10 Factors Of Patient Examination – Dasha Vidha Atura Pareeksha

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Ayurveda has explained the examination of the disease (roga pareeksha) and diseased (rogi / atura pareeksha) in a most comprehensive way. It is very important to know the nature of the disease and the status of the patient before a treatment protocol is initiated or before any medicine is administered. 

Dasha Vidha Pareeksha

Dasha Vidha Pareeksha – Ten Fold Examination of a Patient
Among different types of protocols of patient examination explained by Ayurveda, Dasha Vidha Pareeksha is an important format.

Charaka explains the ‘Dasha Vidha Pareekshya Bhavas’ – ’10 factors to be examined’. Among these factors he mentions the Desha Pareeksha. Desha means region.

Dasha Vidha Pareekshya Bhavas

The Dasha Vidha Pareekshya Bhavas are –
Karana (cause, the one responsible for treatment i.e. doctor),
Karana (the instruments which are used in the treatment, mainly the medicines),
Karya Yoni (Source of action, i.e. dhatu vaishamya or disease or imbalances in tissues and body components on which the physician operates),
Karya (action i.e. treatment so as to bring dhatu samya or equilibrium in the body components and establish health),
Karya Phala (result of action, i.e. establishment of sukha, comfort, happiness and health),
Anubandha (association of the patient with ayu  – lifespan),
Desha (habitat or land),
Kala (time factor),
Pravritti (initiation) and
Upaya (means of action).

Among the above mentioned ten factors, Desha pareeksha or examination of habitat includes Dasha Vidha Pareeksha or tenfold treatment of the patient.

According to Charaka, desha is of two types, Bhumi desha (the land, earth or the place in which we live) and Atura Desha (the human body, which itself is a land). Thorough examination of both deshas is mandatory if effective treatment has to be planned and implemented.
Related Reading – Roga-Rogi-Pareeksha

Atura Desha

Atura Desha / Deha Desha – the object of Dasha Vidha Pareeksha
Atura Desha or Deha (human body) is a site where all the diseases are manifested. It is also a desha which should be thoroughly examined so as to find the disease and diseased place (tissue, organ or system).  It is also a place where all sorts of treatments and medicines would be implemented so as to cure the manifested diseases. Charaka tells that the Atura Desha shall be effectively examined and interrogated by means of Dasha Vidha Pareekshas or tenfold treatment. Through Dasha Vidha Pareeksha the physician will get a precise knowledge of the life span of the patient and also about the strength and intensity of the disease. The knowledge of these factors is very essential for implementation of treatment.

Dasha Vidha Pareeksha importance

Why and how is Dashavidha Pareeksha important?
Life is a beautiful gift to us on this Earth. With life come the compliments in the form of diseases, disorders and ailments. It is very difficult to keep ourselves sterile and disease free. There are many causes which cause diseases in us, most of the times the choices we make in our lives are the prime factors leading to the manifestation of many diseases. They include food, lifestyle choices, the stress factor, geography etc. Inevitable factors like seasonal changes etc also play a major part.

Man has been in constant search of better and better remedies as and when he encountered health issues, throughout the length of his evolution. This pursuit of getting relieved from pain and diseases led to the advent of medical science. The medical system too was updated time and again as the science and technology developed around us.

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.

Now let us discuss this with the help of an example!!

If we have a patient who has low physical strength, low tolerance and endurance, low in confidence and immunity we cannot plan to administer stronger treatments or cleansing treatments like Panchakarma treatments mainly Vamana (therapeutic emesis) and Virechana (therapeutic purgation), though the disease condition demands these treatments to be done for better impact. We need to go to plan B and come out with simpler measures and softer measures of treatment. These people should be addressed with the help of low strength medicines and diet and essential dietetic recommendations.

If a physician administers intensively potent medicines without skillfully judging the strength and tolerance of the patient and without having conducted proper examination, it may cause serious life threatening complications and also can eventually cause death. The medicines predominant in agni and vayu mahabhutas are very intense and strong acting. They are not well tolerated by all patients, especially by those having weak constitution. Similarly weak people may not tolerate shastra karmas (surgeries), kshara and agni karmas (alkali and fire cauterization). Some treatments may cause immediate death due to low tolerance of the patient or due to the intense nature of the drug or medicines used. The most effective treatments and medicines might just be a hindrance and limiting factors in treating such patients. After having considered these factors, the physicians should treat the weak patients with medicines which are safe, mild in nature, delicate and those which are known not to cause complications and which are stronger in progressive order. The base line of treatment is to cure the ailment and not to cause the complications and definitely not to harm the body and mind of the patient. In weak patients the stronger medicines can be administered but it needs experience and lot of observation on the part of the physician. Those stronger medicines which doesn’t cause distress while getting metabolized in the body and also do not cause complications shall be administered but in a slow and gradual way. Utmost care and keen observation shall be kept while administering strong medicines in weak patients and those medicines should be administered only with the intention of saving life, only if it is inevitable to use them. Thus, the patient shall be examined thoroughly using the tool called Dasha Vidha Pareeksha which will enable to know the strength of the patient and disease. Only after this, the treatment blueprint shall be prepared.

The opposite is also true. Weak therapies should not be administered to stronger patients, i.e. to the patients who are physically and mentally strong, especially when they are suffering from a serious disease which demands stronger therapies, treatments or medications. Just as in the case ofweak patients, the bala i.e. strength and tolerance of the patient shall be known through thorough examination even in strong patients, through Dasha Vidha Pareeksha. If a weak medicine or weak cleansing treatments (Vamana, Virechana etc in moderate quantity such that they cause mild to moderate cleansing) are administered to strong patients having serious ailments demanding stronger interventions, without proper examination and analysis of roga and rogi bala, the disease doesn’t get cured in totality. On the other hand, the weak medicines may exacerbate the doshas and other morbidity in the body and cause improper and incomplete cleansing. The morbid elements which were provoked by the medicines but couldn’t be expelled would cause some serious complications in the body in a later time. We also should remember that the stronger doshas were not only disturbed and provoked by the weaker medicines, but were also displaced from their sites. The displaced doshas tend to attack the tissues and block (vitiate or contaminate) channels of the body causing many complications and disorders in a long run.

In order to avoid such blunders and unforced and unintentional errors in treatment and also to avoid complications, the physician should thorough himself or herself in the knowledge of Dasha Vidha Pareeksha.

Factors in Dasha Vidha Pareeksha

What constitutes Dasha Vidha Pareeksha?
Dasha Vidha Pareeksha is a protocol comprising of examination of ten factors before drawing the blueprint of an effective treatment lineup.

Dasha Vidha Pareeksha comprises of examination of the below mentioned 10 factors –
Prakriti – Dosha body type
Vikriti – anamoly / pathology
Sara – Dhatu Body Type
Samhanana – compactness
Pramana – measurements of patient
Satmya – Congenial things and habits of patient
Satva – tolerance capacity of patient toward strong medical treatments
Ahara Shakti – digestion capacity
Vyayama Shakti – exercise capacity
Vaya – age of the patient.

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.

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.

Sara

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.

Samhanana

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.

Pramana

Pramana determines the measurements of the body parts and calculations of components to differentiate between normal and abnormal mathematics of the body. In this, the quantity of the body components and also the numbers are mentioned. 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.

Satmya

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.

Satwa

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. Patients are classified as Pravara Satva (mentally strong), Madhyama Satva (moderate mental strength) and Avara Satva (less mind strength). The tolerance towards diseases, strength of treatment and medicines are all dependent on mind strength. The status of satva helps in categorizing the patient into different groups of different mind strengths which will in turn help in providing comprehensive treatment. Thus Satva will help in determination and deciding the mind strength of the patient.

Aahara Shakti

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.

Vyayama Shakti

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.

Vaya

Vaya means the age of the patient. Age is the most important and inevitable factor which should be taken into consideration while treating a patient. The strength of the patient is also dependent on his or her age.

Benefits of Dasha Vidha Pareeksha

Benefits of knowing 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 and in turn help in planning an effective treatment blueprint.

Just Before Finishing
In this article I have comprehensively covered about the tenfold examination of the patient or Dasha Vidha Pareeksha Vidhi as explained in Ayurvedic treatises. The knowledge of Dasha Vidha Pareeksha is mandatory for a physician to gain mastery over diagnosis and planning treatment protocol for any disease.
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