Roga Nidana evam Vikriti Vigyana रोग निदान एवं विकृति विज्ञान

Diagnosis and pathology · Second Professional (Dwitiya Varsha) · AyUG-RN

Papers

• Paper I — Roga Nidana (Ayurvedic)
• Paper II — Vikriti Vigyana (modern pathology)

Units in this subject

Study notes

Diagnosis. How a disease is traced from its cause to its manifestation, and how it is identified at the bedside and in the laboratory. The single most useful thing this subject teaches is that a symptom is not a diagnosis.

Nidana Panchaka

• Nidana (cause), Purvarupa (prodrome), Rupa (manifest signs), Upashaya (therapeutic test — relief or aggravation used diagnostically), Samprapti (pathogenesis).
• Samprapti ghataka: dosha, dushya, agni, ama, srotas, srotodushti prakara, udbhava sthana, sanchara sthana, vyakta sthana, roga marga, sadhyasadhyata.
• Upashaya has six types and is Ayurveda's own diagnostic device — worth explaining fully in an answer.

Trividha bodhya sangraha — hetu, linga, aushadha

• Charaka Sutrasthana 1 sets the whole of medicine under three things to be known: hetu, the cause; linga, the sign; and aushadha, the remedy. Everything else in Roga Nidana is an elaboration of the first two.
• Hetu is nidana — the cause, whether aharaja, viharaja, manasika or agantuja. Nidana parivarjana, removing the cause, is the first treatment and sometimes the whole of it.
• Linga is rupa and purvarupa together — what the disease shows now and what it showed before it declared itself.
• Aushadha is the whole of chikitsa, not only a drug: shodhana, shamana, ahara, vihara and the daivavyapashraya measures.
• It is asked against Trisutra, which is the same three called by another name, and against the Nidana Panchaka, which is the five-fold diagnostic frame and belongs to linga rather than replacing it.
• Charaka pairs it with the trividha chikitsa — daivavyapashraya, yuktivyapashraya and sattvavajaya — so the three causes, three signs and three treatments are learnt as one scheme.

Shatkriyakala

• Sanchaya, Prakopa, Prasara, Sthana samshraya, Vyakti, Bheda.
• The clinical value is that intervention in the first three stages prevents the disease, which is the classical statement of early detection.
• Sthana samshraya is where khavaigunya decides which organ is affected.

Examination

• Trividha: darshana, sparshana, prashna. Shadvidha adds. Ashtavidha: nadi, mutra, mala, jihva, shabda, sparsha, drik, akriti. Dashavidha pariksha of the patient: prakriti, vikriti, sara, samhanana, pramana, satmya, sattva, ahara shakti, vyayama shakti, vaya.
• Nadi pariksha: vata as a snake or leech, pitta as a frog or crow, kapha as a swan or pigeon. Site and technique.
• Ama lakshana and the distinction between sama and nirama states, which decides whether shodhana can begin.

Modern pathology

• Cell injury, inflammation, healing, neoplasia.
• Haematology: anaemias, leukaemias, coagulation. Normal ranges.
• Clinical pathology: urine, stool, sputum, body fluids.
• Biochemistry: liver and renal function, lipids, glucose. Imaging in outline.
• The examinable link: a classical presentation such as Kamala or Asrigdara maps to several modern causes, and naming them is what turns a symptom into a diagnosis.

Trividha and Ashtavidha pariksha

• Trividha: Darshana (inspection), Sparshana (palpation), Prashna (questioning) — the three that Charaka gives.
• Shadvidha adds Shravana (auscultation), Ghrana (smell) and Rasana (taste), giving six.
• Ashtavidha: Nadi, Mutra, Mala, Jihva, Shabda, Sparsha, Drik, Akriti. This is Yogaratnakara's list and is the one most quoted today.
• Say which list you are using; the three are not interchangeable.

Imaging, in outline

• X-ray, ultrasound, CT and MRI — what each is good for, and what it exposes the patient to.
• The examinable point is appropriateness: which investigation answers which question, and when none is needed.
• Reading a report rather than an image is the realistic skill, and knowing when to refer for imaging matters more than interpreting it.

General pathology

• Cell injury: reversible and irreversible; necrosis and its types; apoptosis.
• Inflammation: acute and chronic; the cardinal signs; the cells involved.
• Healing: by primary and secondary intention; granulation tissue; factors delaying it.
• Neoplasia: benign versus malignant; carcinoma versus sarcoma; metastasis; the classical Arbuda description and where it does and does not correspond.

Jwara nidana

• Jwara is the adhirajа of all roga and is the first disease in Charaka Chikitsasthana. Its seat is rasa dhatu and its defining lakshana is santapa of the body AND the mind together.
• Eight types: vataja, pittaja, kaphaja, and the dvandvaja and sannipataja, plus agantuja. Two by origin — nija and agantu.
• Purvarupa: aruchi, jrimbha, angamarda, netra daha, ashru, nidra nasha, romaharsha. These appear before the santapa and are what makes early diagnosis possible.
• SAMA and NIRAMA jwara is the distinction that decides the whole treatment: sama shows aruchi, gaurava, anaha, alasya and a coated tongue; nirama shows kshut, laghuta and clear senses. Langhana in sama, brimhana in nirama.
• Vishama jwara by interval: santata, satata, anyedyushka, tritiyaka, chaturthaka. Dhatugata jwara by depth: rasagata to shukragata, each with its own lakshana and each harder than the last.

Prameha nidana

• Twenty types — ten kaphaja, six pittaja, four vataja. The count and its division is a certain question. Kaphaja are sadhya, pittaja are yapya, vataja are asadhya.
• The ten kaphaja by the urine: udaka, ikshu, sandra, sandra prasada, shukla, shukra, sikata, sheeta, shanair and alala meha.
• The four vataja: vasa, majja, hasti and madhu meha. MADHUMEHA is the one that maps onto diabetes mellitus, and the texts describe the urine as sweet and attracting ants.
• Purvarupa: sweat, foul body odour, sluggishness, a coated tongue and palate, ants gathering at the urine, and a sweet taste in the mouth. Six classical signs, all still clinically recognisable.
• Two patient types the texts separate: sthula pramehi, treated by shodhana and apatarpana, and krisha pramehi, treated by brimhana. Giving the wrong one is the classical error.
• Prameha pidaka ten, which are the complications: sharavika, kacchapika, jalini, sarshapika, alaji, vinata, vidradhi, vidarika, masurika and putrini.

Kushtha, Amlapitta and Vatavyadhi nidana

• KUSHTHA: seven mahakushtha and eleven kshudrakushtha — eighteen in all. All seven dhatu are involved and three doshas, which is why no kushtha is purely one dosha.
• The seven maha: kapala, udumbara, mandala, rishyajihva, pundarika, sidhma and kakanaka. Kakanaka is the worst and is asadhya.
• Nidana includes viruddha ahara, and the texts name mishra of fish with milk specifically. Kushtha is one of the diseases classically attributed to viruddha ahara.
• AMLAPITTA: two by direction — urdhwaga with sour and bitter vomiting, and adhoga with burning and loose stool. Nidana is vidahi, amla and pitta-vardhaka ahara. Shankha bhasma and Avipattikara churna are the named yoga.
• VATAVYADHI: eighty in Charaka Sutrasthana 20, the largest count of any nanatmaja group. Two mechanisms — dhatukshaya janya and margavarana janya — and telling which one is present decides whether to give brimhana or shodhana. Getting that backwards is the commonest clinical error in vata practice.

Where the texts disagree

• The count of prameha is twenty in Charaka (ten kaphaja, six pittaja, four vataja); other texts order the subtypes differently.
• Kushtha is seven maha and eleven kshudra in the usual reckoning, but the assignment of individual types between the two groups differs.
• Madhava Nidana reorganises the nidana of the earlier Samhitas and is the text most universities actually examine from.
• The shatkriyakala is Sushruta's; Charaka describes the same progression without the six-fold naming.

Commonly confused

• Purvarupa (before) and Rupa (during) - the stage is the whole distinction.
• Upashaya (relief) and Anupashaya (aggravation) - both are diagnostic trials.
• Samprapti (the process) and Nidana (the cause).
• Prameha (twenty types) and Madhumeha (one of the four vataja).

Practise it, and prove it