Rogi-roga prariksha. Patient examination.

Very briefly, Baghbath reveals how the physician diagnoses the patient by observation, palpation and listening. These three means are very extensive, but their interconnection and gradual deduction lead to the specific illness. One by one, sight, touch and hearing have to be used to find out and subsequently confirm the gradually revealed findings, again and again. It is like uncovering an asparagus root in the garden bed. The root be anywhere, but the look of the earth, where it is soft, or where it is cracked and hard, the direction of the leaves, the shape of the surface - all this suggests whether the root may be taken out in one piece, undamaged. Thus, the Ayurvedic practitioner uses his tools - sight, touch, hearing - in order to reveal the exact form of the patient's illness.

The Ayurvedic practitioner should use his sight to notice the balanced or unbalanced condition of the Doshas and Gunas of the patient's tissue. At the same time, he should observe the patient's behavior and movements (psyche). The examination by the means of sight does not only mean that we see, but rather that we find out the fluctuations of the Doshas by sight. We observe the patient's eyes, skin, nose, lips, palms, hands, legs, body form etc. We see the expressions of the Gunas such as dryness, unctuosity, easiness of movement, heaviness of movement, tongue condition as well as the condition of the sclera, etc. For example, we see swellings, shine, fullness of skin, emptiness of skin, smoothness or roughness of joints, etc. We see the facial expression, posture etc. All this leads the Ayurvedic practitioner to reveal the imbalance of the Doshas.

Next, the diagnosis uses touch. We investigate softness, toughness, smoothness, roughness, lightness etc. By sight, we may see a swelling, but we have to check whether it is tough or soft. Touch checks temperature, and touch together with observation specify what kind of swelling it may be. Thus, the Ayurvedic practitioner gradually comes closer to the conclusion of the Doshas disbalance.

Asking leads to the overall specification. For example, something may hurt, burn or itch the patient, etc. Thus, the previous thinking is confirmed. Subsequently, touch will find out the nature of circulation, speed, pulsation, strength, intensity etc.

To sum up: through observation, Ayurveda determines the fluctuations in the morphological tissue, body, organs. Palpation specifies the diagnosis and questioning confirms it.

All this is within the meaning of the word Gunas (properties). These lead to the specification of the Tridosha and then, by analytical thinking, questioning, refining, the diagnosis is gradually confirmed. The Ayurvedic practitioner thus narrows and refines his decision.

For example, a swelling that is cold, lacks pulsation and hurts the patient leads to the suspicion of Vata increase. In the next round of the diagnosis, the Ayurvedic practitioner concentrates on the expansion of Vata activity. This means how long this Vata stays in the body. This is found out by looking at the tongue. He sees cracks that confirm the presence of Vata expansion throughout the whole body over a longer period of life. Using questions he verifies what has led to the Vata increase, i.e., he recognizes the lifestyle (Ahar, Vihar, Dinacharya). He looks for the connection between that and the Vata increase. Of course, there are many other examinations that verify Vata expansion, such as information about sleep, menses, examination of the skin,information about defecation, etc. All this is related to the swelling. In this way Ayurveda uses analogous thinking about the interlaced Doshas, Dhatus, and lifestyle.

The practitioner goes through the other body parts, perceives the pulse by touch, asks about the duration of the illness, and finds out the history of the patient and his illness. He wants to detect whether there was an injury, or whether this is a prolonged condition lasting for decades, or if it is a reaction to a drug or food. By analogy, the damaged tissues are specified, i.e., whether it is Rasa Dhatu or Rakta Dhatu or Meda Dhatu etc., - and another round of identification begins, which is aimed at the organs affected by the illness or involved in it, for example, whether it is a swelling in which kidney is involved, or possibly the liver, pancreas, or spleen, or an infection, etc.

The examination then continues to specify the decision by looking at samples of urine and faeces, questioning about the process of urination and defecation, about the lifestyle, such as the sleeping, eating and drinking habits, and the regular use of drugs and their side effects. Then the practitioner continues the diagnosis by thinking and analogous reasoning. All the time he uses his three tools, i.e., sight, questioning and touch. These words are simple, but the methods are crucial and subtle - they provide complex information about the illness, from the patient's mental condition to its manifestations in the tissues.

Baghbath only suggests the diagnostic tools here, but to use them requires complete scope and knowledge of human bodily function according to Ayurveda and of the connection with the lifestyle. However, no examination of any illness may be generalized. Everybody is individual, and the Ayurvedic practitioner has to use intelligence in order to explore the illness.

To diagnose a patient's illness, darśana,  sparśana and  praśnai the key in Ayurveda. In modern medicine there is a great deal of reliance on laboratory tests - blood tests, Xrays, MRI, etc. This means doctors today are reliant on what lab technicians do or do not discover. 

The Ayurvedic technique of palpation involves a very wide range of what can be discerned, basically all of the gunas can be determined through the sense of touch as well as by observation. The questioning follows these two techniques. This means that 66 % of an Ayurvedic diagnosis is done by observation and palpation, and the questioning is used to confirm or refute parts of the diagnosis. The questioning covers the patient's history as well as their subjective symptoms. The questions include how the patient matured, what it was like for them to begin their individuation as an adult, how they dealt with failures, etc., as well as questions about what the person is focused on right now. These questions aid the practitioner with understanding how extensive and long-lasting the illness is. This means the practitioner has to comprehend what the normal, healthy state of a person is in order to diagnose deviations from the norm. We have to know what the body normally looks like and feels like - what are the eyes, the nose, the musculature, etc. supposed to look like. This requires learning, and that applies to anything that we are involved with. Once we know what is standard we can diagnose what is not standard. It is not necessary to have super complex diagnoses, what is important is to understand what is abnormal - but for this we must understand what is normal and standard. 

Observation and palpation involve comparing how the patient is to what we would normally expect to find and that helps us determine what the disease is and therefore its resolution, and if we restore the patient to normal that is success. Any disease is a deviation from the norm - the skin, blood, liver, mind all have their normal parameters that we have to understand, how can the norms be maintained, what is the normal function and process. When we learn this, it is not the same as going into business to sell medicine - learning is about understanding how and why things are as they are. 

The "laboratory" of Ayurveda is the sensory processing of the practitioner, therefore. We must understand what is meant by the senses here. This is not just about the sensory organ itself, but a whole apparatus and instrument. The instrument itself is separate from its input and output. The sense are not the organ. There are three parts of the senses:  the raw material for the senses (the sense object), the force of the processing (perception), and the perceiver. All three "live" in the sense organ. We must remember this.

When we consider the eyes, we normally consider a sketch of the eye as it exists in material form to be sufficient, but that does not tell us what we need to know about the three aspects of vision - what is seen, how it is processed, and who does the seeing. The perceiver who uses the senses is a representative of our inner core (man, buddhi, chitt, ahankar)- this means the mind (liking/disliking), the intellect, the memory and other aspects of cognition, and the ego with its drives. When we have cravings for chocolate, for example, it is our passions that drive us - the perceiver who ate chocolate and remembers it and wants more. Remember that when we look for things, we are drawing on our memory, we have a pattern we are trying to match in the outside world. When we are observing, though, we are comparing things as they actually are in the world, there is no pre-conditioning or expectation.

When we see something, we see what is, and we must determine whether it is normal or exceptional, and that requires intervention by the seer, by his mind, etc. - which means that the contents of our memory are important to recognizing what we see. When vision is functioning, we are able to understand whether what we are seeing is normal or not, and that is done by the mind of the viewer. This means we must learn what is normal and use the mind to explain the deviations we observe, verify them through experiment, and draw a conclusion. A person in whom learning is underway develops conclusions that can be used in this process. It is possible to draw an image in the mind of what is happening and then to augment that image by asking the patient questions.