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Books > Ayurveda > Diagnostic Methods in Ayurveda
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Diagnostic Methods in Ayurveda
Diagnostic Methods in Ayurveda
Description

From the Jacket

The book 'Diagnostic Methods in Ayurveda' written by the well known author Prof. Ajay Kumar Sharma is a complete and comprehensive treatise on the subject. This book is one of its own kinds which deals with the subject in all completeness and clarity covering all aspects of Ayurvedic Diagnostics as described in various Ayurvedic treatise and judiciously supplemented by the modern literature available on the subject. The entire text is nicely supported with original references from Ayurvedic Classics. Latest information regarding Diagnostics has been incorporated with the objective of bridging the gap between the information available in various Ayurvedic classics and the books of Clinical Medicine with the objective of providing basic and complete knowledge to the readers. The book is meant especially for Ayurvedic Students, Physicians and Teachers for creating awareness amongst masses about the dependable holistic approach of Ayurveda in the scientific and systematic manner about the clinical methods in Ayurveda.

Efforts have been made to produce the subject matter in absolutely a new form detailing the ancient concepts of Ayurvedic advances in the field of Diagnostic.

The author of the book being a senior Professor of Ayurvedic Medicine (Kayachikitsa) in National Institute of Ayurveds, Jaipur and being a reputed teacher, clinician and researcher, this book has been richly benefited by his scholarship and professional experience. It is expected that this book will be useful for prospective readers.

About the Author

Born on 31st May, 1954 Prof. Ajay Kumar Sharma graduated in Ayurveda with Medicine and Surgery from A. & U. Tibbia College, New Delhi in 1976 with throughout top rank career. He completed his M.D. (Ay.) [B.H.U.] and Ph. D. under the guidance of his illustrious mentor Prof. R.H. Singh, presently Professor-Emeritus, Faculty of Ayurveda, I.M.S., B.H.U., Varanasi and Ex-Vice Chancellor, Rajasthan Ayurveda University, Jodhpur.

Prof. Sharma is one of the senior most Professors and Head of P.G. Department of Kayacikitsa and Deputy Medical Superintendent of the Hospitals at National Institute of Ayurveda, Jaipur. He is one of the Chief Ayurvedic Physician and Panca Karma specialist in the Institute. Prof. Sharma has published 10 standard books on Ayurveda and over 190 research papers. He received many awards and prizes for his outstanding career. He has contributed chapters to the prestigious volumes on Ayurveda-Kayacikitsa-Panca Karma published by CRC Press London, New York Washington and Argentina. Prof. Sharma has produced 40 M.D. (Ay.) and 6 Ph. D. under his guidance. He is the expert member of several important national level committees.

Preface

Ayurveda is the most ancient system of medicine in the world. Ayurvedic Medicine was a highly developed medical science with its manifold specialized practices in pre-independent era. Following the classical age Ayurveda had flourished well till the medieval period, after which followed the phase of decline of Ayurveda. However last few decades have proved important towards revival of Ayurveda with noticeable upsurge of interest throughout the world.

With the growing interest in Ayurveda there has been increasing demand of authentic literature on Ayurveda suitable for practice of Ayurvedic medicine. During last few years the revival activities in Ayurveda and interaction with other systems of medicine has lead to lot of clarity in the priorities and perspectives of contemporary Ayurvedic medicine. Such advances prompt to the need of producing newer literature incorporating the recent advances in terms of conceptual and strategic clarity and scientific developments. It is with this background that the present book was launched.

Clinical methods is a book for student of all ages age all degrees of experience. We all have gaps in our knowledge and this book should help fill them. it is intended to provide insight into the acquisition of the traditional clinical skills of history taking and physical examination, and of the increasingly complex and accurate methods available to modern clinicians. If modern investigative methods are to be applied to patient care intelligently, they must be integrated with traditional methods. The latter remain invaluable and irreplaceable clinical skills. Extended investigations and more complex managements must be both useful and humane. It is expected that the book will be recognized by prosperous readers as an old friend, a friend offering some new information, together with much that is well tied, and that ought to be as well known to new generation of students as it was to their teachers when they were students. Good clinical method is still the root of the matter.

The present book has been written with an objective of providing elaborate and comprehensive knowledge of the subject suitable to the present day students and teachers of Ayurveda. The subject matter has been elaborated with in the frame work of Ayurveda, supplemented at various places with modern knowledge of the subject, just to fill in the gaps. Efforts have been made to avoid the usage of complex technical terms. The language used is simple, easily understandable and self explanatory. Efforts have been made to provide Ayurvedic equivalents to modern terminology and vice-versa logically at appropriate places with the intentions of providing clarity to the subject matter. Throughout the book an attempt has been made to indicate particularly important matters and to suggest the diagnostic relevance of certain findings. The book may therefore be used not only as a text of clinical methods, but as a supplement to text book of medicine.

The author of this book being teacher, physician and researcher in this field has had the advantage of utilizing his professional experience with clinical medicine of Ayurveda in compiling the present book. It is hoped and believed that this small effort will prove to be of some benefit to the prospective readers.

The book is presented in the form of four units. Unit one deals with general considerations, Diseases and Disease process and Rogi Pariksa described in three chapters. Unit two is composed of nineteen chapters which cover various types of examination of Rogi, Trividha and Sadavidha Pariksa, Astavidha and Dasavidha Pariksa and Srotasa Pariksa describing in details Racana Sarira, Kriya Sarira, Srotodusti Karana, clinical manifestations, Sroto Pariksa Vidhi, investigations and important disorders of all Srotasas. Unit third describes the details of methods of Roga Pariksa in three chapters covering in details Panca Nidana Pariksa, Sadhyasadhyata of various diseases and Arista-vijnana. Unit four provides miscellaneous information regarding clinical methods including Ayurvedic case History Sheet, Modern Case History Sheet and laboratory investigations. The book is supplemented with an uptodate bibliography on the topics covered.

While compiling this book I received invaluable help from my post graduate students who kept me on developing the subject with due rationality and clarity by putting across a variety of questions in the classroom and departmental seminars. I take this opportunity to express my heartfelt gratitude to Dr. Vinod Gautam, my post graduate M.D. (Ay.) scholar who contributed richly in compilation and completion of this work.

 

Foreword

The clinical Methods form an important component of any medical discipline. Conventional western Medicine has developed its clinical methods to a great extent in recent years, further strengthened with amazingly advanced investigative facilities. But the modern diagnostics seems to have been reduced to mere diagnostic technology and bio-engineering. Real Clinical Medicine and clinical sense of a physician are already loosing grounds and a physician is fast becoming a technocrat and is no more a first-hand Pratyaksa observer, neither the patient has remained an Apta any more. The result is the fast erosion of the clinical sense and power of healing in a physician in coventional medical practice.

On the other hand Ayurveda presents an unique holistic approach to diagnostics which needs to be developed into practical clinical methodology useable on bed-side in a meaningful manner. Impersonal subjectivity depth of clinical sense and healing power are the valued features of Ayurvedic clinical science. There are several books already published on Clinical Methods of Ayurveda by different authors, the present book authored by Doctors A.K. Sharma and Vinod Gautam is another addition on the same lines. Most of there books are of descriptive nature and to not come out with real practical approach and clinical methodology and hence the Ayurvedic graduate students remain bewildered in the jugglary of theoretical descriptions and fail to apply a real objective methodology to examine their patients on Ayurvedic lines for classical Ayurvedic treatment. It is often seen that the Ayurvedic case-history-taking and clinical examination remains a ritualistic exercise for theoretical satisfaction and it really does not serve a useful purpose to make a serious workable Ayurvedic diagnosis. This is why the trend of modern diagnosis and unconventional Ayurvedic treatment is increasing day by day in general practice. This is a dangerous trend and tends to reduce the science of Ayurveda into a mere therapeutic modality.

The teachers involved in teaching this subject and the authors desirous to produce literature have to play a realistic role. The whole subject has to be evolved into a practice-oriented wisdom and professional skill. I find large number of graduate students of Ayurveda highly confused about the scope of application and purpose of different sets of examination schedules described by ancient and medieval texts of Ayurveda such as Dwividha Pariksa, Trividha Pariksa, Caturvidha Pariksa, Sadvidha Pariksa, Astavidha Pariksa, Dasavidha Pariksa, Trayodara Srotas Pariksa and Astavidha Monovikara Pariksa. These sets of parameters have been described in our texts in different contexts and in different perspectives. Some of these depict the object of clinical examination while some others like Sadvidha Pariksa of Susruta describes the actual tools and methodology of clinical examination. The Astavidha Pariksa of Yoga Ratnakara, Dasa- vidha Pariksa and Trayodasa Srotasa Pariksa of Caraka enlist and outline the points of physical examination, general and systemic, over the Sadangas and Srotamsi of the patients' body during Rogi-Roga Pariksa. The available knowledge has to be suitably fabricated in a way so that it can be suitably utilised by a clinician in clinical examination and diagnosis on bed-side.

This is a message to promote clinical sense in a physician and the need of transparancy and willfulness in transaction of clinical responsibility. Medical profession is not an impersonal profittering profession rather is a superior science and art of humanism and healing saddled with divine grace. The nature and Body-Mind-Spiriton continuum is the fundamental feature of Ayurvedic holistics. Sincerity and compassion towards all is the principle fabrics.

Ayurvedic diagnostics while conceiving two-fold Rogi-Roga Pariksa intends to emphasise that a patient who presents himself before a physician for diagnosis and treatment is not merely a bundle of diseases. He is much more than that. Inspite of being sick the patient is a living being with a particular Eco-genomic nature i.e. Prakrti and he also enjoys varying degree of remainder health i.e. Swasthyasa which need to be evaluated carefully during clinical Examination irrespective of the disease he is suffering from. This is important because healing of a disease occurs only through the enherent help of the Prakrti and Avasista Swasthyamsa of the patient. This is while Ayurveda advocates to assess the nature of the patient and his remainder health. Examining 'health' of a patient in diseased state is the unique feature of Ayurveda. The conventional system of medicine ignores this aspect and devotes all its effort only to examine the diseases of the patient.

 

General Introduction

Introduction

Ayurveda is one of the most ancient systems of life, health and disease. Its antiquity goes back to the Vedas. Ayurveda is a highly evolved and codified system of life and health sciences based on its own unique and original concepts and fundamental principles. Ayurveda is already a highly developed system of medicine and health care with unique holistic and human approach advocating practice of medicine through an unique science of life. Some of important principles of Ayurveda are briefly described below:

Health and Disease Svasthya (Health) is described in Ayurveda as a state of equilibrium of Dosas (Body humors), Dhatus (Body tissues), Malas (Waste materials) and Agnis (Enzymes), along with happiness of Atman (Soul), Indriya (Sensory perception) and Manasa' (Mental faculties). It is clear from this definition of health in Ayurveda that merely absence of a disease does not mean the healthy state. One should possess physical and mental health, then only he could be considered to be having 'Total Health'. Even WHO also supports this definition of health.

According to WHO, 'Health is a state of complete physical, mental or social well-being and not merely the abscence of disease or infirmity'. When this equilibrium of Dosa, Dhatu, Mala, Agni, Atma, Indriya or Manasa is deranged, the body gets subjected to disease or destruction, which disturbs the normal functioning of the body at all levels. Every disease having its origin in Satva (Mind) and Sarira (Body) has impact on the counter part.

Concept of Pancamahabhutas

It has been described in Ayurveda that Satva (Mind), Atman (Spirit or soul) and Sarira (Physical body) are three important factors which represent a tripode on which the entire living world is stabilised. That (Living body) is termed as Purusa (Person or man).

Sarira (Body) is defined in Ayurveda as the seat of consciousness which is composed of the aggregate of the products of Pancamahabhutas (the five essential elements viz. Prthvi, Apa, Tejas, Vayu and Akasa) and carrying on in the state of equilibrium".

According to Acarya Caraka all physically perceptible materials, living or non-living, are essentially made of five essential elements (Pancamahabhutas). The Pancamahabhutas are present in the body in the form of Dosas (Body humors), Dhatus (Body tissues) and Malas (Waste materials) including various organs and organic systems of body. Different combination and proportion of the Pancamahabhutas are expressed as correlates of different biological qualities including the proportions of drugs and diet and also the pathological alterations of the biological systems including the presentation of symptoms and signs of a disease and also their remedies.

Atman is associated with 'Satva' on one side and with Sarira (Body) on the other side. Atman activates the body with the help of 'Manasa' along with Pancajnanendriyas (Sense faculties) and it is eternal and seer who sees all the actions/activities performed by the individuals. 'Satva' is responsible for the actions of Pancajnanendriyas (Sense organs). Both of these co-ordinate the functions of Atman and Sarira. Thus, all activities of our body are regulated properly and under normal circumstances our health (Svasthya) and physiology of the body are maintained within normal limits.

Concept of Tridosas

It is described in Ayurvedic classics that the basic components of the body are Dosas, Dhatus and Malas, The Dosas are the executives in this organisation. Though Pancamahabhutas are essential constitutents of Dosa, Dhatu and Malas but Tridosas regulate the functions of life and control the biological functions of human body. They are termed Dosa because these have a tendency to get vitiated and to vitiate each other or it can be said that they have the capacity to precipitate a disease under adverse circumstances.

 

Contents

 

Chapter
UNIT-I General Considerations
1-36
1 General Introduction  
  Introduction 3
  Health and Disease 3
  Concept of Pancamahabhutas 4
  Concept of Tridosas 5
  Concept of Dhatus 9
  Concept of Malas 9
  Concept of Agni and Ama 9
  Importance of Diagnosis 11
  Diagnostic Methods in Ayurveda 12
2 Disease and the Disease Process  
  Definition of Vyadhi 15
  Synonyms of Vyadhi 16
  Classification of Vyadhi 16
  Fundamental causes of Diseases 21
  Rogamarga 23
  The Disease Process 24
  Concept of Sata Kriyakala 26
3 Concept of Rogi-Roga Pariksa  
  Introduction 31
  Different Types of Examination 32
  Components of Diagnostic Methods in Ayurveda 33
 
UNIT – II Rogi Pariksa
(Examination of the Patient)
37-484
4 Pramana Pariksa  
  Introduction 39
  Dvividha Pramana Pariksa 39
  Trividha Pramana Pariksa 45
  Caturvidha Pramana Pariksa 47
5 Trividha and Sadavidha Pariksa (Scheme of Physical examination of Patient and Case History taking Scheme)  
  Trividha Pariksa 49
  Darsana Pariksa 49
  Sparsana Pariksa 55
  Prasna Pariksa 58
  Case History 59
  Sadavidha Pariksa 61
  Modern Concept of Examination of Patient : Inspection, Palpation, Percussion, Auscultation 65
6 Astavidha Pariksa (General Physical Examination of the Patient)  
  Introduction 69
  Nadi Pariksa 70
  Mutra Pariksa 82
  Mala (Purisa) Pariksa 89
  Jihva Pariksa 92
  Sabda Pariksa 93
  Sparsa Pariksa 94
  Drka Pariksa 95
  Akrti Pariksa 97
7 Dasavidha Pariksa (General Physical Examination of the Patient)  
  Introduction 99
  Prakrti Pariksa 104
  Vikrti Pariksa 125
  Sara Pariksa 125
  Samhanana Pariksa 129
  Pramana Pariksa 132
  Satmya Pariksa 133
  Satva Pariksa 134
  Ahara Sakti Pariksa 135
  Vyayama Sakti Pariksa 135
  Vaya Pariksa 135
8 Srotasa Pariksa (Systemic Examination)  
  Srotasa : General Considerations 139
  Srotasa Samkhya 140
  Type of Srotasa 141
  Importance of Srotasa 142
  Factors Responsible for Vitiation of Srotasas 144
  General Features of Vitiation of Srotasas 144
9 Pranavaha Srotasa Pariksa (Examination of Respiratory System)  
  Introduction 146
  Racana Sarira of Pranavaha Srotasa 146
  Kriyasarira of Pranavaha Srotasa 148
  Pranavaha Srotodusti Karanas 150
  Clinical Manifestations 151
  Pranavaha Srot Pariksana 160
  Investigations 167
  Important Disorders 169
10 Udakavaha Srotasa Pariksa (Examination of Water Balance System)  
  Introduction 171
  Racana Sarira of Udakavaha Srotasa 171
  Kriyasarira of Udakavaha Srotasa 173
  Udakavaha Srotodusti Karanas 174
  Udakavaha Srotodusti Laksanas 174
  Clinical Manifestations 175
  Udakavaha Srotasa Pariksana 179
  Investigations 180
  Important Disorders of the Udakavaha Srotasa 180
11 Annavaha Srotasa Pariksa (Examination of Alimentary/Digestive System)  
  Introduction 181
  Racana Sarira of Annavaha Srotasa 181
  Kriya Sarira of Annavaha Srotasa 186
  Annavaha Srotodusti Karanas 188
  Clinical Manifestations 190
  Annavaha Sroto Pariksana 200
  Investigations 210
  Important Disorders 211
12 Rasavaha Srotasa Pariksa (Examination of Cardio Vascular System)  
  Introduction 214
  Racana Sarira of Rasavaha Srotasa 214
  Kriya Sarira of Rasavaha Srotasa 217
  Rasavaha Srotodusti Karanas 220
  Clinical Manifestations 221
  Rasavaha Sroto Pariksana 235
  Investigations in Cardio Vascular Diseases 239
  Main Disorders 241
13 Raktavaha Srotasa Pariksa (Examination of Haemopoitic System)  
  Introduction 243
  Racana Sarira of Raktavaha Srotasa 243
  Kriya Sarira of Raktavaha Srotasa 244
  Raktavaha Srotodusti Karanas 250
  Vikrti Laksana 253
  Raktavaha Sroto Pariksana 270
  Investigations 274
  Important Disorders 278
14 Mamsavaha Srotasa Pariksa (Examination of the Muscular System)  
  Introduction 280
  Racana Sarira of Mamsavaha Srotasa 280
  Kriya Sarira of Mamsavaha Srotasa 285
  Mamsavaha Srotodusti Karanas 287
  Investigations 301
  Important Disorders 302
15 Medovaha Srotasa Pariksa (Examination of Adipose System)  
  Introduction 303
  Racana Sarira of Medovaha Srotasa 303
  Kriya Sarira of Medovaha Srotasa 305
  Medovaha Srotodusti Karanas 308
  Clinical Manifestations 309
  Medovaha Sroto Pariksana 317
  Investigations 318
  Important Disorders 319
16 Asthivaha Srotasa Pariksa (Examination of Skeletal/Osseous System)  
  Introduction 320
  Racana Sarira of Asthivaha Srotasa 320
  Kriya Sarira of Asthivaha Srotasa 324
  Asthivaha Srotodusti Karanas 325
  Clinical Manifestations 326
  Asthivaha Sroto Pariksana 337
  Investigations 339
  Important Disorders 339
17 Majjavaha Srotasa Pariksa (Examination of Myeloid/Bone Marrow System)  
  Introduction 341
  Racana Sarira of Majjavaha Srotasa 341
  Kriya Sarira of Majjavaha Srotasa 343
  Majjavaha Srotodusti Karanas 345
  Clinical Manifestations 345
  Majjavaha Sroto Pariksana 349
  Investigations 351
  Important Disorders 351
18 Sukravaha Srotasa Pariksa (Examination of Male Reproductive System)  
  Introduction 353
  Racana Sarira of Sukravaha Srotasa 354
  Kriya Sarira of Sukravaha Srotasa 355
  Sukravaha Srotodusti Karanas 356
  Clinical Manifestations 357
  Sukravaha Sroto Pariksana 365
  Investigations 367
  Important Disorders 368
19 Artavavaha Srotasa Pariksa (Examination of Female Reproductive System)  
  Introduction 369
  Racana Sarira of Artavavaha Srotasa 369
  Kriya Sarira of Artavavaha Srotasa 371
  Artavavaha Srotodusti Karanas 374
  Clinical Manifestations 376
  Artavavaha Sroto Pariksana 388
  Investigations 390
  Important Disorders 391
20 Mutravaha Srotasa Pariksa (Examination of Urinary System)  
  Introduction 393
  Racana Sarira of Mutravaha Srotasa 393
  Kriya Sarira of Mutravaha Srotasa 395
  Mutravaha Srotodusti Karanas 396
  Clinical Manifestations 397
  Mutravaha Sroto Pariksana 405
  Investigations 407
  Important Disorders 409
21 Purisavaha Srotasa Pariksa (Examination of Feces System)  
  Introduction 411
  Racana Sarira of Purisavaha Srotasa 411
  Kriya Sarira of Purisavaha Srotasa 412
  Purisavaha Srotodusti Karanas 413
  Clinical Manifesations 414
  Purisavaha Sroto Pariksana 420
  Investigations 422
  Important Disorders 423
22 Svedavaha Srotasa Pariksa (Examination of Sweat System)  
  Introduction 424
  Racana Sarira of Svedavaha Srotasa 424
  Kriya Sarira of Svedavaha Srotasa 425
  Svedavaha Srotodusti Karanas 426
  Clinical Manifestations 426
  Svedavaha Sroto Pariksana 429
  Important Disorders 430
23 Manovaha Srotasa Pariksa (Examination of
A. Manovaha Srotasa-Medical Psychiatry
B. Vata Nadi Tantra-Nervous System of Neurological Disorders)
 
  Introduction 431
  Racana Sarira of Manovaha Srotasa 432
  Kriya Sarira of Manovaha Srotasa 436
  Part - A  
  Concepts of Manasa (Mind) 439
  Manovaha Srotodusti Karanas 444
  Clinical Manifestations 447
  Manovaha Sroto Vikaras 449
  Manovaha Sroto Pariksana 454
  Investigations 458
  Important Disorders 459
  Part - B  
  Vata Nadi Tantra Pariksa (Nervous System) 461
  Introduction 461
  Importance of Vayu 462
  Nervous System 464
  Vata Nadi Tantra Dusti Karanas 469
  Clinical Manifestations and Examination of Neurological Disorders 470
  Investigations 476
  Vata Nadi Tantra Vikaras 478
  Important Disorders 483
 
Unit-III Roga Pariksa
(Examination of the Disease)
485-508
24 Pancha Nidana Pariksa (Five Methods of Diagnosis)  
  Introduction 487
  Nidana 488
  Purvarupa 492
  Rupa 494
  Upasaya-Anupasaya 496
  Samprapti 498
25 Sadhya-Asadhya Pariksa (Prognosis)  
  Introduction 501
  Sadhya Vyadhis 502
  Asadhya Vyadhis 503
26 Arista Vijnana (Fatal Signs and Symptoms/Prognosis)  
  Definition of Arista 504
  Arista Pariksa 505
  Prakrti 506
  Vikrti 506
  Different Pariksya Bhavas 506
 
UNIT – IV Miscllaneous
509-520
27 Atura Pariksana Patra (Case History Sheet)  
  Ayurvedic Case History Sheet 511
  Modern Case History Sheet 514
28 Laboratory Investigations  
  Reference Values 517
  Clinical Chemistry 518
  Lipid Profile 519
  Cerebro Spinal Fluid (C.S.F.) 520
  Urine Analysis 520
  Bibliography 521

 

Sample Pages




















Diagnostic Methods in Ayurveda

Item Code:
IDK531
Cover:
Hardcover
Edition:
2013
ISBN:
9789381301333
Language:
English
Size:
8.9" X 5.8"
Pages:
540
Other Details:
weight of book 630 gms.
Price:
$40.00   Shipping Free
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From the Jacket

The book 'Diagnostic Methods in Ayurveda' written by the well known author Prof. Ajay Kumar Sharma is a complete and comprehensive treatise on the subject. This book is one of its own kinds which deals with the subject in all completeness and clarity covering all aspects of Ayurvedic Diagnostics as described in various Ayurvedic treatise and judiciously supplemented by the modern literature available on the subject. The entire text is nicely supported with original references from Ayurvedic Classics. Latest information regarding Diagnostics has been incorporated with the objective of bridging the gap between the information available in various Ayurvedic classics and the books of Clinical Medicine with the objective of providing basic and complete knowledge to the readers. The book is meant especially for Ayurvedic Students, Physicians and Teachers for creating awareness amongst masses about the dependable holistic approach of Ayurveda in the scientific and systematic manner about the clinical methods in Ayurveda.

Efforts have been made to produce the subject matter in absolutely a new form detailing the ancient concepts of Ayurvedic advances in the field of Diagnostic.

The author of the book being a senior Professor of Ayurvedic Medicine (Kayachikitsa) in National Institute of Ayurveds, Jaipur and being a reputed teacher, clinician and researcher, this book has been richly benefited by his scholarship and professional experience. It is expected that this book will be useful for prospective readers.

About the Author

Born on 31st May, 1954 Prof. Ajay Kumar Sharma graduated in Ayurveda with Medicine and Surgery from A. & U. Tibbia College, New Delhi in 1976 with throughout top rank career. He completed his M.D. (Ay.) [B.H.U.] and Ph. D. under the guidance of his illustrious mentor Prof. R.H. Singh, presently Professor-Emeritus, Faculty of Ayurveda, I.M.S., B.H.U., Varanasi and Ex-Vice Chancellor, Rajasthan Ayurveda University, Jodhpur.

Prof. Sharma is one of the senior most Professors and Head of P.G. Department of Kayacikitsa and Deputy Medical Superintendent of the Hospitals at National Institute of Ayurveda, Jaipur. He is one of the Chief Ayurvedic Physician and Panca Karma specialist in the Institute. Prof. Sharma has published 10 standard books on Ayurveda and over 190 research papers. He received many awards and prizes for his outstanding career. He has contributed chapters to the prestigious volumes on Ayurveda-Kayacikitsa-Panca Karma published by CRC Press London, New York Washington and Argentina. Prof. Sharma has produced 40 M.D. (Ay.) and 6 Ph. D. under his guidance. He is the expert member of several important national level committees.

Preface

Ayurveda is the most ancient system of medicine in the world. Ayurvedic Medicine was a highly developed medical science with its manifold specialized practices in pre-independent era. Following the classical age Ayurveda had flourished well till the medieval period, after which followed the phase of decline of Ayurveda. However last few decades have proved important towards revival of Ayurveda with noticeable upsurge of interest throughout the world.

With the growing interest in Ayurveda there has been increasing demand of authentic literature on Ayurveda suitable for practice of Ayurvedic medicine. During last few years the revival activities in Ayurveda and interaction with other systems of medicine has lead to lot of clarity in the priorities and perspectives of contemporary Ayurvedic medicine. Such advances prompt to the need of producing newer literature incorporating the recent advances in terms of conceptual and strategic clarity and scientific developments. It is with this background that the present book was launched.

Clinical methods is a book for student of all ages age all degrees of experience. We all have gaps in our knowledge and this book should help fill them. it is intended to provide insight into the acquisition of the traditional clinical skills of history taking and physical examination, and of the increasingly complex and accurate methods available to modern clinicians. If modern investigative methods are to be applied to patient care intelligently, they must be integrated with traditional methods. The latter remain invaluable and irreplaceable clinical skills. Extended investigations and more complex managements must be both useful and humane. It is expected that the book will be recognized by prosperous readers as an old friend, a friend offering some new information, together with much that is well tied, and that ought to be as well known to new generation of students as it was to their teachers when they were students. Good clinical method is still the root of the matter.

The present book has been written with an objective of providing elaborate and comprehensive knowledge of the subject suitable to the present day students and teachers of Ayurveda. The subject matter has been elaborated with in the frame work of Ayurveda, supplemented at various places with modern knowledge of the subject, just to fill in the gaps. Efforts have been made to avoid the usage of complex technical terms. The language used is simple, easily understandable and self explanatory. Efforts have been made to provide Ayurvedic equivalents to modern terminology and vice-versa logically at appropriate places with the intentions of providing clarity to the subject matter. Throughout the book an attempt has been made to indicate particularly important matters and to suggest the diagnostic relevance of certain findings. The book may therefore be used not only as a text of clinical methods, but as a supplement to text book of medicine.

The author of this book being teacher, physician and researcher in this field has had the advantage of utilizing his professional experience with clinical medicine of Ayurveda in compiling the present book. It is hoped and believed that this small effort will prove to be of some benefit to the prospective readers.

The book is presented in the form of four units. Unit one deals with general considerations, Diseases and Disease process and Rogi Pariksa described in three chapters. Unit two is composed of nineteen chapters which cover various types of examination of Rogi, Trividha and Sadavidha Pariksa, Astavidha and Dasavidha Pariksa and Srotasa Pariksa describing in details Racana Sarira, Kriya Sarira, Srotodusti Karana, clinical manifestations, Sroto Pariksa Vidhi, investigations and important disorders of all Srotasas. Unit third describes the details of methods of Roga Pariksa in three chapters covering in details Panca Nidana Pariksa, Sadhyasadhyata of various diseases and Arista-vijnana. Unit four provides miscellaneous information regarding clinical methods including Ayurvedic case History Sheet, Modern Case History Sheet and laboratory investigations. The book is supplemented with an uptodate bibliography on the topics covered.

While compiling this book I received invaluable help from my post graduate students who kept me on developing the subject with due rationality and clarity by putting across a variety of questions in the classroom and departmental seminars. I take this opportunity to express my heartfelt gratitude to Dr. Vinod Gautam, my post graduate M.D. (Ay.) scholar who contributed richly in compilation and completion of this work.

 

Foreword

The clinical Methods form an important component of any medical discipline. Conventional western Medicine has developed its clinical methods to a great extent in recent years, further strengthened with amazingly advanced investigative facilities. But the modern diagnostics seems to have been reduced to mere diagnostic technology and bio-engineering. Real Clinical Medicine and clinical sense of a physician are already loosing grounds and a physician is fast becoming a technocrat and is no more a first-hand Pratyaksa observer, neither the patient has remained an Apta any more. The result is the fast erosion of the clinical sense and power of healing in a physician in coventional medical practice.

On the other hand Ayurveda presents an unique holistic approach to diagnostics which needs to be developed into practical clinical methodology useable on bed-side in a meaningful manner. Impersonal subjectivity depth of clinical sense and healing power are the valued features of Ayurvedic clinical science. There are several books already published on Clinical Methods of Ayurveda by different authors, the present book authored by Doctors A.K. Sharma and Vinod Gautam is another addition on the same lines. Most of there books are of descriptive nature and to not come out with real practical approach and clinical methodology and hence the Ayurvedic graduate students remain bewildered in the jugglary of theoretical descriptions and fail to apply a real objective methodology to examine their patients on Ayurvedic lines for classical Ayurvedic treatment. It is often seen that the Ayurvedic case-history-taking and clinical examination remains a ritualistic exercise for theoretical satisfaction and it really does not serve a useful purpose to make a serious workable Ayurvedic diagnosis. This is why the trend of modern diagnosis and unconventional Ayurvedic treatment is increasing day by day in general practice. This is a dangerous trend and tends to reduce the science of Ayurveda into a mere therapeutic modality.

The teachers involved in teaching this subject and the authors desirous to produce literature have to play a realistic role. The whole subject has to be evolved into a practice-oriented wisdom and professional skill. I find large number of graduate students of Ayurveda highly confused about the scope of application and purpose of different sets of examination schedules described by ancient and medieval texts of Ayurveda such as Dwividha Pariksa, Trividha Pariksa, Caturvidha Pariksa, Sadvidha Pariksa, Astavidha Pariksa, Dasavidha Pariksa, Trayodara Srotas Pariksa and Astavidha Monovikara Pariksa. These sets of parameters have been described in our texts in different contexts and in different perspectives. Some of these depict the object of clinical examination while some others like Sadvidha Pariksa of Susruta describes the actual tools and methodology of clinical examination. The Astavidha Pariksa of Yoga Ratnakara, Dasa- vidha Pariksa and Trayodasa Srotasa Pariksa of Caraka enlist and outline the points of physical examination, general and systemic, over the Sadangas and Srotamsi of the patients' body during Rogi-Roga Pariksa. The available knowledge has to be suitably fabricated in a way so that it can be suitably utilised by a clinician in clinical examination and diagnosis on bed-side.

This is a message to promote clinical sense in a physician and the need of transparancy and willfulness in transaction of clinical responsibility. Medical profession is not an impersonal profittering profession rather is a superior science and art of humanism and healing saddled with divine grace. The nature and Body-Mind-Spiriton continuum is the fundamental feature of Ayurvedic holistics. Sincerity and compassion towards all is the principle fabrics.

Ayurvedic diagnostics while conceiving two-fold Rogi-Roga Pariksa intends to emphasise that a patient who presents himself before a physician for diagnosis and treatment is not merely a bundle of diseases. He is much more than that. Inspite of being sick the patient is a living being with a particular Eco-genomic nature i.e. Prakrti and he also enjoys varying degree of remainder health i.e. Swasthyasa which need to be evaluated carefully during clinical Examination irrespective of the disease he is suffering from. This is important because healing of a disease occurs only through the enherent help of the Prakrti and Avasista Swasthyamsa of the patient. This is while Ayurveda advocates to assess the nature of the patient and his remainder health. Examining 'health' of a patient in diseased state is the unique feature of Ayurveda. The conventional system of medicine ignores this aspect and devotes all its effort only to examine the diseases of the patient.

 

General Introduction

Introduction

Ayurveda is one of the most ancient systems of life, health and disease. Its antiquity goes back to the Vedas. Ayurveda is a highly evolved and codified system of life and health sciences based on its own unique and original concepts and fundamental principles. Ayurveda is already a highly developed system of medicine and health care with unique holistic and human approach advocating practice of medicine through an unique science of life. Some of important principles of Ayurveda are briefly described below:

Health and Disease Svasthya (Health) is described in Ayurveda as a state of equilibrium of Dosas (Body humors), Dhatus (Body tissues), Malas (Waste materials) and Agnis (Enzymes), along with happiness of Atman (Soul), Indriya (Sensory perception) and Manasa' (Mental faculties). It is clear from this definition of health in Ayurveda that merely absence of a disease does not mean the healthy state. One should possess physical and mental health, then only he could be considered to be having 'Total Health'. Even WHO also supports this definition of health.

According to WHO, 'Health is a state of complete physical, mental or social well-being and not merely the abscence of disease or infirmity'. When this equilibrium of Dosa, Dhatu, Mala, Agni, Atma, Indriya or Manasa is deranged, the body gets subjected to disease or destruction, which disturbs the normal functioning of the body at all levels. Every disease having its origin in Satva (Mind) and Sarira (Body) has impact on the counter part.

Concept of Pancamahabhutas

It has been described in Ayurveda that Satva (Mind), Atman (Spirit or soul) and Sarira (Physical body) are three important factors which represent a tripode on which the entire living world is stabilised. That (Living body) is termed as Purusa (Person or man).

Sarira (Body) is defined in Ayurveda as the seat of consciousness which is composed of the aggregate of the products of Pancamahabhutas (the five essential elements viz. Prthvi, Apa, Tejas, Vayu and Akasa) and carrying on in the state of equilibrium".

According to Acarya Caraka all physically perceptible materials, living or non-living, are essentially made of five essential elements (Pancamahabhutas). The Pancamahabhutas are present in the body in the form of Dosas (Body humors), Dhatus (Body tissues) and Malas (Waste materials) including various organs and organic systems of body. Different combination and proportion of the Pancamahabhutas are expressed as correlates of different biological qualities including the proportions of drugs and diet and also the pathological alterations of the biological systems including the presentation of symptoms and signs of a disease and also their remedies.

Atman is associated with 'Satva' on one side and with Sarira (Body) on the other side. Atman activates the body with the help of 'Manasa' along with Pancajnanendriyas (Sense faculties) and it is eternal and seer who sees all the actions/activities performed by the individuals. 'Satva' is responsible for the actions of Pancajnanendriyas (Sense organs). Both of these co-ordinate the functions of Atman and Sarira. Thus, all activities of our body are regulated properly and under normal circumstances our health (Svasthya) and physiology of the body are maintained within normal limits.

Concept of Tridosas

It is described in Ayurvedic classics that the basic components of the body are Dosas, Dhatus and Malas, The Dosas are the executives in this organisation. Though Pancamahabhutas are essential constitutents of Dosa, Dhatu and Malas but Tridosas regulate the functions of life and control the biological functions of human body. They are termed Dosa because these have a tendency to get vitiated and to vitiate each other or it can be said that they have the capacity to precipitate a disease under adverse circumstances.

 

Contents

 

Chapter
UNIT-I General Considerations
1-36
1 General Introduction  
  Introduction 3
  Health and Disease 3
  Concept of Pancamahabhutas 4
  Concept of Tridosas 5
  Concept of Dhatus 9
  Concept of Malas 9
  Concept of Agni and Ama 9
  Importance of Diagnosis 11
  Diagnostic Methods in Ayurveda 12
2 Disease and the Disease Process  
  Definition of Vyadhi 15
  Synonyms of Vyadhi 16
  Classification of Vyadhi 16
  Fundamental causes of Diseases 21
  Rogamarga 23
  The Disease Process 24
  Concept of Sata Kriyakala 26
3 Concept of Rogi-Roga Pariksa  
  Introduction 31
  Different Types of Examination 32
  Components of Diagnostic Methods in Ayurveda 33
 
UNIT – II Rogi Pariksa
(Examination of the Patient)
37-484
4 Pramana Pariksa  
  Introduction 39
  Dvividha Pramana Pariksa 39
  Trividha Pramana Pariksa 45
  Caturvidha Pramana Pariksa 47
5 Trividha and Sadavidha Pariksa (Scheme of Physical examination of Patient and Case History taking Scheme)  
  Trividha Pariksa 49
  Darsana Pariksa 49
  Sparsana Pariksa 55
  Prasna Pariksa 58
  Case History 59
  Sadavidha Pariksa 61
  Modern Concept of Examination of Patient : Inspection, Palpation, Percussion, Auscultation 65
6 Astavidha Pariksa (General Physical Examination of the Patient)  
  Introduction 69
  Nadi Pariksa 70
  Mutra Pariksa 82
  Mala (Purisa) Pariksa 89
  Jihva Pariksa 92
  Sabda Pariksa 93
  Sparsa Pariksa 94
  Drka Pariksa 95
  Akrti Pariksa 97
7 Dasavidha Pariksa (General Physical Examination of the Patient)  
  Introduction 99
  Prakrti Pariksa 104
  Vikrti Pariksa 125
  Sara Pariksa 125
  Samhanana Pariksa 129
  Pramana Pariksa 132
  Satmya Pariksa 133
  Satva Pariksa 134
  Ahara Sakti Pariksa 135
  Vyayama Sakti Pariksa 135
  Vaya Pariksa 135
8 Srotasa Pariksa (Systemic Examination)  
  Srotasa : General Considerations 139
  Srotasa Samkhya 140
  Type of Srotasa 141
  Importance of Srotasa 142
  Factors Responsible for Vitiation of Srotasas 144
  General Features of Vitiation of Srotasas 144
9 Pranavaha Srotasa Pariksa (Examination of Respiratory System)  
  Introduction 146
  Racana Sarira of Pranavaha Srotasa 146
  Kriyasarira of Pranavaha Srotasa 148
  Pranavaha Srotodusti Karanas 150
  Clinical Manifestations 151
  Pranavaha Srot Pariksana 160
  Investigations 167
  Important Disorders 169
10 Udakavaha Srotasa Pariksa (Examination of Water Balance System)  
  Introduction 171
  Racana Sarira of Udakavaha Srotasa 171
  Kriyasarira of Udakavaha Srotasa 173
  Udakavaha Srotodusti Karanas 174
  Udakavaha Srotodusti Laksanas 174
  Clinical Manifestations 175
  Udakavaha Srotasa Pariksana 179
  Investigations 180
  Important Disorders of the Udakavaha Srotasa 180
11 Annavaha Srotasa Pariksa (Examination of Alimentary/Digestive System)  
  Introduction 181
  Racana Sarira of Annavaha Srotasa 181
  Kriya Sarira of Annavaha Srotasa 186
  Annavaha Srotodusti Karanas 188
  Clinical Manifestations 190
  Annavaha Sroto Pariksana 200
  Investigations 210
  Important Disorders 211
12 Rasavaha Srotasa Pariksa (Examination of Cardio Vascular System)  
  Introduction 214
  Racana Sarira of Rasavaha Srotasa 214
  Kriya Sarira of Rasavaha Srotasa 217
  Rasavaha Srotodusti Karanas 220
  Clinical Manifestations 221
  Rasavaha Sroto Pariksana 235
  Investigations in Cardio Vascular Diseases 239
  Main Disorders 241
13 Raktavaha Srotasa Pariksa (Examination of Haemopoitic System)  
  Introduction 243
  Racana Sarira of Raktavaha Srotasa 243
  Kriya Sarira of Raktavaha Srotasa 244
  Raktavaha Srotodusti Karanas 250
  Vikrti Laksana 253
  Raktavaha Sroto Pariksana 270
  Investigations 274
  Important Disorders 278
14 Mamsavaha Srotasa Pariksa (Examination of the Muscular System)  
  Introduction 280
  Racana Sarira of Mamsavaha Srotasa 280
  Kriya Sarira of Mamsavaha Srotasa 285
  Mamsavaha Srotodusti Karanas 287
  Investigations 301
  Important Disorders 302
15 Medovaha Srotasa Pariksa (Examination of Adipose System)  
  Introduction 303
  Racana Sarira of Medovaha Srotasa 303
  Kriya Sarira of Medovaha Srotasa 305
  Medovaha Srotodusti Karanas 308
  Clinical Manifestations 309
  Medovaha Sroto Pariksana 317
  Investigations 318
  Important Disorders 319
16 Asthivaha Srotasa Pariksa (Examination of Skeletal/Osseous System)  
  Introduction 320
  Racana Sarira of Asthivaha Srotasa 320
  Kriya Sarira of Asthivaha Srotasa 324
  Asthivaha Srotodusti Karanas 325
  Clinical Manifestations 326
  Asthivaha Sroto Pariksana 337
  Investigations 339
  Important Disorders 339
17 Majjavaha Srotasa Pariksa (Examination of Myeloid/Bone Marrow System)  
  Introduction 341
  Racana Sarira of Majjavaha Srotasa 341
  Kriya Sarira of Majjavaha Srotasa 343
  Majjavaha Srotodusti Karanas 345
  Clinical Manifestations 345
  Majjavaha Sroto Pariksana 349
  Investigations 351
  Important Disorders 351
18 Sukravaha Srotasa Pariksa (Examination of Male Reproductive System)  
  Introduction 353
  Racana Sarira of Sukravaha Srotasa 354
  Kriya Sarira of Sukravaha Srotasa 355
  Sukravaha Srotodusti Karanas 356
  Clinical Manifestations 357
  Sukravaha Sroto Pariksana 365
  Investigations 367
  Important Disorders 368
19 Artavavaha Srotasa Pariksa (Examination of Female Reproductive System)  
  Introduction 369
  Racana Sarira of Artavavaha Srotasa 369
  Kriya Sarira of Artavavaha Srotasa 371
  Artavavaha Srotodusti Karanas 374
  Clinical Manifestations 376
  Artavavaha Sroto Pariksana 388
  Investigations 390
  Important Disorders 391
20 Mutravaha Srotasa Pariksa (Examination of Urinary System)  
  Introduction 393
  Racana Sarira of Mutravaha Srotasa 393
  Kriya Sarira of Mutravaha Srotasa 395
  Mutravaha Srotodusti Karanas 396
  Clinical Manifestations 397
  Mutravaha Sroto Pariksana 405
  Investigations 407
  Important Disorders 409
21 Purisavaha Srotasa Pariksa (Examination of Feces System)  
  Introduction 411
  Racana Sarira of Purisavaha Srotasa 411
  Kriya Sarira of Purisavaha Srotasa 412
  Purisavaha Srotodusti Karanas 413
  Clinical Manifesations 414
  Purisavaha Sroto Pariksana 420
  Investigations 422
  Important Disorders 423
22 Svedavaha Srotasa Pariksa (Examination of Sweat System)  
  Introduction 424
  Racana Sarira of Svedavaha Srotasa 424
  Kriya Sarira of Svedavaha Srotasa 425
  Svedavaha Srotodusti Karanas 426
  Clinical Manifestations 426
  Svedavaha Sroto Pariksana 429
  Important Disorders 430
23 Manovaha Srotasa Pariksa (Examination of
A. Manovaha Srotasa-Medical Psychiatry
B. Vata Nadi Tantra-Nervous System of Neurological Disorders)
 
  Introduction 431
  Racana Sarira of Manovaha Srotasa 432
  Kriya Sarira of Manovaha Srotasa 436
  Part - A  
  Concepts of Manasa (Mind) 439
  Manovaha Srotodusti Karanas 444
  Clinical Manifestations 447
  Manovaha Sroto Vikaras 449
  Manovaha Sroto Pariksana 454
  Investigations 458
  Important Disorders 459
  Part - B  
  Vata Nadi Tantra Pariksa (Nervous System) 461
  Introduction 461
  Importance of Vayu 462
  Nervous System 464
  Vata Nadi Tantra Dusti Karanas 469
  Clinical Manifestations and Examination of Neurological Disorders 470
  Investigations 476
  Vata Nadi Tantra Vikaras 478
  Important Disorders 483
 
Unit-III Roga Pariksa
(Examination of the Disease)
485-508
24 Pancha Nidana Pariksa (Five Methods of Diagnosis)  
  Introduction 487
  Nidana 488
  Purvarupa 492
  Rupa 494
  Upasaya-Anupasaya 496
  Samprapti 498
25 Sadhya-Asadhya Pariksa (Prognosis)  
  Introduction 501
  Sadhya Vyadhis 502
  Asadhya Vyadhis 503
26 Arista Vijnana (Fatal Signs and Symptoms/Prognosis)  
  Definition of Arista 504
  Arista Pariksa 505
  Prakrti 506
  Vikrti 506
  Different Pariksya Bhavas 506
 
UNIT – IV Miscllaneous
509-520
27 Atura Pariksana Patra (Case History Sheet)  
  Ayurvedic Case History Sheet 511
  Modern Case History Sheet 514
28 Laboratory Investigations  
  Reference Values 517
  Clinical Chemistry 518
  Lipid Profile 519
  Cerebro Spinal Fluid (C.S.F.) 520
  Urine Analysis 520
  Bibliography 521

 

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