Roga Nidan Chapter 2: Pareeksha – Roga and Rogi Pareeksha

Last updated on January 2nd, 2025 at 07:33 pm

Chapter 2: Pareeksha – Roga and Rogi Pareeksha
(Examination of the Disease and the Patient)

1. Introduction and Definition

In Ayurveda, the proper assessment of both the disease (Roga) and the patient (Rogī) is vital for accurate diagnosis and effective treatment. The term “Pareeksha” in Sanskrit means “examination” or “investigation.” Various Ayurvedic texts have outlined different methods or models of examination (Pareeksha) to comprehensively evaluate the patient’s physical, mental, and pathological conditions.

“Rogamāgamanaṃ pūrvaṃ parīkṣeta cha tadgatam |
Rogināṃ rogaṃ vijñāya chikitseta tataḥ param ||”

This classical approach ensures that the Ayurvedic practitioner gathers essential information about the patient (Rogī) and the disease (Roga) before charting out a treatment plan. Over time, different scholars have proposed various frameworks—Trividh, Panchavidh, Shadavidh, Ashtavidh, Dashavidha, and Pramāṇa Pareeksha—to systematically study the complex interplay of clinical signs, symptoms, and patient constitution.

2. Trividh Pareeksha (Threefold Examination)

Trividha Pareeksha is the fundamental tri-fold method of clinical examination as described in classical Ayurveda. It comprises:

1. Darśana (Inspection)
2. Sparśana (Palpation)
3. Praśna (Interrogation or Inquiry)

2.1 Darśana (Inspection)

• Observing the patient’s general appearance, gait, posture, skin color, and facial expression.
• Identifying any visible abnormalities or deformities.
• Noting signs of discomfort, restlessness, or other behavioral cues.

2.2 Sparśana (Palpation)

• Examining the pulse (Nāḍī Parīkṣā), body temperature, and texture of the skin.
• Checking for tenderness, swelling, or localized abnormalities in specific regions.
• Assessing muscle tone, joint mobility, and other relevant physical parameters.

2.3 Praśna (Inquiry)

• Collecting detailed information about the patient’s symptoms, onset, and duration.
• Understanding dietary habits, lifestyle routines, sleep patterns, and mental state.
• Exploring family history, previous illnesses, and any aggravating or alleviating factors.

Significance: Trividh Pareeksha forms the backbone of clinical diagnosis in Ayurveda. These three basic methods provide the initial and most essential clues needed to understand the disease process and the patient’s condition.

3. Panchavidh Pareeksha (Fivefold Examination)

Some classical references expand the basic threefold approach to Panchavidh Pareeksha, adding two more parameters:

1. Darśana (Inspection)
2. Sparśana (Palpation)
3. Praśna (Inquiry)
4. Śhravaṇa (Auscultation / Listening)
5. Gandha (Smell / Odor Examination)

3.1 Śhravaṇa (Listening)

• Closely related to both modern auscultation and simply “listening” to the patient.
• Involves hearing the patient’s breath sounds, heart sounds, bowel sounds, and other physiological noises.
• Also includes listening to the patient’s tone of voice, speech patterns, and emotional expressions.

3.2 Gandha (Odor Examination)

• Smelling bodily odors (sweat, breath, excreta) that can indicate specific pathological conditions (e.g., fruity odor in diabetic ketoacidosis, foul-smelling discharges in certain infections).
• Checking for any abnormal smells around lesions, ulcers, or excretions.

Significance: Panchavidh Pareeksha offers an expanded perspective, integrating smell and sound to provide deeper insights into underlying disorders, ensuring a comprehensive initial assessment.

4. Shadavidh Pareeksha (Sixfold Examination)

Some Ayurvedic traditions further detail a Shadavidh (sixfold) approach, building upon the previous methods. While the exact categorization may vary among different Ācāryas (scholars), a commonly cited model includes:

1. Darśana (Inspection)
2. Sparśana (Palpation)
3. Praśna (Inquiry)
4. Śhravaṇa (Listening / Auscultation)
5. Gandha (Odor Examination)
6. Rasa (Taste Examination)

4.1 Rasa (Taste Examination)

• Involves examining the patient’s taste preferences, aversions, or any altered taste sensations.
• In specific conditions, direct tasting of bodily fluids (like urine) was sometimes described historically (e.g., in diagnosing Madhumeha, or diabetes mellitus, the urine’s sweetness).
• More practically, it could entail evaluating the patient’s appetite, digestion, and the presence of any bad aftertaste in the mouth, which can hint at specific pathologies.

Significance: The Shadavidh approach underscores the holistic observation of all senses—visual, tactile, auditory, olfactory, and gustatory—along with careful questioning.

5. Ashtavidh Pareeksha (Eightfold Examination)

Ashtavidh Pareeksha is one of the most traditionally emphasized examination methods, often mentioned in classical texts like Bhāvaprakāśa and elaborated in various Ayurvedic treatises. The eight components are:

1. Nāḍī (Pulse)
2. Mūtra (Urine)
3. Mala (Stool)
4. Jihvā (Tongue)
5. Śabda (Speech / Voice)
6. Sparśa (Touch / Skin)
7. Drik (Eyes / Vision)
8. Ākṛti (General appearance / Body build)

5.1 Nāḍī Parīkṣā (Pulse Examination)

• One of the hallmark approaches in Ayurveda for understanding the involvement of Doshas (Vāta, Pitta, Kapha).
• Observing rate, rhythm, volume, and character of the pulse at specific sites (primarily the radial artery at the wrist).

5.2 Mūtra Parīkṣā (Urine Examination)

• Analyzing color, consistency, odor, presence of abnormalities like crystals, sediments, or froth.
• In some classical methods, conducting an oil drop test (“taila bindu parīkṣā”) to infer Dosha dominance.

5.3 Mala Parīkṣā (Stool Examination)

• Observing color, consistency, frequency, odor, presence of mucus or blood.
• Indicating the status of digestion (Agni) and the level of Dosha imbalance.

5.4 Jihvā Parīkṣā (Tongue Examination)

• Checking for tongue coating, color, dryness, cracks, or other morphological changes.
• Helps reveal digestive health, hydration status, and Dosha aggravation.

5.5 Śabda Parīkṣā (Speech/Voice)

• Assessing voice tone, clarity, pitch, dryness, or hoarseness.
• Observing any slurred or incoherent speech that may signify neurological or other systemic disturbances.

5.6 Sparśa Parīkṣā (Skin/Touch)

• Feeling the skin’s temperature, texture, dryness, or moisture.
• Identifying lesions, rashes, swelling, or tenderness.

5.7 Drik Parīkṣā (Eyes/Visual Examination)

• Checking sclera color, conjunctiva, pupil reaction, clarity of vision, dryness or excess tearing.
• Certain pathologies manifest as yellowing (jaundice), redness (inflammation), or dryness (Vāta imbalance).

5.8 Ākṛti Parīkṣā (General Appearance)

• Observing the patient’s overall physique, posture, body proportions, and facial expressions.
• Evaluating for emaciation, obesity, edema, or any other outwardly visible abnormality.

Significance: Ashtavidh Pareeksha provides a systematic and meticulous approach to identify early signs of Dosha imbalances, digestive issues, organ dysfunctions, and other subtle changes.

6. Dashavidha Pareeksha (Tenfold Examination)

Expanding further, Charaka Samhitā (particularly in Vimānasthāna) highlights the Dashavidha Pareeksha, primarily focusing on understanding the Rogī (patient) comprehensively rather than just the Roga (disease). These ten factors are:

1. Doṣa Prakṛti (Constitutional Type)
2. Vikṛti (Current Imbalance / Pathological State)
3. Sara (Excellence of Tissues)
4. Samhanana (Compactness / Body Build)
5. Pramāṇa (Measurement / Anthropometry)
6. Satmya (Suitability / Compatibility)
7. Satva (Mental Strength)
8. Āhāra Śakti (Dietary Capacity)
9. Vyāyāma Śakti (Exercise Capacity)
10. Vaya (Age)

6.1 Importance of Dashavidha Pareeksha

• Holistic Assessment: Beyond just diagnosing a disease, it evaluates the patient’s constitution, tissue health, physical and mental endurance, and overall vitality.
• Personalized Treatment: Helps tailor treatments according to the individual’s constitution (Prakṛti) and current imbalance (Vikṛti).
• Prognosis & Guidance: By assessing factors like mental resilience (Satva) and dietary/exercise capacity, physicians can gauge recovery potential and necessary lifestyle modifications.

7. Pramāṇa Pareeksha (Examination by Measurement)

Pramāṇa literally means “measurement” or “standard.” In Ayurveda, Pramāṇa Pareeksha is the examination by quantitative assessment. Traditionally, this could involve:

• Anthropometric measurements such as height, weight, chest circumference, etc.
• Vital signs like pulse rate, respiratory rate, and blood pressure (in modern integrative practice).
• Body mass index (BMI) or Quetelet’s index (adapted from modern methods), though classically, measurements had different reference systems.
• Checking the equilibrium of Doshas relative to body measurements, proportions, and structural harmony.

7.1 Significance of Pramāṇa Pareeksha

• Assessing Growth and Development: Useful for pediatric and geriatric assessments to track normal or abnormal developments.
• Monitoring Disease Progression: Changes in weight, girth, or organ measurements (e.g., spleen/liver size) can indicate disease severity or improvement.
• Customizing Therapies: Dosage of herbal formulas and diet prescriptions may vary based on the patient’s body measurements and metabolic status.

8. Roga Pareeksha vs. Rogi Pareeksha

• Roga Pareeksha (Examination of the Disease): Emphasis on signs, symptoms, and pathophysiological factors (Samprāpti) specific to the disorder itself.
• Rogī Pareeksha (Examination of the Patient): Focus on the patient’s constitution (Prakṛti), psychological status (Satva), dietary capacity (Āhāra Śakti), and physical resilience (Vyāyāma Śakti).

In classical Ayurveda, both must be done in tandem to devise a treatment plan that is disease-focused yet patient-centric. For instance, two patients with the same disease (Roga) but different constitutions (Rogī Prakṛti) may require different therapeutic approaches.

9. Integrative Approach

Modern medicine often corroborates these traditional examination methods with laboratory investigations, imaging techniques (X-ray, CT scan, MRI), and specialized tests (blood work, biopsies, cultures, etc.). An integrative approach, combining Ayurvedic Pareeksha with contemporary diagnostic tools, provides a comprehensive viewpoint, ensuring:

1. Holistic Diagnosis: Capturing the subtle energetic imbalances (Dosha) along with objective lab findings.
2. Precise Prognosis: Confirming disease staging through classic Samprāpti analysis and modern metrics of organ function.
3. Tailored Treatment: Designing therapy regimens that respect both the ancient wisdom of personalized care and modern evidence-based practice.

10. Conclusion

Ayurveda’s methodology of examining a patient and a disease is both art and science, as evident in the numerous “Pareeksha” methods—Trividha, Panchavidh, Shadavidh, Ashtavidh, Dashavidha, and Pramāṇa. Each framework enriches the understanding of a patient’s health status, unveiling the complexity of pathophysiological and psychosomatic elements involved. By seamlessly integrating these classical approaches, Ayurvedic practitioners can diagnose diseases accurately and holistically, while aligning therapeutic strategies with the patient’s unique constitution and current health state.

Key Takeaways

• Trividha Pareeksha forms the foundational triad of observation, touch, and inquiry.
• Panchavidh, Shadavidh incorporate smell, sound, and taste into clinical assessment.
• Ashtavidh (eightfold) offers a structured lens to examine pulse, urine, stool, tongue, speech, skin, eyes, and overall appearance.
• Dashavidha (tenfold) focuses on understanding the patient’s constitution, mental strength, and physical capacities.
• Pramāṇa Pareeksha uses measurement-based assessments for a quantitative dimension.
• A combined Roga (disease) and Rogī (patient) perspective ensures individualized, effective, and comprehensive Ayurvedic care.

By mastering these distinct yet interconnected methods of Pareeksha, one can uphold the Ayurvedic principle of personalized medicine, ensuring the right diagnosis and optimal therapeutic outcomes.