Physician as depicted in Manasollasa

by Sri B. S. Hebballi | 2001 | 75,801 words

This thesis critically evaluates the role of physicians in Ayurvedic literature, particularly in King Somesvara's Manasollasa. It explores the connection between mind and body health, emphasizing the influence of diet and actions....

4. Nidana-pancaka (Pathology or Investigation of Diseases)

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In Ayurveda, the Methods of Investigation of Diseases are usually described under the following five heads : (a) nidana (Nidana), (b) purvarupa (Poorva-roopa), (c) rupa (Roopa), (d) upasaya (Upasaya) and (e)(Samprapti). These are known as "nidanapamcaka " where Nidana means " roganiscaya . "

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101 (a) Nidana : means the 'root-cause of the disease' and may be (external), abhyamtara (internal), viprakrsta ( remote), sannikrsta (immediate and hence exciting ), pradhanika (primary), or vyabhicari (minor). Nidana is brought about by 1. 2. 3. asatmyemdriyarthasamyoga - incompatible correlation of the senses with their objects, i.e., transgression of the power of tolerance; e.g., exposure to cold, causing nasal or pulmonary catarrh. - Indiscretion in behaviour and irregularity in life, External influences such as seasonal and climatic factors. (b) Poorvaroopa : is suggestive of premonitory symptoms. The symptoms only suggest that some internal derangement has been started and that toxins are making their way towards the tissue-cells : dosadusyasammurcchanavastha . The infection is still undeveloped and does not show any characteristics of a particular dosa (disease) : limgamavyaktamalpatvat vyadhinama . It is a precursor of future trouble. (c) Roopa : When the develops there is a clear manifestation of subjective symptoms and physical signs. These signs and symptoms go by the names : rupa, limga, laksana, akrti, samsthana . (d) Upasaya Caraka explains 'Upasaya' as 34: (Satmya) in in the eleventh chapter of Sootrasthana and defines the eighth chapter of Vimanasthana as 'satmyam nama tadyatsatatyenopasevyamanamupasete '. Satmya is thus that property which, owing to a habitual use, develops adaptability. So, if a certain property in an article brings relief to a patient by removing the disturbing factor, it is said to be an Upasaya of that derangement. sukhanubamdho yo heturvyadhyadiviparitakah (Sudant-Sen, Commentary on Madhava-Nidana). This is just like tracing the disease (cause) from the effect. In other words, it is an art a device of diagnosing by "applied therapeutics". Caraka advises this method of

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102 diagnosis when the dosa is avyakta ; for he says gudhalimgam vyadhisupasayanupasayabhyam parikseta || carakasamhita - vi . 4.15. - (e) Samprapti : Means the knowledge of the way in which a certain disease develops. By knowing the Samprapti almost all the circumstances related to the development of a disease, whether arising from intrinsic or incidental causes, can be estimated. The main features of Samprapti are described as ETTET bala kala visesatah madhava nidana . 1. 2. 3. 4. 5. - (Samkhya) the number of varieties or types in which diseases manifest themselves. This is, of course, only a general statement and hence does not give any idea of the particulars. vikalpa (Vikalpa) : dosanamamsamsakalpana . This gives a correct idea of the direction in which the different (toxins) have developed. This is eventually of great value in Treatment'. (Pradhanya): Nature of the disease as to whether it is primary or secondary. bala (Bala) : Severity or otherwise : ( uttana Uttana or gambhira Gambheera). < (Kala) : Season, whether favourable or otherwise. Next, the morbid phenomena which are ascertained by studying the c (Kriyakala) in Samprapti are thus mentioned : (i) (ii) c (Sancaya): means the Accumulation of s (Prakopa): means Excitation. (iii)(Prasara): means Extension of lesion. (iv) P 3/4 (Sthanasamsraya): means Location of the affection.

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103 (v) (Vyakti): Manifestation of symptoms. (vi) e (Bheda) : means variation in the spread of the disease. It is thus clear that all the details of 'Pathology' are taken into consideration by the Ayurvedists in following these methods of diagnosis. Clinical descriptions of symptoms caused by pathological derangements in the sand as are given by Susruta in the fifteenth chapter of Sootrasthana and by Vagbhata in the eleventh chapter of Sootrasthana. In surgical pathology, naked-eye appearances characteristic of s are minutely described in terms such as varna, chaya, raga, daha, paka, kamdu, toda, etc. For the symptoms and pathological manifestations the reader should refer to the fifteenth chapter of Vagbhata's Nidanasthana wherein detailed description of ¶¶¶ (Vatavikara) in the different 3/4 1/4 (Asayas), ¿ (Dhatus) and (rotas) is given. Similarly, the derangements caused by Pitta and Kapha when they attack the (Saptadhatus) and the resultant symptoms are given in the nineteenth chapter of Sootrasthana of Vagbhata's Astangasangraha. Both these deserve to be thoroughly mastered for a thorough understanding of the real part played by the as in their vitiated condition in respect of their influence on the body-tissues. The pathology of nija and agamtukaroga s is described accordingly as they arise from intrinsic (dhatuvaisamya ) and incidental (agamtuka ) causes respectively. Ayurvedists hold that even these such as bacteria, have a constitution of their own which can be described in Tridosa terminology. These organisms have, after all, a material body which carry with them a type of Pancha-bhautika costitution. They grow under particular favourable conditions and die when the environment becomes unfavourable. The internals are the resultant products of the Tridosas, while the external have their origin in the environment. In treatment, importance is given to both types, as they are likely to transgress their limits and encroach upon each other. Caraka has

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104 put this beautifully in the following words : agamturanveti nijamvikaram nijastathagamtumapipravrddhah || carakasamhita - sutrasthana - 20.18. agamtu (roga ) is defined by him in the next chapter.51 In Agantu diseases affliction is the first occurrence, and this is, in course of time, followed by derangement of the three dosas. In Hula, Vata, Pitta and Kapha are first deranged by some internal pathogenic cause, and then the symptoms (like pain) follow. In the opinion of the Ayurvedists, the internal bacteria are only the result of failure in equilibrium in the body-constitution caused by chemical products of bad digestion. The chief reason why the ancient physicians do not totally depend upon the Bacterial theory is, because of the non-applicability of that theory in all diseases and in all individuals. They, therefore, while reserving the germ theory, its own place in treatment, are not ready to assign to it an invariable position in the causation of disease. In short, the origin and cause of disease suggested in Ayurveda is placed on a broader basis. According to Caraka, 52 diseases take place when toxins singly or collectively affect the lymphatics, blood vessels and the nerves in a person who takes insalutary food and has no control over his mind. On studying the methods of Roga-pareeksha till now gone over, one should be able to estimate the extent of the virulence of the dosas or the disease itself. But there is another side of medical examination which is very important, and which, if neglected, would make all attempts of 51. aganturhi vyathapurvam samutpanno jaghanyam vatapittaslesmanam vaisamyamapadayati, nije tu vatapittaslesmanah purvam vaisamyamapadyante jaghanya vyathamabhinirvartayanti | | - carakasamhita - sutrasthana - 20.7 52. yadatu raktavahini rasasamjnavahani ca | prthakprthaksamasta va srotamsi kupita malah | | malinaharasaulasya rajomohavrtatmanah | pratihatyavatisthante jayante vyadhayastada | | carakasamhita - sutrasthana - 24 25 26

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105 treatment useless. And this is which means an approximate estimation of the state of natural resistance in an individual, both in normal as well as in the impaired conditions of health. It involves the investigation of various factors about the patient viz., those connected with his nature, temperament, constitution, hereditary influences, habit, environments etc. (For particulars vide Caraka, Vimana, Ch.8). These undoubtedly throw a flood of light on the prognosis of the case and enable the physician to choose remedies of a definite potency. Caraka has given detailed descriptions about the methods of understanding the personal constitution of the patient in the first chapter of varnasvariya This part of investigation is often neglected both by students and vaidyas and it will be no exaggeration to say that no method of treatment would be complete and successful without a knowledge of personal vitality and power of resistance of a patient. asatmyendriyarthasamyoga, the first condition mentioned in the array of etiological factors points to the natural resistance of an individual to disease. In fact, the first three stages, caya, prakopa and prasara, in the development of the disease, are directly connected with the personal resistance of the patient. The question of tempering the virulence or checking the progress of the disease depends upon a clear understanding of the elementary factors in Samprapti. The significance of this, especially in treatment, is well expressed by Vagbhata. An attempt should always be made to check the accumulation of dosas; but when the toxins are already there, treatment should be so adopted, whether by means of diet or medicines, that it does not provoke further complications. When all the three dosas are affected, one should aim at removing the affection which is more harmful or more advanced. The credit of bringing these elementary principles of pathology really falls to the share of ancient Ayurvedists. Except through the 53. caya eva jayeddosam kupitam tvavirodhayan | sarvakope baliyamsam sesadosavirodhatah | | - a .hr .su .a. 13.15

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106 agency of Tridosa theory or some other, which is akin to it, it is not possible to understand the samcaya stage in the samprapti of a disease. There is no doubt that imagination has to be stretched and inferences drawn upon probabilities and possibilities. Even in laboratory work much of imagination, discrimination and reasoning are required to arrive at conclusions. In research work, it is often found that theory and practice scarcely differ. The first directs the second, while the second confirms the truth of the first, Caraka expresses the same idea in the following words : pratyaksam tu khalu tat, yat svayamindriyairmanasa copalabhyate || carakasamhita - vi - 4.5 This sort of thought-sequence is necessary to understand the dosadrsyasammurcchanavastha - the basis of samcaya and to trace its development further and correlate the particular dosa with the particular symptoms.

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