Blog

Patient and Disease Examination, Rogi and Roga Pariksha

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.

Haritaki

In the cornucopia of Ayurvedic herbs, there are only a few which have the quality of being tri-doshic. Such herbs are much celebrated in India for their ability to bring balance all three doshas, and so restore health to anybody regardless of their particular constitution. Of these herbs is Haritaki, a powerful and well-rounded herb with a vast range of applications in ayurvedic medicine. Astringent and unpleasant in taste, it is a Vata rejuvenator, Kapha regulator and Pitta aggravator.

Sanskrit Name – Haritaki, because it carries away (harate) all diseases.

Botanical Name – Chebulic Myrobalan / Terminalia chebula

Part Used – Fruit

According to the folklore, legend has it that haritaki came from a drop of Indra’s cup which grew into a tree when spilt upon the ground.

The origin of the name Haritaki could be an indicator of its power and versatility. It is named after Shiva or Hara, as it both comes from the Himalayas, the realm of Shiva, and imparts the fearlessness and the clear perception for which Shiva is known.

This name also refers to the universal action of the fruit by indicating that it carries away (harate) all diseases, and also to the yellow dye, harita, which is derived from it.

The power and range of application which Haritaki bears are derived from its dynamic energetics. Haritaki combines five of the six tastes, excluding only saltiness, however, it is primarily astringent in taste. It is further heating in energy and has a sweet post-digestive effect, or vipraka.

This combination renders it a very effective alleviator of vata imbalance and the eliminator of ama, or accumulated toxins. After the dryness of its astringent taste has broken down ama and accumulated vata, its heating energy and moistening effect then work to counteract the cold and dry nature of vitiated vata and move the toxins from the body. While it is a strong rejuvenative for vata, it also regulates kapha, and only aggravates pitta in excess.

The wide applicability of Haritaki is directed through its manner of use, and the form in which it is taken. When taken as a powder, Haritaki is an efficacious purgative, but when the whole dried fruit is boiled the resulting decoction is useful in the treatment of diarrhea and dysentery. The fresh or reconstituted fruit fried in ghee and taken before meals enhances digestion. If this latter preparation is taken with meals it increases clarity of mind, voice, and vision, and the remaining senses as well as the five actions of the body, it is also purifying for the digestive and genito-urinary tract. Taken after meals, Haritaki quickly cures diseases caused by the aggravation of vata, pitta and kapha which have resulted from unwholesome food and drinks.

There are few ayurvedic herbs which have the range and power of Haritaki. It is a potent purifier of the body, and acts effectively to mitigate the cold and erratic nervousness of vata imbalance. It feeds the brain and the nerves and imparts the energy for awareness, increased wisdom and intelligence. It scrapes endotoxins (ama) away from the tissues, especially from the digestive tract, and rejuvenates the body, especially the colon and lungs. Haritaki being an effective astringent and can be used as a gargle for ulcerated surfaces and membranes.

This herb is a gift from the Himalaya which has been used for the benefit of humanity for thousands of years, and surely will continue to do so for millennia to come.

Haritaki is one of the three fruits (bibitaki, amalaki) in Triphala.

Suggested Use

Haritaki is given with jaggery in summer, rock salt during the monsoon, sugar in autumn, ginger powder in early winter, long pepper in late winter and honey in spring.

Alternatively, it may be given with salt in diseases of kapha. With sugar for pitta problems, with ghee for vata, and with jaggery if all three doshas are aggravated.

Suggested Dosage

As recommended by your Ayurvedic physician and as per your doshic type and imbalances.

3 to 5g at bedtime with warm water.

Not recommended during pregnancy.

All information provided on this website is for informational purposes only, Please seek professional advice before commencing any treatment.
This product is not intended to diagnose, treat, cure or prevent any disease.

Oil Pulling

What Is Oil Pulling?

Oil pulling is a remedy that uses a natural oil to help clean and detoxify teeth and gums. It has the added effect of whitening teeth naturally, and there is evidence to show that it is beneficial in improving gums and removing harmful bacteria.

This simple home remedy can also speed up recovery from various diseases ranging from common colds to acute allergic conditions, bronchitis, indigestion, stomach ulcers, headaches and migraines. The treatment involves rinsing your mouth with 10 ml of sesame oil for a few minutes.

During oil pulling, the oil binds to the biofilm, or plaque, on the teeth and reduces the number of bacteria in the mouth.

This treatment has its roots in the ancient Indian traditional medicine system of Ayurveda, considered by most Eastern and Western scholars as the oldest and original form of health care in the world as noted in the Ayurvedic textbook, Charaka Samhita.

Ayurveda recommends the use of sesame oil as the oil of choice as it is more warming and may be more gently detoxifying than other oils that are “colder” energetically. It has a somewhat strong sesame flavor, which is a familiar food taste for most people.

However, today, people have been using different types of oils and are also seeing effective results. Recently people have started using organic coconut oil because it tastes better and has antibacterial, anti-inflammatory properties. Coconut oil has a cooler energy than sesame oil, so it can be helpful for people who tend to have a warmer constitution, or condition of heat. Some people have reported that coconut oil is more strongly detoxifying. This is not always recommended for some people, so it’s best to be cautious and go slowly.

The benefits of oil pulling

Oil pulling is known to be useful in the treatment of the following conditions:

• Common diseases such as the common cold, coughs, allergies, headaches, etc.,
• Skin problems such as itching, pigmentation, eczema, scars, rashes, etc.,
• Respiratory problems such as bronchitis, asthma, etc.,
• Headaches and migraines,
• Tooth pain, gum diseases, dental caries,
• Back pain, neck pain, joint pain and arthritis
• Constipation and other conditions arising to problems in the digestive system
• Blood pressure, heart disease, and diabetes
• Piles ( hemorrhoids ).

In addition to the aforementioned conditions, which studies confirm can be treated, prevented, or controlled by oil pulling, other conditions for which oil pulling might be useful include:

• Chronic sleepiness
• Liver disease
• Kidney disease
• Cancer

A survey conducted by an Indian daily newspaper, Andhra Jyoti, confirms the healing properties of oil pulling

Approximately 2 ½ years after publishing an article on oil pulling and its several benefits, Andhra Jyoti conducted a survey to understand the following:
• The kind of health conditions the procedure cured
• The degree of its effectiveness
1041 readers responded to the advertisement sharing their experience with oil pulling. Among the respondents, 927 (about 87%) stated that oil pulling cured one or more of their diseases. 114 respondents (approx. 11 %) reported that oil pulling did not provide relief from the ailment(s) they were suffering from.

An analysis of the testimonies of the people who had found oil pulling useful, revealed that it successfully cured the following diseases: allergies, coughs and common colds, gum diseases, dental caries, infections in the ear, nose, mouth, eyes, and throat, tooth pain, headache, neck pain, migraines, back pain, cracked lips, allergic sneezing, and fevers.

When to do oil pilling
Ayurveda recommends oil pulling first thing in the morning (on an empty stomach) immediately after brushing your teeth.

How to do oil pulling
To use oil pulling, follow these steps:

After brushing your teeth, on an empty stomach, place 10 ml of sesame oil into your mouth.
Hold the oil in your mouth for a few minutes.
Swish your mouth thoroughly with the oil, before spitting it out. White sputum indicates that you have done the procedure correctly.
Wash your mouth out thoroughly with water.
Drink a glass or two of water afterwards.

Precautions
– Oil pulling is not recommended for children under 5 years of age
– Use only 5 ml of oil for children above 5 years of age
– Do not gargle and do not swallow. However, more importantly, do not worry if you do swallow some oil. Sesame oil is edible. When swallowed, it is either digested or excreted naturally.
– If the colour of your sputum is yellow, it could mean that you have not held the oil in your mouth long enough, or that have used an amount greater than the recommended dosage. Alternatively, it could simply be cleaning up too much turmeric or saffron from your food, or be an indication from your liver, in which case, further investigation may be prudent.