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History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c22.s1: Diagnostic Techniques

History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c22.s1

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Diagnostic Techniques

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Diagnostic skill was the greatest achievement of ancient Indian Medicine. Caraka lays great emphasis on an early and correct diagnosis as the basis of any rational treatment. He devotes two complete *Sthānas*, the *Nidāna* and *Vimāna* in his ‘*Saṃhitā*’ to an exhaustive discussion of the subjects of different diagnostic techniques. Chapter 8 of the *Vimāna Sthāna* is perhaps the most comprehensive and complete discussion of the subject of diagnosis we possess in any ancient medical literature. The physicians conversant with this science, reflecting in all manner of ways, upon everything as far as possible, should then come to a conclusion about the diagnosis of the disease before him and the treatment that should be followed. The physician who fails to understand the constitution of the patient with knowledge and perceptual vision can never treat diseases (CS.VI. 4.13-15).

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The methods of approaching the patient to diagnose the ailment can be of two types.

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1.1. Examination of the patient

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1.2. Examination of the disease

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*Examination of the patient* (CS. VI. 7.94-122)

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Great emphasis was laid on the examination of a patient. This essentially involves the study of personality, strength and vitality of the patient. Caraka describes the following techniques for this purpose.

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(1) *Prakṛti* (Constitution), (2) *Vikṛti* (Morbidity), (3) *Sāra* (Excellence of *Dhātus* or tissue elements), (4) *Saṃhanana* (Compactness of organs),(5) *Pramāṇa* (Measurement of the parts of the body) (6) *Sātmya* (Homologation),(7) *Sattva* (Psychic condition),(8) *Āhāra Śakti* (Power of Intake and Digestion of Food), (9) *Vyāyāma Śakti* (Power of Performing Exercise), (10) *Vayaḥ* (Age).

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1. *Prakṛti*: Total constitution of the foetus is genetically determined by (1) Sperm and Ovum, (2) Seasons and Conditions of the Uterus, (3) Food and regimen of the mother and (4) Nature of the *Mahābhūtas* comprising the foetus. The foetus gets characterised with one or more of the *doṣas* which are dominantly associated with the above mentioned factors when they initially unite in the form of foetus.

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*Prakṛtis* are of seven types, three individual doṣic constitutions and three dual with combination of two *doṣas* and one with all *doṣas* in equal proportions. A detailed description of the qualities of individual constitutions is available in all major ancient classics of Indian Medicine. The *Doṣa Prakṛti* of an individual presents as the sum total of his physique, physiology and psychology and hence the *Acāryas* describe a comprehensive typology of human variation for determination of which an equally comprehensive technology is visualised.

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2. *Vikṛti* (Morbidity): Morbid manifestations are to be examined with reference to the specific causative factors *doṣas* and *dhātus* involved in the pathogenesis, *prakṛti* or constitution of the individual, habitat, season and strength and also the symptoms of the disease.

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Without determining the nature and strength of the causative factors etc it is not possible to know the nature of the disease. Moreover, morbidity helps in the assessment of the susceptibility and endurance pattern of an individual.

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3. *Sāra*: Patients are to be examined with reference to *sāra* or the excellence of their *dhātus* and body tissues with a view to determining the specific measure of strength. They are classified into qualitative categories depending upon the *sāra* or excellence of their *dhātus*:

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(1) Tvak (Skin, contextual meaning Rasa Dhātu), (2) Rakta (Blood), (3) Māṃsa (Muscle tissue), (4) Medas (Adipose tissue), (5) Asthi (Bone tissue), (6) Majjā (Marrow), (7) Śukra (Semen), (8) Sattva (Mental faculties).

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The detailed description of the qualities of above types are mentioned in Caraka Saṃhitā with brief mention of the technique of determination of the Sāra.

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4. Saṃhanana: A compact body is characterized by the symmetrical and well divided bones, well knit joints and well bound muscles and blood. An individual having a compact body is very strong, otherwise he is weak. When the body is moderately compact, the individual is possessed of moderate strength.

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5. Pramāṇa: A patient is also to be examined with reference to pramāṇa or the measurement of his bodily parts. This is determined by measuring the height, length and breadth of different parts by taking finger breadth of the individual as the unit of measurement. This is called Aṅgula Pramāṇa.

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The normal measurements of individual (all) body parts in Aṅgula Pramāṇa are described in all the three Saṃhitās. A body possessed of organs having proper measurement is endowed with longevity, strength ojas, happiness, power, wealth and virtues. If the measurements are not at par with standard norms the individual is considered weak and inferior.

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6. Sātmya: Stands for such factors as are wholesome to the individual even if used continuously. Individual for whom ghee, milk, oil and meat soup as well as the drugs and diets having all the six tastes are wholesome, are endowed with strength, the power of facing difficult situations and longevities. Those who are accustomed to unctuous things and drugs and diets having only one particular taste, are mostly possessed of less strength, less power (or resistance) to face difficult situations, are of smaller life-span and of meagre accessories like drugs for the treatment of his diseases. If there are combinations of both these types of homologation, individuals are possessed of moderate strength. Sātmya-asātmya is determined in terms of Rasa, Guṇa etc.

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7. Sattva is mind and it regulates the body functions to a great extent of its association with the soul. Depending upon its strength it is categorised to be of three types viz. 1) Superior, (2) Medium, (3) Inferior. Sattva Parīkṣā is essentially the Manobala Parīkṣā i.e. examination of mental stamina.

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8. Āhāra Śakti: One's capacity for food can be examined from two angles viz. (1) power of engestion, (2) power of digestion. Both these strengths and life-span are determined by giving a particular diet and by watching its digestion.

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9. Vyāyāma Śakti: The patient should be examined with reference to his capacity for exercise in the fixed exercise endurance. Strength of individuals is classified into three categories depending upon the ability to perform works/exercise, viz. (1) Pravara, (2) Madhyama, (3) Avara.

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10. Vayaḥ: The age of the patient represents the state of his body depending upon the length of the time that has passed since birth with a view to ascertaining the life span of an individual, and the rate of ageing process. A schedule of symptoms are described in the Indriya sthāna of Caraka Saṃhitā.

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*Examination of the disease*

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The ancient classical methods of investigation of disease are described under the following headings (CS. Ni. 1.7-11)

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1. *Nidāna*: *Nidāna* essentially refers to the aetiology of disease. One finds extensive description of a wide variety of causative factors, viz. biological, psychosocial and environmental. The basic technique of detection of aetiology is interrogation and observation.

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2. *Pūrva Rūpa*: This refers to the prodromate of the disease. By analysing this, the intensity and character of the disease can be ascertained at the earliest. It is also helpful in the prognosis. This description of prodromal symptoms and signs are seen in the texts while describing the features of the individual diseases.

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3. *Rūpa*: The knowledge of the manifested characteristic features of different diseases is very important for the diagnosis and to assess the intensity of the disease. These descriptions are also seen in all major classics either in the Nidāna Sthāna or in the context of Cikitsā.

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4. *Upaśaya*: It is a technique of diagnosis by utilising therapeutic test usually applied in cases where the etiology and symptomatology of a disease do not give conclusive clue to the predominance of *doṣa*. This diagnostic therapy is used in the form of diet, drug and or any other remedial measure to find out the original nature of disease.

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5. *Samprāpti*: It is the description, in detail of all the morbid processes that take place in different diseases or in different stages of the same disease. The accumulation of *doṣas*, their movements and the particular form which the disease takes, are included in *Samprāpti*. *Dosa*, *Duṣya*, and *Adhiṣṭhāna* are the main *Ghaṭakas* or components of the *Samprāpti* of a disease.

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These five techniques are useful to ascertain the character and strength of a disease.

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*The Four Pramāṇas of Ayurveda*

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According to *Darśanas* i.e. the systems of Indian Philosophy, the means of obtaining true knowledge are mainly three, viz.

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(1) *Pratyakṣa* (perception)

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(2) *Anumāna* (Inference) and

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(3) *Āptavacana* (revelation, oral evidence or valid testimony).

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These three, known as *pramāṇa* provide within themselves for a thorough investigation of all the material and abstract aspects of the universe. Hence they have been accepted as the methods of examination by all ancient Hindu Sciences including Ayurveda.

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*Caraka Saṃhitā* (Su. 11.17) enumerates the above three *Pramāṇas* and adds one more, the *Yukti* as the fourth. In fact it is included in *Anumāna* itself but it has been given an independent status in view of its importance in practical application.

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*Three other techniques of examination*

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1. *Darśana Parīkṣā (Inspection)*: Under this technique the physician has to inspect the *Varṇa* (colour), *Chāyā* (lustre and complexion), *Saṃsthāna* (shape, quality, external appearance features), *Pramāṇa* (number and proportion), *Prakṛti-Vikāras* (the normal and abnormal appearance of the body) and *Anuktam* which ever else not mentioned here but comes within the perview of the eyes like *saṃkhyā* (number, counting) *ceṣṭāgati*, *spandana* (movements, pulsations, throbing etc.) (*CS Vi* 4.7).

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2. *Sparśana Parīkṣā (Palpation)* (CS. In. 3.3.): It is the hands of the physician that are essential for this examination. Through this technique physican can get the knowledge regarding ‘Gunas’ like *Śīta*, *Uṣṇa*, *Mṛdu*, *Kaṭhina* etc. (qualities such as heat, cold, soft, hard and many other *spandanas* or pulsations); *sat* and *asat* *bhāvas*. (Ca. Indriya 3/4).

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3. *Praśna parīkṣā*: This is the technique of obtaining knowledge regarding the etiology and symptomatology of a disease by interrogation. This is an important technique which is ultimately helpful in the diagnosis and prognosis of a disease.

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As a matter of fact *Praśna* or interrogation is the basic technique of all other clinical investigations. When the patient is in unconscious state, the well wishers and attendants of the patient (*Āptas*) are to be interrogated. This gives the first hand knowledge about the disease.

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*Nāḍī Parīkṣā*: Examination of pulse is another important diagnostic technique. The description about the *Nāḍī Parīkṣā* is not available in the major ancient classics of Ayurveda. However, this technique appears to have been introduced during the medieval period by Sārangdhara in the context of *Aṣṭavidha Parīkṣā* i.e. eightfold clinical examination namely *Nāḍī* (Pulse), *Mūtra* (urine examination), *Mala* (stool examination), *Jihva* (tongue), *Tvak* (skin), *Dṛṣṭi* (eyes), *Śabda* (speech), *Ākṛti* (appearance) are described in details in *Yoga Ratnākara*.

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The *Nāḍī* (pulse) is examined at the root of the hand i.e. at the wrist in a relaxed state. A pulse of very high rate with low pitch and volume gives the feeling of a serpentine movement which is characteristic of *Vātika Nāḍī*. A moderately rapid pulse with high pitch gives the feeling of a movement simulating jumping movement of a frog which is characteristic of *Paittika Nāḍī*. A pulse which is relatively slow in rate but high in volume gives the feeling of the movement of a swan which is characteristic of *Kaphaja Nāḍī* (*Sāraṅg.S.* 3. 1-8)

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*Mūtra Parīkṣā*: Urine examination has been an important technique for clinical diagnosis. Besides the physical examination in terms of colour, consistency, turbidity, taste etc the technique of *Taila Bindu Parīkṣā* (oil drop test) is described in later texts. In this technique a drop of oil is left on the surface of the patient’s urine and the movements of the oil drop in different directions and its rate of spread and change in colour etc are interpreted in terms of a number of chemical and physical properties of urine such as ph, specific gravity, surface tension etc. and also in terms of *Pañca Mahābhuta* and *Tridoṣa* (*YY*. 1, *Bās*. 3):

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*Mala Parīkṣā*: Examination of faeces is described as an important technique for diagnosis of a disease and disease state. Besides routine physical characteristics of stool such as colour, consistency appearance etc, an important consideration is the Sama-Nirāma Parīkṣā (M.Ni. 3, Ma.K, vs 12-13). For this a known amount of the faecal matter is dropped in water and if it floats on the surface of water it is inferred that the Mala is in Nirāma Avastha. If it dips in water it is considered Sama. The degree of Amavastha can be measured quantitatively by measuring the degree of dipping of the stool in depth of water. It is a very useful technique which can be interpreted in a variety of ways giving significant information on digestive and metabolic state of a patient.

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