E-ISSN:2456-3110

Review Article

Ashtasthana Pariksha

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 8 September
Publisherwww.maharshicharaka.in

Applied aspect of Ashtasthana Pariksha w.s.r. to tools used in current era

Yadav N.1*, Kumar Singh A.2
DOI: https://www.jaims.in/jaims/article/view/1972

1* Neha Yadav, Post Graduate Scholar, Department of Rog Nidan evum Vikriti Vigyan, Govt. Ayurvedic College & Hospital, Patna, Bihar, India.

2 Amarendra Kumar Singh, Associate Professor, Department of Rog Nidan evum Vikriti Vigyan, Govt. Ayurvedic College & Hospital, Patna, Bihar, India.

Health is a state of equilibrium of the Dosha, Dhatu and Mala along with proper functioning of Indriya, Manas and Atma. To treat the disease, it is necessary to keep balance between Doshas and to bring back them into their normal condition. Ayurveda had described various tools to diagnose various diseases and one of them is Rog and Rogi Pariksha. For Rogi Pariksha, various Parikshas have been described like Dwividha Pariksha, Trividha Pariksha, Chaturvidha Pariksha, Panchvidha Pariksha, Ashtavidha Pariksha and Dashvidha Pariksha. Yogratnakara provides a clear picture of scenery of illness and healthy condition through Ashtavidha Pariksha. In current era, various diagnostic tools like urine examination, stool examination, tongue examination, auscultation, percussion, eye examination and gait examination are also very helpful in the prognosis of many common diseases. In current paper, attempts were made to study the relation of Ashtasthana Pariksha with special emphasis on tools used in modern era.

Keywords: Ashtasthana Pariksha, Ayurveda, Examination, Prognosis, Diagnosis, Yogratnakara

Corresponding Author How to Cite this Article To Browse
Neha Yadav, Post Graduate Scholar, Department of Rog Nidan evum Vikriti Vigyan, Govt. Ayurvedic College & Hospital, Patna, Bihar, India.
Email: 		Neha Yadav, Amarendra Kumar Singh, Applied aspect of Ashtasthana Pariksha w.s.r. to tools used in current era. J Ayu Int Med Sci. 2022;7(8):46-53.
Available From
https://www.jaims.in/jaims/article/view/1972

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-07-30 2022-08-01 2022-08-08 2022-08-15 2022-08-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Neha Yadav, Amarendra Kumar Singhand 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

The fundamental principle of Ayurveda is to maintain health of a healthy person and to diminish the disease of patient. Yogratnakara stresses on the importance of “Vyadhi Vinishchaya” (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.[1]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:

Methods of Examination Methods
Dwividha Pariksha[2] Pratyaksha & Anumana
Trividha Pariksha[3] Aptopadesha, Pratyaksha & Anumana, Darshan, Sparshan & Prashna
Chaturvidha Pariksha[4] Aptopadesha, Pratyaksha, Anumana & Yukti
Shadvidha Pariksha[5] Panchendriya Pariksha & Prashna Pariksha
Ashtavidha Pariksha[6] Nadi, Mutra, Mala, Jihwa, Shabda, Sparsha, Drika, Akriti
Dashvidha Pariksha[7] Prakriti, Vikriti, Sara, Samhnana, Pramana, Satmya, Satva, Aharshakti, Vyayama Shakti & Vaya

Among all these methods of examination, Ashtasthana Pariksha is one of the best and the most significant method of clinical assessment.

It is a complete clinical examination of a patient which has very close resemblance with general physical examination of the patient as described in Modern Medicine. It is indeed the examination of eight aspects of a person to determine their health status.

Aim and Objectives

1. To assess the diagnostic and prognostic aspect of disease with the help of Ashtavidha Pariksha.

2. To make the prognosis of diseases with the help of tools used in current era.

Material and Methods

References of Ashtavidha Pariksha and different types of Pariksha have been collected from the available literature of Ayurveda.

Ashtasthana Rogi Pariksha (Eight fold Examination)

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. Akriti Pariksha (General appearance Examination)

1. Nadi Pariksha (Pulse Examination)

नाड़ीमअंगुष्ठमूलाधः स्पर्शेदक्षिणगे करे | ज्ञानार्थ रोगिणो वैद्यो निजदक्षिणपाणिना || (यो.र.१/४३)

The status of Doshas in diseased as well as in healthy individual can be assessed by Nadi Pariksha.

Like Prakriti, Nadi also varies in person depending on health and diseased person.[8]

Paryayas of Nadi

Snayu, Nadi, Hansi, Dhamani, Dharani, Dhara, Tantuki and Jeevan Gyan.[9]

Nadi Location

Vata, Pitta and Kapha Nadi lies respectively under Tarjini (index), Madhyama (middle) and Anamika (ring) fingers of examining physician.[10]

Tridosha Examination

Three fingers placed in position over Nadi indicate the condition of the Tridosha and their Gati (i.e. Manda, Madhyama and Tikshna).  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, Tridoshaja and Sadhya Asadhyata.[11]

Jiva Sakshini

Anatomical position of the Jiva Sakshini Nadi is at Angushtha Moola.[12] The pulsation in the Dhamani (artery) reflects the evidence of life and the learned physician through Sparshana Pariksha is able to come to assessment of the person concerned, whether the person is ill or well. In female, left hand Nadi should be palpated and vice- versa.



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How to examine

Nadi should be examined in mental stability and peace of mind with his hand pulse (beat) below the right thumb. The elbow (Kurpara) of the patient should be lightly flexed to the left and the wrist slightly bent to the left with the fingers distended and dispersed. Nadi should be examined repeatedly for three times by applying and releasing pressure alternatively over Nadi to assess the condition of Doshas rightly.[13]

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.[14]

Nadi Gati[15]

  • Vataja Nadi: Sarpa and Jalauka
  • Pittaja Nadi: Kaak, Lavaka and Manduka
  • Kaphaja Nadi: Raj hansa, Mayura, Paravata, Kapota and Kukkuta
  • Vata- Pittaja Nadi: Sarpa and Bheka (mandooka)
  • Pitta- Kaphaja Nadi: Hari (Vaanar) and Hansa
  • Vata- Kaphaja Nadi: Sarpa and Hansa
  • Sannipataja Nadi: Kashthakutta

Nadi Gati in different Pathological Conditions[16]

Pathological Conditions Nadi Gati (Pulse movements)
Jwara Gambheera, Ushna and Vegavati
Kama, Krodha Vegavati (Rapid)
Chinta & Bhaya Kshina (Weak)
Mandagni Manda (Slow)
Rakta Dosha Ushna, Gurvi and Sama
Ama Gambheera
Deeptagni Laghu and Vegavana

Tools used for Nadi Pariksha

Pulse oximetry is a non invasive test that measures the oxygen saturation level of the blood. It can rapidly detect even small changes in oxygen

levels. These levels show how efficiently blood is carrying oxygen to the extremities furthest from our heart, including our arms and legs.  The pulse oximeter is a small, chip – like device. It attaches to a body part, most commonly to a finger. The purpose of pulse oximetry is to see if the blood is well oxygenated. Medical professionals may use pulse oximeters to monitor the health of people with conditions that affect blood oxygen levels, specially while they’re in the hospital.

The diseases like COPD, asthma, pneumonia, lung cancer, anemia, heart attack or heart failure and congenital heart diseases can be included.[17]

2. Mutra Pariksha (Urine Examination)

अथातः संप्रवक्ष्यामि च मूत्रस्य परीक्षणम | येन विज्ञातमात्रेण रोगचिन्हं प्रकाश्यते | (यो.र. १/८६)

By Mutra Pariksha (urine examination) one can assess any running pathology inside the body. 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 urine.

Urine appearance involving Doshas[18]

Dosha Urine colour/ Appearance
Vata Pandu
Pitta Rakta
Kapha Phenayukta
Dwandaja Mixed/ as per predominant Dosha
Sannipataja Krishna

Taila Bindu Pariksha

Urine collected in a round low bottom vessel and a drop of oil is dropped in the collected urine very lightly with the help of grass (Truna). As oil is lighter than urine, oil spreads over the urine. Observations and conclusions are made on the basis of direction, shape and speed of spreading of oil drop. The Taila Bindu Appearance in Vata, Pitta and Kapha Dosha Vikaras are of snake, umbrella and pearl shaped respectively.[19]

Oil Position in different diseased condition[20]

Urine Diseased Condition
If instilled oil spreads quickly over the surface of urine Sadhya (Curable)
If the oil does not spread Kashta Sadhya (difficult to treat)
If oil sinks and touches the bottom of vessel Asadhya (Incurable)

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Taila Bindu Inference[21]

Direction Curableness
East Shighramsukhi (Early Curable)
South Kramen Sadhyam (Curable step by step)
North Curable (Arogita Samprajayate)
West Sukha Arogya (Health and Pleasure)
North-East Masen Nashyati (Must die in 1 month)
South-East Maranam (Must die)
South- West Maranam (Must die)

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 accordingly.

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 result.

Urine Examination

  • Physical Examination: The parameters to be examined on physical examination of urine are volume, color, appearance, odor and specific gravity.[22]
  • Chemical Examination: The chemical examination is carried out for parameters like pH, proteins, glucose, ketones, bilirubin, bile salts, urobilinogen, blood, haemoglobin, myoglobin and nitrite.[23]

3. Mala Pariksha (Stool Examination)

Direct examination of the faecal matter by the naked eye can tell a lot about the digestive state of the body.

The colour, consistency, floating nature, smell, presence of blood or mucus in stool gives a lot of information about various Dosha imbalances or diseases.

Sama-Nirama condition of the faeces is noted specifically in Ayurveda.

Jala Nimajjana Purisha Pariksha

A specialised technique of stool examination is conducted to detect the presence of Ama thereby inferring the status of Agni. If stool sinks in water, it has Ama Dosha and if not then it is normal.[24]


Mala Swarupa in different diseases[25]

Mala Swarupa Diseases
Whitish, bulky with foul smell Jalodara
Shyama Kshaya
Yellowish associated with pain in the Kati Amayukta disorders
Jatharagni passes Pandu and dry mala while in Mandagni state passes Drava and Durgandhita Mala Asadhya Vyadhi

Stool Examination

Examination of feces is helpful in the investigation of disease of gastrointestinal like detection of parasites. Other examinations involved are bacteriologic examination, chemical examination and microscopic examination.[26]

Colour/ Appearance of Fecal Specimens are black if there is bleeding in upper GIT, red if bleeding in large intestine and watery in certain strains of E. coli.[27]

4. Jihwa Pariksha: The colour, shape, coating of a tongue can be indicative of many digestive abnormalities.   Detection of the type of disease condition can be made by Jihwa Pariksha. Commonly we observe only Sama-Nirama condition. 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 noted.

Characteristics of tongue in different Doshik Condition[28]

Diseases Tongue
Vataja Khara Sparsh, Sphutita
Pittaja Rakta, Shyama Varna
Kaphaja Shweta, Pichhila
Sannipataja Krishna, Sakantaka, Shushka
Dwandaja Mishrit Lakshana

Tongue features in different diseased conditions[29]

Tongue Features Diseased Condition
Pale coloured Anaemic
Yellow coloured Jaundice, possible liver disorders
Blue coloured Heart diseases
Smooth, often sore tongue without papillae Atrophic Glossitis
Softening of the skin at the angles of the mouth followed by cracking Angular stomatitis



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5. Shabda Pariksha (Voice Examination)

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.[37] These are the sounds which we have to feel from the patient like Intestinal gargling, Heart sounds, Pleural rub, Crepitus etc.

Auscultation: Auscultation can be compared with the Shabda Pariksha of Ayurveda. Four auscultatory areas of the heart facilitate clinical diagnosis. Triangle of auscultation involves lateral border of trapezius muscle, medial border of scapula and upper border of lattisimus dorsi muscle. In Respiratory examination, inspiratory and expiratory sounds with or without an intermediate pause or interval is observed as normal condition. Abnormal breath sounds are heard if they are abnormally generated and if they are abnormally conducted. Auscultation is also an important part of abdominal examination for detecting bowel sounds and vascular bruits.[30]

6. Sparsha Pariksha (Skin Examination)

The tactile perception or touch reveals many aspects. Cold, hot, smooth, rough, soft, hard perceptions, fever, oedema etc. should be examined through tactile perception. Skin is Moist or wet in Kaphaja diseases, hot in Pittaja and rough and cold in Vataja disorders.[31] Sparsha Pariksha can be compared with palpation and percussion.

Palpation: Palpation is the examination method that relies on the sense of touch. The method of palpation is applied depending upon the area to be examined. It involves palpating individual structures on the surface and within the body cavities, particularly the abdomen. It elicits important information regarding the position, size, shape, consistency and mobility of the normal anatomic components. It uncovers crucial clues to the presence of abnormalities such as enlarged organs and palpable masses. It may be effective in assessing fluid within a space.

Percussion: Percussion is a method of tapping on a surface to determine the underlying structures, and is used in clinical examinations to assess the condition of the thorax or abdomen. It is done with the middle finger of one hand tapping on the middle finger of the other hand using a

wrist action. The non-striking finger is placed firmly on the body over tissue. Effective percussion is a knack that requires consistent practice; we can do so upon ourselves or on willing colleagues, as percussion can be uncomfortable for patients if performed repeatedly and inexpertly.[32]  

7. Drika Pariksha (Eye Examination)

Different types of eye features may reflect the personality of a person as well as the state of his health. The colour of the sclera, conjunctiva, size of eyeball, shape, and the area around the eyes give insight into various serious metabolic diseases.

Drika Pariksha[33]

Doshaja Prakriti Drika
Vata Dhumra, Aruna, Nila, Ruksha, Chanchala, Antrapravista, Roudra, Antarjwala
Pitta Aruna, Haridra, Rakta, Malina, Tikshna, Dipa Dwesha, Dahayukta
Kapha Shweta, Dhavala,Pluta, Snigdha, Sthira, Shanta, Jyotish, Kanduyukta
Dwandaja Mixed Lakshana of involved Doshas
Sannipataja Rakta and Roudra

Eye features in different diseased condition[34]

Eye Features Diseased Condition
Congenital small discs Optic disc swelling
Hard exudates in retina Microaneurysms in diabetes
Blot haemorrhages in retina Hypertension and retinal vein occlusion

8. Akriti Pariksha (General Appearance of the body)

Examination of Akriti include Diagnosis of hair, nails and other body organs can reveal many signs which point towards different diseases. Kaphaja personalities have oily skin, well-built body and joints, tolerance to hunger, thirst, hardship, hot sun. Pittaja personalities have strong appetite and thirst, fair complexion; they are brave, bold, egoistic and less hair. Vataja personalities are prone to many diseases and have split hairs and dry skin with Dhusara Varna and they dislike cold things and atmosphere.[35]

Gait Examination

The gait will play a big role in Akriti examination. The gait may be defined as the forward propulsion of body by the lower limbs in a systematic, coordinated, semi- rotator movements of the trunk, arm and head. A normal gait must be rhythmic and soundless, having springiness in the feet which work alternatively in a definite cyclic order.


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Gait Abnormalities[36]

1. Antalgic Gait: Pain related to arthritis or tendonitis

2. Spatic Gait: Hemiplegia related to CVA

3. Shuffling Gait: Parkinson’s disease

4. Ataxic Gait: Cerebellar disease

5. Waddling Gait (Trendelenburg): Bilateral gluteus medius tendinopathy

6. High stepping (Foot drop): Peroneal neuropathy (multiple causes)

Discussion

Ashtavidha Pariksha in Ayurveda is one of the important examinations to find different causing factors of diseases. These eight factors are mentioned in Ashtavidha Pariksha - Nadi Pariksha (Pulse Study), Mutra Pariksha (Urine Examination), Mala Pariksha (Stool Examination), Jihwa Pariksha (Tongue Examination), Shabda Pariksha (Voice Examination), Sparsha Pariksha (Skin Examination), Drika Pariksha (Eye Examination), Akriti Pariksha (General appearance Examination). Each one of them plays very important role in diagnosis of the disease. By Ashtavidha Pariksha characters of various Doshas can be evaluated either they are in balanced form or unbalanced. Ashtavidha Pariksha was mentioned in detail by Acharya Yogratnakar. The modern tools have also been described to make the prognosis easy going. Urine examination is used to detect and manage a wide range of disorders such as UTI, kidney disease and diabetes. Stool examination is used to detect colour, consistency and to classify type of faeces (diagnostic triad for IBS). Tongue examination can reflect a number of underlying diagnosis such as infections, nutritional deficiencies, malignancy and even neurological dysfunction. Auscultation, palpation, percussion are the methods of clinical examination for disease of different systems. Gait analysis is a way to assess the dynamic posture and coordination during movement.

Conclusion

Before starting the treatment of any disease, diagnosis is the first and most important step. To diagnose various diseases, Ashtavidha Pariksha is mentioned as a necessary tool in

our different Ayurvedic texts. On the basis of eight factors mentioned in Ashtavidha Pariksha, diagnosis can be conclude to a particular disease and then treatment can be done. These got modified with the advent of time and the additions of things were done according to requirements.

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