10 fold clinical examination in Ayurveda (दशविधपरीक्षा)

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

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.

Dashavidha pariksha precisely falls under the category of Ayurvedic diagnosis and more specifically it is a tool for diagnosis. There are few other kinds of examination techniques mentioned in Ayurvedic treatises like ashtavidha pariksha (अष्टविधपरीक्षा eight fold examination of patient), trividha pariksha (त्रिविधपरीक्षा three fold examination of patient) etc. which are isolated concepts and foundations of clinical assessment in Ayurveda.

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.                                                          

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 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 body type), vikrti (विकृतिः disease), sara (सारम् essence of dhatu) etc. is essential in Ayurveda.

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,

तस्मादातुरंपरीक्षेतप्रकृतितश्च, विकृतितश्च, सारतश्च, संहननतश्च, प्रमाणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च, वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः|| (Char. Vima. 8.94)

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).

Dashavidha Pariksha Components	Artha(meaning)
Prakrti	Body type or constitution of an individual
Vikrti	Assessment of the existing ailment in the person
Saara	The quality and strength of the dhatus/body tissues
Samhanana	The tone of muscles/muscularity or built of an individual
Pramana	Bodily measurements or anthropometrics
Satmya	Habituation, diet and lifestyle or a certain long term habit/addiction etc
Satva	Examination of mental strength
Aaharashakti	Ability to ingest food
Vyayama Shakti	Ability to work or exercise capability or examination of physical strength.
Vaya	Consideration of age

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.

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.

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)  

Meaning: The one (Vaidya) who makes the diagnosis and starts the treatment after considering detail evaluation of factors like Dushya (दूष्यम्), Desha (देशम्), Bala (बलम्), Kala (कालम्), Anala (अनलम्), Prakruti (प्रकृतिः), Vaya (वयः), Satva (सत्वम्), Satmya (सात्म्यम्), ahara (आहारः) and stage of disease, never fails in his efforts / succeeds.

प्रकृति परिक्षा ॥ Prakriti Pariksha

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,

1. Vata dominant (वातप्रधाना)
2. Pitta dominant (पित्तप्रधाना)
3. Kapha dominant (कफप्रधाना)
4. Samadhatu (all 3 doshas in equilibrium) (समधातु)
5. Vata-pitta dominant (वातपित्तप्रधाना)
6. Vata-kapha dominant (वातकफप्रधाना)
7. Pitta-kapha dominant (पित्तकफाप्रधाना)

                                                                                     

Prakriti	Features
Vata (वात)	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 (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 life span.
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.

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 (हेतुः cause of the disease), dosha (दोषाः), dushya (दूष्याः । tissues like dhatus and malas), desha (देशः), kala (कालः) and specific symptoms must be examined.  For example if the vitiated doshas in a particular diseased individual are similar to the dominant doshas of 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 in order to plan the treatment and consider the prognosis.

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.

Sara	Features
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 superior quality of rasa dhatu which resides predominantly in skin. It is believd to bring forth sukha(happiness), saubhagya(good fortune), buddhi(intelligence) etc.
Rakta Sara (रक्तसारः)	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 and it leads to happiness, moderate strength, low endurance, high intellect etc.
Mamsa Sara (मांससारः)	Those having excellent mamsa dhatu, have their shankha(temples), lalata(fore head), akshi(eyes), udara(abdomen) etc well developed. Indicates strength and longetivity.
Meda Sara (मेदसारः)	Has excellent varna(complexion), hairs, eyes etc, Having good quality of Meda dhatu is known to generate sukumara(delicate), happiness, wealth etc
Asthi Sara (अस्थिसारः)	Has well-built bones, teeth and joints due to supreme quality Asthi dhatu. Indicates endurance, strength, enthusiasm
Majja Sara (मज्जासारः)	Shareera of purusha having superior quality Majja dhatu is mrudu(soft) with good complexion and prominent joints. Indicates dirgha ayush(long life).
Shukra Sara (शुक्रसारः)	Those having excellent shukra dhatu are pleasant looking with compact built and indicate, good health, strength.
Satva Sara (सत्वसारः)	Satva means 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.

संहनन परीक्षा ॥ Samhanana pariksha

The built of an individual or tone of the muscles is regarded as samhanana (संहननम्). Samhanana is examined on the basis of susamhata shareera (सुसंहत शरीरः । symmetry, shape, built and compactness) of the body, samasuvibhakt asthi (समसुविभक्त अस्थिः) which means well defined bones, subaddha sandhi (सुबद्ध संधीः) which means strong joints. the purusha or person is balavant (बलवंतः । strong) who has a compact and well-built body which indicates strong samhanana.

प्रमाण परीक्षा ॥ Pramana Pariksha

Pramana (प्रमाणम्) 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 (स्वाङ्गुलीप्रमाण । unit of measurement is one's own finger). These measurements when in appropriate proportions cause good health and further provide sukha (सुखम् । happiness), arogya (आरोग्यम् । health), aishvarya (ऐश्वर्यम्। wealth).

सात्म्य परीक्षा ॥ Satmya 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).

सत्व परीक्षा ॥ Satva Pariksha

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.

आहारशक्ति परीक्षा ॥ Ahara Shakti Pariksha

Assessment of an individual based on the ability to ingest food is known as ahara Shakti pariksha. Ones' ahara shakti or ability to eat a certain quantity of food depends upon his hunger and metabolism controlled by Agni. Thus it is examined to determine the strength of the Agni (अग्निः) of individual. When the Agni is strong it can manage most of the disturbances in the body independently as per Ayurveda. Moreover it gives good appetite, proper metabolism which leads to development and nourishment of all the body tissues. This ultimately gives balam (बलम् । strength and immunity) to the person.

व्यायामशक्तिः परीक्षा ॥ Vyayama Shakti pariksha

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.

वय परीक्षा ॥ Vaya pariksha

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 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 (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 could be more specific and beneficial. Thus, ancient Ayurveda acharyas have given high importance to understanding this point.

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

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