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As has been stated earlier, in addition to assessing the doshic vitiation, the physician also must understand the tissues affected, the srotas involved, the patient's social circumstances, the emotional tendencies, personality traits, and the general state of the patient's health and life. Clearly, this information gathering demands an extensive interrogation and physical examination, which Ayurveda teaches as a two-part approach: |
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The first of these, rogipareeksha, is the true strength of Ayurvedic diagnosis. It includes the physician's judgment regarding the patient as a whole, his temperament, discipline, habits, digestive capacity, intelligence, hereditary traits, emotional set, finances, support system, desire to heal, and of course his constitutional type. Charaka also described a ten-fold methodology for this aspect of Ayurvedic diagnosis which is still in use today precisely as outlined below:
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| Ten-fold Ayurvedic Diagnosis of the Patient (Rogipareeksha) |
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| 1. |
Constitution (Prakriti): |
Constitution includes the inherited physical and mental characteristics of an individual. These characteristics are assessed through the physician's knowledge of the tridosa and the triguna. Recall that prakriti represents the proportion of the three doshas and three gunas, which is the original proportion for a given individual. It is that very proportion which manifests in the physical and psychological features of the person. |
| 2. |
Doshic Vititation (Vikriti): |
This refers to the degree to which an individual has deviated from the original proportion of the three doshas (prakriti). This can be assessed by close observation of the dhatus, upadhatus, malas, function, structure, intellect, and emotions of the individual. |
| 3. |
Quality of the Tissues (Sara): |
This aspect of the patient examination assesses the quality of the seven dhatus and the mind. We usually grade the quality of each tissue as pravara (excellent), mahdyama (medium), or avara (inferior). Pravara status implies overall excellent immune status, recuperative capacity, and good prognosis; avara status implies poor immunity and general vitality and a poorer prognosis. Sara pariksha also includes assessment of the degree of sattvic quality in the mind. It presence is indicated by brightness of the intellect, mental calm, and capacity for discrimination; its absence is recognized by rajasic or tamasic qualities of the mind. |
| 4. |
Compactness of the Body (Samhanana): |
This is the solidity and overall physique of the body frame. A more compact body usually indicates better immunity and healing capacity than a very soft and flaccid body habit. |
| 5. |
General Stature and Physical Proportionality (Pramana): |
This term really refers to the ratio of the height to the outstretched arms (which should be the same), and several other scriptural measurements said to indicate a well-proportioned body. The well-proportioned frame is said to have superior health capacity and better prognosis. |
| 6. |
Physical Strength (Vyayama Shakti): |
This factor means the capacity of the individual to be physically exerted and is measured by assessing the powers of endurance. The exercise endurance is a good measure of certain metabolic measures that create strength and stamina. These include the ability of the heart rate and blood pressure to increase appropriately, the ability to generate sympathetic nervous activity, the ability to secrete insulin, cortisol, and other hormones, the ability to up-regulate the respiratory rate. All of these functions are tested by the patient's exercise capacity. |
| 7. |
Adaptability (Satmya): |
This is a measure of the capacity of an individual to adjust to both physically and mentally unsettling conditions and to maintain homeostasis in the face of these factors. This is a very unique diagnostic concept that we find only in Ayurveda. It includes a wide range of psycho-neuro-immunological assessments but can be simplified for clinical measurements to the following data. |
| 8. |
Emotional Balance (Sattva): |
This feature specifically refers to the mental steadfastness: the ability to tolerate and withstand distractions such as pain and physical or mental discomfort and still proceed with one's duties. It also includes the immediate reaction which one has toward unexpectedly altered circumstances and strange situations. The capacity to remain even-minded and calm is a sign of emotional balance and a strong and healthy buddhi (intellect). |
| 9. |
Digestive Capacity (Ahara Shakti): |
This is an assessment of the capacity to ingest, digest, and assimilate food. One-way of assessing this is by virtue of the appetite and how strong and sharp (sudden onset) it is. The actual quantity of food consumed is another feature of this assessment. The time period between consuming a meal and the next onset of hunger is a measure of agnibala, or the strength of the agni. The more optimum the ahara Shakti of a patient the faster will be the recovery from imbalance and disease. |
| 10. |
Rate of Aging (Vaya): |
This is the comparison of the person's actual chronological age with one's apparent age. If one appears to be younger than one's chronological age, this is a sign of positive health; and the converse holds true. Parameters such as long and short-term memory, skin texture and luster, strength of the voice, posture, quality of movements, gait, quality of the hair, and daily activities are the measures of vaya. The antidote to premature aging is rasayana cikitsa, or anti-aging therapies. |
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The diagnosis of the disease, rogapareeksha, is aimed toward assessing the nature of the disease and is divided into three main activities: |
| 1. |
Prasna (Interrogation): |
Obtaining the history of present illness, pertinent positives and negatives of the past medical history, and a very complete and accurate review of systems. |
| 2. |
Panchendriya pariksha (Physical examination using the five senses): |
Complete physical examination; Ayurveda divides the body into the sadangas, or six major regions, for this purpose and includes the head, neck, chest, abdomen, and the upper and lower extremities. This includes assessment of the srotas (channels) and dhatus (tissues) throughout the entire body. The physical examination includes darshana (inspection) and sparshana (palpation). |
| 3. |
Ashtavidha pariksha (Specialized "Eight-fold" Ayurvedic examination): |
This is given below in table form:
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| Ayurvedic Eight-fold Examination to Assess Disease (Rogapariksha) |
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| 1. |
Examination of the complexion |
| 2. |
Examination of the eyes |
| 3. |
Examination of the speech and voice |
| 4. |
Examination of the tongue |
| 5. |
Examination of the skin |
| 6. |
Examination of the stool |
| 7. |
Examination of the urine |
| 8. |
Examination of the pulses |
These three activities are applied to assess the nature of disease using the following rational and orderly approach. First one identifies the cause(s) of the disease (Nidana). Next, one evaluates the stage of progression of the disease or pathogenesis (Samprapti). This is followed by careful observation of any very early signs of disease (Purvarupa) and the overt symptoms of the manifest disease condition (Rupa). Finally, we derive additional information about the disease from how it responds to theraputic interventions, which are administered, i.e. response to treatment (Upashaya). |
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