(under the aegis of Ashtanga Educational Trust)

The Leading Ayurveda Medical College Hospital & Research Center


Dr. Srinivasa Acharaya

MD (Ay), Former    Principal SDM Ayurveda College Udupi



The diagnostic approach to any treatment is of prime importance. A physician by and far undertakes a heap of responsibilities as far as treatment of the patient is concerned. One can relate to an interesting simile in this regard. Consider how a monkey and a cat raise its child. The baby monkey clings onto the abdomen of the mother, as the monkey jumps from tree to tree, undertaking the whole responsibility of being safe by itself. However, the cat holds the kitten firmly by its mouth. Here the kitten rests the whole responsibility of it being safe on its mother, taking least responsibility of its own safety.

Similarly, as the patient approaches the physician, he no longer holds the responsibility of his health and shoulders that over to the doctor. The mode of approach here being similar to the cat.

A physician has to look into diagnosis, prescription, diet, other regimens etc, so that disease is attended to well. The first step is to have a thorough understanding of the diagnosis. Second, is to give appropriate treatment and the third and final step is to ensure regular follow up. Here, the right approach to diagnosis makes way for successful treatment.

 The initial approach to diagnosis

Literature speaks tatra idam upadishanti budhimantaha:, rogamekaaikam ……

The initial approach is the quest to find out what is the cause for aggrevation of the doshas, its mode of aggrevation, type of dosha involved and the intensity by which it manifests – mild or severe. Also to understand whether the body or mind is involved, its symptoms and if there are any complications that may be involved. All such information sum up in understanding the diagnosis.


Unravel the story of the illness

This can be achieved by Darshan sparshana prashnai

Either by inspecting, examining or taking a detailed history of the illness all the signs and symptoms required for the diagnosis of the disease may be understood.

This can be achieved in 5 steps 

i)                    Designation/ Name the disease

ii)                  Differential diagnosis

iii)                Determine the type –

iv)                Assess the stage

v)                  Explore the etiology


And the first step to diagnose a disease is to assess the samprapti ghatakas 

(yatha dushtene doshene yatha chaanuvisarpataa

Nivrittihi aaamayasyaasou sampraptihi jaatihi aagatihi)

Understanding the dosha, dushya, srotas, dosha samchara sthana, pratyatmalinga, vyaktisthana etc makes it easier to name a disease.


I . Understand the dosha 

Every symptom has a definite relation, which may be either physical or mental.

The rule is – a depleted dosha does not cause a disease. It is the aggravated dosha that causes a disease. In some cases, there may be exceptions where dosha may not be necessarily involved, the determining factors may be something else.

Eg – The exception is rajayakshma  

When a person takes food, and if a grass or hair falls onto the food, then it is considered to be the premonitory symptom of rajayakshma, which is unrelated to the dosha, hence the exception.


II. Twin role of dosha

Symptoms have a relation with one or more doshas. These doshas which may either be reason for causing or modifuying the disease.

Eg – shotha is caused by kapha dosha, but divabali shotha has predominance of vata. Here, more importance has to be given to kapha and not vata. Kapha which is the causative dosha has to be diagnosed and treated here, accordingly than vata, which is the modified dosha. Hence, one has to consider it as simple shotha and not divabali shotha. Smilarly for kasa with expectoration, where causative dosha is kapha dosha and if its yellow in color then the modifying dosha is pitta dosha.

So in the first phase the causative relation is considered for diagnosis purpose and the modified doshas are considered to have a better understanding of the second stage, where the type of disease have to be assessed.

For every symptom, it is always best to consider the dosha vridhi , dosha prakopa, dosha dushti lakshana and ignore the dosha kshaya and dosha prakriti lakshana as this will help to reach to a diagnosis easily. Thereby, the treatments also becomes easier. However, this analysis has to be considered for only dosha and not dushya.

Eg –karshya can be considered as vata prakupitha lakshana and also kapha kshaya lakshana. Here approach needs to be considering the prakupitha dosha.

Hence, to deduce the diagnosis:

i)        Consider all the symptoms

ii)      Consider dosha dushti, prakopa lakshana

iii)    Ignore the modifying dosha

iv)    Ignore kshaya lakshana also


III. Considering the secondary factors

After determining dosha, the secondary factors need to be determined. These factors include dushya as well as mala, indriya, manas etc. A symptom is related to any one of these dushyas. Vriddhi, kshaya and dushti lakshana of the dushya needs to be assessed. Here, kshaya isn’t to be ignored.

Eg – kshaya as in pandu, where there is rakta kshaya 

Hence, take into consideration –

i)        Dhatu vridhi dushti kshaya pradosha lakshana

ii)      Mala vriddhi ksaya lakshana

iii)    Indriya pradosha lakshana

iv)    Mano dushti lakshana


IV. Consider the Srotas

Every symptom has an involvement with the srotas . This may rerfer either to the bahya or abhyantara srotas.

For diagnostic purpose, the abhyantara / adrisya  srotas have to be considered, not the bahya/ drishya srotas. Even if the symptoms vary or exceed in number, all the symptoms have to be assessed for their individual sroto involvement, hence making a precise diagnosis.

     Srotamnsi nasike karne…..annavaahini


To understand the sroto involvement, one may categorize the symptom based on their distribution –ie, those which are spread on the center or on the peripheries.

Eg: shotha (shakashrita srotas) and swasa (skandashrita srotas)


Name the relevant srotas of dhatu, mala, indriya and manas affected. For peripheral symptoms single srotas may be affected. For central symptoms, two srotas may be involved – one the dhatuvaha srotas and the other which is very specific to the skanda pradesha.

Eg – shotha – rasavaha

Swasa – rasavaha, praanavaha

Pralapa – raktaaha, manovaha

One exception is the sweda vaha srotas, which involves the medavaha srotas also. Determining the srotas is simple as in case of peripheral doshas, the dhatu involved is itself the srotas and if the symptoms are in the center, then two srotases have to be mentioned.


V. Assessing the Sancharasthana

Determination of sancharasthana can be done on the basis of distribution of the symptoms. Symptoms may be categorized into 2 – constitutional and local symptoms. Constitutional symptoms are that which involves the whole body.

Eg – jwara , daurbalya

Local symptoms affect one part of the body

Eg – gulma, ,mandala


IV. Assessing the Pratyatma lakshana

These are factors without which the disease will not occur. This involves considering the symptom that is most severe. Suppose a person suffers from pain abdomen, loose stool or distension of abdomen, one can diagnose it as udarashoola, atisara or anaha.

Eg –  if a person suffers from 20 loose stools, with slight distension of abdomen, the pratyatmalaskhana is atisara and not anaha here.

It may be udarashoola if the patient has severe pain and not atisara, even if he may have two loose stools.

The pratyatma laskshana may be that which is most persistent, most chronic, widely distributed, or with the most evident symptom or site. The examples may be as follows:-


Most persistent – if in a skin disease, the itching is more severe than discharge or extent of leision, then itching becomes the pratymalinga

Most chronic – if the pt has weakness and loss of strength in one half of the body associated with shoulder pain, one can diagnose it as pakshaghata instead of avabahuka.

Widely disatributed –  Having multiple leisions in multiple areas, throughout the whole body. Here itching or redness may not be the main feature, rather the extent may be as like scaling in ekakushta

Having diagnostic significane – as in exertional dyspnea which is the leading symptom in pandu


VII. Vyaktasthana

Where the pratyatma linga is present that is the vyaktasthana


VII. Explore the Nidana

 Comparatively easier causative factors are the following:

i-                    External trauma

ii-                  Illness, if transmitted from co-habitants

iii-                Illness, if is inherited

iv-                Any exposure immediately before illness (eg – virudha ahara causing chardi, or suryaaghata leading to death )

v-                  Incompatible / Allergic factors (Atma asatmya) – rajo , dhuma etc


Comparitively difficult nidana to determine is when more people exposed to a factor and  only some suffer, where the cause is not rightly known.


VIII. Naming the disease

§  Etiology – Paanatyaya, Avarana, Kalayakhanja

§  Organ affected – Prameha pidaka

§  Organ and symptom – Hruthshoola, paadadaari

§  Morbid Physiology – Nidranasha

§  Dosha involved – Vata vyadhi

§  Morbidity of dosha – Amla pitta, sheetapitta

§  Dhatu affected – Shukradushti

§  Structural damage – Sandhimoksha, Gudabhramsha

§  Leading presentation – jwara, atisara, chardi swasa

§  Interacting dosha dushya – Raktapitta

§  Simile of symptom – Gulma, bhrama

§  Incidence –  Aadyavaata


After assessing all the samprapthi ghatakas, tally those with the disease determined.

These steps involve in coming to a conclusion of the diagnosis of the disease and thereby lead to inculcate appropriate treatment for the same. 

Article Prepared by

Vd. GreeshmaPurushothaman