूपं येन लक्ष्यते ॥ ३ ॥ दोषविशेषेणानधिष्ठितः । उत्पित्सुरामयो
लिङ्गमव्यक्तमल्पत्वाद् व्याधीनां तद्यथायथम् ॥ ४ ॥
Pragrupa (or purvarupa) are those (signs and symptoms) which appear earlier to the forthcoming disease, not assignable to any dosa specifically because of their poor manifesatation and mild nature; they are enumerated in the 3b-4. way they manifest in each disease (further on)
Notes: Purva rupa is of two kinds. samanya and 2. visista. The first one comprises of symptoms produced by one or more of the aggravated dosa, these usually disappear when the disease actually manifests, and these may be common to many diseases. The second one, comprises of the signs and symptoms of the forthcoming the diseases itself, appearing mildly and continuing their existence in the further stages of the disease. The ancient texts describe the first kind only under the heading ‘purvarupa’ in some diseases, as it is difficult for the physician to recognise be either them and assign them to specific diseases. The second kind may mentioned or not, as it is easy for the physician to recognise the characterstic features of the diseases. In some diseases ‘purvarupa’ is not mentioned at all, this should not be taken to mean that such a disease has no purvarupa at all but should be understood that in such diseases the specific features of the disease itself appear as Purvarupa.
Rupa – Clinical features/characteristic signs and symptoms
तदेव व्यक्ततां यातं रूपमित्यभिधीयते । संस्थानं व्यञ्जनं लिङ्गं लक्षणं चिह्नमाकृतिः ॥ ५ ॥
These (premonitory symptoms) only, after attaining clear manifestation, come to be known as Rupa (characteristic signs and symptoms of the disease); also called samsthana, vyanjana, linga, laksana, cinha and akrti. 5.
Upasya diagnostic tests
सुखावहम् ॥ ६ ॥
विद्यादुपशयं व्याधेः स हि सात्म्यमिति स्मृतः । विपरीतोऽनुपशयो व्याध्यसात्म्याभिसंज्ञितः ॥ ७ ॥
Administration of either medicine, pod or activity which is the viparita (opposite) of either the cause, the disease or of both, or though not actually opposite (but of identical nature) yet produces the effect of the opposite (viparitarthakari)– that of giving comfort to the patient is known as Upasaya. It is also called satmya (suitable to the disease and the pateint). The opposite of upasaya is anupasaya and asatmya (unsuitable) to the disease. 6-7.
Notes: Diagnostic tests becomes necessary only when the physician is unable to clinch the diagnosis by other methods, the following is an example furnished by ancient commentators. A patient comes to the physician complaning of stiffness (rigidity and loss of movement) of his thigh. This is a symptom of two diseases, viz- (1) paksaghata (paralysis of the legs (hemiplegia) a disease caused by increase of vata and (2) urustambha a disease caused by increase of kapha and medas (fat). Even after other methods of examination the physician is unable to determine the disease. So he prescribes anoiting the thigh with oil. If, this treatment gives comfort to the patient (upasaya) then the disease is determined as paksaghata, because vata was mitigated by the oil. If, on the other hand, this treatment increased the discomfort (anupasya) then the diagnosis will be, urustambha, because the oil produced greater increase of kapha. Thus producer helped to clear the doubt in the diagnosis. Readers will find details of these different kinds of upasaya in the commentaries on Madhava nidana, Caraka samhita etc.
Samprapti – pathogenesis
यथादुष्टेन दोषेण यथा चानुविसर्पता | निर्वृत्तिरामयस्यासौ सम्प्राप्तिर्जातिरागतिः ॥ ८ ॥
The genesis (evolution, process of manifestation) of the disease by the vitiated (increased) dosas which are constantly circulating is known as Samprapti; also called jati and agati. 8.
सङ्ख्याविकल्पप्राधान्यबलकालविशेषतः सा भिद्यते, यथाऽत्रैव वक्ष्यन्तेऽष्टौ ज्वरा इति ॥ ९ ॥ दोषाणां समवेतानां विकल्पोंऽशांशकल्पना । स्वातन्त्र्यपारतन्त्रयाभ्यां व्याधेः प्राधान्यमादिशेत् ॥ १० ॥ हेत्वादिकार्ल्यावयवैर्बलाबलविशेषणम् नक्तंदिनर्तुभुक्तांशैर्व्याधिकालो यथामलम् ॥ ११ ॥
It is of five kinds such as Sankhya, Vikalpa, Pradhanya, Bala and Kala. Counting the varieties ( kinds) of each disease, as for example, when it is said that jvara ( fever) is of eight kinds (and so on in other diseases ) is Sankhya samprapti; to indicate the different aspects of the dosas involved (their kind, quantity, qualities and functions ) is Vikalpa, samprapti signifying a disease as either independent (primary) or dependent (secondary) is Pradhanya samprapti; signifying a disease as strong (severe, grave) or weak ( mild) based on the nature of the cause etc. ( signs, symptoms, organs involved, nature of abnormalities, general health, age and sex and many other aspects) is Bala samprapti; to signify the time of the night, day, season, and digestion of food during which the disease and the dosa are strong (predominant) is Kala samprapti. 9-11.
इति प्रोक्तो निदानार्थः तं व्यासेनोपदेक्ष्यति ।
Thus a breif narration of the nidana ( etc) here; they will be described in detail later. 12a.
Sarvaroga karana – causes of all diseases / aetiology
सर्वेषामेव रोगाणां निदानं कुपिता मलाः ॥ १२॥ तत्प्रकोपस्य तु प्रोक्तं विविधाहितसेवनम् ।
For all the diseases, the causes are the aggravated (increased) mala (dosa); for their (of the dosas) aggravation (the causes are) indulgence in different kinds of unsuitable (foods, activities etc.). 12b-13a.
अहितं त्रिविधो योगस्त्रयाणां प्रागुदाहृतः ॥ १३ ॥
Unsuitables are the three kinds of yoga (association, contact) of the three (factors) which were described previously (chapter 12 of sutrasthana) 13b.
Notes The three dosas (vata, pitta and kapha) have three states in respect of their pramana (quantity), guna (quality) and karma (function), viz., 1. sthana/sama or prakrta-normal. 2. vrddhi or prakopa- aggravation or increase, more than the normal. 3. ksaya or decrease less than the normal.; the last two are visama or vikrta/dusta (abnormal). The dosas in their normal state maintain the body in good health. This normalcy is very unstable, dosas undergo either increase or decrease by the effect of food, activity, season etc; among these two abnormalities, vrddhi or increase is powerful. The dosas which have become abnormal (especially the increased) bring about abnormal changes in the dhatus (tissues) and give rise to the diseases. Hence the above statement that dosas are the causes of all diseases, The causes for the abnormalities of the dosas are the three factors viz. kala (season), artha (objects of the five sense organs-light, sound, smell, taste and touch) and karma (activities of the body, mind and speech) in their three kinds of abnormal states (visama yoga) viz, atiyoga (excess contact), ayoga (inadequate/poor contact and even absence of contact) and mithya yoga (improper contact, perverse condition etc). Three technical terms are also used to denote these three causes, viz
1. Asatmyendriyartha samyoga (improper, excess, poor and perverse contact of the sense organs with their respective objects).
2. Prajnaparadha (transgression or violation of normal regimen regarding all the activities of the body, mind and speech; in other words, doing them either in an excess, poor or perverse manner.
3. Parinama-effect of the season – the normal climatic condition of the season becoming either excess, poor or perverse.
All these are breifly called either as Ahitahara vihara, Mithyahara vihara or Asatmayahara vihara (unsuitable, improper or unaccustomed foods and activities).
Vatavriddhi Karana – causes of increase of vata
तिक्तोषणकषायाल्परूक्षप्रमितभोजनैः 1 धारणोदीरणनिशाजागरात्युच्चभाषणैः
Vata gets aggravated (increased) from-consuming foods which are bitter, salt and astringent in taste, of less quantity, dry (moistureless, fatless) taking food long after the usual time, suppression and premature initiation of the urges (of urine, feaces, flatus etc.), keeping a awake at nights, speaking in high pitch for a long time, effect of therapies (emesis, purgation etc.) in excess (more than the required degree); (sudden) fear, greif and worry, excess of physical activities and sexual intercourse; during summer, terminal part of the 14-15. day, night and food (digestion).
Pittavriddhi Karana – causes of increase of pitta
पित्तं कटुम्लतीक्ष्णोष्णपटुक्रोधविदाहिभिः । शरन्मध्याह्नरात्र्यर्धविदाहसमयेषु च ॥ १६ ॥
Kaphavriddhi Karana – causes of incrase of kapha
स्वाद्वम्ललवणस्निग्धगुर्वभिष्यन्दिशीतलैः । आस्यास्वप्नसुखाजीर्णदिवास्वप्नातिबृंहणैः ॥ १७ ॥ भुक्तमात्रवसन्तयोः । प्रच्छर्दनाद्ययोगेन पूर्वाह्ने पूर्वरात्रे च श्लेष्मा
Kapha (get increased) from consuming foods which possess sweet, sour and salt tastes, which are unctuous (fatty, moist); heavy (undigestable, more in quantity) producing more secretions in the tissue and cold; sitting for long periods, sleeping too much, eating uncooked foods, sleeping during day, over nourishment, inadequate degree of therapies like emesis etc; soon after taking food (during the first part of digestion), during spring, forenoon and early part of the night. 17-18a.
द्वन्द्वं तु सङ्करात् ॥ १८ ॥
Aggravation of dvandva (two ) dosa, simultaneously occurs by indulgence in mixture of factors causing their increse.
Sarvadosa vrddhi karana – causes for increase of all the dosas
मिश्रीभावात्समस्तानां सन्निपातस्तथा पुनः । ॥१९॥ । ॥२०॥ सङ्कीर्णाजीर्णविषमविरूद्धाध्यशनादिभिः व्यापन्नमद्यपानीयशुष्कशाकाममूलकैः पिण्याकमृद्यवसुरापूतिशुष्ककृशामिषैः दोषत्रयकरैस्तैस्तैस्तथाऽन्नपरिवर्तनात् ग्रहावेशाद्विषाद्गरात् ॥ २१ ॥ ऋतोर्दुष्टात्पुरोवाताद् दुष्टान्नात् पर्वताश्लेषाद्ग्रहैर्जन्मर्क्षपीडनात् । मिथ्यायोगाच्च विविधात्पापानां च निषेवणात् ॥ २२ ॥ स्त्रीणां प्रसववैषम्यात्तथा मिथ्योपचारतः ।
Indulgence in mixture of factors causing increase of individual dosa gives room for increase of all the three dosas (sannipata) and also, indulgence in improper dietary regimen, foods which are uncooked (causing indigestion), contaminated, incompatable, and excess ( in quantity and frequency); wines and other drinks which are spoilt; dried vegetables, uncooked roots and tubers, pinyaka ( fried seeds of sesame and jaggary pounded together and made into balls used as sweet pudding), mud (eating of mud) yavasura (beer prepared from barely), meat which is foul smelling, dry and thin; so also consuming foods which is inauspicious, by the effect of spoilt season (abnormal climatic changes); diree breeze, possession of the body by evil spirits, poisions (natural) and artificial poision, contaminated foods, residing in the slopes of mountains; ill effects of planetary positions and of the birth star (constellation during which the person is born), improper administration and effects of therapies, committing different kinds of sin, abnormalities of delevery and improper management (of labout and perpeureum) in women-these bring about increase of all the dosas. 19-23a.
Vriddha dosa gati – fate of increased dosas
प्रतिरोगमिति क्रुद्धा रोगाधिष्ठानगामिनीः ॥ २३ ॥ रसायनी: प्रपद्याशु दोषा देहे विकुर्वते ॥ २३ ॥
Dosas getting aggravated (increased) in these ways enter into the channels of rasa (to circulate all over the body) and produce abnormalities quickly in places which become the seat of diseases. 23b.
Notes: The increased dosas circulate along with the rasadhatu and accumulate in places where the rasadhatu gets obstructed due to abnormalities of the channels (sroto dusti) in the dhatus (tissues). Such a place becomes the site of origin of the diseases.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने सर्वरोगनिदानं नाम प्रथमोऽध्यायः ॥ १ ॥
Thus ends the chapter called Sarvaroga nidana-the first in of Astangahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.