by Shanti Gowans © 2021
Ayurvedic assessment methodologies include several assessments and protocols to detect an individual’s mind-body constitution and their state of imbalance. Ayurvedic classical texts clearly explain how to identify subtle disease conditions, which a physical examination or other assessment techniques are unable to recognise.
There are 9 different ways to examine a disease,
Five sense organs to examine a disease,
Five different modes of disease examination, and
10 ways of patient examination.
Clinical examination of a disease and its condition (roga), together with the diseased person, (rogi), form the basis of a comprehensive protocol for examination. The exact nature of the disease and the diseased person should be clearly known, and are critical for comprehensive treatment to be planned and administered.
The Benefits that arise from Examination (Pariksha)
Proper diagnosis of a disease
Proper step-by-step assessment of the disease process,
Knowing the prognosis, thereby obtaining a clear idea of the physician’s limitations in handling a case. It helps the physician decide whether they can handle the case, or if it would be wiser, and in the best interest of the patient, to refer the case to related specialists.
It helps to ascertain the physical and mental condition of the patient.
It helps in the planning of a comprehensive treatment protocol which includes dietary and lifestyle recommendations.
A comprehensive treatment can be planned and administered, only if the diagnosis of a disease is made properly and the condition of the disease known. For this to happen, the physician should be well versed in the knowledge and skills of clinical examination. Clinical examination of the disease and the diseased person, form the cream of clinical success.
Examination of the Patient, Rogi Pareeksha
The constitution of a person from the time of their conception, is known as Prakruti. This is the balanced state, or state of health for a person.
The imbalanced state is known as a person’s Vikruti. The cause and subsequent development of an abnormal condition or of a disease is known in medicine as etiopathogenesis (plural etiopathogeneses), from the words: etiology + pathogenesis.
etiology: the science of finding causes and origins (of a disease)
pathogenesis: the production or development of a disease
For an accurate assessment, a physician needs to differentiate between a person’s constitution that was established at conception (prakruti), and their current state of health (vikruti). if it is different to their constitution.
The systems and channels in the body, known as srotas, also need to be assessed. This is known as sroto pariksha.
This article is about the examination of a patient. There are many tools and ways of assessment in Ayurvedic practice, in which the examination of a patient, or Rogi Pariksha, is conducted in Ayurveda.
The patient can then be assisted and their constitution (prakruti) can be brought back to balance for them, which in Ayurveda means to bring them back to their constitution, prakruti established at conception. They can also be educated in preventing illness, by understanding their constitution and living in accord within its parameters.
Tools for Examination of a Patient, rogi pariksha
There are several ways to examine a patient. These include:
Two-fold assessment, Dwi Vidya Pariksha includes:
– That which is seen and perceived by a doctor directly, pratyaksha
– Through inference, anumana
Three-fold assessment, Trividhya Pariksha includes:
– Inspection, darshana. Darshan is a way of seeing, and is regarded as a blessing. It is observing things as they are, without judgement or comparison. An Ayurvedic practitioner must develop ‘darshan’.
– Touch, palpation, percussion, auscultation or by feeling the diseased area, sparshana.
– Questioning the patient thoroughly, prashna.
Four-fold assessment, Chaturvidhya Pariksha
– That which is seen and perceived by the physician directly, pratyaksha
– That which is assessed through inference, anumana
– Application of knowledge learnt from the science (shastra) and its teachings, aptopadesha
– Situational application of wisdom and knowledge, yukti.
Six-fold assessment, Shadvidhya Pariksha
– Examination by seeing/inspecting, chakshurindriya dwara pariksha
– Examination through smelling, ghanendriya dwara pariksha
– Examination through hearing, (auscultation), shravanendriya dwara pariksha
– Examination through taste, jihvendriya dwara pariksha
– Examination through touch, sparshanendriya dwara pariksha
– Questioning a patient, prashna pariksha
Eight-fold assessment, Ashtavidhya Pariksha includes examination of
– Pulse diagnosis, nadi pariksha
– Tongue diagnosis, jihva pariksha
– Visual examination, netra or drik pariksha, of the external appearance of the person
– Stool examination, mala pariksha
– Urine examination, mutra pariksha
– Examination based on sound, shabda pariksha, such as the timbre and hoarseness of a patient’s voice, and various bodily sounds, such as cracking in the joints (arthritis),
– Touch, sparsha pariksha, examination of the skin, twak, to ascertain body temperature, localised rise of temperature in a swelling, dryness/oiliness etc.
– Examination of the whole body, such as its structure and shape, the build of a patient, their, gait, decubitus, akriti pariksha.
Ten-fold assessment, Dasavidha Pariksha.
All in all, you must ascertain the following:
– The basic constitution (the physical and mental makeup) of a patient as acquired at birth. This is known as their prakruti.
– The changes occurring in the patient’s basic constitution, together with various changes taking place in different parts of the body or mind (or both), in relation to their basic constitution. This is known as the patient’s vikruti. Vikruti is the abnormal deviation or imbalances of a person’s Prakruti.
– The essence of the tissues, (dhatus), their status, quality and quantity etc. This is known as sara.
– The compactness of the body, samhanana.
– The measurement of the size and proportion of the human body (anthropometry), and any deviations according to mathematical proportions of the body. This is known as pramama.
– Compatibilities relating to a patient and wholesomeness developed by habits which result in suitability to the patient and are conducive to their health (homologation). This is known as satmya.
– The psyche and mental faculties and parameters, such as the mental strength, tolerance levels, emotions and mood of a patient. This is known as satva.
– The patient’s capacity regarding food intake, such as appetite, digestion and metabolic capacity. This is known as ahara shakti.
– The patient’s capacity and tolerance for exercise. This is known as vyama shakti.
– The age of the patient, vaya.
– The physical build, strength and immunity of a patient. This is known as Bala. Their endurance, compactness and stamina will need to be factored in too.
Pulse reading or pulse diagnosis, nadi pariksha is amongst the eight methods of examination. However, it has.not been elaborated by Archarya Charaka, Sushurata, or Vagbhata, in the Charaka Samhita, Sushruta Samhita or Vagbhata’s Ashtanga Hrudaya. These texts span a period of time between 1000 BC – 2000 AD.
It is referenced in the later books in Ayurveda, and seems to appear after the arrival of the Unani doctors, knowns as Hakims, who introduced the Unani system of medicine to India. They could be attributed to the popularity of nadi pariksha, pulse diagnosis.. It involves spirituality, science and elements of astrology. However, it must be remembered that a doctor’s performance is ultimately based on their ability to generate a cure for their patient’s disease, rather than telling their patient about their health history, or predicting their past or future symptoms.
For the Hakims, the importance of pulse diagnosis was crucial, especially when the patient was female, as the culture required her to cover up her face.The only available part for the physician to touch and examine was the hand. Thus, the Hakim was professionally compelled to examine the pulse. If the patient was a princess, she never came out from behind the padra (veil), or curtain. A thread was tied to the princesses’ wrist, and the other end of the thread was given to the Hakim to predict her disease. Such were the limitations under which the Hakim had to work.
When the science of the pulse came to Ayurveda, everybody was very hopeful about pulse diagnosis, as the arterial pulse of the hand tells a seasoned practitioner, known as a nadi vaidya about all diseases,. There are some 108 pulse differences, some of which feel like the slithering of a snake, or a jumping frog, or the subtle gliding of a swan etc. This diagnosis is indicative of gross and subtle observances of the pulse.
The text entitled ‘Sarangadhara’, in the 12th century, gave importance to pulse diagnosis in the following verse:
Karasyangushta mooleya, Dhamani jeevasaksini
Tat Cheshtaya ‘sukham’ ‘dukham’
Njeyam kayasya panditaha
“the vein that is found in the root of the Palm is the symbol of life. The behavioural pattern of the same explains to an expert the body’s well being (sukham) as well as any ailments (dukham) of the patient”.
Details about pulse diagnosis are also mentioned in Yoga Ratnakara, a 17th century text.
Pulse reading provides a practitioner an index of cardiac rhythms, which can also be supported by the use of a stethoscope. Sometimes, if there is a disease process in between the heart and the pulse, the rhythm of the heart may be different to the rhythm of the pulse. It also indicates whether the volume is full or weak, and whether the heart rate is fast or slow.
The text ‘Nadi Tattva Darshanam, by Vaidya Satya Deva Vashisth, has produced some commendable work, having collated all works on Nadi pariksha from the Vedas, Upavedas, Charaka Samhita, Sushurata Samhita, Rava Nadi Pariksha, Kanada Nadi Pariksha and others.
Ayurvedic practitioners now diagnose Blood Pressure with sphygmomanometers, and check for sugar and cholesterol through blood and urine tests as well as urine and faecal examinations. These tests were mentioned by Yoga Ratnakara, and Ayurveda has welcomed many forms of diagnosis, which have now been extended to laboratory tests since the early renditions.
Examination of a Disease, Roga Pariksha
Disease examination, Roga pariksha
Understanding the nature of a disease helps with accurate diagnosis of the disease. The disease should be examined to know:
The quality and nature of the disease, vyadhi svabhava
The quantity or magnitude of the disease, vyadhi pramana
The cause/s of the disease, nidana jnana
Premonitory symptoms, those which occur before the manifestation of the disease, poorvarupa jnana
Signs and symptoms of the disease, rupa jnana
Aggravating and pacifying factors of the disease, upashaya-anupashaya jnana
The process of the formation of the disease, samprapti jnana
Prognosis, in terms of curabnility or non-curability of the disease, saadhya-asaadhyata gnana
Complications and progression of a disease, upadrava-udarka jnana
Tools for disease examination, nidana panchaka
Five key tools, known as nidana panchaka, are used for the diagnosis of a disease (roga pariksha), and to know the nature of the disease. These are:
The causative factors of the disease, nidana, the knowledge of which is the key to knowing why and how the disease process was initiated.
Premonitory symptoms of the disease, purvarupa, which helps to know the disease in its earlier stages of manifestation.
Signs and symptoms of the disease, rupa, which help us understand the manifestation of the disease.
Identifying a disease, upashaya-anupashaya, or diagnosing it on the basis of a trial and error method, after analysing the aggravating and pacifying factors operating on the disease.
The disease’s story, samprapti. The pathogenesis of the disease helps us understand the process or steps in which the chain of events leading from ‘exposure, or causative factors’ to the ‘manifestation of the disease’ occurred.