ASTASTHANA PARIKSHA - A DIAGNOSTIC METHOD OF YOGARATNAKARA AND ITS CLINICAL IMPORTANCE

Abstract

Indian traditional medicine, Ayurveda has a great history. Researchers of India have tried to corroborate ancient wisdom with modern scientific practices. It is necessary to diagnose the disease after proper examination and medicines are to be given. There are many diagnostic tools of examination. Yogaratnakara provides a clear picture of scenery of illness and healthy condition through Astasthana Pariksha. Tailabindu pariksha, one among Ashtasthana pariksha is a diagnostic tool of urine examination developed by the medieval Ayurvedic scholars. It also helps in establishing prognosis of various diseases. In current paper, attempts were made to study the relation of Ashtasthana Pariksha in therapeutics with special emphasis and its applicability in medical practice. [PUBLICATION ABSTRACT]

Headnote

ABSTRACT

Indian traditional medicine, Ayurveda has a great history. Researchers of India have tried to corroborate ancient wisdom with modern scientific practices. It is necessary to diagnose the disease after proper examination and medicines are to be given. There are many diagnostic tools of examination. Yogaratnakara provides a clear picture of scenery of illness and healthy condition through Astasthana Pariksha. Tailabindu pariksha, one among Ashtasthana pariksha is a diagnostic tool of urine examination developed by the medieval Ayurvedic scholars. It also helps in establishing prognosis of various diseases. In current paper, attempts were made to study the relation of Ashtasthana Pariksha in therapeutics with special emphasis and its applicability in medical practice.

Keywords: Ashtasthana Pariksha, Ayurveda, Nadi, Tailabindu, Yogaratnakara

INTRODUCTION

A physician by treating the persons who are deeply immersed in the sea of disease (Roga) due to their ill fate (Papa) are pulled out from the sea. This humanistic effort under taken by the physician ensures an honourable place for him in the society, even-though he does not perform other routine dharma1. Yogaratnakara stresses on the importance of "Vyadhi Vinischaya" (Diagnosis of ailment). It is essential that physician should examine the disease thoroughly and arrive at a proper diagnosis (Vyadhi Nirnaya). Afterwards i.e. knowing fully about the nature etc of diseases he should commence the Chikitsa (treatment) by administering suitable "Aushadha" or by employing a procedure e.g. Snehana, lepa etc.

Different methods of examination have been explained in classics of Ayurveda, which will be helpful in diagnosis of a disease, estimating the status of Rogibala and Rogabala etc. Following table provides a glimpse on this: Among all these methods of examination Ashtasthana Pariksha (popularly known as Ashtavidha Pariksha) has its own significance.

Asta Sthana Rogi Pariksha12 (Eight- fold examination of patient)

(1) Nadi Pariksha (Pulse Study)

(2) Mutra Pariksha (Examination of Urine)

(3) Mala Pariksha (Stool Examination)

(4) Jihwa Pariksha (Tongue Examination)

(5) Shabda Pariksha (Voice Examination)

(6) Sparsha Pariksha (Skin Examination)

(7) Drik Pariksha (Eye Examination)

(8) Akrti Pariksha (General appearance Examination)

Nadi Pariksha (Pulse Study)

The status of Doshas in diseased as well as in healthy individual can be assessed by Nadi Pariksha13. It illustrates all types of diseases progressions, just as the strings of a veena (a musical instrument) can produce different ragas so the Nadi can speak of different diseases14. Like Prakriti, Nadi also varies in person depending on health and disease condition. (Tables 2-5)

Paryayas of Nadi

Snayu, Nadi, Hansi, Dhamani, Dharani, Dhara, Tantuki, and Jeevan Gyan15.

Nadi location

Vata, Pitta and Kapha Nadi lies respectively under Tarjini (index), Madhyama (middle) and Anamika (ring) fingers of examining physician16.

Tridosha examination

Three fingers placed in position over Nadi indicate the condition of the Tridosha and their Gati (i.e. Manda, Madhyama and Tikshna) 17. The index finger denotes Vata, the middle finger Pitta and the ring finger Kapha. Nadi Pariksha offers knowledge about involvement of dosha- Vata, Pitta and Kapha, Dwandaja (any two dosha) and Tridoshaja (all three dosha), and Sadhya Asadhyata (prognosis of disease)18.

Jiva sakshini

Anatomical position of the Jiva sakshini Nadi at Angushtha moola and its clinical importance as pulse has been stressed19. The pulsation in the Dhamani (artery) reflects the evidence of life and the learned physician through Sparsana Pariksha is able to come to assessment of the person concerned, whether the person is ill or well. In female lefthand Nadi should be palpated and vice versa.

How to examine

Nadi should be examined in mental stability and peace of mind before with his hand pulse (beat) below the right thumb. As regards methodology, the elbow (Kurpara) of the patient should be lightly flexed to the leftand the wrist slightly bent to the leftwith the fingers distended and dispersed. Nadi should be examining repeatedly for three times by applying and releasing pressure alternately over Nadi to assess the condition of Dosas rightly20. After Nadi Pariksha physician should wash his/her hands because disease disappears from the patient like mud gets washed away21.

Method for Arterial pulse examination-

An ideal time for pulse examination is early morning with empty stomach. But in case of emergency, it can be examined at any time of the day or night. It is essential as a routine to feel not only the radial pulse but also the other peripheral pulses. The pulse is usually felt at the wrist and over the radial artery, because of its superficial position and ease of palpability. The radial artery is situated slightly medial to the styloid process of the radius, on the anterior aspect of the wrist, and is best felt with the subject's forearm slightly pronated and wrist somewhat flexed22.

New Findings- in relation to Nadi Pariksha

The pulse is a wave, which, after being produced by cardiac systole, travels or advances through the arterial tree in a peripheral direction. It arrives at the wrist long before the column of blood ejected by heart. Characteristics of the pulse i.e. Rate, Rhythm, Volume, Force etc of pulse varies from individual to individual and even from time to time23. The pulse rate is unduly high during fever, infectious diseases etc. and slow pulse rate may be indicative of certain clinical status e.g. Hypotension, etc24.

Contraindication for Nadi Pariksha

In the following conditions Nadi Pariksha gives no correct information- immediately after bath, immediately after having food, after massaging, hungry, thirsty and while sleeping25.

Asadhya Nadi

'Sannipata Nadi' pulsate slowly, intermittently (Vyakula) and is extremely thin. This is mentioned as Asadhya Nadi. It indicates imminent death. When Nadi firstly pulsates like Pitta gati, afterwards it becomes like Vata gati then transforming to Kapha gati and moves like a wheel, sometimes it is rapid and sometimes very thin such Nadi should be considered as Asadhya Nadi and act accordingly. Mrityu Suchaka Nadi- the Nadi which resembles Damru (a musical instrument), means which is strong at opening and ending but very slow in between, is the indicator of death in a day30.

New findings- in relation to Asadhya nadi

Forceful and jerky rise of the Corrigan pulse is due to the rapid filling of the radial artery caused by an extra large amount of blood pushed by the distended leftventricle during systole into relatively empty arterial vessels. The collapsing character or the sudden down stroke of the pulse may be due to partly to the sudden fall of pressure in the aorta due to regurgitation of blood into the leftventricle through a leaky valve during diastole31.

Healthy Pulse: Hamsa gamana (Swan like walk), Gajagamini (elephant like) and who is having cheerful face is considered to be a healthy32.

Mutra Pariksha

Importance

By Mutra Pariksha (urine examination) one can assess any running pathology inside the body30. Urine is the end product of metabolism by billions of human cells and the body chemistry, blood pressure, fluid balance, nutrient intake, and the state of health are key elements in establishing the characteristic of urine33.

Method

The wise physician should wake up the patient early in the morning around 4 o'clock, avoid the first stream of early morning urine, then collect the urine of subsequent flows in a clean glass vessel and examine thoroughly to assess the disease process and treat the patient accordingly34-35.

New findings- in relation to mutra pariksha

For routine urine examination, midstream sample of urine which is the first morning sample, collected in a clean container is preferred since it gives a more constant result36.

Method of Examination (Tailabindu Pariksha)

Along with the examination of colour, appearance and consistency of urine (Tables 6- 7), a special technique for the examination of the Mutra, Tailabindu Pariksha, was developed to diagnose disease conditions and to find out their prognosis. Both examination of urine sample and questioning of patients are important for assessing Doshic influence. A modification of this is the oil (taila) drop (bindu) test (pariksha) in which the effect of an oil drop on urine sample suggests the curability of disease.

Urine should be examined carefully as stipulated. Instil one or two drops of Tila taila into the vessel, where in the patients' urine is collected37. Type of dosha vikara is assessed by appearance of taila bindu39 (Table 8). According to direction of spread of drop one can assess the curability or non-curability of disease40 (Tables 9-10), prognosis of disease41. By urine appearance doshic predominance42 and disease condition43 can be diagnosed (Tables 11-12).

Mala Pariksha

Type of dosha vikara and disease condition can be determined by Mala pariksha44 (Tables13-14). If digestion & absorption of food are poor, the stool carries a foul odour and sinks in water. Vata aggravated, the stool is hard, dry and grey/ash in colour. Excess Pitta makes it green/yellow in colour and liquid in form. And high Kapha lines it with mucus.

New Findings- in relation to Mala pariksha

Stool examination is one of the simplest, widely applicable and most important tests for the diagnosis of intestinal parasitic infection and other inflammatory condition. In Ayurveda Rashi, Swarupa, Varna, Gandha, Sama-Nirama Lakshana of stool etc are the diagnostic tools for many diseases. In modern era microscopic examination of the stool is important to diagnose Amoebic dysentery etc. Blood in stool indicate gastrointestinal lesion and fat determination is done for seborrhoea45.

Jihwa Pariksha46

Detection of the type of disease condition can be made by Jihwa Pariksha (Tables15-16).

New findings in relation to Jihwa pariksha

Different areas of the tongue correspond to different organs of the body. Hence by correlating the location of the blemishes on the tongue, the Ayurvedic practitioner can determine which organs of the body are out of balance. The colour, size, shape, coating, anomalies, surface, mobility and local lesion are all noted47.

Asya Pariksha

Different dosha can change the taste of mouth. This can be including only in Prashna Pariksha. (Table-17)

New findings- in relation to Asya Pariksha

In Yogaratnakar, Asya pariksha is described as subjective condition. Acharya Charaka described different types of Rasa vishayaka arishta in Indriyasthana but they all are in excessive condition and in abnormal conditions48. According to modern science, oral examination contains tongue, teeth, gums, buccal mucosa etc examination but in Yogaratnakara it is described as taste examination. Different taste on tongue in abnormal condition is important to know by asking for different Doshik vitiation. In modern science, there is no any direct relation with taste is described for diagnosis.

Shabda Pariksha

Healthy and natural when the doshas are in balance, the voice will become heavy when aggravated by kapha, cracked under pitta effect and hoarse & rough when afflicted by vata. (Table 18)

New Findings- in relation to Shabda pariksha

Auscultation can be compared with the Shabda Pariksha of Ayurveda. Four auscultatory areas of the heart facilitate clinical diagnosis. Interscapular area, infrascapular area, cranial area, Abdominal area and peripheral arterial sites may disclose murmers of diagnostic significance59.In Respiratory examination, inspiratory and expiratory sounds with or without an intermediate pause or interval is observed as normal condition51.Abnormal breath sounds are heard if they are abnormally generated and if they are abnormally conducted52.Aucultation is an important part of abdominal examination. It is best carried out in deep expiration and with light application of the bell chest piece over all the four abdominal quadrants60. In abnormal condition also Auscultation of abdomen give some clue for diagnosis e.g. Succussion (Gastro intestinal splashing sound) sounds are found in stomach fluid or gas etc61.

New Findings- in relation to Sparsha pariksha

Sparsha Pariksha can be compare with palpation and percussion. Palpation is only second to that of auscultation. It is an important clinical method for examination of skin for assessing the state of organs and tissues. The examiner stands or sits on the right of the patient and places the palm of hand which must be warm, on the area under investigation. It was customary to define the apex of the leftventricle57.

Sparsha Pariksha

Used for assessing the state of organs and tissue, palpation is an important clinical method for examination of skin. Noted for doshic influences, a vata aggravated skin is course & rough with below normal temperature, a pitta influenced one has quite high temperature and kapha affected it becomes cold & wet. (Table- 19)

In Respiratory system, comparative palpation of both two sides of the chest and Localised swelling, tenderness, Crepitus, Ronchial Fremitus, Palpable rales, friction fremitus, lymph nodes enlargement are observed through palpation66. In abdominal examination also Muscle rigidity, tenderness, oedema, doughy feel, haematoma, lump etc are examined.

By percussion normal health condition, area of cardiac dullness (Table 20), liver dullness, Splenic dullness etc are examined67. Abnormal percussional findings in different disease also give clue for many diseases e.g. Shifting dullness in Hydro or pyo-pneumothorax, Fluid thrill, horse shoe shaped dullness, shifting dullness are found in Ascites68.

Drika Pariksha

Vata domination makes the eyes sunken, dry and reddish brown in colour. On aggravation of pitta, they turn red or yellow and the patient suffers from photophobia and burning sensations. High kapha makes them wet & watery with heaviness in the eyelids. (Table 21-23)

It can be understood as follows:

Some special features of eyes also indicate certain diseases eg. Excessive blinking is a sign of nervousness, anxiety or fear and a drooping upper eyelid indicates a sense of insecurity, fear or lack of confidence.

Arishta lakshana

One eye opened and the other closed, whose eyes become bright lustrous and red, when patient sees reddish, bluish and terrifying images, when one eye loses vision and other eyeball rotates; all these are bad prognosis. Acharya Charaka described Arishta vishayaka lakshanas of Chakshu71.

New Findings- in relation to drika pariksha

Different types of eyes features may reflect the personality of the individual and his reaction to disease72.Expression of the eyes may reflect the health and diseased condition of an individual.

Akriti Pariksha

The doshic influences that reflect on the face of the patient enables physicians to gauge the basic constitution and the nature of the disease. (Table-24)

New Findings- in relation to Akriti pariksha

The doshic influences that reflect on the face of the patient enable physicians to gauge the basic constitution and the nature of the disease. The constitution or body type of the individual may have a bearing on the disease process75. The regional distribution of eruptions gives an idea of the diagnostic clues. Abnormal dryness of the skin from loss of sweating may be found in dehydration, hypothyroidism, Scurvy etc76.

DISCUSSION

Yogaratnakara describes movements of Nadi under the influence of Doshas and their combinations. Further to make it more appealing, the author correlates the character of each type of pulse with movement of animals, birds etc (Table-2). The position of index finger denotes Vata Dosha. In Vata predominant constitution, the index finger will feel the pulse strongly. The pulse movement will be like motion of a serpent. This type of pulse is called 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 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. Acharya Charaka described different Nadi conditions in Indriyasthana for Jwara purvalakshana77. The movements of Nadi according to different pathological conditions are well described by Yogaratnakara78 (Table-3). Not only different status of fever79 but also the prognosis of disease can be made by detecting Nadi gati (Table-4 and Table-5). Examination of mootra is very important in diagnosis. Mutravaha Srotas is affected by various causes like Ahara (excess of Katu, tikshna, Amla, Lavana), Vihara (Trishnanigraha, Atapasevana, Ativyayama),Abhighata ,etc or some diseases affecting Rakta, Hridaya etc. The color, consistency, character, quantity of Mutra varies in different illnesses. Examination of faces gives valuable clues regarding the Annavaha Srotas as well as Purishavaha Srotas. Prakriti, Ahara, Vihara, kala, Satmya, Vyadhi etc influence features of Purisha. Susruta describes the features of Purishakshaya are to be inferred from complaints of pain on the sides and cardiac regional feeling of vayu crushing upwards, flatus, rumbling sounds in intestine etc. Jihva Pariksha has great importance. Tongue is considered as the index of stomach and its examination produce vital clues to diagnosis. Any abnormality in color, shape, size, presence of fissures or cracks ulcerations, salivation, furr on tongue, tremor, and deviation to one side should be noted. Shabda pariksha has specific role in diagnosis. Pratyaksha is main stream to understand things and Shabda is one of the main Upadhi for that purpose. Different organs like heart, intestine etc produce sound while working. These sounds may be altered in diseases. People use sounds in communicating with others, this can also be altered in various diseases. By percussion and listening to the sounds produced, the position of hard organs, presence or absence of fluid or gas in cavities etc can be determined. Sparsha has great role in diagnosis; it is mentioned by all acharyas and also included in Trividha, Shadavidha and Ashtasthan Pariksha. These all shows the importance of Sparsha pariksha in diagnosis. By examination of eye, one can find some Arishtalakshana like Urdhva Drishti, Bramayuta, etc. Akriti Pariksha has mainly to do with physiognomy it means judging a man's nature by his features. Here, the most obvious external features like appearance, built, height, shape, size, complexion etc are put to evaluator scrutiny. The attitude of affected organs in Dhanustambha, Manyastambha, Ardita etc are also included in Akriti pariksha.

CONCLUSION

The principles of the treatment vary from patient to patient on the strength of the patients and morbidity of the disease. Hence it is essential to acquire complete knowledge of Ashtasthana Pariksha of Yogaratnakara. Different methods of examinations were adopted with the different times. These examination methods were designed in such a way that these were very much applicable in leading to the diagnosis of a certain disease. These got modified with the advent of time and the additions of things were done according to the requirements.

References

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68. Aspi F. Golwala and Sharukh A. Golwala, (2006), Physical Diagnosis, A textbook of Symptoms and Physical Signs, by Media Performance and Publishers, 11th Edition, Delhi, p.244

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75. Aspi F. Golwala and Sharukh A. Golwala, (2006), Physical Diagnosis, A textbook of Symptoms and Physical Signs, by Media Performance and Publishers, 11th Edition, Delhi, p.244

76. Aspi F. Golwala and Sharukh A. Golwala, (2006), Physical Diagnosis, A textbook of Symptoms and Physical Signs, by Media Performance and Publishers, 11th Edition, Delhi, p.345

77. Trikamji Jadavaji, (2007), Charaka Samhita (Dridhabala with Chakrapani), Reprint, Varanasi, India, Chaukhambha Prakashana, p. 276

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Source of Support: Nil Conflict of Interest: None Declared