INTERNATIONAL AYURVEDIC MEDICAL JOURNAL

International Ayurvedic Medical Journal, (ISSN: 2320 5091) (March, 2017) 5 (3)

DASHAVIDHA PARIKSHA- A PRACTICAL APPROACH TO CLINICAL METHOD OF DIAGNOSIS

Moksha B M1, Byresh A2, Amritha E Pady3, Gurmel Singh4

1PG Scholar, 2MD (AYU), HOD & Guide, 3PG Scholar, 4PG Scholar, Dept of PG studies in Kayachikitsa, SKAMCH&RC, Bangalore, Karnataka, India

Email: [email protected]

ABSTRACT Pariksha is an important clinical tool for assessment of the Roga and Rogi Bala. Different types of Pariksha have been mentioned in our classics. Dashavidha Pariksha mentioned by Acharya Charaka is one such Clinical assessment protocol. A standard protocol has to be developed to clinically assess the Dashavidha Pariksha without any ambiguity. Such protocols will help to reproduce the same assessment done at different places by different physicians. The 10 point examination can be employed to a “Swas- tha Purusha” to assess the risk factors and make necessary changes in the Ahara and Vihara to prevent the impending disease.

Keywords: Pariksha, Roga, Rogi Bala, Dashavidha Pariksha, “Swastha Purusha.

INTRODUCTION

The first and foremost requirement be- classics, Acharyas have given different types of fore starting any Chikitsa is to examine the dis- Pariksha like Trividha Pariksha, Chaturvidha ease. Later with due consideration of all factors, Pariksha, Shadvidha Pariksha, Ashtavidha Pa- the physician should initiate the treatment1. The riksha, Dashavidha Pariksha which helps in purpose of clinical examination is to assess Ro- diagnosis of the disease and to plan treatment. ga & Rogi Bala. A patient constitutes the Ka- Acharya Charaka has explained the importance ryadesha or the site for the administration of of Dashavidha Pariksha. It can be applied to therapies to bring back the homeostasis of Dha- know the Bala Pramana of both Aatura (pa- tus2. Before starting any treatment; we have to tient) and Roga (disease). It includes the ten as- do clinical examination of the patient to gain pects which are to be examined viz., Prakruti, more knowledge about the patient’s condition Vikruti, Sara, Samhanana, Pramana, Satmya, and for getting an idea about probable diagnosis. Satwa, Ahara Shakti, Vyayamashakti, Vaya.4 Examination of the patient gives an idea about Ayu Pramana and Bala Dosha Pramana3. In our PRAKRUTI Moksha B M Et Al: Dashavidha Pariksha- A Practical Approach To Clinical Method Of Diagnosis

Prakruti is the Swabhava/ inherent cha- is always stable there won’t be any changes un- racteristic property of an individual. It refers to less if it is the last stage of Ayu. Also it helps to the physical and mental constitution of the indi- know the limitation of treatment in case of Ku- vidual determined from the time of conception5. laja Roga. It is determined by the Doshas dominating the sperm and the ovum during the time of concep- SARA tion and also those inhabiting the uterus at that Sara is the Shuddhatara Dhatu or the es- time determine the Prakruti of the individual. sence of the Dhatu, which is of superior quality. It is mentioned for the assessment of Bala Pra- The types of Prakruti depends on different fac- 8 tors like Shukra-shonita Prakruti, Kala- mana of the patient . Bala means biological garbhashaya Prakruti, Maturahara-vihara Pra- strength or power of resistance against the dis- kruti, Mahabhutavikara Prakruti.6 eases. 8 types of Sara are mentioned- Twak, Rakta, Mamsa, Medo, Asthi, Majja, Shukra and Prakruti Assessment Satwa Sara. Dalhana in his commentary has . A Questionnaire consisting of both the phys- mentioned that Twak Sara indicates the Rasa ical and psychological parameters of the Sara itself, which is present in the Twak9. The 8 Tridosha can be made. Each parameter is types of Sara may be assessed in term of rela- given 1 score and the total is calculated. tive quality i.e., Pravara Sara Purusha, Mad- . The individual total of each Dosha is calcu- hyama Sara and Avara Sara Purusha10.

lated separately out of total& the percentage 11 noted. Sara Assessment . The percentage determines his predominant  Each parameter i.e., Lakshana of the Sara is Doshic Prakruti. given 1 score each and the total is divided by total number of Lakshanas in that Sara . For Eg: if V -15, P – 6, K – 3, out of total 24 parameters, then the individual is 60% V, and percentage is calculated. 28% P & 12% K i.e., VataPittaja Prakruti  If 3 Dhatu Sara or < 25% is considered as Avara Sara Importance of Prakruti Pariksha  4 to 6 Dhatu Sara or 26% to < 75% is con- Prakruti won’t affect the individual just sidered as Madhyama Sara. like Visha of the Keeta won’t affect itself7. But  More than 6 Dhatu Sara or >75% is consi- the Prakopa Karanas of the particular Dosha in dered as Pravara Sara. Prakruti has more chances of leading to that NOTE: This Dhatu Sara should co-relate particular Dosha Vikruti because of Samana with Bala assessed by Vyayamashakti as Guna Dharma. For example, a Vataja Prakruti Pravara Dhatu Sara represents Uttama Bala person is more prone to certain diseases because & Vice-Versa. of indulging in VataPrakopaka Ahara, Vihara. Also the effect of Kala, Rutu, Vaya can be seen Importance of Sara Pariksha in particular Prakruti persons. Hence preventive Charaka has emphasized that sometimes the measures can be taken by knowing the Prakruti physicians may take a wrong decision only by and avoiding the Prakopakara Nidana. Prakruti seeing the body of the patient. Like- the person

IAMJ: MARCH, 2017 832 Moksha B M Et Al: Dashavidha Pariksha- A Practical Approach To Clinical Method Of Diagnosis is strong because he is possessing Sthula Share- Those peoplewill have Uttama Ayu (longevity), era and weak because of possessing Krusha / Bala, Oja, Sukha, Aishwarya. The person hav- Alpa Shareera. But factually it is observed that ing Anguli Pramana more than 84 Angula or some persons who possess Krusha / Alpa less will be considered as Adhika or Heena.14 Shareera are strong. They are like ants that have small body and look emaciated but can carry too Pramana Assessment heavy load. Sthula Shareera persons may have . Body frame size, BMI and Waist Hip ratio strength less than the Krusha /Alpa Shareera, can be considered for assessing Pramana. just like an elephant having big and corpulent Body frame size denotes bone mass and body possessing less strength than the lean and muscle mass and has an important role in short body of lion possessing greater strength. determining weight ranges. These ranges in Hence Sara has to be examined.12 turn act as guides for people to determine the weight they should be, depending on their frame size. It varies according to the SAMHANANA A person having compact body reflects the gender. There are 3 frame sizes: small, me- quality of overall body build. Clinically patient dium, large. may be assessed as Pravara, Madhyama and . BMI can be considered as one such parame- Avara Samhanana, depending on the compact- ter to assess the Pramana of the person. It is ness of body parts. Pravara Samhanana- A per- a parameter to assess the healthy weight range for height of that individual. It is cal- son having Samasuvibhakta Asthi, Subaddha 2. Sandhi i.e., well-formed bones and joints, Suni- culated as BMI= Weight in kg/ Height in m vishta Mamsa Shonita is said to have Susamhata Within this healthy weight range for height, Shareera and Balavan. The person having op- BMI of 19-21 is considered as best for posite qualities is considered as Avara Bala and small frame. the one having Madhyama Samhanana is having BMI of 21-23 is best for a medium frame. Madhyama Bala.13 BMI of 23- 25 is best for a large frame in- dividual. . PRAMANA The Waist-Hip Ratio also has an important Pramana is determined by measuring role in identifying the risk factors. It is the Utsedha, Vistara, Ayama of the body part stated that a waist–hip ratio of above 0.90 taking the Anguli Pramana of that particular for males and above 0.85 for females, or a individual as the unit of measurement. For clini- Body Mass Index (BMI) above 30.0 are at increased health risk for cardio-vascular dis- cal assessment, it can be subdivided into – Pra- vara, Madhyama and Avara Pramana. The orders, reproductive status & long term Ayama of the entire body should be 84 Angula. health risk. The Ayama should be equal to Vistara of the Importance of Pramana body. The person having Ayama and Vistara Charaka has mentioned about the Ashta equal to each other is known as Sama Purusha, Nindita Purusha like Atidirgha, Atihriswa, Atis- anatomically proportionate and healthy person. thula, Atikrusha15. By assessing the Pramana in

IAMJ: MARCH, 2017 833 Moksha B M Et Al: Dashavidha Pariksha- A Practical Approach To Clinical Method Of Diagnosis a patient, these can be known which helps to Importance of Satwa know the Sadhyasadhyata of the disease and the A Pravara Satwa person will be tolerant probable plan of treatment. In modern context, in all kinds of situations.19Even if possessed the first two can be compared to gigantism and with weak physique, such persons having excel- dwarfism, which can be due to any hormonal lent mental faculties will be having more tole- imbalance or due to genetic conditions for rate any disease and without much difficulty. which treatment is difficult. From the treatment point of view, one can with- stand Shodhana procedures, Shastra Karma SATMYA without any difficulty. Madhyama Satwa per- Satmya is that which is being used con- sons can tolerate the pain themselves when they stantly over a long period of time and has be- realise that others can also tolerate it. The Avara come a habit and which are homologous to the Satwa persons can neither by themselves nor body. Satmya can be of 3 types- Sarva Rasa through others sustain their mental strength and Satmya, Eka Rasa Satmya, Vyamishra Satmya. in spite of having sound physique, they cannot Individuals for whom Ghrita, Ksheera, Taila tolerate even mild pain. They are susceptible to and Mamsa Rasa as well as the drugs and diets fear, grief, greed, delusion, ego. Such persons having all six Rasa are wholesome are endowed may be prone to psychological diseases, Unma- with strength and longevity. They are consi- da, Apasmara, Mada etc. dered as Pravara Satmya. One who is Ruksha Satmya, Ekarasa Satmya will be having Alpaba- AHARA SHAKTI la, Alpayusha and is Alpakleshasaha. One who Ahara Shakti of an individual can be ex- is accustomed to Vyamishra Satmya will have amined by two ways – by Abhyavaharana Shak- Madhyama Bala.16 ti - the power of ingestion and Jarana Shakti– the power of digestion.20Abhyavaharana Shakti Satmya Assessment depends on the condition of Agni itself. Jarana By knowing the selectivity of food- Satmya can Shakti is assessed by the Jeernahara Lakshanas be assessed i.e., Udgara Shuddhi, Utsaha, Yathochita Kale . Non- selective- PravaraSatmya Vegotsarga, Laghuta, Kshut, Pipasa.21 . Moderately selective- MadhyamaSatmya . Very Selective AvaraSatmya – VYAYAMA SHAKTI Importance of Satmya Vyayamashakti should be examined by Charakahas mentioned the importance of Sat- the capacity for doing work. It is of 3 types- mya stating that Sarva Rasabhyasa is the reason Pravara, Madhyama and Avara Vyayamashak- 22 for Bala and Eka Rasabhyasa for Dourbalya.17 ti.

SATWA Vyayamashakti Assessment Satwa is mind and it regulates the body because Samyak Vyayama Lakshana can be con- of its association with soul. Acc. to Bala Bheda, sidered as the optimal capacity of the person for it is of 3 types, viz., Pravara, Madhyama, Avara exercise/ work. A person can have good exer- Satwa.18 cise capacity / feel tired before achieving Sa-

IAMJ: MARCH, 2017 834 Moksha B M Et Al: Dashavidha Pariksha- A Practical Approach To Clinical Method Of Diagnosis myak Lakshana which can be taken as Pravara good power of exercise. This helps in faster re- or Avara. covery. Exercise capacity of an individual can vary depending on many factors like age, gender VAYA etc. Depending on these if a standard protocol is Vaya is defined as the state of the body developed in relation with the variables, corresponding to the length of time that has Vyayamashakti can be assessed in a better way. passed since birth. It is broadly classified into 3 Exercise tolerance refers to the exercise stages as per Charaka: Bala (childhood)- 0- 30 capacity of an individual as measured by their yrs- again divided into 2 as 0-16 yrs- Aparipak- ability to endure exercise and/or the maximum wa Dhatu Kala, 16-30 yrs- Vivardhamana Dha- tu Kala. MadhyamaVaya- 30-60 yrs and Jeerna work load achieved during the exercise period. 24 Exercise tolerance can be measured accurately Vaya- 60- 100 yrs. during an exercise tolerance test. It involves Importance of Vaya monitoring of heart rate, BP, ECG as well as The examination ofVaya helps in know- physical symptoms. Most commonly treadmill ing the diseases and Doshas which are specific can be used. to that particular age. The dose of medicine is Perceived exertion is how hard you feel different for different age groups. So it helps in your body is working. It is based on the physical calculating the dosage as per the age group. Cer- sensations a person experiences during physical tain treatment procedures are contraindicated in activity, including increased heart rate, in- Bala, Vruddha which are to be avoided. creased respiration or breathing rate, increased VIKRUTI sweating, and muscle fatigue which can be cor- Vikruti Pariksha is done to know the related to Samyak Vyayama Laksha- Roga Bala by examining Hetu, Dosha, Dushya, 23 nas. Althoughthis is a subjective measure, a Prakruti, Desha, Kala, Bala Lakshanas in the person's exertion rating may provide a good es- affected Rogi25. Without determining the timate of the actual heart rate during physical strength of the causative factors etc., it is not activity. possible to obtain the knowledge regarding the The other method is to check the pulse intensity of the diseases. rate during maximum exertion. It should be Hetu- It can be interpreted as the causative fac- within 1 ½ times of the normal pulse rate of that tor of the disease whether the origin is due to individual. Shareerika/ Agantuja/ Manasika Nidana also, whether the cause of the Roga is Sahaja, Garb- Importance of Vayamashakti A person with good Vyayamashakti will haja, Jataja, Pidaja, Kalaja, Prabhavaja or possess good Bala, hence can tolerate Shodhana Swabhavaja. therapies and any kind of Shastra Karma. Also Dosha- The Doshaswhich are vitiated Vyayama helps to increase the Agnibala. There- should be evaluated. Whether it is Shareerika or by helps in planning the type of medicine to be Manasika Dosha; or it can be Vriddhi or Kshaya administerd, its dosage. To undergo rehabilita- of the Dosha. tion programme, the person should be having

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Dushya- It can be Dhatu/ Mala/ Srotas. tu, Linga are having Alpa Bala, then the Roga is The vitiated Dhatu/ Mala can show respective considered as Alpa Bala Roga. Vriddhi/ Kshaya Lakshanas and vitiated Srotas The strength of the individual can be can show the respective Sroto Dushti Lakshana classified as Pravara, Madhyama, Avara de- which helps in the understanding of the diagno- pending upon the Prakruti, Sara, Samhanana sis. etc., except Vikruti. The strength of the Doshas Prakruti- Constitution of an individual is inferred from the Vikruti. Depending on these helps to know the susceptibility of the individu- factors, the type of Bheshajato be administered, al to certain kind of diseases and also to under- whether Teekshna/ Mrudu/ Madhyama can be stand prognosis of the disease. For example: Va- known. taja Prakruti persons are more prone to Vataja Roga. Here we can also assess whether it is Importance of VikrutiPariksha Prakruti Sama Samaveta or Vikruti Vishama Vikruti refers to morbidity of the susceptible Samavaya. individual and it also helps to ascertain the Desha- It can be Bhumi Desha or Aatura strength of the pathogenesis factors responsible Desha.Bhumi Desha is of 3 types- Jangala, for the manifestation of disease and also helps to Anupa and Sadharana. By knowing the Bhumi predict the prognosis of the disease. The Vyadhi Desha, it gives a clue regarding the Doshas Bala is assessed by the intensity of Hetu, Lak- which have a tendency to get aggravated, dis- shana parameters. They are collectively de- eases which are prevalentin that particular place, scribed as the conditions namely of Sukha Sad- the type of Ahara, Vihara people are accus- hya, Krichrasadhya and Asadhya. It helps in tomed to, Bala of the persons residing in that planning of the treatment. For example, we can region, their Satmya can all be predicted. Atura advise Nidana Parivarjana by knowing the He- Desha is examined to know the extent of Dosha tu. By knowing the Dosha involvement, Dosha Bala Pramana and Ayu Pramana. Pratyaneeka Chikitsa can be planned. Kala- can also be considered as the stage of the DISCUSSION disease- whether it is acute or chronic stage. For • Dashavidha Pariksha of Charaka is ex- Example: In Navajwara, Langhana is preferred plained for the examination of the Atura. and Kashaya is contraindicated. • The aim is to assess Ayu (Life span), Bala & Depending on these factors like Hetu, Dosha Pramana of the patient. Dosha etc., the severity of the disease can be • Dashavidha Pariksha helps to identify the classified into 3 types as Uttama Bala Roga, Rogi & Roga Bala there by selection of ap- Madhyama Bala Roga, Alpa Bala Roga. In case propriate dose & strength of medication of any disease, if the Dosha, Dushya, Prakruti, (Shodhana & Shamana). Desha, Kala, Bala are having similar Gunas; if • The 10 point examination has to be practi- Hetu, Linga are having Mahat Bala, then the cally understood and interpreted to obtain Roga is considered as Balawan Roga. Contrary optimum result. to this, if the Dosha, Dushya, Prakruti, Desha, • The same may be employed to a ‘Swastha Kala, Bala are having dissimilar Gunas and He- Purusha’ and try to assess his Ayusha Pra-

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mana and analyze the underlying risk factors 3. Agnivesha, CharakaSamhita, Ayurveda that may cause disease in future. Deepika Commentary by Chakrapanidatta, Edited by Vaidya YadavjiTrikramji CONCLUSION Acharya, ChoukambhaSurbharatiPrakashan, • A standard protocol has to be developed to Varanasi, reprint 2014, Pp: 738, vimanas- clinically assess the Dashavidha Pariksha thana, chapter:8, verse:94,Pg: 276 without any ambiguity. 4. Agnivesha, CharakaSamhita, Ayurveda • Such protocols which help to reproduce the Deepika Commentary by Chakrapanidatta, same assessment done at different places by Edited by Vaidya YadavjiTrikramji different physicians. Acharya, ChoukambhaSurbharatiPrakashan, • The 10 point examination can be employed Varanasi, reprint 2014, Pp: 738, vimanas- to a “Swastha Purusha” to assess his risk thana, chapter:8, verse:94, Pg:276 factors and make necessary changes in his 5. Sushruta, SushrutaSamhita, Nibandhasan- Ahara & Vihara to prevent the impending graha Commentary by Dalhanacharya, disease. NyayachandrikaPanjika of Gayadasacharya, • Dashavidha Pariksha can be used as a tool Edited by Vaidya YadavjiTrikamji Acharya, for ‘Preventive & Positive Health’. ChaukhambaSurbharatiPrakashan, Varanasi, • Dashavidha Pariksha coupled with Dina- reprint 2014, Pp: 824, shareerasthana, chap- charya & Rutucharya will help to achieve ter: 4, verse: 63, Pg: 360 the goal “Health for all by 2020”. 6. Agnivesha, CharakaSamhita, Ayurveda As Charaka quotes- If the person is having Sa- Deepika Commentary by Chakrapanidatta, maMamsa, Pramana, Samhanana and all the Edited by Vaidya YadavjiTrikramji Indriyas are in good condition, and then the per- Acharya, ChoukambhaSurbharatiPrakashan, son will not be affected by the strength of the Varanasi, reprint 2014, Pp: 738, vimanas- 26 disease. thana, chapter:8, verse:95, Pg:277 7. Sushruta, SushrutaSamhita, Nibandhasan- REFERENCES 1. Agnivesha, CharakaSamhita, Ayurveda graha Commentary by Dalhanacharya, Deepika Commentary by Chakrapanidatta, NyayachandrikaPanjika of Gayadasacharya, Edited by Vaidya YadavjiTrikramji Edited by Vaidya YadavjiTrikamji Acharya, Acharya, ChoukambhaSurbharatiPrakashan, ChaukhambaSurbharatiPrakashan, Varanasi, Varanasi, reprint 2014, Pp: 738, sutra stha- reprint 2014, Pp: 824, shareerasthana, chap- na, chapter:20, verse:20,Pg:115 ter: 4, verse: 79, Pg: 362 2. Agnivesha, CharakaSamhita, Ayurveda 8. Agnivesha, CharakaSamhita, Ayurveda Deepika Commentary by Chakrapanidatta, Deepika Commentary by Chakrapanidatta, Edited by Vaidya YadavjiTrikramji Edited by Vaidya YadavjiTrikramji Acharya, ChoukambhaSurbharatiPrakashan, Acharya, ChoukambhaSurbharatiPrakashan, Varanasi, reprint 2014, Pp: 738, vimanas- Varanasi, reprint 2014, Pp: 738, vimanas- thana, chapter:8, verse:88,Pg: 275 thana, chapter:8, verse:102 commentary, Pg:278

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22. Agnivesha, CharakaSamhita, Ayurveda Deepika Commentary by Chakrapanidatta, Edited by Vaidya YadavjiTrikramji Acharya, ChoukambhaSurbharatiPrakashan, Varanasi, reprint 2014, Pp: 738, sutra stha- na, chapter:7, verse:33 (1), Pg:51 23. Agnivesha, CharakaSamhita, Ayurveda Deepika Commentary by Chakrapanidatta, Edited by Vaidya YadavjiTrikramji Acharya, ChoukambhaSurbharatiPrakashan, Varanasi, reprint 2014, Pp: 738, vimanas- thana, chapter:8, verse:121, Pg:280 24. Agnivesha, CharakaSamhita, Ayurveda Deepika Commentary by Chakrapanidatta, Edited by Vaidya YadavjiTrikramji Acharya, ChoukambhaSurbharatiPrakashan, Varanasi, reprint 2014, Pp: 738, vimanas- thana, chapter:8, verse:122, Pg:280 25. Agnivesha, CharakaSamhita, Ayurveda Deepika Commentary by Chakrapanidatta, Edited by Vaidya YadavjiTrikramji Acharya, ChoukambhaSurbharatiPrakashan, Varanasi, reprint 2014, Pp: 738, vimanas- thana, chapter:8, verse:101, Pg:278 26. Agnivesha, CharakaSamhita, Ayurveda Deepika Commentary by Chakrapanidatta, Edited by Vaidya YadavjiTrikramji Acharya, ChoukambhaSurbharatiPrakashan, Varanasi, reprint 2014, Pp: 738, sutra stha- na, chapter:21, verse:18, Pg:117

Source of Support: Nil Conflict Of Interest: None Declared

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