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Monday, September 6, 2010

ROGA PARIKSHA AND ROGI PARIKSHA IN AYURVEDA

ROGA PARIKSHA AND ROGI PARIKSHA IN AYURVEDA


  


Ayurveda is often called as a samakaalina sastra (a science of all times). The fundamentals of this ancient science are simple and easily applicable to all eras. In fact, a majority of modern medical science principles are based on the fundamentals of Ayurveda. One cannot help but wonder at the profound wisdom and observational skills of the early Ayurvedic physicians, who could fathom the deepest secrets of the human body and mind even in the absence of technology.

Ayurveda's success can be attributed to its organized and methodical ways, a good example being Ayurveda's clinical methods. A proper diagnosis forms the basis for effective treatment, whereas ignorance of disease or improper diagnosis leads to inefficient treatment. In Ayurveda, the diagnosis and treatment of diseases are based on the information derived from two areas:

* examination of the patient (rogi pariksa)
* examination of the disease (roga pariksa)

Rogi pariksa or the examination of a patient consists of three steps:

* Darsana - examination by inspection
* Sparsana - examination by touch
* Prasna - examination by interrogation

Difficulty: Easy Instructions


1The process of diagnosis begins even as the patient walks into the consultation room. In addition to gathering information from specific questions about symptoms, lifestyle, diet and medical history, the physician systematically observes other features that may provide clues to the cause and duration of the illness. A sharp observation of the patient's gait, physique and appearance conveys a lot of information about his general condition. This is called "darsana pariksa" or observation.

"Sparsana pariksa" is examination by touch (sparsa). The physician can evaluate several factors through the medium of touch. He can assess the temperature of the body, feel the margins of swellings in skin, read and note the characteristics of pulse, or check for organ enlargements. The conventional clinical methods of palpation and percussion are examples of tactile examination.


2For an overall picture of the illness, a detailed interrogation of the patient and his family member or relative is necessary. This is "prasna pariksa" (prasna = question). It is always favorable to allow the patient to relate the entire history of the ailment in his own words.

Darsana, sparsana and prasna together comprise "Trividha Pariksa" - the threefold method of clinical examination. An elaborative version of the above is the "Astavidha Pariksa" or the eightfold method of patient examination that includes the following eight factors: Nadi (pulse), Mala (frequency, color, consistency of bowel movements), Mutra (urine - color, frequency, burning sensations), Jihva (tongue), Sabda (voice and speech of the patient), Sparsa (touch, skin and tactile sense), Drik (eyes and vision), and Akriti (general body build, eg: lean, obese, muscular, etc.).

The entire demeanor of the patient during the consultation provides valuable information to the physician. Emotional state and nature, strength and vitality, intelligence, and character can all be ascertained from attire, posture, body language, breathing patterns and even gait and bearing.


3The primary goal of clinical examination in Ayurveda is to locate the unbalanced doshas that caused the disease. The methods employed by the physician (observation, touch and interrogation) are all aimed at identifying the dosha disturbance. For example, a person with hot, flushed skin and symptoms such as burning sensations, fever, digestive disorders or urinary infections has a disturbance of pitta. Dry, cracked, rough skin that is cold indicates an imbalance of vata. Fluid retention, swelling, moist skin, dull, watery eyes and symptoms such as chest congestion are kapha related

A clinical diagnosis resulting from these examinations, along with a clear understanding of the pathogenesis of the disease, aids in accurate diagnosis and treatment.



Apart from earlier said methods, some more methods for examinations are also described in details in the classical book of Ayurveda


Prakruti Pariksha
Examination of a patient by the study of Temperaments


Vikratih Pariksha
Examination of the patient by the study of the morbid condition


Avastha Pariksha
Examination of the patient by the age factors


Ahar shakti Pariksha
Examination of the patient by evaluating the capacity of digestion and ingestion


Vyayam shakti pariksha
Examination of the patient by the evaluating the physical power, capacity of work or capacity of exercise


Saratah Pariksha
Examination by study of Sara of parient


Samhananatah Pariksha
Examination by the study of the constitution of a patient


Satavatah Pariksha
Examination of the patient by observing and studying mental condition


Satmyatah Pariksha
Examination by the study of the capacity of the diet intake


Pramantah Pariksha
Examination of the patient by the study of the measurements of body and body parts, like length, weight, breadth of the different organs and parts




Roga Pariksha [Diagnosis of Diseases]


Nidana
That means , the etiology of a disease
Which provides complete picture, in relation to the causative factors of a disease



Purvaroop
That means, early signs and symptoms of a disease
Before the beginning of a complete disease condition


Rupa
That means , main signs and symptoms, which indicates a disease condition


Upashaya
When disease condition is mixes with some signs and symptoms, creating doubts and confusion for correct diagnosis
In this stage, dietetic and therapeutic steps are taken to remove the obstacles
This process is known “Upashaya”


Samprapti
This is called “Pathogenesis of diseases”
Samprapti is divided and subdivided in few points for better understanding
The details should be seen in classical books of Ayurveda




Dasavidha & Ashtasthana Pareeksha
Apart from this threefold examination the patient is also put to further detailed examination at times in order to find out all the possible causative elements behind the ailment. The three steps are then elaborated in two ways - Dasavidha Pareeksha (tenfold examination) and Ashtasthana Pareeksha (eightfold examination). In the Dasavidha Pareeksha (tenfold examination), check up of the patient is done by this test considering ten factors and in the Ashtasthana Pareeksha, the check up of the patient is done by this test considering eight factors.

Dasavidha Pareeksha (Tenfold Examination)


Dooshyam- Regarding the structural and functional abnormalities of the body
Desham -Geographical situation of the place where patient lives (eg: marshy)
Balam -Physical strength
Kalam- The season and climatic conditions
Analam -The digestive system of the patient
Prakrithi- The natural Thridosha constitution of the body
Vayas -Age of the patient.
Satvam- Psychological strength of the patient
Sathmyam- General and personal habits of the patient e.g.: smoking, hard working, day sleeping etc.
Aharam- Nature of food (e.g. vegetarian or non-vegetarian)


Ashtasthana Pareeksha (Eightfold Examination)


Nadi-Pulse
Moothram-Urine
Malam -Faecal matter
Jihwa- Tongue-taste
Sabdam -Voice and speech of the patient
Sparsham-Touch, skin and tactile sense
Drik -Eyes and vision
Akrithi- General body build, eg: lean, muscular, etc.




Ten fold rogi pareeksha routine as described by Charaka



The ten fold rogi pareeksha routine as described by Charaka in his book Charaka Samhita are described below.

Prakriti  – prakriti refers to the physical condition of a human being. It is the some total of the state of tridoshas and trigunas. Identifying the states in each place forms the first step in assessing the physical and mental state of a person.

Vikriti – vikriti is the vitiation from prakriti. Diseases caused due to vikriti are easier to treat than diseases caused due to prakriti itself. The state of vikriti is identified by closely examining the dhatus, malas, and the emotional control of the person.

Sara – Sara refers to the quality of sapta dhatus. The conditions of dhatus are classified as pravara (good), madhyama (medium) and avara (poor). Pravara suggests excellent immune system and condition. In Sara, the physician also checks the extent of satwa in the mind of the person. Emotional stability, clear thoughts, calmness, optimism, etc are regarded as high level sattwa, while a decreased level of this quality refers to rajas and tamas gunas of trigunas, the three qualities of mind.

Samhanana – samhanana refers to the physique of the person. A compact body frame usually suggests a healthy body. Lean or obese body are unhealthy.

Pramana – pramana or examining body proportion involves assessing the relationship between the lengths of spread arms and the height of the person. An almost same length is a healthy sign. There are also several other measurements that tell the physician about a well proportioned body.

Vyayama shakti – (or strength for exercise) is the strength of the person for physical exertion. Appropriate secretion of metabolic or endocrine products during physical is essential for good endurance in demanding situations.

Satmya – adaptability measurement. It is a process of measuring the capabilities of the person to physically or mentally adapt to changing conditions. It is a complex process, measuring the mental and physical reaction of the person to demanding conditions. His/her psychological, neurological, immunological conditions are checked. No other treatment method had similar tests.

Sattva – checking mental balance. It is the capability of the person to continue doing what is required of him without giving heed to distractions – both physical and mental.

Ahara Shakti – or the power of digestion, this test involves checking the metabolic capacity of the person. To take, digest and absorb food to the body.

Vaya – vayassu or age – Ayurvedic physician compares the actual age of the person with his or her apparent age. Sounds strange, but a person appearing younger than he or she really is, is a sign of health. There are different things to look for – skin condition, hair, lifestyle, etc.


DIFFERENT DIAGNOSIS IN AYURVEDA



Eye Diagnosis



Vata eyes are characterized by small, nervous, with drooping eyelids and dry, scanty lashes. The white of the eye is muddy, while the iris is dark, gray-brown or black. Pitta eyes are moderate in size. They are sharp, lustrous, and sensitive to light. The lashes are scanty and oily. The iris is red or yellowish. Kapha eyes are large, beautiful and moist. They have long, thick, oily lashes. The white of the eye is very white. The iris is pale, blue or black.

Excessive blinking is a sign of nervousness, anxiety or fear. A drooping upper eyelid indicates a sense of insecurity, fear or lack of confidence. These are all signs of vata imbalance.

Prominent eyes indicate thyroid gland dysfunction. An yellow conjunctiva may signal a weak liver. A small iris indicates weak joints. A white ring around the iris may mean an excessive intake of salt or sugar. If the white ring is very prominent and very white, it is an indication of joint degeneration with potential for arthritis and joint pain.


Pulse Diagnosis


Pulse Diagnosis is a very important tool used by all Oriental Medical Practitioners. It is a very important tool used by Chinese and Tibetan Health Practitioners as well as Conventional medical doctors. To a skilled practitioner, taking your pulse is more than counting the beats. The functioning and health of the entire mind body constitution can be determined from the pulse, including the balance of the doshas, the health of the various organs, advance warning signs of potential problems that may crop up later etc. By detecting early symptoms of imbalance and disease reaction in the body, one can take preventive steps to correct the problem before it manifests into a major one.

Radial pulse is felt with the first three fingers, the index, middle and ring fingers. Pulse from both wrists are taken. To get an accurate pulse, the patient should be as close to his norm as possible. Taking pulse after strong exertion, after exposure to a severe environment etc. will give wrong indications.

The position of the index finger denotes the Vata dosha. When vata is strong in the constitution, the index finger will feel the pulse strongly. The pulse will be irregular and thin moving in waves like the motion of a serpent. This type of pulse is called a snake pulse.

The middle finger denotes the pulse corresponding to the Pitta dosha. When the person has a predominant pitta constitution, the pulse under the middle finger will be stronger. Ayurveda describes this pulse as "active, excited, and move like jumping of a frog." This pulse is called frog pulse.

When the throbbing of the pulse under the ring finger is most noticeable, it is a sign of Kapha constitution. The pulse feels strong and its movement resembles the floating of a swan. Hence, this pulse is called swan pulse.




Facial Diagnosis


Ayurveda teaches that face is the mirror of the mind. Disorders and disease is manifested on the face in the form of lines, wrinkles, etc. For example, horizontal wrinkling on the forehead indicates the presence of deep-seated worries and anxieties. A vertical line between the eyebrows on the right side indicates repressed emotions in the liver. On the other hand, the presence of a vertical line between the eyebrows on the left side will indicate that the spleen is holding in emotions.

A full and fluffy lower eyelids is an indication of impaired kidneys. A butterfly-like discoloration on the nose or on the cheeks may signal mal-absorption of iron or the folic acid and the sign of a low agni (fire).

The nose can be used to determine the dosha of a person. Vata persons have crooked nose. Kapha persons have a blunt nose. On the other hand, a sharp nose may denote a person with Pitta dosha.




Nail Diagnosis


Ayurveda considers nails as the waste product of the bones. If the nails are dry, crooked, rough and break easily, it indicated a predominance of the vata constitution. Soft, pink, tender nails that are easily bent are indication of a Pitta constitution. When the nails are thick, strong, soft and very shiny, then Kapha predominates.

Longitudinal lines on the nails indicate mal-absorption in the digestive system. Transverse grooves on the nails may indicate the presence of long-standing illness or malnutrition.

Yellow nails indicate a delicate liver or jaundice. Blue nails are manifestation of a weak heart. Undue redness shows an excess of red blood cells.



Lip Diagnosis (OSTHA)

If the lips are dry and rough, it may indicate dehydration or vata imbalance. Pale lips indicate anemia. Repeated attacks of inflammatory patches along the margins of the lips indicates the presence of herpes and a chronic Pitta derangement. Poor digestion of worms in the colon are indicated by the presence of multiple pale brown spots on the lips. A person with jaundice will have yellow lips. Blue lips may signal heart problems.






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