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.

Dashavidha pariksha described in Vagbhata

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.

Prakriti Pariksha

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)

Prakrti 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 which is specific to each individual.      

·       Vata dominant (वातप्रधाना)

·      Pitta dominant (पित्तप्रधाना)

·      Kapha dominant (कफप्रधाना)

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

·      Vata-pitta dominant (वातपित्तप्रधाना)

·      Vata-kapha dominant (वातकफप्रधाना)

·      Pitta-kapha dominant (पित्तकफाप्रधाना)

                                                                                     

Prakriti	Features
Vata	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.
Pitta	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.
Kapha	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

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)

3.    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	Features
Tvak (skin) sara	Has snigdha(unctuous), mridu(soft) skin and alpa(little) hairs. The tvak sara purusha(person) indicate, sukha(happiness), saubhagya(good fortune), buddhi(intelligence) etc.
Rakta Sara	Has karna,akshi,mukha etc rakta varna(red colour), unctuous and lusturous. It indicates happiness, moderate strength, low endurance, high intellect etc.
Mamsa Sara	Those having excellent mamsa dhatu, have their shankha(temples), lallata(fore head), aksh(eyes)i, udara(abdomen) etc well developed. Indicates strength and longetivity.
Meda Sara	Has excellent varna(complexion), hars, eyes etc, this indicates sukumara(delicate), happiness, wealth etc
Asthi Sara	Has well-built bones, teeth and joints. Indicates endurance, strength, enthusiasm
Majja Sara	Shareera of majja sara purusha is mrudu(soft) with good complexion and prominent joints. Indicates dirgha ayush(long life).
Shukra Sara	Those having excellent shukra are pleasant looking with compact built and indicate, good health, strength.
Satva Sara	Satva sara purusha are endowed with good memory, bhakti(devotion), skills and techniues etc. indicates high intellect.

     

4.    Samhanana pariksha

The built of an individual or tone of the muscles is regarded as samhanana. Samhanana is examined based on susamhata shareera(compactness) of the body, samasuvibhakt asthi which means well defined bones, subaddha sandhi which means strong joints. the purusha or person is balavant(strong) who has a compact and well-built body which indicates strong samhanana.(char.vima.8.116)

5.    Pramana Pariksha

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)

6.    Satmya Pariksha

Satmya means habituation, here examination based on a certain habit or acclimatisation to a certain food or habit is done. 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). (char.vima.8.118)

7.    Satva Pariksha

Determination of one’s mental strength is known as satva pariksha. Satva here means the mind. Pravara(excellent) satva, madhyama(moderate) satva, and avara(weak) satva are three fundamental parameters of examination. An individual is said to have pravara satva when the mind stays unaffected and stable even during worst situations. Whereas avara satva individuals are unable to withstand mild pain and have ualities like lobha, moha, shoka etc. (char.vima.8.119)

8.    Ahara Shakti Pariksha

Examination of an individual based on the ability to ingest food is known as ahara Shakti pariksha. This is examined to determine the diet and strength of the individual. (char.vima.8.120)

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)

10.  Vaya

(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.

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