In any system of medicine, good treatment
is founded on impeccable diagnosis. In allopathic medicine, symptoms and outcomes
of clinical investigations using modern diagnostic tools determine the course
of treatment. Traditionally, Ayurveda has relied on its unique method of
diagnosis based on the principles enunciated by great sages Charaka, Sushrutha
and many others like them.
Once a pupil once asked Acharya Charaka: “You have taught us
about diseases, their origins, their cures, specific nature of different medicines.
But what if we come across a new disease, which you have not described yet?
What should we do then?”
To this Charaka is said to have replied thus: “All diseases change.
Some disappear, others appear in new forms and new diseases arise. We cannot
learn about all of them. Therefore, you should learn the 10 principles of
examination of patients. You should apply these principles when you examine a
patient. If you do this carefully, you will find the cause, nature and
treatment for the diseases.”
What Sage Charaka told his disciple is today known as the Dasavidha
Preeksha. To this date,
Ayurveda physicians with scholarly knowledge follow these 10 principles
of examination for precise diagnosis.
The 10 principles underline the fact that the nature of diseases
change with time, nutritional habits, weather, society, way of life, etc., and,
hence, it is impossible to foresee all future diseases.
Today, new diseases such as Covid-19 and AIDS break out of
nowhere and new forms of cancers are diagnosed. While it could put any
physician, especially those who follow modern medicine, in a spot, a learned
Ayurevda physician would not waver, thanks to the 10 principles of diagnosis
that Ayurveda follows.
As is well-known, Ayurveda looks beyond the symptoms and seeks
to unravel causes for diseases. In treatment, its goal is not suppression of
the symptoms, but to remove the root causes of diseases. And, it all begins
with the right diagnosis, which itself is divided into three stages where every
possible causative factor behind the ailment is examined.
The three stages are as follows:
Darsanam (Observation): Here, various factors like appearance, body mass, age and
other physical characteristics of the patient is thoroughly examined.
Sparsanam (Physical examination): In this stage, the Ayurveda practitioner would examine the
patient physically by checking the pulse, palpation or examination by touching and feeling the body to assess the
size, consistency, texture, location, and tenderness of an organ or body part, percussion or tapping a part of the body for diagnostic purposes,
and auscultation or listening to sounds within the body.
Prasnam (Interrogation): In this stage, the patient is asked about the ailment and
the symptoms that he/she observes on a daily basis. It helps synchronize the
observation of the practitioner with the experience of the patient.
The three steps are further elaborated in two ways – Dasavidha
Pareeksha (Ten-point examination) and Ashtasthana Pareeksha
(Eight-point examination).
Dasavidha Pareeksha
(Ten-point examination):
It is important that the practitioner gains a thorough knowledge
of the patient’s state prior to treatment through an analysis of the following 10
components:
Prakruti (Body constitution): Prakriti refers to the physical condition of a
human being. It is the sum total of the state of tridoshas and trigunas.
Identifying the states in each place forms the first step in assessing the
physical and mental state of a person.
Ayurevda founded on the concept that one of the tridoshas
would be predominant in every human being, and classifies people accordingly.
In some people, it could be a mixture of more than one. Determined by relative
predominance of doshas during foetal development, the prakriti
can be vatika, paithika, kaphaja, vata paittika, vata kaphaja, pitta kaphaja
or samdoshaja.
Vikruti (Pathological state): Vikruti is the vitiation of prakruti.
Diseases caused due to vikruti are easier to treat than diseases caused
due to prakruti itself. The state of vikruti is identified by
closely examining the dhatus, malas, and the emotional control of
the person.
Related to the biological history of the diseases in its
entirety, it enables physicians to consider the signs and symptoms of the
disease in order to assess the intensity of the disease, the causes, the doshas,
the affected body elements, body constitution, time and strength of an
individual.
Saara (Tissue vitality): Broadly speaking, there are seven vital tissues, namely lymph (rasa),
blood (rakta), muscle (mamsa), adipose (medha), bone (asthi),
bone marrow (majja) and reproductive tissue (sukla). Lymph in the
skin is assessed by its smoothness, softness, clearness, thinness and whether
the skin is covered with short, deep rooted and delicate hair.
The percentage of blood in the body is evaluated from the
condition of the eyes, mouth, tongue, lips, nails and soles of the feet. When
muscles are in perfect condition, the temples, forehead, nape of the neck,
shoulders, belly, arms, chest, joints of the body, jaws and cheeks are covered
firmly with the skin.
People with healthy adipose tissue have oily skin and healthy
hair, nails, voice and teeth. The health of bones is determined by pliable but
firm forearms, chin, nails, teeth, ankles, knees and other joints of the body.
Healthy bone marrow leads to good complexion and stout, long,
round and stable joints. People with perfectly healthy reproductive system are
strong and cheerful.
The dhatus are classified into three: Good (pravara), medium (madhya) and poor (avara).
Pravara suggests that a person has excellent immune system. It helps the
predominance of the trigunas in the patient: a person is said to belong
to the satwa group if he/she has high emotional stability, clarity of
thoughts, calmness, optimism etc. The lower levels will qualify him/her to be
included in the rajas and tamas of trigunas, which are the
three qualities of mind.
Samhanana (Physical build): Body examination is carried out by direct perception – a healthy
body being well-built and symmetrical.
Satmya (Adaptibility): Satmya is a process of measuring the capabilities of the
person to physically or mentally adapt to changing conditions. It is a complex
process, measuring the mental and physical reaction of the person to demanding
conditions. Here the patient’s psychological, neurological, immunological
conditions are checked.
Indicating substances intrinsic to the body, satmya refers
to two types of people: those who are strong, can adjust easily to difficulties
and have excellent digestive capacity and those that are generally weak,
intolerant to change and can have only a few food options. This is an
examination tool unique to Ayurveda.
Satwa (Psychic constitution): Satwa refers to the mind which controls the body in
liaison with the soul (atma). It is the capability of the person to
continue doing what is required of him/her without giving heed to
distractions—both physical and mental. A person can be judged to be of high,
moderate or low mental strength.
Ahara Sakthi (Digestive capacity): This has to be judged from the individual’s capacity to consume,
digest and absorb food. It also indicates the metabolic capacity of the person.
Vyayama Sakthi (Capacity for Exercise): It indicates a person’s ability to stand physical
exertion, and do hard work. Appropriate secretion of metabolic or endocrine
products during physical exercise is essential for good endurance in demanding
situations. It is can be low, moderate or high.
Vaya (Age): The age of a person provides vital clues for the diagnosis and
treatment. The physician compares the actual age of the person with his or her
apparent age. If a person appears younger than he or she really, then it is a
sign of health. It is broadly categorised into childhood, middle age and old
age.
Along with the Dasavidha Pareeksha, Ayurveda suggests an
eight-point examination (Ashtasthana Pareeksha) to help the physician
make the right diagnosis, especially the doshik imbalance. The following
examinations are part of it: Pulse (Nadi), tongue (jihwa), stool (malam),
urine (mootram), voice and speech (sabdam), body temperature,
skin and tactile sense (sparsanam), eye balls and vision (drik)
and the physique (akriti).
Pulse (nadi): It
provides deep insights into the history of the patient. It gives the physician
an idea about body nature, pathological state and imbalances of the tridhosha.
Tongue (jihva): By examining
the tongue, a physician can assess the doshic state: a Vata-aggravated
tongue is dry, rough and cracked, Pitha-aggravted tongue is red with a
burning sensation and Kapha aggravated one is wet, slimy and coated. It
also gives an idea about the digestive system.
Voice (sabda): The voice is
natural and clear when a person is healthy with the doshas in balance.
It becomes heavy when Kapha is aggravated, cracked when Pitha is
aggravated and hoarse and rough when afflicted by Vata.
Skin (sparsha): Skin gives
away the tridosha state in a person’s body. It becomes coarse and rough
with below normal temperature (Vata), high temperature (Pitha)
and cold and wet (Kapha).
Eyes (drik): A person with Vata
domination has sunken eyes that are dry and reddish brown in colour. When Pitha
is aggravated, they turn red or yellow and the patient suffers from photophobia
and burning sensations. Vitiated Kapha makes them wet and watery with
heaviness in the eyelids.
General appearance (akriti): A trained physician can judge the doshic influences
by examining the face of the patient.
Urine (mootra): Examination of
the urine helps identify the doshik imbalance in a body.
Stool (mala): When Vata
is aggravated, the stool becomes hard, dry and grey/ash in colour. Excess Pitta
makes it green/yellow and liquid in form whereas high Kapha lines it
with mucus.
As can be seen here, Ayurveda relies
heavily on the observations of the practitioner, which is based on a
time-tested methodology. It is not the disease the Ayurveda practitioner looks
at, but the disease as it manifests in each individual in specific physical and
emotional contexts.