Clinical Diagnosis in Ayurveda: A Practical Book of Ayurvedic Diagnosis in the Light of Modern Medical Science

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Clinical diagnosis is an art with scientific basis, to achieve that art this book is highly useful. To become perfect Ayurvedic physician you must have knowledge of Ayurvedic fundamentals and their role in diagnosis and for plan of treatment for which this book is recommended.

This book is divided into three sections. Section-I (containing 7 chapters) deals with general examination and case taking based on classical methods of Panchendriya Pariksha, Ashtavidha pariksha and Dashavidha Pariksha. Section-Il (containing 14 chapters) discusses in details the systemic examination based on the concept of Trayodasha srotas pariksha as described by Charaka. Section - III (containing 2 chapters) specially deals with examination of Tridosha and examination of Manas. This book also becomes a guide to know the utility of laboratory investigations in each condition. This book mostly deals with clinical diagnosis on Ayurvedic lines, along with modern parameters.

The Author is having varied clinical experience in tribal, rural, suburban, urban setup and his involvement in clinical teaching, research activities, has greatly enriched this book for the benefit of clinicians.

“the learned author with his deep textual knowledge and practical clinical experience deals with the subject in a comprehensive manner aiming to identify the hidden knowledge about disease…”

...the study and practice of Ayurvedic medicine in right perspective adopting in-depth original knowledge of Ayurveda as well as conventional science with ability to develop an appropriate interface of the two counterpart sciences yielding bilateral benefit with scientific temper.

Prof. Dr. M. Srinivasulu passed his graduate and postgraduate studies in Ayurveda as an university ranker from the Osmania University. Doctorial studies done at National Institute of Ayurveda, Jaipur on Hyperlipidemias. Apart from Ayurvedic courses underwent post-graduate courses in psychology and medicinal botany. He completed 30 years of service in Govt. of Andhra Pradesh as Medical Officer, inspecting Medical Officer, Lecturer, Asst. Professor, Professor (UG) and retired as Professor P.G & Head of Post Graduate Department of Pancakarma, Govt. Ayurvedic College, Hyderabad, A.P.

He is having vast clinical experience as a physician, since he worked in rural, tribal, sub urban and urban setups. His entire teaching was as clinical teacher for Undergraduate, Post graduate and Ph.D scholars. His core subject of interest is in Concept of Ama and its related disorders. Evolved pathological parameters in diagnosing the Saama conditions. Done many works on physiological concepts of Ayurveda, like estimation of Ramraktadhatu parimanas and Prakriti in relation to blood groups etc.

Participated in more than 115 International/National seminars, symposiums, workshops in the country as paper presenter/guest speaker/chairman and as resource person. Have given invited lectures in prestigious institutions and scientific firms like IIT-Bombay, Madras, Delhi, JAM, IRI, NPL, CSIR Organizations, New Delhi, Indian Institute of Sciences, NIMI-IANS, Bangalore etc. More than 80 publications are to his credit, including reputed books like ‘Fundamentals of Kayachikitsa’, ‘Concept of Ama’ which took 2nd edition also.

Engaged in postgraduate entrance coaching, preparing many students to achieve their targets and published books like ‘Brihattrayi Prashnavali’ and ‘Laghuttrayi Prashnavali’. Life member of many Academic Organisations and member Board of studies of various universities. Now he established his own institution for research and academic activities under banner of Marri Academy of Ayurveda, Hyderabad.

I had a pleasure to go through the pre-press copy of the book Clinical Diagnosis in Ayurveda - A practical book of Ayurvedic diagnosis in the light of modern medical science’ authored by Professor M. Srinivasulu, Head of Department of Pancakarma, Government Ayurvedic College, Hyderabad. The book presents a lucid account of clinical medicine in Ayurveda and its diagnostics creating an useful interface of Ayurveda with conventional clinical medicine. The book is divided in three sections. Section - 1 (containing 7 chapters) deals with general examination and case-taking based on classical methods of Pancendriya Pariksa, Astavidha Pariksa and Dasavidha Pariksa. Section - 2 (containing 14 chapters) discusses in details the systemic examination based on the concept of Trayodasa Srotas Pariksa described by Caraka. Section - 3 (containing 2 chapters) specially deals with Examination of Tridoa (Vata-Pitta-Kapha) and Examination of Manas. Section - 3 seems to follow a classical Ayurvedic style of clinical examination elucidating Tridoa characters in clinical settings on one hand and on the other clinical application of the Eight mental state factors described by Caraka namely Manas, Buddhi, Samjna-jnana, Smrti, Sila, Bhakti, Cesta, Acara utilising the inputs from earlier studies conducted on Ayurvedic mental state examination at NIMHANS and Central Council for Research in Ayurveda & Siddha and certain other authors.

The learned author with his deep textual knowledge and practical clinical experience deals with the subject in a comprehensive manner aiming to identify the hidden knowledge about disease i.e. the Samprapti and then paves the path to plan Samprapti-based treatment Yuktivyaparaya pattern. As the author himself states, the knowledge t modern science is a great help to understand the subtle knowledge of Ayurveda but it is not meant to replace Ayurveda. Modern science and technology are just a tool for Ayurvedic enquiry which has to be utilised appropriately in tune with principles and philosophy of Ayurveda. An inappropriate crude hasty use of modern technology for study of subtle subjective issues of Ayurveda carry a great risk of distorting the true meaning of Ayurveda. Hence fruitful interface of Ayurveda with conventional science is permissible only for mature scholor scientists who understand both the sciences in depth and who understand clearly that Ayurveda and modern medical science are fundamentally different from each other in their approach and comparisons are not always easy and useful.

Clinical medicine and diagnostics form the most important segment of any medical discipline, and Ayurveda can not be an exception. It is evident from the fact that the classical science of Ayurveda devotes more time and space in describing the biology of living being, its probable pathology and methods of identifying the same than mere cure. The concepts of Tridosa, Dwidosa, Agni, Ama, Dhatus, Ojas and Srotas were developed in Trisutra Ayurveda by the ancients for this very reason. In recent years Modern Medicine too has made tremendous advances in the areas of understanding the bioscience and diagnostics. The advances the therapeutics has not been so great as compared to the basics of biomedicine. Unfortunately contemporary Ayurveda has not shown this trend. Clinical medicine and diagnostics in real Ayurvedic sense have gone to the back seats so much so that many contemporary Ayurvedic physicians are seen to follow the principle of modern diagnosis and Ayurvedic treatment in their professional practice which does not appear to be logical and long lasting. Because of this trend Ayurveda is being gradually reduced to mere therapeutics instead of remaining a full medical science of its own kind. This reductionist trend is dangerous for the very existence of Ayurveda and Ayurvedic therapeutics too is gradually becoming no man’s land leading to quackery and irrational use of Ayurvedic drugs and therapies by practitioners of other systems of medicine including allopathy. Considering the scope of easy marketing many nonserious drug companies are producing proprietary herbal formulations with scratchy evidence base for use of non Ayurvedic practitioners. Such trends in due course may question the very existence of Ayurveda as an independent system of medicine, Questions are already being raised from some corners that if practitioners are not marking Ayurvedic diagnosis for Ayurvedic treatment what is the use and need of teaching the basics of Ayurveda and the subjects like Sarira, Roga-vijnana and Vikrti-vijnana which occupy nearly half of the curricular time of our graduate students.

However, those who take Ayurveda seriously, very well know that the entire Ayurvedic therapeutics is based on Ayurvedic principles and the understanding of disease too is in terms of Ayurvedic principles. Except few examples in majority of cases there is no one-to-one correlate of an Ayurvedic disease with a modern disease. And therefore modern diagnosis and Ayurvedic treatment is not feasible unless all the drugs and therapies of Ayurveda are studied for their modern pharmacology and modern pharmaceutics followed by extensive clinical trials which may take few hundred years, even then things will remain un certain and inconclusive. Hence instead of the costly time consuming exercise of transforming Ayurveda into modern medicine for its allopathisation, it is easier and rational to use Ayurveda as it is of course with continued efforts to develop it into an evidence-based Ayurveda with due safety, efficacy and quality assurance of its medications.

Such a professional crisis in Ayurveda has occurred because of decades of neglect of Ayurveda and Ayurvedic education. The present educational system has not succeeded to impart adequate practical and theoretic training to empower our graduates to make Ayurvedic diagnosis and Samprapti-based Ayurvedic treatment taking care to relieve symptoms, Samprapti-vighatana and Prakrti-sthapana. Most of the teaching of basic subjects and Ayurvedic clinical medicine theoretical and there is hardly any bed-side clinical training of our students. Hence they do not attempt any Ayurvedic approach and pick up few popular medicines, Ayurvedic or allopathic to run their professional career. We have landed into this precarious situation because of lack of competent teachers, good text books and lack of practical clinical training on bed-side as is evident from empty beds in Ayuvedic hospitals. I hope this book produced by Professor Srinivasulu will help to fill the gap to some extent. But books alone are not enough, we need more competent and serious teachers to teach clinical Ayurvedic medicine and diagnostics with strategies of Samprapti-based treatment.

Ayurveda never preferred any kind of short cut in diagnostics. It was always broad based and comprehensive enough to encompass the disease, the patient and his genetic social and environmental background. Clinical medicine of Ayurveda is characteristically two-fold comprising of Rogi Pariksa and Roga Pariksa. Examination of Rogi, the patient Irrespective of the disease is of prime significance. Caraka describes the Ten-fold method or Dasavidha Pariksa through Prakrti, Vikrti, Sara, Samhanana, Sattva, Satmya, Pramana, Aharasakti, Vyayamasakti and The general examination of the diseased person is best done by Astavidha Pariksa through Nadi, Mutra, Mala, Jihva, Sabda, Sparsa, Drk and Akrti followed by a systemic examination by detailed Trayodasa Sroto-pariksa. These three principal dimensions of Rogi-Roga Pariksa are done utilising the tools of Sadvidha Pariksa i.e. Prasna Pariksa or Interrogation and Pancendriya Pariksa or Physical examination. All this is done r. the light of the theoretical background of the doctrine of Caturvidha Prananas (Pratyaksa Anumana, Aptopadesa and Yukti). Thus it would be seer. that the classical method of Ayurvedic diagnostics is more comprehensive than the conventional modern methodology except the fact that modern medicine has succeeded to develop elaborate laboratory technology support of its clinical methods. It is advisable that Ayurvedic practitioners may also use such investigations as a support by appropriate Tridosika interpretation of the laboratory findings. It is also suggested that we should seek help and advice of basic biomedical scientists to develop new tools, techniques, biomarkers and indicators for important biofactors implicated in Ayurvedic diagnostics such as Agni, Ama, Ojas, Srotas, Nadigati etc. The Ayurvedic diagnosis has to be more descriptive in terms of the Samprapti-ghatakas of a disease besides the Deha and Manasa prakrti of each individual patient, then only one can plan a Samprapti-vighatana approach of treatment.

Ayurvedic diagnostics not only intends to identify the name of a disease rather it intends to understand the phenomenon of the disease i.e. the Samprapti on one hand and the Prakrti of the patient and his remainder health status on the other. An Ayurvedist not only examines the disease in his patient rather also endeavours to examine the health of the patient. This approach is essential because the Ayurvedic therapeutics (Ausadhi-Anna-Vihara) wins a ‘disease’ only with the power of the ‘health’ of the patient. The primary principle of treatment is (1) to weaken the disease by Nidana-parivarjana, (2) to reverse the disease process by the principle of Samprapti-vighatana and (3) to restore normalcy i.e. Prakrti-sthapana by help of the power of remainder health i.e. Swasthyamsa of the patient. Thus the patient’s remainder health status and Ojobala are the positive tools of healing process in Ayurveda.

‘Clinical diagnosis is an art and the mastery of an art has no end; you can only be a better diagnostician’.

Students of Ayurveda across the country do clinical study based on the books of modern medical system, with that approach students as well as practitioners are facing problems in applying the principles described in the Ayurveda Samhitas for clinical diagnosis. Always translating or correlating modern medical literature to Ayurveda is harmful and it is like venturing into the ocean without any compass of your own. Bearing this in mind an effort has been made to equip students and practitioners with one who compass titled ‘Clinical Diagnosis in Ayurveda that would help them to do clinical diagnosis in Ayurveda. This book incorporates all the techniques of the modern era concerned with Ayurvedic diagnosis however, the modern medical terms has been retained without disturbing the message, the nearest possible Ayurvedic terms have been mentioned in brackets to enable the reader to understand and not with the intention of providing an exact translation.

The contents of the book have been classified into three sections.

Section-I deals with the general examination in which art of case taking and examination of the patients have been explored with application of basic ancient Ayurvedic principles and put forth in the light of present day science. Detailed clinical methodologies in Ayurveda like Pancendriya pariksa, Astasthana pariksa and Dasavidha pariksa have been detailed with a modern approach.

In Section-II Systemic examination concerned with each system of the body has been described. In Ayurvedic lines system wise classification is nothing but Yogavahasrotas. In this view examination of each of the Trayodasa srotas have been described in detail. Each stotras has been described in detail in terms of a) Introduction b) Mula organs involved c) Anatomical considerations d) Physiological considerations e) Common symptoms f) Method of enquiry g) Examination of Srotas h) Laboratory & special investigations. With this view, Grahani is described under puriavahasrotas, prameha under mutravahasrotas, sandhiroga under asthivahasrotas, rajayakma under rasavahasrotas purely basing on the laksana.

Section-III deals with the examination methods related to tridosas and examination of mind purely in Ayurvedic style with a unique approach of CCRAS & NIMHANS, which are more applicable to Indian culture. Assessment of prakrti, normal values of biochemistry and case sheet to study a psychiatric patient are enclosed as appendices. Important illustrations, tables and color pictures which are vital in clinical diagnosis have been incorporated wherever useful for Ayurvedic diagnosis.

Case taking is an art which must be acquired through experience. The zeal of a modern physician to indulge in the aid of electro-medical gadgets might mislead young medicos that ultimate diagnosis of a disease rests on mechanical gadgets. This pitfall must be avoided by one who wishes to be a successful clinician.

Mention of laboratory investigations for Ayurvedic clinical diagnosis under each condition does not mean that one should go for modern diagnosis; it is for confirmation of pathogenesis, prognosis of the disease and for estimating the effects of the treatment. However higher technological investigations have been avoided which are not under the purview of an Ayurvedic student.

Since clinical diagnosis in Ayurveda is a vast and exhaustive subject purely based on experiences, I may not be able to cover the spread of the subject, but those will be covered in future editions. There are many of my own experiences and thoughts in this text which may not be common for all; however they are practically approachable views to derive a diagnosis and plan the treatments.

Without sound knowledge of the hidden process of disease, the physician will flounder along in an aimless fashion. Clinical diagnosis means estimating the hidden iceberg by observing the part exposed above water. The true objective of this book is not merely to describe concepts but to assist and guide in making a diagnosis. I wish Ayurvedic medicos; practitioners and academicians will find this book equally needful.