Patient examination plays a vital role in diagnosing the illness.The precursor to treating a patient, is taking a detailed history of the illness followed by examination of the patient. Examination of a patient opens a window to diagnosing the disease and hence aids in treatment.
Brihatrayis( acharya charak, sushrut and vaghbhata)have mentioned the dasavidha pareeksha of atura( patient) . This includes the examination of prakriti, vikruti, Sara, samhanana, ahara Satmya, Bala,dushya, desha, kala and anala.
Whereas acharya yogaratnakar has mentioned astavidha pareeksha. This pareeksha involves the examination of Nadi( pulse) jihva( tongue) mala( stool) mutra( urine) akriti ( general appearance) drik ( eyes) shabda( voice) and sparsha( touch).
Nadi pareeksha involves the examining the Nadi for dosha dominance. This in turn helps us to know the vitiation of the dosha in the body. Various diseases such as jwara, mala avastambha,rakta vikaras etc can be diagnosed by examining Nadi.
In children too Nadi pareeksha can be used for the conditions mentioned above.
In children it is advised to examine the pulse rate after 2 years of age. It is only after 2 years of age ,the heart rate and the pulse rate synchronise.Nadi pariksha can still be used in younger children to diagnose the various dosa vitiation in the body. This aids in treating the disease effectively. Since children cannot express the symptoms, Nadi examination will help us in diagnosing the predominant vitiated doshas.The different types of Nadi in children should be standardized using various clinical trials.
Jihva pareeksha: while we are examining the tongue, we should observe the samata/ niramata, colour, any abnormal shape of the tongue, tongue tie, atrophy etc. in children especially the samata of the tongue tells us the state of jataragni. Children don't express their symptoms. So by examining the tongue we are able to learn about the Agni avastha which is an important component while treating a patient.
Mala: Acharya 's have mentioned to test the stool in water for its samata and niramata. This is a simple test and easy to perform. It tells us about the digestion and assimilation status of the food. Mala is also examined for its colour, frequency,consistency,smell etc.colour of the stools can be shweta, pita, krushna, aruna etc depending on the dosha vitiation.
Smell can be putigandha, visragandha etc.
The frequency and consistency of the Mala helps us to differentiate it from different types of atisara .
Now we have stool examination. We can use this to understand the presence of worms, mucus or occult blood in the stools. This helps us in the accurate diagnosis.
Astasthana pareeksha should be the main examination of the patient. And this has to be updated with newer investigations like urine routine, stool routine, blood investigation s ,2D echo etc.
I have discussed only 3 pareekshas . Rest of them will be continued in the next post.
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