Dasha Vidha Pareeksha
ЁЯСЙЁЯП╗ Introduction:
As a rule, before starting any treatment, the disease and diseased should be thoroughly checked and examined. Dasha Vidha Pareeksha or tenfold examination as explained in Ayurvedic treatises is one of the most comprehensive protocol of patient and disease examination, to the point of perfection. Dasha Vidha Pareeksha enables a physician to reach accurate diagnosis of the disease, to know the nature and strength of the disease and the diseased. It also helps in knowing the life span of the individual in question. By learning the quality and quantity of the life element in the patient, the physician can figure out if the patient fits into the treatment protocol or not. Likewise it helps in planning and determining the methods and strength of treatment which needs to be conducted and also to make a proper choice of the medicines.
ЁЯСЙЁЯП╗ Dasha Vidha Pareeksha comprises of examination of 10 factors are as follows;
1.Prakriti – Dosha body type
2.Vikriti – anamoly / pathology
3.Sara – Dhatu Body Type
4.Samhanana – compactness
5.Pramana – measurements of patient
6.Satmya – Congenial things and habits of patient
7.Satva – tolerance capacity of patient toward strong medical treatments
8.Ahara Shakti – digestion capacity
9.Vyayama Shakti – exercise capacity
10.Vaya – age of the patient.
1. Prakriti:
Prakriti means the basic constitution (physical and mental makeup acquired at birth) of the patient or inherent characteristic features of an individual. Prakriti helps to know about the natural inheritances of an individual so that it can be differentiated from the abnormalities. It helps in knowing what is natural and normal for an individual. Kapha predominant Prakritis are strong, Pitta Prakritis carry moderate strength and Vata predominant Prakritis have less strength. Thus Prakriti is a determinant of atura bala or strength and tolerance of a patient.
Prakruti is mainly considered as the swabhava of an individual. The Ayurvedic concepts of physiology, pathology, diagnosis, medicine, and therapeutics are based on the doctrine of the three dosha. Every dosha is believed to have inherent attributes, which are expressed in the physical, psychological, and physiological characteristics of an individual.
2. Vikriti:
Vikriti is opposite of Prakriti. It is the abnormal deviation from the Prakriti or imbalances occurring in the Prakriti. The abnormal changes occurring in the basic Prakriti or the morbid changes taking place in different parts of the body or mind or both in relation to Prakriti is called Vikriti. The Doshic vitiation occurring in the body is also called as Vikriti. It helps in figuring out what is abnormal to an individual. This helps in addressing the health issues. It is the Vikriti which we treat. Vikriti shows the Vyadhi bala i.e. the strength of a disease or doshas, which is important to plan a treatment protocol effective enough to abort the disease process following the strength of the disease and the doshas involved.
If the afflicted doshas and dhatus physical constitution of patient (prakruti), desha, kala, bala, of the individual resemble that of disease in quality and the causative factors and symptoms are too strong and numerous. The disease manifested is acute and severe. In brief vikriti refers to morbidity of the susceptible individual and it is also helps to ascertain the strength of the pathogenesis
factors responsible for the manifestation of
disease and also helps to predict the prognosis of the disease. The vikriti pareeksha is stated for dosha Bala pramana of atura. For the assessment of vyadhi – hetu (cause), dosha, dusya, prakruti, desha, kala and Bala must be observed with their sub-types also. The vyadhiBala is assessed by the intensity of etiology (hetu), symptoms of diseases parameters. They are collectively described as the conditions namely of easily curable (sukhsadhya), moderately curable
(krichsadhya) and in-curable (asadhya).
3. Sara (Examination of essence of all
dhatus):
Sara means the status, quality, quantity and goodness of the tissues. Dhatus are building blocks of the body and also form the defense unit. Everyone has all dhatus but any one or few dhatus are predominantly strong in a given individual. Those dhatus have a natural immunity and are less susceptible to be afflicted by diseases. They stand a lesser chance to be invaded by doshas. Diseases manifest when morbid doshas invade and damage the dhatus. Saratva of dhatus indicate how strong the immunity of the tissues is in the body. If all the dhatus have good sara, it indicates optimum immunity and a good operating defense mechanism in the body. The stronger the dhatus, the stronger is the person. Thus Sara is an indicator of the atura bala or strength of an individual. This in turn helps in planning a treatment protocol according to ones tissue strength, durability and endurance.
Importance of Sara Pareekhsa:
Charaka has described sara examination
under the tenfold s examination techniques.
Charaka has emphasized that sometimes the physicians may take a wrong decision only by seeing the body of the patient such asstrong
because of being corpulent, weak becauseof
leanness, very weak because of possessing
small body. But factually it is observed that
some persons possess small body and leanness is strong. They are like ants that have small body and look emaciated but can carry too heavy a load. Big and corpulent persons may have strength than the lean and short body, like elephant having big and corpulent body possessing less strength that the lean and short bodies lion.The eight subtypes of sara may be assessed in term of relative quality i.e. sarva sara purusha, madhyama and asara or avara.
The characteristic are as follows:
a. Sarvasara or pravara sara purusha -
These person have all the dhatus in abundance and of good quality. They are endowed with great biological strength, absolute happiness, endurance against difficulties, self confidence in all enterprises,
inclination benevolent acts, firm and
balanced body, well balanced gait, nature
of voice is resonant, unctuous, serious, and
high pitch, happiness, supremacy, wealth,
enjoyments, honor, delay of aging, low
degree of pathogenesis, minimum diseases, numerous offspring’s of identical qualities and longevity, presence of great respect, hope of success in all activities, capacity of withstanding troubles, wisdom and steadiness.
b. Madhyama sara purusha-
Moderate amount of different sara possess qualities of respective Saras in moderate degree and show characteristics of sarva Sara moderately.
c. Asara / avara sara purusha-
These persons having least amount of different sara possess qualities of respective Sara in less degree.
4. Samhanana (compactness):
Samhanana means the compactness of the body. It indicates the integrity of the body components and the composure of the body. It also determines the coordination between the body and mind and their integral health and strength. Lesser the compactness more is the proneness to diseases.
Thus Samhanana is one of the indicators of the atura or rogi bala.
a. Pravara samhanana –
Symmetrical and well demarcated bones, well joints, well bound muscles blood, strong built , excellent strength
b. Madhyama samhanana –
Moderately symmetrical and demarcated bones, moderately joints, moderately bound muscles blood, moderately built, moderately strength.
c. Avara samhanana –
Weakly Symmetrical and demarcated bones, Weakly joints, Weakly bound muscles blood, Weak built, Weak strength.
Samhanana, samhati and samyojana are its
synonyms. Evenly well-demarcated bones,
well-bound joints, well formed muscles are
known as compact body. Who having well
compact body they are strong and having
good strength.
5. Pramana (Anthropometry-examination
of measurement of bodily organs):
Pramana determines the measurements of the body parts. Body components should be present in the desired quantity or numbers. This is measured in terms of Anguli Pramana (dimensions, i.e. length, breadth, circumference etc of the body parts) and Anjali Pramana (quantity of body tissues) and Sankhya Shareera (number of organs, body parts and tissues). If the pramana of body components are in right proportions, the health, integrity and strength of the body is at its optimum best. Thus, Pramana of body components is an indicator of rogi bala or strength and endurance of the patient.
For assessment it can be subdivided into
a. Pravara Pramana- standard measurement
criteria excellently height, length and
breadth.
b. Madhyama pramana- standard
measurement criteria moderately height,
length and breadth.
c. Avarapramana- standard measurement
criteria lesser extent height, length and
breadth.
6. Satmya (Suitability or examination of
homologation):
Saatmya explains the compatibilities related to the patient, wholesomeness developed by habits which result in conduciveness to the health. Knowledge of Satmya tells us what is good and what is bad, what is compatible and what not to body and mind (and for maintenance of good health), what to take and what to avoid. Satmya is any food (or activity) which on consumption becomes adjustable to the body and mind. Knowing Saatmya helps in providing comprehensive medical care.
Satmya is that which being used constantly has wholesome effect; those used to ghrita, kshera, taila, mamsa rasa, and all rasas are strong, enduring and long-lived. On the contrary, those used to irregular diet and single rasa are often weak, un-enduring, and short lived with a little means. Those having mixed suitability have medium strength.
7. Satva (psyche-examination of mental
faculties):
Satva denotes mental strength, tolerance levels, emotions and moods of the patient (mental parameters). Body and mind are two sides of the same coin. The wellness of body and mind are interdependent.
Depending upon its strength, it is of three
types, viz. pravara, madhyama and avara satva
depending on their mental faculties.
a. Pravara satva:
1. Excellent mental faculties.
2. Able to bear the stronger therapies without
producing any harmful effect to the body.
3. Weak physique person having excellent
mental faculties tolerates serious
exogenous and endogenous diseases
without diseases without much difficultly.
4. Tolerates and adjusts to pain or odd
situations well.
b. Madhyama satva:
1. Moderate mental faculties.
2. Able to bear the stronger therapies without
producing any harmful effect to the body.
3. Weak physique person having moderate
mental faculties tolerates serious
exogenous and endogenous diseases with
much difficultly.
4. Tolerates and adjusts to pain or odd
situations moderately.
c. Avara satva:
1. Inferior types of mental faculties.
2. Neither by themselves nor through other
can sustain their mental strength.
3. In spite of having sound physique, they
cannot susceptible to fear, grief, greed,
delusion and ego.
4. When they hear even stories describing
wrathful, fearful, hateful, terrifying and
ugly situation or come across visions of
flesh or blood of an animal or man, they
fall victims to depression, pallor, fainting,
madness, giddiness of falling on the
ground, such events may even lead them
to death.
5. These type of person are contraindicated
to samsodhana karma
6. Tolerates and adjusts to pain or odd
situations very badly.
Satva controls the body by conjunction with
the self.
8. Ahara shakti (Examination for intake of
food):
Ahara Shakti comprises of assessment of metabolism and digestion capacity of an individual (patient). Food or aahara is a vital component needed for life activities and sustenance of life. For this to happen one should be able to take proper quality and quantity of food, digest, and assimilate it to get energy and strength. Health and disease, both are dependent on what and how much we eat. Ahara Shakti also is an indicator of metabolic health and strength of the patient (atura bala) and is also helpful in planning a proper protocol for treatment since dietetics are essential part of comprehensive treatment plan up.
This may be classified into three subtypes for the purpose of assessment are as follow:
a. Pravara ahara shakti(excellent power of
digestion ):
Person having excellent power of ingestion and digestion of food are claimed to be healthy persons. These kind of person endowed with excellent strength, longevity, joy, good physique, superior mental faculties, full of essence of dhatus, power of resisting any sort of difficulties etc. digestion of food when taken in large quantity is indicative of excellent Ahara Shakti.
b. Madhyama ahara shakti (Moderate
digestive power):
Individual having moderate strength of ingestion and digestion of the food are claimed to be moderately healthy. Moderate medicaments may be prescribed for the effectivemanagement. These persons possess moderate strength, longevity and immunity.
c. Avara ahara shakti(weak digestive power):
Person is unable to digest even small quantities of food these persons suffers from diseases very often and endowed with less strength longevity, immunity and unable to sustain the stronger medicaments. Mild medicaments are required for the effective management and medicines should be administered for longer duration to recover from diseases.
This is examined by the power of ingestion
(abhyavaharana shakti) as well as digestion
(Jarana shakti). Strength and life depend on
diet, jarana shakti is assessed by Udgarasuddhi, utsaha, vegotsarga- yathocita, laghuta, ksut (appetite) and pipasa (thirst). In clinical practice assessment of agni is very important for the selection of medicine, selection of treatment modalities and fixation of dose of medicine.
9. Vyayama shakti (capacity of exercise):
Vyayama Shakti means exercise tolerance of the patient. Exercise is an important aspect of treatment protocols. Good exercise capacity and tolerance is an important indicator of good health and good strength and endurance. Exercise can be included as a component in the treatment protocol for these patients.
For the assessment of vyayama shakti three parameters were selected which are breath holding exercise, stepping exercise, measurement of basal pulse rate.
a. Pravara vyayama shakti -
Individual possess a excellent exercise endurance. To advice rehabilitation programme person should have a good power of exercise. These persons able to do a physiotherapy technique without much difficulty, this helps for faster recovery. These kinds of individual are able to perform heavy exercise.
b. Madhyama vyayama shakti–
Individual possess a moderate power of exercise. Person follows the physiotherapeutic technique moderately as a result it hampers the quicker relief. Moderate
medicaments must be prescribed to gain
desirable results.
c. Avara vyayama shakti-
Individual possess a mild power of exercise. These people are unable to follow the physiotherapeutic technique even up to slighter extent. This hastens the slower recovery. Mild medicaments are suitable to gain good results.
10. vaya (Examination in respect of age):
Vaya is defined as the state of the body corresponding to the length of time that has passed since birth. Age is broadly divided into three stages – bala (childhood), madhya (middle age), jeerna (old age). Childhood is determined up to sixteen years when the dhatus are immature, sexual character are not manifested; the body is delicate, unstable with incomplete strength and predominant in kapha dosha. This again with dhatus in developing stages and unstable mind remains up to thirty years. Mild medicaments may be employed. The middle age is assessed by strength, energy, virility, acquisition, retention, recollection, speech, understanding and qualities of all dhatus having reached the normal limit, with proper physical and mental strength, without degeneration in qualities of dhatus, with predominance of pitta dhatu and is up to 60 years. Stronger medicaments may be employed to gain the success.
Life span of individual viz. long, medium and
short can be determined by superiority, mediocrity and inferiority of prakruti, Sara etc. except vikruti.
For example if a person possess a prava qualities of prakruti, sara etc excepts
vikruti then individual lives longer , madhyama qualities leads to medium life span and avara qualities leads to short life span. So depending upon the long, medium and short life span age may be divided into Bala, Madhyama, Jeerna. Age is defined as the state of body corresponding to the duration of time. Childhood is determined up to sixteen years when the dhatus are immature, sexual characters are not manifested; the body is delicate with incomplete strength and predominant of kapha dosha. This again with dhatus in developing stage and unstable mind remains up to thirty years. The middle age is characterized by strength, energy, virility, acquisition, retention, recollection, speech, understanding and qualities of all dhatus having reached the normal limit; with proper physical and mental strength, without
degeneration in qualities of dhatus, with predominance of pitta dosha and is up to sixty years.
Sushruta considered the Madhya vaya
up to 70 years with four division of Madhya
avastha. The old age is characterized by the
gradual degeneration or decline of strength,
organs, energy, virility, prowess, acquisition,
retention, recollection, speech and
understanding. Qualities of dhatus go down
and there is predominance of vayu, during this age the measure of life span is one hundred years.
ЁЯСЙЁЯП╗ Importance of Dasha Vidha Pareeksha:
Dasha Vidha Pareeksha or tenfold examination is one of the most comprehensive formats of patient examination explained in Ayurvedic treatises.
It is done mainly to study and analyze –
• Rogi Bala – Strength (physical and mental) and endurance of the patient (except Vikriti)
• Roga Bala – Strength of the disease
• Ayu Bala – Quantity and quality of lifespan
• Helps in planning a comprehensive treatment protocol (including diet and lifestyle recommendations) protocol
• Helps in analyzing the normal and abnormalities related to body components, nature of morbidity, basic constitution, measurements and quantity of body components, tissues and organs, capacity to exercise and consume food, compactness and compatibilities related to body and mind and best qualities of the tissues of the body, all of which helps to know the strength of disease and diseased.
Hence the concept of dasha vidha pareeksha described in Ayurveda is very much scientific in terms of understanding the span of life, strength of person, probable cause and strength of the disease. Before planning any treatment to the patient proper understanding of patients is required. The tenfold diagnosis process is a vital diagnostic Ayurvedic tool for assessing the current health of a patient and providing a
basis for prognosis.
