Diagnostic Methods in Ayurveda

DIAGNOSTIC METHODS
OF AYURVEDA
Dr. K.S. Nandalal MD (Ay)
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www.ayurvedicmedicinalplants.com
CONTENTS
Page No.
1. Introduction 02
2. Thrividha Pareeksha 05
3. Chathurvidha Pareeksha 12
4. Shadvidha Pareeksha 13
5 Ashtasthana Pareeksha 15
6. Dasavidha Pareeksha 26
7. Srotho Pareeksha 47
8. Examination of Infants & Children 49
9. Roga Pareeksha 50
10. Clinical Approach in Allopathic Medicine 53
11. Psychiatric Examination 66
12. Model Case Sheet 68
13. Conclusion 72
14. Bibliography 73
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INTRODUCTION
Ayurveda, the science of life and living has evolved through years. It is as
ancient as Vedas. Priliminary thinkings about health care can be seen in ‘Rik’
veda and ‘Adharva’ Veda. Ayuveda is also considered as the fifth veda or upveda
of Adharva Veda. The fundamental principles of Ayurveda are based on the
metaphysical and philosophical background. Such decriptions are available in the
Ayurvedic texts. They are based on the various Indian philosophies like Naya-
vaisehik, Sankhya, Yoga and Vedanta with slight modification to suit the aims and
objects of Ayurveda.
In a way the ultimate goal of Ayurveda is the well being of the society or
disease free healthy individuals. In a broden sense the contents of Ayurveda can
be divided into two.
(i) º´ÉºlÉ´ÉÞkÉÆ (ii) +ÉiÉÖ®ú´ÉÞkÉÆ
Among these we cannot consider one important or supurb to the other as
both are equally important for society.
Ayurveda is a complete science or ‘¶ÉÉºjÉÆ’.
¶ÉºÉxÉÉiÉÂ ¶ÉÆºÉxÉÉiÉÂ ¶ÉÉºjÉÆ ¶ÉÉºjÉÊ¨ÉiªÉÊ¦ÉvÉÒªÉiÉä
The entire science of Ayurveda obey the above principle. The main objective
of this science is
Ê½þiÉÉÊ½þiÉÆ ºÉÖJÉÆ nÖù&JÉÆ +ÉªÉÖºiÉºªÉ Ê½þiÉÉÊ½þiÉÆ
¨ÉÉxÉÆ iÉSSÉ ªÉjÉÉäCiÉÆ +ÉªÉÖ´Éænù ºÉ =SSÉiÉä **
The main object of this science is Karmapurusha
JÉÉnùªÉ¶SÉäiÉxÉÉ¹É¹`öÉ PÉÉiÉ´É {ÉÖ¯û¹É& º¨ÉÞiÉ& (SÉ - ¶ÉÉ)
+Îº¨ÉxÉ ¶ÉÉºjÉä {É\SÉ¨É½þÉ¦ÉÚiÉ¶É®úÒ®úºÉ¨É´ÉÉªÉ& {ÉÖ¯û¹É <iªÉÖSªÉiÉä (ºÉÖ. ¶ÉÉ. ®ú.)
The physical body with Atma and Manas constitute ‘Chethanapurusha’. The
physical body has mentioned as Sarira, deha and kaya. It is composed of three
doshas viz. ´ÉÉiÉÆ, Ê{ÉkÉÆ and Eò¡Æò and Saptha dhadus. Viz. ®úºÉÆ, ®úHÆò, ¨ÉÉÆºÉÆ, ¨ÉänùºÉ, +ÎºlÉ,
¨ÉVVÉÉ, ¶ÉÖC±ÉÆ. The equilibrated combination of these constitute prakruti. Any type of
vitation from this can be considered as vikruthi. Such a combination of the dhadus
is a proper mains is know as ‘Samayogavahi’ and is the basic criteria for a disease
free body.
ºÉ¨ÉäxÉ +ÉªÉiÉ|É¨ÉÉhÉäxÉ vÉÉiÉÖ´ÉÉÆ ¨ÉäEòEäòxÉ
ºÉ¨ªÉRÂó ÊxÉ®úÉäMÉiÉÉªÉÉ ´É½þiÉÒÊiÉ ºÉ¨ÉªÉÉäMÉ´ÉÉ½þÒ (SÉGò{ÉÉÊhÉ SÉ ¶ÉÉ)
When ever a person come in contact with various etiological factors either in
the from of Ahara or Vihara on with some external factor (+ÉMÉxiÉÖ) the disease process
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starts. With the advent of a favourable climatic conditions these process advance.
The whole process for the development of a disease from the contact with etiological
factors (or ÊxÉnùÉxÉ) to the manifestation of the disease is called ºÉÆ|ÉÉÊ¨É. This etiological
process starts with the vitation of dosha and the progress of this doshas to different
stages like SÉªÉÆ, |ÉEòÉä{ÉÆ, |ÉºÉ®Æú, ºlÉÉxÉºÉÆ¸ÉªÉÆ, ´ªÉÊHò and ¦ÉänÆù. During this process prakupitha
doshas get lodged where there is a srothovaigunya in the dhadus and intract with
the samadhadus (ºÉÉ¨ÉvÉÉiÉÖ). There the intraction with dhatus and doshas takes place
- nùÉä¹ÉnÚù¹ªÉºÉ¨¨ÉÚSUÇôxÉÆ - and this entire process is considered as Samprapthi. Correct
knowledge of these stage wise progression of disease process is essential for a
physician to tackle the disease as ÊSÉÊEòiºÉÉ is ºÉÆ|ÉÉÎ{iÉ Ê´ÉPÉ]õxÉÆ *
The main aim or duty of the physician is to alleviate or cure a disease. For
this a proper diagnosis is essential. The causative factors, the pathogenesis its
complications etc are to recognised. That is why the physician has to make a spot
diagnosis, provisional diagnosis and a differential diagnosis.
For the purpose of identifying and diagnosing a disease, Ayurvedic science
has its own methods and methodologies. All these has clearly described in various
basic texts of Ayurveda. They have given due importance both to ®úÉäMÉÒ{É®úÒIÉÉ and
®úÉäMÉ{É®úÒIÉÉ. Allopathic system of medicine also has eloborate methods for this. They
mainly depend on laboratory investigations and investigations making use of
sophisticated equipments like ultrasongram, magnetic resonance imaging etc in
addition to introgation and physical examination. Various biochemical investigations
give an in sight to what is happening in the Dhadu level and X’ray, MRI, USG etc.
will give a better idea of structural abnormalities of deep organs.
Pareeksha is defined as the means by which a person get a definite or real
knowledge of a subject.
{É®úÒIªÉxiÉä ´ªÉ´ÉºlÉÉ{ªÉxiÉä ´ÉºiÉÖ º´É°ü{ÉÉÊhÉ +xªÉlÉÉ <ÊiÉ {É®úÒIÉÉ *
Pareeksha is the method of obtaining knowledge by the help of Pramanas (Proofs).
|É¨ÉÉhÉèºlÉÇ´ÉvÉÉ®úhÉÆ {É®úÒIÉÉ * (´ÉÉiºÉÉªÉxÉ ¦ÉÉ¹ªÉ)
Proper examination of the patient (®úÉäMÉÒ{É®úÒIÉÉ) is the ideal first to know a disease
present in the patient (ie diagnosis of the disease). So a thorough examination
and interogation or history taking is the vital part of a case recording.
Ê¨ÉlªÉÉ où¹]õÉ Ê´ÉEòÉ®úÉ ªÉä nÖù®úÉJªÉÉiÉÉºiÉlÉÉè´É SÉ * iÉlÉÉ nÖù¹{ÉÊ®ú¨ÉÖ¹]õÉ®ú ¨ÉÉä½þªÉä¹ÉÖ ÊSÉÊEòiºÉÒxÉ¨ÉÂ *
Su.Su 10/4
If the patient is not examined properly or if the facts observed are not properly
taken into consideration and if the physician don’t have the thorough knowldege
of ®úÉäMÉÒ {É®úÒIÉÉ, then both patient and the physician will not get favourable results.
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Acharya Charaka in his Sutrasthana says,
®ú É äM É¨ÉÉnù É è {É®úÒ IÉäi É iÉiÉÉä xÉxiÉÆ® ú +Éè¹ÉvÉ¨ÉÂ
iÉiÉ& Eò¨ÉÇ Ê¦É¹ÉEÂò {É¶SÉÉiÉ YÉÉxÉ{ÉÚ´ÉÇ ºÉ¨ÉÉSÉ®äúiÉÂ * (SÉ. ºÉÚ. 20/20)
The importance of ®úÉäMÉ and ®úÉäMÉÒ {É®úÒIÉÉ are higlighted by SÉ®úEò as follows.
´ÉºiÉÖ ®úÉ äMÉÊ´É¶Éä¹ÉhÉ& ºÉ´ÉÇ¦ ÉÉè¹ÉVªÉ EòÉäÊ ¹Énù & * näù ¶ÉEòÉ±É|É¨ÉÉhÉnù & iÉºªÉ ÊºÉÊrù &
+ºÉ¶ÉªÉ¨ÉÂ *
(SÉ. ºÉÚ. 20/22)
To perform a duty it is important to know about that particular thing before
performing it. For this purpose, {É®úÒIÉÉ will be helpful.
YÉÉxÉ{ÉÚ´ÉÇEÆò Ê½þ Eò¨ÉÇhÉÉÆ ºÉ¨ÉÉ®ú¨¦ÉÆ |É¶ÉÆºÉÉxiÉÒ EÖò¶É±ÉÉ& - (SÉ. Ê´É. 8)
A skilled person is one who does {É®úÒIÉÉ before doing any work SÉ®úEò says
xÉ Ê½þ +±ÉÆ YÉÉxÉ´ÉÉxÉÂ Ê¦É¹ÉbÂ÷¨ÉÖ¨ÉÖ¹ÉÖÇ¨ÉÉiÉÖ®ú¨ÉÖiªÉÉÊ{ÉiÉÖÆ - {É®úÒIªÉEòÉÊ®ú - ªÉÉä Ê½þ EÖò¶É±ÉÉ ¦É´ÉÉÎxiÉ *
(SÉ. ºÉÖ.10/1)
The use of {É®úÒIÉÉ is told as -
{É®úÒIÉÉªÉÉºiÉÖ JÉ±ÉÖ |ÉªÉÉäVÉxÉÆ |ÉÊiÉ{ÉiÉÒYÉÉxÉ¨ÉÂ |ÉÊiÉ{ÉÊkÉxÉÉ¨É ªÉÉä Ê´ÉEòÉºÉä ªÉlÉÉ
|ÉÊiÉ{ÉkÉªªÉºxÉºªÉ iÉlÉÉxÉÖ¹`öÉxÉYÉÉxÉ¨ÉÂ - (SÉ. Ê´É 8)
Any doubt in understanding a subject has to be cleared by the help of
pareeksha and a decisive, confirmatory inference can be obtained. Inorder to
attain a proper knowledge of the disease, different types of proofs or pareekshas
are to be adobted. Only after attaining a correct knowledge, physician will be able
to advocate a proper treatment.
The some total of Ayurvedic examinations or ®úÉäMÉ, ®úÉäMÉÒ {É®úÒIÉÉ can be classifed
under various groups.
TYPES OF PAREEKSHA
2 types : Roga Pariksha & Rogi Preeksha.
Prathyaksha & Anumana
3 types : Prathyaksha, Anumana & Apthopadesha
Prathyaksha, Anumana & Upamanam
Darshanam, Sparshanam & Prashnam
4 types : Prathyaksha, Anumana, Apthopadesham & Yukthi
6 types : Panchendriya Pareeksha & Prashana Pareeksha
8 types : Nadi, Moothram, Malam, Jihwa, Sabda, Sparsha, Drik &
Akruthi
10 types : Prakruthi, Vikruthi, Sara, Sathwa, Samhanana, Pramana,
Aharasakthi, Vyayamasakthi, Vayaha.
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TRIVIDHA PAREEKSHA
This method of examination is explained in ÊjÉÊ´ÉvÉ ®úÉäMÉ Ê´É¶Éä¹É Ê´ÉYÉÉxÉÒªÉÆ +vªÉÉªÉ of

SÉ®úEòºÉÆÊ½þiÉÉ (SÉ. Ê´É. 14/9). According to this method, the knowledge about the disease
is attained by three pramanas - +É{iÉÉä{Énäù¶É, |ÉiªÉIÉ and +xÉÖ¨ÉÉxÉ.
ÊjÉÊ´ÉvÉÆJÉ±ÉÖ ®úÉäMÉÊ´É¶Éä¹É Ê´ÉYÉÉxÉÆ ¦É´ÉÊiÉ, iÉPÉlÉÉ +É{iÉÉä{ÉiÉä¶ÉÆ |ÉiªÉIÉÆ, +xÉÖ¨ÉÉxÉ¨ÉÂ SÉäÊiÉ *
(SÉ. Ê´É. 4/3)
1. +É{iÉÉä{Énäù¶É
+É{iÉÉä{Énäù¶É means +É{iÉ´ÉSÉxÉ, ie, advices given by a master. +É{iÉ is a person who
have sound, complete and confirmitive knowledge with good memory power. They
would not have any ®úÉMÉ, uäù¹É, EòÉä{É, ¨ÉÉiºÉªÉÇ etc. So they always speak truth and their
advices are accepted as |É¨ÉÉhÉÆ.
The +É{iÉÉä{Énäù¶É is also called ®úÉ¹nù|É¨ÉÉhÉ, and it may be in following forms.
a) Scriptures - such as treatises, texts etc, because these are written by great
scholars, and their literatures are accpeted as proof.
b) Speech - from teacher to student. So education is also +É{iÉÉä{Énäù¶É. It includes
{ÉÉ®úÎ¨{ÉEò YÉÉxÉ also.
c) Complaints presented by patients or/and his relatives.
It is an important aspect of patient examination, because only the patient
can tell what he is experiencing, better than any others. So the patient is also
an +É{iÉ in view of diagnosing the disease.
+É{iÉÉä{Énäù¶É YÉäªÉ Ê´É¹ÉªÉÉ
|ÉEòÉä{É - Provoking factors of disease
ªÉÉÉäÊxÉ - Source of dosha involved
=ilÉÉxÉ - Mode of onset
+Éi¨ÉÉ - Nature of disease
+ÉvÉÒ¹`öÉxÉ - Location of disease
´ÉänùxÉÉ - Pain and its characteristics in a disease
ºÉÆºlÉÉxÉ * ±ÉIÉhÉ - Symptons
={Épù´É - Complication
´ÉÞÊrù - ºlÉÉxÉ - IÉªÉ - Stages of Dosha
=nùEÇò - Sequele
xÉÉ¨É - Name
½äþiÉÖ - Cause
ªÉÉäMÉ - Medicine and Therapy useful
So +É{iÉÉä{Énäù¶É includes two factors in diagnosing a disease.
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Ø Getting the knowledge of disease, before seeing or examining a patient.
Ø Getting the knowledge of disease from the patient itself. These two will give
a chance for recognising a disease.
2. +xÉÖ¨ÉÉxÉ
+xÉÖ¨ÉÉxÉ {É®úÒIÉÉ is the means by which the diagnosis is made by inference. This
is the method of examination of the patient which is performed in most or all of the
occasions. In Ayurvedic classics, much importance has given in diagnosing the
disease using Anumana Pareeksha. Here are a few examples.
+ÏMxÉ VÉ®úhÉ¶ÉHòªÉÉ {É®úÒIÉäiÉ: +ÎMxÉ should be assessed by the capacity/power of
digestion. It will be different in different individuals. Depending on the
constitution, based on the predominance of the nùÉä¹É, four types of +ÎMxÉ are
mentioned in our classics. Namely, Ê´É¹É¨ÉÉÎMxÉ, iÉÒIhÉÉÎMxÉ, ¨ÉxnùÉÎMxÉ, ºÉ¨ÉÉÎMxÉ depending
on predominance of ´ÉÉiÉ, Ê{ÉkÉ, Eò¡ò or balance of the nùÉä¹És respectively.
¤É±ÉÆ ´ªÉÉªÉÉ¨É¶ÉHòªÉÉ: The strength of the patient is assessed by his capacity to do
exercise. The strength will be more if the person is having the habit of doing
daily exercise. Eg. Coolie workers. The strength will be less if the person is
having severe debilitating illness such as stroke, myopathy etc.
¸ÉÉäjÉÉnùÒÊxÉ ¶É¤nùÉPÉlÉÇOÉ½þhÉäxÉ: Condition of sense organs like auditory faculty etc.
are assessed by their capacity to perceive the respective objects like sound
etc. eg. The perception of hearing is tested by whispered voice test or spoken
voice tests and tuning fork tests - Rinnie test, Weber’s test and Schwabach’s
test (ABC test).
¨ÉxÉÉälÉÇ´ªÉÊ¦ÉSÉ®úhÉäxÉ: Existence of mind can be assessed from the perception of
specific objects even in the presence of all other senses along with their
objects. Nowadays, this is tested by assessing the general behaviour such
as consciousness and interest in surroundings and mini-mental status
examination such as attention, presence or absence of delusion,
misinterpretation, hallucination, orientation of space and time etc.
Ê´ÉYÉÉxÉÆ ´ªÉ´ÉºÉÉªÉäxÉ: Knowledge of a thing can be assessed by proper action and
reaction to it. Eg: A computer engineer will be knowing about the scope of
computers in different fields such as medicine, social field in a better way
than others. So by asking questions on the application of computers we can
infer his knowledge.
®úVÉ& ºÉRóMÉäxÉ: Presence of attachment are caused by ®úVÉÉä MÉÖhÉ alone i.e. passion.
¨ÉÉä½þ¨ÉÊ´ÉYÉÉxÉäxÉ: Unconsciousness can be assessed from lack of understanding.
Level of unconsciousness for descriptive purposes, are being divided into 4
grades - somnolence, stupor, semi-coma and coma. The level of
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consciousness if diagnosied by the simple commands - such as naming the
patient, light touch and complex commands such as pressure over styloid
process, supra - orbital nerve or root of finger nails. Glasgow - coma scale is
also helpful to assess the same.
EòÉävÉ¨ÉÊ¦ÉpùÉä½äþhÉ: Presence of anger can be known by the patient-s attitude of
revengeful disposition.
¶ÉÉäEÆò nèùxªÉäxÉ: Sorrow of a person is known from sorrowful attitude.
½þ¹ÉÇ¨ÉÉ¨ÉÉänùäxÉ: Joy is known from happiness. Here the world ‘+É¨ÉÉänù’ refers to various
activities such as dancing, singing etc.
|ÉÒËiÉ iÉÉä¹ÉähÉ: Pleasure assessed from satisfaction which is reflected by joyous
appearance of face, eyes etc.
¦ÉªÉÆ Ê´É¹ÉÉnäùxÉ: Fear is known from apprehension.
vÉèªÉÇ¨ÉÊ´É¹ÉÉnäùxÉ: Courage is assessed from the strength of the mind even when
one is in dangerous situation.
´ÉÒªÉÇ¨ÉÖilÉÉxÉäxÉ: Energy of an individual is assessed from his initiative in such
actions as are normally difficult to perform.
+´ÉºlÉÉxÉ¨ÉÊ´É§É¨ÉähÉ: Stability of mind is assessed from the avoidance of any
mistake.
¸ÉrùÉ¨ÉÊ¦É|ÉÉªÉähÉ: Desire is assessed from the request.
¨ÉävÉÉÆ OÉ½þh ÉäxÉ: Intelligence is known from the power of comprehension of
scriptures.
ºÉÆYÉÉÆ xÉÉ¨ÉOÉ½þhÉäxÉ: Recognition is assessed from the recollection of the name.
º¨ÉÞËiÉ º¨É®úhÉäxÉ: Memory is assessed from the power of rememberance.
Ê¿ªÉ¨É{ÉjÉ{ÉhÉäxÉ: Modesty is assessed from the bashfulness.
¶ÉÒ±É¨ÉxÉÖ¶ÉÒ±ÉxÉäxÉ: Liking is assessed from habitual intake of things.
uäù¹ÉÆ |ÉÊiÉ¹ÉävÉäxÉ: Dislike is assessed from disinclination for taking something.
={ÉÉÊvÉ¨ÉxÉÖ¤ÉxvÉäxÉ: Deception is assessed from subsequent manifestations. An
individual pretending to be a well - wisher but actually having evil intentions
can be judged from his subsequent activities like murder of the brother etc.
vÉÞÊiÉ¨É±ÉÉè±ªÉäxÉ: Courage is assessed from firmness.
´É¶ªÉiÉÉÆ Ê´ÉvÉäªÉiÉªÉÉ: Obedience is known from compliance with others.
The examinations mentioned for anger upto examination for obedience can
be included in the examination of mental state.
´ÉªÉÉä¦ÉÊHòºÉÉi¨ªÉ´ªÉÉÊvÉºÉ¨ÉÖiÉÂlÉÉÊxÉ EòÉ±Énäù¶ÉÉä{É¶ÉªÉ´ÉänùxÉÉ Ê´É¶Éä¹ÉähÉ: Age, liking, homologation
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and cause of the disease can be assessed from knowing the stage of life, habitat,
conduciveness and characteristic features of pain respectively. Age of the patient
is determined by the state of life - i.e. by appearance of secondary sexual
characters etc. habitat of an individual determines his likings e.g. if an individual
has liking for wheat and black-gram them he should be inferred to be an inhabitant
of central region of the country. When something is conducive to the individual,
it should be treated as wholesome. If somebody is having fever, it can be inferred
that the causative factors of fever are responsible for this condition.
MÉÚfø Ê ±ÉRÆó MÉ ´ªÉÉÊvÉ¨ÉÖ{É¶ÉªÉÉxÉÖ{É¶ÉªÉÉ¦ªÉÉÆ {É®úÒIÉäi ÉÂ:
Diseases having latent symptoms
are diagnosed from the administration of such therapies as would aggrevate or
alleviate the condition. Diseases with well manifested symptoms can easily
be diagnosed and no exploratory therapies are required. Eg: If there is a
doubt whether the condition is >ð¯ûºiÉÆ¦ÉÆ or Eäò´É±É´ÉÉiÉ´ªÉÉÊvÉ, by applying medicated
oils over the body, the condition can be differentiated. If the condition improves,
then the patient is considered to be suffering from vatavyadhi and if it worsens,
the patient is considered to be suffering from the disease urustambha.
Upasaya can be called as the ‘therapeutic tests’. If the person is suffering
from high grade fever and is not responding to antipyretics, if on administration
of quinine the condition improves, it indicates the fever was due to malarial
parasite.
nùÉä¹É|É¨ÉÉhÉÊ´É¶Éä¹É¨É{ÉSÉÉ®úÊ´É¶Éä¹ÉähÉ: Degree of the vitiation of dosas can be assessed
from the measurement of provocative factors. If the provocative factors are
less, then the dosa vitiation will be mild.
+ÉªÉÖ¹É& IÉªÉ¨ÉÊ®ú¹]èõ: Approaching death can be diagnosed from bad prognostic
signs.
={ÉÎºlÉiÉ¸ÉäªÉºiÉ´ÉÆ Eò±ªÉÉhÉÉÊ¦ÉÊxÉ´Éä¶ÉäxÉ:Approaching prosperity can be known from the
initiation of useful work.
+¨É±ÉÆ ºÉi´É¨ÉÊ´ÉEòÉ®äúhÉ: Promotion of qualities of the mind can be assessed from
the absence of its impairments - attachment, envy etc.
So Anumana Pramana is of great importants in Roga - Rogi Pareeksha. There is
one more three-fold examination (ÊjÉÊ´ÉvÉ {É®úÒIÉÉ) as mentioned by ´ÉÉM¦É]õ.
nù¶ÉÇxÉº{É¹ÉÇxÉ|É¶xÉè& {É®úÒIÉäiÉ SÉ ®úÉäÊMÉhÉ¨ÉÂ * (+. ¾þ. ºÉÚ.-1)
The examination of the patient is done by inspection, palpation and
interrogation. Most of the diagnosing criteria we follow now a days is +xÉÖ¨ÉÉxÉ itself.
Eg: By seeing jaundice, inference of liver disease is nothing but anumana. So
Anumana needs proper history, proper physical examination and ªÉÖÊHò to come to a
conclusion.
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3. |ÉiªÉIÉ
Acharya Charak defines |ÉiªÉIÉ as
|ÉiªÉIÉÆ iÉÖ JÉ±ÉÖ iÉPÉiÉÂ º´ÉªÉÆ <ÎxpùªÉè& ¨ÉxÉºÉÉ SÉ ={É±É¦ªÉxiÉä * (SÉ. Ê´É. 4/4.)
|ÉiªÉIÉ is getting knowledge through sense organs. |ÉiªÉIÉ YÉÉxÉ occurs when
there is contact between <ÎxpùªÉ and their particular +lÉÇ directly. The manas become
the mediator between <ÎxpùªÉ & +Éi¨ÉÉ.
Regarding the benefit of |ÉiªÉIÉ {É®úÒIÉÉ, in ®úÉäMÉÒ {É®úÒIÉÉ Charaka says that,
|ÉiªÉIÉºiÉÖ ®úÉäMÉiÉi´ÉÆ ¤ÉÖ¦ÉÖiºÉÖ& ºÉ´ÉêÊ®úÎxpªÉè& ºÉ´ÉÉÇxÉ <ÎxpùªÉÉlÉÉÇxÉÂ +ÉiÉÖ®ú¶É®úÒ®úMÉiÉÉxÉÂ
{É®úÒIÉäiÉÂ +xªÉjÉ ®úºÉYÉÉxÉÉiÉÂ * (SÉ.Ê´É 1/10)
By the help of |ÉiªÉIÉ, the things related to the disease can be found out. All the
<ÎxpùªÉ are to be used to perceive their respective in the body of patient except
®úºÉxÉäÎxpùªÉ.
a) ¸ÉÉäjÉäÎxpùªÉiÉ& {É®úÒIÉÉ
By using ¸ÉÉäjÉäÎxpùªÉ, many sounds both Normal and Abrnormal produced in
patients body can be heard.
SÉ®úEò comments about uniqueness of ¸ÉäjÉäÎxpùªÉ {É®úÒIÉÉ as follows:
+ÉxjÉEÚòVÉxÉÆ ºÉÉxvÉÒº¡Öò]õxÉÆ +RóMÉÖ±ÉÒ{É´ÉÇhÉÉ\SÉ º´É®úÊ´É¶Éä¹ÉÉÆ\SÉ,
ªÉänù +xªÉäÊ{É EòÊSÉiÉ ¶É®úÒ®úÉä{ÉMÉiÉÉ& ¶É¤nùÉ& ºªÉÖ& iÉÉxÉÂ ¸ÉäjÉähÉ {É®úÒIÉäiÉ *
+ÉxjÉEÚòVÉxÉÆ (sounds of intestine) crackling noise of joints and fingers. º´É®úÊ´É¶Éä¹É
(variance of its modulation and other sounds that are produced in the body are
heard by ¸É´ÉhÉäÎxpùªÉ. Susrutha says that during the manifestation of µÉhÉ, many sounds
may be heard.
iÉjÉ ¸ÉäjÉäÎxpùªÉ Ê´ÉYÉäªÉÉ& Ê´É¶Éä¹ÉÉ ®úÉäMÉä¹ÉÖ |ÉhÉºjÉÉ´ÉÊ´ÉYÉÉxÉÒªÉÉÊnù ´ÉIªÉxiÉä -
iÉjÉ º¡äòxÉÆ ®ú¨xÉ¨ÉÒ®úªÉÉ¦ÉÊxÉ±É& ºÉ¶É¤nÉä ÊxÉMÉÇSvÉÎxiÉ <iªÉä´É¨ÉnùªÉ * (ºÉÖ. ºÉÚ 8)
The ¸ÉäjÉäÎxpùªÉ {É®úÒIÉÉ of 2 types - a) Hearing sounds directly - may be by physician
or by patient him self and b) Hearing the sounds using instruments. Sounds like
cough and its modulations sounds of respiratory distress (wheezing) etc. are heard
directly without using any instruments. By using instruments like Stethescope we
can hear - heart sounds and their modulations, respiratory sounds and their
modulations, intestinal gargling sounds etc. So we can include Auscillation under
¸É´ÉhÉäÎxpùªÉiÉ& {É®úÒIÉÉ itself. Percussion can also be included here as the physician is
listening to percussion notes.
b) º{É¶ÉÇxÉäÎxpùªÉiÉ {É®úÒIÉÉ
This is necessary when the facts cannot be perceived through SÉIÉÖÊ®úÎxpùªÉ (ie
nù¶ÉÇxÉ). º{É¶ÉÇxÉ is the best and widely practiced method to know the clinical manifestation
in the body.
10
Since the º{É¶ÉÇxÉ {É®úÒIÉÉ is done by hands, the physician’s hands must be warm (if
cold or hot it will be uncomfortable for the patient). Before examining the patient must
be explained about the procedure. The patient should be given confidence. After
this, the part of body to be examined should be exposed to good light. The palpation
should start from normal parts first and then abnormal parts gently so as not to give
any unnecessary pain to the patient. Charaka says about the usefulness of º{É¶ÉÇxÉ{É®úÒIÉ
as,
º{É¶ÉÈ SÉ {ÉÉÊhÉxÉÉ |ÉEÞòiÉÒÊ´ÉEÞòÊiÉªÉÖHò¨ÉÂ - (SÉ. Ê´É. 4/7)
º{É¶ÉÇxÉ is done by palms to feel the normal and abnormal touch of body parts.
Susrutha says
º{É¶ÉÇxÉäÎxpùªÉÊ´ÉYÉäªÉÉ& ¶ÉÒiÉÉä¹hÉ¶±ÉIÉhÉ EòEÇò¶É¨ÉÞnÖùEòÊ`öxÉi´ÉÉnùªÉ& º{É¶ÉÇÊ´É¶Éä¹ÉÉ V´É®ú¶ÉÉäEòÉÊnù{ÉÖ *
(ºÉÖ.ºÉÚ. 10)
Excessive heat or cold, Normal or Abnormal roughness or smoothness of the
body etc. can be assessed by º{É¶ÉÇxÉ{É®úÒIÉÉ. Here +ÉÊnù can be understood as
Îº´ÉxxÉiÉÉ - +Îº´ÉxxÉiÉÉ (Excessive or no Sweating)
MÉÖ¯ûiÉÉ - ±ÉPÉÖiÉÉ (Heavyness or Lightness)
ºÉÖ{iÉxÉÉ - +ºÉÖ{iÉxÉÉ (Sensitiveness or non sensitiveness)
¦ÉÉ´ÉiÉÉ - +¦ÉÉ´ÉiÉÉ (Abnormal presnece or absnece of organs in particular
part)
=xxÉiÉÉ - +´ÉxÉiÉÉ (Elevation / Swelling or depression)
ºÉ¶ÉÖ±ÉiÉÉ - ÊxÉ¶ÉÖ±ÉiÉÉ (Tenderness/nor tenderness)
º{ÉxnùxÉÆ - +º{ÉxnùxÉÆ (Pulsatileness or not/abnormalities)
Palpation is usually performed to examine abdomen as well as chest. We
can elicit organ involved in pathogenesis, or enlargements of organ if any. In a
sense percussion is also a type of palpation, by which we can assess abnormal
accumulation of fluid or gases in the abdominal cavity or thoracic cage. Per rectal
examination and per vaginal examinations are also a form of º{É¶ÉÇxÉ {É®úÒIÉÉ.
c) SÉIÉÖÊ®úÎxpùªÉ {É®úÒIÉÉ
Inspection is the most important form of examination for diagnosing a disease.
It starts, from the time when a patient enters into a physicians room. Inspection is
done in a comfortable environment to the patient with sufficient good natural light.
It is better to remove all clothes of the patient, so as to facilitates a good look of
the entire body, care being taken no to cross the line of morality, and effigy in
female.
According to Charaka, colours, site, measurements of the body abnormalities
of the body parts like UôÉªÉÉ, |ÉEÞòÊiÉ, Ê´ÉEòÉ®ú etc. are to be examined by SÉIÉÖÊ®úÎxpùªÉ.
11
´ÉhÉÇº ÉÆº lÉÉxÉ|É¨ÉÉhÉUôÉªÉÉ|ÉEÞò ÊiÉÊ´ÉEòÉ®ú É è {ÉIÉÖ´ Éê¶ÉäÊ ¹ÉEòÉÊxÉ SÉÉxªÉÉxªÉÖHòÉÊxÉ SÉIÉÖ¹ÉÉ {É®ú Ò IÉäi ÉÂ *
(SÉ. Ê´É. 4/7)
According to Acharya Sushrutha the nutritional status of the body like +ÉªÉÖ ±ÉIÉhÉ
¤É±É, ´ÉhÉÇ, Ê´ÉEòÉ®ú etc. are to be examined and estimated by nù¶ÉÇxÉ{É®úÒIÉ.
SÉIÉÖÊ®úÎxpùªÉÊ´ÉYÉäªÉÉ& ®úÉ®úÒ®úÉä{ÉSÉªÉÉ{ÉSÉªÉ +ÉªÉÖ±ÉÇIÉhÉ¤É±É ´ÉhÉÇÊ´ÉEòÉ®úÉnùªÉ& (ºÉÖ. ºÉÚ. 10)
d) QÉÉhÉäÎxpùªÉiÉ {É®úÒIÉÉ
By QÉÉhÉäÎxpùªÉ we can examine for normal and abnormal smells of body and its
waste product.
MÉxvÉÉºiÉÖ JÉ±ÉÖ ºÉ´ÉÇ¶É®úÒ®úMÉiÉÉxÉÉxÉÖ®úºÉ |ÉEÞòÊiÉ ´ÉèEòÉÊ®úEòÉxÉÂ, QÉÉhÉäxÉ {É®úÒIÉäiÉÂ (SÉ.Ê´É. 4/7)
QÉÉhÉäÎxpùªÉÊ´ÉYÉäªÉÉ +Ê®ú¹]õÊ±ÉRóMÉÉÊnù¹ÉÖ µÉhÉÉxÉÉ¨ÉµÉhÉÉxÉÉ¨É SÉ ¶É¤vÉ Ê´É¶Éä¹ÉÉ& (ºÉÖ. ºÉÚ.10/8)
Some prognostic signs regarding MÉxvÉ can also be identified. Some classical
examples for this are, in Paithika prakriti there will be foul smell for the body. ºÉÉ¨É
¨É±É will have bad smell, urine will have in Ê´É¸ÉMÉxvÉ in +É¨É´ÉÉiÉ & +¶¨ÉÊ®ú.
e) ®úºÉxÉäÎxpùªÉiÉ& {É®úÒIÉÉ
Since it is an unhygenic and unsuitable method, it is not adopted as a routine
part of patient examination. But the ‘rasa’ of body parts of patients is either inferred
or asked to patient. Eg: In ¶É®úÒ®ú¨ÉÉvÉÖªÉÇÆ - flies are attracted towards patient, in ¨ÉÚjÉ¨ÉÉvÉÖªÉÇÆ
- ants are attracted. In ¶É®úÒ®úÊ´É®úºÉiÉÉ, lies may be found in patient’s body.
®úºÉxÉäÎxpùªÉÊ´ÉYÉäªÉÉ& |É¨Éä½þÉÊnù¹ÉÖ ®úºÉÊ´É¶Éä¹ÉÉ (ºÉÖ. ºÉÚ. 101)
®úºÉÆ iÉÖ JÉ±ÉÖ +ÉiÉÖ®úMÉxÉ¨ÉÂ <ÎxpùªÉ´Éè¹ÉÊªÉEò¨ÉÊ{É +xÉÖ¨ÉÉxÉÉnäù´É +´ÉMÉSUôiÉÂ,
xÉ ½þªÉºªÉ |ÉiªÉIÉäh É OÉ½þh É¨ÉÖ{É{ÉvÉiÉä, iÉº¨ÉÉiÉÂ +ÉiÉÖ®ú{ÉÊ®ú| É¶xÉxÉè´É +ÉiÉÖ®ú¨ÉÖJ É®úº ÉÆ Ê´ÉvÉÉiÉÂ *
(SÉ. Ê´É. 4)
12
CHATURVIDHA PAREEKSHA
ÊuùÊ´ÉvÉ¨Éä´É JÉ±ÉÖ ºÉ´ÉÈ ºÉSSÉÉºÉSSÉSÉ iÉºªÉ SÉiÉÖÌ´ÉvÉÉ {É®úÒIÉÉ - +É{iÉÉä{Énäù¶É&,

|ÉiªÉIÉ¨É, +xÉÖ¨ÉÉxÉÆ, ªÉÖÊHò¸ÉäÊiÉ ** (SÉ. ºÉÚ.-1/17)
Acharya Charak explains four-folds of examination to examine two-folds of
subjects-existing and non-existing things-namely, authoritative testimony (+É{iÉÉä{Énäù¶É),
direct observation (|ÉiªÉIÉ), inference (+xÉÖ¨ÉÉxÉ) and reasoning (ªÉÖÊHò).
Out of them, +É{iÉÉä{Énäù¶É, |ÉiªÉIÉ and +xÉÖ¨ÉÉxÉ are explained earlier. Here, in this
context, ªÉÖÊHò |É¨ÉÉhÉ/{É®úÒIÉÉ will be discussed in detail.
ªÉÖÊHò {É®úÒIÉÉ
Definition:
¤ÉÖÊrù& {É¶ªÉÊiÉ ªÉÉ ¦ÉÉ´ÉÉxÉÂ ¤É½ÖþEòÉ®úhÉªÉÉäMÉVÉÉxÉÂ *
ªÉÖÊHòÎºjÉEòÉ±ÉÉ ºÉÉ YÉäªÉÉ ÊjÉ´ÉMÉÇ& ºÉÉvªÉiÉä ªÉªÉÉ ** (SÉ.ºÉÚ.-22/25)
The intellect perceives the unknown factors which are produced by multiple
causes. This occurs due to the comparison of unknown factors with the known
cause - effect relationship. With this, one can have the knowledge of past, present
and future days and is helpful in achieving the vÉ¨ÉÇ, +lÉÇ and EòÉ¨É.
For this, SÉ®úEò gives two examples in the same chapter.
VÉ±ÉEò¹ÉÇhÉ¤ÉÒVÉºÉÆªÉÉäMÉÉiÉÂ ºÉºªÉºÉÆ¦É´É& *
ªÉÖÊHò& ¹ÉbÂ÷vÉÉiÉÖºÉÆªÉÉäMÉÉiÉÂ MÉ¦ÉÇhÉÉÆ ºÉÆ¦É´ÉºiÉlÉÉ **
¨ÉlªÉ¨ÉxªÉÉxÉºÉÆªÉÉäMÉÉnùÎMxÉºÉÆ¦É´É& *
ªÉÖÊHòªÉÖHòÉ SÉiÉÖ¹{ÉÉnùºÉÆ{ÉnÂù ´ªÉÉÊvÉÊxÉ¤É½ÇþhÉÒ ** (SÉ.ºÉÚ.-22/23-24)
The wheat rice etc. will be produced, if there is a proper combination of water,
phloughing, seeds and season. Similarly, the combination of {É\SÉ¨É½þÉ¦ÉÚiÉs and +Éi¨ÉÉ
will lead to the formation of MÉ¦ÉÇ.
The fire is produced, if there is proper combination of two woods or fuel and
the person who will perform the friction between the two. Similarly, the proper
combination of the physician, drugs, attender and patient will result in cure of the
disease.
Importance of ªÉÖÊHò&
¨ÉÉjÉÉEòÉ±ÉÉ¸ÉªÉÉ ªÉÖÊHò& ÊºÉÊrùªÉÖÇHòÉè |ÉÊiÉÎ¹`öiÉÉ *
ÊiÉ¹`öiªÉÖ{ÉÊ®ú ªÉÖÊHòiÉYÉÉä pù´ªÉYÉÉxÉ´ÉiÉÆ ºÉnùÉ ** (SÉ.ºÉÚ.-2/6)
Use of any medicine depends upon the quantity & time and the success is
definite, if one follows this. The physician who possesses this ªÉÖÊHò is considered
as best among the physicians who knows regarding the plants only.
13
SHADVIDHA PAREEKSHA
The six fold examinations are described by Acharya Sushrutha. These includes
interrogation and the examination with five sense organs.
¹ÉÊb÷Â´ÉvÉÉä Ê½þ ®úÉäMÉÉhÉÉÆ Ê´ÉYÉÉxÉÉä{ÉÉªÉ&, iÉPÉlÉÉ - {É\SÉÊ¦É& ¸ÉäkÉÉÊnùÊ¦É& |É¶xÉäxÉ SÉÉäÊiÉ *
(ºÉÖ.ºÉÚ - 20/4)
Out of these, five - folds examinations have explained earlier. Therefore only
|É¶xÉ {É®úÒIÉÉ will be discussed here in detail.
|É¶xÉäxÉ {É®úÒIÉÉ
|É¶xÉäxÉ SÉ Ê´ÉVÉÉxÉÒªÉÉiÉÂ näù¶ÉÆ EòÉ±ÉÆ VÉÉËiÉ ºÉÉi¨ªÉ¨ÉÉiÉRóEò ºÉ¨ÉÖi{ÉËkÉ ´ÉänùxÉÉºÉ¨ÉÖSUôÉªÉÆ,
¤É±É¨ÉxiÉ®úÎMxÉ ´ÉÉiÉ¨ÉÚjÉ{ÉÖ®úÒ¹ÉÉhÉÉÆ |É´ÉÞÊkÉ¨É|É´ÉÞËkÉ EòÉ±É|ÉEò¹ÉÇnùÓ¸É Ê´É¶Éä¹ÉÉxÉÂ *
+Éi¨ÉºÉoù¶Éä¹ÉÖ Ê´ÉYÉÉxÉ¦ªÉÖ{ÉÉªÉä¹ÉÖ iÉilÉÉxÉÒªÉèVÉÉÇxÉÒªÉÉiÉÂ * (b÷±½þhÉSÉ ºÉÖ.ºÉÚ.-20/4)
The points to be assessed during interrogation are - place of the patient, time
or season of the first appearance of the disease, the caste which the patient
belongs to; things or measures which tend to bring about a manifest amelioration
of disease or prove comfortable to the patient; cause of the disease, aggravation
of pain, strength of the patient, digestive power, proper or improper elimination of
flatus, faeces, urine; maturity of the disease as regards to time. These are the
factors which should be elicited by interrogation of the patient.
näù¶É: As per b÷±½þhÉ, the näù¶É is of three types, namely, VÉÉÆMÉ±É, +ÉxÉÚ{É and ºÉÉvÉÉ®úhÉ.
That implies the site where the patient born, grown up and got disease, by which
the nidana can be assessed. The descriptions of these three types of näù¶É are
available in the classics. According to another opinion, näù¶É is of two types - ¦ÉÚÊ¨Énäù¶É
and +ÉiÉÖ®únùä ¶É. In case of +ÉiÉÖ®ú näù¶É, one has to consider the following factors like site
of nùÉä¹É SÉªÉ, |ÉEòÉä{É etc.
After considering the birth place, site where the patent has grown and the
place where got the disease, one has to enquire with the patient or relative about
dietary habits, culture, regimens of that area; strength, mental strength,
homologation and habits of the people of that area. The aggravating the
unwholesome and relieving factors for those diseases in that area. The proper
understanding of above said factors is possible by näù¶É{É®úÒIÉÉ. Accordingly, the
assessment of nùÉä¹É and disease and proper plan of management can be done
satisfactorily.
EòÉ±É : According to b÷±½þhÉ, EòÉ±É is of two types; ÊxÉiªÉMÉ and +É´ÉÎºlÉEò. More details
are included along with nù¶ÉÊ´ÉvÉ{É®úÒIÉ.
VÉÉÊiÉ : In olden days, occupation was closely related with the caste of the
person. Nowadays, there is no relation with the caste and the occupation of the
14
patient. In +ÉªÉÖ´Éænù, the following persons are said to be diseased very frequently like
Brahmins/Priests, servants to king, prostitutes, merchants, etc. because they cannot
follow the proper diet and regimen in appropriate time. Nowadays, certain diseases
are very specific to certain occupations. Eg: the persons working in an asbestos
factory is likely to suffer from asbestosis. The knowledge of this is thus helpful in
diagnosis and proper management.
ºÉÉi¨ªÉ : This will be explaining in detail with nù¶ÉÊ´ÉvÉ{É®úÒIÉ.
+ÉiÉRóEò ºÉ¨ÉÖi{ÉÊkÉ And EòÉ±É|ÉEò¹ÉÇ : +ÉiÉRóEò ºÉ¨ÉÖi{ÉÊkÉ means the onset of the disease
and EòÉ±É|ÉEò¹ÉÇ means the duration of the illness which should be asked to the patient
or the person accompanying him. The knowledge of this is helpful in assessing
the strength of the disease and planning the treatment. Eg: If the person gets
disease by continuous intake of dry food substances, the most appropriate
treatment would be the administration of ÎºxÉMvÉs. The knowledge of EòÉ±É|ÉEò¹ÉÇ will
help in identifying º´ÉiÉxjÉ and {É®úiÉxjÉ lakshanas i.e. differentiating the symptoms and
complications of a disease.
´ÉänùxÉÉ ºÉ¨ÉÖSUôÉªÉ : It means the descriptions of the symptoms eg: type of pain,
nature of pain etc. It helps in the type of dosa prakopa based on the site and
character of the symptom.
nùÉä¹É ´ÉänùxÉÉÊ´É¶Éä¹É
´ÉÉiÉÆ iÉÉänÆù, ¦ÉänùÆ, SUäônùÆ, ¶ÉÚ±ÉÆ
Ê{ÉkÉÆ +Éä¹É, SÉÉä¹É, nùÉ½þ, +¨±ÉEò
Eò¡Æò MÉÉè®ú´É, ºiÉèÊ¨ÉiªÉ, EòhbÚ÷
+ÎMxÉ : As it is stated that the VÉÉ`ö®úÉÎMxÉ is considered as the origin for all other
+ÎMxÉs. If it is proper, then it nourishes other vÉÉi´ÉÎMxÉs and ¦ÉÚiÉÉÎMxÉs which are responsible
for stable physical strength. While interrogating the patient, one has to enquire
about the digestive power, recent change in the digestive power capacity; the type
of food substance which causes indigestion; the type of food stuffs which cause
alteration in ºÉ¨ÉÉÎMxÉ.
´ÉÉiÉ¨ÉÚjÉ{ÉÖ®úÒ¹ÉÉhÉÉÆ |É´ÉÞÊkÉ B´ÉÆ +|É´ÉÞÊkÉ
: The knowledge of the proper or improper
evacuation of faeces, urine, belching, menstruation can be attained by interrogation
itself. The interrogation regarding the appearance of blood/pus in semen etc can
be included in this. Though, the laboratory examination of urine, faeces, semen
etc are necessary, but the primary idea regarding the abnormalities in urine faeces
etc. can be identified by |É¶xÉ {É®úÒIÉÉ.
15
ASHTASTANA PAREEKSHA
Among the different method of ®úÉäMÉÒ {É®úÒIÉÉ, +¹]õºlÉÉxÉ {É®úÒIÉÉ (+¹]õÊ´ÉvÉ {É®úÒIÉÉ) is
newer one. It is mentioned in ªÉÉäMÉ®úixÉÉEò®ú and ¦ÉÉ´É|ÉEòÉ¶É, but not in old ºÉÆÊ½þiÉÉ. Here the
physicians examins eighth different parts of factors related to patients body. They
are
“®úÉäMÉÉGòÉxiÉ ¶É®úÒ®úºªÉ ºlÉÉxÉÉxªÉ¹]õÉè {É®úÒIÉªÉäiÉ
xÉÉb÷Ò ¨ÉÚjÉ¨ÉÂ ¨É±ÉÆ ÊVÉuùÉ ¶É¤nù º{É¶ÉÇoùEò+ÉEÞòÊiÉ” * (ªÉÉä. ®ú.)
1. xÉÉb÷Ò The pulse
2. ¨ÉÚjÉÆ The Urine
3. ¨É±ÉÆ The faecas
4. ÊVÉ¼´ÉÉ The tongue
5. oùEÂò The eyes
6. ¶É¤nù Sound produced by body of patient
7. º{É¶ÉÇ Examination of body by palpation
8. +ÉEÞòÊiÉ Dimension, measurements colour etc. of the body.
The examination of all the eighth factors are related to |ÉiªÉIÉ |É¨ÉÉhÉ and all are
objective in nature. The xÉÉb÷Ò {É®úÒIÉÉ, º{É¶ÉÇ {É®úÒIÉÉ come under º{É¶ÉÇxÉäÎxpùªÉiÉ& {É®úÒIÉÉ. ¶É¤nù
{É®úÒIÉÉ comes under ¸ÉÉäjÉäÎxpùªÉiÉ& {É®úÒIÉÉ, and the other five are included mainly in SÉIÉÖÊ®úÎxpùªÉiÉ&
{É®úÒIÉÉ.
ªÉÉäMÉ®úixÉÉEò®ú says each and every disease is due to the vitiated ´ÉÉiÉÉÊnù ¨É±É, which
is due to +Ê½þiÉ +É½þÉ®ú - Ê´É½þÉ®ú. But sometimes one disease entity itself may become
a cause for another (ie ÊxÉnùÉxÉÉlÉÇEò®ú ´ªÉÉvÉÒ). Examining the +¹]õºlÉÉxÉ of a patient, one
can identify the cause and nature of disease.
“±ÉIÉÉÊªÉi´ÉÉ näù¶ÉEòÉ±ÉÉè YÉÉi´ÉÉ ®úÉäMÉ¤É±ÉÉ¤É±É¨ÉÂ * ÊSÉÊEòiºÉÉÆ
+É®ú¨¦ÉäiÉÂ ´ÉèPÉÉä ªÉ¶É& EòÒÍiÉ +´ÉÉ{iÉxÉÖªÉÉiÉÂ” - (ªÉÉä.®ú.)ú
The physician who have the knowledge of desa, kala and who treats the
patient by keeping in mind the ¤É±É & +¤É±É of ®úÉäMÉÒ & ®úÉäMÉ will get success and fame.
the +¹]õºlÉÉxÉ {É®úÒIÉÉ is necessary to know the ¤É±É & +¤É±É of ®úÉäMÉ & ®úÉäMÉÒ.
1. xÉÉb÷Ò{É®úÒIÉÉ
Examinations of xÉÉb÷Ò is the first and fore most among +¹]õºlÉÉxÉ {É®úÒIÉÉ. It comes
under º{É¶ÉÇxÉ {É®úÒIÉÉ. The term nadi means a tubular structure, but here we have to
conisder ‘vÉ¨ÉxÉÒ’. The diagnosis of disease with the help of nadi pariksha is possible
only by experience and constant practice. It is just similar similar to assessment
of value of precious gems. The nadi shows every changes that occur in the body.
Just similar to the strings of ´ÉÒhÉÉ which produce music.
16
ªÉlÉÉ ´ÉÒhÉÉMÉiÉÉ iÉxjÉÒ ºÉ´ÉÉÇx É ®úÉ MÉÉxÉÂ |É¦ÉÉ¹ÉiÉä
iÉlÉÉ ½þº iÉMÉiÉÉ xÉÉb÷ Ò ºÉ´ÉÉÇxÉÂ ®úÉ äMÉÉxÉÂ |ÉEòÉ¶ÉªÉäi ÉÂ - ªÉÉä. ®ú.
The nadi can tell us the dosa |ÉvÉÉxªÉ in body; dosa involved in pathogenesis,
ºÉÉvªÉÉºÉÉvªÉiÉÉ of disease, planetary influences on the persons, the span of life, and
even forth coming death. There are many xÉÉb÷Ò in our body. viz. ½þºiÉ xÉÉb÷Ò, {ÉÉnù, Eòh`ö,
xÉÉºÉÉ, EòhÉÇ, +ÊIÉ, ÊVÉ¼´ÉÉ, ¨ÉänÂù xÉÉb÷Ò. But the ½þºiÉ xÉÉb÷Ò is commonly used for examination
and it is called VÉÒ´ÉºÉÉÊIÉhÉÒ also.
+RóMÉÖ¹`ö¨ÉÖ±É¦ÉÉMÉä ªÉÉ vÉ¨ÉxÉÒ VÉÒ´ÉºÉÉÊIÉhÉÒ
xÉiÉÂ SÉä¹]õªÉÉ ºÉÖJÉÆ nÖù&JÉÆ YÉäªÉÆ EòÉªÉºªÉ {ÉÎhb÷iÉè& * ªÉÉä. ®ú.
Synonyms of Nadi
xÉÉb÷Ò, vÉ¨ÉxÉÒ, iÉxiÉÖEòÒ, ´ÉºÉÉ, ºxÉÉªÉ,Ö vÉ®úhÉÒ, VÉÒ´ÉxÉYÉÉxÉ, VÉÒÊ´ÉiÉYÉ, ½ÆþºÉÒ, vÉ®úÉ, Ë½þ»ÉÉ, ÊºÉ®úÉ
Location of Nadi
Pulsation over the radial artery is palpated above the wrist.
xÉÉb÷Ò +RóMÉÖ¹`ö¨ÉÖ±ÉÉvÉ& º{ÉÞ¶ÉäiÉÂ nùÉIÉÒhÉMÉä Eò®äú *
YÉÉxÉÉlÉÇ ºÉäÊMÉhÉÉä ´ÉèvÉÉä ÊxÉVÉnùÉÊIÉhÉ{ÉÉÊhÉxÉÉ ** (ªÉÉä. ®ú.)
xÉÉb÷Ò{É®úÒIÉÉ Ê´ÉÊvÉ
The best time for xÉÉb÷Ò {É®úÒIÉÉ is in the morning. Both ´ÉÉèvÉ & ®úÉäMÉÒ should be having
cool and calm mind. They must sit in a comfortable place and in ºÉÖJÉÉºÉxÉ facing one
another. The xÉÉb÷Ò of right hand will be clear (º{ÉÖ]õ) in males while in females xÉÉb÷Ò of
left hand. The patient must sit calmly, his wrist must be partially flexed and partially
abducted, the fingers must extended fully and abducted and elbow must be
extended. The elbow must be supported, to relieve the strain on the shoulders.
In such position, the physician should examine Nadi of the patient. Usually
xÉÉb÷Ò {É®úÒIÉÉ is done by right hand but some physicians use their left hand.
Physician should hold the wrist of the patient by the examining hand and
must support the elbow of the examining hand of the patient with the other hand.
Physician should place his index, middle and ring fingers one Angula below the
+RóMÉÖ¹`ö¨ÉÖ±É and then be must examine the nadi. The index (iÉVÉÇxÉÒ) finger must be
nearer to +RóMÉÖ¹`ö¨ÉÖ±É.
+OÉä´ÉÉiÉ´É½þÉ xÉÉb÷Ò ¨ÉvªÉä ´É½þÊiÉ Ê{ÉiiÉ±ÉÉ *
+xiÉä ¶±Éä¹É¨ÉÉÊ´ÉEòÉ®äúhÉ xÉÉb÷Ò YÉäªÉÉ ¤ÉÖvÉ& ºÉnùÉ& * ªÉÉä. ®ú.
The Vata vaha nadi can be felt in the +OÉ¦ÉÉMÉ (just proximal to +RóMÉÖ¹`ö¨ÉÖ±É ie by
the index finger) Pitanadi is felt by the middle finger and Eò¡òxÉÉb÷Ò will be felt by ring
finger.
The Nadi must be examined by repeated application of pressure by fingers
and release of pressure. By this we can know ¤É±É/strength of nadi - whether ºÉ¤É±É
17
or +¤É±É. By applying and releasing pressure for three consecutive times one can
identify the nature of Nadi.
´ÉÉ®újÉªÉÆ {É®úÒIÉäiÉ PÉÞi´ÉÉ PÉÞi´ÉÉ Ê´É¨ÉÉäSÉ®äúiÉÂ *
Ê´É¨ÉÞ¦ªÉ ¤É½ÖþvÉÉ ¤ÉÖrùªÉÉ ®úÉäMÉ {ªÉÉËHò Ê´ÉÊxÉÌnù¶ÉäiÉ * (ªÉÉä. ®ú)
It is not advice to examine Nadi immediately after bath, after food in take
,after consuming alcoholic brings, oil massage or exercise. It is better to avoid
examining the Nadi of a patient while the patient is hungry or immediately after
waking up from sleep.
After nadi {É®úÒIÉÉ the physician must wash his hands. By this the disease present
in patient is washed off just similar to the mud on the hand which is washed off by
washing with water. It is a part of keeping personal hygene.
ªÉÉä ®úÉäÊMÉhÉ Eò®Æú º{ÉÞ¹]Âõ´ÉÉ º´ÉEò®Æú IÉÉ±ÉªÉävÉÉÊ{É
®úÉäMÉÉºiÉºªÉ Ê´ÉxÉÉ¶ªÉÎxiÉ {ÉRóEò |ÉIÉÉ±ÉxÉÉPÉiÉÉ * ªÉÉä. ®ú.
º´ÉºlÉ xÉÉb÷Ò (Normal Pulse)
½ÆþºÉMÉÉ SÉè´É ªÉÉ xÉÉb÷Ò iÉlÉè´É MÉVÉMÉÉÊ¨ÉÊxÉ *
¨ÉÖJÉÆ |É¶ÉºiÉÆ SÉ ¦É´ÉäiÉÂ iÉºªÉÉ ®úÉäMªÉ¨ÉÂ ¦É´ÉäiÉÂ ºÉnùÉ * (ªÉÉä. ®ú.)
The healthy nadi is one which is moving similar to ½ÆþºÉ or MÉVÉ. A person who is
having such a nadi and will always be happy and healthy.
On palpation nadi may be felt either as ¨ÉÞnùÖ or EòÊ`öxÉ. The ¨ÉÞnÖù nadi stops pulsating
when slight pressure is applied and it is due to kapha |ÉvÉÉxªÉ seen in ¤ÉÉ±ªÉÉ´ÉºlÉÉ. Contrary
to this EòÊ`öxÉ nadi would not stop pulsating by slight or moderate application of
pressure and it is a future of vata |ÉÉvÉÉxªÉ and is usually seen in ´ÉÞrùÉ´ÉºlÉÉ.
nùÉä¹É¦ÉÉ´É on xÉÉb÷Ò
nùÉä¹ÉÉÊvÉCªÉ Nature Similarity
´ÉÉiÉÉvÉÒCªÉ Ê´É¹É¨É (Irregular) ºÉ{ÉÇ VÉ±ÉÉèEòÉ
Ê{ÉkÉÉÊvÉCªÉ iÉÒIhÉMÉÊiÉ (fast & bounding) EòÉEò, ±ÉÉ´ÉEò, ¨ÉhbÚ÷Eò
Eò¡òÉvÉÒCªÉ ¨ÉxnùMÉÊiÉ (slow) ½ÆþºÉ, {ÉÉ®úÉ´ÉiÉ, ¨ÉªÉÚ®ú
uùxuù nùÉä¹ÉÉvÉÒCªÉ Combined features
ÊjÉnùÉä¹ÉºÉ¨ÉiÉÉ +ÊiÉ´ÉäMÉiÉ& EòÉ¹`öEÖò]Âõ]õÉä
EòÉ¹`öEÖò]Âõ]õÉä ªÉlÉÉ EòúÉ¹`Æö EÖò]Âõ]õiÉä SÉÉÊiÉ´ÉäMÉiÉ& *

ÎºlÉi´ÉÉ ÎºlÉi´ÉÉ iÉlÉÉ xÉÉb÷Ò ºÉÊzÉ{ÉÉiÉä ¦É´ÉäiÉÂ wÉÖ´É¨ÉÂ ** (ªÉÉä. ®ú.)
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®ú É äM Éä¹ ÉÖ xÉÉb÷ Ò MÉÊiÉ
+´ÉºlÉÉ xÉÉb÷Ò
º´ÉºlÉ ÎºlÉ®ú & ¤É±É´ÉiÉÂ
nùÒ{iÉÉÎMxÉ iÉÒIhÉ´ÉäMÉ´ÉiÉÒ
¨ÉxnùÉÎMxÉ ¨ÉxnÆù
vÉÉiÉÖIÉªÉÉ ¨ÉxnÆù
¦ÉªÉ, ÊSÉxiÉÉ, ¶ÉÉäEò IÉÒhÉ
V´É®ú =¹hÉ & ´ÉäMÉ´ÉiÉÒ
{ÉÉhbÖ÷ & EòÉ¨É±ÉÉ SÉ\SÉ±É & iÉÒIhÉ
xÉÉb÷ÒºÉÆJªÉÉ (Rate of nadi)
In Ayurveda, rate of nadi was counted per ¡ò±ÉÂ (2.5 ¡ò±ÉÂ makes one minute). The
rate of pulse is different at different ages and is as follows.
Age Pulse rate per ¡ò±É Pulse rate in minute
New born 56 140
Infant 50 125
Child 40 100
Young 36 90
Middle aged 29 72
Old 28 70
Very old 31 77
Pulse Examination in Modern Science
Modern medical science do examine pulse as a routine part of examination.
Generally radial pulse is examined at wrist, but others like brachial, carotid, femoral,
popliteal, posterior tribial, dorsalis pedis pulses are also examined for comparison
whenever it is necessary.
Things to be examined
Rate, Rhythm, Volume, Condition of blood vessel, Tension Character and a
comparitive study of other beats with radial pulse should be carried out. Any change
in the above parameters are indicative of systemic disorders.
1. Rate: It is number of pulse beats per minute. It normally corresponds to heart
rate. Pulse must be counted for 1 minute. Normal pulse rate at rest various
from 60 - 100 per minute. Tachycardia is, heart rate above 100 per minute
and bradycardia is heart rate below 60. It differs according to age, in newborns,
it will be high (120/mi) and gradually reduce as the age advances. During
fever 10C rise in temp. will lead to rise in 10 beats per minute of pulse.
2. Rhythm: It is the time gap between the successive pulse. It can be regular
or irregular. Irregularity may be of two types.
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(a) Regularly irregular - Absence or Missing of a pulse at regular
intervals. Eg: Heart block. Irregularity does not change with exertion.
(b) Irregularly irregular - The pulse rate will be totally irregular. Eg:
Atrial fibrilation.
3. Volume: The pulse is called ‘full pulse’ if the blood vessel is filled with blood
and properly raised on touch. The pulse is called ‘small or thredy’ when touch
is light and soft due to incomplete filling of blood vessel. In high cardia output
stage the amplitude will be increased.
4. Condition of blood vessel: It is done by applying ‘little pressure over the
pulse. Smooth wall of vessel indicate good health, but walls become hard to
touch as age advances (due to atherosclerosis). A soft pulse is difficult to
feel, but hard pulse feels like a rope. It can be confirmed by moving the blood
vessel over the bone.
5. Tension (Strength): The pressure needed to stop the pulse is the tension.
The volume and tension are to be examined simultaneously. Eg: Full volume
with increased tension indicates Hyper Tension; low volume with increased
tension indicates cardiac problems and low volume with low tension indicates
weak heart.
6. Character: We get special characteristics of pulse which indicate certain
diseases.
(a) Dicrotic pulse: The dicrotic wave becomes more prominent and can
be felt as a “notch” in the descending limb. This is an exaggeration of
the normal pattern and it is not suggestive of any reduction
cardiovascular disease. This is seen in fevers. eg: typhoid, due to
reduction in vascular tone.
(b) Anacrotic pulse: This is slow rising pulse of smaller amplitude, seen
in conditions like aortic stenosis. Due to delay in ejection and reduction
in the pressure in the aorta, the pulse is smaller in amplitude and is
wider.
(c) Collapsing pulse: Syn: Corrigan’s pulse - water - hammer pulse. This
is seen in conditions where the stroke volume is high and the peripheral
resistance is low, classically occurring in free aortic incompetence.
7. Comparison: A comparison between different pulses are essential when
occlusion/obstruction in arteries are suspected.
2. ¨ÉÚjÉ {É®úÒIÉÉ
Urine is an important waste product of the body and its examination yields
valuable information for the determination of health and ill health. Normally it is
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having <Ç¹Éi{ÉÒiÉ´ÉhÉÇ, +Ê{ÉÎSUô±É (non greasy) +xÉÉÊ´É±É (clear) with =¹hÉ, iÉÒIhÉ, IÉÉ®úMÉÖhÉ. Its
quantity of four Anjali.
‘Yoga Ratnakar’ expalins the method of collection of ¨ÉÚjÉ along with ¨ÉÚjÉ{É®úÒIÉÉ.
The ¨ÉÚjÉ must be collected in the last |É½þ®ú of night (when there is still four PÉÊ]õEòÉ for
sunrise). The ¨ÉÚjÉ must be collected in a clean glass vessel and has to examined
immediately after sunrise. The initially expelled ¨ÉÚjÉ must be discarded and ¨ÉÚjÉ
expelled in the later part of micturition must be collected for examination.
nùÉä¹É¦ÉÉ´É in ¨ÉÚjÉ
+´ÉºlÉÉ ¨ÉÚjÉÆ
´ÉÉiÉ|ÉEòÉä{É {ÉÉhbÖ÷®ú´ÉhÉÇ / xÉÒ±É´ÉhÉÇ & °üIÉ
Ê{ÉkÉ|ÉEòÉä{É ®úHò´ÉhÉÇ / {ÉÒiÉ/+¯ûhÉ
Eò¡ò|ÉEòÉä{É ºÉ¡äòxÉ / Ê{ÉÎSUô±É, ´ÉÉÊ®úiÉÖ±ªÉ ´ÉhÉÇ
®úHò|ÉEòÉä{É Ê{ÉÎSUô±É =¹hÉ / ®úHò´ÉhÉÇ
uùxnù|ÉEòÉä{É combined features
ºÉÊzÉ{ÉÉiÉVÉ |ÉEòÉä{É EÞò¹hÉ´ÉhÉÇ
®úÉäMÉä¹ÉÖ ¨ÉÚjÉ´ÉhÉÉÇ&
nù Éä¹É ¨ÉÚjÉ´ÉhÉÈ
+ÎMxÉ¨ÉÉxtÆ ¨ÉÉiÉÖ±ÉÖRóMÉ º´É®úºÉ
+VÉÒhÉÇ iÉhbÖ÷±ÉÉänùEò
Ê{ÉkÉ´ÉÉiÉ|ÉEòÉä{É vÉÚ©ÉVÉ±ÉÉ¦É
´ÉÉiÉEò¡òEòÉä{É ·ÉäiÉÆ & ¡äòÊxÉ±É
Eò¡òÊ{ÉkÉ|ÉEòÉä{É Eò±ÉÖ¹É & ®úHò´ÉhÉÈ
The physician should also note the ´ÉhÉÈ, ÎºxÉMvÉiÉÉ, ¶ÉÒiÉiÉÉ / =¹hÉiÉÉ of the ¨ÉÚjÉ
iÉè±É Ê¤ÉxnÖù{É®úÒIÉÉ
Examination of Urine with Oil
One drop of pure sessame (ÊiÉ±É iÉè±É) when drip over a cup of clean water it
may show different patterns of spread and dispersion. According to Yoga Ratnakara
many inferences regarding Dosha Dushya and prognosis of the disease can be
made. Possibilities of observations with their interpretations are given below.
Dosha Kopa Nature of Spread of Oil

´ÉÉiÉÊ´ÉEòÉ®ú ºÉ{ÉÇºÉoù¶É¨É
Ê{ÉkÉÊ´ÉEòÉ®ú vÉjÉºÉoù¶É¨É
Eò¡òÊ´ÉEòÉ®ú ¨ÉÖHòÉºÉoù¶É¨É
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ºÉÉvªÉÉ ºÉÉvªÉÉiÉÉ accroding to iÉè±É Ê¤ÉxnÖù{É®úÒIÉÉ
Spread of Oil Prognosis
Even spread over the surface ºÉÉvªÉ®úÉäMÉ¨É
Oil remains assets Eò¹]õºÉÉvªÉ
Oil drops sinks to the bottom +ºÉÉvªÉ
¨ÉÚj ÉIÉªÉ±ÉIÉhÉ
Acharyas has clearly mentioned ¨ÉÚjÉIÉªÉ±ÉIÉhÉ like ´ÉÎºiÉiÉÉänù, ¨ÉÚjÉÉ±{ÉiÉÉ, ¨ÉÚjÉ ´Éè´ÉhªÉÇ,
iÉÞ¹hÉÉ, ¨ÉÖJÉ®úÉä¹É etc. These will help to identify diseases pertaining to urinary system.
¨ÉÚjÉ´ÉÞÊrù±ÉIÉhÉ
As like that of ¨ÉÚjÉIÉªÉ±ÉIÉhÉ Acharya’s had also mentioned ¨ÉÚjÉ´ÉÞÊrù±ÉIÉhÉ like ¨ÉÚjÉÉÊiÉ|É´ÉÞÊkÉ,
´ÉÎºiÉiÉÉänù, ´ÉÎºiÉ+Év¨ÉÉxÉ etc.
Certain other things with much importance during ¨ÉÚjÉ{É®úÒIÉÉ are number of
micturition per day, pain/burning sensation/obstruction during micturition etc.
The MÉxvÉ of ¨ÉÚjÉ may give us the following hints.
¨ÉÚjÉMÉxvÉ ®úÉäMÉÉ´ÉºlÉÉ
ÊxÉMÉÇxvÉ =nùEò¨Éä½
IÉÉ®ú¨ÉxvÉ IÉÉ®ú¨Éä½
+¨±ÉMÉxvÉ xÉÒ±É¨Éä½
¨ÉvÉÖ®ú®úºÉÆ +Ê®ú¹]õ±ÉIÉhÉÆ
¤ÉºiÉMÉxvÉ +¶¨É®úÒ {ÉÚ´ÉÇ°ü{É
Ê´É»ÉMÉxvÉ ¨ÉänùIÉªÉ, |É¨Éä½þ{ÉÚ´ÉÇ°ü{É
{ÉÚÊiÉMÉxvÉ EòÉä`ö, +¶¨É®úÒ, ºÉÊzÉ{ÉÉiÉV´É®
EXAMINATION OF URINE
1. Examination of colour
Colour of freshy void urine varies from nearly colour less to clear yellow or
straw colour. Change in colour is due to the degraded prdoucts of urobilinogen
after exposure to air. Abnormal colours may be as follows.
l Pale dilute urine - DM, Chronic renal failure
l Reddish (due to blood) - trauma, Porphyria.
l Brownish yellow - presnece of bile pigments (Jaundice)
l Milky white - presence of glucose.
2. Examination for Deposits
Fresh urine if normal rarely has deposits. But after sometimes deposits of
phosphates and urates produce cloudiness / thick layer. Pathological
constituents such as pus or blood produce turbidity.
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3. Specific Gravity
Normal specific gravity of urine is between 1.015 - 1.025. A persistant low specific
gravity below 1.010 indicate Chronic Renal Failure, Diabetis Insidipus etc. High
specific gravity of Urine (1.030-1.060) is found in conditions like glycosuria,
acute neuritis, oliguria etc.
4. Smell
Freshly void urine has a characteristic aromatic odour due to volatile organic
acids. If allowed to stand, the urea will be decomposed to anaemia causing
ammonical smell. Foul smell or rotten smell indicate Urinary tract infection.
Fruity smell indicate diabetic ketosis.
5. Quantity
Normal 1500ml/24hrs.
Polyurea >2000ml/24 hrs. eg: DM, Neuritic polydypsia.
Oligurea <500ml/24 hrs. eg: Dehydration, renal Isehemia.
Anuria <100 ml/24 hrs.
6. Chemical Examination
To know presence of protein, glucose, kelone, bilirubin blood etc.
7. Microscopic Examination
To detect RBC, pus cells, Epithelial cells, casts, crytals, foreign bodies,
microber, parasites.
3. ¨É±É/{ÉÖ®úÒ¹É {É®úÒIÉÉ
Normally {ÉÖ®úÒ¹É will have ÊEò\SÉÒiÉ, {ÉÒiÉ´ÉhÉÇ, ¤Érù (moderately hard) ¶ÉÖC±ÉiÉÉÆ ®úÊ½þiÉ, nÖùMÉÇxvÉ
®úÊ½þiÉ (In offensive smell) and expelled easily.
Yogaratnakar explains the different features of ¨É±É in different abnormal
conditions of body.
®úÉäMÉÉ´ÉºlÉÉ {ÉÖ®úÒ¹É±ÉIÉhÉÆ
´ÉÉiÉ|ÉEòÉä{É où]õ, ¶ÉÖ¹Eò, EÞò¹hÉ´ÉhÉÇ.
Ê{ÉkÉ|ÉEòÉä{É {ÉÒiÉ´ÉhÉÇ
Eò¡ò|ÉEòÉä{É ¶ÉÖC±É, ·ÉäiÉ´ÉhÉÇ
ºÉÊzÉ{ÉÉiÉVÉ |ÉEòÉä{É EÞò¹hÉÆ, iÉÞÊ]õiÉ
+É¨ÉnùÉ¹ä É {ÉÒiÉÆ, ºÉ¶ÉÖ±É¨É±É|É´ÉÞÊkÉ
VÉ±ÉÉävÉ®Æú ·ÉäiÉÆ, nÖùMÉÇÎxvÉ
IÉªÉ®úÉäMÉ EÞò¹hÉÆ
iÉÒIhÉÉÎMxÉ ¨É±É Ê{ÉÎhb÷iÉ, ¤Érù, ¶ÉÖ¹Eò
¨ÉxnùÉÎMxÉ ¨É±É pù´É
+¶ÉÇ, MÉÖnùÊ´ÉEòÉ®ú ®úHò´ÉhÉÈ
23
{ÉÖ® ú Ò ¹ÉIÉªÉ±ÉIÉhÉ
A reduction in the bulk of feacal matter can be identified by the {ÉÖ®úÒ¹ÉIÉªÉ±ÉIÉhÉ
explained by Acharyas like ¾þkÉ¶ÉÚ±ÉÆ, {ÉÉ¶´ÉÇ¶ÉÚ±É, >ðv´ÉÇMÉÊiÉ of vayu with sounds, movement
of vayu in EÖòÊIÉ|Énäù¶É.
{ÉÖ®Ò¹É´ÉÞÊrù±ÉIÉhÉ
The main two science of accumulation of feacal matter are +É]õÉä{É & =nù®ú¶ÉÚ±É.
Differentiation between +É¨É & {ÉC´É{ÉÖ®úÒ¹É - by Yukti
A small amount of feacal matter when placed over water, either remain floated
or will sink down to the bottom of the container. If it sinks then it is +É¨É/+{ÉC´É {ÉÖ®úÒ¹É.
If it floats then it is ÊxÉ®úÉ¨É / {ÉC´É{ÉÖ®úÒ¹É.
Examination of Faeces
Examination of stools/faces will be necessary when patient presents with
Gastro industinal Tract symptoms. The faces are made up of residues of intestinal
secretions and excreations, innumerable bacteria, undigested and unabsorbed
food. It is examined for the following:
1. Quantity: Varies considerably according to the type of diet, usually it is about
100-200gm/day in one or two motions. It may be increased by undigested
food, bulky food, pancreatic diseases, malabsorption syndrome etc.
2. Orders: A certain degree of offensiveness is normal due to presence of indol
and Eatol (which are bi products of protein decomposition) when offensiveness
is excessive some derangement in Gastro Intestinal Tract is be suspected.
3. Colour: It varies according to diet Eg: milk foods - canary yellow; meat diet -
dark stools; Iron or bismuth containing food - dark coloured stoods. In bile
obstruction - stools are pale coloured. Blood staining of stools may be of two
types.
(i) Fresh blood derived from large intestine espelly from lower parts.
(ii) Altered blood - originating from either stomach or intestine will be partially
digested and give dark hairy appearance to stools, called Malena.
4. Constistance: Normally it will be sufficiently soft to get moulded in the
intestinal tube. If too soft it may have liquid or semi liquid consistancy of a
diarehoeic stool, if it is unusually hard, it forms rounded masses.
5. Abnormal Constituents
Microscopical examination can determine abnormal constituents. These mayt
be blood, serum, pus, mucus, parasites, gall stones, ova, larvae and adult
worms may be found eg: tapeworm, round worm, hook worm.
4. ÊVÉ¼´ÉÉ {É®úÒIÉÉ
The tongue is told to be the mirror of Gastro Intestinal Tract. The examination
of tongue gives us important clues about the condition / disease of Eòh`ö, +É¨ÉÉ¶ÉªÉ,
24
+ÉxjÉ. The tongue of a healthy person will be wet, clear, reddish in colour, smooth,
even with proper +ÉªÉÉ¨É - Ê´ÉºiÉÉ®ú (length breadth).
nùÉä¹ÉEòÉä{ÉÆ ÊVÉ¼´ÉÉ
´ÉÉiÉ|ÉEòÉä{É ¶ÉÒiÉ±ÉÆ, JÉ®úº{É¶ÉÇÆ, º{ÉÖÊ]õiÉÆ
Ê{ÉkÉ|ÉEòÉä{É ®úHò´ÉhÉÇ / {ÉÒiÉ´ÉhÉÇ
Eò¡ò|ÉEòÉä{É ·ÉäiÉ´ÉhÉÇ / +ÉÊiÉÊ{ÉÎSUô±
ºÉÊzÉ{ÉÉiÉVÉ |ÉEòÉä{É EÞò¹hÉÉ, Eòh]õEòªÉÖHò, ¶ÉÖ¹Eò
Other important features which are to be noted are pain, loss of sensation in
the tongue, any bad smell from mouth, capacity of gustalory apparatus, any change
in size of tongue, any ¶ÉÉälÉ or µÉhÉ or ÊVÉ¼´ÉÉ any abnormality of salivary activity,
coating. Any deviation of the tongue to sides or inability to protrude has to be look
for.
5. ¶É¤nù {É®úÒIÉÉ
In this context, the sounds produced in the body of patient are examined.
The main sound is the voice of patient, other beings sounds of joints, intestive
lungs, heart.
nùÉä¹ÉEòÉä{ÉÆ ¶¤nùÊ´É¶Éä¹É
´ÉÉiÉ|ÉEòÉä{É abnormal other than guru and º{ÉÖ]õ
Ê{ÉkÉ|ÉEòÉä{É +º{É¹]
Eò¡ò|ÉEòÉä{É MÉÖ¯û
nÖù¤ÉÇ±ÉiÉÉ +º{É¹]õ
xÉÉºÉÉ®úÉvä É +xÉÖxÉÉÊºÉEò
´ÉÉiÉÊ{ÉkÉÆ |É±ÉÉ{ÉÆ
6. º{É¶ÉÇ {É®úÒIÉÉ
Here the body parts are palpated by hands of physician to determine ¨ÉÞnÖùiÉÉ -
EòÊ`öxÉiÉÉ, ¶ÉÉälÉ, V´É®ú, =¹hÉ, ¶ÉÒiÉÆ, °üIÉiÉÉ, ÎºxÉMvÉiÉÉ, ºÉÖ{iÉiÉÉ, JÉ®úi´É - ¶±ÉIÉhÉi´É.
ªÉÉäMÉ®úixÉÉEò®ú uses this for following purposes.
nùÉä¹ÉEòÉä{ÉÆ º{É¶ÉÇùÊ´É¶Éä¹É
´ÉÉiÉ|ÉEòÉä{É =¹hÉº{ÉÇ¶ÉÆ
Ê{ÉkÉ|ÉEòÉä{É ¶ÉÒiÉº{ÉÇ¶ÉÆ
Eò¡ò|ÉEòÉä{É VÉ±ÉÒªÉº{ÉÇ¶ÉÆ
This has wide use in clinical practice.
7. oEò {É®úÒIÉÉ
Examination of xÉäjÉ provides information about the condition of dosa. Each
and every parts of xÉäjÉ is to be examined like {ÉI¨É, ´Éi¨ÉÇ, ºÉÎxvÉ.
ªÉÉäMÉ®úixÉÉEò®ú explain this is
25
nùÉä¹ÉEòÉä{ÉÆ oùEòÊ´É¶Éä¹ÉÆ
´ÉÉiÉ|ÉEòÉä{É °üIÉÉ, vÉÚ©É´ÉhÉ
Ê{ÉkÉ|ÉEòÉä{É {ÉÒiÉÆ, ®úHÆò
Eò¡ò|ÉEòÉä{É VÉ±ÉÒ ªÉÆ/ ÎºxÉMvÉiÉÉªÉÖHò
ºÉÊzÉ{ÉÉiÉVÉ |ÉEòÉä{É ¶ªÉÉ¨É´ÉhÉÇ, ®úÉèpù
If one eye becomes larger and other becomes smaller then patient will die in
3 days.
He has mentioned other +ºÉÉvªÉ/+Ê®ú¹]õ ±ÉIÉhÉ *
8. +ÉEÞòÊiÉ {É®úÒIÉÉ
+ÉEÞòÊiÉ {É®úÒIÉÉ includes external features of the body. Here we have to examine
|ÉEÞòÊiÉ, ´ÉhÉÇ, ºÉÉ®ú, ºÉÆ½þxÉxÉ, |É¨ÉÉhÉ, näù½þÎºlÉÊiÉ. All of them come under nùÎ¶xÉ{É®úÒIÉÉ itself.
Also details related to +¹]õÉè ÊxÉÎxnùiÉ{ÉÖ¯û¹É±ÉIÉhÉ, Ê´É¹É¨É+ÉºÉxÉ¶ÉªÉxÉ, ºÉ½þVÉÊ´ÉEÞòÊiÉ (congenital
abnormality) ¨ÉÖJÉ¦ÉÉ´É facial expression are to be collected under this heading.
26
DASA VIDHA PAREEKSHA
According to Charaka, with the help of four pramanas, examination has to be

carried out in 10 topics. A physician can accomplish the desired object without
any special effort, provided he duly initiates action after having full knowledge of
these 10 topics, otherwise called nù¶ÉÊ´ÉvÉ {É®úÒIÉÉ:
VÉÉi´ÉÉ Ê½þ EòÉ®úh ÉEò®ú h ÉEòÉªÉÇª ÉÉäÊ xÉ EòÉªÉÇ EòÉªÉÇ¡ ò±É +xÉÖ¤ ÉxvÉ näù ¶ É EòÉ±É |É´ÉÞi ªÉÖ{ ÉÉªÉÉxÉ
ºÉ¨ªÉMÉÊ¨É
ÊxÉ´ÉÇkÉÇ¨ ÉÉxÉ& EòÉªÉÇÊ ¨ÉÊxÉ´ÉÇk ÉÉê <¹]õ ¡ ò±ÉÉxÉÖ¤ ÉxvÉÆ EòÉªÉÇ¨ÉÊ¦ÉÊxÉ´ÉÇk ÉÇª ÉÊiÉ +xÉÊiÉ¨É½þ i ÉÉ ªÉixÉäx É
EòkÉÇ **
(SÉ. Ê´É. 8/68)
These ten pareekshya bhavas are to be well assessed by all before starting
any kind of action. In the case of a physician. These bhavas can be interrupted as
explained below:
1. EòúÉ®úhÉ - Cause - Physician

2. Eò®úhÉ - Instrument - Medicaments
3. EòÉªÉÇªÉÉäÊxÉ - Source of Action - Disequilibrium of Dhatus
4. EòÉªÉÈ - Action - Maintenance of Equilibrium of Dhatus
5. EòÉªÉÇ¡ò±É - Result of Action - Attaining cure from disease.
6. +xÉÖ¤ÉxvÉ - Subsequent manifestation - Longivity
7. näù¶É - Habitat - Both land and the pit.
8. EòÉ±É - Season - Seasons and the stage of disease
9. |É´ÉÞÊkÉ - Initiation - Therapeutic action
10. ={ÉÉªÉ - Means of action - Excellence of the physician and
correctness of therapy.
The three main considerations evident here are the Ê¦É¹ÉEÂò, +Éè¹ÉvÉ & ®úÉäMÉÒ padas.
The Ê¦É¹ÉEò, being the most important {ÉÉnù, has been given prime importance as the
object of examination (EòÉ®úhÉ). But from the point of view of the physician, the most
important factor to be examined is the ®úÉäMÉÒ who represents the EòÉªÉÇnäù¶É.
Charaka further goes on to describe ten ways of examining the EòÉªÉÇnäù¶É or the
rogi. These constitute the nù¶ÉÊ´ÉvÉ{É®úÒIÉÉ in the context of rogivijnana.
iÉº¨ÉÉnùÉiÉÖ®Æú {É®úÒIÉäiÉ - |ÉEÞòÊiÉiÉ¶SÉ Ê´ÉEÞòÊiÉiÉ¶SÉ ºÉÉ®úiÉ¶SÉ ºÉÆ½þxÉxÉi¶SÉ

|É¨ÉÉhÉiÉ¶SÉ ºÉÉi¨ªÉ¶SÉ ºÉi´ÉiÉ¶SÉ +É½þÉ®ú<ÊHòiÉ¶SÉ ´ªÉÉªÉÉ¨É<ÊHòiÉ¶SÉ ´ÉªÉºÉ¶SÉääÊiÉ **
(SÉ. Ê´É.8/94)
27
The patient should be examined with refernece to his prakriti, vikriti, sara,
samhanana, pramana, satmya, satva, aharasakti, vyayamasakti and vayah.
In vagbhatas description, the dasavidha pareekshas are-

nÚù ´ ªÉÆ näù ¶ÉÆ ¤É±ÉÆ EòÉ±É¨ÉxÉ±ÉÆ |ÉEÞò ËiÉ ´ÉªÉ&
ºÉi´ÉÆ ºÉÉi¨ªÉÆ iÉlÉÉ½þ É ®ú¨É´ÉºlÉÉ<SÉ {ÉÞlÉÎM´ÉvÉÉ&
ºÉÚI ¨ÉºÉÚI ¨ÉÉººÉ¨ÉÒIªÉè¹ÉÉÆ nù É ä¹ ÉÉè{ ÉvÉÊxÉ°ü{ÉhÉä
ªÉÉä ´ÉkÉÇiÉä ÊSÉÊEòiºÉÉªÉÉÆ xÉ ºÉ ºJÉ±ÉÊiÉ VÉÉiÉÖÊ VÉiÉÂ ** (+.½þ.ºÉÚ. 12/66-67)
Though not under the heading of dasavidha pareeksha susruta also gives
detailed description of examination of the above factors in the chapter +ÉiÉÖ®úÉ{ä ÉGò¨ÉhÉÒªÉÆ.
+ÉiÉÖ®ú É ä{ ÉGò¨É¨ÉÉhÉäxÉ Ê¦É¹ÉVÉÉ +ÉªÉÖ® úÉ nù É näù ´ É {É®úÒ ÊIÉiÉ´ªÉÆ,
ºÉiªÉÉªÉÖÊ ¹É ´ªÉÉÊvÉ ¸ÉÞi ÉÖ +ÎMxÉ ´ÉªÉÉä näù ½ þ ¤É±É ºÉi´É ºÉÉi¨ªÉ |ÉEÞò ÊiÉ
¦Éä¹ÉVÉ näù ¶ÉÉxÉ {É®úÒ IÉäiÉ * (ºÉÖ. ºÉÚ. 35/3)
According to Susruta, the examination of a patient should first be carried out
with regard to the +ÉªÉÖ (span of life) and then ´ªÉÉÊvÉ, ¸ÉÞiÉÖ, +ÎMxÉ, ´ÉªÉ&, näù½Æþ ¶ÉÂ(|É¨ÉÉhÉ), ¤É±É,
ºÉi´É, ºÉÉi¨ªÉ, |ÉEÞòÊiÉ, ¦Éä¹ÉVÉ & näù¶É are to be considered one by one.
Purpose of Dasavidha Pareeksha
It is explained by Charaka as -
+ÉiÉÖ®úºiÉÖ JÉ±ÉÖ EòÉªÉÇnäù¶É&, iÉºªÉ {É®úÒIÉÉ +ÉªÉÖ¹É& |É¨ÉÉhÉYÉÉxÉ½äþiÉÉä´ÉÉÇ ¤É±ÉnùÉä¹É|É¨ÉÉhÉYÉÉxÉ½äþiÉÉä´ÉÉÇ *
(SÉ. Ê´É. 8)
The three main objects of rogipareeksha are -
1. +ÉiÉÖ®ú¤É±É|É¨ÉÉhÉ {ÉÊ®úYÉÉxÉÆ
2. +ÉiÉÖ®únùÉä¹É|É¨ÉÉhÉ {ÉÊ®úYÉÉxÉÆ
3. +ÉiÉÖ®úÉªÉÖ&|É¨ÉÉhÉ{ÉÊ®úYÉÉxÉÆ
Otherwise, it may be understood that the dasavidha pareeksha helps to
determine the ¤É±É|É¨ÉÉhÉ of the rogi (®úÉäMÉÒ¤É±É) & ¤É±É|É¨ÉÉhÉ of the roga (®úÉäMÉ¤É±É). Though
mutually influencing factors, rogabala and rogibala need to be evaluated separately.
The patient should be examined to obtain knowledge regarding the span of
life, strength of the patient and the intensity of his disease. Here, the purpose of
examination is to obtain the knowledge relating to the strength of the individual
and the intensity of the disease because it is on the basis of the ®úÉäMÉ¤É±É that the
dosage of the therapy is determined and the rogabala is dependant on the strength
or power of resistance of the individual.
iÉjÉ iÉÉ´ÉÊnùªÉÆ ¤É±ÉnùÉä¹É|É¨ÉÉhÉYÉÉxÉ½äþiÉÉä& nùÉä¹É|É¨ÉÉhÉÉxÉÖ°ü{ÉÉä Ê½þ
¦Éä¹ÉVÉ|É¨ÉÉhÉÊ´ÉEò±{ÉÉä ¤É±É|É¨ÉÉhÉÊ´ÉZÉä¹ÉÉ{ÉäIÉÉä ¦É´ÉÊiÉ *
Not only this, in conditions demanding strong medication, prior examination
is a must. Weak patients are incapable of tolerating strong therapies like teckshna
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dravyas (dominating in agni & vayu mahathootas); Agni Karma, Shara Karma &
Sastra Karma. These therapies are very sharp and sudden in their action and
may even result in death if applied in a very weak patient.
ºÉ½þº ÉÉ ½þ ªÉÊiÉ¤É±É¨ÉÉè¹ ÉvÉ¨É{É®ú Ò IÉEò|ÉªÉÖHÆò , +±É{É¤É±É¨ÉÉiÉÖ® Æú +ÊiÉ{ÉÉiÉªÉäi É
xÉ Ê½þ +ÊiÉ¤É±ÉÉÊxÉ +ÉMxÉäª É´ÉÉªÉ´ÉÒªÉÉÊxÉ +Éè¹ÉvÉÉÊxÉ +ÎMxÉIÉÉ®ú¶ ÉºjÉEò¨ÉÇÊ hÉ ´ÉÉä
¶ÉCªÉxÉiÉä +±É{É¤É±Éè& ºÉÉäf Âø ¨ ÉÂ, +ºÉ½þ ª ÉÉÊiÉiÉÒIhÉ´ÉäM Éi´ÉÉiÉ Ê½þ iÉÉÊxÉ ºÉPÉ& |ÉÉhÉÉ½þ® ú Ê hÉ
ºªÉÖ& *
The most common example given for such weak patients is women, who need
more careful attention regarding the dosage and type of treatment. Women are by
nature unsteady, light and of sensitive temperament and have comparatively less
physical strength. So they need therapies that are neither distressing during digestion,
nor associated with any serious complications.
BiÉSSÉè´ É EòÉ®úh É¨É{ÉäI É¨ÉÉhÉÉ ½þÒ xÉ¤É±ÉÆ +ÉiÉÖ® Æú +Ê´É¹ÉÉnù Eò®èú& ¨ÉÞn Öù ºÉÖEÖò ¨ÉÉ®ú | ÉÉªÉè&
=kÉ®úM ÉÖ¯ûÊ¦É®úÊ ´É§É¨Éè& +xÉÉiªÉÊªÉEèò <SÉ ={ÉSÉ®úx iªÉÉè¹ ÉvÉè& Ê´É¶Éä¹ÉiÉ¶SÉ xÉÉ®úÒ &,
iÉÉ Ê½þ +xÉ´ÉÎºlÉiÉ ¨ÉÞnÖù Ê´É´ÉÞi É Ê´ÉC±É´É¾þnù ªÉÉ& |ÉÉªÉ& ºÉÖEÖò¨ÉÉªÉê ¤É±ÉÉ- {É®ºÉÆºiÉ¦ªÉÉ¶SÉ *
If weak therapies are administered to a strong individual having a serious
disease without proper examination, the disease does not get cured.
iÉlÉÉ ¤É±É´ÉÊiÉ ¤É±É´É½þªÉÉÊvÉ{ÉÊ®úMÉiÉä º´É±{É¤É±ÉÆ +Éè¹ÉvÉÆ +{É®úÒIÉEò|ÉªÉÖHÆò +ºÉÉvÉEò¨Éä´É ¦É´ÉÊiÉ *
A strong patient with a serious disease needs the therapy in a stronger dose.
A weak patient suffering from a serious disease should be adminsitered strong
therapy slowly and gradually, depending upon his strength and power of resistance
acquired. Mistakes like giving strong therapies to weak patients and vice versa
can be avoided if patients are duly examined before giving medicine.
From Charaka’s point of view, this is further explained in terms of MÉÖ¯û´ªÉÉÊvÉ &
±ÉPÉÖ´ªÉÉÊvÉ & the effects of these two on patients. A MÉÖ¯û®úÉäMÉÒ may appear to be a ±ÉPÉÖ®úÉäMÉÒ
if he is endowed with mental and physical strength. A ±ÉPÉÖ®úÉäMÉÒ may seem to be
gravely diseased if he lacks mental and physical strength. A physician may be
misled by these conditions if he fails to examine the ®úÉäMÉ & the ®úÉäMÉÒ thoroughly.
<½þ JÉ±ÉÖ uùÉè {ÉÖ¯û¹ÉÉè ´ªÉÉÊvÉiÉ°ü{ÉÉè ¦É´ÉiÉ&, MÉÖ¯û´ªÉÊvÉiÉÉ ±ÉPÉÖ´ªÉÉÊvÉiÉ<SÉ iÉjÉ
MÉÖ¯û´ªÉÉÊvÉiÉ BEò& ºÉi´É ¤É±É ¶É®úÒ®úºÉ¨{Éoùù{ÉiÉi´ÉÉiÉÂ ±ÉPÉÖ´ªÉÉÊvÉiÉ <´É où¶ªÉiÉä *
±ÉPÉÖ´ªÉÉÊvÉiÉÉä {É®ú& ºÉi´ÉÉnùÒxÉÉ¨É±{Éi´ÉÉiÉÂ MÉÖ¯û´ªÉÉÊvÉiÉ <´É où¶ªÉiÉä * iÉªÉÉä®úEÖò¶É±ÉÉ&
Eäò´É±ÉÆ SÉIÉÖ¹Éè´É °ü{ÉÆ où¹]Âõ´ÉÉ ´ªÉ´ÉºlÉxiÉÉä ´ªÉÉÊvÉ MÉÖ¯û±ÉÉPÉ´Éä Ê´É|ÉÊiÉ{ÉvÉiÉä * (SÉ. Ê´É.7/2)
Partial knowledge never helps a physician. Errors in diagnosis lead to errors
in treatment. The ill effects of such imperfect knowledge are
1. Mistaking a MÉÖ¯û®úÉäMÉÒ for a ±ÉPÉÖ®úÉäMÉÒ, the physician may do ¨ÉÞnÖù¶ÉÉävÉxÉ, considered the
dosha as +±{É. This leads to further aggravation of his doshas.
29
2. The ±ÉPÉÖ®úÉäMÉÒ may be mistaken for a MÉÖ¯û®úÉäMÉÒ & his actually +±{É dosha may be
mistaken for |É¦ÉÚiÉ & the physician may resort to iÉÒIhÉ¶ÉÉävÉxÉ that causes excessive
emaciation and other such complications.
So, to avoid all such errors, ®úÉäMÉ®úÉäMÉÒ{É®úÒIÉÉ should be perfectly done.
Now it needs to be discussed how each of ten factors for examination of the
patient helps in the achievement of better results with therapy.
1. |ÉEÞòÊiÉ
In a broad sense, |ÉEÞòÊiÉ may be defined as the nature of an individual.
|ÉEÞòÊiÉ& º´É¦ÉÉ´ÉÉä ªÉ& *
According to the Ayurvedic texts, |ÉEÞòÊiÉ of a person is his normal condition ie
when he is healthy and unaffected by disease.
Ê´ÉEòÉ®úÉä vÉÉiÉÖ´Éê¹É¨ªÉÆ ºÉÉ¨ªÉÆ |ÉEÞòÊiÉ°üSªÉiÉä * (SÉ. ºÉÚ)
In other words, |ÉEÞòÊiÉ is a parameter for assessing the dominance of the doshas
or more precisely their gunas in making up a man’s constitution. |ÉEÞòÊiÉ is determined
by the following factors -
1. ¶ÉÖGò¶ÉÉäÊhÉiÉ|ÉEÞòÊiÉ
2. EòÉ±ÉMÉ¦ÉÉÇ¶ÉªÉ|ÉEÞòÊiÉ
3. ¨ÉÉiÉÖ®úÉ½þÉ®ú Ê´É½þÉ®ú|ÉEÞòÊiÉ
The influence of the three doshas on each of these factors, both independently
and by combinations, gives rise to seven types of prakruti.
iÉjÉ |ÉEÞòiªÉÉÊnùxÉ ¦ÉÉ´ÉÉxÉxÉÖ´ªÉÉJªÉÉºªÉÉ¨É& * iÉPÉlÉÉ - ¶ÉÖGò¶ÉÉäÊhÉiÉ |ÉEÞòËiÉ,
EòÉ±ÉMÉ¦ÉÉÇ¶ÉªÉ|ÉEÞòËiÉ, ¨ÉÉiÉÖ¶É½þÉ®úÊ´ÉEòÉ®ú|ÉEÞòËiÉ, ¨É½þÉ¦ÉÚiÉÊ´ÉEòÉ®ú |ÉEÞòËiÉ SÉ
MÉ¦ÉÇ¶Ê®ú®ú¨É{ÉäIÉiÉä * BiÉÊxÉ Ê½þ ªÉäxÉ ªÉäxÉ nùÉä¹ÉähÉ +ÊvÉEäòxÉ BEäòxÉ +xÉäEäòxÉ ´ÉÉ
ºÉ¨ÉxÉÖ¤ÉvªÉxiÉä, iÉäxÉ iÉäxÉ nùÉä¹ÉähÉ MÉ¦Éæ +xÉÖ¤ÉvªÉiÉä, iÉiÉ& ºÉÉ ºÉÉ nùÉä¹É|ÉEÞòÊiÉ°üSªÉiÉä
¨ÉxÉÖ¹ªÉÉhÉÉÆ MÉ¦ÉÇÊnù|É´ÉÞkÉÉ * iÉº¨ÉÉiÉÂ <±Éä¨¨É±ÉÉ&ñ|ÉEÞòiªÉÉ EäòÊSÉiÉ, Ê{ÉkÉ±ÉÉ&,
EäòÊSÉiÉ, ´ÉÉiÉ±ÉÉ& EäòÊSÉiÉ, ºÉÆºÉÞ¹½þÉ EäòÊSÉiÉ, ºÉ¨ÉvÉÉiÉ´É& EäòÊSÉiÉ ¦É´ÉÎxiÉ * (SÉ. Ê´É. 8/15)
From the general characteristics listed out under each of the three primary
prakritis (´ÉÉiÉ, Ê{ÉkÉ & Eò¡ò) it can be seen that |ÉEÞòÊiÉ has its own mark on the physical,
mental and intellectual features of an individual and whatever goes to make his
life completely as it is.
Chakra says that |ÉEÞòÊiÉ influences the strength, wealth, knowledge and longevity
etc. of a person. The person enjoys these in a comparatively higher extent when
he is ºÉ¨É|ÉEÞòÊiÉ or Eò¡ò|ÉEÞòÊiÉ. But Ê{ÉkÉ|ÉEÞòÊiÉ renders moderate qualities and ´ÉÉiÉ|ÉEÞòÊiÉ
shows the least.
Eò¡ò|ÉEÞòÊiÉ - iÉ B´ÉÆ MÉÖhÉªÉÉäMÉÉiÉÂ <±Éä¹¨É±ÉÉ ¤É±É´ÉxiÉÉä ´ÉºÉÖ¨ÉxiÉÉä Ê´ÉvÉÉ´ÉxiÉ +ÉäVÉÎº´ÉxÉ& ¶ÉÉxiÉÉ
+ÉªÉÖ¹¨ÉxiÉÉ¶SÉ ¦É´ÉÎxiÉ *
30
Ê{ÉkÉ|ÉEÞòÊiÉ - iÉ B´ÉÆ MÉÖhÉªÉÉäMÉÉiÉÂ Ê{ÉkÉ±ÉÉ& ¨ÉvªÉ¤É±ÉÉ& ¨ÉvªÉÉªÉÖ¹ÉÉä ¨ÉvªÉYÉÉxÉ Ê´ÉYÉÉxÉ Ê´ÉkÉ ={ÉEò®hÉ´ÉxiÉ¶SÉ
¦É´ÉÎxiÉ *
´ÉÉiÉ|ÉEÞòÊiÉ - iÉ B´ÉÆ MÉÖhÉªÉÉäMÉÉiÉÂ ´ÉÉiÉ±ÉÉ& |ÉÉªÉähÉ +±É{É¤É±ÉÉ¶SÉ +±{ÉÉªÉÖ¹É¶SÉ +±É{ÉÉ{ÉiªÉÉ¶SÉ
+±{ÉºÉÉvÉxÉÉ¶SÉ +±{ÉvÉxÉÉ¶SÉ ¦É´ÉÎxiÉ *
ºÉ¨É|ÉEÞòÊiÉ - ºÉ´ÉÇMÉÖhÉºÉ¨ÉÖÊnùiÉÉºiÉÖ ºÉ¨ÉvÉÉiÉ´É& *
A ºÉ¨ÉvÉÉiÉÖ type of individual who has all the doshas in a state of equilibrium, is
endowed with the good qualities of all the three types of individuals - Vatha, Pitha
and Kapha prakritis.
Elsewhere, Charaka also exprresses the opinion that |ÉEÞòÊiÉ exclusively denotes
ºÉ¨ÉnùÉ¹ä É. Dominance of one or two doshas cannot be termed |ÉEÞòÊiÉ. For such conditions,
the terms ´ÉÉiÉ±ÉÉ& Ê{ÉkÉ±ÉÉ& ¶±Éä¹¨É±ÉÉ& etc. may be assigned, instead.
ºÉ¨É´ÉÉiÉÊ{ÉkÉ¶±Éä¹¨ÉÉhÉÉÆ Ê½þ +É®úÉäMªÉÊ¨ÉSUôÎxiÉ Ê¦É¹ÉVÉ& * ªÉiÉ& |ÉEÞòÊiÉ¶SÉ +É®úÉäMªÉÆ,
+É®úÉäMªÉÉlÉÉÇ SÉ ¦Éä¹ÉVÉ|É´ÉÞÊkÉ&, ºÉÉ SÉä¹]õÉ°ü{ÉÉ, iÉº¨ÉÉiÉÂ ºÉÎxiÉ ºÉ¨É´ÉÉiÉÊ{ÉkÉ¶±Éä¹¨ÉÉhÉ&,
xÉ iÉÖ JÉ±ÉÖ ºÉÎxiÉ ´ÉÉiÉ|ÉEÞòiÉªÉ& Ê{ÉkÉ|ÉEÞòiÉªÉ& ¶±Éä¹¨É|ÉEÞòiÉªÉÉä ´ÉÉ, iÉºªÉ iÉºªÉ ÊEò±É
nùÉä¹ÉºªÉÉÊvÉEò ¦ÉÉ´ÉÉiÉÂ ºÉÉ ºÉÉ nùÉä¹É |ÉEÞòÊiÉ¯ûSªÉiÉä ¨ÉxÉÖ¹ªÉÉhÉÉ¨É * xÉ SÉ Ê´ÉEÞòiÉä¹ÉÖ
nùÉä¹Éä¹ÉÖ |ÉEÞòÊiÉºlÉi´É¨ÉÖ{É{ÉvÉiÉä * iÉº¨ÉÉzÉèiÉÉ |ÉEÞòiÉªÉ& ºÉÎxiÉ, ºÉÎxiÉ iÉÖ JÉ±ÉÖ ´ÉÉiÉ±ÉÉ&
Ê{ÉkÉ±ÉÉ& ¶±Éä¹¨É±ÉÉ¶SÉ +|ÉEÞòÊiÉºlÉÉºiÉÖ iÉä YÉäªÉÉ& * (SÉ. Ê´É. 6/10)
It can be seen that the concept of |ÉEÞòÊiÉ also takes into consideration ºÉÆ½þxÉxÉ,
ºÉi´É, +ÊMÉxÉ¤É±É, ´ªÉÉªÉÉ¨É¤É±É etc. though these are separately dealt with in nù¶ÉÊ´ÉvÉ{É®úÒIÉÉ.
Other factors that are said to be contributory to |ÉEÞòÊiÉ are VÉÉÊiÉ, EÖò±É, näù¶É, EòÉ±É, ´ÉªÉ& &
|ÉiªÉÉi¨ÉÊxÉªÉiÉEòÉ®úhÉÉ like +É½þÉ®ú, ºÉÉi¨ªÉ, Ê´É½þÉ®ú, ÊxÉpùÉ etc.
In modern medical science, there is one classification which simulates the
above mentioned classification of physical constitution of individuals. This is the
simplest and most useful method of somato - typing is based on simple clinical
observation of the bodily habits.
Asthenic (hyposthenic) - Thin, long and underdeveloped body with long neck,
flat chest, prominent hypogastrium, slender fingers and with a proclivity to
neurasthenia and visceroptosis. (Longilinear somatic consitution with vertical heart).
This can be correlated to individual of vataja constitution.
Normosthenic (orthosthenic) - With a normal average body build. This can
be correlated to the individual of pittaja constitution.
Sthenic (hypersthenic) - Broad, short and fat with short neck, muscular chest,
large and stumpy fingers. (Brevlinear somatic constitution with horizontal heart).
This can be correlated to the individual of kaphaja constitution.
There is another (anthropometric) classification which resembles classification
of |ÉEÞòÊiÉ by SÉ®úEò. On the basis of bodily measurements or physical anthropometry,
it is possible to distinguish three main types of humans (according to the
preponderance of one or other of the three primary germ layers).
31
Endomorph - With soft, round contours and well developed cutaneous tissues.
This can be correlated with individual of kaphaja constitution.
Mosemorph - Wide, stocky, muscular individual which is similar to features of
pittaja constitution.
Ectomorph - With long narrow hands and long feet, frequently shallow thorax
and a small waist. This is very much similar to features of vataja constitution.
Uses of |ÉEÞòÊiÉ{É®úÒIÉÉ
1. It gives idea about the strength and immunity status of the patient. People
with ºÉ¨É|ÉEÞòÊiÉ remain always healthy, but the other dosha prakritis, though they do
not directly cause any disequilibrium in the body, make the person susceptible to
diseases caused by the dominating dosha or doshas. So in this way, they exert an
additive influence on the nidana or causative factors of a disease.
´ÉÉiÉ±ÉºªÉ ´ÉÉiÉÊxÉÊ¨ÉkÉÉ& Ê{ÉkÉ±ÉºªÉ Ê{ÉkÉÊxÉÊ¨ÉkÉÉ& ¶±Éä¹¨É±ÉºªÉ ¶±Éä¹¨ÉÊxÉÊ¨ÉkÉÉ& ´ªÉÉvªÉ&
|ÉÉªÉähÉ ¤É±É´ÉxiÉ¶SÉ ¦É´ÉÎxiÉ ** (SÉ. Ê´É. 6/18)
(It is to be remembered here that there is a slight difference of opinion
according to Susruta. Susrata does not fully agree to it that a particular dosha
prakriti favours diseases due to that particular dosha. He says that due to continuous
association, Ê´É¹É¨É|ÉEÞòÊiÉ also proves to be harmless to the body.
Ê´É¹ÉVÉÉiÉÉä ªÉlÉÉ EòÒ]õÉä Ê´É¹ÉähÉ xÉ Ê´É¹ÉvÉiÉä
iÉuùiÉÂ |ÉEÞòiÉªÉÉä& ¨ÉiªÉÈ ¶ÉCxÉÖ´ÉÎxiÉ xÉ ¤ÉÉÊvÉiÉÖ¨É ** (ºÉÖ. ¶ÉÉ. 4/)
To an extent, knowledge of |ÉEÞòÊiÉ helps knowledge of the prognosis of a disease
condition. For example, +iÉÖ±ªÉiÉÚ¹ªÉnäù¶ÉkÉÖÇ|ÉEÞòÊiÉ is a feature of ºÉÖJÉºÉÉvªÉ rogas ie it indicates
good prognosis.
In treatment both in curative and preventive aspect knowledge of |ÉEÞòÊiÉ helps
to give better results. For eg: ´ÉÉiÉ¶É¨ÉxÉ upakramas can be used to cure vathic disorders
occuring in a patient with vatha prakruti and also to prevent the occurence of
dosha kopa in a person with ´ÉÉiÉ|ÉEÞòÊiÉ (who is prone more to vathic disease).
2. Ê´ÉEÞòÊiÉ
Ê´ÉEÞòÊiÉ refers to the pathologic condition or the state of disequilibrium in a
diseased body.
Ê´ÉEÞòÊiÉ¯ûSªÉiÉä Ê´ÉEòÉ®ú& *
Ê´ÉEòÉ®úÉä vÉÉiÉÖ´Éè¹É¨ªÉ¨ÉÂ *
The Ê´ÉEÞòÊiÉ{É®úÒIÉÉ, according to Charaka, is to be done with reference to eight
factors.
1. ½äþiÉÖ1 2. nùÉä¹ÉÆ 3. nÚù¹ªÉÆ 4. |ÉEÞòÊiÉ
5. näù¶ÉÆ 6. EòÉ±ÉÆ 7. ¤É±ÉÆ 8. Ë±ÉMÉù (±ÉIÉhÉ)
32
iÉjÉ Ê´ÉEòÉ®Æú ½äþi ÉÖ nùÉ ä¹É nÚù ¹ªÉ |ÉEÞò ÊiÉ näù ¶É EòÉ±É ¤É±É-Ê´É¶Éä¹Éè& Ë±ÉMÉiÉ¶SÉ {É®úÒ IÉäi É *
(SÉ. Ê´É.)
These eight factors should be essentially known to get a clear picture of the
intensity of a disease.
In practice, three out of these are most important which are -
1. nùÉä¹É 2. nÚù¹ªÉ 3. +ÊvÉ¹`öÉxÉ
1. nùÉä¹É{É®úÒIÉÉ
The nùÉä¹ÉÊ´ÉEÞòÊiÉ may occur in differnet ways, when viewed with different aspects
of diagnosis and treatment. In any particular use, nùÉä¹ÉÊ´ÉEÞòÊiÉ must be analysed from
different angles before proceedings to the treatment. This includes examining.
1. Whether the dosha is |ÉÉEÞòiÉ or ´ÉèEÞòiÉ
2. Whether the dosha is º´ÉiÉxjÉ or {É®úiÉxjÉ (+xÉÖ¤ÉxvªÉ or +xÉÖ¤ÉxvÉ)
3. Whether the dosha is ºÉÉ¨É or ÊxÉ®úÉ¨É
4. Whether the dosha gets fall into the categories.
(a) IÉªÉ / ºlÉÉxÉ / ´ÉÞÊrù
(b) >ðvÉÇ´É / +vÉ& / ÊiÉlÉÇEÂò
(c) EòÉä¹`ö / ¶ÉÉJÉÉ / ¨É¨ÉÉÇÎºlÉºÉÎxvÉ
5. Whether the stage of nùÉä¹ÉÊ´ÉEÞòÊiÉ reached is ºÉ\SÉªÉ / |ÉEòÉä{É / |ÉºÉ®ú / ºlÉÉxÉºÉÆ¸ÉªÉ/
´ªÉÊHò / ¦Éänù
6. In a condition of +É´É®úhÉ, the type of +É´É®úhÉ of dosha is - +xªÉÉäxªÉÉ´É®úhÉ /
+xªÉÉ´É®úhÉ
2. nÚù¹ªÉ{É®úÒIÉÉ
This includes - (a) vÉÉiÉÖ{É®úÒIÉÉ & (b) ¨É±É{É®úÒIÉÉ
(a) vÉÉiÉÖ{É®úÒIÉÉ
Dhatus exist in any one of the three states
1. IÉªÉÆ 2. ºlÉÉxÉÆ 3. ´ÉÞÊrù
In ºlÉÉxÉ, the dhatu performs normal functions and show normal lakshanas. In
a disease condition, the IÉªÉ & ´ÉÞÊrù of dhatus is more important.
vÉÉiÉÖIÉªÉ can occur in either of the two ways
1. +xÉÖ±ÉÉä¨ÉIÉªÉ or 2. |ÉÊiÉ±ÉÉä¨ÉIÉªÉ. Both these conditions are seen in ¶ÉÉä¹É due to
the difference in causative or triggering factors. Anulomakshaya is caused by
vÉÉi´ÉÎMxÉ¨ÉÉxvÉ and »ÉÉäiÉÉä®úÉävÉ. Improper conversion of ®úºÉvÉÉiÉÖ to the successive dhatus
which result from these, gradually lead to depletion of all the dhatus, which causes
¶ÉÉä¹É.
33
ªÉlÉÉº´ÉäxÉ +ÎMxÉ {ÉÉEÆò ¶ÉÉ®úÒ ®úÉ ªÉÉÎxiÉ vÉÉiÉ´É&
»ÉÉäiÉºÉÉ SÉ ªÉlÉÉº´ÉäxÉ vÉÉiÉÖ& {ÉÖ¹ªÉÊiÉ vÉÉiÉÖV ÉÉ
»ÉÉäi ÉºÉÉÆ ºÉÊ¦É®úÉ änù É SSÉ ¶HòÉnù Ò xÉ\SÉ ºÉÆI ÉªÉÉiÉÂ
vÉÉiÉÚ¹¨ÉhÉÉÆ SÉÉ{ÉSÉªÉÉiÉÂ ®úÉ VÉªÉI¨ÉÉ |É´ÉkÉÇi Éä * (SÉ.ÊSÉ. 8/)
In |ÉÊiÉ±ÉÉä¨ÉIÉªÉ the primary cause is ¶ÉÖGòIÉªÉ (due to +ÊiÉ´ªÉ´ÉÉªÉ). Even though vÉÉiÉÖ{ÉÊ®úhÉÉ¨É
is proper ¶ÉÖGòIÉªÉ leads to derangement of ´ÉÉªÉÖ & subsequent ¶ÉÉä¹ÉhÉ (emaciation) of
the {ÉÚ´ÉÇ dhatus.
Eò¡ò|ÉvÉÉxÉè& nù É ä¹Éèº iÉÖ ¶ÉÖräù ¹ÉÖ ®úº É´Éi¨ÉÇº ÉÖ
+ÊiÉ´ªÉ´ÉÊªÉxÉÉä ´ÉÉÊ{É IÉhÉä ®äúi ÉÉÊºÉ +xÉxiÉ®úÉ &
IÉÒªÉxiÉä vÉÉiÉ´É& ºÉ´Éæ iÉiÉ& ¶ÉÖ¹ªÉÊiÉ ¨ÉÉxÉ´É& ** (¨ÉÉ. ÊxÉ. ®úÉ VÉªÉI¨ÉIÉiÉIÉÒhÉ ÊxÉ)
In vÉÉiÉÖ´ÉÞÊrù, increase of a dhatu or dhatus occurs due to »ÉÉäiÉÉä®úÉävÉ. Here, obstruction
leads to ´ÉÞÊrù of one particular dhatu but in effect, it produces IÉªÉ of the subsequent
dhatus.
Eg: In Sthoulya
+´ªÉÉªÉÉ¨É Ênù´ÉÉº´É{xÉ ¶±Éä¹¨É±ÉÉ½þÉ®úºÉäÊ´ÉxÉ&
¨ÉvÉÖ®úÉä ¦É®úºÉ& |ÉÉªÉ& ºxÉä½þÉx¨Éänù& |É´ÉvÉÇªÉäiÉÂ
¨ÉänùºÉÉ +É´ÉÞiÉ¨ÉÉMÉÇi´ÉÉiÉÂ {ÉÖ¹ªÉÎxiÉ +xªÉä xÉ vÉÉiÉ´É&
¨ÉänùºiÉÖ SÉÒªÉiÉä iÉº¨ÉÉnÂù +¶ÉHò& ºÉ´ÉÇEò¨ÉÇºÉÖ * (¨ÉÉ.ÊxÉ.¨ÉänùÉäÊxÉnùÉxÉÆ)
Other examples are ®úHò´ÉÞÊrù in ®úHòiÉÊ{ÉkÉ & ¨ÉÉÆºÉ´ÉÞÊrù in +¤ÉÖÇnù.
In both ´ÉÞÊrù and IÉªÉ conditions, the specific actiological factors, the signs and
symptoms etc. must be carefully looked for.
Examination of ={ÉvÉÉiÉÖs is also included in vÉÉiÉÖ{É®úÒIÉÉ (eg. ºiÉxªÉÆ, ®úVÉºÉÂ etc.) They
also exhibit different IÉªÉ, ºlÉÉxÉ, ´ÉÞÊrù lakshanas.
(b) ¨É±É{É®úÒIÉÉ
Just like doshas and dhatus, the malas also exhibit various symptoms in
conditions of ºlÉÉxÉ, ´ÉÞÊrù & IÉªÉ. In the examination of malas - ¨ÉÚjÉ, {ÉÖ®úÒ¹É & º´Éänù, observation
of the physician should concentrate mainly on two points.
1. MÉÊiÉ & 2. |É´ÉÞÊkÉ of the malas.
MÉÊiÉ includes - IÉªÉ, ºlÉÉxÉ and ´ÉÞÊrù
|É´ÉÞÊkÉ deals with the nature of elimination of malas from the body. It includes
(a) Frequency of elimination
(b) Whether free/obstructed
(c) Whether painful/painless
(d) Whether there are any associated symptoms.
Eg: +ÉÊ´É±É¨ÉÚjÉiÉÉ in prameha is symptom (sign) showing the nature of the mala.
¨ÉÚjÉÉ´É®úÉävÉ in ¨ÉÚjÉEÞòSUô & is an example for obstructed elimination of
34
3. +ÊvÉ¹`öÉxÉ{É®ú Ò IÉÉ
Disease is manifested when the vitiated dashes undergo ºlÉÉxÉºÉÆ¸ÉªÉ to a
particular site or +ÊvÉ¹`öÉxÉ.
Not only the doshas, but also the dooshyas that they vitiate are in constant contact
with the numerous srotases in the body and therefore they also deserve attention
while considering the +ÊvÉ¹`öÉxÉ. Thus, the doshas, dhatus and malas are to be examined
with regard to their adhishtanas in ºlÉÉxÉ, ´ÉÞÊrù & IÉªÉ conditions.
+ÊvÉ¹`öÉxÉ{É®úÒIÉÉ also includes examination of vÉÉi´ÉÉÊ¸ÉiÉ & ¨É±ÉÉÊ¸ÉiÉ EÖòÊ{ÉiÉ doshas and
examination of »ÉÉäiÉÉänÖùÎ¹]õ.
Dushtilakshanas of doshas located in certain other angapratyangas like EòÉä¹`ö,
{ÉC´ÉÉ¶ÉªÉ, <ÎxpùªÉ, ºxÉÉªÉÖ, ÊºÉ®úÉ etc. are also detailed in the classics.
Susruta has include Ê´ÉEÞòÊiÉ{É®úÒIÉÉ in ´ªÉÉÊvÉ{É®úÒIÉÉ. The ´ªÉÉÊvÉÊ´É¶Éä¹É, Susruta says,
may be considered in three groups.
1. ºÉÉvªÉ 2. ªÉÉ{ªÉ 3. |ÉiªÉÉJªÉäªÉ
Each of these types must be carefully observed so as to determine whether
the disease is curable or not and to what extent. Whether a disease is primary
and independent or merely an accessory one or the premonitary indication of an
incipient derangement in its incubative stage must be clearly found out.
´ªÉÉÊvÉ Ê´É¶Éä¹ÉÉºiÉÖ |ÉÉMÉÊ¦ÉÊ½þiÉÉ&, ºÉ´ÉÇ B´ÉèiÉä ÊjÉÊ´ÉvÉÉ& - ºÉÉvªÉÉ ªÉÉ{ªÉ |ÉiªÉÉJªÉäªÉÉ<SÉ *
iÉjÉèiÉÉxÉÂ ¦ÉÚªÉ& ÊjÉvÉÉ {É®úÒIÉäiÉ - ÊEò¨ÉºÉÉè +Éè{ÉºÉÌMÉEò& |ÉÉCEäò´É±É&, +xªÉ±ÉIÉhÉ <ÊiÉ *
( ºÉÖ.ºÉÚ.25/20)
Advantages of Ê´ÉEÞòÊiÉ {É®úÒIÉÉ
1. Just as |É¶xÉ{É®úÒIÉÉ helps to elicit the ÊxÉnùÉxÉ, |ÉÉOÉÖ{É, ={É¶ÉªÉ etc. & {É\SÉäÎxpùªÉ{É®úÒIÉÉ helps
examination of ±ÉIÉhÉ, the Ê´ÉEÞòÊiÉ{É®úÒIÉÉ helps to trace the ºÉÆ|ÉÉÎ{iÉ.
2. According to Charaka, the diseases are graded into three - +±É{É¤É±É, ¨ÉvªÉ¤É±É &
¤É±É´ÉÉxÉ (¨É½þÉ¤É±É) - based on the severity of nùÉä¹ÉoùÎ¹]õ.
ªÉºªÉ Ê½þ ´ªÉÉvÉänùÉæ¹É nÚù¹ªÉ |ÉEÞòÊiÉ näù¶É EòÉ±É ¤É±É ºÉÉ¨ªÉÆ ¦É´ÉÊiÉ, ¨É½þSSÉ ½äþiÉÖË±ÉMÉ¤É±Éä,
ºÉ ´ªÉÉÊvÉ& ¤É±É´ÉÉxÉÂ ¦É´ÉÊiÉ * iÉnÂù Ê´É{ÉªÉÇªÉÉSSÉ +±É{É¤É±É&, ¨ÉvªÉ¤É±ÉºiÉÖ
nùÉä¹ÉnÚù¹ªÉÉÊnùxÉÉÆ +xªÉiÉ¨ÉºÉÉ¨ÉÉxªÉÉiÉ ½äþiÉÖË±ÉMÉ ¨ÉvªÉ¤É±Éi´ÉÉiÉÂ SÉ ={É±É¦ªÉiÉä ** (SÉ. Ê´É. 8/)
Thus Vikriti Pareeksha gives hints about the prognosis of a disease.
3. The correct line of treatment can be adopted only with the aid of Ê´ÉEÞòÊiÉ{É®úÒIÉÉ.
Eg: ±ÉÆPÉxÉ or ¤ÉÞ¨½hÉÆ can be selected accordingly. In +±É{ÉnùÉä¹É, ±ÉÆPÉxÉÆ should be done.
In ¨ÉvªÉnùÉä¹É the line of treatment should be ±ÉÆPÉxÉ{ÉÉSÉxÉÆ and in |É¦ÉÖiÉnùÉä¹É the treatment
is ¶ÉÉävÉxÉÆ.
4. The right time for a therapeutic intervention can be determined only if the
different stages of pathogenesis (Shad kriya kalas) are known which is possible
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only after Ê´ÉEÞòÊiÉ{É®úÒIÉÉ is done.
5. It helps in differential diagnosis. Minute details about dosha, dhatu & malas,
rogamarga & adhishtana which are covered in Ê´ÉEÞòÊiÉ{É®úÒIÉÉ help to differentiate
a pathological condition from others.
3. SARA
The word ºÉÉ®úÉ& means Ê´É¶ÉÖrùiÉ®úÉä vÉÉiÉÖ& ie the state of excellence of a particular
dhatu or dhatus in the body.
Its definitions are
1. =kÉ®úÉäkÉ®ú¨ÉÖiEò¹ÉÉæ ´ÉºiÉÖxÉ& ºÉÉ®ú =SªÉiÉä * (¶É¹nùEò±É{ÉpÖù¨É&)
2. ºÉÉ®ú& ÎºlÉ®úÉÆ¶É& * (+¨É®úEòÉä¶É)
Charaka and Susruta have given detailed description of Sara, by classifying
it into eight categories.
According to Charaka, the object of ºÉÉ®ú{É®úÒIÉÉ is to determine the specific measure
of strength of an individual.
ºÉÉ®úiÉ¶SÉäÊiÉ - ºÉÉ®úÉhªÉ¹]õÉè {ÉÖ¯û¹ÉÉhÉÉÆ, ¤É±É¨ÉÉxÉÊ´É¶Éä¹ÉYÉÉxÉÉlÉÇ¨ÉÖ{ÉÊnù¶ªÉxiÉä (SÉ.Ê´É. 8/102)
The ashtasaras are, in order,
i´ÉEÂò, ®úHò, ¨ÉÉÆºÉ, ¨Éänù&, +ÎºlÉ, ¨ÉVVÉ, ¶ÉÖGò & ºÉi´É. (SÉ.Ê´É.8/102)
Susruta lists them in the decreasing order of excellence is from ºÉi´ÉºÉÉ®ú to
i´ÉCºÉÉ®ú.
Charaka gives a more elaborate description of saras. The saras can be
identified from the excellent appearance and condition of the body parts to which
the dhatus attribute their qualities.
Excellence of a dhatu imports not only physical and functional qualities, but
also imparts varying degrees of mental and intellectual qualities, strength and
longivity.
It can be seen that increased longevity is the particular feature of i´ÉEò, ¨ÉÉÆºÉ,
+ÎºlÉ & ¨ÉVVÉÉ saras. Physical strength is characteristic of +ÎºlÉ, ¨ÉÉÆºÉ, ¨ÉVVÉ, ¶ÉÖGò saras.
Maximum amount of physical, mental, spiritual health & strength is ensured by
ºÉi´ÉºÉÉ®ú. ¨ÉVVÉÉºÉÉ®ú & ¶ÉÖGòºÉÉ®ú ensure good progeny.
While all other saras are evaluated by increase of strength and other qualities,
only ®úHòºÉÉ®ú is indicated to be identified by moderate strength and inability to face
difficulties.
(ºÉÉ ºÉÉ®úiÉÉ ºÉÖJÉÆ =rùiÉÉÆ ¨ÉävÉÉÆ ¨ÉxÉÎº´Éi´ÉÆ ºÉÉèEÖò¨ÉÉªÉÈ +xÉÊiÉ¤É±ÉÆ +Eò±Éä¶ÉºÉÊ½þ¹hÉÖi´ÉÆ
=¹hÉÉºÉÊ½þ¹hÉÖi´ÉÆ SÉ +ÉSÉ¹]äõ * )
Of the eight saras, ºÉi´ÉºÉÉ®ú is the best. Individuals having the excellence of
mental faculties are characterised by good memory, devotion, gratefulness wisdom,
36
purity, excessive enthusiasm, skill, courage, absence of sorrow, proper gait, sincerity
in actions etc.
º¨ÉÞÊiÉ¨ÉxiÉÉä ¦ÉÊHòiÉ¨ÉxiÉ& EÞòiÉYÉÉ& |ÉÉYÉÉ ¶ÉÖSÉªÉÉä
¨É½þÉäiºÉÉ½þÉ& nùIÉÉ& vÉÒ®úÉ& ºÉ¨É®úÊ´ÉGòÉxiÉªÉÉäÊvÉxÉ&
iªÉHòÊ´É¹ÉÉnùÉ& ºÉÖ´ªÉ´ÉÎºlÉiÉMÉÊiÉ MÉ¨¦ÉÒ®ú¤ÉÖÊrùSÉä¹]õÉ&
Eò±ÉªÉÉhÉÉÊ¦ÉÊxÉ´Éä¶ÉÉ¶SÉ ºÉi´ÉºÉÉ®úÉ& * iÉä¹ÉÉÆ º´É±ÉIÉhÉè®äú´É
MÉÖhÉÉ ´ªÉÉJªÉÉiÉÉ& * (SÉ. Ê´É. 8/110)
The characteristics of ºÉ´ÉÇºÉÉ®ú{ÉÖ¯û¹É are given. They include great strength and
hapiness, resistance to difficulties, self-confidence, virtuous acts, firm and well -
built body, correct gait, resonant melodious and high pitched voice, happiness
power, wealth, enjoyment, honour, slow ageing, resistance against diseases, large
number of children with similar qualities and longevity.
iÉjÉ ºÉ´Éê& ºÉÉ®èú°ü{ÉäiÉÉ& {ÉÖ¯û¹ÉÉ ¦É´ÉxiªÉÊiÉ¤É±ÉÉ& {É®ú¨É
ºÉÖJÉªÉÖHòÉ& Eò±Éä¶ÉºÉ½þÉ& ºÉ´ÉÉÇ®ú¨¦Éä¹ÉÖ +Éi¨ÉÊxÉ VÉÉiÉ|ÉiªÉªÉÉ&
Eò±ÉªÉÉhÉÉÊ¦ÉÊxÉ´ÉäÊ¶ÉxÉ& ÎºlÉ®úºÉ¨ÉÉÊ½þiÉ¶ÉÊ®ú®úÉ& ºÉÖºÉ¨ÉÉÊ½þiÉMÉiÉªÉ&
ºÉÉxÉÖxÉÉnù ÎºxÉMvÉMÉ¨¦ÉÒ®ú¨É½þÉº´É®úÉ& ºÉÖJÉè·ÉªÉÇ Ê´ÉkÉÉä{É¦ÉÉäMÉ
ºÉ¨¨ÉÉxÉ¦ÉÉVÉÉä ¨ÉxnùVÉ®úºÉÉä ¨ÉxnùÊ´ÉEòÉ®úÉ& |ÉÉªÉ& iÉÖ±ªÉMÉÖhÉ
Ê´ÉºiÉÒhÉÉÇ{ÉiªÉ& ÊSÉ®úVÉÒÊ´ÉxÉ¶SÉ * (SÉ. Ê´É. 8/11)
Charaka gives another method of rating the ºÉÉ®ú ie
1. =kÉ¨ÉºÉÉ®ú 2. ¨ÉvªÉ¨ÉºÉÉ®ú 3. +ºÉÉ®ú
+iÉÉä Ê´É{É®úÒiÉÉºiÉÖ +ºÉÉ®úÉ& * ¨ÉvªÉÉxÉÉÆ ¨ÉvªÉè& ºÉÉ®úÊ´É¶Éä¹Éè&
MÉÖhÉÊ´É¶Éä¹ÉÉ ´ªÉÉJªÉÉiÉÉ ¦É´ÉÎxiÉ * (SÉ. Ê´É. 8.113)
Qualities opposite to the described saras are indicative of the absence of
excellence of the respective dhatus. Individuals having moderately excellent dhatus
possess the respective qualities in moderate intensity.
Importance of ºÉÉ®ú{É®úÒIÉÉ
Charaka says that it is not advisale to conclude that a person is ¤É±É´ÉÉxÉÂ or
½þÒxÉ¤É±É from the external appearnace, that is, ºlÉÚ±ÉiÉÉ or EÞò¶ÉiÉÉ of his body. Some
people having small physique are seen to be comparatively stronger.
For making his idea clear, Charaka gives a suitable example from nature.
Ants, who have small body and look emaciated, can carry very heavy load
compared to their body weight. Likewise some people with physique too large or
too small, mislead the physician regending their strength and ability to do work or
bear difficulties.
EòlÉÆ xÉÖ ¶É®úÒ®ú¨ÉÉjÉnù¶ÉÇxÉÉnäù´É Ê¦É¹ÉEÂò ¨ÉÖ½þªÉäiÉ +ªÉÆ
={ÉÊSÉiÉi´ÉÉiÉÂ ¤É±É´ÉÉxÉÂ, +ªÉ¨É±É{É¤É±É& EÞò¶Éi´ÉÉiÉÂ, ¨É½þÉ¤É±ÉÉä
+ªÉÆ ¨É½þÉ¶É®úÒ®úi´ÉÉiÉÂ, +ªÉÆ +±É{É¶É®úÒ®úi´ÉÉiÉÂ +±É{É¤É±É <ÊiÉ * (SÉ. Ê´É. 8/114)
37
où ¶ ªÉxiÉä Ê½þ +±É{É¶É®ú Ò ®úÉ & EÞò ¶É¶SÉèE äò ¤É±É´ÉxiÉ&,
iÉjÉ Ê{É{ÉÒÊ±ÉEòÉ¦ÉÉ®ú½ þ®ú h É´ÉiÉÂ ÊºÉÊrù & * +iÉ¶SÉ ºÉÉ®ú&
{É®úÒIÉäiÉ <iªÉÖHò¨ÉÂ * (SÉ. Ê´É. 8/115)
Therefore, the physician should examine the individual with reference to the
excellence of his dhatus (ºÉÉ®ú).
4. ºÉÆ ½ þ x ÉxÉ
ºÉÆ½þxÉxÉ is defined as ºÉÆ½þÊiÉÊ®úÊiÉ ÊxÉÊ¤Éb÷ºÉxvÉÉxÉiÉäiªÉlÉÇ& *
In Charaka Samhita, the definition given is
ºÉÆ½þxÉxÉÆ ºÉÆ½þÊiÉ& ºÉÆªÉÉäVÉxÉÊ¨ÉiªÉäEòÉälÉÇ& *
Samhanana is the compactness of the body. ºÉÆ½þÊiÉ, ºÉÆªÉÉäVÉxÉ and ºÉÆ½þxÉxÉ all mean the
same.
ºÉÆ½þxÉxÉ is also categorised into three.
1. |É´É®ú 2. ¨ÉvªÉ¨É 3. +´É®ú
The features of a ºÉÖºÉÆ½þiÉ¶É®úÒ®ú are given by charaka as -
iÉjÉ ºÉ¨ÉºÉÖÊ´É¦ÉHòÉÎºlÉ, ºÉÖ¤ÉrùºÉÎxvÉ, ºÉÖÊxÉÊ´É¹]õ
¨ÉÉÆºÉ¶ÉÉäÊhÉiÉÆ, ºÉÖºÉÆ½þiÉÆ ¶É®úÒ®Æú <iªÉÖSªÉiÉä * iÉjÉ ºÉÖºÉÆ½þiÉ¶É®úÒ®úÉ&
{ÉÖ¯û¹ÉÉ ¤É±É´ÉxiÉ& Ê´É{ÉªÉÇªÉähÉ +±É{É¤É±ÉÉ&
¨ÉvªÉi´ÉÉiÉÂ ºÉÆ½þxÉxÉºªÉ ¨ÉvªÉ´É±ÉÉ ¦É´ÉÎxiÉ * (SÉ. Ê´É. 8/116)
A compact body is characterised by symmetrical and well divided bones, well
- knit joints and well - bound muscles and blood. An indivdiual having a compact
body is very strong. Otherwise, he is weak. When the body is moderately compact,
the individual possesses moderate strength.
ºÉÆ½þxÉxÉ
is therefore a purely physical or structural parameter to measure the
strength of a person.
5. |É¨ÉÉhÉ&
¶É®úÒ®ú|É¨ÉÉhÉ
is the measurement of the bodily parts of an individual and is
determined by measuring the height, length and breadth of organs by taking the
finger breadth (+ÆMÉÖ±É) of the individual as the unit of measurement.
|É¨ÉÉhÉiÉ¶SÉäÊiÉ - ¶É®úÒ®ú|É¨ÉÉhÉÆ {ÉÖxÉªÉÇlÉÉº´ÉäxÉ +ÆMÉÖ±ÉÒ|É¨ÉÉhÉäxÉ
={ÉnäùIªÉiÉä, =iºÉävÉ Ê´ÉºÉiÉÉ®ú +ÉªÉÉ¨Éè& ªÉlÉÉGò¨É¨ÉÂ * (SÉ. Ê´É. 8/117)
Charaka gives 33 standard measurements of different parts of the body. The
measurement from the sole of the feet to the top of the head is 84 angulas (3½
hastas) by the individuals own hand. When both the hands are fully out spread,
the height and breadth of the body are equal ie 84 angulas.
Eäò´É±ÉÆ {ÉÖxÉ& ¶É®úÒ®Æú +ÆMÉÖÊ±É{É´ÉÉÇÊhÉ SÉiÉÖ±É¶ÉÒÊiÉ& *
iÉnùÉªÉÉ¨ÉÊ´ÉºiÉÉ®úºÉ¨ÉÆ ºÉ¨ÉÖSªÉiÉä * (SÉ.Ê´É.8/117)
38
Susruta’s description of angapramanas is still more elaborate. There is
difference in the statements of Susruta and Charaka about the height of the whole
body. According to Susruta, the height is 120 angulas. (This may be due to the
difference in the basic unit +ÆMÉÖ±ÉÒ which is smaller according to Susruta). Susruta
has also given certain relative measurements of the body in males and females.
Charaka states that a body with organs having proper measurement will be
endowed with longevity, strength, ojas, happiness, wealth and virtues. These
qualities vary accordingly as the measurement becomes more or less than normal.
iÉjÉ +ÉªÉÖ¤ÉÇ±ÉÆ +ÉäV É& ºÉÖJÉÆ Bä· ÉªÉÈ Ê´ÉkÉÆ <¹]õÉ¶SÉÉ{É®äú
¦ÉÉ´ÉÉ ¦É´ÉÎxiÉ +ÉªÉkÉÉ& |É¨ÉÉhÉ´ÉÊiÉ ¶É®úÒ ®äú, Ê´É{ÉªÉÇªÉºiÉÖ
+iÉÉä ½þÒxÉä +ÊvÉEäò ´ÉÉ * (SÉ. Ê´É. 8/117)
(According to Susruta, the body of a man of 25 years and a woman of 16 years
of age can be considered as fully developed in respect of the maturity of the seven
fundamental principles (dhatus) of the body).
Susruta divided |É¨ÉÉhÉ into 3 types -
1. |É´É®ú 2. ¨ÉvªÉ¨É 3. +´É®ú
and states that the well being of a person depends on ¶É®úÒ®ú|É¨ÉÉhÉ accordingly.
ªÉÖHò|É¨ÉÉhÉäxÉ +xÉäxÉ {ÉÖ¨ÉÉxÉÂ ´ÉÉ ªÉÊnù ´ÉÉRÂó¨ÉxÉÉ
nùÒPÉÇ¨ÉÉªÉÖ®ú´ÉÉ{xÉÉäÊiÉ Ê´ÉkÉÆ SÉ ¨É½þnÂù ¸ÉÞSUôÊiÉ
¨ÉvªÉ¨ÉÆ ¨ÉvªÉ¨Éè®úÉªÉÖÌ´ÉkÉÆ ½þÒxÉèºiÉlÉÉ +´É®ú¨ÉÂ ** (ºÉÖ. ºÉÚ. 35/)
The examination of +ÆMÉ|ÉiªÉÆMÉ |É¨ÉÉhÉ & ºÉÉ®ú of a patient are being given equal
significance of Susruta.
ºÉÉ¨ÉÉxªÉiÉÉä +ÆMÉ|ÉiªÉÆMÉ|É¨ÉÉhÉÉnùlÉ ºÉÉ®úiÉ&
{É®úÒIªÉ +ÉªÉÖ& ºÉÖÊxÉ{ÉÖhÉÉä Ê¦É¹ÉEÂò ÊºÉvªÉÊiÉ Eò¨ÉÇºÉÖ * (ºÉÖ. ºÉÚ. 35/)
Considering grossly the body-size of a person, pramana may also be classified
into three according to Susruta -
näù½þ& ºlÉÚ±É& EÞò¶ÉÉä ¨ÉvªÉ <ÊiÉ |ÉÉMÉÖ{ÉÊnù¹]õ& * (ºÉÖ. ºÉÚ. 35/)
Describing the +¹]õ ÊxÉÎxnùiÉ purushas, charaka highlights the importance of
¶É®úÒ®ú|É¨ÉÉhÉ in determining the health - status of a person. He includes +ÊiÉnùÒPÉÇ +ÊiÉ¿º´É
+ÊiÉºlÉÚ±É and +ÊiÉEÞò¶É in the ÊxÉÎxnùiÉ purushas. Of these, +ÊiÉºlÉÚ±É & +ÊiÉEÞò¶É are the two
people who deserve more attention since they are more prone to illnesses than
others.
ºÉiÉiÉÆ ´ªÉÉÊvÉiÉÉ´ÉäiÉÉè +ÊiÉºlÉÚ±ÉEÞò¶ÉÉè xÉ®úÉè * (SÉ. ºÉÚ. 21/)
Uses of |É¨ÉÉhÉ{É®úÒIÉÉ -
1. To determine the site of a disease or disorder as in ¶ÉÉä¡ò, ¨ÉÉÆºÉ, ¶ÉÉä¹É etc.
2. To determine the dhatu affected in a particular condition - as in ºlÉÉè±ªÉ (¨Éänù&)
39
3. To determine ¶É®úÒ®ú¤É±É
4. To determine +ÉªÉÖ
6. ºÉÉi¨ªÉÆ
Charaka defines ºÉÉi¨ªÉ as
ºÉÉi¨ªÉÆ xÉÉ¨É iÉtiÉÂ ºÉÉiÉiªÉäxÉ ={ÉºÉä´ªÉ¨ÉÉxÉÆ ={É¶ÉäiÉä * (SÉ. Ê´É. 8/118)
ºÉÉi¨ªÉ stands for, those factors that act as wholesome to the individual even
when continuously used.
Another definition for ºÉÉi¨ªÉÆ from Bhaishajyaratnavali is
ºÉÉi¨ªÉÆ ºÉÖJÉVÉxÉEò¨ÉÂ * +Éi¨ÉxÉÉä Ê½þiÉÆ Eò¨ÉÇ +Éi¨ªÉÆ
+Éi¨ªÉäxÉ ºÉ½þ ´ÉkÉÇ¨ÉÉxÉÆ ºÉÉi¨ªÉ¨ÉÂ *
Satmya is that which is favourable for the body and mind alike.
Susruta’s definition is -
ªÉÉä ®úºÉ& Eò±É{ÉiÉä ªÉºªÉ ºÉÖJÉÉªÉè´É ÊxÉ¹ÉäÊ´ÉiÉ&
´ªÉÉªÉÉ¨ÉVÉÉiÉÆ +xªÉuùÉ iÉiÉÂ ºÉÉi¨ªÉÊ¨ÉÊiÉ ÊxÉÌnù¶ÉäiÉÂ ** (ºÉÖ. ºÉÚ. 36/)
Satmya is whatever that gives ºÉÖJÉ (well-being) either used in the form of rasa
(+É½þÉ®ú®úºÉ) or viharas like ´ªÉÉªÉÉ¨É.
In a sense, ºÉÉi¨ªÉ stands for +ÉäEòºÉÉi¨ªÉ or the homologation of food. On prolonged
use of particular types of food and other materials, it becomes ºÉÉi¨ªÉ to the body ie
it creates no adverse effects in the body and gives a feeling of well-being to the
person.
Besides aharaviharas, certain other factors are also brought to notice by
Susruta.
ºÉÉi¨ªÉÉÊxÉ iÉÖ näù¶É EòÉ±É VÉÉÊiÉ ¸ÉÞiÉÖ ®úÉäMÉ ´ªÉÉªÉÉ¨É
=nùEò Ênù´ÉÉº´É{xÉ ®úºÉ |É¦ÉÞiÉÒÊxÉ, |ÉEÞòÊiÉÊ´É¯ûrùÉÊxÉ +Ê{É
ªÉÉÊxÉ +¤ÉÉvÉEò®úÉÊhÉ ¦É´ÉÎxiÉ ** (ºÉÖ. ºÉÚ. 35/)
Satmya towards rasas is given prime importance by acharayas. Rasa satmya
is of three types.
1. BEò®úºÉºÉÉi¨ªÉÆ
2. Ê¨É¸É®úºÉºÉÉi¨ªÉÆ
3. ºÉ´ÉÇ®úºÉºÉÉi¨ªÉÆ
iÉjÉ ÊjÉÊ´ÉvÉÆ - |É´É®úÉ´É®ú¨ÉvªÉÊ´É¦ÉÉMÉäxÉ * iÉjÉ ºÉ´ÉÇ®úºÉÆ |É´É®Æú,
+´É®Æú BEò®úºÉÆ * ¨ÉvªÉ¨ÉÆ iÉÖ |É´É®úÉ´É®ú¨ÉvªÉºlÉ¨ÉÂ * (SÉ. Ê´É. 7/)
Another type of satmya taking into account two opposite gunas - ÎºxÉMvÉ & °üIÉ
- is also given by Charaka. Such satmya can also be of three types.
1. ÎºxÉMvÉºÉÉi¨ªÉÆ 2. °üIÉºÉÉi¨ªÉÆ 3. ´ªÉÉÊ¨É¸ÉºÉÉi¨ªÉÆ
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Charaka’s satmya towards PÉÞiÉ, IÉÒ®ú, iÉè±É & ¨ÉÉÆºÉ®úºÉ as well as drugs and diet
having all the six rasas provides a person with strength, the power for facing
difficulties and longevity. Those who have satmya for any single rasa and for
things that possess °üIÉ guna possess less strength, less power of resistance and
shortter life span and meagre accessories like drugs for the treatment of his
diseases. If the person is accoustomed to a combination of both the above types of
homologation, he possesses moderate strength.
iÉjÉ ªÉä PÉÞi É IÉÒ®ú iÉè±É ¨ÉÉÆº É®úº É ºÉÉi¨ªÉÉ& ºÉ´ÉÇ®úº ÉºÉÉi¨ªÉÉ¶SÉ
iÉä ¤É±É´ÉxiÉ& Eò®ú É ä¶ÉºÉ½þÉ & ÊSÉ®úV ÉÒÊ´ÉxÉ¶SÉ ¦É´ÉÎxiÉ * °üIÉºÉÉi¨ªÉÉ&
{ÉÖxÉ®äúE ò®úº ÉºÉÉi¨ªÉÉ¶SÉ ªÉä iÉä |ÉÉªÉäh É +±É{É¤É±ÉÉ& +±É{ÉEò±Éä¶ÉºÉ½þÉ
+±É{ÉÉªÉÖ¹ÉÉä +±É{ÉºÉÉvÉxÉÉ¶SÉ ¦É´ÉÎxiÉ * ´ªÉÉÊ¨É¸ÉºÉÉi¨ªÉÉºiÉÖ ªÉä
iÉä ¨ÉvªÉ¤É±ÉÉ& ºÉÉi¨ªÉÊxÉÊ¨ÉkÉiÉÉä ¦É´ÉÎxiÉ ** (SÉ.Ê´É. 8/118)
The strength of the person can be assessed from his type of ºÉÉi¨ªÉ, accordingly
as -
1. ºÉ´ÉÇ®úºÉºÉÉi¨ªÉ & ÎºxÉMvÉºÉÉi¨ªÉ → ¤É±É´ÉÉxÉÂ, Eò±Éä¶ÉºÉ½þ, ÊSÉ®úVÉÒÊ´É
2. BEò®úºÉºÉÉi¨ªÉ & °üIÉºÉÉi¨ªÉ → +±É{É¤É±É, +±É{ÉEò±Éä¶ÉºÉ½þ, +±É{ÉºÉi´É
3. ´ªÉÉÊ¨É¸É®úºÉºÉÉi¨ªÉ → ¨ÉvªÉ¤É±É, ¨ÉvÉªÉÉªÉÖ&
Advantages of ºÉÉi¨ªÉ{É®úÒIÉÉ
ºÉÉi¨ªÉ{É®úÒIÉÉ Helps to elicit the nature of the ¶É®úÒ®ú¤É±É, ºÉi´É¤É±É & +ÉªÉÖ of the person.
Accordingly, the right method of treatment or drugs that are well - tolerable by the
patient’s body and mind can be selected and administered.
For example, ´É¨ÉxÉEò¨ÉÇ can be conveniently done in a ¨ÉtºÉÉi¨ªÉ patient by
administering ¨Ét as the vehicle for ´É¨ÉxÉÉè¹ÉvÉ.
7. ºÉi´ÉÆ
The term ºÉi´É in this context, stands for the state of a persons mind or the
condition of his mental faculties.
ºÉi´É¨ÉÖSªÉiÉä ¨ÉxÉ& * iÉiÉÂ ¶É®úÒ®úºªÉ iÉxjÉEÆò +Éi¨ÉºÉÆªÉÉäMÉÉiÉÂ * (SÉ. Ê´É. 8/119)
Satva is the mind and it regulates the body because of its association with
the soul.
Satwa is classified in to three by Charaka as -
1. |É´É®ú 2. ¨ÉvªÉ¨É 3. +´É®ú
iÉjÉ ÊjÉÊ´ÉvÉÆ ¤É±É¦ÉänäùxÉ - |É´É®Æú ¨ÉvªÉ¨ÉÆ +´É®Æú SÉäÊiÉ *
+iÉ¶SÉ |É´É®ú ¨ÉvªÉ +´É®úºÉi´ÉÉ& {ÉÖ¯û¹ÉÉ& ¦É´ÉÎxiÉ **
The qualities of |É´É®úºÉi´É are the same as that of ºÉi´ÉºÉÉ®ú. A |É´É®úºÉi´É {ÉÖ¯û¹É therefore
possesses mental faculties of the superior type.
iÉjÉ |É´É®úºÉi´ÉÉ& ºÉi´ÉºÉÉ®úÉºiÉä ºÉÉ®äú¹ÉÖ ={ÉÊnù¹]õÉ& * (SÉ. Ê´É. 8/119)
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Even if a person is physically not strong enough, he achieves the power to tolerate
serious exogenous and endogenous diseases without much difficulty if he possesses
ºÉi´É of superior quality.
º´É±É{É¶É®úÒ ®ú É ½þ ªÉÊ{É iÉä ÊxÉVÉÉMÉxiÉÖ ÊxÉÊ¨ÉkÉÉºiÉÖ ¨É½þi ÉÒ¹ÉÖ +Ê{É
{ÉÒb÷ É ºÉÖ +´ªÉlÉÉ où ¶ªÉxiÉä ºÉi´ÉMÉÖh É´Éè¶Éä¹ªÉÉiÉÂ **
Individuals with ¨ÉvªÉºÉi´É ie having mediocrity of mental faculties tolerate the pain
themselves when they realise that others can also tolerate such pain. Thus,
occasionally, they gain mental strength from others.
¨ÉvªÉºÉi´ÉÉºiÉÖ +{É®úÉxÉÂ +Éi¨ÉÊxÉ ={ÉÊxÉvÉÉªÉ ºÉÆºiÉ¨¦ÉªÉÎxiÉ +Éi¨ÉxÉÉ {É®èú´ÉÉÇÊ{É ºÉÆºiÉÉ¦ªÉxiÉä **
Those with ½þÒxÉºÉi´É can sustain their mental strength neither by themselves
nor with the help of others. They may be stout, but would nbot tolerate even mild
pain. They are susceptible to fear, grief, greed, delusion and ego. They cannot
stand the sight of blood or terrifying situations and may be led to pallor, fainting,
madness or even death by such events.
½þÒxÉºÉi´ÉÉºiÉÖ xÉ +Éi¨ÉxÉÉ xÉÉÊ{É {É®èú& ºÉi´É¤É±ÉÆ |ÉÊiÉ¶ÉCªÉxiÉä
={ÉºiÉ¨¦ÉÊªÉiÉÖÆ, ¨É½þÉ ¶É®úÒ®úÉ ½þªÉÉÊ{É iÉä º´É±É{ÉÉxÉÉÆ +Ê{É ´ÉänùxÉÉxÉÉÆ
+ºÉ½þÉ où¶ªÉxiÉä * ºÉÊxxÉÊ½þiÉ ¦ÉªÉ ¶ÉÉäEò ±ÉÉä¦É ¨ÉÉä½þ-¨ÉÉxÉÉ
®úÉèpù ¦ÉäJÉ Êuù¹]õ ¤ÉÒ¦ÉiºÉ Ê´ÉEÞòiÉ ºÉÆEòlÉÉº´ÉÊ{É SÉ {É¶ÉÖ{ÉÖ¯û¹É
¨ÉÉÆºÉ¶ÉÉäÊhÉiÉÉÊxÉ SÉ +´ÉäIªÉ Ê´É¹ÉÉnù ´Éè´ÉhlÉÇ ¨ÉÚSUÇô =x¨ÉÉnù §É¨É
|É{ÉiÉxÉÉxÉÉÆ +xªÉiÉ¨ÉÆ +É{xÉÖ´ÉÎxiÉ +lÉ´ÉÉ ¨É®úhÉÊ¨ÉÊiÉ * (SÉ. Ê´É. 8/119)
Uses of ºÉi´É{É®úÒIÉÉ
1. ºÉi´É{É®úÒIÉÉ is essential to decide upon the correct mode of treatment for a patient.
For example, in case of ¶ÉºjÉEò¨ÉÇ and for sodhana like ´É¨ÉxÉEò¨ÉÇ, the patient must
necessarity be ºÉi´É´ÉÉxÉÂ.
2. Lack of ºÉi´É¤É±É increases the chances for certain diseases like =x¨ÉÉnù. So, to
some extent, ºÉi´É{É®úÒIÉÉ can give dues about the ÊxÉnùÉxÉ of such diseases.
8. +É½þÉ®ú¶ÉÊHò
It is the capacity for intake of food by a person. One’s capacity for food can
be examined from two angles - by examining.
(a) The power of ingestion
(b) The power of digestion
+É½þÉ®ú¶ÉÊHòiÉ¶SÉäÊiÉ +É½þÉ®ú¶ÉÊHò& +¦ªÉ´É½þ®úhÉ¶ÉEòiªÉÉ VÉ®úhÉ¶ÉEòiªÉÉ SÉ {É®úÒIªÉÉ * (SÉ.Ê´É.8/120)
Both the strength and life span of a person can be determined by his diet.
¤É±ÉÉªÉÖ¹ÉÒ Ê½þ +É½þÉ®úÉªÉkÉä (SÉ. Ê´É. 8/120)
+¦ªÉ´É½þ®úhÉ¶ÉÊHò & VÉ®úhÉ¶ÉÊHò are interdependent factors. Depending on the VÉ®úhÉ¶ÉÊHò
(digestive capacity) agni is classified into four types.
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+ÎMxÉ¹ÉÖ iÉÖ ¶É®úÒ®äú¹ÉÖ SÉiÉÖÌ ´ÉvÉÉä Ê´É¶Éä¹ÉÉä ¤É±É¦Éänäù xÉ ¦É´ÉÊiÉ *
iÉvÉlÉÉ - iÉÒIhÉÉä ¨Éxnù & ºÉ¨ÉÉä Ê´É¹É¨É¶SÉäÊiÉ * (SÉ. Ê´É. 6/9)
The association between agni and the doshic constitution of a person is
described by Charaka as -
<iªÉäi Éä SÉiÉÖÌ ´ÉvÉÉä ¦É´ÉxiªÉMxÉªÉ¶SÉ, SÉiÉÖÌ ´ÉvÉÉxÉÉ¨Éä´ É {ÉÖ¯ û¹ÉÉhÉÉ¨ÉÂ -
iÉjÉ ºÉ¨É´ÉÉiÉÉÊ{ÉkÉ¶±Éä¹ ¨ÉÉhÉÉÆ |ÉEÞò ÊiÉºlÉÉxÉÉÆ ºÉ¨ÉÉ ¦É´ÉÎxiÉ
+MxÉªÉ& * ´ÉÉiÉ±ÉÉxÉÉxiÉÖ ´ÉÉÆi ÉÉÊ¦É¦ÉÚi Éä +MxªÉÊvÉ¹`öÉ xÉä Ê´É¹É¨ÉÉ
¦É´ÉÎxiÉ +MxÉªÉ& * Ê{ÉkÉÉÊ¦Éuù i Éä Ê½þ +MxªÉÊvÉ¹`öÉ xÉä lÉÒIhÉÉ
¦É´ÉÎxiÉ +MxÉªÉ& * ¶±Éä¹¨É±ÉÉxÉÉxiÉÖ ¶±Éä¹¨ÉÉÊ¦É¦ÉÚi Éä Ê½þ
+MxªÉÊvÉ¹`öÉ xÉä ¨Éxnù É ¦É´ÉxiªÉMxÉªÉ& * (SÉ. Ê´É. 6/10)
The doshic constitution has an influecne over the agni and similarly, agni becomes
responsible for dosha vikriti which is specific to it. Thus, Ê´É¹É¨ÉÉÎMxÉ leads to diseases
characterised by ´ÉÉiÉ|ÉEòÉä{É, iÉÒIhÉÉÎMxÉ is responsible for {ÉèÊkÉEò vikaras and ¨ÉxnùÉÎMxÉ causes
Eò¡òVÉ vikaras.
Ê´É¹É¨ÉÉä ´ÉÉiÉVÉÉxÉÂ ®ú É äMÉÉxÉ iÉÒIhÉÉä Ê{ÉkÉÊxÉÊ¨ÉkÉVÉÉxÉÂ
Eò®úÉ äi ªÉÉÎMxÉºiÉlÉÉ ¨Éxnù É ä Ê´ÉEòÉ®ú É xÉÂ Eò¡òºÉ¨¦É´ÉÉxÉÂ *
Deviations from the normal diet pattern would not cause much harm in a person
with iÉÒIhÉÉÎMxÉ. But ¨ÉxnùÉÎMxÉ is very sensitive to such changes. ºÉ¨ÉÉÎMxÉ can be maintained
by following proper diet, but +xÉ{ÉSÉÉ®ú tends to disrupt its normalcy. Ê´É¹É¨ÉÉÎMxÉ shows
unstable characteristics.
iÉjÉ iÉÒIhÉÉäÎ MxÉ& ºÉ´ÉÉÇ{ ÉSÉÉ®úº É½þ& , iÉnÂù Ê´É{É®úÒ iÉ±ÉIÉhÉºiÉÖ
¨Éxnù , ºÉ¨ÉºiÉÖ JÉ±ÉÖ +{ÉSÉÉ®úi ÉÉä Ê´ÉEÞò ÊiÉ¨ÉÉ{ÉvÉiÉä, +xÉ{ÉSÉÉ®úi ÉºiÉÖ
JÉ±ÉÖ +{ÉSÉÉ®úi ÉÉä +Ê´ÉEÞò ÊiÉ¨ÉÉ{ÉvÉiÉä, +xÉ{ÉSÉÉ®ú º iÉÖò |ÉEÞò iÉÉè B´É
+´ÉÊiÉ¹`öi Éä, ºÉ¨É±ÉIÉhÉ-Ê´É{É®úÒ iÉ±ÉIÉhÉºiÉÖ Ê´É¹É¨É& * (SÉ. Ê´É. 6/9)
Importance of +É½þ É®ú ¶ ÉÊHò {É®ú Ò IÉÉ
1. Agni is said to be one of the main determining factors of health and disease
(®úÉäMÉÉ& ºÉ´ÉæÊ{É ¨ÉxnùÉMxÉÉè). It is a good indicator of dosha predominance both in health
and disease.
2. The mode of treatment and the dosage of drug can be decided only after
assessing the agnibala of the patient.
3. VÉ`ö®úÉÎMxÉ is the basic factor that influences the state of doshas, dhatus and
malas in the body.
In short, the condition of º´ÉÉºlÉªÉ cannot be attained without maintaining ºÉ¨ÉÉÎMxÉ
and +É½þÉ®ú¶ÉÊHò is one of the easiest aids to detect any disorder in the equilibrium
since even the slightest derangement manifests easily and grossly in it.
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Uses
1. Helps to know the ¶É®úÒ®ú¤É±É.
2. Helps in differential diagnosis especially in diseases related to disorder of
agni. If agni is Ê´É¹É¨É - the disease is possibly caused by ´ÉÉiÉ, if iÉÒIhÉ - Ê{ÉkÉ and if
¨Éxnù - Eò¡ò.
3. Helps in selecting correct line of treatment.
Eg: ´É¨ÉxÉ should be done ¨ÉxnùÉÎMxÉ & Ê´É®úÉäSÉxÉ for iÉÒIhÉÉÎMxÉ.
4. Helps in fixing dosage of medicine.
Eg: In snehapana - ¿º´É, ¨ÉvªÉ¨É, =kÉ¨É matras are indicated, according to agnibala.
9. ´ªÉÉªÉÉ¨É¶ÉÊHòþ
The patient must be examined with refernece to his capacity for exercise,
which is determined by his ability to perform work.
´ªÉÉªÉÉ¨É¶ÉÊHòiÉ¶SÉäÊiÉ - ´ªÉÉªÉÉ¨É¶ÉÊHò®úÊ{É Eò¨ÉÇ¶ÉHòªÉÉ {É®úÒIªÉÉ * (SÉ. Ê´É. 8/121)
Here, Eò¨ÉÇ means physical work and the ability to do physical work is Eò¨ÉÇ¶ÉÊHò.
Eò¨ÉÇ ¦ÉÉ®ú´É½þxÉÉÊnù, iÉjÉ ¶ÉÊHò& Eò¨ÉÇ¶ÉÊHò *
The ability fo exercise is also graded as three.
1. Mild 2. Moderate 3. Good
Eò¨ÉÇ - ¶ÉCiªÉÉ Ê½þ +xÉÖ¨ÉÒªÉiÉä ¤É±ÉjÉèÊ´ÉvªÉ¨ÉÂ * (SÉ. Ê´É. 8/121)
The ability to do physical work is the integrated function of all the systems in
the body. So the state of function of these systems can be indirectly assessed
from the ´ªÉÉªÉÉ¨É¶ÉÊHò.
´ªÉÉªÉÉ¨É¶ÉÊHò of the whole body and also of the individual parts can be assessed
in different pathological conditions.
Eg: In >ð¯ûºiÉ¨¦É, the affected limb becomes difficult to be lifted and moved (EÞòSUôÉärù®úhÉ).
In {ÉIÉÉPÉÉiÉ half of the body becomes incapable of movement.
(EÞòiºxÉÉävÉÇEòÉªÉºiÉºªÉ ºªÉÉnùEò¨ÉÇhªÉÉä Ê´ÉSÉäiÉxÉ& *)
Uses
1. It helps to assess the ¶É®úÒ®ú¤É±É and also ºÉi´É¤É±É (Eò±Éä¶ÉºÉ½þ)
2. It is also part of ºÉÉi¨ÉªÉ{É®úÒIÉÉ (´ªÉÉªÉÉ¨ÉºÉÉi¨ªÉ)
3. In some cases, it helps to elicit the nidana.
+ÊiÉ´ªÉÉªÉÉ¨É results in ´ÉÉiÉÊ´ÉEòÉ®ú and +±É{É´ªÉÉªÉÉ¨É results in Eò¡òVÉ disorders.
10. ´ÉªÉ&
Age represents the state of a person’s body, depending upon the length of
time that has passed since birth.
´ÉªÉºÉ¶SÉäÊiÉ - EòÉ±É|É¨ÉÉhÉÊ´É¶Éä¹ÉÉ{ÉäÊIÉhÉÒ Ê½þ ¶É®úÒ®úÉ´ÉºlÉÉ ´ÉªÉÉäÊ¦ÉvÉÒªÉiÉä ** (SÉ. Ê´É. 8/122)
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Age is broadly of three types
iÉuùªÉÉä ªÉlÉÉ ºlÉÚ±É¦ÉänäùxÉ ÊjÉÊ´ÉvÉÆ - ¤ÉÉ±ÉÆ ¨ÉvªÉÆ VÉÒhÉÇÊ¨ÉÊiÉ * (SÉ. Ê´É. 8/122)
Young age is again divided in to two stages.
1. Immature stage - upto 16th yr. of age.
2. Maturing stage - upto 30th yr. of age.
During immature stage, the body is not well developed. It is tender and of
incomplete strength. Kapha dominates in this period and the individual cannot
tolerate difficulties.
iÉjÉ ¤ÉÉ±ÉÆ +{ÉÊ®ú{ÉC´É vÉÉiÉÖÆ +VÉÉiÉ´ªÉ\VÉxÉÆ ºÉÖEÖò¨ÉÉ®Æú +Eò±Éä¶ÉºÉ½Æþ
+ºÉ¨{ÉÚhÉÇ¤É±ÉÆ ¶±Éä¹¨ÉvÉÉiÉÖ|ÉÉªÉÆ +É¹ÉÉäb÷¶É´É¹Éæ *
During the next stage of maturing, the mental faculties are not properly
developed.
Ê´É´ÉvÉÇ¨ÉÉxÉvÉÉiÉÖMÉÖhÉÆ {ÉÖxÉ& |ÉÉªÉähÉ +xÉ´ÉÎºlÉiÉ ºÉi´ÉÆ
+ÉÊ¸É¶ÉnÂù ´É¹ÉÈ ={ÉÊnù¹]¨ÉÂ *
During middle age lasting upto sixtieth year, the physical, mental and
intellectual qualities are well manifested. There is prominence of pithadosha in
this period.
¨ÉvªÉ¨ÉÆ {ÉÖxÉ& ºÉ¨Éi´ÉÉMÉiÉ ¤É±É ´ÉÒªÉÇ {ÉÉè¯û¹É {É®úÉGò¨É OÉ½þhÉ vÉÉ®úhÉ
º¨É®úhÉ ´ÉSÉxÉ Ê´ÉYÉÉxÉ ºÉ´ÉÇvÉÉiÉÖMÉÖhÉÆ ¤É±ÉÎºlÉiÉÆ +´ÉÎºlÉiÉºÉi´ÉÆ
+Ê´É¶ÉÒªÉÇ¨ÉÉhÉvÉÉiÉÖMÉÖhÉÆ, Ê{ÉkÉvÉÉiÉÖ|ÉÉªÉÆ +É¹ÉÎ¹`ö´É¹ÉÈ ={ÉÊnù¹]õ¨ÉÂ *
Thereafter during old age, gradual diminition, of all these qualities occurs.
Vatha gains dominance over the other doshas.
+iÉ& {É®Æú ½þÒªÉ¨ÉÉxÉ vÉÉiÉÖ <ÎxpùªÉ ¤É±É ´ÉÒªÉÇ {ÉÉè¯û¹É {É®úÉGò¨É
OÉ½hÉ vÉÉ®úhÉ º¨É®úhÉ ´ÉSÉxÉ Ê´ÉYÉÉxÉÆ §É¶ªÉ¨ÉÉxÉ vÉÉiÉÖMÉÖþhÉÆ
´ÉÉªÉÖnùÉiÉÖ|ÉÉªÉÆ Gò¨ÉähÉ VÉÒhÉÇ¨ÉÖSªÉiÉä +É¤É¶ÉiÉ¨ÉÂ
Since in these three stages of life each of the three doshas are dominant, the
person becomes more liable to be affected by diseases caused by the particular
dosha at a particular period of life. Besides, in old age, the dhatus are in the
degenerative stage and it will be reflected in the ºÉÉ®ú, ºÉÆ½þxÉxÉ, ºÉi´É, ´ªÉÉªÉÉ¨É¶ÉÊHò and
+É½þÉ®ú¶ÉÊHò of the person.
It is also said that ¤ÉÉ±É and ´ÉÞrù are unlike the ¨ÉvªÉÉ´ÉºlÉÉ, weak and so special
care should be taken while prescribing treatment for these people.
Advantages of ´ÉªÉ& {É®úÒIÉÉ
1. To know the ¶É®úÒ®ú¤É±É and ºÉi´É¤É±É. These are excellent in youth and less in ¤ÉÉ±É
and ´ÉÞrù.
45
2. To fix the dosage of medicine and the type of treatment.
3. To know the prognosis of the disease.
Special attention should be given in case of doing sodhana therapy.
Eg: Nasya is contra indicated below 7 years and above 80 years. Dhoomapana
below 18 years, Kabalam - below 5 years, Virechanam - below 10 years and
above 70 years are not advised in normal condition.
Peculiarities in Dashavidha Pareeksha of Vagbhata
Vagbhata has included the whole of Vikruti Pareeksha under Dooshya
Pareeksha.
Unlike Charaka, Vagbhata includes Desha Pareeksha and Kala Pareeksha in
Dashavidha Pareeksha. Charaka explains it under Dashavidha Pareeksha.
näù¶É
Desa is considered in terms of both the patients body and his dwelling place.
¦ÉÚÊ¨Énäù½þ|É¦ÉänäùxÉ näù¶É¨ÉÉ½ÖþÊ®ú½þ ÊuùvÉÉ *
1. ¦ÉÚÊ¨Énäù¶É - Land is of three types. - VÉÉÆMÉ±É, +ÉxÉÚ{É and ºÉÉvÉÉ®úhÉ. Of these, VÉÉÆMÉ±Énäù¶É is
predominant in ´ÉÉiÉ and +ÉxÉÚ{Énäù¶É is predominant in Kapha. ºÉÉvÉÉ®úhÉnäù¶É maintains is
equilibrium of doshas.
2. näù½þnùä ¶É - In this, the site of manifestation of disease or the site where dosha
kopa occurs etc. are considered.
According to Charaka, ¦ÉÚÊ¨É{É®úÒIÉÉ has two objectives
1. for +ÉiÉÖ®ú{ÉÊ®úYÉÉxÉÆ 2. for +Éè¹ÉvÉ{ÉÊ®úYÉÉxÉÆ
iÉjÉ ¦ÉÚÊ¨É{É®úÒIÉÉ +ÉiÉÖ®ú{ÉÊ®úYÉÉxÉ½äþiÉÉä´ÉÉÇ ºªÉÉùnÂù +Éè¹ÉvÉ{ÉÊ®úYÉÉxÉ ½äþiÉÉä´ÉÉÇ *
For +ÉiÉÖ®ú{ÉÊ®úYÉÉxÉ, the following points are to be examined.
1. Place of birth, growth and affliction with disease.
2. Specific features concerning +É½þÉ®ú, Ê´É½þÉ®ú, +ÉSÉÉ®ú, ¤É±É¨ÉÂ, ºÉi´É, ºÉÉi¨ªÉ, nùÉä¹É, ¦ÉÊHò,
´ªÉÉÊvÉ, Ê½þiÉÆ and +Ê½þiÉÆ.
iÉjÉ iÉÉ´ÉÉÊnùªÉ¨ÉÉiÉÖ®ú{ÉÊ®úYÉÉxÉ½äþiÉÉä& * iÉvÉlÉÉ - +ªÉÆ EòÎº¨ÉxÉÂ ¦ÉÚÊ¨Énäù¶ÉÉä VÉÉiÉ&
ºÉÆ´ÉÞrùÉä ´ªÉÉÊvÉiÉÉä ´ÉÉ, iÉÏº¨É¶SÉ ¦ÉÚÊ¨ÉiÉä¶Éä ¨ÉxÉÖ¹ªÉÉhÉÉÆ <nÆù +É½þÉ®úVÉÉiÉÆ, <nÆ Ê´É½þÉ®úVÉÉiÉÆ,
<nÆù +ÉSÉÉ®úVÉÉiÉÆ, BiÉÉ´ÉSUô ¤É±ÉÆ, B´ÉÆ Ê´ÉvÉÆ ºÉi´ÉÆ, B´ÉÆ Ê´ÉvÉÆ ºÉÉi¨ªÉÆ, B´ÉÆ Ê´ÉvÉÉä nùÉä¹É&,
¦ÉÊHòiÉÊ®úªÉ¨ÉÂ, <¨Éä ´ªÉÉvÉªÉ&, Ê½þiÉÊ¨ÉnÆù, +Ê½þiÉÊ¨ÉnùÊ¨ÉÊnù |ÉªÉÉä OÉ½þhÉäxÉÆ *
In the case of +Éè¹ÉvÉ{ÉÊ®úYÉÉxÉ, ¦ÉÚÊ¨É{É®úÒIÉÉ is important for collection drugs suitable
for a patients natural constitution and his habitat, and also that which suits his
pathological condition.
46
EòÉ±É&
EòÉ±É& {ÉÖxÉ& ºÉÆ´ÉiºÉ®ú¶SÉÉiÉÖ®úÉ´ÉºlÉÉ SÉ *
Charaka divides EòÉ±É into ºÉÆ´ÉiºÉ®ú (IÉhÉÊnùEòÉ±É) and +ÉiÉÖ®úÉ´ÉºlÉÉ.
ºÉÆ´ÉiºÉ®úEòÉ±É - Includes consideration of the 6 rithus based on which the natural
course of SÉªÉ, |ÉEòÉä{É and ¶É¨É of doshas occur. EòÉ±É{É®úÒIÉÉ in this sense
is important since.
1. The state of doshas can be determined.
2. The therapies especially ¶ÉÉä v ÉxÉ has certain specific indications and
contraindication in specific seasons.
3. Collection and preparation of drugs should be done in the particular season
indicated for them. Otherwise, the desired effect is not produced.
Eg: iÉjÉ ºÉÉvÉÉ®ú±ÉIÉhÉä¹ÉÖ ¸ÉÞiÉÖ¹ÉÖ ´É¨ÉxÉÉnùÒxÉÉÆ |É´ÉÞÊkÉÌ´ÉvÉÒªÉiÉä, ÊxÉ´ÉÞÊkÉÊ®úiÉ®äú¹ÉÖ *
+ÉiÉÖ®úÉ´ÉºlÉÉEòÉ±É& The determination of utility of a particular medicine depends upon
the state of the patient. (+ÉiÉÖ®úÉ´ÉºlÉÉ) or the disease. The therapy does not produce its
desired effect if administered after the passage of or before the arrival of the night
time. So +ÉiÉÖ±ÉÉ´ÉºlÉÉEòÉ±É is the time which determines the manifestation of the desired
effects of the therapy administered.
Eg: In xÉ´ÉV´É®ú, Kashaya is indicated only after the 6th day.
47
SROTOPAREEKSHA
The formation of any disease takes place only, when there is a combination
of vitiated dosha, dhatu in turn manifested by the affected srotas. The term srotas
comprehends all channels, big small and perceptible and imperceptible and it is
referred with different synonyms like siras, dhamanis, rasayanis, saravahini nadis,
margas, sthana, ashayas, niketanan etc. For the therapeutic purpose srotases
described are only sthoola srotas which are of two types.
(1) Bahirmukha Srotas - include all the 9 external openings ie 2 nasal pasages, 2
eyes, aural openings mouth, urethra, anus. In women other 2, a genital passage and
2 lacteal passages are present in excess.
Antarmukha Strotas - Charaka enumerated 13 types of strotas ie
Pranavaha Srotas Udaka Vaha Srotas
Annavaha Srotas Rasavaha Srotas
Rakthavaha Srotas Mamsavaha Srotas
Medavaha Srotas Asthivaha Srotas
Majjavaha Srotas Suklavaha Srotas
Mutravaha Srotas Purishavaha Srotas
Swedavaha Srotas
Susrut having an emphasize on surgical procedures has left out the Ashivaha,
majjavaha, Swedavaha Srotas and included one more srotas, Artavaha Srotas.
Kashyapa described garbhasaya as ‘Vipula Srotas’ Sukshma srotas are
numerous in no man itself is defined as ‘Conglemeration of Srotamsi’ which persue
the entire body. In Ayurveda all the diseases are caused by ‘Khavaigunya’ ie the
impairment of the functional intergrity of srotas. It may occur due to any of 4
forms. They are Atipravrithi or sunga or sira grandhi or vimarga gamana. General
most of the diseases are Srotovedhajanga.
+ÊiÉ|É´ÉÞÊkÉ, ºÉÆRóMÉÆ, ÊºÉ®ÉOÉÎxvÉ and Ê´É¨ÉÉMÉÇMÉ¨ÉxÉÆ are the sins of srothodushty. These signs are
applicable to all the srothases. In each and every disease there will be envolvement
of the respective srothas/srothases and the dushty will produce any of the above
signs. In Samhithas disease pretaining to different srothases are explained in
detail. In my paper I would prefer to differentiate diseases of various srothases
according to the type of involved dushty.
Pranavahasrota (Respiratory System)
Cough with sputum, Haemoptysis, chest pain comes under the symptoms of
48
vitiation of Pranavaha Srotas.
4 types of |ÉhÉ´É½þ »ÉÉäi ÉÉäÊ ´ÉEòÉ®ú
1. +ÊiÉ|É´ÉÞÊkÉ - ¨É½þÉ·ÉÉºÉ, >ðv´ÉÇ·ÉÉºÉ
2. ºÉÆMÉ - xÉÉºÉÉxÉÉ½þ, |ÉÊiÉ¶ªÉÉªÉ
3. ÊºÉ®úÉOÉÎxlÉ - ¶ÉiÉÉÎvxÉ
4. Ê´É¨ÉÉMÉÇMÉ¨ÉxÉ - Ê½þCEò, EÞòSUôJÉÉºÉ
Annavaha Srotas (Alimentary System)
Abdominal pain, +ÉxÉÉ½þ, =UôÉ´ÉiÉÇ include in it as the main symptoms of vitiation.
4 types of +zÉ´É½þ¸ÉÉäiÉÉäÊ´ÉEòÉ®ú
1. +ÊiÉ|É´ÉÞÊkÉ - +ÊiÉºÉÉ®ú, |É{ÉÉÊ½þEò, OÉ½þÊhÉ
2. ºÉÆMÉ - =nùÉ´ÉÞiÉÇ, +ÉxÉÉ½þ, +Év¨ÉÉxÉ
3. ÊºÉ®úÉOÉÎxlÉ - +¶ÉÇ
4. Ê´É¨ÉÉMÉÇ{ÉÉ¨ÉxÉ - UôÒnæù, {ÉÖ®úÒ¹ÉVÉ=nùÉ´ÉiÉÇ
=nùEò - º´Éänù - ¨ÉänùÉä´É½þ»ÉÉäiÉºÉÂ (Water balancing system)
4 types of =nùEòº´Éänù¨ÉänùÉä´É½þ»ÉÉäiÉÉä Ê´ÉEòÉ®ú&
1. +ÊiÉ|É´ÉÞÊkÉ - iÉÞ¹hÉ
2. ºÉÆMÉ - VÉ±ÉÉänù®ú
3. ÊºÉ®úÉOÉÎxlÉ - OÉÎxlÉ, +¤ÉÖÇnù
4. Ê´É¨ÉÉMÉÇ MÉ¨ÉxÉ - ¶ÉÉälÉ
®úºÉ´É½þ»ÉÉäiÉ (Cardiovascular system)
A distinction between the circulating rasa and rakta is not possible as it
composite a complex flowing tissue.
4 types of ®úºÉ´É½þ»ÉÉäiÉÉäÊ´ÉEòÉ®ú
1. +ÊiÉ|É´ÉÞÊkÉ - +vÉªÉÉÎºlÉ, MÉ±É¶ÉÖÊhÉ, +ÊvÉ¨ÉÉÆºÉ
2. ºÉÆMÉ - >ð¯ûºiÉ¨¦É, {ÉIÉÉPÉÉiÉ, +ÌnùiÉ
3. ÊºÉ®úÉOÉÎxlÉ - ¨ÉÉÆºÉVÉOÉÎxlÉ
4. Ê´É¨ÉÉMÉÇMÉ¨ÉxÉ - +xiÉ®úÉªÉÉ¨É, ¤ÉÊ½þ®úÉªÉÉ¨É, +{ÉxÉxiEò
¨ÉÚjÉ´É½þ»ÉÉäiÉÉänÖùÎ¹]õ (Genetic Urinary System)
4 types of ¨ÉÚjÉ´É½þ»ÉÉäiÉÉäÊ´ÉEòÉ®ú
1. +ÊiÉ|É´ÉÞÊkÉ - ¨ÉvÉÖ¨Éä½þ, +ºÉÞEònùÉ®ú, ¶ÉÖC±ÉÉ¶¨ÉÉÊ®úú
2. ºÉÆMÉ - ¨ÉÚjÉÉPÉÉiÉ, ¶ÉÚ±ÉIÉªÉ
3. ÊºÉ®úÉOÉÎxlÉ - ¨ÉÚjÉVÉ`ö®ú, +¹]õÒ±ÉÉ, ¶ÉEÇò®ú
4. Ê´É¨ÉÉMÉÇMÉ¨ÉxÉ - ¨ÉÚjÉ´ÉÞÊrù
49
EXAMINATION OF INFANTS AND CHILDREN
Examination of the Infants are very difficult as they cannot express their grieves
in words, most of the things are to be observed through inference or from mother,
who is more reliable than others.
Kashyapa in his chapter named Vedananam Adhyam has elaborately
explained the methods for examining a child to arrive a diagnosis.
Seersha roga - tremors of head, blinking of eyes
Karma soola - oscillatory movement of head, touching ear with his hand,
reluctance to feeding, sleeplessness.
Mukha roga - Salivation, vomiting of milk.
Kanta vedana - forceful expulsion of milk, anorexia.
Udara Shoola - Weeping by raising up his abdomen, sweating over face.
Athisara - Discolouration of skin, pain, obstruction of vata, insommia.
Swasa - Frequent warmth respiration.
Trishna - Dryners of lips and palate, liking towards water.
Mutra Krichra - Touching the site of bladder, hiting lips.
Prameha - Heaviness in the body, inertia, sudden onset of polyurea.
Asmari - Pain and weeping during micturation.
Peenasa - Buccal respiration during milking.
Pandu - Swelling around umbilicus and eye balls.
Kandu - Scratch marker and dryness in skin.
Grahani - Weight loss with diarrhoea.
Kashyapa and Susrut gives a general inference that the severity of pain is in
proportional to child’s weeping. Frequent touching of a point denote pain at that
site and blinking of eyes in headache. Vagbhata, specially describes some diseases
occuring in neonatal period as ‘Jala Seershaka’, ‘Kukunaka’ which are caused in
neonates. The latter occurs during dental Erysepalous neonatorum ie known as
‘Mahapadma Visarpa’. Scrotal inflammation in children as Kuruandaka. Rectal
ulceration and burnings are described as ‘Andhaputana graha’ and ‘Anamika’.
Aversion of milk in important indication of many graha vyadhis. Thus an infant
should be examined with Yukti, Anumana, Aptopadesha and Pratyaksha pramanas.
50
ROGA PAREEKSHA
Different aspects of the disease has to be examined next. It is done by Roga
Pareeksha. Pancha Nidana examination is for identifying the different aspects of
Roga. This includes Nidanan, Poorvaroopam, Roopam, Upasayam and
Samprapthi. A brief description is worth stating.
ÊxÉnùÉxÉÆ {ÉÚ´ÉÇ°ü{ÉÉÊhÉ °ü{ÉÉhªÉÖ{É¶ÉªÉºiÉlÉÉ *
ºÉÆ|ÉÉÎ{iÉ¶SÉäÊiÉ Ê´ÉYÉÉxÉÆ ®úÉäMÉÉhÉÉÆ {É\SÉvÉÉ º¨ÉÞiÉÆ **ú (¨ÉÉ. ÊxÉ)
1. Nidana
Nidana is the important factor in estimating and understanding a disease.
The word Nidana is defined by various scholars of Ayurveda. The definitions of
Nidana are as follows:
ÊxÉÌnù¶ÉªÉiÉä ´ªÉÉÊvÉ®úxÉäxÉ <ÊiÉ ÊxÉnùÉxÉ¨ÉÂ * (¨ÉvÉÖ; ¨ÉÉ. ÊxÉ. - 1/-)
Nidana is one which gives complete knowledge of a disease.
ÊxÉÎ¶SÉiªÉ nùÒªÉiÉä |ÉÊiÉ{ÉÉvªÉiÉä ´ªÉÉÊvÉ®úxÉäxÉäÊiÉ ÊxÉnùÉxÉ¨ÉÂ * (VÉäVVÉ]õ ¦É]Âõ]õÉ®ú ½þÊ®úSÉxpù)
Nidana is the one by which one can get the knowledge regarding a disease.
Nidana is the one which gives the description of causative factors and the clinical
features. Nidanas are considered as the factors to know the cause of the manifested
or unmanifested disease. Eg. in the disease called pandu, eating the mud is
considered as the definite cause.
The assessment of Nidana will be helpful in assessing the prognosis of a
disease. ie. if the causative factor is mild, then the disease is curable and if the
causative factor is much virulent and is in contact with the body for longer duration,
then the disease is considered as incurable.
In the classics, it is being told that the avoidance of the causative factor is the
prime and first line of management in treating any type of disease.
According to Ayurveda various type of Nidanas.
4 types : ºÉÊzÉEÞò¹]õ, Ê´É|ÉEÞò¹]õ, ´ªÉÊ¦ÉSÉÉÊ®ú, |ÉÉvÉÉÊxÉEò
3 types : +ºÉÉi¨ªÉäÎxpùªÉÉlÉÇºÉÆªÉÉäMÉ, |ÉYÉÉ{É®úÉvÉ, {ÉÊ®úhÉÉ¨É
3 types : nùÉä¹É½äþiÉÖ, ´ªÉÉÊvÉ½äþiÉÖ, =¦ÉªÉ½äþiÉÖ
2 types : =i{ÉÉnùEò ½äþiÉÖ, ´ªÉ\VÉEò ½äþiÉÖ
2 types: ¤ÉÉÁ½äþiÉÖ, +É¦ªÉxiÉ®ú ½äþiÉÖ
It can again be sub-classified into
3 types : IÉªÉ, ºlÉÉxÉ, ´ÉÞÊrù
2 types : |ÉÉEÞòiÉ, ´ÉèEÞòiÉ
2 types : +xÉÖ¤ÉxvªÉ, +xÉÖ¤ÉxvÉ
51
2 types : |ÉEÞòÊiÉ, Ê´ÉEÞòÊiÉ
1 type : +É¶ÉªÉÉ{ÉEò¹ÉÇ
2 types : ºÉÉ¨É, ÊxÉ®úÉ¨É
2. Purvarupa
The initial symptoms produced during the course of disease is termed as
Purvarupa. These are symptoms suggestive of the forthcoming disease. The
purvarupa is the lakshanas that occurs during the course of onset of a disease
and during this period the lakshanas will be unmanifested (Avyaktha) or poorly
manifested (Alpa Avyaktha). It anyhow does not indicate the specificity of the
Roga, ie, regarding the Dosha involved etc.
.......................|ÉÉOÉÚ{ÉÆ ªÉäxÉ ±ÉIªÉiÉä *
=Îi{ÉiºÉÖ®úÉ¨ÉªÉÉä nùÉä¹ÉÉÊ´É¶Éä¹ÉähÉÉxÉÊvÉÎ¹`öiÉ& **
Ê±ÉRóMÉÆ¨É´ªÉHò¨É±{Éi´ÉÉiÉ, ´ªÉÉvÉÒxÉÉÆ iÉvlÉÉªÉlÉÆ ** (¨ÉÉ. ÊxÉ)
Purvarupas are those lakshanas produced by the doshas during the fourth
stage of kriyakala and these are indicative of the development of a disease.
Proper identification of the disorder or to differentiate the disorders that have
almost similar symptoms. Eg: In case of Prameh and Rekthapitha. Charaka has
told that in those patients having yellowish, reddish urine without history of Prameha
purvarup, it should not be diagnosed of having Prameh, but it should be diagnosed
as Rekthapitha. Purvarupas helps to assess the Sadhyasadhyatha (prognosis) of
the disease.
3. Rupa
Rupa is an important vyadhibodhak hethu among the nidana panchaka and
is one among the thrisutra of Ayurveda.
Rupa is both the signs and (objective) and symptoms (subjective) of a disease
and is the prominent diagnostic key of a disease. The various definitions found in
the classics are:
iÉnäù´É ´ªÉHòiÉÉÆ ªÉÉiÉ °ü{ÉÊ¨ÉiªÉÊ¦ÉvÉÒªÉiÉä *
ºÉÆºlÉÉxÉÆ ´ªÉ\VÉxÉÆ Ê±ÉRóMÉÆ ±ÉIÉhÉÆ ÊSÉ¼xÉ¨ÉÉEÞòÊiÉ& ** (+. ¾þ. ÊxÉ)
Rupa gives information about the involved dosha and its severity. According
to the manifestation of different Rupas, we can assess the degree of vitiation of
different dosha, i.e., Ekadoshaj, Samsargaja and Sannipathaja and this helps in
planning the proper management. Rupa is helpful to assess the site of the lesion.
Eg: Hridroga, Shirasoola
Each disease is explained in our science as Rupasamudaya or group of
symptoms and this is helpful for the proper diagnosis of a particular disease. Eg:
Ekadasarupa of Yakshma.
52
Rupa is useful to list the differential diagnosis and to know the prognosis of a
disease. Rupa is a prominent diagnostic tool of a disease.
4. Upasaya
The administration of Aushadha (medicine), Ahara (food) and Vihara (regimen)
which are either antagonistic or similar to hethu (cause), vyadhi (disease) or both
hethuvyadhi (cause and disease) are called Upashaya when it produces a relief in
the symptoms and are called Anupashay when there is aggrevation of the
symptoms.
½äþiÉÖ´ªÉÉÊvÉÊ´É{ÉªÉÇºiÉÊ´É{ÉªÉÇºiÉÉlÉÇEòÉÊ®úhÉÉ¨ÉÂ *
+Éè¹ÉvÉÉzÉÊ´É½þÉ®úÉhÉÉ¨ÉÖ{ÉªÉÉäMÉÉä ºÉÖJÉÉ´É½þ¨ÉÂ **
Ê´ÉvÉÉnÖù{É¶ÉªÉÆ ´ªÉÉvÉä& ºÉ Ê½þ ºÉÉi¨ªÉÊ¨ÉÊiÉ º¨ÉÞiÉ¨ÉÂ *
Ê´É{É®úÒiÉÉäxÉÖ{É¶ÉªÉÉä ´ªÉÉvªÉºÉÉi¨ªÉÉÊ¦ÉºÉÆÊYÉiÉ& ** (+. ¾þ. ÊxÉ)
When the lakshanas of the disease are crude (latent) ie when they are not
presented properly, then such a disease is diagnosed by the method of Upashaya
and Anupashaya. Charaka has classifed Upashaya into 18 types. Ashtanga
Samgraha has added two more ie Desha and Kala.
Upashaya is used to arrive at a diagnosis when the specific symptoms which
should be present in a particular disease are either absent/less marked/having
feeble strength.
Upashaya is a trial and error method of treatment.
Some symptoms are common in two diseases and when the specific symptom
which differentiate it from other diseases is absent, then the Upashaya form of
treatment is used thinking that it is a particular disease out of the two.
If the Upashaya used in the patient becomes successful then the same
Upashaya can be continued as cikitsa. Eg: Dr. Chandrakanth Shukla explains
that in some conditions, it becomes difficult to differentiate between Amlapitha
and Vidagdha Ajeerna in such cases, administer Shunti - 1 mash t. i. d If the
condition improves, then diagnosis of Vidgdha Ajeerna is done and if the condition
worsens, then it implies that the patient is suffering from Amlapitha. The same
principle of Upashaya - Anupashaya can be applied to other diseases also.
5. Samprapti
ºÉÆ|ÉÉÎ{iÉ : ºÉÆ + |É + +{É + ÊHòxÉ
+{É means +É{xÉÉäÊiÉ to ‘attain’
ºÉ¨ªÉEò |ÉÉ{ÉEòhÉÆ or ºÉ¨ªÉEò |ÉÉ{xÉÉäÊiÉ ®úÉäMÉÉxÉ
That which gives the perfect information about the disease is called samprapti.
This includes all the stages from the very contact of the body with hetus till the
development of a disease.
53
Vagbhatacharya clearly defines Samprapti as the way in which the doshas get
vitiated and the course it follows for the manifestation of a disease.
ªÉlÉÉ nÖù ¹]äõxÉ nù É ä¹Éäh É ªÉlÉÉ SÉÉxÉÖÊ ´ÉºÉ{ÉÇi ÉÉ *
ÊxÉ´ÉÞÇÊkÉ®úÉ¨ÉªÉºªÉÉºÉÉè ºÉÆ|ÉÉÎ{iÉ .... ** (+. ¾þ. ÊxÉ)
Mainly there are two diffferent types of Samprapties viz ‘Samanya Samprapti‘
and ‘Vishesha Samprapti’. Samanya Samprapti includes Shadkriya Kalas.
Vishesha Samprapti includes Sankhya, Vikalpa, Pradhanya, Bala, Kala.
The major utility of samprapti is to treat the patient efficiently and accurately,
so that the recurrence of the disease becomes remote. Because, if one does not
judge the disease as per the samprapti, then one cannot understand the qualitative
and quantitative increase of any dosa and strength of the causative factors, pre-
monitory symptoms and clinical features of the disease which may lead to proper
management.
54
CLINICAL APPROACH IN MODERN MEDICINE
Saking contributions from contemporary science like modern, physics, chemistry,
electronics etc. allopathic system had developed a very systematic and authentic
schemat in approaching a patient. A through knowledge about than cough are definitely
contributory to our science also. A brief scheme of systemic examination is included
herewith. It is interesting to note that the introgation and physical examination are
well in accordance with that of Ayurvedic Acharyas.
EXAMINATION OF RESPIRATORY SYSTEM
General Signs and Symptoms:
1. Hoarseness of Voice 2. Clubbing of fingers, pallor or cyanosis
3. Central cyanosis 4. Intercostal recession
5. Malaise or weight loss 6. Rhino sinusitis
Cardinal Symptoms:
1. Cough (dry or productive) 2. Dyspnoea
3. Expectoration 4. Chest pain
5. Haemoptysis
I INSPECTION
1. Size, shape and type of chest
2. Presence of any asymeetry or deformity of the chest
a) Symmetrical types of abnormal chest
i) Long flat chest ii) Alar chest (pterygoid chest)
iii) Pthinoid chest iv) Viseroptotiochest
v) Pigeon chest vi) Ricket chest
vii) Barrel chest viii) Funnel chest
b) Asymmetrical types of abnormal chest
i) Spinal curvature ii) Unilateral bulging
iii) Unilateral flattering iv) Local bulging
v) Local retraction
3. Respiratory movements
a) Type of breathing
i) Thoracic
ii) Abdominal
b) Rate (Normal is 18 - 22 per min.)
55
c) Rhythm - Abnormal rhythm
a) Periodic brathing - Cheyne - stoke breathing
b) Susperisious breathing or sighing respiration
d) The respiration - pulse ratio (Normal is 1:4)
e) Movement of two sides
4. Position of the apical thrust
5. Diaphrgmatic movement
6. Additional observations like enlarged lymph nodes, visible pulsations,
sternomastoid sign and oedema of chest.
II PALPATION
l Movements of upper lobes and lower lobes and lower lobes of both
sides are compared.
l Tactile Vocal Fremitus (T.V.F.)
l Position of apex beat and trachea are confirmed.
l Presence of lymph nodes in axilla and supraclavicular fossae.
l Pain and tenderness.
III PERCUSSION
l Anterior, posterior parts of chest and axilla are percussed on both sides.
l Upper and lower limits of lungs are noted (Topographic percussion)
l Percussion notes
a) Normal lung resonance (vesicular resonance) is of low pitch and
clear in character.
b) Hyper resonance - in pneumo thorax.
c) Reduced resonance or dulness - thickening of pleura, pleural
effuision, pleural cavity containing fluid.
d) Pain and tenderness.
IV AUSCULATION
1. Breath sounds
a) Intensity (loudness) - normal, increased or diminished.
b) Quality - vesicular or bronchial.
c) Comparison of inspiratory and expiratory elements of sound.
2. Vocal resonance
56
3. Added sounds
a) Wheezes (rhonchi) - monophonic or polyphonic
b) Crepitus (rales)
c) Pleural rub
Special Investigations
1. Radiograph 2. Sputum examination (AFB)
3. Spirometry 4. C.T. Scan
5. Radio - isotope imaging 6. Bronchoscopy
EXAMINATION OF ABDOMEN
I INSPECTION
1. Contour or shape (Generalised fullness/Localised distension)
2. Abdominal asymmetry (Due to enlargment of liver, spleen, tumour/cyst)
3. State of the skin (Stretching/prominent superficial veins/scars/
pigmentation)
4. State of the umbilicus (Retracted/Inverted/Everted)
5. Veins and arteries
6. Diastasis of the recti
7. Peristalsis
8. Respiratory movements
II PALPATION
A. Methods of Palpation
1. Superficial palpation
2. Deep palpation
3. Bimanual palpation
4. Dipping or ballotment
B. Abnormal palpatory findings
1. Muscle guard or rigidity
a) Generalised - in general peritonitis
b) Diffuse - in acute intestinal obstruction, emningitis, tetanus...
c) Localised or unilateral - in appendicitis
57
d) Transient or momentary - in severe abdominal pain
2. Tenderness
a) Rebound tenderness - inflammation of the peritoneum
b) Shifting tenderness - appendicitis
3. Oedema of abdominal wall
4. Doughy feel
5. Haematoma of rectus sheath
6. Mass or lump
III PERCUSSION
A. Normal Sounds:
1. Resonant or tympanic 2. Dull
B. Abnormal sounds:
1. Increased resonance - gaseous distension of stomach, splenic
flexure, distension of small intestine.
2. Reduced resonance or dullness - tumour, cyst, enlargement of liver
or spleen, enlarged glands, aortic aneurysm, ascites etc.
C. Special test for ascites:
1. Fluid thrill
2. Horse-shoe dullness
3. Shifting dullness
IV AUSCULTATION
A. Peristaltic Sounds:
1. Normal sounds or Borborygmi
2. Exagerrated peristaltic sounds
3. Absence of peristalsis (silent abdomen)
B. Vascular sounds
1. Murmurs - physiological and pathological
2. Venous hums - Physiological and pathological
C. Friction sounds - Over the liver and spleen
D. Miscellaneous sounds like succession sounds (gastro - intestinal
splash) and oesophageal sounds.
58
V. SPECIAL INVESTIGATIONS
1. Examination of the gastro - intestinal contents
a. Vomits - Quantity, odour, colour and constituents
b) Faeces - Quantity, odour, colour, consistency and abnormal
constituents.
2. Plain radiograph
3. Radiological examination using barrium (Barrium meal, Barrium enema,
Barrium follow - through)
4. Endoscopy (Gastroscopy, Duodenoscopy, Proctoscopy etc.)
5. Scanning (Ultra sound and Computerised Tomography - CT)
6. Maximum HCl, output, gastric acid analysis
7. Widal test
8. Biopsy and cytological examinations
9. Xylose excretion test
10. Schilling test
11. Paracentesis (Needle aspiration of the peritoneal cavity) and
micorscopical examination and culture of ascitic fluid.
12. Direct and intravenous cholangiography.
EXAMINATION OF CARDIO VASCULAR SYSTEM
CARDINAL SYMPTOMS
1. Dyspnoea 2. Palpitation
3. Angina 4. Oedema of dependent parts
GENERAL SIGNS AND SYMPTOMS
1. Anaemia 2. Clubbing of fingers
3. Cyanosis 4. Wasting
5. Loss of weight 6. Fatigue
7. Splinter haemorrhages in the nail-bed 8. Palpitation
I ARTERIAL PULSE EXAMINATION
The arterial pulse is to be noted in the following arteries.
1. Radial 2. Brachial
3. Carotid 4. Temporal
5. Femoral 6. Popliteal
7. Posterior tibial 8. Dorsalis pedis
In each artery, note the following characteristics of the pulse.
59
1. Rate
2. Rythm - Regular
Irregular - Regularly irregular
Irregularly irregular
3. Character of pulse wave
a) Anacrotic pulse b) Collapsing pulse
c) Bisferien’s pulse d) Pulsus paradoxus
e) Pulsus alternans
4. Volume
Hypokinetic or Hyperkinetic
5. Radio - femoral delay
6. Condition of arterial wall
II VENOUS PULSE EXAMINATION
1. Position 2. Visible or palpable
3. Wave form 4. Timing in cardiac cycle
5. Effect of compression on vesicles
6. Effect of respiration, posture and abdominal compression.
Also note if there is any
1. Englogement 2. Varicosity
3. Presence of thrombi 4. Evidence of inflammation
5. Venous pulsation
III BLOOD PRESSURE
VI INSPECTION
1. Abnormal pulsations
2. Size, shape of type of chest
3. Position, Extent and character of Apex beat
4. Distended blood vessels over chest and neck
5. Pre-cordial bulging
V PALPATION
1. Position of Apex beat
2. Thrills - Palpable murmur
3. Abnormal pulsation in
60
a) Supra sternla notch
b) Carotid Vessels in neck
c) Epigastrium
4. Character oc cardiac impulse
VI PERCUSSION
1. Border of heart
2. Hypertrophy ordilatation of heart
VII AUSCULTATION
1. Rate of heart beat
2. Rythm of Heart
3. Heart sounds
4. Exaggeration or Diminition in the intensity of heart sounds
5. Splitting of heart sounds
6. Abnormal sounds
a) Opening snap - Mitral or Tricuspid
b) Ejection click
7. Additional sounds
a) Pericardial friction sound b) Venous hum
c) Murmurs
i) Systolic ii) Late systolic or pre-diastolic
iii) Diastolic iv) Pan-systolic
v) Early diastolic vi) Mid diastolic
INVESTIGATION OF MURMUR
1. Timing or position in cardiac cycle
2. Site of maximum intensity
3. Intensity or loudness
4. Quality or character
5. Extent or area of distribution
6. Pitch
7. Transmission or Direction of selective propagation
8. Effects of posture, respiration, exercise and other manuevers
9. Effects of drugs and other pharmacological agents
10. Presence of thrill
61
SPECIAL INVESTIGATIONS
1. Electro cardiography (E.C.G.) 2. Chest radiography
3. External pulse recording 4. Cardiac catheterization
5. Echocardiography
EXAMINATION OF CENTRAL NERVOUS SYSTEM
I HIGHER FUNCTIONS (MENTAL FUNCTIONS)
Conscious/Unconscious
1. Appearnace and behaviour
2. Emotional state
3. Delusions and Hallucinations
4. Orientation in place and time
5. Clouding of consciousness (Stupor, Coma)
6. Confusional states (Demential, Delirium)
7. Memory (Short term and long term)
8. General Intelligence
9. Released reflexes in dementia
10. Apraxia
11. Speech and language (Dysarthria, Aphasia)
II MOTOR FUNCTIONS
1. Bulk of muscle (Measure it)
2. Tone of muscle (Hypertonia and Hypotonia)
3. Strength of muscle (tested by pressure against movement)
4. Reflexes:
a) Superficial
l Corneal l Pharyngeal l Abdominal
l Conjuctival l Palatal l Gluteal or Anal
l Cremasteric l Plantar
b) Deep
l Knee l Biceps l Ankle
l Supinator l Triceps l Jaw Jerk
(Clonus in ankle jerk and knee jerk)

c) Visceral, Sphincteric or Organic
l Defaecation l Micturition l Swallowing
62
5. Co-ordination of movements
a) Motor
Upper Limb
l Finger nose test l Writing l Lifting objects
l Buttening l Pronation - Supination
Lower Limb
l Straight Line Walking l Knee Heel Test
l Finger Toe Test
b) Sensory - Romberg’s sign

6. Gait
Hemiplegic - Spastic - Crossed - Parkinsonian - Ataxic - High stepping -
Choriac
Hysterical - Waddling - Injurious - Senile
7. Involuntary Movements
l Epilepsy l Tremor l Fasciculations (muscle)
l Tetany l Torticolis l Dystonia (torsion spasm)
l Chorea l Tics l Myoclonus
III SENSATION
1. Tactile sensation - Light Touch and Pressure
2. Position sense - Appreciation of passive movements (Proprioception)
3. Recognition of the size, shape, wieght and form of objects (Stereognosis)
4. Appreciation of vibration
5. Pain
6. Temperature Sense
EXAMINATION OF CRANINAL NERVES
I OLFACTORY NERVE (Sensory Only)
l Test for smell - oils of Clove, Peppermint, Soap, Fruit or Scent
a) If lesion is in anterior fossa - anosmia (Sense of smell is abolished)
b) If lesion is in uncus and pyriform cortex - parosmia (Sense of smell
is perverted)
c) In Epilepsy - hallucination of smell.
II OPTIC NERVE (Sensory only)
63
l Test for visual acuity (Snellen’s Chart)
l Test for visual fields (with or without perimetry)
l See for colour vision - visual localisation and recognition
III OCCULOMOTOR, IV. TROCHILEAR & VI. ABDUCENT NERVES (Motor
only)
l Presence of Squint (strabismus)
l Presence of double vision (diplopia)
l Defective movements of eyes (nystagmus)
l Pupillary abnormalities - size & reactions
l Drooping of eye lids (ptosis)
V TRIGEMINAL NERVE (Both Sensory and Motor)
A. Sensory:
l Tested by using cotton wool - face, buccal mucosa and cornea.
B. Motor:
l See for deviation of jaw - compare with position of teeth
l Plapate temporal and masseter muscles
l Side to side movement of jaw (Pterygoids)
l Jaw jerk - brisk in bilateral upper neuron lesion
l Waisting of muscles of mastication - hollowed appearance of the
face and temples.
In LMN lesions
(i) Trigeminal neuralgia (ii) Ophthalmic herpes
VII FACIAL NERVE (Both Sensory and Motor)
l Closing of the eyes - see for Bell’s phenomenon
l Whistiling
l Clenching or showing teeth or smiling
l Blowing
l Angle of the mouth
l Naso labial fold
l Test of sense of taste - anterior part of the tongue
l Raising of the eye brows - Frowning
64
VIII VESTIBULO COCHILEAR NERVE (Sensory only)
l Test for hearing (Whispered or spoken voice)
l Tuning fork test
l Tinnitus, Hyper acusis, Auditory hallucinations, delusions, Vertigo
IX GLOSSOPHARYNGEAL NERVE (Both Sensory and Motor)
l Test - Taste Sensation - Posterior 1/3 part of the tongue
l Palatal reflex
X VAGUS NERVE (Both Sensory and Motor)
l See for difficulty in swallowing (dysphagia) - regurgitation of fluids through
nose while swallowing.
l Difficulty in pronouncing some words like egg, where complete closure
of nasopharynx is needed.
l Examine palate and pharynx
l If larynx is involved - Hoarseness of voice
XI ACCESSORY NERVE (Motor Only)
l Supplies trapezius and sternomastoid muscles
l Test trapezius muslce - shrugging the shoulders - repeat - apply pressure
in opposite direction
l Test sternomastoid muscle - rotation of head - apply pressure in opposite
direction.
XII HYPOGLOSSAL NERVE (Motor Only)
l Supplies tongue
l Ask the patient to protrude his tongue
l See lateral movements of the tongue within the cheek
l See for atrophy and fasciculations
l In myotonia, on tapping the surface of the tongue, a clear furrow appears,
which lasts for few seconds.
LESIONS OF THE CEREBELLUM
l Early sign in ataxial of gait alone
l Common lesion involves the lateral lobes
l Signs of unilateral cerebellar disease are on the SAME SIDE OF THE
BODY as the lesion.
SIGNS:
65
1. Hypotonia (loss of muscle tone) 2. Muscular inco-ordination
3. Ocular disturbances 4. Altered postures
5. Speech defects
LESIONS OF THE EXTRA PYRAMIDALSYSTEM
Eg: Parkinsonism
l Degenerative process affecting basal ganglion (Corpus striatum)
l Only on older persons
l Start as vague stiffness or triedness of limbs with difficulty in per forming
fine movements.
SPECIAL INVESTIGATIONS:
1. Cerebrospinal fluid investigations
2. Radiology
a) Plain radiograph of skull b) Arteriograms
c) Pneumoencephalography d) Myelography
3. Computerised Axial Tomography (CAT)
4. Isotope Brain Scan
5. Electro Encephalography (EEG)
6. Electro myography, muscle biopsy and never conduction studies.
7. Musclebiospy
8. Nerve conduction studies
LOCOMOTOR SYSTEM
Locomotor system includes
a) Muscles b) Bones c) Joints
d) Soft tissues like Ligaments and Tendons
(Here, mainly Bones Examinations included)
EXAMINATION OF THE BONES
I INSPECTION:
1. Swelling
2. Skin overlying the swelling
a) red and oedematous
b) tense and glossy with dialated veins
66
c) Sprounting granulation tissue
3. Pressure effects
4. Neighbouring joints
5. Muscular wasting
6. Shortening or lengthening of the bones
II PALPATION
1. Local temperature - felt with back of fingers.
2. Tenderness
a) Localised - Fractures, infections or bone tumors
b) Diffuse - Leukaemia, aplastic anaemia
3. Swelling
i) situation ii) size and shape iii) surface
iv) edge v) consistency vi) pulsation
4. Bone deformities or irregularities - Chronic pyogenic or syphilitic or
tuberculous osteomyelitis.
5. Ulcers and sinuses
6. Presence of fractures
7. Neighbouring structures
III PERCUSSION
l Localised tenderness may be elicited.
IV AUSCULATION
l Detect the presence of a murmur and note is character in case of a
pulsatile swelling.
V MEASUREMENTS
l Length of the bones are noted
67
PSYCHIATRIC EXAMINATIONS
It includes a) Psychiatric interview, b) Mental status examination c) Physical
examination d) Laboratory examination, e) Psychological test.
A PSYCHIATRIC INTERVIEW
1. Physician - Patient relationship
2. The information mental status examination
a. Appearance
b. Manner of relating
c. Use of language
d. Mood and affect
e. Content of discussion
3. Interview technique
B MENTAL STATUS EXAMINATION
1. Appearance
a. Overall appearance b. Dress
c. Grooming d. Unusual fetures
2. Attitude
a. Co-operative/Un co-operative b. Bored
c. Seductive d. Hostile
3. Behaviour and psychomotor activity
a. Gait b. Position
c. Overall level of activity d. Psychomotor retardation
4. Speech
a. Rate of speech b. Amount of speech
c. Tone of speech d. Speech impairments
e. Aphasia
5. Mood and affect
l Whether the mood and affect are same or not
l The depth and range of emotional expression
6. Perception
a) Hallucinations
l Auditory, Visual, Gustatory, Olfactory, tactile, kinesthetic,
hypnagogic and hypnopompic hallucinations.
68
b) Illusions
c) Depersonalization and derealization
7. Thinking Process
a) Loose associations
b) Tangential thinking
c) Circumstantiality
d) Blocking
e) preservation
f) Echolalia
g) Flight of ideas
8. Content of thought
a) Delusion
b) Obsessions
c) Suicida and homicidal thoughts
9. Judgement
10. Cognition and sensorium
LABORATORY EXAMINATIONS
1. Screening tests for organic illness
2. Electro encephalography (EEG)
3. Identifying biologic markers by brain imaging - MRI, CT, PET
PSYCHOLOGICAL TESTS
1. Intelligence tests
2. Personality tests
a) Minnesota Multiphasic Personality Inventory (MMPI)
b) Rorschach test
c) Thematic Appreciation Test (TAT)
d) Sentence completion Test (SCT)
e) Draw - a - person Test (DAP)
69
MODEL CASE SHEET
I am herewith including A Model Case Sheet considering all the above
discussed aspects of Roga-Rogi Pareeksha.
CASE SHEET
1. Kramankaha 2. Vibhagaha
3. Shayyankaha 4. Rugnanama
5. Vayaha 6. Lingam
7. Vyavasayaha 8. Nivasastanam
9. Praveshastitihi 10. Sambhavita Rogaha
11. Vyadhi Vinishchayaha 12. Nirgamanasthitihi
Chikitsa Phalam - Vyadhi Nivaranam / Upashamana/Anyadha Bhavaha
(I) Prashna Pareeksha -
1. Pradhana Vedana 2. Anubandha Lakshanani
3. Poorvotpanna Anayae Vyadhihi 4. Vartamana Pogeti Vruttam
5. Koutumbiketi Vruttam 6. Vaiyyaktiketi Vruttam
(II) Ashtastana Pareeksha -
(1) Nadi:
Doshagatihi: Sankhya:
Kramaha: Raktabharaha:
(2) Mootram:
Saznkhya: Rasihi Varnaha
Gandhaha: Vaisistyam/Anyam
(3) Purisham:
Sankhya: Rasihi Varnaha
Gandhaha: Vaisistyam/Anyam
(4) Jihwa - Varnaha:
Sparshaha:
Ama/Nirama Anyata
(5) Sabdaha: Vyaktha/Avyaktha
(6) Sparshaha:
Sheetaha/Ushnaha Varnaha Chaya
(7) Drik (Netram):
(8) Akrutitaha:
70
Chaya: Dehopachayaha
(III) Sroto Pareeksha
(1) Pranavaha Srotas:
Uraha: Nasika: Nisteevam:
Puppusaha: Hridayam:
(2) Anna Vaha Srotas:
Mukhaha: Udaraha: Amasayaha:
Patchamanasayaha: Grahani: Pakwasayaha
(3) Sweda Vaha Srotas:
Romani Twak Swedaha
(4) Udaka Vaha Srotas:
Twak: Kloma: Talu: Udakasanchyaha:
(5) Rasa Vaha Srotas:
Dehooshma: Rasa Vahinya Dhamanya/Siraha
Anyalakshanani:
(6) Rakta Vaha Srotas:
Yakrutu Pleeha Rakta Pareeksha
(7) Medo Vaha Srotas:
Medhaha Sareera Bharaha
(8) Asti Vaha Srotas:
(9) Majja Vaha Srotas:
Purisha Snigdata Netramalam
(10) Sukra Vaha Srotas:
Mushkou Medram
(11) Mootra Vaha Srotas: Yonihi
Garbha Shyam Rajaha Pravruttihi
(12) Mootra Vaha Srotas: Vastihi
Vrikkou Mootra Praseka
Gavinyaha
(13) Pureesha Vaha Srotas: Gudam
Pureeshashayaha
(IV) Shiraha-Greevaha
(1) Shiraha
(2) Greevaha
(3) Pancha Gnanedriyani
71
Shrotra Twak Chakshu
Jihwa Ghrana
(V) Manasaha Pareeksha
Smrutihi Sheelam Shoucham
Chesta Acharaha Vuha
Vicharaha Indrayabhi Graha
(VI) Nidana Panchaka Vinichayaha
(1) Nidanam:
Bhaya Karanani-Aharaha
Viharaha Anyata
Abhyantara Karanani
Doshaha Dooshyani
(2) Poorva Roopani
Samanya: Vishishta:
(3) Roopani:
Vyadhi Lakshanani: Vyadyadhishtanam:
Doshalakshanam: Doshadhishtanam:
(4) Upashayaha:
Snupashayaha:
(5) Aampraptihi:
Adhishtana Vikrithi:
(VII) Anya Vishishta Pareeksha:
(VIII) Atura Bala Pramana Pareeksha:
(1) Prakrutihi: (6) Satvam
(2) Saram: (7) Ahara Shakti:
(3) Samhananam: (8) Vyayama Shakti:
(4) Pramanam (9) Vayaha:
(5) Satmyam:
Shareerayamam Bharam
(IX) Vikruti Pareeksha:
(1) Hetavaha: (5) Prakrutihi:
(2) Doshaha: (6) Deshaha:
(3) Samhananam: (7) Balaha:
(4) Lingam: (8) Kalaha:
72
(X) Vyadhi Vinishchayaha:
Vyavachedaka Nidanam: Vyadhi Nirnayaha:
(XI) Sadhyasadhyaha Nirayaha:
(1) Aturabalam: Prakrutyadyanusaram:
Garbhini/Balyavastha/Vrudhavastha:
Sabalaha/Durbalaha:
(2) Samshodhana Chikitsa:
Purvakarmtha: Pradhana Karma:
Pashchat Karma:
(3) Shadupa Kramaha:
(4) Samshamana Chikitsa (Aushadhavyavastha)
Chikitsalaya Dainandina Chikitsa
Tithihi Pradana Lakshanaha Aushadha
Aharaha/Viharaha/ Anyath
(5) Pathyam:
(6) Apathyam:
(XIII)Karya Pareeksha:
Karya Phalam:
Sameeksha:
Vidyarthihi/Vidyarthini Acharyaha
73
CONCLUSION
As I mentioned earlier the main aim and duty of the physician is to cure disease. This
can be achieved only through the intellectual intervention using proper drugs and
trained assistants. It is the process that bring back the homogenisity of the doshas
and dhadus of the diseased. Or treatment is the suit of efforts and effect of the
procedures in the diseased body. This honogenesity is achieved by the breaking the
pathogenesis (ºÉÆ|ÉÉÎ{iÉ Ê´ÉPÉ`öxÉÆ). So for an eminent physician it muds to understand and
estimat ethe nature and severity of the pathogenesis. This can be achieved by
following the above mentioned ®úÉäMÉ®úÉäMÉÒ {É®úÒIÉÉ and assessing them
properly. So these examinations are utmost importance and utility.
We should give importance to Rishta Lakshana and Sadhya - Asadhya
Lakshanas. This will give a better idea about the prognosis of the disease and
longivity of the patient. Such an elaborate consideration is the uniqueness of
Ayurvedic system of medicine.
Those physicians who are not capable of understanding the conditions of
patients using his knowledge and intelligent is not capable of curing a disease.
YÉÉxÉ ¤ÉÖÊ rù |ÉiÉÒ{ÉäxÉ ªÉÉä xÉÉ Ê´É¶ÉÊiÉ iÉi´ÉÊ´ÉiÉÂ
+ÉiÉÖ®úºªÉÉxiÉ®úÉi¨ÉÉxÉÆ xÉ ºÉ ®úÉäMÉÆÎ¶SÉÊEòiºªÉÊiÉ (SÉ. Ê´É.)
74
BIBLIOGRAPHY
1. Amarakosham - Amarasimha - Nornaya Sagar Press, Bombay.
2. Astanga Hrudayam Aruna and Hemadri Tika, Chowkambha Sanskrit - Series,
Varanasi.
3. Astanga Sangraha - Published by Baidyanath, Nagpur.
4. Ayurveda Vyadi Vignanam Part I and II - Yadav Ji, Trikamji, Baidyanath
Publications, Nagpur.
5. Ayurveda Saukhyam - Todarananda - Bhagwandas - concept publishers, Delhi.
6. An Introduction to Kaya Cikitsa - Dwarakanath C. Popular Prakasan, Bombay.
7. Bhava Prakasha (Hindi) - Chowkhambha, Publications, Varanasi.
8. Bhela Samhita - Central Council for Research in Ayurveda, New Delhi
(Government of India0
9. Basava Rajeeyam - S.V. Gopal and Co.- Madras
10. Bhaisajya Ratnavali (Hindi) - Sri Govinda Das - Chowkambha Publication,
Varanasi (1952).
11. Best and Taylor’s Physiological Basis of Medical Practice - John R. Brobeck
- Chand and Co. Delhi.
12. Bed - Side Medicine, Batta Charya - Calcuttaz
13. Clinical Methods in Ayurveda - Sri Kanta Murthy, Chowkhamba Orientala,
Bansaras.
14. Charaka Samhita.
15. Clinical Medicine - Krishnadas
16. Clinical Medicine Hutchinsons
17. David’s Son’s Principles and Practice of Medicine - Elbs and Churchil, Living
Stone.
18. Differential Diagnosis of Internal Diseases Part I & II, Mir Publishers.
19. Hareeta Samhita
20. Harrison’s Principles of Internal Medicine - Bravanwald etc. Mcgraw Hill Books.
21. Introduction To Kaya Cikitsa - Suresh Babu
22. Internal Diseases - Bogolyubon V.M., Mir Publishers.
23. Kasyapa Samhita - Vidyothini Vyakya.
75
24. Madhava Nidana with Madhukosha - narendranath Sasthri.
25. Nidana Cikitsa Hasta Malaka - Vol.I
26. Oxford English Dictionary - 6th Edn. Oxford University Press, Delhi.
27. Susruta Samhita - Nibanda Samgraha
28. Sharanga Dhara Samhita - with Adamallu Teeka
29. Tridosha Theory - Sastri V.V.S., Arya Vaidya Sala, Kottakal.
30. Vedome Ayurveda
31. Vangasena Samhita
32. Yoga Ratna Karam
76
About the Author
Dr. K.S. Nandalal MD (Ay) (Patho) is one of the outstanding Academicians and
Practitioners in the field of Ayurveda in Kerala. He is the biographer of many books
and articles related with diagnosis and treatment in Ayurveda and presented papers in
National and International seminars and moderated many events. At present he is
working as Associate Professor, Vaidyaratnam Ayurveda Medical College,
Thrissur, Kerala, India.
Digitally signed by Dr. Eby Abraham

DN: CN = Dr. Eby Abraham, C = IN, O = www.
ayurvedicmedicinalplants.com, OU = Ayurveda
Reason: I have reviewed this document
Location: Kerala
77

Diagnostic Methods in Ayurveda

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DIAGNOSTIC METHODS

Dr. K.S. Nandalal MD (Ay)

8. Examination of Infants & Children 49

10. Clinical Approach in Allopathic Medicine 53

11. Psychiatric Examination 66

12. Model Case Sheet 68

This method of examination is explained in ÊjÉÊ´ÉvÉ ®úÉäMÉ Ê´É¶Éä¹É Ê´ÉYÉÉxÉÒªÉÆ +vªÉÉªÉ of

ÊuùÊ´ÉvÉ¨Éä´É JÉ±ÉÖ ºÉ´ÉÈ ºÉSSÉÉºÉSSÉSÉ iÉºªÉ SÉiÉÖÌ´ÉvÉÉ {É®úÒIÉÉ - +É{iÉÉä{Énäù¶É&,

EòÉ¹`öEÖò]Âõ]õÉä ªÉlÉÉ EòúÉ¹`Æö EÖò]Âõ]õiÉä SÉÉÊiÉ´ÉäMÉiÉ& *

Dosha Kopa Nature of Spread of Oil

According to Charaka, with the help of four pramanas, examination has to be

1. EòúÉ®úhÉ - Cause - Physician

iÉº¨ÉÉnùÉiÉÖ®Æú {É®úÒIÉäiÉ - |ÉEÞòÊiÉiÉ¶SÉ Ê´ÉEÞòÊiÉiÉ¶SÉ ºÉÉ®úiÉ¶SÉ ºÉÆ½þxÉxÉi¶SÉ

In vagbhatas description, the dasavidha pareekshas are-

l Conjuctival l Palatal l Gluteal or Anal

l Supinator l Triceps l Jaw Jerk

(Clonus in ankle jerk and knee jerk)

l Buttening l Pronation - Supination

l Finger Toe Test

b) Sensory - Romberg’s sign

l Tetany l Torticolis l Dystonia (torsion spasm)

l Chorea l Tics l Myoclonus

hypnagogic and hypnopompic hallucinations.

Digitally signed by Dr. Eby Abraham

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