DIAGNOSIS FOR AYURVEDIC TREATMENT-
PROBLEMS AND WAY OUT
Dr. Shri Krishna Sharma Khandel, MD (Ay),
Former Professor,
Dept of Roga Nidana NIA, Jaipur
PROBLEMS
Common problem for science fraternity as raised by Dr C V Raman is “students of today are being taught by the teachers of yesterday with the curriculum of the day before yesterday”. But the problem with Ayurveda teaching is more serious than this. Here, the students of today are taught by teachers of day before yesterdays with the curriculum of many years back. There is a need to make up the gap of all 5000 years to this generation. Ayurveda developed in last 5000 years based on specific epistemiology and ontology is being taught with the help of modern science developed in last 200 years. Modern science is based on temperament of science without understanding the philosophy of man. But Ayurveda is based on the philosophy between the person and the cosmos.
Second problem is the difference in the ayurvedic and modern diagnosis. Ayurveda starts with cosmos to person (loka-purusha samya). Ayurveda starts with diagnosing the person with the connection of the cosmos. Then comes the other factors like ahara-vihara-dosha-dhatu-srotas-avayava-beeja ang beeja bhaga etc. Ayurveda stress for health and it stress upon the functions. Modern system starts with cellular pathology. Modern diagnostic system stress upon the diseases. They stress upon the structure. The problem is that both the system end up their search in half way. Ayurvedic research is unable to reach at the cellular pathology. Modern medical science is failed to understand the relation between the cosmos and man. Ayurveda initiate a search for source cause and modern science initiate with the immediate cause. Objective of Ayurveda is dhatu samya and focus of modern science is in organic pathology. Common problem is partial knowledge and it can’t give a full picture about the person, disease or anything.
Insufficiencies of modern diagnostic system
Modern diagnostic system has more insufficiencies. The narrow view of atomic knowledge compartmentalizes the subject with whole. We, human beings are not segmented with the cosmos. So there is some problem with this narrow vision.
Second problem is trying to know the innermost through the man made machines. No machine can overpower the wisdom of man. Each laboratory report advice for the clinical correlation. This means that the clinical diagnosis is more superior than the laboratory findings. Also, the normal values of various investigations may vary from person to person, country to country, and those values changed many times. Nothing is as reliable as the self-observation of a Vaidya.
Latest reports (2016) by John Hopkins Maryland, USA says that 10 medical errors cause 12% of total death on annual average and are more than the noted fatal diseases like cardiac diseases. Wrong diagnosis is the topmost of those medical errors. Even though the cure rate of modern medical science is 20%, they propagate it as 80%. Ayurvedic cure rate is reported as 80% but cure propagation is very poor and it shows just 10%.
Strength of Ayurvedic diagnosis
In Ayurveda, there is a good knowledge about the interrelation between macro and microcosm. Connection between soma-surya-anila and kapha-pitta-vata is well explained and understood.
The knowledge and application of thridoshas,trigunas,antha karana,bahya karana,dhatu,satwa,ojas etc is clear. Also there is a clear understanding of dravya-rasa-guna-veerya-vipaka-karma, their samskara and medical use.
Regarding the Ayurvedic diagnosis, it is effective for earlier detection of diseases. It is possible to diagnose a disease even at the sanchaya stage and treatment is also mentioned for the earlier stages of diseases.
Classifications of patients and diseases as per the requirement of treatment is well defined in Ayurveda.It is possible to classify a patient at every level like guru vyadhitha -laghu vyadhitha etc. which helps understand a patient better. Also diseases can be classified in many ways like nija-agantu etc to further subtle level.
Strength of Ayurvedic treatment
Macrocosm-microcosm homeostasis loka -purusha samya
Ayurvedic treatment starts with “yat pinde,that brahmande” .The body has some cosmic anchors and human beings are part of this cosmos which is the prime source of energy. This cosmic energy control, monitor and nurture manall the time. They are the source of udbhava-sthithi- laya. Soma-surya-anila represents the cosmos in the body as kapha-pitta-vata. Pancha mahabhoothas are essential composition of this cosmos and body. “Sarvam dravyam paanchabhotikam”. Bhootha sanghatha is dravya and sanghatha bheda is energy. Each dosha manifest in all the functions of the body and mind.Jala santhana- Archi santhana- Sabda santhana are the three physiological organizations done by thridoshas which has been briefly described by susruthacharya. These are the three regulators of the circulation in the body. These three kinds of functions are termed as-
Soma-kapha-Visarga-Jala santhana
Surya-pitta-adana-archi santhana
Anila-vata-vikshepa- sabda santhana
Visarga-Jala santhana (fluid balance)
Organization of the fluid balance of the body(water balance)
A specific fluid matrix is essential to fulfill the expression of every living phenomenon.This organization has to maintain the specific consistency and structure of the fluid matrix under the varying environmental factors. Initially functions like evolution of the universe and various objects, new creations, birth in case of living beings, growth, nourishment, etc depends on this.
Adana-archi santhana(thermal balance)
Organization of the thermal balance-specific heat(agni) is necessary to digest and assimilate materials from the environment and convert it into one’s own body and also to maintain the optimum heat of the body for fulfilling the expressions life. This is the cause for the depletion of existing structures, dissociation, catabolism, desiccation, annihilation of existing structures
Vikshepa -sabda santhana(vital balance)
Organization of vital balance- vital force is essential for the purpose of creation, evolution, transportation of materials, elimination of wastes, etc
SOLUTIONS
Shradha eva samadhanam-faith brings solutions
Believing in the science is the fundamental process for knowing. Aptopadesa is the first and foremost eligibility to enter into the diagnosis. Aptopadesa is the basis for prathyaksha and anumana. If one does not believe in aptopadesa, other diagnostic procedures become useless. The process of knowledge begins with sasthra jyoti(light of texts). Believing the texts conceived under the lotus feet of Guru, seeing (prathyaksha), inference of unseen, logical thinking(yukti), practicing and constant refinements are the process of learning.
The practicality of Ayurvedic diagnosis
Practice makes the concepts practical. Practicing is yukti using all the three pramanas. One patient can clear many concepts in the sasthra. Unpracticed sasthra is meaningless. Today, many parts of Ayurveda is out of practice. Gradually, we started loosing practicality. Ayurvedic way of diagnosis is mandatory for practicing Ayurveda. It is necessary to understand every disease based on the basic principles told as aptopadesa.
Teaching the students only the headings (upadravam, adhishtanam etc) is not appreciated. This is because students can learn and memorize those headings, but they feel difficulty to use those headings in practice. So, do not teach the student only headings, sub headings and commentaries. Instead, teach them what is needed to understand those headings. It is the sincere responsibility of the teacher to make the student confident in practice. The intension behind every word in the sasthra is known from where they practice this word. For this, it is possible to Divide the diagnosis in some layers
Diagnostic layers based on aptopadesa
1st layer-Darsan(seeing the patient)
2nd layer-Sparsan-physical diagnosis
3rdlayer-Prasna-interrogation: 1. Socio -personal history
4th layer-Prasna-interrogation: 1. Disease history
These 3 examinations are sufficient in a patient. Doctor should not trouble the patients much in the name of examination because it is the duty and responsibility of the doctor to find the conclusion about the disease.
Then finding of 4 layers -Deha, Agni, Chetas & rogi bala. Also finding of 4 layers- Roga bala and nidana panchaka and conclude roganeeka.
To include all these points, bulky case proforma is not needed. Instead, it should be made concise and useful
Darsan-sparsan-physical diagnosis-1st layer
Varna-colour & complexion of nakha-nayana-vadana-moothra-pureesha-twacha of the patient in every disease is to be noted. Different colours are specifically mentioned as arishta lakshanas in indriya sthana.
Swara- voice,sounds & expressionNote for prakrita/vaikrita/gambheer/saanunaasik/theevra etc swara
Gati-gait
Aasana-posture
Parimarsan-mridu/katina/seetha,ushna etc
Gandha- Odour & smell(aama/lohitha/mathsya/poothi/kunapa etc)
Samhanana-constitution
Pramana-measurement
Prasna-interrogation-2nd layer-: i.socio -personal history
Name,age & address-note the finding as jati,kula,desa,vayas
Pratyathma niyata-personal habits & habitats
Aharavritta-food history, timing, quantity, samskara, satmya-asatmya ahara
Vihara vritta-daily regimen(wake up to bed time activities), vyayama
Mala pravritti-Urine, bowel, flatulence, adhaaraneeya vega
Vritti-occupational history
Vaivahika & santati vritta-marital history
Artava vritta-menstrual history
Prasna-interrogation- 3rd layer- :ii.disease history
Atanka samutpatti-onset of disease
Vedana samuchraya-complaints,duration
Purva Rogavritta-past diseases
Kula vritta-genetic history
Chikitsa vritta-treatment history
Samuthanam-trigger causes
Prasamam-remission -intervals
Kala prakarsha-vega- episodes
Sthaananthara-sites & lesion
These 3 layers are mandatory for diagnosis &treatment. So a doctor should find out these factors in the patient with keen observation
Finding of 3 layers-Deha bala
Deha bala: Assess for krisa/Kshama/ksheena/sthoola. Krisa-mamsa kshaya;Kshaama-klaantha deha;Ksheena-dhathu ksheena-that may be organic damage also.Because maargaga(parinaama aapadyamaana) dhathu kshaya will cause the kshaya of sthayi (parinaama praaptha) dhatu (avayava).so there are two types of dhatu kshaya-i) asthaayi dhatu kshaya and ii) sthaayi dhatu kshaya. In case of asthaayi dhatu kshaya, can be able to nourish the same. If sthayi rasa dhatu kshaya is there, it need hridya oushadha as hridaya sthayi rasa is different from parinama aapadyamaana rasa. Sthoola- may be rasa dhatu nimithaja/ama nimithaja/dushta medo nimithaja/kleda nimithaja etc. Even psychotic drug may cause sthoolatha. Assess the various causes of agni mandya like athi sneha, udavartha, upavasa, deergha kala vyadhi, annava peeditha etc because each of those causes require specific treatment
Agni bala-sama/vishama/manda/teekshna-These are agni prakriti.
Maanasa bala-guru/laghu vyadhitha
Maanasa bala(emotional quotient) is satwa bala and satwa is dhatu bala
Prakriti-sareera/manasa
Vayas-bala/yuva/vridha
Satmya-ekaras/sarvarasa/ruksha/snigdha
Then categorize the patient as
sukumara-sukhopachita/ karma nitya/ manda kriya/ mithaahara/ mahodara/ kharahara/ snigdhahara/ garbhini and decide the Sodhana yogyatha-samana yogyatha based on all these findings
Finding of 3 layers- roga bala
Dosha bala-sarva/madhyama/alpa linga; Eka dosha/dwidosha/tridosha;Sama vridhi/vishama vridhi
Dhatu samya-margaga dhatu or sthayi dhatu kshaya/pradoshaja vikara
Srotas prakriti-physiological deficit/pathological dushti
Avayava dusthi-sthayi dhatu haani
Ojo dusthi/ marmopaghata/thrimarma/other marmas
Indriya upaghata/upatapa
Roganeeka- conclusions of the findings
Samprapti is the total story of the disease commencing from the nidana and end in remission/disabilities/ or in death
Target of the treatment is total rehabilitation of each component of the disease. Vikriti vighata is not the ultimate target as it may result in punaravarthi of the disease. So prakriti sthapana to be achieved.
Agni is to be considered first
Dushta Doshas are leading the disease phenomena and hence dosha samya is to be attained
Srotas are the site of disease manifestation if there is vaigunya present.
Revival of physiological balance is dhatu samya
Conclusion
Name of the disease has no meaning and meaning has no name. If one got the meaning of the disease, that is -constituents, composition and triggers of the disease etc, no need for naming of the disease. This is the pattern that needs to document for evidence.
They are
- Ruja
- Varna
- Samuthana-dosha hetu or vyadhi hetu
- Sthana- dhatu/srotas/avayaya
- Samsthana-dosha/dhatu/sroto/agni dushti lingas
This is the basis of naming a disease. Anuktha vyadhis also to be understand with these factors. Teachers should Make the student a perfect practitioner and and diagnosis perfect. Teacher should guide the student to go beyond the headings and meanings. Ayurvedic diagnosis has high potential because it is knowing the totality of a disease. So any new diseases like Covid 19 can be clearly understood in Ayurveda with its basic principles. So this is the high time for ayurveda to come to the frontline medical system. Kerala is the land of Ayurveda and hence effort should to taken to bring Ayurveda to higher levels.
Article Prepared by
Vaidya Vandana. A
Assistant Professor
Dept of Roganidana
AACV