International Journal of Multidisciplinary Health Sciences

“A REVIEW ON TRIVIDHA PARIKSHA AND ITS IMPORTANCE”

IJMHS; Vol. VI, Issue: III, JUL-SEPT 2020

International Journal of Multidisciplinary Health Sciences
ISSN: 2394 9406

“A REVIEW ON TRIVIDHA PARIKSHA AND ITS IMPORTANCE”

Dr. Sonali Pramodrao Mahamune1, Dr. Suhas B. Mohite2, Dr. G.A. Mulik3 1P. G. Scholar, Dept. of Rognidan and V.V,. 2Assistant Professor of Panchakarma Department, 3Guide and H.O.D., Dept. of Rognidan and V.V, L.R.P. Ayurvedic Medical College, Islampur, Sangli, Maharashtra. Corresponding Author’s Email ID –
[email protected]

ABSTRACT:Indian traditional medicine, Ayurveda has a great history. Ayurveda as a holistic medicine has a sound philosophical and experimental basis. Rognidan comprises of knowledge of etiology and includes the pathology. It is one of the process, with the help of which we come to the certain conclusion about the nature and localization of lesion and cause of suffering of a person. Diagnostic methods in Ayurveda rely more on the physician reading of patient signs and symptoms than on diagnostic practice (subjective interpretation). Various diagnostic methods has been described in various ayurvedic texts, out of which ‘Trividhapariksha’ i.e. Darshana (Inspection), Sparshana (Palpation, Percussion), Prashana (Questionnaire) forms the basis of all. Categorised under these basic ‘Trividhapariksha’. Darshan or direct observation is the first diagnostic technique of the three fold Rogipareeksha method. Factors those are elicited by Chakshurindriya (eyes) come in this category. It begins with the initial greeting and continues through the entire data collection process. Observation or inspection of patient is done through the patient’s general appearance, eyes, skin, scalp hair, body hair , teeth, walking, complexion, etc. Inspection begins through active observation.

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Physician must note the facial expressions of patients even during interrogating the patient. In our day to day practice we either directly or indirectly use this Trividhapariksha to arrive at certain diagnosis and give proper treatment. As these Trividhapariksha plays a key role in diagnosis of any disease condition. So this is a sincere effort to elaborate the practical utility of Trividhapariksha . Keywords: Ayurveda, Roga- Rogipariksha , Trividhapariksha, Tailbindupariksha.

INTRODUCTION: Ayurveda is often called as a Samakalinshastra (a science of all times). The fundamentals of this ancient science are simple and easily applicable to all eras. One cannot help but wonder at the profound wisdom and observational skills of the early ayurvedic physicians who could fathom the deepest secrets of human body and mind even in absence of modern technology1. Diagnosis comprises of knowledge of etiology and symptomatology both and includes pathology 2. It is a result of various process by the means of which we conclude about the nature and localisation of lesion and the cause of suffering of the person3. Thus, Pariksha means observation from all direction4. A proper diagnosis forms the basis for effective treatment, whereas ignorance of disease or improper diagnosis leads to inefficient treatment5. In Ayurveda, the physician’s approach of clinical examination (disease diagnosis

and patient diagnosis) is used to determine the root cause of disease and to determine the treatment of the disease. Ayurveda diagnostic methods:This involves keen observation of each aspect of patient. It relies mostly on physicians’ skills than on modern technology. Various diagnostic methods are described in different ayurvedic texts. This are broadly classified into two categories 6Rogapariksha (Diagnosis of disease) and Rogipariksha (Examination of patient). These Pariksha together helps in proper diagnosis of disease. Rogpariksha means nidanpanchak i.e. Nidan (cause), Purvarupa (early signs and symptoms), Rupa (signs and symptoms), Upashaya, Samprapti (etiopathogenesis) we get to know the disease. Rogipariksha includes diagnostic method of different Ayurvedic texts. Various diagnostic texts described in Ayurveda are as follows7,8,9,10,11,12,13,14,15,16 Classification of Pariksha :Table no. 1

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“A REVIEW ON TRIVIDHA PARIKSHA AND ITS IMPORTANCE”

IJMHS; Vol. VI, Issue: III, JUL-SEPT 2020

Pratyaksha , Anumana

Dwividhapar

iksha

Pratyaksha , Anumana ,

Trividhapari Aaptopdesha

ksha

Darshana, Sparshana,

Prashana

Pratyaksha , Anumana ,

Chaturvidha Aptopdesha, Yukti

pariksha

PanchagyanendriyaevamP

Shadvidhapa rashnapariksha

riksha

Astavidhapar iksha
Dashavidhap

Nadi, Mutra, Mala, Jihwa, Shabda, Sparsha, Druk, Akruti Prakruti, Vikruti, Sara,

ariksha

Samhanana, Pramana,

Satmya,

Satwa,

Aharashakti, Vyamashakti,

Vaya.

Dwadashapa Ayu, Vyadhi, Agni,Vaya,

riksha

Ritu, Deha, Bala, Satwa,

Satmya,

Prakruti,

Bheshaja, Desha.

These form the base of all the other

diagnostic methods. As years passed by

this pariksha was further revised by

Vagbhat in AshtangaHridiyaSamhita as

arshan, Sparshan, Prashna. Which

together

were

tagged

as

‘Trividhapariksha’. Similar description

was further traced in Yogratnakar and

BhavprakashSamhita 17,18,19

Trividhapariksha:-

This comprises the aspect of both Roga

and Rogipariksha.

I. Darshanapariksha (Inspection)

II. Sparshanpariksha (Palpation

Percussion)

III.

Prashnapariksha

(Questionnaire/interrogation)

I.DarshanaPariksha:

The word ‘Darshana’ means it is the stage

of

inspection

and

observation.DarshanPariksha is vague

term. It includes variety of observational

examination. In this stage various factors

like age and other physical characteristics

of the patient are thoroughly examined.

This is the first method of clinical

assessment in ayurveda. In this the nature

of the disease can be known externally.

For study purpose it can be simplified

under the following headings from

ayurved point of view .

1. Gati (Gait):

[Table no. 2]

Gait

Disease condition

1.Limbinggait

Grudhrasi (sciatica)

2.Forward bending Katigraha (low back

while walking

pain)

3.Walking with Sandhivaat (joint

hands placed on pain)

both knee

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4.

Holding

abdomen while

walking

5.walking with

tremors in whole

body

6.Hands placed over chest while walking

Udarshool (pain in abdomen)

Kampavaat

(parkinsonism),

Madatyay (alcoholic

liver

disease),

Khanja

Shwas (respiratory

disease),

Hridrog(Cardiac

disease)

2. Asana (sitting position): [Table no. 3]

Asana 1. Sits in forward bending position

2.

Putting

complete weight

on one side while

sitting

3. Sits with the

support of hands

4. Sits with head

in one direction

Disease condition

Tamakshwas

(bronchial asthama),

Udarshool (pain in

abdomen)

Arsha

(piles),

Bhagandhar (fistula

in ano), Katigraha

(low back pain)

Daurbalya

(weakness)

Manyasthamb (neck

pain)

3. Shayana (Supine position) [Table no. 4]

Shayana

Disease condition

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1.Lying with both Udarshool,

legs flexed in knee Shitanubhuti

towards abdomen (shivering)

2. Prone position Udarshool,

Prushtashool (back

pain), Daurbalya

3.Incomplete

Hridayrog,

supine position

Tamakshwas

4.Lying with face Avasad (epileptic

in towards the wall attack),

or in direction of Dhanustambh

dark

(Tetanus)

4. Varna (change in complexion, change

in colour of urine, stool, sputum, sweat)

[Table no. 5]

Varna

Disease condition

1.Panduvarna

Pandu (anaemia)

(pallor)

2.Pitahvarna

Kamla (jaundice),

(yellowish

Pittajpandu,

Paitikgulma

3.Atipitahvarni

Halimaka,

Lagharak

4.Raktavarna

Vatarakta (gout),

Visarpa

(erysepalis)

5.Presence of sirajal Jalodar

on udar

These are few examples of darshan pariksha. 20

According to Acharya Charak – colour ,

shape, size, luster, normal and abnormal

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characters of the body and other visual

objects unsaid here , should be examined

with eyes.

According to Acharya Sushrut – By the

help of eyes one can acquire knowledge

about metabolism of body , colour and

any deformity in body.

According to modern context , Diseases

are diagnosed according to change in

colour of urine, stool, sputum.

Darshanpariksha is part of their physical

examination in terms of modern context.

Swelling, elevation or depression of

umbilicus, Vranavastu (type of injury) are

also included in Darshanapariksha.

Kashyap

Samhita

speciality

Vedanaadhyaya is completely based on

Darshanpariksha. X-ray, Endoscopy,

microscopic examination these modern

technologies are nothing but advanced

version of Darshanapariksha. Now a

day’s various tools are used for indirect

inspection (Darshanpariksha) of various

organ.

II. Sparshanpariksha (Palpation,

Percussion)

It is examination by Sparsha (touch).

Stage where observation is done through

touch method. Palpation, Percussion are

different ‘Sparshana’ techniques. It is one

of the methods from the triad described

inTrividhPariksha for the assessment of

diseases. The resembling organ of touch

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i.e. the skin carries out this examination.

Here we can evaluate several factors

through the medium of touch. One can

assess temperature of the body i.e.

coldness, hotness, clamminess, dryness,

palpation of glands and tumour,

intolerance to touch, feel the margins of

the swelling in skin, palpate and note the

characteristics of pulse, palpation and

percussion of ascitis, or check for organ

enlargements.

According to the commentary of

AshatangHridiya

SparshanPariksha

includes Sheeta (cold), Ushna (hot),

Shlakshna (smooth), Karkash (rough),

Mrudu (soft), Kathin (hard) interpretation

on tactile examination 21 .

Examples of sparshanpariksha are as

follows

1. Ushnasparsha in jwar. (fever)

2. Pronmati-unmati examination of Shoth.

(pitting and non-pitting oedema)

3. Vaatpurnadrutisparsha in Sandhivaat.

(crepitus in joints)

4. Dravasanchiti in Jalodar. (fluid

collection in ascites)

5. SthanikushnaSparsha in Aamvaat.

6. Sparshasahatva (hyperesthesia) in case

of acute pain, sensory examination in

various neurological disease like

peripheral neuritis, diabetic neuropa thy,

alcoholic neuritis. Hyperesthesia in

peritonitis.

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7. Pidanasahatva (Tenderness)

8. Fluctuation test is performed in cyst

(granthi)

Yogratnakar and bhavprakash has

included

Nadipariksha

(pulse

examination) in Sparshanpariksha22,23.

Nadipariksha is done by the palpation of

radial artery at the wrist. The strength,

rhythm, speed, quality of pulse is

examined to decide the condition of Dosha

and diagnose the disease. The

conventional clinical methods of palpation

and percussion are also examples of

Sparshanapariksha.

According to AcharyaCharak ,

Sparshapariksha is carried out with the

help of hands24

According to AcharyaSushruta , With the

help of Sparshanpariksha one get

knowledge about coldness, hotness,

smoothness , roughness, softness, hardness

and it is especially important in Jwara

(fever) and Shopha (inflammation).

III.Prashnapariksha

(Questionnaire/interrogation)

Prashna means question. It is the stage of

interrogation where the patient is asked

about his illness and the symptoms that he

is observing on a daily basis. Interrogation

with the patient is most important in

clinical practice. It is done in order to

synchronize the observation of the Vaidya

with the feeling of the patient. It is an

IJMHS; Vol. VI, Issue: III, JUL-SEPT 2020

important aspect of the whole diagnostic

process, here it is important to ask the

patient all the necessary questions in order

to treat them properly. Family history,

history of previous illness, personal,

occupational, socio-economic history are

taken into the consideration for finding the

cause. These questions at times are very

beneficial as they enhance the treatment or

diagnosis process.

According to AcharyaCharak , Etiology ,

pain, suitability and power of digestion

should be known by patients statement.25

According

to

Sushrutsamhita,

prashnapariksha is helpful in knowing

Desh (region), kala (climate), jati

(religion), Vaat-mutra-malaadipravruti

(natural urges), Satmya-asatmya

(wholesome-unwholesome),

Vyadhiutpattikram (chronology of

symptoms), Pramukhavedana (main

complaints), Sharirbala (physical

strength), Agnibala (digestion)26 .

Prashnapariksha (history taking) can be

done in following format

i) Pramukhvedana (chief complaint)

ii) Vartamanvayadhivrutta (history of

present illness)

iii) Purvavyadhivrutta (history of previous

illness)

iv) Parivarikvrutta (Family history)

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v) Vyaktigat, Vyavsayik,Samajikitivrutta (Personal, occupational and socioeconomic history) 1. Pramukhvedana (chief complaint): Precise and complete information of the suffering can be obtained directly from the patient. 2. Vartamanvayadhivrutta (history of present illness): Patient should be asked for complete information about the disease. He should be allowed to address his suffering in his own words from the arrival of first symptom to the present complaint, type of pain, various treatment he has taken, reliving factors according to him, all this should be taken into consideration. 3. Purvavyadhivrutta (history of previous illness): History of Previous illness like DM, HTN, Malaria, jaundice should be asked for. If patient is suffering from diabetes or hypertension he is generally on regular medication. . 4.Parivarikvrutta (Family history): Hereditary disease are increasing day by day. If any of the family member is suffering from hereditary disease like Diabetes, hypertension, sickle cell anaemia etc. 5.Vyaktigat, vyavsayik, samajikitivrutta (Personal, occupational and socioeconomic history): Some of the disease are more common in occupational population.

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Some diseases are more common in

certain economic status like malnutrition,

tuberculosis, rickets in poorer and

Diabetes, Heart disease in high society.

DISCUSSION:

In Charak samhita vimanasthana it has

been mentioned that the physician who are

unable to enter the soulful mind of the

patient with the help of enlighten

knowledge and fails to acquire the trust of

the patient are always unsuccessful in their

treatment . So it is mandatory for the

physician to have a full flesh knowlwdge

of various pariksha for a good clinical

practice. TrividhaPariksha is supreme of

all the methods .

Physician should be expert in Darshan,

Sparshan, prashnapariksha because it also

has application in modern diagnostic tests.

Xray , MRI, CTscan, Endoscopy , USG ,

these all are indirect Darshanpariksha

with the help of modern technology .

Sparshanpariksha like palpation,

percussion is also practice by every

physician in his day to day clinical

practice.

PrashnaPariksha

is

atmostimportance , and practioners should

be expert at this. In many cases half of the

symptoms of the patient is relieved just by

having a positive conversation with doctor

, because due to changing lifestyle many

of the disease are due to depression ,

mental stress . Proper case history can

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“A REVIEW ON TRIVIDHA PARIKSHA AND ITS IMPORTANCE”
guide us to right diagnosis without requirement of any special investigation. CONCLUSION: Trividhapariksha _comprises the aspect of Roga and Rogipareeksha which is an important clinical tool for assessment of diagnosis . 1. Rogapariksha – diagnosis of the disease 2.Rogipariksha – Examination of the patient . Trividhapariksha approach helps to cover the diagnosis as well as prognosis of diseases27. From the above we can conclude that Trividhapariksha i.e. Darshana, Sparshan, Prashna is soul of the Ayurvedparikshapadhati. It has great importance in clinical practise. Though various modern technology and laboratory test have arrived in today’s era, but Trividhapariksha still has as that spark and capacity to guide towards the proper diagnosis. Its importance has not faded. Trividhapariksha is boon to mankind. Proper Diagnosis without any advance expensive tests in clinical practise will facilitate more patients without financial hesitation. This will increase the number of skilled physicians. The coming era will be of physician based good clinical practise and other tests will be considered as a secondary source at the time of dilemma. REFERENCES: 1. Dr. SumitSrivastav, Comparative study of patient examination (RogPariksha)

IJMHS; Vol. VI, Issue: III, JUL-SEPT 2020
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“A REVIEW ON TRIVIDHA PARIKSHA AND ITS IMPORTANCE”

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