A Text Book on Roga Nidana Evum Vikriti Vijnana (Nidana Bodhini)

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About the Author Dr. Nitin R. Krishnan completed his graduation from Amrita School of Ayurveda (Amrita Vishwa Vidyapeetham), Kollam, Kerala and Post-Graduation from Sri Dharmasthala Ma njunatheshwa ra College of Ayurveda and Hospital - SDMCA & H (Rajiv Gandhi University of Health Sciences - RGUHS), Hassan, Karnataka. Author has rendered service as Assistant Professor, Department of Roganidana, Parul Institute of Ayurveda and Deputy Medical Superintendent, Parul Ayurveda Hospital, Vadodara, Gujarat. He also contributed his service as Senior Technical Associate (Ayurveda Expert) and E - Learning Consultant and Coordinator for E - Learning Cell in Central Council of Indian Medicine, New Delhi for E -Vidya, an E- Learning project of CCIM inspired from Digital India initiative by Honourable Prime Minister of India. He has a spectrum of contributions in various domains of Ayurveda through several scientific articles published in National & International Peer Reviewed Journals and Scientific papers presented in various Scientific Platforms. Author has been conferred 6 times Best Paper Award in various National & International Conferences. Currently the author is working as Assistant Professor, Department of Roganidana, Faculty of Indian Medical System, SGT University, Guru gram, Haryana.

About the Book The text book named "Nidana Bodhini" -A Textbook on Roga Nidana Evum Vikruti Vijnana is a comprehensive text book for learning pathology and diagnosis in Ayurveda for undergraduate and postgraduate scholars. This book emphasizes on Ayurvedic understanding of pathogenesis and its components without losing integrity from Ayurvedic literature. The chapters are very keenly knitted with a continuous flow of thought. The topics are elaborately discussed with the commentaries of respective reference to make it a complete reading. The book also simultaneously acts as a glossary, thereby by clarifying the exact concepts tagged behind various words mentioned by the Ayurveda Acharyas and Commentators for a better comprehension. Concepts and methods of pathogenesis and diagnosis of diseases in Ayurveda have been explained in various sections. Textbook can be used as a reference by Ayurveda Scholars for Roganidana, Kayachikitsa, and for certain topics on other subjects. The detailed description of various topics of Ayurveda in the book will stimulate the scholars an interest in reading Samhitas and contemplate on them.

Preface The science of Ayurveda revolves around the very basic and realistic concepts of dosha, dhatu and mala. These components when existing in relative state of equilibrium or harmony manifests health. When, they deviate from the harmonious state, an individual succumbs to disease. Ayurveda literature explains the knowledge of life and its various domains based on dosha, dhatu and mala. Therefore, it's paramount to un-distend those entities properly. The budding scholars in graduate and post graduate course are highly influenced by the "translated science", where "translated science" refers to the mere literary or dictionary meaning of the most sophisticated and encrypted Sanskrit verses, which are available in current books at the market. Also, they depict various opinions revolving around a fact. This creates and multiplies the dogmatism with regard to the knowledge of Ayurveda. Hence, this text book has been written with an objective to curb dogmatism in the branch of Roganidana and Ayurveda through appropriately discerning various terminologies with precise references from Ayurveda literature. This fundamental knowledge helps the scholars to build an intense and strong base, to prepare them for strengthening the clinical knowledge and dexterity.

This book emphasises on Ayurvedic understanding of pathogenesis and its components without losing the integrity. The chapters are very keenly knitted with a continuous flow of thought, rather than any conventional way of framing chapters. This allows the reader to acquire knowledge and relate them appropriately. The work is not just a key to crack exams; instead, it's made to inspire the readers to think between the lines, stick on to the classical books, and avoid any erroneous under-standings or mere correlations and thereby promoting comprehension of Ayurveda in its own language, without losing the essence. The book is not just a compilation of all the chapters as per norms of undergraduate and postgraduate course, but a de-tailed analysis of topics, sufficient enough to kindle the quest for knowledge regard-in the subject. It is observed that majority of medical students in the field of Ayurveda read the concepts and practices without appropriately understanding the crux of the topics. And also a lot of time is spent by the students to imbibe the contemporary science. At the end of the day students are neither confident in Ayurveda nor well versed and competent in managing with contemporary science.

My intention in the current work is to enlighten the student community with regard to basic concepts of Roganidana Evum Vikruti Vijnana. This enlightenment is only possible through a meaningful and productive effort by the reader to delineate the definitions of various Ayurveda terminologies in different contexts. This broad understanding throws light on drawing a precise diagnosis and thereby framing a fruitful treatment protocol. There are various domains to be covered by an individual to become a good physician. Most important among them is to understand the patient and the discomfort suffered by the patient. To comprehend the same a flawless and strong, theoretical knowledge is required. The application of this fundamental knowledge is the next step. This is possible through extensive learning and gaining clinical skills. Ayurveda scholar gaining fundamental knowledge of dosha, dhatu and mala, later learning clinical methods from contemporary science without understanding the rationality abridging them for solving the crisis in a patient is highly contradictory and ridiculous. The Acharyas of Ayurveda have mentioned various methods for examination of disease. Revalidating and practicing the same in the current era is a major challenge what the emerging scholars have to accept. The reason for the de-cline of Ayurvedic methods of examination is due to the technological advancements in diagnosis and prognosis. This has reduced the clinical dexterity and knowledge along with blind dependence on technology causing errors in diagnosis. Despite the dependence on technology, eighty percent of data favouring the diagnosis arrive from history taking and its interpretation.

While engaging the students, it has been observed that students feel difficulty in discerning even the basic terminologies and its relevance in clinical context. The cur-rent books available in the market do not serve a detailed analysis of the basic concepts, creating lack of interest in continuing a meaningful and productive learning. Therefore, my work brings to you a detailed, clear and accurate understanding with authentic references along with its commentary for various topics. The book reaches every nook and corner of Bruhatrayees to acquire a complete and comprehensive knowledge of the topics dealt. This prepares the student for the next phase of learning and exercising clini-cal skills in Ayurveda. That's why being the author I strongly suggest and recommend to follow the book. This work helps the user to save time as the work is an authentic compilation of different topics from the great works of ancient Ayurveda Acharyas in a digestible, absorbable and assimilative format. The book is formulated for students, faculties, practitioners, research scholars, and those wishing to explore and pursue pathology and diagnosis in Ayurveda.

Volume 1 of this book is divided into four units. Each unit is furnished with various sections. First unit is Introduction to Roganidana. It comprises of Definition of Roga, Definition of Nidana, Definition of Roganidana, History of Roganidana, Importance of Roganidana and Basic knowledge on Madhavanidana. Second unit is named as Dosha dushti. It includes information regarding the topics - Definition & Concept of Dosha, Pivotal role of Dosha in Health & Disease, Definition of Dushti, Introduction to types of Dushti, Different dimensions of Dushti, Sub classification of Vriddhi & Definition of Chaya, Definition of Hrushta, Definition of Utklesha, Definition of Leena, Definition of Prakopa, Types of Prakopa and Definition of Kshaya. Third unit is named as Nidana. It is furnished with details regarding - Definition of Nidana, Synonyms of Nidana, Enumerating & Mentioning types of Nidana, Definition of Utpataka & Vyanjaka hetu, Definition of Prakruta & Vaikruta hetu, Definition of Prakriti & Vikriti hetu, Definition of Bahya & Abhyantarahetu, Definition of Anubandhya & Anubandha hetu, Definition of Sarno & Nirama hetu, Introduction of Asatmyendriyarthadi samyoga, Asatmya Chakshuindriyartha Samyoga, Asatmya Srotrendriyartha Samyoga, Asatmya Ghranendriyartha Samyoga, Asatmya Rasenedriyartha Samyoga, Asatmya Sparshenedriya Samyoga, Introduction to Vak Mana Shareera Ati Mithyaand ayoga and Pranjaparadha & Parinama. The last unit of the book is named as Doshagati. It comprises of Introduction to Dosha Gati, Intro-duction to Prakruta Dosha Gati, Introduction to Vikruta Dosha Gati, Jwara Samprapti, Raktapitta Samprapti, Gulma Samprapti, Prameha Samprapti, Kushta Samprapti, Shosha Samprapti, Unmada Samprapti, Apasmara Samprapti, Difference between Unmada & Apasmara, Consolidating Nidana Sthana, Nidanarthakara Roga, Consolidating Vikruta Dosha Gati WRT NidanaSthana, Vikruta Dosha Gati WRT Adharaneeya vega, Vikruta Dosha Gati WRT Dosha Vriddhi, Kshaya, Prakopa Lakshana, Nanatmaja Vikara, Dosha Prakopaka Nidan ,Koshta to Shakha & Shakha to Koshta Gati, Ashayapakarsha Gati, Chikitsartha Dosha Gati, Sannikrushtadi Hetu and Doshad iHetu.

It was a challenge to compile and analyze word to word meaning and relevance according to various contexts and throw light regarding its broad understanding. Each section is novel and different from the current works available till date. The result of this work hence upholds the good old science of Ayurveda passing down its tradition from time immemorial. The work provides a detailed, comprehensive, clear and accurate guidance, from the literature of Ayurveda. I hope it instigates the users to explore and ponder the topics dealt in the book, for enhancing the knowledge on the subject Roganidana evum vikriti vijnana.

Introduction Roga is discerned as a state of imbalance of dosha, dhatu and or mala. This may lead an individual to suffer. It may arise due to multiple factors arising out of inappropriateness with reference to body, speech and mind. Nidana is understood as either hetu or aetiology and as nidana panchaka or vyadhi bodhaka nidana or tool for diagnosis of a disease. Nidana panchaka refers to nidana, purvarupa, rupa, upashaya and samprapti. Nidana as hetu or etiol-ogy is the entity responsible for causing or producing a disease. Purvarupa is the initial signs and symptoms which may be mild or obscure. Rupa refers to the signs and symptoms of a disease. Upashaya is defined as those practices such as aushadha, ahara, and vihara that pro-vide comfort to the body by acting against a disease. Sam prapti refers to the process occurring right from the time of consuming nidana till the manifestation of signs and symptoms. Roganidana and vikruti vijnana, hence deals with the study of various forms of discomfort suffered at different levels due to inappropriate act of body, speech and mind, by precise un-derstanding of the etiological factors or hetu.

When the deterioration of knowledge and knowledge acquiring skills started occur-ring, it demanded the emergence of the much needed branch "Roganidana" - based on the text Madhavanidana (Rugvinischaya) authored by Madhavakara. The branch serves to be very important as it deals with study of regarding deviation of dosha, dhatu, mala from its relative balance. Also, the branch focuses on examination of patient and disease. It is termed as pareeksha. After conducting pareeksha and drawing a precise understanding of the condition, a wise physician has to plan for a fruitful treatment. This highlights the importance of the branch - Roganidana evum vikruti vijnana. The literature Madhavanidana is a valuable work for the branch Roganidana. It has been written in 700 AD. The literature has been commented by various commentators. The most widely accepted and used commentary is Madhukosha commentary by Vijayarakshita and Srikantha Dutta.

The entity that is responsible for causing imbalance or vitiation to the mind and body is called as dosha. The doshas are responsible for sustaining body as kapha provides strength or energy, pitta takes the strength or energy, and vata is essential for modulating the strength or energy. When they are in balance manifests health, on the contrary, the imbalance leads to morbidity and even mortality. Dushti is understood as abnormality or deviation from normalcy. It may be structural or functional. Dosha dushti is classified into vriddhi and kshaya. Vriddhi can be understood as quantitative increase, qualitative increase of various functional and structural components in the body. Chaya refers to stabilized or solidified increase of dosha. The doshas tend to stagnate or when the movement is lost in any location of body due to any reason, it is considered to be of Samhita dosha avasta. Utklesha is a state in which dosha is defined as in a state of movement in its own site. The term leena refers to dosha avasta in various contexts, or vega avasta in apasmara. It is characterized by its nature of strongly being adhered to srotas and dhatu, fixed in a specific site and the signs and symptoms are mostly subclinical or in latent stage. The term prakopa refers to aggravation or features of aggravation of dosha, etc. reduction in the attributes, features and or functions of dosha, etc. is termed as kshaya.

Various types of nidana leading dushti are mentioned based on the strength in manifesting a disease, based on the body constitution, seasonal variation, site of the aetiology, relevance based on the direction of dosha, avasta of dosha, location or rogamarga, based on conjunction of indriya and indriyartha, based on importance in considering for treatment, proximity of the aetiology in manifesting a disease, etc.

Gati or movement is the chief expression of life,gati is required for sanchara of prana, sanchara of nutrition, sanchara of sanja, sanchara of mala, or any such essential factors. Gati can be discerned as movement, motion or locomotion or doshaavasta, expulsion of flatus, etc. Chalanam, gamanam, chankramanam are the synonyms of gati. Broadly based on these understandings doshagati can be classified into prakrita, vikrita dosha gati and chikitsa-rthadoshagati. Prakrita dosha gati includes all the normal functions performed by the dosha, whereas vikrita dosha gati includes dosha vriddhi kshaya and prakopa lakshana, dharana of aadharaneeya Vega, and pathogenesis of various diseases. Vikrita dosha gati explains in detail about the various concepts of pathology in Ayurveda, responsible for manifestation of dis-ease. Chikitsarta dosha gati refers to the third type of broad classification of dosha gati. The movement of dosha with reference to the treatment administered or the gati induced through a dravya administered for the purpose of treatment.

Book's Contents and Sample Pages