Tenfold Examination of Patient Strength
For adequate management, it is essential to evaluate the exact strength of the patient as well as the disease. For this, Charaka advocates a tenfold clinical examination (Dashavidha Pariksha).
- Body Constitution :- First the basic or birth constitution of the person must be determined. This is the main background factor in all treatment. The constitution is of seven types as already discussed: Vata, Pitta, Kapha, Vata-Pitta, Vata-Kapha, Pitta-Kapha and balanced Vata-Pitta-Kapha.
- Disease Condition :- Determination of the particular disease is the major object of the clinical examination. Under this heading, one has to assess the causative factors, aggravated doshas, affected bodily tissues, habitat, time, strength, signs and symptoms. As the strength of the disease can be assessed only by the consideration of this factor, the entire clinical examination is designed to elucidate its nature.
- Tissue Vitality :- The seven types of tissues - plasma, blood, muscle, fat, bone, marrow, and reproductive are examined for the assessment of their optimal state along with the examination of the mind. A person having particular tissue vitality does not suffer from diseases affecting that tissue. Note the section on Tissue Sara.
- Body Build :- This refers to the compactness and tone of the tissues like bone, muscle, and blood. Generally, it means a well-built body in which the bOl1es, are symmetrical and well distributed, andin which the joints are well bound with enough flesh and blood. Such persons are strong; those who appear contrary, with weak or flaccid muscles and joints, are weak.
- Body Measurement
:- Proper proportion of the body and limbs indicates health. Improper proportion shows disease. This factor has already been discussed .under Measurement of Body Proportion.
:- Substances which are homologous, or of like nature to the body, are known as "Satmya." Individuals for whom ghee, milk, sesame oil and all the six tastes are adaptable are strong, tolerant of difficulties, and long lived. Those who have adapted to only a few things, who are hypersensitive or intolerant of many things, are generally weak and short lived.
This factor of adaptation is very important in health and disease. We easily habituate ourselves in life, including to health matters of food, exercise and medicines. If we are habituated to bad food, wrong exercise and to a poor health regimen, then our health will not be good. For this same reason, treatment takes time, as habits must change. Similarly, we should strive to create good habits in children so that they don't become habituated to what is harmful for them.
- Mental Nature
:- The mind is the controller of the body as long as it is in contact with the soul. According to its degree of strength, the mind is graded as either high medium or low. Accordingly, individuals have three types of mental constitutions according to the three gunas of Sattva, Rajas and Tamas. Those who are predominant in Sattva possess high mental strength. Those predominant in Tamas possess low mental strength. Those predominant in Rajas fall in the middle. Mental constitution has been described in detail elsewhere in this text.
- Capacity for Food
:- The capacity for food is to be judged from the ability to ingest and digest food and by regularity of the appetite. Good capacity for food indicates health, while poor capacity shows disease. That is why loss of appetite or dislike of food is' a common symptom of many diseases starting with the common cold.
- Capacity for Exercise
:- The capacity for exercise is judged by the capacity for work. From the capacity for work, three degrees of strength - low, moderate and high - can be determined. Those who have fatigue upon slight exertion are low in strength. Those who do not fatigue even after severe exertion are high in strength. The rest fall in the middle.
- Age :- Age is broadly divided into three phases: Childhood, middle age and old age. Kapha, Pitta and Vata energies are more predominant during .childhood, middle age and old age respectively. Diseases occurring in these age groups should consider the dosha governing that stage of life. Particularly for elderly people, Vata should always be considered in treatment, regardless of their birth constitution.