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Nidanapanchakam (निदानपञ्चकम्) is one of the exclusive theories in the field of pathology and evaluation of diseases in Ayurveda. It is utilized for clinical evaluation, diagnosis or discernment of diseases in authentic Ayurvedic manner. By understanding nidanapanchakam of a particular disease, one can have complete knowledge about that disease and this further helps in discernment of a presented illness in clinical setting. Therefore this is an important tool for diagnosis and evaluation of disease presented in front of a vaidya.
Elaboration on basic concept of Nidanapanchakam in Ayurveda and description of multiple diseases on the basis of this theme can be found in Madhavanidanam. Acharya Vagbhata has also described various points in nidanapanchakam in his treatise named Ashtanga hrdayam. The foundation theories for health and illness are peculiar in Ayurveda. The imbalances in Doshas, dhatus, malas, agni and other body constituents are reflected in the form of disease. The entire process of development and progression of disease largely depends upon the hetus (causative factors) and if left untreated gives rise to upadravas (complications). Thus, greater emphasis is laid upon understanding of hetus (causative factors). Further, the clinical features at every level of disease development are different their progression or suppression both have been regarded as clinically significant since the final outcome and prognosis may also depend upon these. Thus ancient Ayurveda scholars after keenly observing the trends of various diseases and their clinical variations have described Nidanapanchakam of most of the prevalent diseases of their time which is helpful for Vaidyas of today's age also to view and treat diseases in an authentic Ayurveda methodology.
5 elements of Nidanapanchakam are as follows,
Hetu (etiological considerations or origin of disease)
This includes detail analysis of association of various dietary and lifestyle components as well as other factors with development of a particular disease. These factors are believed to cause vitiation of doshas as well as damage to Dhatus, Agni & Srotas (body channels) affected in a particular disease.
Purva-rupa (Prodromal symptoms)
Ayurveda believes that every disease shows specific prodromal signs and symptoms before full fledged development and manifestation of its clinical features. These signs or symptoms are very subtle, developed from the same factors that have led to development of disease and are definitely present before onset of disease. Thus, Purva-rupas are considered the harbingers of the disease. These have certain clinical significance. Thus, Ayurveda scholars have given high importance to study and assessment of Purva-rupas.
Rupa (clinical features or signs & symptoms)
Rupa means presentation or feature. Thus, in Nidanapanchakam, Rupa refers to clinical features of developed disease. Most of time, disease is diagnosed in this stage on the basis of classical set of clinical features or Rupa specific for that disease.
Upashayaanupashaya (therapeutic diagnosis)
This is unique tool or element used for diagnosis in Ayurveda. Upashaya refers to mild relief in the suffering from disease with use of certain food, medicine or lifestyle elements. Whereas, Anupashaya refers to the exacerbation or no improvement in disease on use of certain food, medicine or lifestyle factors considered favourable for a particular disease. Again, this element has clinical significance from the point of view of diagnosis and management and hence Ayurveda practitioners consider this element while evaluating any presented case.
Samprapti (Onset of disease or patho-physiological processes)
One of the most important factor to unfold the sequence of events in the process of development of a disease. Samprapti refers to the chain of events occurred in a sequential manner and tracing all the causative factors along with their role in the development of a particular disease. This tremendously helps a Vaidya to understand the presented case thoroughly, plan a treatment and opine on prognosis. Besides this, for most of the diseases, 2 more elements are also considered. These are as follows,
Some other equally important tools for disease evaluation
There are some other other important tools or elements that are not a part of Nidanapanchakam but perform significant role in evaluation and management of various diseases. Upadravas and Sadhyasadhyata are some of them.
Upadrava (clinical manifestations of complications)
When a particular disease is neglected, left unattended or remains seated in a body for a long time; it further damages the other body elements and gives rise to certain ailments which are developed only because of the untreated already existing diseases in a body. This later developed ailment is totally dependent on the disease which originally gave rise to it and has no separate aetiology or even management. Wise Vaidyas inspect any disease keeping in mind the possible upadravas and only then plan the treatment. In the words of western medical science ‘Upadravas’ can be correlated with complications of a disease. However, western medical science does not regard the study of complications as a diagnostic tool but, Ayurveda does recognise its use in this manner.
Sadhyasadhyatva (prognostic features)
This word comprises of 2 terms. Sadhya is the first term which refers to curable status of the disease. While asadhya refers to the uncurable or just treatable status of a particular disease. Ayurveda acharyas have given detailed description on the presentation of the disease and its possible prognosis. They have also further graded the possibility of cure of disease in 4 degrees and relevant necessary modality of treatment.