Rogi Pariksha

Trividha Pariksha
• त्रिविधं खलु रोगविशेषविज्ञानं भवति; तद्यथा आप्तोपदेशः, प्रत्यक्षम्, अनु
मानं चेति| C.Vi.4/3
• तस्माद्द्विविधा परीक्षा ज्ञानवतां प्रत्यक्षम्, अनुमानं च; C.Vi.4/5
Anumaan

Trividha Pariksha

Aptodesha Pratayksha
 Trividha Pariksha
• दर्शनस्पर्शनप्रश्नैः परीक्षेत च रोगिणम्||३२| A.S.Su.1

Darshana

Trividha Pariksha

Sparshan Prashna
 Shadvidha Pariksha
• षड्विधो हि रोगाणां विज्ञानोपायः,
तद्य- पञ्चभिः श्रोत्रादिभिः प्रश्नेन चेति ||४||Su.Su.10

Shadvidha Pariksha
1. श्रोत्रेन्द्रिय परीक्षा
2. स्पर्शनेन्द्रिय परीक्षा
3. चक्षुरिन्द्रिय परीक्षा
4. रसनेन्द्रिय परीक्षा
5. घ्राणेन्द्रिय परीक्षा
6. प्रश्न परीक्षा
Asthavidha Pariksha

Aakriti Nadi
Drika Mutra

Sparsha Mala
ShabdaJihwa
 Dashavidha Pariksha
• तस्मादातुरं परीक्षेत प्रकृ तितश्च, विकृ तितश्च, सारतश्च, संहननतश्च, प्र
माणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च,
वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः|| (Ch.Vi.8/94)

Dashavidha Pariksha
1. प्रकृ ति परीक्षा 6. सात्म्य परीक्षा
2. विकृ ति परीक्षा 7. सत्त्व परीक्षा
3. सार परीक्षा 8. आहारशक्ति परीक्षा
4. संहनन परीक्षा 9. व्यायामशक्ति परीक्षा
5. प्रमाण परीक्षा 10. वय परीक्षा
 Dwadashavidha Pariksha
• In Su.Su.35

Dwadashavidha Pariksha
1. Ayu Pariksha 7. Bala
2. Vyadhi Pariksha 8. Satva
3. Ritu 9. Satmya
4. Agni 10. Prakriti
5. Vaya 11. Bhesaja
6. Deha 12. Desha
Asthavidha Pariksha

Aakriti Nadi
Drika Mutra

Sparsha Mala
ShabdaJihwa
 Laboratory Examination

Mala

Mutra

“Favored" biofluid
Urine and stool are important metabolic products
in which there will be changes when a person
suffers from disease.
What is Metabolomics ? - A Rising Star
with Great Potential
Metabolomics is an emerging omics that
detects hundreds of small molecules present
in a given biological system such as fecal, urine
or saliva samples.
• Metabolomics is a powerful technique for the
discovery of novel biomarkers to improve
diagnosis, prognosis and therapy.
• This branch provide new insights into biological
pathways that characterize the shift from a
healthy to an unhealthy metabolic phenotype
and may help in identifying entry points for
prevention and intervention strategies.
 Urine Metabolomics
• Urine-an extremely complex biological fluid
but is "favored" biofluid among metabolomics
researchers.
• Urine biomarkers in lung cancer, cardiovascular
disease, blood coagulation system, kidney
cancer and other kidney diseases, bladder
cancer, prostate cancer, Alzheimer’s disease
and autoimmune diseases have been found in
the study of urine biomarkers.
Urine metabolomics - Advantages

Relatively early marker

Non-invasive of disease

Collection is
easy
Large number of
metabolites
Reflects
imbalances of all
biochemical
pathways
 Mutra Pariksha in Ayurveda
• Mutra pariksha as such is not described in systematic way
in Brihatrayi. Scattered references are available in these
texts related to physiological and pathological state.
• Charaka described physical aspects of urine for diagnosis
of diseases.
• Sushruta and Vagbhata follows more or less same
pattern.
• Bhava Mishra included the examination of urine as a
separate entity in scheme of general examination.
• Yogaratnakara has mentioned a special test for predicting
prognosis – Taila bindu Pariksha.
CHARACTERISTICS OF NORMAL URINE
• Mahabhuta : Charaka states predominance of apya
bhava. According to Ashtanga Hridaya, urine is
ashraya or seat of kapha.
• Rasa : According to Charaka and Sushruta rasa of
normal urine is katu and lavana and according to
Acharya Harita, it is kshara, katu and madhura.
• Gandha : Acharya Kashyapa has mentioned about
normal gandha of urine. According to him, normally
urine is natigandhi i.e. an odour which is not
irritating.
• Mutra has Ushna (when freshly passed it is slightly
warm), Tikshna guna can be attributed to agneya
predominance, apichhila and aruksha.
• Normally it is avivarnam i.e. not having pathological
colour. It refers to normal pale yellow colour of urine.
• Normal urine is drava (liquid), sara (with low density)
and laghu (light).
• It is vishada i.e. transparent in nature.
• Four anjali is the normal parimana of urine as
described by Charaka.
Mutra Pariksha can be done for

Diagnsosis

Prognosis
Taila bindu pariksha

19
 Taila Bindu Pariksha
• Taila bindu pariksha has been described in Ayurvedic texts during medieval
period.
- Vangasena Samhita 1210 A.D.
- Vasavarajiyam 15th cent.
- Yoga Tarangini 1650 A.D.
- Yogaratnakara 17th cent.
- Hansaraja Nidana 17th cent.

• This method is also described in Siddha system of medicine. Neerkkuri refers

to urine examination and Neikkuri refers to urine examination by putting
sesame oil over urine surface.
• This practice was reported to be very popular till the end of the Seventeenth
century in India by John Ovington in his book “A Voyage to Surat in the Year
1689”.
 CLASSICAL METHODOLOGY

Diet &Sleep Regime

Include the six rasa
At proper time
Sound sleep

Time of urine collection

When 4 ghatika are left in last yama of night

21
 Patra for collection of urine

Glass (Kancha)
or Vangasena Samhita
Bronze (Kansya) patra

Glass (Kancha) patra Yogaratnakara

Vasavarajiyam

22
 Time of performance of Taila bindu pariksha

-
There is a rapid fall in the surface tension of urine before the
so called static value is attained.
Ref.: (P.W. Perryman and C.F.Selous, Some physiological and physical aspects
of the surface tension of urine,1935).

Oil
Tila taila

23
 Material used for dropping the oil

Trina – Yoga Tarangini, Yogaratnakara, Vasavarajiyam

24
Parameters related to spread
Parameters described in Ayurvedic texts

Shape of spread

Direction of spread

Rate of spread

25
SHAPE RELATED TO SADHYA CONDITIONS
(Good prognosis)
How to interpret these shapes ???????

30
Ursa Major – The Great Bear Hydra – The water snake

31
Orion – The Hunter constellation
Karanda:
Circular shape

Tadaga :
Almost circular shape

Kamal :
Oval Shape

32
Gaja :
Almost circular

Chamara:
Semi circular shape

Chhatra:
Semi circular shape
33
Torana
Semi circular shape

Hansa
Semi circular shape

Harmya
Semi circular shape
34
Parvat
Triangular shape

Vriksha
Semi circular shape

Matsya
Oval Shape

35
 Interpretation of shapes related to good
prognosis

The shapes related to good prognosis as

described in various Ayurvedic texts can be
broadly classified as circular, semi-circular and
triangular in nature. They are normally
universal an all directions.
 Interpretation of shapes related to bad
prognosis
Hala
Linear shape

Kurma
Circular shape with
projections

Sairibha
Circular shape with
projections
37
Vrishchika
Linear shape having ten
projections

Ushtra
Irregular shape with
few projections

Shara
Linear shape
38
Trichatushpatha
A way, path, road, course

Laguda
A stick, staff, club

Khadaga,
Mushal, pattisha etc.
Linear shape

39
 Interpretation of shapes related to bad
prognosis
The shapes related to bad prognosis as
described in various Ayurvedic texts can be
broadly classified as either irregular linear
directing to specific direction or irregular
shapes with projections and so multi
directional in nature.
 DIRECTION OF SPREAD

DIRECTION RELATED TO SADHYA CONDITIONS (Good

prognosis)
 East ward Spread
 Westward Spread
 Northward Spread
 Southward spread in case of jwara only
 Spreads in all direction

41
 DIRECTION RELATED TO ASADHYA CONDITIONS (Grave
prognosis)
 South ward Spread
 North-eastward Spread
 North-Westward Spread
 South-east ward
 South-west ward Spread

42
 RATE OF SPREAD

If drop of oil spreads : Disease is easily curable.

If drop spreads slowly : Disease is difficult to
treat.
If drop of oil sinks : Disease is incurable

43
 VARIATION OF SHAPE AS PER DOSHIC PREDOMINANCE

• Vatika Predominance : Oil lengthens like

serpent
: Takes shape of Mandal
• Paittika Predominance :Becomes Chhatrakara
: Presence of ring(Siddha)
• Kaphaja Predominance : Stays like a pearl
: Stays like a dot
• Tridoshaja Predominance: Sinks in urine

44
Colour Vs Shape

Chhatrakar shape in yellow urine

Ring in yellow urine

45
Oil was dropped at 10 sec. Shape after 2 min 44 sec

Shape after 4 min. 54 sec Final Sketched shape

46
 Picture of hasti balak

Possible shape Final Sketched shape

47
48
SCIENTIFIC BASIS OF TAILA BINDU
PARIKSHA

49
• Oil spreads because the density of the oil is less
than urine.
• Surface active molecules and other metabolites
present in traces probably affect the spread. These are
substances which are normally not recordable and they
determine the spread pattern of oil.
• With the continuous development of testing
technology, urine biomarkers are slowly being
discovered.

50
Other factors affecting spread
• Surface tension of oil as well as of urine
• Specific gravity of both oil and urine
• Temperature
• Viscosity of oil etc.

51
 Spread of oil over liquid can be broadly
divided in three phases.
- In first phase, gravity and inertia forces
- In the second phase gravity and viscous forces
- In the third phase interfacial tension and
viscous forces dominates the spreading.

52
 In case of Taila bindu pariksha, first
two phases are not important as weight of
oil drop is very less and thus effect due to
gravity can be neglected. The third stage
may be the final determinant of the extent
and rate of spread.

53
 Distribution of surface active
molecules over the urine surface during
circular spread

54
 Distribution of surface active
molecules over the urine surface during
spread other than circular.

55
• Presence of paramagnetic molecules among
such molecules may also have the patches
aligned to earth’s magnetic field giving a
directional spread to the oil.
• The interfacial tension between the surface
active molecules and the oil may decide
providing possibilities of different shapes,
speed and extent of spread.

56
 Stool Examination

Physical
Examinatio
n

Microscopi
Chemical
c
Examinatio Laboratory
Examinatio
n
n

Stool
culture
Stool – Area of interest
Valdes A M, Walter J, Segal E, Spector T D. Role of the gut microbiota in nutrition and
health BMJ 2018; 361 :k2179 doi:10.1136/bmj.k2179
“Look after your microbiota and it will look after you”
 Relation of gut and health
• रोगाः सर्वेऽपि मन्देऽग्नौ
• Gut is related to health and disease
Why Purisha Pariksha is important?
Agni assessment
Status of Agni &Purisha Pariksha
Purisha Pariksha
Status of Dosha &Purisha Pariksha
Koshtha & Purisha Pariksha

Consisten
Urgency
cy

Koshtha

Response
Passage
to
of stool
laxative

Frequenc
y
 Purisha Pariksha
• Examination of mala is very important.
• Helps in deciding Agni, koshtha, avastha etc.
• Helps in deciding drug and dose
• Can be used for tracking course of treatment
• It should be done in every patient.
Puri
sha

Kos
htha

Agni
 Purisha Pariksha
• The changes pertaining to Purisha (stool) have been
described under various disease conditions
in Brihattrayi but are scattered.
• In Ayurvedic texts, examination of stool is limited
mainly up to the examination of physical
characteristics such as color, quantity, odor, froth,
and consistency.
• Besides these, a specialized technique of stool
examination, i.e., Jala Nimajjana Purisha Pariksha has
been described to detect the presence of Ama.
 Purisha Pariksha
• Examination of color
• Changes in consistency
• Odour
• Sinks/floats
• Change in temperature
• Presence of undigested materials, mucus, blood etc.
• Prashna Pariksha (interrogation) - Frequency,
urgency, feeling of incomplete evacuation, amount
of stool and associated symptoms such as pain,
 Characteristics of normal Purisha

• Characteristics of normal stool in terms of physical

characteristics such
as Gandha (odor), Sparsha (touch), Varna (color),
and Vaishadya (unstickiness/clear) are not described
separately in the ancient and medieval period texts
of Ayurveda, but stool examination has been given
due importance in context of the diseases.
• Only Pramana (quantity) of Purisha has been
described by Acharya Charaka as Sapta Anjali
Pramana.
 Purisha Pariksha
• Vatika Arsha, • Vatika Udara Roga,
• Vatika Gulma Arsha, Atisara,
• Kumbha Kamala Gulma, Jvara, Pandu
• Vata Prakopa • Vata Prakopa

Krishna Shyava,
Varna Aruna Varna

Shukla
Rakta Varna
Varna
• Shlesmika Jwara, • Kamala,
Udararoga, Arsha, • Pittaja Atisara
Pandu, Gulma • Raktapittaa
• Shakhashrita Kamala • Sahaja Arsha,
• Sahaja Arsha • Chhidrodara
 Purisha Pariksha

Shushka Vibaddha Sandra Bhinna Drava

Paittika Arsha,
Shlesmika Paittika
-Udararoga - Kaphaja Grahani, Arsha, Vatika
Vataja -Baddhodara Kshayaja Kasa,
-Purishavrita Vata Atisara Grahani,
Grahani and - Tikshnagni - Sahaja Kaphavirita Asadhya
Sahaja Arsha -Vataja Atisara, Apanavayu,
Visarpa Arsha Yakshma, and Atisara, and
Arsha Samanya Mandagni
Lakshana
 Purisha Pariksha
Durgandhi •Shleshmika Atisara, Paittika Pandu, Asadhya Sannipataja Chhardi, Ama Purisha, Purishavaha Srotodusti, Vid Vighata

Visragandhi •Paittika Arsha and Shleshmika Atisara

Atidurgandhi •Paittika Arsha

Amagandhi •Amatisara

Kunapagandhi •Chhidrodara and Sahaja Arsha

Kunapa, Puya, Ama Matsyagandhi •Sannipataja Atisara

Mahatputigandhi •Jalodara

Nirgandha or Sagandha •Agantuj Atisaraa

 Purisha Pariksha
Sheeta
• Ajirna
• Shleshmika Atisara

Ushna

• Paittika Atisara

Snigdha
• Shleshmika Arsha
• Kaphaja Atisara

Ruksha
• Vataja Jwara
• Vataja Atisara
 Purisha Pariksha

Sanga Alpa Alpa Krichra Sashabda Atiprav Muhur

alpa mala pravritti ritti muhur
pravriti
Sannipataja Vataja ataja
Vataja Paittika Vataja
Vatika Jwara,
Ashmari, Arsha,
Gulma, Pandu, Vataja Atisara, Grahani
Atisara, Vid Ama
Apana Atisara, Amatisar and Vataja
Shlesmik Vataja Pakva Vighata, Atisara,
Vayuavru Atisara, a, Atisara
a Atisara, Amashaya Purishava
Kshayaja
dha, Purishavaha
Krudha ha Sroto
Sannipata
Pravahika srotodusht Yakshma,
Vayu Dushti, ja Atisara
 Purisha Pariksha
Sashula - Amatisara

Sashula Sabda – Paittika Atisara

Parikartika – Vataja Atisara

Pravahana - Pravahika

Shula, Gudasrava - Jalodara

Chirat Dukham – Vataja Grahani

Sashula Pravahana – Kaphaja Arsha, Kaphaja Atisara

Kunthana – Samatisara, Vishamagni

Sama Nirama Pariksha

संसृष्टमेभिर्दोषैस्तु न्यस्तमप्स्ववसीदति |
पुरीषं भृशदुर्गन्धि पिच्छिलं चामसञ्ज्ञितम् ||१२||
एतान्येव तु लिङ्गानि विपरीतानि यस्य वै |
लाघवं च विशेषेण तस्य पक्वं विनिर्दिशेत् ||१३||
(सु. उ. तं. अ. ४०) |
 Jihwa Pariksha
• Vata – Cold (Sheeta), rough (Khara) and fissured
(Sphutita)
• Pitta - red or blackish in colour (Rakta & Shyam
Varna)
• Kapha - coated (Lipta), and excessively greasy
(Atipichhila) and white in colour (Shweta)
• If there is involvement of Tridosha it appears like a
burnt organ, black in colour (Krishna), dry (Shushka )
and very much rough on touch (Sakantak)
• If two Doshas are involved mixed features are seen.
 Criteria for Healthy Tongue
• A healthy tongue should
look like a children
tongue: symmetric and
evenly pink, free of cracks
and not quiver or tremble.
• It should be slightly moist.
It is neither too thick nor
too thin, and oval in
shape.
• It should remain still, not
trembling, flaccid, and
flat-tipped or stiff.
Chinese Medicine and Greek Medicine consider that various regions or
zones of tongue
Arishta Lakshanas are elaborated in Indriyasthana
• Stabdha (Tongue becomes hard and rigid).
• Nishcetana (It becomes insensitive to touch or and type of tastes).
• Gurvi (Heaviness in tongue).
• Kantakopacita (Tongue is covered by thorn like eruptions).
• Bhrusham Shyava (Bluish black in colour).
• Shushka (Dry or inflamed).
• Shuna (Swollen) and Visarpini (constantly mobile).
• Even in the absence of Mukhapaka (stomatitis), if person fails to
perceive the taste sensation or has a wrong gustatory perception
indicates Arishta.
 Shabda Pariksha
• Tone, strength to speak, continuity,
hoarseness and clarity of speech give us the
idea of the dosha involved in the pathogenesis
of disease and the underlying disease
processes.
 Sparsha Pariksha
• Idea perceived (skin temperature, its colour,
tenderness, abnormality in pattern) by
inspecting or palpating the patients give us an
idea of the doshapradhanya of the diseases
and the information about many chronic
alignments present.
 Drik Pariksha
In drik pariksha we observe:
• Color of sclera
• Conjunctiva
• Size of eye ball
• Dryness
• Shape of eyes
• Area around eyes
 Akriti Pariksha
• Built & Gait examination
• Akriti pariksha is the judgement of owns
disease status by the examination of owns
body features because the overall built is
indicative of the amount of strength, stamina
and life force.
• Pramana (measurement) & samhanana
(compactness) pariksha are essential in this.
 Shadvidha Pariksha
• तत्र श्रोत्रेन्द्रियविज्ञेया विशेषा रोगेषु व्रणास्रावविज्ञानीयादिषु वक्ष्यन्ते ‘तत्र
सफे नं रक्तमीरयन्ननिलः सशब्दो निर्गच्छति’(सू. अ.२६)
• स्पर्शनेन्द्रियविज्ञेयाः शीतोष्णश्लक्ष्णकर्क शमृदुकठिनत्वादयः (स्पर्शविशेषा)
ज्वरशोफादिषु,
• चक्षुरिन्द्रियविज्ञेयाः शरीरोपचयापचयायुर्लक्षणबलवर्णविकारादयः,
• रसनेन्द्रियविज्ञेयाः प्रमेहादिषु रसविशेषाः,
• घ्राणेन्द्रियविज्ञेयाअरिष्टलिङ्गादिषु व्रणानामव्रणानां च गन्धविशेषाः,
• प्रश्नेन च विजानीयाद्देशं कालं जातिं सात्म्यमातङ्कसमुत्पत्तिं वेदनासमुच्छ्रा
यं बलमन्तरग्निं वातमूत्रपुरीषाणां प्रवृत्तिमप्रवृत्तिं कालप्रकर्षादींश्च विशेषान्
|