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Ayurvedic Concepts and tools of diagnosis and treatment

Ayurvedahas elaborated various concepts and tools to understand disease. The focus is mainly on liGgas, which enable one to recognize and understand a disease and then on tests or investigations, which enable one to understand a disease when, liGgas fail to do so.

The conceptual framework evolved in Ayurveda for rigorous observation and analysis of liGgas is called the paJcalakSaNa nidAna.

In addition, there are various tools for diagnosis like examination of urine, feces, pulse and so on to understand disease when liGgas are evasive.

Methods to study disease

The paJcalakSaNa nidAna provides a very broad framework to understand the mechanism of disease causation. It consists of five steps.
1. nidAna — aetiology,
2. pUrvarUpa — premonitory symptoms,
3. rUpa — symptoms,
4. upazaya — Diagnostic medication, and
5. saMprApti — pathogenesis.
Half the work is done if causative mechanisms are identified and removed. Therefore, Ayurveda lays emphasis on detecting causes that have operated behind causation of disease.

Arresting the disease causing mechanism can effect a cure in conditions where the disease process is being triggered into manifestation by causes. This will not work when the disease process begins to operate independent of triggering causes. In such cases, it is necessary to know what has happened in the body so that necessary actions can be performed to reverse it.

This is done by first systematically observing premonitory signs and full-blown clinical signs. On the basis of a thorough analysis of signs and symptoms a hypothetical assumption of the disease process is arrived at. This is confirmed by giving a test medication and the final picture of the disease process is sketched.

Tools and techniques of diagnosis are used in the broad framework of the paJcalakSaNa nidAna to arrive at specific and factual understanding of the disease process.

Tools and techniques of diagnosis

paJcalakSaNa nidAna enables one to arrive at a tentative diagnosis. Very often it has to be confirmed with the help of tests to arrive at a final diagnosis.

The various tools and techniques developed by Ayurveda to arrive at final diagnosis are
1. Pulse examination
This technique is used to mainly understand the disease origins in terms of the imbalance of vAta, pitta and kapha.
2. Urine examination
Special methods of urine examination have been mentioned in Ayurvedic texts to gain specific understanding of disease origins and processes including prognosis.
3. Blood examination
Though Ayurveda did not know chemical tests, physical examination of blood and its administration to animals have been mentioned.
4. Examination of eight entities
Pulse, urine, feces, tongue, sound, touch, eyes and physique constitute the eight entities that can be examined to understand disease.
5. Diagnostic medication
Medicines are given to confirm a tentative diagnosis.

Concepts and Tools of treatment

In the ultimate analysis, everything in this Universe can potentially be used as medicine. At a more practical level, only those substances whose medicinal properties and application have been discovered are considered as medicinal. Changing health problems demand discovery of new drugs. So drug discovery is an ongoing process.

For successful treatment, potent drugs formulated and processed have to be used effectively on the basis of sound concepts. Skill in Ayurvedic treatment consists of a thorough grounding in concepts of treatment and perfect knowledge of drugs.>br>
Ayurvedic textbooks have elaborated such concepts of treatment at length and deal systematically with the knowledge of drugs.

The concept of two-fold therapy is the corner stone of Ayurvedic therapeutics. On this foundation has been erected the edifice of specialized therapeutic strategies.

The twofold therapy

Ayurveda recognizes that the goal of all physiological activities is to achieve balance between conservation, conversion and utilization of energy. This is implied in the concept of tridoSas. Therefore, Ayurveda explains that imbalance of these processes underlie all diseases. Diseases are caused when the system goes into a mode of conservation and is unable to convert and release energy for the basic activities of life. This group of diseases is known as santarpaNa rogas. Diseases manifest also when the body converts and utilizes more energy than is conserved and eventually reaches a stage when it runs out of fuel. This group of diseases is known as apatarpaNa rogas. Since there are two basic pathways for manifestation of diseases, there are two basic solutions to diseases. Treatment methods that enable the body to convert and utilize energy are called as laGghana or Depletive therapy and those that enable the body to convert and preserve energy are called as bRmhaNa or Repletive therapy.

Patient and disease oriented therapeutic modules

The concept of the two-fold therapy is too general to be applied effectively in all diseases. Ayurveda has further expanded this concept to make it oriented to peculiarities of the patient and disease.

langhana therapy is divided into two major categories viz., zOdhana — eliminative and zamana — corrective.

In many santarpaNa diseases, the body can be brought back to balance only when accumulated matter is removed from the system. This is achieved through zodhana. There are mainly five types of eliminative therapies. They are a) vamana or emesis, b) virecana or purgation, c) zirovirecana — cleansing the head by nasal medication, d) vasti — enemata and e) raktamokSa — blood letting.

Some santarpaNa diseases can be cured without zodhana therapy. In such diseases, medicines are given to enable the body to convert and utilize unused matter. There are mainly seven types of zamanatherapy. They are a) dIpana — activating digestion and metabolism,

b) pAcana — therapeutic digestion and metabolism,
c) kSut — Fasting with water,
d) tRT — Fasting without water,
e) vyAyAma — Exercise,
f)Atapa — Exposure to sun,
g) mAruta — Exposure to wind.

apatarpaNa diseases have to be managed by bRmhaNa or depletive therapy.

Specific treatment programs are devised with selected drugs on the basis of the above principles.

Tools and techniques of Ayurvedic treatment

The tools for executing Ayurvedic treatment are the drugs. Ayurveda tells us that such tools need not be substances but can also be specific spatio-temporal situations. Even as Ayurveda talks about the substances of plant, animal and mineral origin that can be processed into drugs, it discusses on the therapeutic properties of sunlight, moonlight, winds and the like. Thus, Ayurveda recognizes two types of treatment — with and without substances called technically as sadravya and adravyacikitsA. Not every medical problem requires a drug for cure and not every consultation has to end up with a prescription for drugs.

However, majority of diseases does require drugs and Ayurveda deals systematically with drug sources and techniques of processing them into drugs. Ayurvedic drugs are derived from plant, animal and mineral sources. Classical Ayurveda is plant based whereas medieval Ayurveda emphasized on usage of mineral substances as medicine. Thus we have two types of Pharmacopoeia in Ayurveda, one that is predominantly plant based but includes a small number of animal products and minerals; the other that is almost exclusively based on minerals. The usage of mineral substances led to development of novel concepts in treatment and drug processing, so much so that it evolved into a specialty called as rasazAstra