NIDANA PANCHAKA

Nidana + Panchaka

Nidana : Denotes pathogenesis / Causative factor

Panchaka : Denotes five

Nidana panchaka means the five aspects of

diagnosis or methodologies used to diagnose a
disease or a condition. It is the first step to
diagnose the disease ,as kārya(rōga) will not
occur without kāraṇa(nidāna).
Without the knowledge of Hētu /
nidana(cause of a disease) and Liṇga (sign
and symptoms), the implication of Auṣadha
(drug and therapy) is not possible.
Treatment of diseases will be effective only
with good knowledge of Nidāna. The term
Nidāna stands for both Vyādhijanak (cause
of disease) and Vyādhibodhak (knowledge
of disease) . Vyādhijanak nidāna, called as
Hētu and Vyādhibodhak nidāna comprises
of five stages .
 These are the 5 means to diagnose a
disease
 Nidāna
 Pūrvarūpa
 rūpa
 Upaśaya
 Samprāptii
 A particular factor can be called as nidāna
only when it will develop a complete
disease process in the body either
immediately or after a certain period,
because Nidāna produces disorder
through aggravation of doṣas. Doṣas
aggravated by respective etiology give rise
to disorder.
If physician is able recognize them as early as
possible and treat accordingly, then the
further progression of disease is ceased. In
the same way, every component of Nidana
Panchaka helps the physician for the better
understanding of disease process and
treating the disease at an earliest possible
stage. The details of Nidana Panchaka and its
role in diagnosis & treatment
NIDANA
Nidāna (Etiology) has many synonyms like
nimitta, hētu, kāraṇa, yoni, āyatana,
pratyaya, utthāna, karta and mūla. Nidāna
considers the disease causing factors like;
diet, lifestyle, environment factors and
injuries as source of any disease, which leads
to imbalance of doṣas.
 Factor that which manifests disease is known
as nidāna.
 Nidāna means one which aggrevates vātadi
doṣas due to intake of ahita āhāra and vihara.
 Nidāna is one which describes causative
factors of the diseases
A factor which is capable of manifesting the
development of the disease either quickly or
after a certain period is called as hētu.
The vitiated dosa are the immediate cause of a
disease and the distant cause are unwholesome
contacts with objects of senses. All these
causative factors constitute nidana. Knowledge
of the etiological factors responsible for the
genesis of a particular disease is useful in as
much as it helps in selection of a therapy.
To cure the disease by normalising the vitiated
dosha in the body. It helps in obtaining the
knowledge regarding the complications and
diseases to be developed in future due to that
particular vitiated dosha . In case of doubt
regarding the diagnosis of a particular disease
examination of the causative factors responsible
for this disease can clarify the position. If the
causative factors are not addressed this can lead
to more serious disease stopping the causative
factor is a treatment itself. Proper
understanding of the causative factor will help to
understand the underlying dosha involvement.
 Incase of doubt regarding diagnosis of a
particular disease examinations of the
casuative factors are responsible for this
disease can clarify the position .
Understanding the depth and strength of the
nidana will help to understand the mode of
treatment to be adopted. For eg: going
outside in the cold and starting to sneeze is
an example of shita and kapha vrudhhi . It is
not a strong hetu. So it only needs mild
treatment.
.
nidana also determines the potency of the
drug required to treat as well as how long it
will take to treat . Example arthritis –
causative factors may be very longlasting so
treatment may also be longstanding . Bala
(strength) of the roga (disease) can be
understood by this. Apart from diagnosing a
disease, they also play a key role in planning
the treatment of that disease.
Nidana, the foremost component of Nidana
Panchaka, not only gives the knowledge of
causative factors of a disease but also helps in
treatment by avoiding them.
 Nidana bheda

* 3 types of nidana

a) Asatmendriya samyog- Atiyoga, Ayoga and

Mithya yoga of indriya are called as
Asatmendriyartha samyog.
Indriya Atiyoga Ayoga Mithyayoga
Chakshurendriya Excessive gazing Not at all seeing Seeing thing which
at highly luminous any object are too far or
substance Not nearer
Shravanendriya Hearing up Not at all hearing
roaring noise from Hearing of harsh
thunder etc words and etc.
Ghranendriya Excessive Not at all
exposure to sharp, smelling Excessive abnormal
intense and odors smell, unpleasant ,
etc poison gas etc
Rasanendriya Excessive Not at all The person who
consumption of consuming foods not follow any rules
various taste described under
foods ashtavidh ahar
visheshayatana
except rashi.
Sparshanendriya
Sparshanendriya Excessive Not at all Touching
exposure to cold, touching unhygienic things.
hot things
b) Prajnaparadha- Doing all asubh karma due to
vibhramadhi, drati and smruti is called
Prajnaparadha.
Prajnaparadha-
* Shareera mithyayoga ( physically)
*Vaak mithyayoga ( verbal)
*Manasa mithyayoga ( mentally)
Improper utilization of body activities like
vegadharan, prahara, mardana etc
Improper utilization of speech like back biting,
lying, talks, irrelevant, harsh words etc.
Improper usage of mind like fear, anger,
greed etc.

c) Kala- also known as parinama i.e

consequences. Atiyoga , ayoga and
mithyayoga of kaala is cause for the disease.
Atiyoga - Excessive manifestation of character
in ritu is called as kaala yoga Eg. Extreme
rainfall in rainy season
Ayoga - Lesser manifestation or not at all
manifestation Eg. No cold in winter season
Mithyayoga - Improper manifestation in
respective ritu. Eg. No rainfall in rainy season
but extreme cold.
* Three types of nidana –
a) Dosha nidana- Normal sanchay, prakopa
and prashamana of doshas take place in
respective ritu and after madhuradi ahar
sevan called as dosha hetu.
b) Vyadhi nidana – It is responsible for
development of specific disease by specific
etiology. Eg. Regular comsumption of
mrutika in mrudbhakshanaj pandu roga.
.
c) Ubhaya nidana –here causative factors
aggravates doshas and simultaneously
manifest disease.
*Two types of nidana
a) Utpadaka nidana- It is one which favors
accumulation of respective doshas with
respect to change in ritu. Eg. In hemanta rutu
due to madhuradi dravya sanchaya of kapha
observed
b) Vyanjaka nidana – Which stimulates the
development of disease. Eg. Sanchit kapha
during hemant rutu manifest disorder of
kapha in vasant rutu due to effect of sun.
*Two types of nidana
a) Bahya nidana- disease manifest due to ahita
ahara ,vihar due to effect of rutu and
responsible for development of disease.
Eg. Vatadi dosha pakopa hetu is called as
bahya hetu
b) Abyantara nidana– Shareerik dosha and
dushyas is called abhyantara hetu.
*Two types of nidana-
a) Prakriti nidana–Who manifest naturally due
to variation in ritu and accordingly vitiates
doshas.
b) b) Vaikriti nidana– which manifest
unnaturally due to abnormal ritu .
*Two type of nidana –
a) Prakriti nidana – Kapha and Pitta rogas are
easily curable in vata prakriti person if those
come under curable category.
b) b) Vikriti nidana – Vata roga are difficult to
cure in vataja person and same applied to
kaphadi prakriti person also.
To conclude
1) The proper knowledge of the nidana-
causative factors helps us for early diagnosis
of the patient. 2) It also helps in the
differential diagnosis of the disease. 3) After
gaining the knowledge of nidana, doctors can
get the proper path for treating the disease.
4) Hence by avoiding all the causative factors
which resembles for manifestation of disease
can treat the disease in its own way
5) So nidana is considered one of the
diagnostic tools which can play an important
role for treatment of disease.
PURVARUPA
Purvarupa : premonitary signs & symptoms

Symptoms which manifest themselves before

the apprearance of the disease or symptoms
indicative of the appearance of the particular
disease in future are known as purvarupa .

Nidana(causative factor) and purvarupa

(premonitary symptoms) are both indicative
of the future disease.
 Purvarupa Bheda
1) Types of purvarupa
a)Samanya
b)Vishishta

Samanya purva roopam- these are those

which indicates the disease to some extent
without giving any indications of the dosha
imbalance.
Visishta purva roopam- these are those
which give an idea of the doshas also in
addition to some idea of the disease. it is
from the roopa (sign and symptoms) that we
can have a clear and definite idea of the
disease and of the doshas. As an example
excessive yawning occurring before fever
may be taken as purva roopam of vata type of
fever.
 Another area of differentiation of the two types
of purva roopam is that the samanya purva
roopam generally vanishes before the beginning
of the disease as compared to the Visishta purva
roopam as the probability of carrying after the
disease commences. If a large number of purva
roopam (prodromal symptoms) mentioned in
the case of a disease, persist also after the
disease manifests itself, the prognosis is
considered to be very bad.
“It is said that if all the purva roopam appears
before the roopam (sign and symptoms), as
mentioned in ayurvedic authentic texts,
before the onset of the disease say that of a
fever, and when these establishes in large
measures then these fever are said to be
fatal.”
“Even in other diseases, if all the purva
roopam appears and then also persist during
the course of the disease in large measures,
such a patient is likely to die”.
In ayurvedic system of medicine purva
roopam and roopam includes both signs and
symptoms. Symptoms are that information,
that a patient describes himself about his
conditions.
2) two types of purvarupa
a) Actual symptoms of the disease which are
not clearly manifested
b) which are manifested by the interaction of
vitiated dosha
In purvarupa it indicates the dominance of
vitiated dosha along the nature of disease.
Purvarupa is a stage that is very mild and not
truly manifested.This is before the full
manifestation of the diseases . They are
always subtle premonitary signs and
symptoms of the disease . They may be very
difficult to asses which roga is going to be
treated because in this period people wont
generally go for any medical management
If the purvarupa are well known in the patient
the disease diagnosis will be stronger an done
will be able to manage it before it advances to
the next stage.
Purvarupas may give a clue to the disease but, at
this stage one cannot be certain whether any
disease will manifest itself or whether the
disease may subside. These signs and symptoms
may be few and may not be very pronounced but
an intelligent physician may be able to guess the
advent of the disease very often
Although the prodromal symptoms should
not be considered as actual symptoms of the
disease as study of these symptoms is' of
great value in detecting the onset of a
particular disease well before hand and even
in preventing it by taking the necessary steps.
It is further stated that if a large number of
premonitory symptoms mentioned in the
case of a disease, persist also after the
disease manifests itself, the prognosis is
considered to be very bad.
Rupa
Ayurveda is a science of lakshana . It is able to
observe lakshana and then cure from that.
There were no investigative science before
then . It is actually just understanding the
nature .
Rupa is the signs and symptoms , of the fully
manifested disease indicating the specific
characteristics of disease like dominence of
dosa, ama etc.
When the Purvarupas, are manifested in the
disease, then they are called Rupas. "The
symptoms are characteristic manifestations
which develop during the course of the
disease”.
Synonyms of rupa are : linga, Akrti, Laksana
Cinha, Samsthana, Vyanjana and' Rupa are
synonyms.
All these synonyms of the word Rupa indicate
the signs and symptoms by which a disease is
identified. Definitely that Purvarupas, which
existed before the onset of disease, are not
Rupas and only those tokens that indicate a
disease are called Rupas. The question now
arises whether the sum total of Rupas is in itself
a disease or not,? Ordinarily when we speak of
Jvara (fever) we intend by that term Jvara, all the
signs and symptoms by which the jvara is
expressed or manifested
Here, Jvara is taken as a disease and not as a
symptoms. In other cases, i.e. in pravahika
(Dysentery) or Kustha (Leprosy), Jvara may
exist along with other predominant
symptoms of Dysentary or Leprosy, then we
consider jvara/fever as one of the symptoms
of the disease and not the disease itself.
It is said that, the symptoms are not the disease
but the abnormal condition of the body which
causes these symptoms, is the disease. A name
given to the group of symptoms, or to one
symptom alone, is accepted as the name of the
disease. Caraka himself has given his consent for
using such nomenclature for purposes of
corvenience in the identification and treatment
of a disease, such as "In this epitome of
description and treatment of a disease,
such as "In this epitome of description of the
diseases, some of those that have been
mentioned as the symptoms of diseases appear
as independent diseases ”. As long as they exist
secondarily, they are called symptoms and not
diseases It often happens that, for the sake of
easy understanding, symptoms by themselves
are spoken of as disease in the section on
Nidana, This was done for the sake of
convenience but the symptoms are only
symptoms and they can never be diseases.
The purpose oftreatrnent should be to break
the Dosa Diishya Samrniirchana (the
abnormal interaction - between dosas and
dusyas). Although, for purposes of
convenience symptomatic treatment is
sometimes given, the original object of the
treatment should never be forgotten. For this
purpose a knowledge of minute details of
Riipas (Signs and symptoms) becomes
essential.
Symptoms caused by vitiation of doshas is
responsible for the causing of disease .
Symptoms indicates stages of disease for eg:
ama (primary stage) pakva (secondary stage)
Jirna (chrionic stage). Thus accordingly the
methods of approach will vary in the
treatment aspect but helps in understanding
of the condition. It gives a clear idea of the
exact progression of the disease or the stage.
Some symptoms arise as a coplication of the
disease indicating their curability. If one
doesn’t know lakshanas they can’t diagnose
the disease . It is the most important factor
on a disease is differentiated from another
because of lakshanas. One can understand
the strength of the treatment if all standard
lakshanas are seen. It can also tell us how
long the patient will need treatment , what
potency be required and the dosage time and
frequency of medications.
Signs – are the objective manifestations of
disease in patient observed by the doctor
during examination.

Symptoms- are subjective sensation

experienced by patient.
Upasaya
Upasaya means Therapeutic test or trial
A form of diagnosis by applied therapeutics.
Medicine, food and rules of conduct as brings
about happiness either by acting directly against
the cause of the disease and or the disease itself
by producing such effects indirectly are called
upasaya. The homologatory signs are those
which indicate what kinds of medicines food and
behaviour are antagonistic directly or in effect to
disaese and its causative factors and what are
agreeble the patients system.
Upasaya is divided into two broad groups
1) remedial agents which are actually
antagonistic to the cause of disease or
disease itself .
2)the remedial agents which are actually not
antagonistic either to the cause of the disease
or the disease itself.
 Upasaya helps in diagnostic and which are
otherwise difficult for diagnosis.

a) Medicines- administration of medicines

having opposite qualities like using usna
dravyas for disease caused by cold regimen
shunti in jwara
Diseases may hide signs and symptoms and may
be difficult to find out the disease . So at this
point we need a method to bring out the effects
directly or indirectly . In ayurveda medicines diet
and regimen is suppossed to bring happiness or
normal functioning in the body either by acting
directly against the cause of the disease or the
diseases itself. Depending on the results the
changes can be made the treatment line can be
done more focussed after the knowing the exact
way to approach it. The modes of administration
the time to perform , the regimen to be perform .
Drugs which work against the disease diet to be
followed etc. All such factors will help for
upasaya .
An attempt to verify the diagnosis through the
proper administration of treatment. If successful
(upasaya), the diagnosis is confirmed. If
unsuccessful (anupasaya), additional information
has been gained through the trial, which is useful
for altering the treatment plan. Trial and error.
Also called satmya.
Samprapthi
Samprarpthi means pathogenesis.Even though it
is after the samprapthi (pathogenesis) onset of
symptoms of the disease manifest themself still
fo rth epurpose of diagnose the knowledge of
samprapthi is not important as the knowledge of
nidana. Hence samprapthi is described at the
end . The genesis of the disease by specific
action of vitiated dosha responsible for its
caution is called samprapthi.
Thus samprapthi helps in comprehension
of the specific features of disease for eg:
affliction of amasaya- reduced power of
digestion and metabolism, vitiation of
rasa- fluid constants of the body etc are all
due to the etiological factors dosha
Similarly purvarupa forms a part of rupa
helps in diagnosis of a disease before its
manifestation .
Samprapthi is the complete manifested stage
The changes that are occuring within the
body , the story of the disease, ingestion of
nidana leads to disease after the signs and
symptoms show up , after that before the
disease is fully blown some pathological
conditions are occuring in the body this
progression of the disease is called
samprapthi.
The way in which dosha gets vitiated and the
course it follows for the manifestation of the
disease is called samprapthi.
A disease should be diagnosed only when it is
fully manifested because even in unmanifested
stage. disease are diagnosed by the help
of'Nidana and Purvariipa, Therefore, the genesis
of the disease by the specific action of vitiated
dosas responsible for its causation is called
Samprapti. Thus, the synonym Agati which
means the course of a disease right from the
affection by the causative factors upto its
manifestation, is justified. This Samprapti helps
in the comprehension of the specific feature of a
disease.
On the basis of certain specific characteristics the
srnaprapti has been subdivided here into
following five kinds:
I. Sankhya sarnprapti :- It is the number of
varieties or types in which diseases may
manifest themselves
"The number of the (Type of the disease is
responsible for the variation of the samprapti.,
e.g. eight kinds ofjvara (Fever), five kinds of
gulma (Abdominal tumour), seven varieties of
Kustha (Dermatosis) and so on"
2. Vikalpa Sarnprapti : VikaJpa or discrimination
is the settling of one or the other component
(dryness, etc of the Vata etc.) of the united
morbific entities. It can also be expresed as,
the measure in which the dosas are excited in
the dosic triad or the measure in which the
dosa gunas that excite the dosas, exist.
3. Pradhanya Sarnprapti :- The predominance
ofa particular dosa or dosas or the
aiscertainment whether a disease is
independent (primary) or dependent
(secondary to or complicating the primary
disease) is the Pradhanya sarnprapti.
4. Bala Samprapti ;- It is the specific force or
weakness of a disease. Bala Sarnprapti is the
strength of a disease, known by its severity or
mildness depending upon presence or
absence of all the cause, prodromes and
symptoms.
Kala Samprapti : It is to signify that a disease
is severe, moderate or mild during a
particular time factor, i.e., the night, day,
season and the (digestive process of the)
ingested food, in accordance with the
particular dosa involved.
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.
Clinical aspect
Importance of nidāna:

The main motto of Ayurveda is swāsthya

paripalana and rōga chikitsa. Doṣas become
vitiated by ahitakara āhāra and vihara, which is
the main cause of the disease nothing but the
nidāna. In present era, people are leading
sedentary life style, over eating and exposed to
stress to earn more money and luxurious
facilities. These are the main nidānas of present
diseases. In clinical practice,obtaining etiological
factors concerning to each disease is very
difficult due to many hinderances like non co-
operation of patients etc. factors.
Preventive aspect:

Dinacharya, Rutucharya and Achara rasayana

which are explained and followed by our
ancestors, thereby avoiding the nidānas is the
preventive measure to rogotpattti.
Diagnostic aspect:

For diagnosis of disease, one should know the

exact reason for the manifestation of disease.
For e.g. The Nidāna of Prameha are idle
sitting, oversleep, excessive use of curd, meat
soup of the domestic, aquatic and marshy
animals and milk, new cereals and drinks,
products of jaggery and all other kapha -
vardhaka regimens. These five nidana
panchaka are the diagnostic tools followed
for the diagnosis and treament.