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A Concise History of Science in India c8.s5.t2: Classification and Diagnosis of Diseases

A Concise History of Science in India c8.s5.t2

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Classification and Diagnosis of Diseases

c8.s5.t2.1

Diseases are the manifestations of the three humours, in their abnormal states, in an organism which already has a propensity for humoral aggravation due to inherent imbalance of humours. Hence *Āyurveda* has classified diseases by the humour affected (also in some cases by blood, which can be vitiated), and also by the causes which can trigger off such aggravations.

c8.s5.t2.2

a *CS. Vi.*, **8**. 3–13; *SS. Sū.* **2**, 4, 5 and 10.

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b *CS. Vi.*, **8**. 13, 20; *SS. Sū.* **2**. 5.

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c *CS. Sū.*, **25**. 24–25.

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d *CS. Sū.*, **10**. 8.

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e *CS. Sū.*, **15**.

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f *CS. Vi.*, **8**. 13.

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g *CS. Sū.*, **9**. 26.

c8.s5.t2.9

Classified according to humours (or blood), diseases are of the following types: due to *vāyu*, due to *pitta*, due to *śleṣman*, due to blood, due to two of them at a time, and due to three of them at a time. When all the three humours are deranged simultaneously, the disease is of the *sānnipātika* type and expected to be severe or even fatal. Classified according to the causes which aggravate the imbalance, all deviations from the healthy state are of three types. The first type, *ādhyātmika* (generated inside the organism or the mind), can be of three origins: *ādibalapravṛtta* (inherited from the stage of sperm-ovum), *janmabalapravṛtta* (acquired after conception but before birth, from the mother, her behaviour and other environmental factors) and *doṣabalapravṛtta* (caused during life by improper conduct, diet, etc.). The second type, *ādhibhautika* (due to adverse outside causes), can be of two origins: *saṁghātabalapravṛtta* (due to painful physical contacts, accidents, poisonous bites, etc.) and *kālabalapravṛtta* (due to abnormal or climatic conditions). The third type, *ādhidaivika* (due to fate, malign influences and other unknown reasons), can also have two origins: *daivabalapravṛtta* (providential, caused by 'acts of God', demoniac influences, charms, spells, natural calamities and epidemic diseases) and *svabhāva-balapravṛtta* (caused by factors which become inevitable with time, like sleep, hunger, thirst, senility and death).

c8.s5.t2.10

The above classification is found in the *Suśruta Saṁhitā*.a The *Caraka Saṁhitā* gives only three major origins: *nijaśarīradoṣaja* (of humoral origin, generated inside the body), *āgantuja* (communicated from outside) and *mānasa* (mental diseases).b The later texts by Vāgbhaṭa, Mādhava, Cakrapāṇidatta, etc., also give elaborate classifications and subclassifications on the general lines given by Suśruta but differing in details and nomenclature.

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All the major texts are also in agreement regarding the principles on which diagnosis is possible, though in some cases like the *Mādhavanidāna*, many chapters are devoted to a learned elaboration of the simple principles. In every case the aetiology, symptoms and prognosis are to be studied and compared to those described in the authoritative texts for different diseases. But, in diagnosis, the personal factors which cannot possibly be found in texts are of major importance. The patient's age, social status, heredity, usual residence, occupation, physical features, hardiness, vitality, habits, accustomed diet and usual appetite form the background which has to be filled in by interrogation and detailed personal examination by the physician who is advised to take the maximum help from his own trained senses. The physician should carefully observe the patient's present appearance, vitality, voice, acuteness of sense perceptions, clarity of mind, memory, any abnormality of behaviour, intestinal and other sounds, pulse, skin, bodily excretions, etc. When necessary, a sample of blood should be drawn and subjected to certain tests. Latent symptoms should be brought to the surface by provocative medication.a

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a *CS. Sū.*, 24.

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b *CS. Sū.*, 1, 19.

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Even with all the above knowledge at his command, the physician can make a correct diagnosis and decide upon a course of treatment, only if he has the mental calibre to apply properly his theoretical knowledge (which should be accurate and extensive) of all diseases and their different complications. He should have at his finger-tips the knowledge of the specific sources, exciting factors, preliminary indications, concomitant symptoms, possible complications and aggravations, variations of symptoms according to degrees of severity, period of duration and indications of recovery or imminence of a fatal end.b The physician should remember that some pathological symptoms are secondary effects of other diseases and may occur either simultaneously with the original disease resulting in a confusion of symptoms, or become apparent after the original malady subsides.c

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Though the above-mentioned personal factors are all important in diagnosis there are certain rational principles on which a diagnosis is to be based. These principles are too technical to be discussed here. The reader is referred to any reliable edition of *Rugviniścaya* by Mādhavakara, popularly known as Mādhavanidāna, for a masterly discussion of these principles.

c8.s5.t2.16

Though symptoms are generally valuable only as indicatives in diagnosis, the physicians should remember that in some cases the specific symptoms (or secondary symptoms) can become so violent and harmful that they should be checked first by any means, as otherwise they may prove more harmful than the disease itself. Symptoms are of three classes: *pūrvarūpa* (indicatory symptoms pointing to a future malady, latent in the system), *prāk-kevala* (specific symptoms appearing along with the onset of the disease) and *aupasargika* (secondary symptoms not specific to the disease, which may develop during the course of disease or after the latter has run its course).d

Cites (2)