NIDANA / HETU

Dr. Jinal Patel

M.D. (Ayu.)
Assistant Professor
 Nirukti
 नि शब्दो निश्चये। निदानं इति करणे ।
- The word Ni denotes Conformation. Theword Danam stands for
Karanam or cause. So, Nidana means conformation of the cause
of disease.

 निदानं कारणमिहोच्यते, तच्चेह व्याधिज

नकं व्याधिबोधकं चसामान्येनोच्यते| त
त्र व्याधिजनकं निदानं हेतुः, व्याधिबो
धकं च कारणं निदानपूर्वरूपरूपोपशयसम्
प्राप्तिरूपम् |
(Ch. Ni. 1/1 Chak.)
• Chakrapani tells that Nidana is a Karana (cause). It is
used in 2 contexts
- Vyadhi Janaka - Nidana is a term used to explain
the causes of a disease.
- Vyadhi Bodhaka - Nidana is a term which by itself
indicates a disease, i.e. is Nidana
helps in identifying or diagnosing

a disease.
 Vyadhi Janak Nidan
सेतिकर्तव्यताक: रोगोत्पादक हेतु: निदानं|
( मा. नि. १/५ मधुकोष टीका)
• The factor which has the ability to perform functions
(इतिकर्तव्यता) which will undoubtedly give rise to disease
through Dosh-Dushya Samurchana, samprapti,etc. is called Nidan.
व्याधि उत्पत्ति हेतुः निदानम्। (मधुकोश)

येन आहार विहारेण रोगाणाम् उद्भवो

भवेत्।
क्षयो वृध्धि च दोषाणां निदानं हि तद्
उच्यते। (वङ्गसेन)
 Vyadhi Bodhak Nidan
 निर्दिश्यते व्याधिः अनेन इति निदानम्।
(मधुकोश)
 निश्चित्य दीयते प्रतिपाध्यते व्याधिः
अनेन इति निदानम्। (मधुकोश)
 व्याधि निश्चय करणं निदानम्। (मधुकोश)
- That which points towards or helps to know about or
diagnose a disease is called Nidana.
- That which helps in confirmatory diagnosis of a disease
(without any doubt) is called Nidana.
 Synonyms
इह खलु हेतुर्निमित्तमायतनं कर्ता कारणं प्रत्ययः स
मुत्थानं निदानमित्यनर्थान्तरम् | (Ch. Ni. 1/3)
निमित्तहेत्वायतनप्रत्ययोत्थानकारणैः
| निदानमाहुः पर्यायैः...
(वा. नि. अ. १)
 Hetu :- Cause of the diseases
 Nimitta :- निमित्तस्य शकुनादौ- As it precipitates the
diseases
 Aayatana:- It indicate the site of disease.
 Karta:- As it initiates the disease process.
 Karan :- Cause of the diseases.
 Pratyaya:- One which is needed to form the disease
 Samutthana:- Which activates the causative factor
 Mulam:- root cause
 Classification
 Four Types
“सन्निकृष्टविप्रकृष्टव्यभिचा
रिप्राधानिकभेदाच्चतुर्धा|
(Ma.Ni. 1/5)
Sannikrishta Viprakrishta
Hetu Hetu

Hetu

Vyabhichari Pradhanik Hetu

Hetu
 Tree types of Nidan
तत्त्रिविधम्- असात्म्येन्द्रिया
र्थसंयोगः, प्रज्ञापराधः, परिणामश्
चेति|
(Ch. Ni. 1/3)
Dosha Hetu

Vyadhi Hetu

Ubhaya Hetu
 1)Kostha
2)Shakha
3)Marmasthi Sandhi
 1) Urdhva
2) Adha
3) Tiryak
 1) Kshaya
2) Sthan
3)Vridhhi
 Two Fold
classification
1)Utpadak 1) Abhyantar 1) Prakrit
1) Sharirik 1) Anubandhya
Hetu 2) Bahya Hetu
Hetu
2) Vyanjak Hetu 2) Vaikrit 2) Anubandh
2) Mansik
Hetu Hetu
Hetu

- Ashayapakarsh Hetu
 Four Types
1) Sannikrishta Hetu:
सन्निकृष्टो यथा
नक्तन्दिनर्तुभुक्तांशा दोषप्रको
पस्य
हेतवः, न ते चयादिकमपेक्षन्ते |
(Ma.Ni. 1/5)
- These are the etiological factors which cause the Dosha
Prakopa immediately, there will be no accumulation of
Doshas such as Vata Dosha is aggrevated immediately by
Ruksha Aahara Vihara.
- It does not require the stage of pathogenesis like Chaya,
Prakopa and Prashar etc.
2) Viprakrishta Hetu :

विप्रकृष्टो यथा– “हेमन्ते निचितः

श्लेष्मा वसन्ते
कफरोगकृत् | (Ma.Ni. 1/5)
- These are the etiological factors of disease which cause
Dosha Prakopa by distant reasons.
- such as Rudrakopa is the Viprakrishta cause of Jwara or
in Hemant Ritu Kapha get accumulated and it is
aggravated in Vasanta Ritu to cause Kaphaja Vikara.
3) Vyabhichari Nidan:
व्यभिचारी यथा– यो दुर्बलत्वाद्
व्याध्यधिकरणासमर्थः| (Ma.Ni. 1/5)
- It refers the cause which is week or less potent to
cause a disease.
- The nature of the cause in this category is such that it
doesn't lead to the development of disease
immediately but it has the potential to cause a
disease.
- For. e.g. eating sweet does not immediately lead to
the diabetes but it has the potential to lead to the
development of diabetes in the long run
4) Pradhanik Hetu:
प्राधानिको यथा– विषादिः
- This refers to the fatal cause which instant lead to
development of disease. For e.g. Poisons
Trividh Hetu
1) Dosha Hetu: Are those factors which are responsible for
disequilibrium of Dosha inside the body
- e.g. seasonal aggravation of Dosha in which Madhur rasa
increases Kapha dosha in Hemanta ritu.
2) Vyadhi Hetu: Are those which are responsible for
development of specific disease by specific etiology. For eg –
regular consumption of Mrd manifest Mrdbhakshanajanaya
Pandu Roga.
- Eg – intake of Kullatha in excess manifest amlapitta
Vikara.
2) Ubhaya hetu- specific factors which aggravates vata and
rakta and simulataneously manifest vatarakta vyadhi.
Here causative factors aggravates dosas and
simulataneously manifest disease.
 Utpadak and Vyanjak Hetu
1) Utpadaka Hetu-
त्रोत्पादको यथा
हेमन्तजो मधुररसः कफस्य
- Are those which favours acculumation of respective Dosas in
respective season due to changes in season . For e.g in Hement
Ritu due to Madhuradi sunstances acculumation of Kapha
observed.
2) Vyanjaka Hetu-
व्यञ्जको यथा– तस्यैव कफस्य व्यञ्जको
वसन्ते सूर्यसन्तापः
- Are those which stimulate the development of disease. For eg
accumulated Kapha in Hemant manifest disrders of Kapha in
Vasanta due to effect of sun.
 Bahya Hetu and Abhyantar Hetu

1) Bahya Hetu– Bahya Hetu is the causes which are

external to the body like microorganisms, injuries,
climate, diet, lifestyle etc.
2) Abhyantara Hetu: means internal factor of the
body like Doshas, Dhatus, Malas, immune
mechanism
 Prakrit and Vaikrit Hetu

1) Prakrit Hetu: It means natural causes which

aggravates Dosha e.g. Vata, Pitta and Kapha dosha
aggravation in Varsha, Sharad and Vasant ritu
respectively.
2) Vaikrit Hetu: means where Dosha prakopa occurs
irrespective of their seasonal effects e.g., Pitta or
Vata aggravation in Vasant ritu.
 Anubandhya and Anubandha Hetu

1) Anubandhya Hetu means prime cause of a disease

e.g. malaria by plasmodium.
2) Anubandha Hetu means secondary or dependant
cause of a disease e.g. if mycobacterium is primary
cause of TB, then unhygienic conditions, humid
climate and overcrowded population are the
secondary causes for it.
HETU
 तदेव व्यक्ततां यातं रूपमित्यभिधीयते |(Ma. Ni.
1/7)
व्याधेः स्वरूपं यद्व्यक्तं तद्रूपम् |
(Eshvarsen on Ma.)
Synonyms of Rupa
 Types of Rupa

1) Samanya Lakshana: General symptoms related to that

particular disease. Eg. Jwara Samanya Lakshana
2) Vishesh Lakshana: Specific symptoms of the particular
type of Dosha.e.g. Vataj Jwara Lakshana, Pittaja Jwara
Lakshana, Kaphaj Jwara Lakshana.
1) Sharir Rupa : physical features eg: in fever Alasya ,
vairsya, Gatragauravm.
2) Manas Rupa: e.g mental features of fever are
disinterested in good advice, mental irritability.

3) Aatur Samvedya Lakshana : Symptoms felt by

Patient. E.g. feve, bodyache, etc.
4) Vaidya Samvedya Lakshana : Signs observed by
physician. E.g. Pallor
1) Prakruti Sama Samvet Rupa: symptoms
correspond to the qualities of involved Doshas.
E. g. Lipta Tiktashyata in Kapha-Pittaja Jwara
2) Vikruti visham samvet Rupa: Symptoms do
not correspond to the qualities of involved
Doshas. E.g. Aruchi in Vata-Pittaja Jwara.
• Pratyatma Rupa:
- Santapa is cardinal feature of Jwara.
- Prabhut avil Mutrata is Cardinal symptom of Prameha
 Importance of Rupa
For diagnosis of disease:
• Some diseases don't have prodromal symptoms. E.g. 'Vata
Vyadhi’. And their diagnosis is made only by observing
their clinical features.
For differential diagnosis of disease:
• Rupa are useful in differential diagnosis of the diseases.
For e.g. the Udarshool (abdominal pain) is present in
Annadrava-shool and Parinam-shool. When the abdominal
pain occure during the digestion of food, it is Annadrava-
Shool and when it is present after the digestion of food then
it is Parinam-Shool.
• Symptoms give us the information about the vitiated
Dosha and also the qualities of Dosha.
- Example Shula (colic pain) suggests the vitiation of Vata
Dosha along with imbalance of its Ruksha (dryness) and
Sheeta (cold) qualities. Similarly, Daha (burning sensation)
indicates the increase of Ushna Guna (heat quality) of Pitta.
- Similarly if the symptoms of 2 or 3 Doshas are
simultaneously observed, it suggests Samsarga and Sannipata
respectively.
For Prognosis of Disease:
• If all the symptoms of disease are present, then disease is
difficult to cure.
• Rupa indicates the site of actual pathology in the body.
E.g. - Shira Shula (headache) indicates that the pain is in
the head (Shira). Udara Shula (abdominal colic pain)
indicates that the pain is present in the abdomen.
For treatment of disease:
• Knowledge of Rupa is very much important for planning
specific treatment of disease. E.g. In Jwara, Aamjwara
(Langhan), Pachyamanjwara (Deepan, pachan drugs),
Niramjwara (Virechana - purgation).
 Difference between Vyadhi and Lakshana
Sr.
Vyadhi Lakshana
No.
It represents itself a It occurs as single representation
1.
syndrome.
It occurs when Dosha It can occur without Dosha Dushya
2. Dushya sammurchhana is sammurchhana during Sanchaya,
present. Prakopa Avastha of Dosha.

It has six stage of It occurs without passing through

3. Pathogenesiss the stage of Shatkriyakala
It has specific treatment. It does not required Vyadhi
4. E.g. Vyadhi Pratyanik pratyanik Chikitsa. Give treatment
Chikitsa. occording to symptms

5. It is independent It is dependent on Vyadhi

Upashaya & Anupshaya
 Definition
सुखावहमिति सुखं रोगनिवृत्तिलक्षणं |
• The word pleasure used in context to Upasaya means which gives
happiness and pacify the disease.
औषधादिजनितः सुखानुबन्ध उपशयः (Ma. Ni.1/9
Madhukosh)
उपशयः पुनर्हेतुव्याधिविपरीतानां
विपरीतार्थकारिणां
चौषधाहारविहाराणामुपयोगः
सुखानुबन्धः|| (Ch.Ni. 1/10)
• Upashaya means which gives pleasure to the person by use of
medicine, diet and regimens. Their action may be directly against the
cause , or to the disease itself or to the both (i.e. the cause and disease).
 गूढलिङ्गं व्याधिमुपशयानुपशयाभ्यां,(Ch. Vi. 4/8)
• In case of difficulty in a diagnosis due to some hidden things of
disease in such circumstances Upasaya and Anupsaya therapy
helps to diagnosis.
हेतुव्याधिविपर्यस्तविपर्यस्तार्थका
रिणाम् |
औषधान्नविहाराणामुपयोगं सुखावहम् ||
विद्यादुपशयं व्याधेः स हि सात्म्यमिति
स्मृतः |
विपरीतोऽनुपशयो व्याध्यसात्म्याभिसञ्
ज्ञितः || (A.H. Ni.1/8,9)
• Upashaya – when a therapeutic test results in lowering the
symptom it is called Upashaya. For example, if due to hot
fomentation joint pain relieves pain it is Upashaya.
• Anupashaya – when a therapeutic test results in increasing
symptoms it is called as Anupashaya. For example, if oil
 Clinical importance of upasaya &
Anupashaya
• For diagnosis of disease
- Relieving factors helps in making correct diagnosis, often
use to differentiate between to diseases with similar
symptoms. Then by the use of aggravating or relieving
factors we can diagnose the disease. E.g. Sandhigat Vata and
Amavata.
• Upashaya and anupashaya help in formulating Pathya-
pathya regime in treatment.
• This Upashaya and Anupashaya also help in treatment of
disease. If we know the causative factor of any disease
simply we can plan for specific treatment with the help of
Hetu Viprita Upashaya.
SAMPRAPTI
 Defination
यथादुष्टेन दोषेण यथा चानुविसर्पता |

निर्वृत्तिरामयस्यासौ सम्प्राप्तिर्जातिराग
तिः||
(A.H.Ni. 1/8)
• Samprapti means pathogenesis. The term signifies the
mechanism starting from vitiation of Dosha till the origin and
complete manifestation / development of the disease.
अ(त)त्रैके व्याधिजन्ममात्रमन्त्यका
रणव्यापारजन्यं सम्प्राप्तिमाहुः|
सम्प्राप्तिर्जातिरागतिरित्यनर्थान्तरं व्या
धेः|| (Ch. Ni. 1/11)
• synonyms – Jati , Agati

 Types of Samprapti
सा सङ्ख्याप्राधान्यविधिविकल्पबलका
लविशेषैर्भिद्यते|
(Ch. Ni. 1/11)
1) Samkhya
2) Pradhanya
3) Vidhi
4) Vikalp
5) Bala-Kala
- Vidhi Samprapti is not mentioned by Acharya Vagabhatta.