Why We Need Detailed Case History In Ayurveda?

Article by Dr MS Krishnamurthy.
Being a pure Ayurvedic physician I spend a lot of time with my patients, especially in first consultation. Many a times it takes as long as 1-2 hours. This is the reason, in few of the cases, I ask the patients to directly approach me personally instead by phone / email.

Usually doctors are fed up due to long queries or multiple questions of the patients.Whereas, in my practice, I have found the patients who were bored by my questions or felt discomfort to answer my 4-5 page queries (especially in first consultation). But the patients will be happy, when they are getting good result out of classical Ayurvedic treatment, who came after approaching several physicians of different specialities of their multiple health issues.

Here are the reasons for long case history needed for classical ayurvedic treatment.
1. Ayurveda treats body as a whole and not diseases with different entities. So priority will be given to understand the body constitution (prakruthi) of the individual first. Based upon this, the nature and grade of derangement is understood. This helps the physicians to understand the exact patho-physiology (samprapti) of the particular illness.

10 crucial points

In this regard following 10 points are very crucial-
1. Desha (the individual’s birth place or place of stay and development)
2. Dosha (affliction of particular Dosha or combination of Doshas)
3. Bala (individual’s body strength)
4. Kala (time of affliction of the diseases and the time taken for the manifestation of the illness)
5. Anala (digestive fire of the patient before the origin of the diseases and after the manifestation of the illness)
6. Prakruti (individual’s body constitution)
7. Vaya (age of the individual)
8. Satwa (mental strength to bear the illness and the potency of the medicine or nature of the specific treatment)
9. Satmya (wholesome food and habits)
10. Ahara (food habits before and after the onset of illness).

Medicines based on disease

2. Choosing medicines based on disease stage:
In Ayurveda, the medicine is not merely disease oriented. In a particular stage of illness specific formulations are preferred.

For example, in fever, initially the effort is carried to overcome the complaint of indigestion which is very common. On attaining good digestive fire/good appetite, medicines are administered so as to open up the sweat pores; these are called diaphoretic drugs (sweda karaka dravya). If it is not achieved some mild exercises are advised so as to induce sweating (unless like modern medicine where complete rest is advised). Further medicated gruel’s admixed with carminative drugs/ spices like pepper, ginger, cumin seeds are recommended. There after the medicaments possessing bitter taste (preferably) like kirata tikta ( Swertia chirayita), Kalamegha (Andrographis paniculata), Guduchi (Tinospora cordifolia), Nimba (Azadirchta indica) etc are recommended.

Dosage form based on disease

3. Choice of dosage form based on disease:
Other than above, in particular conditions of the disease process, definite dosage forms (kalpanas) are adopted to get
– maximum therapeutic benefit,
– minimum toxicity and
– quick therapeutic benefits.

Example, in case of fever, in its beginning stages, kashaya formulations (medicated decoctions) are used.
Thereafter, when the individual feels good digestive capacity tablets (vati yoga) are recommended.
In case, if excess secretions are found in the bodily channels (kleda pradurbhava) , Choorna yogas (medicated powders) are advised.
If the individual is suffering from fever for long with lesser digestive capacity, debility, excess morbidity, nausea, tastelessness etc., Asava- Arishta (fermented preparations) are advocated.
Once after remission, to overcome the fatigue and tissue damage medicated ghee (Ghrita yoga) is prescribed.
Further to overcome the tissue toxicity generated, and for rejuvenation, Rasayana formulations (lehya) are preferred.
This is the prime reason behind the systematic presentation of formulations and dosage forms in the classical texts (whereas texts written in later centuries remained merely as complication of formulations and the sanctity of classical and methodological treatment modules were sidelined).

Accurate diagnosis

4. Detailed case history yields accurate diagnosis:
In pure Ayurvedic treatment, the detail case study/ understanding of the illness followed with proper sub-clinical and clinical manifestations help to understand the direct and indirect causes for the illness. In turn, this helps the clinicians to understand the exact Doshic vitiation, site of infection, further possibility of worsening, extent of the illness and curability of the diseases.

In Ayurvedic texts clear indications of the causative factors like;
• Single cause – single disease
• Single cause – several diseases
• Several causes – single disease
• Several causes – several diseases
are discussed. This gives red and green signals to Ayurvedic physician while arriving at the diagnosis of the cases.
Also, many a time-
• Single symptom – single disease
• Single symptom – several disorders
• Several symptoms – several diseases
• Several symptoms – single disease may also get manifested.

This is understood very well by the detail case study and examination.

8 examinations

5. Unlike modern medicinal system, Ayurveda does not depend upon mere lab investigations for confirmation of the illness. Even though inspection, palpation, percussion and auscultation are said to be the true ways of examination in Allopathic system of medicines, in Ayurveda detail note is mentioned with follows points to arrive at correct Ayurvedic diagnosis –
Nadi – pulse examination
Mootra – urine examination
Mala – tests of faeces
Jihwa –tongue examination
Shabda – auscultation
Sparsha – touch and consistency
Drik – eye examination
Akriti – body built.

10 types of examinations

6. Ten more kinds of examination is mentioned with respect to the patients so as to arrive at the capability of the individual to derive the conclusion about selection of the particular medicine and its dose / potency.
They are –
Prakrititaha – body constitution
Vikruthitaha – nature of affliction of the diseases and possibility
Sarataha – dominant tissue feature
Samhananataha – body built
Satwataha – mental status
Satmyataha – wholesomeness
Aharashaktitaha – capacity of food
Vyayamashaktitaha- capacity of exercise etc

Multiple drug administration

7. Multiple drug administration based upon the multiple symptoms or features of the illness is out of reach in the thinking of pure Ayurvedic practice. That is the reason, the classical literature emphasise single formulations for single illness or single formulation for several disorders.

For example, Sitopaladi choornam (a formulation of 5 ingredients) is indicated in dry coughs. Whereas it can be used safely in indigestion, numbness of the tongue, backache, tastelessness, fever, bleeding disorders of upper body orifices etc.

Selection of Anupana

8. Specific anupana (vehicle / adjuvant) used along with stipulated formulations derives special qualities too.
Example, Triphala choorna if administered along with warm water, acts as laxative.
In association with honey, mouth ulcer can be cured.
Triphala choorna with ghee is very effective in eye diseases.
Triphala choorna with yastimadhu choorna  (called Triphaladi Churna)is highly beneficial in Acid peptic disorders.
Same, if administered along with butter milk, anaemia and oedema can be cured effectively.

This is possible due to selective affinity of the carries of the Anupana (co-drink). Proper understanding of the sequence of the illness helps to decide the proper co-drink for the specific formulation.

Deciding the diet

9. Deciding on diet:
Epitome of above all, Ayurveda is very particular about the wholesome and unwholesome diet and habits with special reference to the diseases as well as the medicine prescribed during particular illness.

Because, it is worth to appreciate the classical sayings –“ Taking the medicine without adopting proper wholesome diet and habits is useless. Likewise, taking the medicines while following strict wholesome diet and habits is meaningless!”

Overall criteria make the ayurvedic physician to take longer time along with the patient. This helps to understand the body and mind of the patient and his sufferings. Thus it gives proper guidance to adopt apt dosage form, formulation, dose, vehicle, wholesome diet and habits to a particular patient, when he/she approaches the physician.

Ayurvedic physician does a great job when a client approaches him with detailed case history. I strongly believe in my Godly preceptor Prof LK Dwivedi’s words –
“He is a great physician who is a great inspirer of hope; to be a good physician you be a good listener”.