Diagnosis in ayurveda

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Diagnosis

Introduction

How to Diagnose

Examination Process

Tribidh Pariksha (Three fold examination)

Ashtbidh Pariksha (Eight fold examination)

Dashbidh Pariksha (Ten fold examination)

Introduction

According to Ayurvedic theory, to assess the symptoms of the diseases as much as the nature of ailment and its root causes is called Nidana (diagonosis).  This is of utmost importance to ensure correct choice of remedial & preventive measures for treatment of the disease. Otherwise, even after therapy, one might not get the desired response and there would remain a chance of recurrence.

Purvaroop (The early signs and symptoms) provide useful warnings and the opportunity for taking necessary action before a disease can assume dangerous magnitudes. The main signs and symptoms (roopa) reflect the true nature and intensity of the disease.

Upasaya (exploratory therapy) is another often used method of diagnosis. It uses diet, medicines and routines to detect diseases. Otherwise, it is difficult to diagnose. Acting either against the cause of disease or the disease itself or producing relief, does not necessarily heal, instead may increase the disease. For example, if a swelling that is alleviated by an oily & hot massage, is obviously caused by an imbalance of vata, will be treated by substances that pacify vata.

How to Diagnose

The imbalance of Doshas and the course they follow to cause disease is termedSamprapti or pathogenesis. Since diseases develop in distinct stages, a good knowledge of those helps in early recognition of disease. Ayurveda thus elaborates a six stage process for diagnosis called Kriya (action) Kal (time). The first 4 stages being unique to Ayurveda in that they permit recognition and elimination of the disease before it ventures into differentiated clinical symptoms.

Saint Charak said, “ A good Vaid (herbalist, physician) is that who knows the   stages of pathogenesis. He has the capability to treat diseases”.

1.       Sanchaya (Accumulation)

2.      Prakop (Provocation)

3.      Prasar (Spread or migration)

4.      Sthan samshaya (Deposition or augmentation)

5.      Vyakti (Manifestation)

6.      Bheda (Differentiation)

Stage One: Sanchaya (Accumulation)

  • People that have weak digestive power and improper food habit are prone to accumulation of excess Dosha. Excess of Dosha is responsible for such a condition.
  • Due to improper digestion ama (toxin) gets collected in the gastro-intestinal (GI) tract.
  • Due to Kapha imbalance toxins are accumulated in the stomach, those associated with a pitta imbalance, collect in the small intestine, and that related to vata malfunction amasses in the colon.
  • Due to the presence of one of these toxins, mild and ill-defined symptoms may show.
  • Herbalist should recognize and eliminate the cause instead of ignoring or suppressing it.
  • Ignoring or suppressing those toxins causes aversion to similar things and attraction for contraries.

Stage Two: Prakop (Provocation, Aggravation)

The accumulated, stagnant Doshas are now `excited’ by factors as Ahara(food), Vihara (discipline and behavior) & seasons. These toxins are amassed in such a degree that toxins get provoked at the site of production in the GI tract.

Stage Three: Prasar (Spread or migration)

The toxins accumulated in the GI tract start overflowing. Generally, up to this stage the damage is entirely reversible and restoration of doshic balance can be achieved with proper measures. Or there may be spontaneous prashama(remission) influenced by seasonal changes. Thus there is sanchaya of pitta in rainy season, prakopa in fall and prasara in early winter. Based on the degree of excitation, it might even pass the stages of prashama or prasara.

Stage Four:  Sthan samshaya (Deposition or augmentation) 

These overflowing toxins migrate, enter and take refuge in localized, weak or defective dhatus thereby leading to malfunction and structural damage. Here the specific degenerating disease and susceptibilities to serious infections begin.

Stage Five:  Vyakti (Manifestation)

Differentiated symptoms first begin to appear from the locations. These manifested symptoms can be used for classification & diagnosis of disease.

Stage Six:  Bheda (Differentiation)

After months, years or even decades these diseases reach their final stage and become chronic. Here, The physician should differentiate between these diseases by detailed understanding of the group of symptoms. It might act as predisposing factors for the spread of other diseases.

Examination Process

Ayurveda is an ancient clinical art of diagnosing the disease process through questioning (inquiring about the past, present and family history), observation (inspection), tactile experience (palpation), percussion, and listening to the heart, lungs and intestines (auscultation). In this art, Ayurveda talks much about interpreting the pulse, tongue, eyes and nails in the clinical examination, and also a specific examination of functional systems separately.

To confirm, evaluate and treat a disease, physicians need to perform clinical examinations of patients – wherein textual knowledge (aptopadesa), direct perception (pratyaksha) and inference (anumana) are all very important components. The examination of patients can be carried out in the following manners:

Tribidh Pariksha (Three fold Examination)

It covers a general examination of the patient.

Involves:

  1. Darshan (Visual observation) obese, slim, fat, medium; Vata brownish or blackish face, shivering; pita yellowish body: kapha whitish eyes, watery eye, thick and soft skin etc.
  2. Sparsh (Tactile perception) Vata patient skin is cracked, hard and dry to touch; pita patient body will be hot; kapha patient body will be cold, soft, oily.
  3. Prashn (Questioning) about the time and period of diseases, age, season, taste, duration of diseases, whether had medicine for it or not etc. depending upon the situation.

Ashatbidh Pariksha (Eight fold Examination) 

Eight-fold examination provides a clear picture of nature of ailment and patient’s general condition. It involves the examination of pulse, tongue, voice, skin, eye, general appearance, urine & stool.

  1. Nadi Priksha (Examination of the pulse):1The foremost clinical art in Ayurvedic diagnosis is Examination of the pulse. It can provide deep insights into the history of the patient. The ideal time for pulse examination is early morning on an empty stomach. But in case of emergency, it can be examined at any time of the day or night. An experienced Ayurvedic physician can assess your body’s nature (prakriti), pathological state (vikruti), and imbalances of body type, very subtle observations & even prognosis of the disease through the pulse.

Ayurveda describes the basic three types of pulses (vata, pitta and kapha) and their characteristics. There are twelve different radial pulses; six on the right side, three superficial and three deep; and similarly, six on the left side. There is a relationship between the superficial and deep pulses and the internal organs. One can sensitively feel the strength, vitality, and normal physiological tone of the respective organs separately under each finger.

2-jivha pariksha (Examination of the tongue):

The tongue is the mirror of the viscera and reflects many pathological conditions.  An ancient art of tongue diagnosis also describes quite characteristic patterns, which can reveal the functional status of respective internal organs merely by observing the surface of the tongue.

A discoloration and/or sensitivity of a particular area of the tongue indicate a disorder in the organ corresponding to that area. A wet, slimy, coated, whitish tongue indicates a kapha derangement and mucus accumulation; a red or yellow-green, burning sensation, tongue indicates a pitta derangement; and a dry, rough and cracked, black to brown coloration indicates a vata derangement. A dehydrated tongue is symptomatic of a decrease in the Rasa Dhatu (plasma), while a pale tongue indicates a decrease in the Rakt Dhatu (red blood cells).

3. Sabda pariksha (Examination of the voice):
Healthy and natural when the Doshas are in balance, the voice will become heavy when aggravated by kapha, cracked under pitta effect and hoarse & rough when afflicted by vata.

  1. Sparsha pariksha (Examination of skin):
    Also used for assessing the state of organs and tissue, palpatation is an important clinical method for examination of skin. Noted for doshic influences, a vata aggravated skin is course & rough with below normal temperature, a pitta influenced one has quite high temperature and kaphaaffected, it becomes cold & wet.
  2. Drka pariksha (Examination of eyes):Vata domination makes the eyes sunken, dry and reddish brown in color. On aggravation of pitta, they turn red or yellow and the patient suffers from photophobia and burning sensations. High kapha makes them wet & watery with heaviness in the eyelids.
  3. Akriti pariksha (Examination of general appearance):
    The doshic influences that reflect on the face of the patient enable physicians to gauge the basic constitution and the nature of the disease.

7.  Mutra pariksha (Examination of urine):
Both examination of urine sample and questioning of patient are important for assessing doshic influence.  The body fluids, such as blood (Rakt) and lymph (Rasa), serve to carry wastes (malas) away from the tissues that produce them. The urinary system removes water (kleda), salt (kshar) and nitrogenous wastes (dhatu malas). The urinary system also helps to maintain the normal concentration of water (apa Dhatu) and electrolytes within body fluids. It helps to regulate the volume of body fluid and thus the urine helps to maintain the balance of the three humors vata, pitta and kapha, and water (kleda).

For clinical examination of urine, take a clean vessel and collect the early morning urine in midstream. Observe the color. If the color is blackish-brown, this indicates a vata disorder. If the color is dark yellow, a pitta disorders. Also when there is constipation or the body has less intake of water, the urine will be dark yellow. If the urine is cloudy, there is a kapha disorder. Red color of urine indicates a Rakt (blood) disorder. Next there is the oil drop test. With a dropper, place one drop of sesame oil into the same sample of urine. If the drop spreads immediately, the physical disorder is probably easy to treat. If the drop sinks to the middle of the urine sample the illness is more difficult to treat. If the drop sinks to the bottom, the illness may be very difficult to treat. If the drop spreads on the surface in wave like movements, this indicates a vata disorder. If the drop spreads on the surface with multiple colors visible like a rainbow, this indicates a pitta disorder. If the drop breaks up into pearl like droplets on the surface of the urine, this indicates a kapha disorder. Normal urine has a typical uremic smell. However, if the urine has a foul odour this indicates ama Dosha (toxins) in the system. Acidic urine, which creates a burning sensation, indicates excess pitta. A sweet smell to the urine indicates a diabetic condition. In this condition, the individual may experience goose bumps on the skin surface while passing urine. Gravel in the urine indicates stones in the urinary tract.

8.  Mala pariksha (Examination of stool):
If digestion & absorption of food are poor, the stool carries a foul odour and sinks in water. Vata aggravated, the stool is hard, dry and grey/ash in color. Excess pitta makes it green / yellow in color and liquid in form. And high kaphalines it with mucus.

Dashbidh Pariksha  (Ten fold Examination):

It covers age, body constitution, pathological state, physical build, tissue vitality, body measurement, adaptability, psychic constitution, capacities for digestion and exercise. Though there are no hard and fast rule to determine the physics and psychic, but for convenience it can be checked as follows:

  1. Auyu (Age): All the diagnosis depends upon age. Broadly categorized into childhood, middle age and old age, it provides vital clues for the diagnosis and treatment and it must be considered in clinical examinations.
  2. Prakriti (Body Constitution):
    Determined by relative predominance of Doshas during fetal development the prakriti can be any of vatika, paittika, kaphaja, vata paittika, vata kaphaja, pitta kaphaja or samdoshaja.
  3. Vikruti (Pathological State):
    Related to the biological history of the diseases in its entirety, it enables physicians to consider the signs & 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.
  4. Samhanana (Physical Build):
    Body examination is carried out by direct perception – a healthy body being well built with symmetrical bones, strong and stable joints and enough flesh & blood.
  5. Pramana (Body Measurement):
    In Ayurveda, body measurement is given in terms of finger-breadth, it differs from individual to individual depending upon broadness of his/her fingers, and any person in close proximity to the ideal measurements is termed as normal and healthy.
  6. Sara (Tissue Vitality):
    Broadly speaking, there are seven vital tissues, namely lymph (Rasa), blood (Rakt), muscle (Mansa), adipose (Meda), bone (Asthi), bone marrow (Majja) and reproductive tissue (Sukra).
    Lymph in the skin is assessed by its smoothness, clearness, softness, 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, body color, mouth, tongue, lips, nails and soles of the feet.
    When muscles are in perfect condition, the temples, forehead, jaws, cheeks nape of the neck, shoulders, arms, belly, chest, joints of the body, 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, hands, nails, teeth, ankles, chin, knees and other joints of the body.
    Healthy bone marrow leads to good complexion and stout, long, round & stable joints.
    Those with perfectly healthy semen are strong, healthy and cheerful.
  7. Ahar-shakti (Digestive Capacity):It differs from individual to individual. This has to be judged from the individual’s capacity to ingest and digest food substances.
  8. Satmya (Adaptibility):
    Indicating substances intrinsic to the body, it refers to three types of people – those that are strong, adjust easily to difficulties and have excellent digestive capacity; moderate; and those that are generally weak, intolerant to change and can have only few food options.
  9. Mansik prakriti (Psychic Constitution):
    Refers to the manna (mind, mental state), which controls the body in contact with the soul (Atma). Depending on degree of mental strength, it is considered to be high, moderate or low.
  10. Vyayama-shakti (Capacity for Exercise);Assessed by capacity for hard work, how capable the person is to do hard work; low, moderate or high.