Ayurveda is an ancient Indian health science which says how to be healthy through 2 ways, Prevention from diseases / ill health & Cure from a disease. For the effective management of a disease proper understanding of a disease – its causes, pathogenesis etc. are very essential. Regarding understanding of a disease medical systems prevailing all over the world have their own analysis. Since thousands of years Ayurveda has also contributed a lot in this regard.

In ancient times there were no advanced tools or technologies to diagnose a disease. There were no lab investigations, scan or X– ray or any other machines to assist or confirm the diagnosis. Still our saints had developed intelligent techniques through their keen observation & insight. Even without these modern accessories, they were able to diagnose & treat a disease with accuracy. For instance, urine sugar was detected by observing the ants around the place where patient urinated. Similarly Ayurveda texts like Charaka samhita, Sushruta samhita, Madhava nidana, Sharangadhara samhita etc. samhitas have given unique methods to examine a patient & understand a disease.

AYURVEDIC VIEW :

It is very essential for a Vaidya to have the basic knowledge of Ayurveda & its clinical application through proper analysis i.e., the prakruthi (normalcy) & vikruti (abnormal condition) of dosha, dhatu (tissue), mala & also the concept of agni & ama.

Our Ayurveda Acharyas have given unique methods of examination called “Pareekshas” like dwividha, trividha, ashtavidha pareekshas etc.

Before understanding the methods of examination it is important to know the purpose of understanding a disease clinically/practically. There come the questions,

• What to understand ?
• Why to understand ?
• How to understand ?

WHAT TO UNDERSTAND ?

• Understanding Dosha imbalance that has taken place in the body & their causes.
• Understanding where the Dosha imbalance has settled (i.e, whether in koshtha or in dhatu / shakha or in any other level).
• Understanding the imbalance of agni & ama.

WHY TO UNDERSTAND ?

Ayurveda quotes,

“ रोगस्तु दोष वैषम्यं दोष साम्यं अरोगता ।”

Balanced state of doshas is termed as ‘Health’ & imbalanced state of doshas is called as ‘Disease’ in a person.

Hence to bring back the normalcy of the doshas & therby restore the health of a person it is important to understand the imbalance of doshas & all these concepts.

HOW TO UNDERSTAND ?

Based on the guidelines given in the Ayurveda classics, dosha imbalance can be accessed in the following manner,

Case taking :

It is an art / skill of a doctor to get the clear history of a case. It is important to get the maximum information with proper questioning of the patient.

When a person comes to a clinic with his / her health issues, a doctor should first analyse whether it is Prakrutha or Vaikrutha. For example:

• If a mother comes with her child c/o very less food intake, at first we need to analyse the prakruthi of the child, as the nature of the agni will be according to the prakruthi. If vata prakruthi – by nature there will be vishamagni (digestive power – variable), if kapha prakruthi – by nature there will be mandaagni (low digestive power). If treated with any medicines, it may lead to disturbance in agni & thereby in prakruthi.
• When a person comes with history of white hairs/ early graying of hairs, then we need to access his prakruthi. If he is of pitta prakruthi, then it is natural for him. Hence we should make the person understand about the condition since the treatment will not give the proper result.

Initially we enquire about the main complaints which made the patient to approach a doctor along with associated complaints. We have to ask the patient to narrate the sequence of his complaints, duration & how they developed gradually. This helps to access specific dosha imbalance, its gati etc. But in few instances we don’t get a clear picture regarding the pathogenesis / course of a disease. Then a simple way to elicit these, is by asking the patient to tell about his Dinacharya (past & present) in detail. As the dosha imbalance is related to his food & activities, it is easy to analyse the probable mode of manifestation of the disease.

About dinacharya :

It can be asked in following manner:

• At what time he wakes up in the morning ?
• Whether the sleep was sufficient or disturbed ?
• Whether the person feels light & fresh or heaviness in body during early morning when he wakes up ? (Because heaviness of body indicates saamatva). Ex: if patient with joints pain says the pain aggravates more during morning hours, then it indicates the involvement of ama.
• Whether they consume anything in the empty stomach ? (like water, tea, coffee etc.)
• What is the nature of mala, whether it is sticky, hard or loose ?
• What is the frequency of urine & motion passed in a day ?
• How much water is taken in a day ?
• Whether they get hungry at regular intervals or not ? Timings of having food ( breakfast, lunch & dinner) ?
• What are the usual food items they consume & its nature? And about the usage of non vegetarian diet & its frequency ?
• Feeling of any discomfort (heaviness, burning, bloating etc.) after the food intake, if any ?
• Habit of divaswapna (day sleep)
• About vyayama (yogasana or any other) & its regularity
• Bed time.

Pareekshas / clinical examination :

When a patient comes to a physician his examination should start from the moment he enters the clinic. These can be explained by following methods:

Dwividha pareeksha :

Through examination, we can analyse whether the vyadhi of that person is Santharpana janya (over nutrition) or Apatarpana janya (malnutrition). Accordingly, this will help a physician to adopt the line of treatment by treating santharpana janya vyadi with apatarpana Chikitsa & vice versa.

Trividha pareeksha :

Darshana, Sparshana & Prashna are the 3 pareekshas which are vital & useful factors without which rogi & roga pareeksha is incomplete.

1. Darshana pareeksha :

It is the method of observation or inspection through pancha jnanendriyas of the physician. Factors to be observed under darshana pareekshas are as follows:

• Prakruthi of a person (Height, built, nature of skin, hair, eyes, nose, palm etc.)
• Vikruthi of a person ( Gait due to disease, tongue, eyes, skin etc

     2.  Sparsha pareeksha :

The first observation that comes under this examination is temperature. Next we should observe the surface of the body. The first observation that comes under this examination is temperature. Next we should observe the surface of the body.

Ex: If the skin is ruksha/ sheethala/ parusha texture indicates vataja roga.

If the skin is snehayuktha & ushna indicates pittaja roga.

If the skin is sticky in nature & greasy indicates kaphaja roga.

In the conditions of swelling we can know by touch its nature, hardness, tenderness etc.

We can find out the location and nature of doshas, saamatva etc. while doing Abhyanga through sparsha pareeksha.

Palpation & percussion also comes under this. By which we can examine the different abdominal organs & their abnormalities.

     3.  Prashna pareeksha :

Major part of case taking comes under this section, which we have already discussed. By a proper interaction, doctor should get a detailed history about his course of disease.

Ashtavidha pareeksha:

These will help in giving the detailed information of the patient condition & his disease, they are as follows:

• Nadi pareeksha :

Nadi pareeksha is very important in diagnosing a disease. Generally it is equated with Pulse examination, but if we observe Ayurvedic explanations, Nadi provides more in-depth knowledge than a pulse. Based on the character of nadi & its gati, a vaidya will be able to analyse the Dosha, Dosha sthana (depth / in which Dhatu the Doshas are located), its avastha – whether saama or niraama, eka doshaja / dvi doshaja / sannipataja and about the aavarana.

If the practitioner is a fresher in nadi pareeksha he can suspect the above factors, where as if he is experienced, with his knowledge he can conclude it.

• Mala pareeksha :

Most of the times, the condition of mala indicates the prakruthi & present status of koshta & jataragni.

The following questions might to be asked to know the above conditions,

• Whether constipated or loose stools?
• Frequency of passage stools?
• Completely evacuated or not?
• Colour & consistency (sticky/ pasty/ dry/ hard) ?
• Associated with bad odour?

• Mootra pareeksha :

The following questions have to be asked:

• What is the frequency of micturition?
• What is the amount of urine output?
• Ratio of day & night urine output?
• Whether it is followed by thirst or not?
• What is the color of the urine?
• Whether it is associated with pain, burning sensation etc.,

All these symptoms will help in diagnosing a disease, as these are particular to some of the diseases like Diabetes mellitus, Chronic kidney disorders, Inflammation etc.

Symptoms told by the patient related to mootra are essential to know the Dhatus involved in the disease (as in case of prameha, mootra pareeksha is vital).

• Jihwa pareeksha :

Tongue is an important indicator of koshtha & koshthangas.

To analyze this, we have to notice

• The color of the tongue
• Coating over the tongue (area, thickness, colour etc.)
• Cracks
• Edges
• Patches   etc.,

With these even we can analyze – Dosha imbalance, Saama & Niraama conditions mainly in the koshta & koshtangas.

To know about the detailed aspects of Jihwa pareeksha, one can refer to Dr. Vasanth lad’s publications, which says:

1. Coating at the tip of the tongue indicates the Doshas present at the upper part of the G.I tract (from oral cavity to lower end of oesophagus).
2. Coating at the middle part of the tongue indicates the dosha present at middle part of G.I. tract. (whole abdomen).
3. Coating at the distal part of the tongue indicates the dosha present at lower part of G.I. tract. (from beginning part of large intestine to rectum).

• Shabda pareeksha :

The character of the sounds while examining gives the diagnostic knowledge about the disease. Auscultation, percussion, breathing sounds etc., give correct picture about the disease.

Ex: Gurgling sounds in the abdomen & intestine, heart sounds & sounds generated at the joints on movements etc., will indicate the healthy/ diseased condition of the body.

• Sparsha pareeksha :

Examination of the patient by touch comes under sparsha pareeksha, which has already been discussed.

• Druk pareeksha :

Examination of eyes indicates the symptoms of many diseases.

Ex:

• Examination of eyelids :

If it is swollen: it indicates vrukka roga, kaphaja roga, shotha, pandu, shithapitta & prathishyaya.

If drooping: it indicates paralysis of cranial nerves.

• Examination of sclera :

Shweta patala : haridra varna indicates kamala,

Conjunctiva : pandura varna indicates paandu.

• Aakruthi pareeksha :

This examination is done by observing the patient from head to toe. The built of the person will help in analyzing the deha prakruthi of that person.

Lean, short, thin body with shyava varna indicates Vata prakruthi.

Madhyama sharira with aruna varna indicates pitta prakruthi.

Shtula, guru sharira with goura varna indicates kapha prakruthi.

Ex: If the patient is emaciated with dhatu shosha indicates raja yakshma/ shosha/ kshata ksheena.

If the patient is sthula kaaya indicates sthoulya, kaphaja vyadhis.

Dashavidha pareeksha :

These are helpful in treatment aspects rather than in understanding the disease  like selection of treatment or medicine, dosage, timing, anupana, etc.

• Prakruthi : The physical & mental characteristic features of the person which are acquired by birth are termed as prakruthi. Broadly they are classified as, Deha prakruthi & maanasa prakruthi.
• Saara : Essence of the body which means perfect form of dhatu. They are 8 in number: (a) twak sara (b) rakta sara (c) mamsa sara (d) medo sara (e) asthi sara (f) majja sara (g) shukra sara (h) sattva sara.
• Samhanana : It means compactness, arrangement of organs in proportion to size & shape of the body. It includes body structure, built & state of nutrition. It is of 3 types: Sthula, Sama & Krusha.
• Vikruthi : it means the pathological changes of a body. i.e, the Dosha, dhatu & mala vaishamya. These can be examined with factors like Dosha, dhatu, prakruthi, desha, bala & kala along with the lakshanas told by patients.
• Pramana : it is the size of the body. It includes the height, weight etc.
• Saatmya : These are the things which are accustomed to an individual with long term use which may be food or activities. It varies from person to person.
• Sattva : It is the examination of mind. Mano bala is the strength of the mind to sustain the disease.

        Ex : If a person is having strong manobala/ will power, he can easily come out of the disease, whereas the  person with weak manobala feels difficulty in getting rid of the disease even with the influence of strong Chikitsa.

• Aahara shakti : it includes the examination of food intake capacity of the person, which indicates the state of Agni in him. It can be measured in two ways;

          a) Abhyavaharana shakti: food intake capacity

          b) Jarana shakti: digestive capacity.

• Vyayama shakti : It means the working capacity of the person. It includes his capacity to perform day to day activities.
• Vaya : it is the age factor of a person which is of 3 types i.e, Baala, Madhya & Jeerna.

Apart from these 10, some other factors have also been told –

• Desha (the area where he lives, nature of the land, climatic conditions,etc.)
• Kaala (present season – summer, winter etc. & its influence on the body).

Without understanding the disease (dosha imbalance, the reasons for dosha imbalance, the stage by stage development & present status) it is highly impossible to treat a health issue. Hence clinical understanding of a case is very important.

Today’s trend is to diagnose on Allopathic lines & treat it with Ayurvedic medicines. As per our understanding this way of analyzing a case is more effective in Ayurvedic management.

By utilizing the above said ways one can analyze a case & plan appropriate treatment. The adoption of above techniques can even help a beginner to get guidelines regarding clinical understanding of a case.

Authors:

     Dr. Prasanna Venkatesh,  Chief Physician, Sriranga Ayurveda Chikitsa Mandira

Dr. Shilpa S. N, Senior consultant, Sriranga Ayurveda Chikitsa Mandira

Dr. Pruthvi, Junior consultant, Sriranga Ayurveda Chikitsa Mandira

Healthcare unit of Prakruthi Ayurveda Pratistana ®,  Mysore