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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.

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