Articles Index-Ayurveda
 
Ayurvedic & Western Medicine Diagnostic Systems
 
Diagnosis in Western medicine (derived from the word "discern" in Greek) is based on the patient's history, physical examination and laboratory testing. Case history-taking is a tradition dating back to the time of Hippocrates and a good physician is skilled at how, when and what to ask; if one asks the right questions, the patient will almost make the diagnosis in their own words for the physician.
 
Physical examination is also an ancient art, which has changed dramatically since the advent of instruments in the 19th century. Laboratory testing is a radical contemporary innovation that is rapidly becoming the basic tool of contemporary Western medical scientific diagnosis and, along with expensive technological diagnostic procedures, threatens to replace the traditional art of case history-taking and direct observation and physical examination.
 
The Ayurvedic physician treats every patient as an individual because, according to Ayurveda, all illnesses are rooted in each patient's unique background and situation. This concept is further expanded to include the chief complaint, accompanying symptoms, and relevant medical, personal, dietary, and spiritual history. Through this process, the physician infers the wider picture of individual health, which characterises the illness. Once the illness is diagnosed, keeping in view all the above factors, the root cause of the complete set of intricate symptoms and conditions can be recognised. It is this root cause of illness in addition to the severe symptoms that Ayurvedic physicians treat. In this approach, each patient's diagnosis and treatment plan are determined on an individual basis.
 
A Western Physician treats a disease whereas an Ayurvedic Physician treats an individual.
 
Ayurvedic Diagnosis
Ayurveda has very extensive methods of recording case history and clinical examination with certain approaches unique to the system. It lays great emphasis on the doctor - patient rapport, being a holistic system; deep understanding of an individual and his total trust is an imperative requirement. Thorough clinical examination is another aspect, which is not dependent on technology for quick diagnosis.
 
Ayurveda distinguishes between rogi (patient) and roga (disease) and treats both separately. The guidelines to evaluate a patient using this approach are:
1. The Individual and her constitution
2. Her remaining health
3. Disease
 
Using these guidelines the Physician concludes: the strength of the patient and the nature and strength of the disease. Considering that a disease exists in an otherwise healthy body, the remaining health 'avasista svasthya' has to be supported and strengthened to enable recovery.
 
Methods and Tools
Method of Rogi Pariksa: Ashtavidha Pariksa, examination of the eight points provides a complete picture of the body and its functions. Each point is capable of reflecting the whole body and its state of health. These points reveal information about the individual's constitution in a healthy state, but in a diseased state they become sites for clinical manifestation. Therefore this examination is used mainly for Roga Pariksa.
 
This examination includes:
1. Nadi (Pulse) This is carried out to perceive the state of the three doshas, vata, pitta, and kapha with the index, middle and ring finger respectively, placed on the radial pulse of the patient at the root of the thumb. It is presumed that the rate and rhythm of the pulse are controlled by vata, while the amplitude of the pulse is controlled by pitta. Kapha governs volume.
2. Mutra (Urine) This helps to determine the tridoshika manifestation through information on quantity, frequency, colour, consistency, smell and taste.
3. Mala (Stool) The purpose of this is to assess the sama/nirama state, tridoshika imbalance and related manifestations. Bulky, foul smelling stool is indicative of kapha and ama dosha with low Agni. A well-formed ripe looking stool with yellowish complexion is considered paittika and is nirama. Small frequent unformed dark stools are considered to be vatika.
4. Jhiva (Tongue) The tongue helps in tridoshika diagnosis and also reflects the ama state of the body. A big, soft flabby tongue with pale coating indicates ama and kapha disorder. A soft, sharp, pointed, moist tongue denotes pitta, while a thin, coarse, furry tongue is suggestive of vata dosha. The tongue is also regarded as a mirror of the whole body, especially of the digestive system.
5. Sabda (Speech and voice) Speech gets altered in different disease states. The dosha that is vitiated gives its attributes to it; e.g. pitta dosha would render it sharp and terse.
6. Sparsa (Skin) Skin examination can reveal changes in colour, texture and firmness and help tridoshika diagnosis.
7. Drk (Eye) The eyes easily get altered in some clinical conditions like anaemia; emotional states are also very apparent from the eyes. In doshic terms, a big, whitish, clear, slow moving eye is the characteristic of kapha. A sharp, moist, pink eye is pitta, whilst a small, dry and flickering eye is of vata nature.
8. Akrti (General appearance) The patient's face is the most revealing part of the body. Both mental and physical disturbances are apparent first on the face.
 
For the purpose of Rogi Pariksa the most popular and practical schedule is Dasa Vidha Pariksa (ten point examination). This is carried out to evaluate the patient's temperament, genetic make up, vitality and health.
1. Prakriti (genetic make up/ constitution) This is considered in relation to the tridosha and triguna. The prakriti represents the normal range of proportions of the three doshas i.e. vata, pitta, kapha and the three gunas i.e. sattva, rajas, and tamas in the psychophysical constitution of an individual.
2. Vikriti This deals with a person's susceptibility to a disease, based on their past and present illnesses.
3. Sara pariksa is intended to examine the saptdhatus and the psyche. They are termed according to their relative qualities i.e. pravara (superior), madhyama (medium) and avara (inferior). This qualitative assessment helps to determine the overall quality of psychobiological health and make up.
4. . Samhanana (compactness of body) This is a qualitative assessment of the body frame and described in similar terms to 'sara'.
5. Pramana (anthropometrics) Textual references are given for the measurement of all body parts in one's own fingerbreadth and are used as guidelines to suggest good or bad prognosis.
6. Satmya Relates to the inherent ability of an individual to adapt and survive in stressful and altered circumstances. This is different from an acquired ability due to habit or constant exposure.
7. Sattva (Mental stamina) This differs in individuals according to genetic make up or general upbringing. Some may be better at dealing with pain than others on a mental level. This information is very helpful in managing the level of medication prescribed.
8. Ahara Sakti This has two aspects: power or capacity to ingest, i.e. quantity of food consumed, appetite; power or capacity to digest. This knowledge enables the physician to give better and more appropriate diet and nutritional advice to restore health.
9. Vyayama Sakti Assesses the physical endurance ability of the individual. This permits the physician to estimate the level of exercise and movement advisable to promote faster recovery.
10. Vaya This consists of verification of age and also the rate of ageing. An individual that looks older than their chronological age can be considered to be unhealthy, as it indicates a faster rate of ageing. Such a patient would need additional support in their disease management.
 
To enable the astavidha and dasavidha pariksa the physician has to employ the tool of Sadvidha Pariksa, which consists of prasna (questioning/interview) and panchendriya (physical examination using the physician's own five senses). The prasna pariksa is the most fundamental method of diagnosis and considers the patient as an apta (expert) as far their subjective state of health is concerned. The interview should draw information about the main complaints with their duration; family and personal history; history of past illnesses and present illnesses, including nidana (possible cause), purvarupa (premonitory signs), rupa (signs), upasyanupasaya (tests) and samprapti (process).
 
Western Diagnosis
The physician begins by considering the broad spectrum of a patient's main complaints; history of present illness; past medical history, and social history. The Western physician then narrows down the possible causes, through a process of elimination, finally arriving at a single disease entity. With this diagnosis having been established, treatment options and expected prognosis can be assessed from statistical and experimental research tested in study populations. This approach does not take the individual into account, but categorises the patient under a particular disease and offers the same treatment as to another individual. It does not take into account that any two people experience the disease differently, and have varying symptoms, cause, prognosis and quality of life.
 
Western approach
History Taking
Physical Examination: Systematic/sequenced approach is taken
Laboratory Investigations/ Tests
 
Method
Interview - this is carried out to ascertain as much information about the person's history in terms of past and present illnesses, past medical history, family history and chief complaint(s). The principal symptoms are to be well characterised, with descriptions of (1) location (2) quality (3) quantity or severity (4) timing, including onset, duration, and frequency (5) the setting in which they occur (6) aggravating or relieving factors and (7) associated manifestations.
 
Inspection/ Physical examination - General survey: the patient's general state of health, height, build, and sexual development are observed. Patient's weight is measured; posture, motor activity, gait, dress, grooming, personal hygiene, and any odours of the body or the breath are noted. Changes in facial expression, manner, affect and reactions are observed. Way of speaking should be heard, and level of consciousness is noted. The review of systems, generally included in the Interview, is quite often conducted alongside the physical examination.
 
Vital signs: Height and weight are measured and blood pressure is taken, pulse and respiration rate are counted. Body temperature is taken.
 
Skin: Facial and body skin is observed for lesions, and their various aspects are noted, such as colour, distribution etc. Hands are studied and hair and nails are palpated.
 
Head, Eye, Ear, Nose, Throat and Neck: these are checked for normal activity, any unusual masses and deviations from normal appearance. Palpation, instruments and diagnostic tests are used.
 
Back, Thorax and Lungs: Spine, muscles, chest are palpated. Chest is percussed to listen to breathing sounds and identify any additional sounds.
 
Cardiovascular System: This is examined to measure pressure in the jugular vein, listening to heart sounds for any bnormalities or murmurs.
 
Abdomen: This is carried out to assess the condition of the liver and spleen.
 
Lower Extremities: Legs are checked for varicose veins, oedema, discolouration, or ulcers. Any abnormalities are noted in the joints, range of motion is evaluated. Alignment of the spine, legs and feet is examined. Muscle bulk, tone and strength are assessed. Unusual movements are noted. Ability to walk heel-to-toe, walk on the toes is observed. Rectal examination is carried out, penis and scrotal contents are checked for hernias in men. In women the external genitalia, vagina and cervix are examined. The uterus and adnexa are palpated.
 
Nervous System: consists of five segments (1) mental status (2) cranial nerves (3) motor system (4) sensory system (5) reflexes. It is a complete evaluation of the nervous system, assessing the patient's memory, information retention, concentration, sense of smell, cerebellar function, pain barrier, response to temperature etc.
 
Conclusion
It is clearly evident that in both systems there are a lot of parallels to approach in diagnosis. In both cases it is the skill, experience and intuition of the Physician that is paramount. Both are dependent on good history taking (prashana), and use inspection (darshana), touch/ palpation (sparshana) and percussion/ sound/ vibration (Sabda) as their main tools. However, over time the individualistic care and interface between the patient and physician has virtually disappeared in the Western system and a greater reliance has been put on instrumentation and tests, carried out in labs. Most of the physical examinations are similar, like taking the pulse, although the reasons and methodology for doing so are different. The results too, are classified differently and in the case of an Ayurvedic diagnosis provide a comprehensive picture of the individual's innate health and their imbalanced state at various levels, whereas in a Western diagnosis they are more geared towards the current state of health and whether the presenting symptoms can be categorised under a known disease. Nevertheless, an integrated approach, which borrows certain aspects from both systems, could prove to be workable. The individualistic approach, and early detection of the possible onset of a disease, of Ayurveda combined with some of the instrumentation and test methods from the Western system, may provide a balanced, more evidence-based and provable system of diagnosis.
 
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