AÉrÉÑuÉåïSÏrÉ AÉrÉÑuÉåïSÏrÉ UÉåaÉÏ mÉUϤÉÉUÉåaÉÏ mÉUϤÉÉ

Presenter:Presenter:Dr. Vidhu b.Dr. Vidhu b.Ist PG ScholarIst PG ScholarDept. Of KayachikitsaDept. Of KayachikitsaD.G.M.A.M.C.P.G.S. & RC, D.G.M.A.M.C.P.G.S. & RC, GADAGGADAG

IntroductionIntroductionPhysician should develop technical skill,

scientific knowledge and human understanding to acquire complete knowledge for the diagnosis of various diseases. Physician should be attentive listener, nonverbal communicator, friendly, empathic and articulate.

It is important to diagnose the disease by using appropriate techniques and accordingly treat the treatable disease with love and affection. It is better not to treat incurable disease. Complete understanding of science is essential to get mastery and supremacy in clinical methods.

ROGIROGI (Derivation and Definition)Derivation:

The word rogi is derived from “Rogaha asya asthi ithi” It means - one in whom roga resides is rogi.Definition:

“Ragopahat shariraha”-Body that has been inflicted with disease is called as rogi.

“Rujathi Jwaradeena Pidamanudhavati ithi rogi” - One who endures pain and disease is rogi, for instance due to – Jwaradi.

Pariksha (Derivation and Definition)• Derivation:

The word Pariksha is derived from the root “iksh” means- to view, to consider, with the preposition “pari” fixed before the root which means from all sides. Thus, Pariksha means viewing or examing a object from all sides.

• Definition: “Parikshayathe vyvasthapyate vastu

swaroopanaya ithi” The due process of examination by which the exact nature of an object is determined is known as pariksha.

Importance of PareekshaImportance of Pareeksha

iÉxqÉS ÍpÉûwÉMçü MürÉïqÉç cÉÏMüÐzÉÑï mÉëMçü MürÉï xÉqÉUqpÉiÉç mÉUϤÉÉ MåüuÉsÉqÉç mÉËU¤rÉçÇ mÉËU¤rÉç MüqÉï xÉqÉÉUpÉåiÉçç MüiÉÑïÇ |

(cÉ.ÌuÉ.8/79) A physician desirous of initiating an

action should examine all that are required to be examined before initiating his action

Importance of rogi Importance of rogi pareekshapareekshaAmiÉç iÉjÉ cÉ EmÉSåzÉålÉ mÉëirÉ¤É MüUhÉålÉ cÉ |AlÉÑqÉÉlÉålÉç cÉ urÉkÉÏlÉç xÉqrÉMçü ÌuɱÉ

ÌuÉcɤÉhÉç: | xÉuÉïjÉÉ xÉuÉïqÉ AÉsÉÉåcrÉ rÉjÉÉ xÉqpÉuÉ AjÉï

ÌuÉiÉç |AjÉ AkrÉuÉxrÉå iÉiuÉå cÉ MürÉï cÉ iÉSèlÉliÉUqÉç |MürÉï iÉiuÉ ÌuÉzÉåwÉ¥ÉÉ mÉëÌiÉmÉiÉÉå lÉ qÉѽÌiÉ |AqÉÔRèû: TüsÉqÉÉmlÉÉåÌiÉ rÉS qÉÉåWû

ÌlÉÍqÉYiÉçeÉqÉ (cÉç.ÌuÉ.4/9-11)

The wise should properly understand a disease by the scriptural testimony, direct observation and inference. As far as possible all factors should be discussed in their entirety. After examining the disease by scriptural testimony etc.; the physician should obtain knowledge regarding the nature of disease and the therapies required therefore.

One who is well versed in the specific nature of the disease as well as the therapies required therefore seldom fails to act properly. It is only he who acts properly reaps the results of proper action.

UÉåaÉUÉåaÉÏÏ mÉU mÉUÏϤÉÉ pÉåS¤ÉÉ pÉåS

̲ÌuÉkÉç mÉUϤÉÉ : mÉëirɤÉ,AlÉÑqÉÉlÉ(cÉ. ÌuÉ.8/83)

There are tow methods namely Pratyaksa (perceptual) and Anumana (inferential).

̧ÉÌuÉkÉ mÉUϤÉÉ : mÉëirɤÉ,AlÉÑqÉÉlÉ,AÉmiÉÉåmÉSåzÉ (cÉ.ÌuÉ.4/3)

Three fold skills for examination of patient are Pratyaksa, anumana and Aptopadesa (authoritative instruction)

SzÉïlÉ,xmÉzÉïlÉ,mÉëzlÉ(A.xÉÔ.1/22)Three fold examination techniques namely Darshan (inspection), sparsana (palpation) and Prasna (interrogation).

wÉQèÌuÉkÉ mÉUϤÉÉ :iɱjÉÉ mÉgcÉÍpÉ:´ÉÉå§ÉÌSÍpÉ: mÉëzlÉålÉç cÉåÌiÉ (xÉÑ.xÉÑ.10/4)

A¹èÌuÉkÉ mÉUϤÉÉ :lÉÉÌQ,qÉsÉ,qÉÔ§É,ÎeÉuWûÉ,SØMçü,AÉM×üÌiÉ,zÉoS,xmÉzÉï.(rÉÉå.U¦Éç.mÉÔ)

SzÉÌuÉkÉ mÉUϤÉÉ :

mÉëM×üÌiÉ,ÌuÉM×üÌiÉ,xÉÉUç,xÉiuÉ,xÉiqrÉç,xÉÇWûlÉlÉ,mÉëqÉÉhÉç,AÉWûUzÉçÌ£ü,

urÉrÉÉqÉzÉÌ£ü,uÉrÉ.(cÉ.ÌuÉ.8/94)

The patient should be examined with reference to his Prakrti(physical constitution), vikrti(morbidity), sara(excellence of dhatus), samhanana(compactness), pramana(measurement of organs of body), satmya(homologation), sattva(psychic condition), aharashakti(power of digestion of food), vyayamashakti(power of performing exercise) and vayas(age) in order to ascertain his strength and the intensity of the malady.

wÉQèÌuÉk

É mÉUϤÉÉ

mÉëirɤÉiÉxiÉÑ ZÉçsÉÑ UÉåaÉiuÉÇ oÉÑpÉÑixÉ: xÉuÉåïÎlSìÄrÉæ: xÉuÉïlÉç CÎlSìrÉÉjÉïlÉ AÉiÉÑUç zÉçUÏUçaÉiÉÉlÉ mÉUå¤ÉåiÉç AlrÉ§É UxÉkrÉlÉÉiÉ

(cÉ.ÌuÉ.4/7)One desirous of examining the specific

characteristics of the disease by “Pratyaksh pramana(direct observation)” should examine by his owns senses the objects of senses in the body of the patient except the one relating to the taste organ (i.e. UxÉlÉåÎlSìrÉ). UxÉlÉåÎlSìrÉ mÉUϤÉÉ is done by “Anumana pramana(inference).”

´ÉÉå§ÉåÎlSìrÉ mÉUϤÉÉ-iÉ§É ´ÉÉå§ÉåÎlSìrÉ ÌuÉ¥ÉårÉç

ÌuÉzÉåwÉç UÉåaÉåwÉÑ uÉëhxÉëÉuÉ ÌuÉ¥ÉÉÌlÉrÉÌSwÉÑ uɤrliÉå iÉ§É xÉTåülÉçÇ U£çüÍqÉUrÉ³É AÌlÉsÉ: xÉzÉoSÉå ÌlÉaÉïcNèûÌiÉ CirÉqÉåuÉSrÉç: |

(xÉÑ.xÉÔ.10/5)The different kinds of information about the

diseases obtainable through the organ of hearing such as safen rakta(frothy blood) coming out accompanied with sound, forced by vata etc.

AÉl§ÉMÑüeÉlÉ xÉÎlkÉxmÉÑOèlÉç Al…¡ÓûÍsÉmÉuÉïhÉçqÉ cÉ xuÉUÌuÉzÉåwÉç cÉ rÉå cÉÉlrÉåÌmÉ MåüÍcÉiÉç zÉçUÏUÉåmÉaÉiÉÉ: zÉçoS: xrÉÑxiÉç ´ÉÉå§ÉåhÉç mÉUå¤ÉåiÉç |

(cÉ.ÌuÉ.4/7)Following should be examined by

auscultation:

•Antrakujan (Gurgling sound in the intestine)

•Sandhi sphutan (cracking sound in the joints)

•Voice of the patient

•Such other sounds in the body of the patient like the sounds of coughing and hiccup

How to doHow to doThe ears of the physician are no doubt the

essential organs for this examination. But there is use of hearing aid to make it easy like stethoscope. In past time Aacharyas use SVARNA YANTRA(hearing instrument in the form of a hallow tube) to examine the patient. In some cases the examiner can do this examination by Pratyaksha karma.

It is quite similar to AUSCULTATION and PERCUSSION EXAMINATION.

Detecting by Detecting by HearingHearing

Name of the Name of the DiseaseDisease

Ruksha Svara PishachonmadaSvara bheda Vataja Kasa, Ksataja

Kasa, Raktapitta, Pinasa, Svara Bheda roga etc.

Atopa Amatisara, Adhmana etc.

Adhmana Udavarta, Baddhagudodara, Vata vyadhi upadrava

Antrakujana Vatatisara, Gulma, Pakvashaya gata vata etc.

xmÉzÉïlÉåÎlSìrÉ mÉUϤÉÉ-xmÉzÉïlÉåÎlSìrÉç

ÌuÉ¥ÉårÉç:zÉÏiÉÉåwhÉç zsɤÉçhMüMïüzÉç qÉ×SÒMüÌOûlÉçiuÉSrÉç: xmÉzÉïç ÌuÉzÉåwÉç euÉUç zÉÉåTüÌSwÉÑ |

(xÉÑ.xÉÔ.10/5)

Those obtainable through the organ of touch are- sheeta(cold), ushna(heat), shlakshna(smoothness), karkash(roughness), mrudu(softness), kathin(hardness), etc. in jwara(fever), shotha(edema) and other diseases.

For example:• Usna sparsa in Jwara• Mrudu sparsa in Pittodar• Kathina udara in Kaphodara

How to doHow to doIt is the hands of the physician that are

essential for this examination with the palm of the hand. All the parts of body of the patient are touched and felt for detecting their normal and abnormal qualities.

In this examination the examiner’s palm should not be more sheet(cold) or more ushna(hot). The touch must be neither too hard or too light: a hard touch makes the underlying muscles to become tense, where as a too light touch will not convey anything to the palpating hand. The touch must be comfortable to the patient.

It also includes NADI PARIKSHA. It is quite similar to PALPATION EXAMINATION.

Detecting by Detecting by TouchTouch

Name of the Name of the DiseaseDisease

Nadi mandatara Mandagni, Ksinadhatu

Paripinditatvat sparsopa labhyah

Gulma

Sparsajnatvamiti Kustha Purva rupa

Bahalam Hasticharmavat

Charma kustha

Kina khara sparsam parusam

Kitibha Kustha

cɤÉÑUåÎlSìrÉ mÉUϤÉÉ-cɤÉÑUåÎlSìrÉ ÌuÉ¥ÉårÉç:

zÉUÏUÉåmÉcÉrÉçArÉÑsÉï¤ÉhÉç oÉsÉ uÉhÉïç ÌuÉMüÉUÉSrÉ: |

(xÉÑ.xÉÔ.10/5)

Those obtainable through the organ of sight increase and decrease of the size of body, signs of aayu(life-span), changes of bala(strength) and varna(color) of the body etc.

uÉhÉïxÉÇxjÉlÉ mÉëqÉÉhÉç NûÉÄrÉÉ zÉUÏUçmÉëM×üÌiÉÌuÉMüÉUÉã cÉç¤ÉÑ ÌuÉwÉçrÉMüÉÍhÉ rÉÉÌlÉ cÉ AlrÉlrÉ rÉÑYiÉÉÌlÉ iÉÉÌlÉ cɤÉÑwÉç mÉËU¤ÉåiÉç |

(cÉ.ÌuÉ.4/7)The following should be examined visually:

•uÉhÉï (colour)

•xÉÇxjÉlÉ (shape)

•mÉëqÉÉhÉç (measurement)

•NûÉÄrÉÉ (complexion)

•zÉUÏUçmÉëM×üÌiÉ (natural state of body)

•zÉUÏUçÌuÉMüÉU (unnatural state of body)

•Others which can be examined visually like signs of the disease and luster

How to doHow to doKeeping the patient in good light and at a

convenient close range, observe all over the body scrupulously, not overlooking or bye-passing any change however minute it be.

Use of a magnifying glass, reflecting mirrors, X-Ray and such other instruments which are helpful to see the internal parts of the body.

It is quite similar to INSPECTION EXAMINATION.

Detecting by SightDetecting by Sight Name of the DiseaseName of the Disease

Avila netrata Ardita purvarupa

Haridra netrata Kamala asadhya lakshana

Akshikuta sotha Mirda bhakshanjanya Pandu

Svetapita lochana Pandu

Kuksheratimatra vrddhi

Jalodara

Drsti viparyaya Udhvaswasa

UxÉlÉåÎlSìrÉ mÉUϤÉÉ- UxÉlÉåÎlSìrÉç ÌuÉ¥ÉårÉç:

mÉëqÉåWûÌSwÉÑ UÎxuÉzÉåwÉç:|

(xÉÑ.xÉÔ.10/5)

Those obtainable through the organ of taste are- the different taste in madhumeha(diabetes) and such other diseases.

UxÉÇ iÉÑ ZÉçsÉ AÉiÉÑU zÉUÏUaÉiÉqÉç CÎlSìrÉÌuÉwÉrÉMqÉmrÉÉlÉÑqÉÉlÉSuÉaÉcNûÌiÉ, lÉ AxrÉ mÉëirɤÉåhÉ aÉëWûhÉçqÉ EmÉmÉkrÉiÉå, iÉxqÉÉSÉiÉÑUmÉËUmÉëzlÉå uÉ AÉiÉÑUqÉÑZÉUxÉÇ ÌuÉkrÉiÉç, rÉÑMüÉmÉxÉmÉïhÉålÉ iÉÑ AxrÉ zÉçUÏUuÉæUxrÉqÉ, qÉͤÉMüÉåxÉmÉïhÉålÉ zÉçUÏUqÉÉkÉÑrÉïå, sÉÉåÌWûiÉÌmɨÉxÉlSåWåû iÉÑ ÌMÇü kÉÉËUsÉÉåÌWûiÉÇ sÉÉåÌWiÉûÌmɨÉÇ uÉåÌiÉ µÉMüÉMüpɤÉhÉÉSËU sÉÉåÌWûiÉqÉpɤÉhÉÉ sÉÉåÌWûÌmɨÉÍqÉirÉlÉÑqÉÉiÉurÉqÉç |

(cÉ.ÌuÉ.4/7)

Tastes of the various factors in the body of the patient are no doubt the objects of the gustatory sense organ. They can however be ascertained by Anumana pramana(inference) and not by Pratyaksha pramana(direct observation). Therefore, Atura mukha rasa (the taste in the mouth of the patient) should be ascertained by mÉëzlÉç mÉUϤÉÉ(interrogation). Impairment of the taste of body should be inferred when lice etc.; go away from the body. Sweet taste of the body can be inferred when flies are attracted towards the body.

In the case of raktapitta (bleeding from various parts of the body), if there is a doubt about the nature of the blood, it should be resolved by giving the blood to dogs and cows to eat. Intake of the blood by dogs and cows is indicative of its purity and rejection by these animals indicates that the blood is vitiated by pitta.

How to doHow to do

Making use of the tongue for the examination of the patient or other materials connected with the patient is an impractical method how as also it was, even in Aacharyas kala. So the findings of the tastes of the materials of the body was attempted indirectly by noting of the behavior of insects like ants, flies etc.

Now a days various laboratory tests are being adopted to determine the taste of many materials of the body like blood, urine etc.

Detecting by Detecting by RasanaprikshaRasanapriksha

Name of the DiseaseName of the Disease

Asya vairasya Jwara, Kasa, Arochaka etc.

Asyamadhurya Kaphapittaja amlapitta, Kaphaja chardi, Kaphaja hrdroga

Aruchi Jwara, Kamla, Krmi, Halimaka, Grahani, Arochaka roga

bÉëÉhÉåÎlSìrÉ mÉUϤÉÉ-bÉëÉhÉåÎlSìrÉ ÌuÉ¥ÉårÉÉ AËU¹è ÍsÉ…

¡ûÉÌSwÉÑ uÉëhÉÉlÉqÉç AuÉëhÉlÉÉÇ cÉ aÉlkÉÌuÉzÉåwÉç |

(xÉÑ.xÉÔ.10/5)

Those obtainable through the organ of smell are- the different odors appearing along with aarishta lakshan(fatal signs) in varna(ulcerous and non ulcerous) and diseases.

aÉlkÉÉÇxiÉÑ ZÉsÉÑ xÉuÉïzÉUÏUaÉiÉlÉÉiÉÑUxrÉ mÉëM×üÌiÉuÉæMüËUMüÉlÉç bÉëÉhÉålÉ mÉUϤÉåiÉ |

(cÉ.ÌuÉ.4/7)Normal and abnormal smells of the entire

body the patient should be examined by the organ of smell.

xuÉpÉÉÌuÉMü aÉlkÉ- cÉlSlÉ, iÉaÉU, AaÉU, AÉÌS |

AzÉÑpÉ aÉlkÉ- qÉÔ§É, mÉÑËUwÉ, MÑühÉmÉ aÉlkÉ AÉÌS |

How to doHow to do

The physician should cultivate the practice of smelling various substances of the body and must train himself to detect their normal or abnormal smell. A pleasant smell or unpleasant smell should be taken with equal regard and decision whether either one is normal or abnormal should be taken careful consideration.

Detecting by SmellDetecting by Smell Name of the Name of the DiseaseDisease

Gatra dauragandhya Kostha varna, Medo roga

Durgandha kapha Kshayaja kasa

Anga lohagandha Raktaja daha

Kaunyam Medagata kustha

mÉëzlÉç mÉUϤÉÉ-mÉëzlÉålÉç cÉ ÌuÉ¥ÉÉÌlÉrÉÉSè SåzÉç

MüÉsÉç eÉÉÌiÉ xÉÉiqrÉ AÉiÉ烡éûxÉqÉÑimÉçÌiÉ uÉåSlÉ xÉqÉÑcNèûrÉç oÉsÉ AliÉUÎalÉ uÉÉiÉç qÉ賈 mÉÑËUwÉÉhÉÇ mÉëuÉ×ÌiÉ AmÉëuÉ×ÌiÉ MüÉsÉçmÉëMüwÉïÌSÇ cÉ |

(xÉÑ.xÉÔ. 10/5)

Those obtainable through questioning, are nature of desh(habitat), kala(time), jati(caste), cause for onset of diseases, exacerbation of the symptoms, bala(strength), nature of agni(internal fire), elimination or non elimination of aadhovata(flatus) mutra(urine) and mala(faeces), time of exacerbation of disease etc.

wÉQèÌuÉkÉ mÉUϤÉÉ in Raktha vaha

Shrotash

´ÉÉå§ÉåÎlSìrÉ ´ÉÉå§ÉåÎlSìrÉ mÉUmÉUÏϤÉÉ ¤ÉÉ in Rakth vah srotas-in Rakth vah srotas-Aadhmatdrathi shabdvat(Dulness or

shifting dulness) in Jalodar (Upadrava of kamala).

xmÉzÉïlÉåÎlSìrÉ xmÉzÉïlÉåÎlSìrÉ mÉUmÉUÏϤÉÉ ¤ÉÉ in Rakth vah in Rakth vah srotassrotas--

In Kafaja Rakthapitta- Greasy in touch blood.

In Kumbhkamla- Rukshta(roughness and dryness) of skin.

cɤÉÑUåÎlSìrÉ cɤÉÑUåÎlSìrÉ mÉUmÉUÏϤÉÉ ¤ÉÉ in Rakth vah srotasin Rakth vah srotas--In Vataj rakthapitta- color of blood is blackish or

blackish brownIn Pittaj rakthapitta- color of blood is dark black or

cow’s urine like color.In Kafaj rakthapitta- color of blood is yellowish. In kamla- yellow discoloration of nails skin eyes and

mouth.In Shakhashirit kamala- White colored stool.In kumbhkamla- dark yellow colored urine and

stool.

UxÉlÉåÎlSìrÉ UxÉlÉåÎlSìrÉ mÉUmÉUÏϤÉÉ ¤ÉÉ in Rakth vah in Rakth vah srotassrotas- -

In Raktapitta- Intake of the blood by dogs and cows is indicative of purity its and rejection by these animals indicates that the blood is vitiated by pitta.

bÉëÉhÉåÎlSìrÉ bÉëÉhÉåÎlSìrÉ mÉUmÉUÏϤÉÉ ¤ÉÉ in Rakth vah in Rakth vah srotassrotas--

In Raktapitta- Iron metal smell (acc to Aacharya Susruta) or Fishy smell (acc to aacharya Charaka) in breath.

mÉëzlÉç mÉUmÉëzlÉç mÉUÏϤÉÉ ¤ÉÉ in Rakth vah srotasin Rakth vah srotas--

In Rakthapitta- burning in palms and feet.Burning due to consumed cereals. To visualize subjects of different colors(Red, Blue, Yellow etc.) in sleep.

In kamala- weakness, burning sensation, constipation, dyspnoea, drowsiness, mild or low grade fever, etc.

ConclusionConclusionAs per acharyas even though they

have classified rogi pariksha (as dividha, trivivdha, shadvidha, asthavidha, dashavidha.) one have to apply their own yukti and do all the pariksha which are applicable in the particular patient so that proper treatment plan can be adopted in curing the diseases.