From the Jacket
The book 'Diagnostic Methods in Ayurveda' written by the well known author Prof. Ajay Kumar Sharma is a complete and comprehensive treatise on the subject. This book is one of its own kinds which deals with the subject in all completeness and clarity covering all aspects of Ayurvedic Diagnostics as described in various Ayurvedic treatise and judiciously supplemented by the modern literature available on the subject. The entire text is nicely supported with original references from Ayurvedic Classics. Latest information regarding Diagnostics has been incorporated with the objective of bridging the gap between the information available in various Ayurvedic classics and the books of Clinical Medicine with the objective of providing basic and complete knowledge to the readers. The book is meant especially for Ayurvedic Students, Physicians and Teachers for creating awareness amongst masses about the dependable holistic approach of Ayurveda in the scientific and systematic manner about the clinical methods in Ayurveda.
Efforts have been made to produce the subject matter in absolutely a new form detailing the ancient concepts of Ayurvedic advances in the field of Diagnostic.
The author of the book being a senior Professor of Ayurvedic Medicine (Kayachikitsa) in National Institute of Ayurveds, Jaipur and being a reputed teacher, clinician and researcher, this book has been richly benefited by his scholarship and professional experience. It is expected that this book will be useful for prospective readers.
About the Author
Born on 31st May, 1954 Prof. Ajay Kumar Sharma graduated in Ayurveda with Medicine and Surgery from A. & U. Tibbia College, New Delhi in 1976 with throughout top rank career. He completed his M.D. (Ay.) [B.H.U.] and Ph. D. under the guidance of his illustrious mentor Prof. R.H. Singh, presently Professor-Emeritus, Faculty of Ayurveda, I.M.S., B.H.U., Varanasi and Ex-Vice Chancellor, Rajasthan Ayurveda University, Jodhpur.
Prof. Sharma is one of the senior most Professors and Head of P.G. Department of Kayacikitsa and Deputy Medical Superintendent of the Hospitals at National Institute of Ayurveda, Jaipur. He is one of the Chief Ayurvedic Physician and Panca Karma specialist in the Institute. Prof. Sharma has published 10 standard books on Ayurveda and over 190 research papers. He received many awards and prizes for his outstanding career. He has contributed chapters to the prestigious volumes on Ayurveda-Kayacikitsa-Panca Karma published by CRC Press London, New York Washington and Argentina. Prof. Sharma has produced 40 M.D. (Ay.) and 6 Ph. D. under his guidance. He is the expert member of several important national level committees.
Ayurveda is the most ancient system of medicine in the world. Ayurvedic Medicine was a highly developed medical science with its manifold specialized practices in pre-independent era. Following the classical age Ayurveda had flourished well till the medieval period, after which followed the phase of decline of Ayurveda. However last few decades have proved important towards revival of Ayurveda with noticeable upsurge of interest throughout the world.
With the growing interest in Ayurveda there has been increasing demand of authentic literature on Ayurveda suitable for practice of Ayurvedic medicine. During last few years the revival activities in Ayurveda and interaction with other systems of medicine has lead to lot of clarity in the priorities and perspectives of contemporary Ayurvedic medicine. Such advances prompt to the need of producing newer literature incorporating the recent advances in terms of conceptual and strategic clarity and scientific developments. It is with this background that the present book was launched.
Clinical methods is a book for student of all ages age all degrees of experience. We all have gaps in our knowledge and this book should help fill them. it is intended to provide insight into the acquisition of the traditional clinical skills of history taking and physical examination, and of the increasingly complex and accurate methods available to modern clinicians. If modern investigative methods are to be applied to patient care intelligently, they must be integrated with traditional methods. The latter remain invaluable and irreplaceable clinical skills. Extended investigations and more complex managements must be both useful and humane. It is expected that the book will be recognized by prosperous readers as an old friend, a friend offering some new information, together with much that is well tied, and that ought to be as well known to new generation of students as it was to their teachers when they were students. Good clinical method is still the root of the matter.
The present book has been written with an objective of providing elaborate and comprehensive knowledge of the subject suitable to the present day students and teachers of Ayurveda. The subject matter has been elaborated with in the frame work of Ayurveda, supplemented at various places with modern knowledge of the subject, just to fill in the gaps. Efforts have been made to avoid the usage of complex technical terms. The language used is simple, easily understandable and self explanatory. Efforts have been made to provide Ayurvedic equivalents to modern terminology and vice-versa logically at appropriate places with the intentions of providing clarity to the subject matter. Throughout the book an attempt has been made to indicate particularly important matters and to suggest the diagnostic relevance of certain findings. The book may therefore be used not only as a text of clinical methods, but as a supplement to text book of medicine.
The author of this book being teacher, physician and researcher in this field has had the advantage of utilizing his professional experience with clinical medicine of Ayurveda in compiling the present book. It is hoped and believed that this small effort will prove to be of some benefit to the prospective readers.
The book is presented in the form of four units. Unit one deals with general considerations, Diseases and Disease process and Rogi Pariksa described in three chapters. Unit two is composed of nineteen chapters which cover various types of examination of Rogi, Trividha and Sadavidha Pariksa, Astavidha and Dasavidha Pariksa and Srotasa Pariksa describing in details Racana Sarira, Kriya Sarira, Srotodusti Karana, clinical manifestations, Sroto Pariksa Vidhi, investigations and important disorders of all Srotasas. Unit third describes the details of methods of Roga Pariksa in three chapters covering in details Panca Nidana Pariksa, Sadhyasadhyata of various diseases and Arista-vijnana. Unit four provides miscellaneous information regarding clinical methods including Ayurvedic case History Sheet, Modern Case History Sheet and laboratory investigations. The book is supplemented with an uptodate bibliography on the topics covered.
While compiling this book I received invaluable help from my post graduate students who kept me on developing the subject with due rationality and clarity by putting across a variety of questions in the classroom and departmental seminars. I take this opportunity to express my heartfelt gratitude to Dr. Vinod Gautam, my post graduate M.D. (Ay.) scholar who contributed richly in compilation and completion of this work.
The clinical Methods form an important component of any medical discipline. Conventional western Medicine has developed its clinical methods to a great extent in recent years, further strengthened with amazingly advanced investigative facilities. But the modern diagnostics seems to have been reduced to mere diagnostic technology and bio-engineering. Real Clinical Medicine and clinical sense of a physician are already loosing grounds and a physician is fast becoming a technocrat and is no more a first-hand Pratyaksa observer, neither the patient has remained an Apta any more. The result is the fast erosion of the clinical sense and power of healing in a physician in coventional medical practice.
On the other hand Ayurveda presents an unique holistic approach to diagnostics which needs to be developed into practical clinical methodology useable on bed-side in a meaningful manner. Impersonal subjectivity depth of clinical sense and healing power are the valued features of Ayurvedic clinical science. There are several books already published on Clinical Methods of Ayurveda by different authors, the present book authored by Doctors A.K. Sharma and Vinod Gautam is another addition on the same lines. Most of there books are of descriptive nature and to not come out with real practical approach and clinical methodology and hence the Ayurvedic graduate students remain bewildered in the jugglary of theoretical descriptions and fail to apply a real objective methodology to examine their patients on Ayurvedic lines for classical Ayurvedic treatment. It is often seen that the Ayurvedic case-history-taking and clinical examination remains a ritualistic exercise for theoretical satisfaction and it really does not serve a useful purpose to make a serious workable Ayurvedic diagnosis. This is why the trend of modern diagnosis and unconventional Ayurvedic treatment is increasing day by day in general practice. This is a dangerous trend and tends to reduce the science of Ayurveda into a mere therapeutic modality.
The teachers involved in teaching this subject and the authors desirous to produce literature have to play a realistic role. The whole subject has to be evolved into a practice-oriented wisdom and professional skill. I find large number of graduate students of Ayurveda highly confused about the scope of application and purpose of different sets of examination schedules described by ancient and medieval texts of Ayurveda such as Dwividha Pariksa, Trividha Pariksa, Caturvidha Pariksa, Sadvidha Pariksa, Astavidha Pariksa, Dasavidha Pariksa, Trayodara Srotas Pariksa and Astavidha Monovikara Pariksa. These sets of parameters have been described in our texts in different contexts and in different perspectives. Some of these depict the object of clinical examination while some others like Sadvidha Pariksa of Susruta describes the actual tools and methodology of clinical examination. The Astavidha Pariksa of Yoga Ratnakara, Dasa- vidha Pariksa and Trayodasa Srotasa Pariksa of Caraka enlist and outline the points of physical examination, general and systemic, over the Sadangas and Srotamsi of the patients' body during Rogi-Roga Pariksa. The available knowledge has to be suitably fabricated in a way so that it can be suitably utilised by a clinician in clinical examination and diagnosis on bed-side.
This is a message to promote clinical sense in a physician and the need of transparancy and willfulness in transaction of clinical responsibility. Medical profession is not an impersonal profittering profession rather is a superior science and art of humanism and healing saddled with divine grace. The nature and Body-Mind-Spiriton continuum is the fundamental feature of Ayurvedic holistics. Sincerity and compassion towards all is the principle fabrics.
Ayurvedic diagnostics while conceiving two-fold Rogi-Roga Pariksa intends to emphasise that a patient who presents himself before a physician for diagnosis and treatment is not merely a bundle of diseases. He is much more than that. Inspite of being sick the patient is a living being with a particular Eco-genomic nature i.e. Prakrti and he also enjoys varying degree of remainder health i.e. Swasthyasa which need to be evaluated carefully during clinical Examination irrespective of the disease he is suffering from. This is important because healing of a disease occurs only through the enherent help of the Prakrti and Avasista Swasthyamsa of the patient. This is while Ayurveda advocates to assess the nature of the patient and his remainder health. Examining 'health' of a patient in diseased state is the unique feature of Ayurveda. The conventional system of medicine ignores this aspect and devotes all its effort only to examine the diseases of the patient.
Ayurveda is one of the most ancient systems of life, health and disease. Its antiquity goes back to the Vedas. Ayurveda is a highly evolved and codified system of life and health sciences based on its own unique and original concepts and fundamental principles. Ayurveda is already a highly developed system of medicine and health care with unique holistic and human approach advocating practice of medicine through an unique science of life. Some of important principles of Ayurveda are briefly described below:
Health and Disease Svasthya (Health) is described in Ayurveda as a state of equilibrium of Dosas (Body humors), Dhatus (Body tissues), Malas (Waste materials) and Agnis (Enzymes), along with happiness of Atman (Soul), Indriya (Sensory perception) and Manasa' (Mental faculties). It is clear from this definition of health in Ayurveda that merely absence of a disease does not mean the healthy state. One should possess physical and mental health, then only he could be considered to be having 'Total Health'. Even WHO also supports this definition of health.
According to WHO, 'Health is a state of complete physical, mental or social well-being and not merely the abscence of disease or infirmity'. When this equilibrium of Dosa, Dhatu, Mala, Agni, Atma, Indriya or Manasa is deranged, the body gets subjected to disease or destruction, which disturbs the normal functioning of the body at all levels. Every disease having its origin in Satva (Mind) and Sarira (Body) has impact on the counter part.
Concept of Pancamahabhutas
It has been described in Ayurveda that Satva (Mind), Atman (Spirit or soul) and Sarira (Physical body) are three important factors which represent a tripode on which the entire living world is stabilised. That (Living body) is termed as Purusa (Person or man).
Sarira (Body) is defined in Ayurveda as the seat of consciousness which is composed of the aggregate of the products of Pancamahabhutas (the five essential elements viz. Prthvi, Apa, Tejas, Vayu and Akasa) and carrying on in the state of equilibrium".
According to Acarya Caraka all physically perceptible materials, living or non-living, are essentially made of five essential elements (Pancamahabhutas). The Pancamahabhutas are present in the body in the form of Dosas (Body humors), Dhatus (Body tissues) and Malas (Waste materials) including various organs and organic systems of body. Different combination and proportion of the Pancamahabhutas are expressed as correlates of different biological qualities including the proportions of drugs and diet and also the pathological alterations of the biological systems including the presentation of symptoms and signs of a disease and also their remedies.
Atman is associated with 'Satva' on one side and with Sarira (Body) on the other side. Atman activates the body with the help of 'Manasa' along with Pancajnanendriyas (Sense faculties) and it is eternal and seer who sees all the actions/activities performed by the individuals. 'Satva' is responsible for the actions of Pancajnanendriyas (Sense organs). Both of these co-ordinate the functions of Atman and Sarira. Thus, all activities of our body are regulated properly and under normal circumstances our health (Svasthya) and physiology of the body are maintained within normal limits.
Concept of Tridosas
It is described in Ayurvedic classics that the basic components of the body are Dosas, Dhatus and Malas, The Dosas are the executives in this organisation. Though Pancamahabhutas are essential constitutents of Dosa, Dhatu and Malas but Tridosas regulate the functions of life and control the biological functions of human body. They are termed Dosa because these have a tendency to get vitiated and to vitiate each other or it can be said that they have the capacity to precipitate a disease under adverse circumstances.
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