E-ISSN:2456-3110

Review Article

Trividha Pariksha

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 4 May
Publisherwww.maharshicharaka.in

Critical Analysis on Trividha Pariksha with special reference to Panchakarma

Sangolli A.1*, Puttur G.2, Madhushree H.3, Narayan P.4
DOI:

1* Akshata Sangolli, Final Year Post Graduate Scholar, Department of Post Graduate studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.

2 Ganesh Puttur, Principal, Professor & H.O.D., Department of Post Graduate studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.

3 H.S. Madhushree, Professor, Department of Post Graduate studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.

4 Prajwal Narayan, Professor, Department of Post Graduate studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.

Introduction: Ayurveda is a holistic medicine and life science and Panchakarma being the major part of it as it has a role in all the Ashtangas of Ayurveda. Pariksha means examination and it is an irreplaceable part before treating any disease. Thus, it has a major role in Panchakarma especially in deciding whether the Rogi is Yogya /Ayogya for various Panchakarma procedures like Vamana as it is indicated only when the patient is strong enough to sustain the procedure. Objectives: To study role of Trividha Pariksha in Panchakarma in detail during Purva Karma, Pradhana Karma and Pashath Karma. Materials and Methods: This is a conceptual study for which various Ayurvedic texts and published articles and research papers are referred. Discussion: Role of Trividha Pariksha as a Purvakarma like Snehana, Swedana, and in Pradhana Karma, Vamana, Virechana, Basti, Nasya and Rakta Mokshana and at Panchakarma preparation room, in Pashath Karma deciding Samsarjana Krama and to look for Prakrutigata Purusha Lakshanas. Result: Trividha Pariksha is a tool for mankind and has its own importance and role in every Panchakarma procedure and hence knowledge of it is necessary for all the Vaidyas.

Keywords: Trividha Pariksha, Panchakarma, Purva Karma, Pradhana Karma, Pashath Karma

Corresponding Author How to Cite this Article To Browse
Akshata Sangolli, Final Year Post Graduate Scholar, Department of Post Graduate studies in Panchakarma, Sri Sri College of Ayurvedic Science & Research, Bangalore, Karnataka, India.
Email: 		Akshata Sangolli, Ganesh Puttur, H.S. Madhushree, Prajwal Narayan, Critical Analysis on Trividha Pariksha with special reference to Panchakarma. J Ayu Int Med Sci. 2022;7(4):86-91.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-03-30 2022-04-01 2022-04-08 2022-04-15 2022-04-22
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© 2022by Akshata Sangolli, Ganesh Puttur, H.S. Madhushree, Prajwal Narayanand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Chikitsa is incomplete without the proper diagnosis of a Vyadhi and for that, the systematic examination of the Aatura is an inevitable part. The term Pariksha refers to examining patients from all dimensions. It is carried out mainly for the purpose of gaining knowledge about the Avastha of the Rogi and the Roga. This is achieved by history taking, physical examination and investigations. The improperly judged clinical condition due to improper examination of the patient and disease will result in perplexed treatment. Thus, proper examination of the patient plays a vital role in treatment. The method of examination in Ayurveda involves two steps, the examination of the patient and the disease.

Importance of Pariksha

Rogi-Roga Pariksha helps to understand the condition of the patient as well as the stage of the disease. It is useful in obtaining Pratipattijnana (knowledge about Vikara Avastha of Rogi). Vaidya, with the help of his Jnana and Buddhi, should enter into the Atura’s mind and experience the sufferings of the patient thoroughly, through his patient listening and good communication skills. Thus he should be able to know the Roga and Rogi Bala and choose what is best for the patient.[1] This will help in achieving the Purushaarthas in life.

Trividha Pariksha

Trividha Pariksha according to Acharya Charaka are Aptopadesha, Pratyaksha and Anumana[2] and according to Acharya Vagbhata are Darshana, Sparshana and Prashna.[3] Here in this article an attempt is made to discuss Trividha Pariksha in detail w.r.t. Panchakarma.

Materials and Methods

Various authentic texts of Ayurveda, recent journals and publications were reviewed on the topic of Trividha Pariksha and have been compiled in this article.

Aptopdesha[4]

The eyes don’t see what the mind doesn’t know. For the smooth conduction of the examination, one should be well versed in all the aspects of it. Hence, one should acquire knowledge in the

beginning through Aptopadesha and thereafter examine the various aspects of disease by using the other Pramanas (folds of examination) i.e., examination through Pratyaksha and then by Anumana. Without the help of Aapta one will be unable to step into the further stages of Pariksha.

Vaidya after knowing the disease from its all aspects, should judiciously plan for the treatment. To know about Vikruta Avastha first one should know about Prakruta Avastha, which are learnt from Aaptas. Hence Aptopadesha is very important. One who follows Aptopadesha does not get confused in choosing apt remedies and thus will be able to attain success in everything he does.

Pratyaksha Pariksha[5]

In Pratyaksha Pariksha there is a comprehensive effort of all Pancha Indriya (five sensory organs) and Manas for gaining knowledge. The features perceived through the sense organs are included under direct observation. Also that which is perceived by the mind are considered under this (for example, happiness, sorrow, jealousy, etc.[6]). Even though Pratyaksha Pariksha is considered more genuine as there is direct perception by the Indriyas except for Rasanendriya (tongue), as different Rasa’s are examined by Anumana Pramana.

Utility of Indriyas in Pratyaksha Pariksha

1. Factors examined by Chakshurendriya: Varna, Samsthana, Pramana, Chaya, Prakruti and Vikara.

2. Factors examined by Shrotrendriya: Antrakujana (gurgling sound in the intestine), Sandhisphutana (cracking sound in the joints), voice of the patient and such other sounds like c3. ughing and hiccup.

3. Factors examined by Ghranendriya: Prakruta and Vikruta Gandha of Sharira.

4. Factors examined by Sparshanendriya: Normal and abnormal features of the patient perceived by touch sensation such as palpation of texture of skin, hardness, roughness, crepitus etc.

Anumana Pariksha

It is the method of examination where an inference is drawn out of assumptions, and coming to a conclusion. For example: status of Agni can be known by Jaranashakti, Bala of person by Vyayama Shakti, similarly rest of the other things are tabled below.[7]


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Indicative knowledge Inferred knowledge
Shabdadiartha Grahanena Shrotradini
Vyavasayena Vijnana
Grahanena Medha
Sangena Raja
Nama Grahanena Sanjna
Avijnanena Moha
Abhiprayena Shraddha
Pratishedhena Dwesha
Toshena Priti
Vishadena Bhaya
Avishadena Dhairya
Uthaanena Virya
Smaranena Smriti
Abhidrohena Krodha
Dainyena Shokha
Kalena Vaya
Arishta Lakshana Ayukshaya

Among Trividha Pariksha, Darshana and Sparshana Pariksha Bhavas are already included under Pratyaksha hence not described again in the article.

Prashna Pariksha[8]

Prashna Pariksha, being one of the most important examination tool, which helps the Vaidya in attaining more detailed information about the Roga and Rogi Avastha from the patient as well as from his/her caretaker for deciding the best remedy for his/her condition. Also, by this, the Vaidya can gain the confidence and trust of the patient through his communication skills. Through repeated and constant interrogation with the patient, Vaidya can find out the main and associated complaints of the Rogi along with the aggravating and relieving factors. History taking is an art which a doctor learns over the years of repeated practice and experience. History is the record of medical events that have already taken place in the life of the patient. Every disease has a pattern of behaviour. History taken in a proper and systematic manner combined with sound knowledge of medicine and treatments would help the Vaidya to judge and treat the likely causes that might have been responsible for the problems of the patient.

Discussion

Proper recording of Vyadhi Vruttanta, Vyadhi Avastha, Chikitsa Vruttanta from the patient is necessary and helpful in treating the patient in a better way and also to analyse

the Avastha of the Roga. This is to check whether the patient is Yogya / Ayogya for Vamanadi Panchakarma procedures. It is also helpful in checking the Upashaya and Anupashaya, Satmya and Asatmya thus, to decide proper medicine and diet.

Prashna Pariksha helps in different stages of Panchakarma procedures. For example, in case of Snehapana, Lakshanas like Adhastat Sneha Darshana can be confirmed from Atura by Prashna Pariksha and thus, Snehapana can be stopped.

Understanding of Koshta in terms of Mridu, Madhyama and Krura Koshta is very important in Panchakarma Chikitsa to decide Snehayoga and its Matra, also before administering Virechana Dravyas (purgatives and laxatives). It can be known by both Prashna and Anumana Pariksha from the frequency, consistency, straining efforts, time taken for proper defecation, complete or incomplete bowel evacuation, need of initiation for defecation or not.

Application of Trividha Pariksha in Purva Karma of Shodhana

Snehana and Swedana Karma constitute the Purva Karma of Shodhana. During the Snehapana, application of Trividha Pariksha can be used to check Samyak Snigdha Lakshana like for assessing the Snigdhata of Anga by Darshana and Sparshana, for assessing the time taken for digestion of Sneha, Udgarashudhi, Adasthat Sneha Darshana etc., by Prashna Pariksha. By utilization of this Trividha Pariksha, Vaidya can decide the number of days required for Snehapana. In the same manner, during Swedana Karma also one can assess the Samyak Lakshanas using the Trividha Pariksha like Sweda Pradurbhava by Darshana, Laghavata by Prashna Pariksha.

Application of Trividha Pariksha in Vamana

Prior to Vamana Karma, whether the person is Yogya / Ayogya can be checked by using Darshana Pariksha.

During the Vamana Karma, after intake of Vamana Dravya, Nirikshana of the patient should be done for Muhurta Kala. By Darshana Pariksha, one should look for Sweda Pradurbhava (sweating)[9] and Lomaharsha (horripilation)[10], which are inferred as the liquefaction of Dosha and movement of vitiated Dosha from their respective places. This can be known by Anumana Pariksha.[11]


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Kukshi Adhmana (bloating abdomen) is to be checked by Darshana and Prashna Pariksha which infers the arrival of Doshas to the Kostha. Hrillasa and Asyasravana (watering from the mouth)[12] are known by Prashna as well as Darshana Pariksha which infers the Urdhwa Gati of Doshas, and initiation of Vamana Vega.

Darshana Pariksha also plays a major role in assessing the Samyak Lakshanas like to observe the expulsion of Doshas in the respective order of Kapha, Pitta and Vata. Darshana and Prashna Pariksha helps to assess if any Ayoga and Atiyoga Lakshanas occur, such as Jeevadana,[13] in order to take the decision to stop the procedure immediately and act accordingly.

Application in Virechana Karma

Right before planning the Virechana Karma, utilization of Trividha Pariksha are essential for checking if the person is Yogya / Ayogya for the Virechana.

After the intake of Virechana Dravya, number of Vegas is assessed by Prashna Pariksha, Samyak Lakshana like Laghuta and Agni Vriddhi by Prashna Pariksha.

Darshana Pariksha by Rogi plays a major role in assessing the Samyak Lakshanas like to observe the expulsion of Doshas in the respective order of Vit, Pitta and Kapha. Darshana and Prashna Pariksha helps to assess if any Ayoga and Atiyoga Lakshanas occur like Balanasha[14] in order to take the decision to stop the procedure immediately and act accordingly.

Application in Basti Karma

Application of Pratyakshadi Pariksha before planning the Basti Karma is to check the state of Agni before the procedure by Prashna and Anumana.

Pariksha Pratyaksha Pariksha is also helpful in checking if the patient is in the correct posture (left lateral) during the administration of Basti.[15]

Prashna Pariksha helps in knowing the retention time of Basti Dravya as maximum retention time in Niruha Basti is one Muhurta[16] and Anuvasana Basti is three Yama[17] which varies from individual to individual, thus depending upon the period of retention of Basti Dravya physician can make changes in the formulation and quantity of Basti Dravya.

Application in Raktamokshana

Pratyaksha Pariksha helps in identifying Nirvisha Jalouka like observing its body features[18] and for application of Jalouka at the desired site. Pratyaksha and Anumana Pariksha are also useful to check whether it is sucking the blood or not by observing its position.[19] In Siravyadha, using Pratyaksha Pariksha appropriate vein is identified for conducting the procedure, as well as to observe Samyak Lakshana and to treat Ayoga and Atiyoga like Alpa Raktasrava, Atiraktasrava[20] accordingly.

Application in Nasya Karma

As explained previously, even in the administration of Nasya Karma, one should confirm the state of Agni using Prashna Pariksha before its administration[21] (as Nasya is contraindicated in Ajirna). One should also ensure the correct posture of the patient (Pralambita Shirasa)[22] during Nasya Karma by Pratyaksha Pariksha. Samyak Lakshanas like lightness of the chest, throat head are assessed by Prashna Pariksha.

In the Panchakarma preparation room and therapy room

The application and utility of Pratyakshadi Pariksha is very much necessary even in the Panchakarma preparation room. During the preparation of medicine for Patra Pinda Sweda, Jambira Pinda Sweda, Basti, etc. the proper formation of Pottali and proper mixing of Dravya is checked by Pratyaksha Pariksha. Pariksha should also be used while doing Abhyangadi procedures, as the comfortability of the patient is to be checked by Prashna Pariksha, to ensure proper pressure being applied and hence the procedure is soothing and beneficial to the patient. During Janu Basti, Kati Basti etc., temperature of oil is to be checked using Pratyaksha Pariksha for preventing adverse events like skin burns. Similarly, in Patra Pinda Sweda, tolerance capacity of the patient is checked by Prashna and Sparshna Pariksha and constant observation of the patient's skin is needed for checking any allergy or rashes during and even after the completion of procedure.

Application of Trividha Pariksha in Pashchat Karma of Shodhana

Application of Trividha Pariksha after Shodhana procedures is generally required to decide Samsarjana Krama depending upon type of Shuddhi[23]


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, to check the criteria’s for starting Tarpanadi Krama[24], to check the attainment of Prakrutigata Purusha Lakshana[25] and Dhatu Samya Lakshanas.[26]

Conclusion

Parikshas are the tool for the knowledge. Ayurveda as well as the contemporary science have various modes of patient examination depending upon the patient condition, but among all the types of Pariksha, Trividha Pariksha has a greater importance in clinical practice as it includes all the other varieties of Pariksha within it.

In spite of various modern technologies and laboratory investigation techniques that have arrived in today’s era still Trividha Pariksha cannot be replaced by all these and has that spark and capacity to guide towards proper diagnosis as well as treatment. Hence it is a boon to mankind. If the physician prescribes proper therapies after proper diagnosis and systematically plans the proper line of treatment after considering the stage of the Samprapti, Desha, Kala, Bala, etc., he will definitely attain success in curing the curable diseases otherwise by misdiagnosing the disease and initiating therapy will not give the desired result and the physician may end up losing his name and fame in the society. Hence, Trividha Pariksha when employed wisely helps to understand Roga and Rogi Avastha more accurately.

Reference

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12. Agnivesha, Charaka Samhitha, revised by Charaka and Dridabala with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Jadavji Trikamji Acharya, Sutrasthana, 15th Chapter/Sloka No 11, Reprint edition 2015, Varanasi: Chaukambha Prakashan.

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21. Agnivesha, Charaka Samhitha, revised by Charaka and Dridabala with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Jadavji Trikamji Acharya, Siddithana, 2nd Chapter/Sloka No 20, Reprint edition 2015, Varanasi: Chaukambha Prakashan.

22. Vagbhata: Ashtanga Hridayam with Commentary of Arunadatta and Hemadri, edited by Bhisagaacharya Harisaastri Paraadakara Vaidya Sutrasthana 29th chapter shloka no.14, Reprint edition 2017, Varanasi: Chowambha orentalia,

23. Agnivesha, Charaka Samhitha, revised by Charaka and Dridabala with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Jadavji Trikamji Acharya, Siddisthana, 1st Chapter/Sloka No 25, Reprint edition 2015, Varanasi: Chaukambha Prakashan.

24. Agnivesha, Charaka Samhitha, revised by Charaka and Dridabala with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Jadavji Trikamji Acharya, Siddisthana, 1st Chapter/Sloka No 26, Reprint edition 2015, Varanasi: Chaukambha Prakashan.

25. Agnivesha, Charaka Samhitha, revised by Charaka and Dridabala with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Jadavji Trikamji Acharya, Siddisthana, 12th Chapter/Sloka No 9, Reprint edition 2015, Varanasi: Chaukambha Prakashan.

26. Agnivesha, Charaka Samhitha, revised by Charaka and Dridabala with Ayurveda Dipika commentary of Chakrapanidatta, edited by Vaidya Jadavji Trikamji Acharya, Vimanasthana, 8 th Chapter/Sloka No 29, Reprint edition 2015, Varanasi: Chaukambha Prakashana.


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