Time-tested tests

Ayurveda has been in practice for more than 4000 years, taking care of people’s health. It is still a vibrant branch of medical science, is part of the human fight against diseases, helps men and women keep healthy. At times it comes up with solutions to problems for which modern science has very little to offer. All in a
natural way. It has enjoyed a flawless continuity of legacy. How does Ayurveda, which had its origins when there was little opportunity for chemical examinations and colleting empirical evidence, has been successful in keeping up its legacy? How is it that its remedies work regardless of age, time, region and sex? It is told that a pupil once asked Acharya Charaka: “You have taught us all about diseases, their origins, their cures, specifications about medicine etc. But what if we meet a new disease, which you have not described yet? What should we do then?” To this Charaka is said to have answered as follows: “All diseases change. Some disappear, other appears in new forms and new diseases arise. We cannot learn all about the disappeared, existing and newly appearing diseases. Therefore you should learn ten principles of examination of diseases, which you should apply always in diagnosing diseases. Each time, if you do so carefully, you will find cause, nature and treatment of the diseases.” Ayurveda physicians till today follow those ten principles of examination (dasa vidha pariksha) which help them keep the flag of Ayurveda afloat in a changing world.

The ten principles underline the fact that the appearance of diseases always changes with time, nutritional habits, climate, society, way of life etc, and hence it is impossible to foresee all future diseases. Today, new diseases such as AIDS break out and new forms of cancers are diagnosed. While it could put any physician, especially those who follow modern branches, in a spot, a learned Ayurevda physician would not waver as he always has a comprehensive tool to understand the disease. All that he needs to do is to strictly follow the golden principles of diagnosis Acharyas had prescribed. As Ayurveda focuses beyond the symptoms and seeks to unravel their reasons, instead of finding methods to suppress them, every physician conduct these examination,
if he were to be successful. This examination is divided into three stages where every possible causative aspect of the ailment is examined. The three stages are as follows:

Observation (Darsanam): This is the first stage. Here, various factors like appearance, body build, age and other physical characteristics of the patient is thoroughly examined.

Physical checking (Sparsanam): In this stage, the body is examined physically by checking the pulse, palpation, (a method of examination in which the examiner feels the size or shape or firmness or location of something) percussion (tapping a part of the body for diagnostic purposes) and auscultation (listening to sounds within the body) are some different ‘sparsanam’ techniques.

Interrogation (Prasnam): In this stage the patient is asked about his ailments and the symptoms that he is observing on a daily basis. It helps synchronize the observation of the doctor with the feelings of the patient. The three steps are further elaborated in two ways – Dasavidha Pareeksha (tenfold examination) and Ashtasthana Pareeksha (eightfold examination).

The 10 point examination (Dasa vidha pariksha): It is important that the practitioner gain a thorough knowledge of the patient’s state prior to treatment through an analysis of the following ten components:

Body Constitution (prakruti): 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 says one of the thridoshas is predominant in each 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.

Pathological State (vikruti): 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 strength of the disease, the causes, the doshas, the affected body elements, body constitution, time and strength of an individual.

Tissue Vitality (sara): Broadly speaking, there are seven vital tissues, namely lymph (rasa), blood (rakta), muscle (mamsa), adipose (meda), bone (asthi), bone marrow (majja) and reproductive tissue (sukra). 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. Percentage of blood in 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 condition of dhatus are classified into three: good (pravara), medium (madhya) and poor (avara). Pravara suggests excellent immune system and condition. It helps the predominance of the trigunas in the patient: a person is said to belong to the satwa group with if he has high emotional stability, clarity of thoughts, calmness, optimism etc. The lower levels will qualify him to be included in the rajas and tamas of trigunas, the three qualities of mind.

Physical build (samhanana):Body examination is carried out by direct perception – a healthy body being well- built with symmetrical

Adaptibility (satmya): 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. His/her psychological, neurological, immunological conditions are checked. Indicating substances intrinsic to the bo y, satmya refers to two types of people: those that 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 few food options. This is an examination tool unique to Ayurveda.

Psychic Constitution (satwa): Satwa refers to the mind which controls the body in contact with the soul (atma). It is the capability of the person to continue doing what is required of him without giving heed to distractions—both physical and mental. A person can be judged to be of high, moderate or low mental strength.

Digestive Capacity (ahara sakti): This has to be judged from the individual’s capacity to ta1ke, digest and absorb food to the body. It also indicates the metabolic capacity of the person.

Capacity for Exercise (vyayama shakti): 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.

Age (vaya): 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 pariksha, Ayurveda suggests an eight point examination (Ashtasthana Pariksha) to help the physician make the right diagnosis, especially the doshik imbalance. The following examinatiosn 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 Kaphaaggravated 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 vecomes heavy when Kapha is aggravated, cracked under 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 his eyes sunken, 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 from examining the face of the patient.

Urine (mutra): 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.

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