Changes

The method of clinical examination of patient in  Ayurveda is known as Dashavidha pariksha (दशविधपरीक्षा). Since this method of examination has 10 criteria based on which the examination is conducted, it is known as Dashavidha (dasha/दश - 10 , vidha/ विध- types/folds) pariksha (परीक्षा examination).  

The method of clinical examination of patient in  Ayurveda is known as Dashavidha pariksha (दशविधपरीक्षा). Since this method of examination has 10 criteria based on which the examination is conducted, it is known as Dashavidha (dasha/दश - 10 , vidha/ विध- types/folds) pariksha (परीक्षा examination).  

== परिचयः Introduction ==

== परिचयः॥ Introduction ==

Pariksha (परीक्षा) means examination or inspection and dashavidha (दशविध) means ten kind or fold or ten methods, thus dashavidha pariksha means ten methods of examination of the patient.

Pariksha (परीक्षा) means examination or inspection and dashavidha (दशविध) means ten kind or fold or ten methods, thus dashavidha pariksha means ten methods of examination of the patient.

Examination of the patient is the primary aspect of initiating treatment in any patient. Clinical examination of the patient plays a significant part in diagnosis of the disease and only a skilled and well versed [[vaidya (वैद्यः)]]  or a physician is capable of attaining desired results with correct application of pariksha methods. <ref>Charaka Samhita (Sutrasthanam Adhyaya 20 Sutra 20-22)</ref>                                                          

Examination of the patient is the primary aspect of initiating treatment in any patient. Clinical examination of the patient plays a significant part in diagnosis of the disease and only a skilled and well versed [[vaidya (वैद्यः)]]  or a physician is capable of attaining desired results with correct application of pariksha methods. <ref>Charaka Samhita (Sutrasthanam Adhyaya 20 Sutra 20-22)</ref>                                                          

== परीक्षाप्रयोजनम् Necessity of examination ==

== परीक्षाप्रयोजनम्॥ Necessity of examination ==

According to Acharya Charaka in Vimana Sthana examination of patient is necessary to know aayushpramana (आयुषःप्रमाण) meaning for understanding the life span of an individual as well as degree of strength of the patient and strength of the disease. The strength of any individual or patient determines the dosage and the potency of the medication to be prescribe. The [[Chikitsa (चिकित्सा)|chikitsa (चिकित्सा]] treatment) modality like need of surgery, Panchakarma etc. selection also depend upon the status of the patient evaluated through pariksha. Thus a thorough examination of [[Prakrti (प्रकृतिः)|prakrti]] ( प्रकृतिः body type), vikrti (विकृतिः disease), sara (सारम् essence of dhatu) etc. is essential in [[Ayurveda (आयुर्वेदः)|Ayurveda]]. <ref name=":0">Charaka Samhita (Vimanasthanam Adhyaya 8 Sutra 94)</ref>  

According to Acharya Charaka in Vimana Sthana examination of patient is necessary to know aayushpramana (आयुषःप्रमाण) meaning for understanding the life span of an individual as well as degree of strength of the patient and strength of the disease. The strength of any individual or patient determines the dosage and the potency of the medication to be prescribe. The [[Chikitsa (चिकित्सा)|chikitsa (चिकित्सा]] treatment) modality like need of surgery, Panchakarma etc. selection also depend upon the status of the patient evaluated through pariksha. Thus a thorough examination of [[Prakrti (प्रकृतिः)|prakrti]] ( प्रकृतिः body type), vikrti (विकृतिः disease), sara (सारम् essence of dhatu) etc. is essential in [[Ayurveda (आयुर्वेदः)|Ayurveda]]. <ref name=":0">Charaka Samhita (Vimanasthanam Adhyaya 8 Sutra 94)</ref>  

== दशविधपरीक्षापद्धतिः Dashavidha pariksha methods ==

== दशविधपरीक्षापद्धतिः ॥ Dashavidha pariksha methods ==

The 10 criteria for clinical assessment of a patient are listed under dashavidha pariksha or 10 fold clinical examination. The 10 criteria are as follows,<blockquote>तस्मादातुरंपरीक्षेतप्रकृतितश्च, विकृतितश्च, सारतश्च, संहननतश्च, प्रमाणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च, वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः|| (Char. Vima. 8.94)<ref name=":0" /></blockquote>Meaning: Therefore to know the strength and overall health of a patient, clinically examine a patient on the basis of criteria like- Prakruti (प्रकृतिः), Vikruti (विकृतिः), Sara (सारः), Samhanana (संहननम्), Pramana (प्रमाणम्), Satmya (सात्म्यम्), Satva (सत्वम्), Aharashakti (आहारशक्तिः), Vyayamashakti (व्यायामशक्तिः) and Vaya (वयः).

The 10 criteria for clinical assessment of a patient are listed under dashavidha pariksha or 10 fold clinical examination. The 10 criteria are as follows,<blockquote>तस्मादातुरंपरीक्षेतप्रकृतितश्च, विकृतितश्च, सारतश्च, संहननतश्च, प्रमाणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च, वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः|| (Char. Vima. 8.94)<ref name=":0" /></blockquote>Meaning: Therefore to know the strength and overall health of a patient, clinically examine a patient on the basis of criteria like- Prakruti (प्रकृतिः), Vikruti (विकृतिः), Sara (सारः), Samhanana (संहननम्), Pramana (प्रमाणम्), Satmya (सात्म्यम्), Satva (सत्वम्), Aharashakti (आहारशक्तिः), Vyayamashakti (व्यायामशक्तिः) and Vaya (वयः).

{| class="wikitable"

{| class="wikitable"

These are the components of examination of any patient according to Ayurveda. These tools help vaidya or physician to not just diagnose but have a deeper understanding of the health status of the patient and disease as well. Each of these factor has some effect on health and life of a patient in general as per Ayurveda. The dynamics of these are responsible for deciding the fate of any illness, recovery, strength and health of an individual.  

These are the components of examination of any patient according to Ayurveda. These tools help vaidya or physician to not just diagnose but have a deeper understanding of the health status of the patient and disease as well. Each of these factor has some effect on health and life of a patient in general as per Ayurveda. The dynamics of these are responsible for deciding the fate of any illness, recovery, strength and health of an individual.  

=== Dashavidha pariksha described in Vagbhata ===

=== दशविधपरीक्षा ॥ Dashavidha pariksha ===

Like Acharya Charaka, Acharya Vagbhata in his treatise Ashtanga Hrudayam has described the 10 fold examination with slight variation in the criteria but collectively they are similar to those described by Acharya Charaka in Charaka samhita. <blockquote>दूष्यं देशं बलं कालमनलं प्रकृतिं वयः| सत्त्वं सात्म्यं तथाऽऽहारमवस्थाश्च पृथग्विधाः||६७||

Like Acharya Charaka, Acharya Vagbhata in his treatise Ashtanga Hrudayam has described the 10 fold examination with slight variation in the criteria but collectively they are similar to those described by Acharya Charaka in Charaka samhita. <blockquote>दूष्यं देशं बलं कालमनलं प्रकृतिं वयः| सत्त्वं सात्म्यं तथाऽऽहारमवस्थाश्च पृथग्विधाः||६७||

सूक्ष्मसूक्ष्माः समीक्ष्यैषां दोषौषधनिरूपणे| यो वर्तते चिकित्सायां न स स्खलति जातुचित्||६८|| (Asht. Hrud. Sutra. 12.67-8)<ref>Ashtanga Hrudayam ([http://vedotpatti.in/samhita/Vag/ehrudayam/?mod=read&h=jAtucit Sutrasthanam Adhyaya 12 Sutra 67-68)]</ref>   </blockquote>Meaning: The one (Vaidya) who makes the diagnosis and starts the treatment after considering detail evaluation of factors like Dushya (दूष्यम्), Desha (देशम्), [[Balam (बलम्)|Bala (बलम्)]], Kala (कालम्), [[Agni in Ayurveda (आयुर्वेदे अग्निः)|Anala (अनलम्)]], [[Prakrti (प्रकृतिः)|Prakruti (प्रकृतिः)]], Vaya (वयः), [[Manas (मनः)|Satva (सत्वम्)]], Satmya (सात्म्यम्), [[ahara (आहारः)]] and stage of disease, never fails in his efforts / succeeds.

सूक्ष्मसूक्ष्माः समीक्ष्यैषां दोषौषधनिरूपणे| यो वर्तते चिकित्सायां न स स्खलति जातुचित्||६८|| (Asht. Hrud. Sutra. 12.67-8)<ref>Ashtanga Hrudayam ([http://vedotpatti.in/samhita/Vag/ehrudayam/?mod=read&h=jAtucit Sutrasthanam Adhyaya 12 Sutra 67-68)]</ref>   </blockquote>Meaning: The one (Vaidya) who makes the diagnosis and starts the treatment after considering detail evaluation of factors like Dushya (दूष्यम्), Desha (देशम्), [[Balam (बलम्)|Bala (बलम्)]], Kala (कालम्), [[Agni in Ayurveda (आयुर्वेदे अग्निः)|Anala (अनलम्)]], [[Prakrti (प्रकृतिः)|Prakruti (प्रकृतिः)]], Vaya (वयः), [[Manas (मनः)|Satva (सत्वम्)]], Satmya (सात्म्यम्), [[ahara (आहारः)]] and stage of disease, never fails in his efforts / succeeds.

=== Prakriti Pariksha ===

=== प्रकृति परिक्षा ॥ Prakriti Pariksha ===

<nowiki>https://dharmawiki.org/index.php/Prakrti_in_Ayurveda_(%E0%A4%AA%E0%A5%8D%E0%A4%B0%E0%A4%95%E0%A5%83%E0%A4%A4%E0%A4%BF%E0%A4%83)</nowiki>

[[Prakrti in Ayurveda (प्रकृतिः)|Prakrti (प्रकृतिः)]] is a certain body type or a basic constitution of an individual. According to Ayurveda there are seven types of prakriti based on dominance of doshas. This dominance of a dosha or a specific combination of doshas is responsible for one's structural and functional peculiarities, state of health and well-being and also for one's response to external stimuli. Although one of the 3 doshas might be dominant and displays major role in body functions, this is not considered as an abnormality. This state of doshas at the very beginning of life is believed to be the natural constitution for that particular individual and thus called as Prakrti or original body-mind type of that individual. The prakrti of a person is quite capable of providing a fair indication of physiological strengths and weaknesses, mental tendencies, and susceptibility to illnesses of various types. Therefore, understanding Prakrti is crucial while making healthcare choices for any person and his treating Vaidya. The types of Prakrti are as follows,   

 

# Vata dominant (वातप्रधाना)

# Pitta dominant (पित्तप्रधाना)

 

# Kapha dominant (कफप्रधाना)

·       Vata dominant (वातप्रधाना)

# Samadhatu (all 3 doshas in equilibrium) (समधातु)

 

# Vata-pitta dominant (वातपित्तप्रधाना)

·      Pitta dominant (पित्तप्रधाना)

# Vata-kapha dominant (वातकफप्रधाना)

 

# Pitta-kapha dominant (पित्तकफाप्रधाना)

·      Kapha dominant (कफप्रधाना)

 

·      Samadhatu (all 3 doshas in equilibrium) (समधातु)

 

·      Vata-pitta dominant (वातपित्तप्रधाना)

 

·      Vata-kapha dominant (वातकफप्रधाना)

 

·      Pitta-kapha dominant (पित्तकफाप्रधाना)

                                                                                       

                                                                                       

|Features

|Features

|-

|-

|Vata

|Vata (वात)

|Vata prakriti is known as ''heena'' prakriti in comparison to kapha  and pitta. They are very short or very tall and have abnormal and rough body  features. The gait is very fast. They have weak strength and less life span.

|Vata prakriti is known as inferior prakriti in comparison to kapha  and pitta. They are very short or very tall and have abnormal and rough body  features. The gait is very fast. They have weak strength and less life span.

|-

|-

|Pitta

|Pitta (पित्त)

|Pitta prakriti people have  a good metabolism and have delicate body features. these individuals have  sharp intellect, high valour and low endurance. They have moderate strength  and ife span.

|Pitta prakriti people have  a good metabolism and have delicate body features. these individuals have  sharp intellect, high valour and low endurance. They have moderate strength  and life span.

|-

|-

|Kapha

|Kapha (कफः)

|Kapha prakriti people are  stable in structure or built,have a stable gait. They are slow in routine  activities. They have excellent strength,are calm and usually live a long  life.  

|Kapha prakriti people are  stable in structure or built,have a stable gait. They are slow in routine  activities. They have excellent strength,are calm and usually live a long  life.  

|}

|}

=== 2.    Vikruti pariksha ===

=== विकृती परीक्षा ॥ Vikruti pariksha ===

Examination of the strength of the disease is of equal importance as of the patient examination. In order to know the manifestation of the pathology or the strength of the disease, factors like hetu(cause of the disease), dosha, dushya(vitiation of tissues like dhatus and malas),desha, kala and specific symptoms must be examined.  For example if there is similarity in properties of doshas and dhatu of that of disease and individual’s prakrti along with the more number of symptoms, then the disease becomes severe as per Ayurveda. This is important from a vaidya or physician’s point of view. (char.vima.8.101)

Examination of the strength of the disease is of equal importance as of the patient examination. In order to know the manifestation of the pathology or the strength of the disease, factors like hetu (हेतुः cause of the disease), [[Doshas (दोषाः)|dosha (दोषाः)]], dushya (दूष्याः । tissues like [[Dhatus (धातवः)|dhatus]] and [[Malas (मलाः)|malas]]), desha (देशः), [[Kala (कालः)|kala]] (कालः) and specific symptoms must be examined.  For example if the vitiated [[Doshas (दोषाः)|doshas]] in a particular diseased individual are similar to the dominant doshas of [[Prakrti in Ayurveda (प्रकृतिः)|prakrti]] of that individuals are the dhatus affected in that disease also share similar properties with vitiated doshas then that disease manifested with more number of symptoms is considered severe as per Ayurveda. It means the disease has more strength than the individual affected by it and hence it must be treated with utmost caution with proper full fledge treatment and may require more days to heal. This is important for a [[Vaidya (वैद्यः)|vaidya]] in order to plan the treatment and consider the prognosis.<ref>Charaka Samhita (Vimanasthana Adhyaya 8 Sutra 101)</ref>

=== 3.    Sara Pariksha ===

=== सार परीक्षा ॥ Sara Pariksha ===

Sara in literal terms means essence. With reference to a physical body known as Shareeram in Ayurveda, sara denotes quality of the tissues or dhatus, which means the finest characteristics of dhatus. This is examined to determine the physical strength of an individual based on certain specific parameters. There are eight types of saras mentioned in Ayurveda which can be examined. (char.vima.8.102 115)

Sara in literal terms means essence. With reference to a physical body, known as Shareeram in Ayurveda, sara denotes quality of the tissues or [[Dhatus (धातवः)|dhatus]], which means the finest characteristics of dhatus. This is examined to determine the physical strength of an individual based on certain specific parameters. There are eight types of saras mentioned in Ayurveda which can be examined.<ref>Charaka Samhita (Vimanasthana Adhyaya 8 Sutra 102-115)</ref>

{| class="wikitable"

{| class="wikitable"

|Sara

|'''Sara'''

|Features

|'''Features'''

|-

|-

|Tvak (skin) sara

|Tvak (skin) sara OR Rasa sara (त्वक सारः / रस सारः)

|Has snigdha(unctuous),  mridu(soft) skin and alpa(little) hairs. The tvak sara purusha(person)  indicate, sukha(happiness), saubhagya(good fortune), buddhi(intelligence)  etc.

|Has snigdha(unctuous),  mridu(soft) skin and alpa(little) hairs. The tvak sara purusha(person)  indicate superior quality of [[Rasa Dhatu (रस धातु)|rasa dhatu]] which resides predominantly in skin. It is believd to bring forth sukha(happiness), saubhagya(good fortune), buddhi(intelligence)  etc.

|-

|-

|Rakta Sara

|Rakta Sara (रक्तसारः)

|Has karna,akshi,mukha etc rakta varna(red colour), unctuous and

|He is recognized by the red color of ears, eyes, face etc. These body parts are also unctuous and lusturous/luminous. It indicates superior quality of [[Rakta Dhatu (रक्त धातु)|Rakta dhatu]] and it leads to happiness, moderate strength, low endurance, high intellect etc.

 

lusturous. It indicates  happiness, moderate strength, low endurance, high intellect etc.

|-

|-

|Mamsa Sara

|Mamsa Sara (मांससारः)

|Those having excellent  mamsa dhatu, have their shankha(temples), lallata(fore head), aksh(eyes)i,  udara(abdomen) etc well developed. Indicates strength and longetivity.

|Those having excellent  [[Mansa Dhatu (मांस धातु)|mamsa dhatu]], have their shankha(temples), lalata(fore head), akshi(eyes),  udara(abdomen) etc well developed. Indicates strength and longetivity.

|-

|-

|Meda Sara

|Meda Sara (मेदसारः)

|Has excellent varna(complexion),  hars, eyes etc, this indicates sukumara(delicate), happiness, wealth etc

|Has excellent varna(complexion),  hairs, eyes etc, Having good quality of [[Meda Dhatu (मेद धातु)|Meda dhatu]] is known to generate sukumara(delicate), happiness, wealth etc

|-

|-

|Asthi Sara

|Asthi Sara (अस्थिसारः)

|Has well-built bones,  teeth and joints. Indicates endurance, strength, enthusiasm

|Has well-built bones,  teeth and joints due to supreme quality [[Asthi Dhatu (अस्थी धातु)|Asthi dhatu.]] Indicates endurance, strength, enthusiasm

|-

|-

|Majja Sara

|Majja Sara (मज्जासारः)

|Shareera of majja sara purusha is mrudu(soft) with good complexion and prominent joints. Indicates  dirgha ayush(long life).

|Shareera of  purusha having superior quality [[Majja Dhatu (मज्जा धातु)|Majja dhatu]] is mrudu(soft) with good complexion and prominent joints. Indicates  dirgha ayush(long life).

|-

|-

|Shukra Sara

|Shukra Sara (शुक्रसारः)

|Those having excellent shukra are pleasant looking with compact built and indicate, good health,  strength.

|Those having excellent [[Shukra Dhatu (शुक्र धातुः)|shukra dhatu]] are pleasant looking with compact built and indicate, good health,  strength.

|-

|-

|Satva Sara

|Satva Sara (सत्वसारः)

|Satva sara purusha are  endowed with good memory, bhakti(devotion), skills and techniues etc.  indicates high intellect.

|Satva means [[Manas (मनः)|manas]]. Satva sara refers to good strength of mind and tolerance. Satva sara purusha are  endowed with good memory, bhakti(devotion), skills and techniques etc.  indicates high intellect.

|}

|}

=== 4.    Samhanana pariksha ===

=== प्रमाण परीक्षा ॥ Pramana Pariksha ===

=== 5.    Pramana Pariksha ===

Satmya (सात्म्यम्) means habituation, here examination is about understanding the properties of certain habit or acclimatization to a certain food or habit of a person. If the person is used to eating or using substances that are good for health then that is known as superior Satmya. Repeated use of things in the form of food or habit cause certain effects on person's health and strength. That individual who is habituated to ghruta (ghee), milk, and all the six rasa (taste) is indicated as balavant meaning strong. On the contrary, that purusha(individual) who is habituated to only single rasa(taste), does not eat ghruta(ghee) or milk etc routinely is indicated as a weak purusha(individual) Thus a person's overall strength and health can be grossly assessed on the basis of examination of satmya (habits/routine).<ref name=":1" />

It is the measurements, proportions and anthropometry of an individual. There is mention of measurements of each and every organ in ayurvedic anatomy. The measurements are in ''swa anguli pramana''().these measurements in appropriate proportions provide sukha(happiness), arogya(health), aishvarya(wealth). (char.vima.8.117)

Satva(सत्वम्) means [[manas (मनः)]] or mind. Understanding the level of one’s mental strength is known as satva pariksha. Pravara(प्रवरम् । excellent) satva, madhyama(मध्यमम्। moderate) satva, and avara(अवरम्। weak) satva are three fundamental levels of mental strength. An individual is said to have pravara satva (superior strength) when the mind stays unaffected and stable even during worst situations. Whereas avara satva individuals are unable to withstand mild pain and have lot of emotional disturbances like anger, jealousy, grief, excitement etc. over and again. Also, the one who has good mental strength can support others in bad situations while the one with weak strength can not control self and support others.<ref name=":1" />

=== 6.    Satmya Pariksha ===

=== आहारशक्ति परीक्षा ॥ Ahara Shakti Pariksha ===

=== 7.    Satva Pariksha ===

[[Vyayama (व्यायामम्)|Vyayama]] (व्यायाम) means Exercise. The capability of an individual to work or exercise is Vyayama Shakti or physical strength. This again is categorized into three basic types viz Pravara (excellent), madhyama(moderate) and avara(weak). This gives idea about overall strength of body. <ref name=":1" />

 

=== Vaya pariksha ===

[[Vayas (वयः)|Vaya (वयः)]]  means age. Assessment of an individual with respect to age is for determination of strength of dhatus. Ayurveda categorizes age in three stages, which is baala (childhood), Madhya(middle age) and jeerna(old age). A specific vayas vibhaga (age group) is vulnerable to specific diseases and must be guarded against them for maintaining their health. Predominance of a particular [[Doshas (दोषाः)|dosha]] is normal for a particular age group and to be more precise it is a necessity in order to be able to carry out the specified Purusharthas in that age. Vaya (Age) is one of the medium to achieve the knowledge regarding [[Ayu (आयुः)|Ayu]] (span of life) besides other tools. When these points are considered, evaluation of a diseased state becomes precise, appropriate treatment can be administered and guidelines given to that individual regarding [[Svasthavrtta (स्वस्थवृत्तम्)|svasthavrtta]] could be more specific and beneficial. Thus, ancient Ayurveda acharyas have given high importance to understanding this point.

 

=== 8.    Ahara Shakti Pariksha ===

 

 

 

=== 9.    Vyayama Shakti pariksha ===

 

 

The capability of an individual to work or exercise is Vyayama Shakti. This again is categorized based on three basic levels viz Pravara(excellent), madhyama(moderate) and avara(weak). (char.vima.8.121)

 

(char.vima.8.122)

 

 

Assessment of an individual with respect to age is for determination of strength of dhatus. Ayurveda categorises age in three stages, which is baala(childhood), Madhya(middle age) and jeerna(old age).

During baala awastha or childhood stage the dhatus are not matured completely, shareera is sukumara (delicate), strength is average.

During baala awastha or childhood stage the dhatus are not matured completely, shareera is sukumara (delicate), strength is average.

On the contrary peope in jeerna awasthaor old age, the dhatus, sense organs, strength gradually degenarates.

On the contrary people in jeerna awastha or old age, the dhatus, sense organs, strength are gradually degenerating hence weak.                                                             

 

                                                                               

== References                                                                          ==

== References                                                                          ==