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Five Ways to Diagnose the Disease (Panchanidan)

In Ayurveda, There are five processes of diagnosis of disease which tell conversion or the process of moving of a normal physiology to a disease causing pathology called Nidan Panchak. It is the tool to diagnose a particular disease. The processes of diagnosis of a disease start from the establishment of appropriate cause (Nidan) followed by primordial signs and symptoms of the disease (Poorvaroopa). One can even diagnose the disease by signs and symptoms which indicate the definitive abnormalities (Roop).


Hetu (Nidan): Cause
Poorvaroop: Primordial signs and symptoms
Roop: Signs and symptoms
Upshaya: Favorable factors
Samprapti : Pathogenesis


Hetu (Nidan)

Hetu (Nidan): Cause
It is the root cause of the disease which directly act upon the equilibrium of three doshes.

Types of Nidan:
- Close factor (Sannikrisht)
These are the factors that bypass the stage accumulation (Sanchaya) of the disease process to the next stage of disease process i.e. provocation (prakopa) by disturbing the equilibrium of the three doshas (vata, pitta, kapha).

Distance factor (Viprikrisht)
These are the factors that affect the equilibrium of doshas, which was developed earlier but was unable to develop disease. In this case as the disturbed equilibrium of dosha already exists the onset of the ailment is quick due to other stimulating factors. For example winter season equilibrium of kapha dosha is disturbed but it doesn't lead to disease as it is frozen due to extreme cold but as soon as the climate changes it melts due the warmth in autumn.

Abuses of sense organ (Asatmiya Indriyartha Samyog)
These types of factor are due tot he unhealthy or improper use of the indriya i.e. sense organs that lead to disease.The types of Abuse of sense organs are
Overuse (Atiyog)
This refers to the overuse of Sense organs. Example: reading for hours together, watching T. V for long and working on computers for hours together develop disease related to eyes due to the overstrain or overuse of eyes.

This term comprises of two words i.e. Pragnya meaning intellect and apradh meaning crime or abuse thus giving the whole term the meaning of doing wrong things in spite of knowing about their negative side effects or consequences that will lead to disease. In Ayurveda it is said that pragyapradh is the main cause of janpadodhwans (epidemic disea


Poorvaroop: Primordial signs and symptoms

It is the primordial signs and symptoms of a disease. It indicates the beginning of some derangements internally and progressing towards damage at the cellular, tissue and organic level that is interaction of vitiated Dosha with Dhatu (The basic components of body). In Poorvaroop there are no sings and symptoms of vitiated Doshas because the disease process is still undeveloped.
Types of Poorvaroop:

Samanya Poorvaroop (General Primordial signs and symptoms)
By these signs and symptoms only the basic disease can be identified but not the subtype. Example: tiredness, uneasy feelings are the sign of pyrexia.

Visheshpoorvroop (special Primordial signs and symptoms)
These not only help in identifying the disease but also the sub type of the ailment. Example: Burning sensation in the eye along with tiredness is pre indicative sign of pittaj fever, developed due to Pitta Dosha.

Importance of Poorvaroop
• Treatment
In Ayurveda some treatment can be given in poorvaroop stage to prevent the disease. Example: In pittaj fever taking ghee is the treatment at its poorvaroop stage.
• Severity of disease
In Ayurveda, it is said if developed disease show all its poorvaroop (pre indicating sign and symptoms) and still remain untreated , it goes to the roopa (indicating sign and symptoms ) stage then the disease is difficult to treat.


Roop: Signs and symptoms

Sign and symptoms developed by the completion of pathology leading to disease which is indicative of definitive abnormalities. Signs are always physical and assessed by the physician and symptoms are always subjective. Collective observation of signs and symptoms of roopa stage by the physician helps to direct the therapeutic approach accordingly.

Importance of the roopa
• Diagnosis
Roopa (indicative sign and symptoms) is the main means of diagnosis of the disease.
• Severity
The disease is severe if it presents all of its roopa (indicative sign and symptoms). That means it is the stage of disease aggravation. If it remains untreated, severity will develop.

Upshaya: Favorable factors or therapeutic test

Upshaya is consideration of the predisposing and relieving factors. It refers to the treatment of the ailment i.e. Aushadhi (medicine), Anna (diet) and Conduct, which is helps to cure the disease.. Treatments are classified as follows:

(1) Hetuviparit (anti factor)
Here Hetu means cause and Viparit means opposite. So this refers to the treatment that is opposite to the factor, which causes the disease. It can be classified according to Medicine, diet and conduct that help disease causing factors to remove.

Hetuviparit aushadhi (Medicine)
They are the medicines that control the ailment.

Example: In Kaphaj fever, dried ginger is the medicine as it corrects the imbalance of kapha dosha in the body, which cures kaphaj fever. Here medicine i.e. ginger is opposite of the factor i.e. kapha dosha.
• Hetuviparit anna (diet)
The diet opposite to the disease-causing factor is called hetuviparit anan.
• Hetuviparit vihara (conduct)
This refers to the type of conduct that controls the disease-causing factor.

Example: Sleeping in day- time disturbs the kapha dosha in the body which leads to kapha (cold and cough), thus the treatment for this is to sleep at night, which controls the disturbed kapha dosha, and ultimately cures the disease.


Samprapti : Pathogenesis

This term is defined as the process of development of disease, which starts from the disturbance of the equilibrium of the doshas and after going through different stages cause disease.

Stages of Samprapti : Pathogenesis
• Sanchaya (Accumulation of Dosha)
• Prakopa (Vitiation of Dosha)
• Prasara (Spreading of Dosha)
• Sthansamshraya ( Localization of Dosha)
• Vyakta (stage of clinical manifestation)
• Bheda ( stage of complications of the diseases)

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