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To confirm, evaluate and treat a disease, physicians need to perform clinical examinations of patients – wherein textual knowledge (aptopadesa), direct perception (pratyaksha) and inference (anumana) are all very important components. The examination of patients can be carried out in the following manners:

Visual observation (Darshan)
Tactile perception (Sparsha)
Questioning (Prashna)

Involves the examination of pulse, tongue, voice, skin, eye, general appearance, urine & stool.

Examination of the pulse ( nadi pariksha) :
The foremost clinical art in ayurvedic diagnosis it can provide deep insights into the history of the patient. The ideal time for pulse examination is early morning in empty stomach. But in case of emergency, it can be examined at any time of the day or night. An experienced ayurvedic physician can assess your body’s nature ( prakriti), pathological state ( vikruti), imbalances of body type, very subtle observations & even prognosis of disease through the pulse.
Examination of the tongue ( jivha pariksha) :
Assessed through its doshic state, a vata aggravated tongue is dry, rough & cracked, pitta suffered tongue is red with a burning sensation and kapha influenced it is wet, slimy and coated. Suggesting the state of the digestive system.
Examination of the voice ( sabda pariksha) :
Healthy and natural when the doshas are in balance, the voice will become heavy when aggravated by kapha, cracked under pitta effect and hoarse & rough when afflicted by vata.
Examination of skin ( sparsha pariksha) :
Also used for assessing the state of organs and tissue, palpation is an important clinical method for examination of skin. Noted for doshic influences, a vata aggravated skin is course & rough with below normal temperature, a pitta influenced one has quite high temperature and kapha effected it becomes cold & wet.
Examination of eyes ( drka pariksha) :
Vata domination makes the eyes sunken, dry and reddish brown in colour. On aggravation of pitta, they turn red or yellow and the patient suffers from photophobia and burning sensations. High kapha makes them wet & watery with heaviness in the eyelids.
Examination of general appearance ( akriti pariksha) :
The doshic influences that reflect on the face of the patient enables physicians to gauge the basic constitution and the nature of the disease.
Examination of urine ( mutra pariksha) :
Both examination of urine sample and questioning of patient are important for assessing doshic influence. A modification of this is the oil ( taila) drop ( bindu) test ( pariksha) in which the effect of an oil drop on urine sample suggests the curability of disease.
Examination of stool ( mala pariksha) :
If digestion & absorption of food are poor, the stool carries a foul odour and sinks in water. Vata aggravated, the stool is hard, dry and grey / ash in colour. Excess pitta makes it green / yellow in colour and liquid in form. And high kapha lines it with mucus.

Covers body constitution, pathological state, tissue vitality, physical build, body measurement, adaptability, psychic constitution, capacities for digestion & exercise and age.

Body Constitution ( prakriti) :
Determined by relative predominance of doshas during foetal development the prakriti can be any of vatika, paittika, kaphaja, vata paittika, vata kaphaja, pitta kaphaja or samdoshaja.
Pathological State ( vikruti) :
Related to the biological history of the diseases in its entirety, it enables physicians to consider the signs & symptoms of the disease in order to assess the strength of the disease, the causes, the doshas, the affected body elements, body constitution, time and strength of an individual.
Tissue Vitality ( sara) :
Broadly speaking, there are seven vital tissues, namely lymph (rasa), blood (rakta), muscle (mamsa), adipose (meda), bone (asthi), bone marrow (majja) and reproductive tissue (sukra).
Lymph in the skin is assessed by its smoothness, softness, clearness, thinness and whether the skin is covered with short, deep rooted and delicate hair.
Percentage of blood in body is evaluated from the condition of the eyes, mouth, tongue, lips, nails and soles of the feet.
When muscles are in perfect condition, the temples, forehead, nape of the neck, shoulders, belly, arms, chest, joints of the body, jaws and cheeks are covered firmly with the skin.
People with healthy adipose tissue have oily skin and healthy hair, nails, voice and teeth.
The health of bones is determined by pliable but firm forearms, chin, nails, teeth, ankles, knees and other joints of the body.
Healthy bone marrow leads to good complexion and stout, long, round & stable joints.
Those in whom the semen is perfectly healthy, are strong and cheerful.
Physical Build ( samhanana) :
Body examination is carried out by direct perception – a healthy body being well- built with symmetrical bones, strong & stable joints and enough flesh & blood.
Body Measurement ( pramana) :
In Ayurveda, body measurement is given in terms of finger breadth and any person in close proximity to the ideal measurements is termed as normal and healthy.
Adaptibility ( satmya) :
Indicating substances intrinsic to the body, it refers to two types of people - those that are strong, adjust easily to difficulties and have excellent digestive capacity and those that are generally weak, intolerant to change and can have only few food options.
Psychic Constitution ( satwa) :
Refers to the mind which controls the body in contact with the soul (atma). Depending on degree of mental strength, it is considered to be high, moderate or low. To know more about your body type,
Digestive Capacity ( ahara sakti)
This has to be judged from the individual’s capacity to ingest and digest food substances.
Capacity for Exercise ( vyayama shakti)
Assessed by capacity for hard work, it is either low, moderate or high.
Age (vaya)
Broadly categorised into childhood, middle age and old age, it provides vital clues for the diagnosis & treatment and is a must consideration in clinical examinations

Indian medicine names three main causes of disease – Asatmendriartha-samyoga, pragyaparadha,and parinama ie 'overuse', 'disuse' or 'misuse’ of faculties; 'errors in judgement'; and influence of seasonal changes are general causes which produce disease’

It is the Ayoga ,Atiyoga and Mithyayoga of karma or action which has been defined as any effort of the body ,mind and speech and also any harmful or undesirable action perpetrated by anybody,who has lost his understanding ,intellect or memory.

It is another name of Kala or time ,inflance of seasonal changes produce the disease.

Disease classification

Diseases are classified primarily as Sarira and Manasika.These are also classified as Nija and Agantuja and also classified based on sadhya and sadhyatwa .Susrutha gave an exhaustive classification,he said that anything wich afflicts the body inclding mind is a disease and than that afflication or pain may be of thee types ie –Adhyatmika ,Adhibhautika,and Adhidaivika

Consists of ailments as obstinate skin diseases, hemorrhoids, diabetes, tuberculosis and asthma that arise primarily due to defects in the sperm ( sukra) of the father – when it is called pitrija or the ovum ( sonita) of the mother – when it is termed matrja.

Undigested food, abnormal behaviour, addiction of any type and stressful situations affect the reproductive elements of both the male and female, resulting in a defective foetus.

Caused essentially due to nutritional disorder ( rasakrita) and unfulfilled cravings of the mother during pregnancy ( dauhrdya)

If diet and / or conduct of the mother aggravates vata, the foetus might end up with deformities as kyphosis (hunchback), blindness and dwarfism; increased pitta may cause alopecia and yellowish pigmentation of skin; and enhanced kapha might result in albinism.

Arise out of any dietary or behavioural disturbance brought about by an imbalance in any one of the three vital physical energies ( Tridoshas) or the three vital mental energies ( Trigunas).

Thus constitutional disorders are of two types : somatic ( Sharirika) & psychic ( Manasika).

This is due to any disturbance in the physical environment of a man .It is of one type

Undergoing any trauma causing experience – external or internal – leads to this.

External trauma is induced by injuries inflicted by sharp instruments and bites of animals or venomous insects.

Sometimes the body fails to adjust itself to the sudden and abnormal climatic changes – extreme cold might lead to frostbite and rheumatic disease. While extreme heat may cause sunstroke or fever.

Either born out of natural calamities as lightning, earthquakes, floods and the invisible, malignant forces of nature.

Or contacted through sexual & physical intimacy and sharing of food, plates, bed, clothes, towels and cosmetics with effected friends & relatives. Or as a result of sheer jealousy.

Even the healthiest of people are struck by hunger, thirst, sleep, death or senility.

Samprapti, the Disease Process

According to Ayurveda, health is a state of balance between the body, mind and consciousness. Within the body, the three doshas, seven dhatus, ; three malas, or wastes; and agni, the energy of metabolism. Disease is a condition of disharmony in any of these factors. The root cause of imbalance, or disease, is an aggravation of dosha, vata-pitta-kapha, caused by a wide variety of internal and external factors. According to the attributes of these different etiological factors the bodily humors become aggravated and start to accumulate at their respective sites. If the provocation continues, the accumulated dosha reaches a state of overflowing the original site and spreads throughout the body. The aggravated dosha then enters and creates a lesion in a specific weak tissue where pathological changes are manifested in the organ or system.

The early signs and symptoms ( purvaroopa) provide useful warnings and the opportunity for taking necessary action before a disease can assume dangerous magnitudes. The main signs and symptoms ( roopa) reflect the true nature and intensity of the disease. Another oft used method of diagnosis is exploratory therapy ( upasaya) which uses diet, medicines and routines to detect diseases otherwise difficult to diagnose. Acting either against the cause of disease or the disease itself or producing relief. For example a swelling that is alleviated by an oily & hot massage, is obviously caused by an imbalance of vata.

The imbalance of doshas and the course they follow to cause disease is termed samprapti or pathogenesis. Since diseases develop in distinct stages, a good knowledge of those helps in early recognition of disease. Ayurveda thus elaborates a six stage process for diagnosis called Kriya (action) Kal (time). The first 4 stages being unique to Ayurveda in that they permit recognition and elimination of the disease before it ventures into differentiated clinical symptoms.

One who knows the various stages of pathogenesis accumulation ( sanchaya), provocation ( prakopa) spread or migration ( prasara), deposition or augmentation ( sthana samshaya), manifestation ( vyakti) and the differentiation ( bheda) is entitled to be a physician.

Here toxins ( ama) produced by improper digestion collects in the gastro-intestinal (GI) tract.

Toxins resulting from a kapha imbalance accumulates in the stomach, those associated with a pitta imbalance collects in the small intestine, and that related to vata malfunction amasses in the colon

Due to the presence of one of these toxins, mild and ill-defined symptoms may show.

We should recognise and eliminate the cause instead of ignoring or suppressing it.

the accumulated, stagnant doshas are now `excited’ by factors as ahara, vihara & seasons.

The toxins amass in such degree to get provoked in the site of production in the GI tract.

Generally, up to this stage the damage is entirely reversible and restoration of doshic balance can be achieved with proper measures. Or there may be spontaneous prashama (remission) influenced by seasonal changes. Thus there is sanchaya of pitta in rainy season, prakopa in fall and prasara in early winter. Based on degree of excitation, it might even passed the stages of prashama or prasara.

Overflowing toxins migrate, entering and taking refuge in localised, weak or defective dhatus thereby leading to malfunction and structural damage.

It is from here that specific degenerating disease and susceptibilities to serious infections begin.

Manifested symptoms being used by modem medicine for classification & diagnosis of disease.

The disease having taken taken years or even decades to reach this final stage, becomes chronic.

Offers detailed understanding of the group of symptoms thereby making clear nature of disease. Might act as predisposing factors for the spread of other diseases.

Diagnosis process	Disease classification
Cause of disease	Samprapthi