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EDITORIAL
CLINICAL DIAGNOSIS IN AYURVEDA: CONCEPTS, CURRENT PRACTICE AND
PROSPECTS
PATIL VASANT, 1* SAPRA UMESH KUMAR2
1
Executive Editor, Journal of Ayurveda and Holistic Medicine, Ilkal-587 125 (India), 2Assistant Editor, JAHM and Lecturer, Department of
Roga Nidan, Chaudhary Brahm Prakash Ayurved Charak Sansthan, Najafgarh, New Delhi -110073 (India).
examination of the patient, and from medical comparing and contrasting their clinical findings
tests performed upon the patient. is called differential diagnosis.
The method of diagnosis in Ayurveda Today with the advancement in the
mainly depends on the in-depth understanding of Medical field, the diagnosis of disease can be
Dosha and Dooshya. The process of diagnosis done from the beginning and the progress of the
begins when the patient consults the doctor and diseases can be stopped. But sometimes the
presents a set of complaints (the symptoms). If patient can not afford expensive imagaing
the patient is unconscious, this condition is the techniques like CT Scan, MRI etc.Thus, we have
de facto complaint. The doctor then obtains to know the diagnosis according to Ayurveda
further information from the patient himself (and which helps in reducing the financial burden on
from those who know him, if present) about the the suffering patients.
patient's symptoms, his previous state of health, Once the physician has completed the
living conditions, and so forth. diagnosis, he explains the prognosis to the
Rather than consider the myriad diseases patient and proposes a treatment plan which
that could afflict the patient, the physician includes therapy and follow-up (further
narrows down the possibilities to the illnesses consultations and tests to monitor the condition
likely to account for the apparent symptoms, and progress of the treatment, if needed), usually
making a list of only those conditions that could according to the guidelines provided by the
account for what is wrong with the patient. medical field on the treatment of the particular
These are generally ranked in order of illness.
probability. Treatment itself may indicate a need for
If the physician is certain of the review of the diagnosis, if there is a failure to
prevailing condition, further medical tests are respond to treatments that would normally work.
performed or scheduled (such as medical Setback in Ayurvedic clinical diagnosis:
imaging), in part to confirm or disprove the
Prof M.S. Baghel, Director, Institute for
diagnosis and also to document the patient's
Post Graduate Teaching and Research in
status so as to keep the patient's medical history
Ayurveda, Gujarat Ayurved University,
up to date. Consultations with other physicians
Jamnagar, India describes the downfall of
and specialists in the field may be sought. If
Ayurvedic clinical diagnosis beautifully as
unexpected findings are made during this
follows - due to the inclusion of Nadi Pareeksha
process, the initial hypothesis may be ruled out
(Pulse diagnosis) and Rasa Shastra, the practice
and the physician must then consider other
of Ayurvedic Clinical Diagnosis declined
hypotheses.
greatly. During the Mughals period, the Mughal
Despite all of these complexities, most kings ordered and forced the Royal Physicians to
patient consultations are relatively brief, because find an alternative and quick method to diagnose
many diseases are obvious, or the physician's their queens ailments without examining the
experience may enable him to recognize the complete body, because the Mughals restricted
condition quickly. Another factor is that the the physicians to see face of queens. The Royal
decision trees used for most diagnostic Physicians then started Nadi Pareeksha, to
hypothesis testing are relatively short. diagnose the diseases without examining eye,
Before reaching at a confirmed tongue, face and other body parts. Rasashastra
diagnosis, the physician must know other similar was included into Ayurveda during 8th century
disorders having the same symptoms and AD. Most of the texts of Rasashastra opined
clinical presentations which is known as that, for administering Rasa Aushadhi, there is
differential diagnosis. The determination of no need of examining the Dosha, Dushya,
which one of two or more diseases or conditions Srotas, Desha, Kala etc. factors. Then gradually,
a patient is suffering from, by systematically the practice of Ayurvedic clinical diagnosis
decreased.
Importance of Clinical Diagnosis: treatment, does not try to enter into the heart of
UÉåaÉqÉÉSÉæ mÉUϤÉåiÉ iÉiÉÉåÅlÉliÉUqÉÉæwÉkÉqÉç the patient by virtue of the light of his
knowledge, he will not be able to treat the
iÉiÉÈ MüqÉï ÍpÉwÉMçü mɶÉÉeÉç¥||lÉmÉÔuÉïÇ xÉqÉÉcÉUåiÉç |3
disease.
The physician should examine first
Utility of Diagnosis:
thoroughly and then treat the patient skillfully.
• Early diagnosis helps in complete and faster
ÌuÉMüÉUlÉÉqÉÉMÑüzÉsÉÉå lÉ ÎeÉ̾ûrÉÉiÉç MüSÉcÉlÉ
recovery
lÉ ÌWû xÉuÉïÌuÉMüÉUÉhÉÇ lÉÉqÉiÉÉåÅÎxiÉ kÉëÑuÉÉ ÎxjÉÌiÉÈ |
• Early diagnosis helps in prevention of
xÉ LuÉ MÑüÌmÉiÉÉå SÉåwÉÈ xÉqÉÑijÉÉlÉÌuÉzÉåwÉiÉÈ complications
xjÉÉlÉÉliÉUaÉiɶÉæuÉ eÉlÉrÉirÉÉqÉrÉÉlÉç oÉWÕûlÉç ||4 • The accurate diagnosis helps in planning
If a physician is not able to name a precise treatment for destroying the root
particular disease, he should not feel ashamed cause of disease and thus recurrence of
because it is not always possible to give a disease.
definite name to all diseases. The same Dosha • Early and correct diagnosis saves money and
when aggravated may cause various diseases reduces mental stress of the patient.
depending upon the various etiological factors
Elements of Diagnosis:
and sites of manifestation.
Dosha: Sthana (location), Atma rupa
So, the physician should comprehend
(cardinal symptom), Prakopa
the nature of disease through Dosha, the site of
Lakshana (symptoms of
manifestation, etiological factors and should
aggravated humor), Gati
then initiate the treatment. Hence, while
(movement),
diagnosing a new disease, it is very essential to
have full knowledge about these three aspects on Dooshya: khavaigunya (genetic defect or
the basis of scriptural instructions. Armed with defect in tissues)
this knowledge one would never fail in his Srotas: Srotodushti Lakshana
attempt to cure the disease. As hypertension is (symptoms of vitiation of
one of the disease having unknown channels)
etiopathogenesis in Ayurveda, it is very Agni: Ama (indigested matter)
necessary to go by the way indicated in the
Srotodushti: Atipravriti (over activity),
scriptural instructions in textbooks of Ayurveda.
Sangha (obstruction),
rÉxiÉÑ UÉåaÉqÉÌuÉ¥||rÉ MüqÉÉïUÉrÉÉUpÉiÉå ÍpÉwÉMçü ! Siragranthi (tumor), Vimarga
AmrÉÉæwÉkÉÌuÉkÉÉlÉ¥|xiÉxrÉ ÍxÉήrÉïSØcNûrÉÉ ||5 gamana (displacement)
A well versed physician who starts the Roga marga: Shakha (periphery), Marma-
treatment without knowing the disease, if he gets Asthi-Sandhi and Koshtha (vital
success, it is by chance. tissues, bone, joint & GIT)
xÉuÉïjÉÉ xÉuÉïqÉÉsÉÉåcrÉ rÉjÉÉxÉÇpÉuÉqÉjÉïÌuÉiÉç Diagnosis of unknown or new disease:
AjÉÉkrÉuÉxrÉå¨ÉiuÉå cÉ MüÉrÉåï cÉ iÉSlÉliÉUqÉç ||6 The methodology of understanding an
After examining the disease by unknown disease has been described in Charaka
scriptural testimony etc.; the physician should Samhita based on Aptopadesha Pareeksha. They
obtain knowledge regarding the nature of are Prakopa (causative factors), Yoni (site of
disease and therapies required therefore. origin), Uthana (site of expression), Atmanam
(cardinal symptoms), Adhisthana (location),
¥||lÉoÉÑήmÉëSÏmÉålÉ rÉÉå lÉÉÌuÉzÉÌiÉ iɨuÉÌuÉiÉç !
Vedana (pain), Samsthana (clinical features),
AÉiÉÑUxrÉÉliÉÉUÉiqÉÉlÉÇ lÉ xÉ UÉåaÉÉǶÉÌMüxÉÌiÉ ||7 Sabda (sound), Sparsa (touch), Rupa
When a physician who even if well (inspection)), Rasa (taste), Gandha (smell),
versed in the knowledge of the disease and its Upadrava (complication), Vridhi (increased
etc. then the patient may be suffering from TB. Table- Ayurvedic Correlation of Lab Tests
Investigations useful in TB e.g. TB Gold, Lab Tests Ayurvedic
Mantoux’s test, chest X-Ray, ESR are not 100% correlation
RBC, Hb %, WBC, Platelet
reliable. So, it is the need of time to increase our Count, MCV, MCHC, MCH
proficiency in clinical diagnosis. We should try Rakta Dhatu
to inculcate the knowledge of clinical diagnosis
in our students and explain to them the utility of Eosinophilia Vata Vriddhi or
the clinical diagnosis. Knowing the use of Prakopa
modern diagnostic methods is appreciable, but it ↑ neutrophilia Saama Kapha
and Pitta
is more important to know the conditions in ↑ Lymphocytes Nirama Kapha
which these investigations should be used. Serum electrolytes Rasa Dhatu
Overuse of laboratory investigations must be Serum Calcium, Phosphate Rasa Dhatu,
discouraged. E.g. in Amavata patient, if the Asthi
clinical features of swan neck deformity, ulnar Serum Creatinine, EMG Mamsa Dhatu
Serum Alkaline phosphatase,
deviation of the hands etc. are obvious, then the
osteocalcin, Acid phosphatase, Asthi Dhatu
use of routine investigations like RA Factor, urine calcium (24 hour)
CRP, Anti-CCP etc. become irrelevant in most Semen Analysis, Testosterone,
Shukra Dhatu
of the cases. So, for better understanding and FSH, LH
treatment of patients, the physicians should Lipid profile Rasagata Sneha
(Abaddha Meda)
practice the clinical examination methods told in
LFT (Liver Function Test) Raktadhatu,
Ayurvedic classics and prefer judicious use of Pitta Dosha
modern tools & methods of diagnosis. PFT (Pulmonary Function Test) Prana Vayu
RFT (Renal Function Test) Mutravaha
Prospects of clinical diagnosis: Srotas
Vaidya can be classified into two TMT, ECG, Echocardiography Vyana Vayu
EEG, CT, MRI Prana Vayu
categories, i.e. a) Vikalpavid & b) Avikalpavid.
Vikalpavid (expert physician) is the one who can Conclusion: In order to diagnose the disease on
understands the subtle changes in Dosha, Dhatu, the basis of Ayurvedic principles, the physician
Mala, Agni, Srotas and its variations by his should work very hard to know the subtle
changes occurring inside the body due to the
Dhyana Chakshu (sixth sense), capable of
imbalance of Dosha. To become perfect in
arriving at precise final diagnosis in shorter
Ayurvedic diagnosis, the physician needs to
time. But in contrary, Avikalpavid is not able to
understand Dosha Vikalpa (Dravyataha-
do so. Most of the current practitioners belong to Gunataha-Karmataha Vriddhi of Dosha), Dhatu
second category due to lack of intuition and also Vaishamya (the quantum of vitiation, the status
practical training. They desperately need the of Dhatu and Srotas), Agni Sthiti (condition of
help of modern methods to understand the subtle the digestive fire viz. Samagni, Mandagni etc.)
changes of Dosha, Dhatu and Mala. Here we and status of Ama (Intermediate matter) in
want caution that only by modern knowledge of body.30 If necessary the Vaidya can use modern
diagnosis cant helps but the Vaidya should have tools and methods of diagnosis judiciously.
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