Chapter CXLVI - Description of the Nidanam of all the diseases

Dhanvantari said:—O Sushruta, now I shall deal with the nosology pathology, pathogeny and symptomology of all the diseases as related by the holy Atreya to the sages of yore, The terms Roga, Papma, Jvara, Vyadhi, Vikara, Dushtam, Amaya, and Yakshma are the synonyms of disease. The five essential categories in respect of a disease may be described as its (Nidanam) pathology (lit., exciting factors), preliminary or incubative stage (Purvarupa), manifestation of characteristic indications (Rupa), amelioration (Upashaya), location (Samprapti), Diagnosis (Vijnanam). Reason, cause, pathogney, exciting factors are the synonyms of the terra Nidanam. The stage in which an uncertain kind of malaise is complained of by the patient in the absence of any particular characterestic triat(trait/trial?) of any given disease, is called its incubative stage, which points to the certain genesis of the disease but does not furnish any clue to its name and character—Manifestation (Rupa) of a disease indicates the stage in which its distinguishing and characterestic traits or symptoms become patent. The terms Samsthanam (fixity), Vijnam (distinctive traits), Lingam (differentiating features), and Lakshanam (symptoms) are the synonyms of Rupam. Upashaya signifies the amelioration of the morbific diatheses in a particular disease, effected with the help of drugs which are contrary in character to the esse of the disease, or are contrary in virtue to its exciting factors, or are contrary both to the esse of the disease and its exciting factors, or are similar in character to the esse of the disease (pathogenetic principle), or are similar in virtues to its exciting factors, or are similar both to the esse of the disease and the elements that favour its genesis, or with the help of proper diet and conduct.^[1]

The genesis or appearance of a disease in a particular part of the human body, either through the upward, downward, oblique, or transverse movement of the morbific principles, such as the deranged nerve force (Vayu), defective metabolism (Pittam), or disordered secretary or execretory process (Kapham) concerned in the case and determining location of the disease, is called its Samprapti (Pathogeny). The terms Agati, and Jati are the synonyms of Samprapti. The contrary of amelioration is called aggravation, disease or incongeniality. The mode of this pathogeny difters according to the nature of the prevailing season of the year and the number nature, strength, predominance, or neutrality of the different morbific principle involved in the case. The genesis of the eight different types of fever owing to the varied strength, and several or combined actions of the three morbific principles of Vayu, Pittam and Kapham, may be cited as an example of the foregoing dictum. The number of types into which a disease may be divided, or which is Usually detected in practice, is called its Sankhya (number). The relative preponderance of any of the pathogenic principles involved iri a disease, is called its Vikalpa. The virulence or serious character of a disease is proportionate to the combined or several actions of the morbific principles acting as its exciting factors. The relative virulence or strength of a disease should be ascertained with a due regard to its pathology, and the import of its indications, etc. Deliberations as to the aggravation or manifestation of a disease whether in day or night, or whether before or after a meal, or during summer or winter, etc., help the determination of its periodicity (Kala Nirupanam). Thus we have briefly described the outlines of pathogeny (Nidanam), etc., which shall be more elaborately described later on. A vareity of injudicious conduct tends to enrage the fundamental organic principles of Vayu, Pittam and Kapham. Ingestion of a large quantity of hot, astringent acid, pungent, and parchifying articles of fare, heavy meals, or voracious eating, running, climbing, lifting, loud-talking, nightkeeping, vigorous and energetic action, fright, mental and physical labour, and sexual intercourse are the factors, which enrage or aggravate the bodily Vayu, which becomes spontaneously aggravated in summer and after meals, and at the close of the day or night. Ingestion of pungent, acid, sharp, hot, fetid, or indigestible articles of food, and indulgence in irascible feelings are the factors which tend to enrage the Pittam, which becomes spontaneously aggravated in Sharat (months of Kartika and Agrahayana according to the Ayurvedic calender), at the middle part of the day or night, as well as when the food undergoes an acid reaction in the stomach after digestion (Videha). Ingestion of sweet, acid, saline, demlúcent, heavy (of digestion) and cold articles of fare, as well as of those which increase the humidity of the system, a long sitting at one place, want of sleep, day-sleep, and indigestion are the factors, which tend to enrage the Kapham, which becomes spontaneously aggravated in spring (Baishakha and Jaishtha), in the forepart of the day or night, and immediately after eating or vomiting.^[2]

Now I shall discourse on the combination of the deranged Vayu, Pittam and Kapham. Ingestion of insufficient, indigestible, irregular and incompatible meals, use of stab wine, dried potherbs, green radish, and fetid or dry fish, sudden change of food and drink, contrary or unnatural seasons, exposure to the east wind, sudden change of one’s mode of living, partaking of raw, uncooked food accumulation of phlegm in the body, malignant influence exerted by one’s natal star, false dealings and evil doings, non-gratification of any mental or bodily hankering, and the puerperal conditions of women are the factors, which help the combination and concerted action of the deranged Vayu, Pittam and Kapham. In each disease, the Vayu, Pittam and Kapham produce chemical changes in the blood according to the nature of the disease they give rise to and their characterestic symptoms.