An Important Tool In Clinical Decision Making

Introduction
 
Prakriti or constitution of a person is determined at conception. Each person is born with one of the seven prakritis, vata, pitta, kapha, vata-pitta, vata-kapha , pitha-kapha or sama prakriti. Ayurveda does not comply with the ‘general line of treatment approach’ of modern medicine. As it is a complete health treatise which restores the balance of doshas in the body thereby ridding the body of the disease.

The concept of prakriti is unique to Ayurveda. Prakriti pareeksha is done by the physician by observing physical characteristics , traits and interrogation of the patient. This is the base on which a treatment can be planned for the patient. Predisposition to certain diseases is due to one’s prakriti. The knowledge of Prakriti gives an Ayurvedic physician a cutting edge in his/her approach to disease management. Understanding of prakriti may even help prevent certain diseases in future in healthy persons. Patients receive the dignity due to them in this personalized form of treatment. In contrast the modern approach reduces a patient to a mere case.

Ayurveda places the study of Prakriti or constitution of a person high in the different steps leading to clinical decision making. It is not surprising to note that Prakriti Pareeksha(study of the constitution) is done prior to Vikruti Pareeksha(study of the disease pathology).

It is common knowledge that no two individuals are alike. Why should then there be a common line of treatment for different individuals suffering with the same disease?. How scientific is it to generalize treatment without taking into account the differences in personality and constitution of different people.

Can body weight be the only criterion for administering a medicine? These and some other basic questions regarding health and treatment were addressed at least 5000 years ago by our rishis. Prakriti Pareeksha is one such unique concept of Ayurveda the relevance and significance of which will be dealt with in this paper.

The Panchamahabhutas manifest as tridoshas, vata, pitta and kapha in the human body. These are responsible for every aspect structural, physiological and pathological, of the human body and mind. The predominance of one or more of the tridoshas at the time of conception gives rise to Prakriti.

Samapithanilakaphah kechidgarbhadi manavah|
Drishyante vatalah kechitpittalah sheleshmasthatha||
Teshamanaturah poorvi vataladyah sadatwah||
Doshanushamita dyesham dehaprakritirushyate||
— Ch.Su.7.39-40

From the moment of conception some men are equi-balanced as regards the three doshas-vata, pitta and
kapha and some have a predominance of vata, some of pitta, and some of kapha. Of them the rest are
even liable to disease. Their body type is named according to the continual predominance of a particular
dosha in the body.

Prakopo vaanyabhavo va Kshayo va Nopajyayate|
Prakriteenam Swabhavena jayate the gatayushah||
— Su.Sha.4-78

The constitutional condition does not change, it neither increases nor diminishes except at the end of
life. While Prakriti cannot be altered, a good understanding of it can help prevent diseases and keep one
healthy.

Prakriti has been classified into three main types- vata, pitta, kapha. In reality however Dwidoshaj
prakriti (involving two doshas) has been seen in majority of people with varying percentages of the
doshas. Sama prakriti or prakriti incorporating the positive aspects of all the three doshas leaving out the
negative aspects is very rare.

The following table indicates the comparative characteristic features of vata, pitta and kapha Prakriti.

Application of Prakriti Pareeksha.

1. Diagnosis of Prakriti Leads to Diagnosis of Vikruti.

It is said that everything about a patient, right from how he enters a doctor’s chamber to his speech, his way of sitting, his body language and build give an indication of his prakriti. A doctor observes keenly the prakriti of a patient even before he starts relating his complaints. Certain prakriti types are susceptible to certain diseases. Armend with this knowledge, a doctor nows what questions have to be put to the patient to diagnose the vikruti(roga).

2. Prevention of Illness

When prakriti has been diagnosed the doctor is also in a position to forewarn the patient regarding future illness he may be vulnerable to.

3. Proper Management of Diseases.

An overall understanding of prakriti makes it easy to manage a disease in the best possible way. Suitable Ahara(diet) Vihara(regimen) and Aushadha(medicine) may be prescribed to suit one’s prakriti along with other measures for Vikruti management. This helps in speedy recovery.

4. Minimizing Adverse Reactions to Treatment

If prakriti is not taken into consideration in a person who suffers with an illness contrary to his prakriti type treatment may go wrong and lead to adverse effects. For instance if a pitta prakriti person is suffering with a phlegmatic disorder like pneumonitis and only the aggravated vata and khapa are treated with vata kapha shamaka drugs disregarding his prakriti it may lead to pitta aggravation causing the patient much distress. A doctor would administer only such medicines to him which would calm vata and kapha while not aggravating pitta.

Prakriti Pareeksha and Contemporary Diseases.

1. Susceptibility of vata Prakriti to vata Related Disorders

The ruksha and khara swabhava of vata subject the vata Prakriti person to dry skin diseases like eczema and blakish discolouration. The quickness of vata or in other words the faster metabolic rate in vatala person trends to keep him underweight. He or she is quite inclined to suffer with Asthishosha or osteoporosis. The shortage of moisture or synovial fluid in the joints due to vata causes sandhivata at an earlier age. The chanchala swabhava of vata causes restlessness and instability. This also makes a person prone to worry. Vata Prakriti person sleeps lightly. Hence his capacity to endure hardships is less compared to other prakriti types. Hence it is not uncommon to see vatala persons suffering with stress related disorders like headaches, hypertension, anxiety and unexplained pain like fibromyalgia. A vata Prakriti person is also prone to udavartha(constipation) and Udarashoola(pain in abdomen).

On the positive side this person is free from worries of weight management and diseases related to obesity. In case he suffers with Hridrog(cardiac disorders) it is not due to sedentary life style or obesity but due to poor stress management skills. Hence meditation may be a better option for him compared to brisk walking.

2. Susceptibility of pitta Prakriti type to pitta Related Disorders.

Pitta being ushna gives the person a warmer body temperature. Even ordinary fevers may shoot up to high temperatures in pittala person compared to other prakriti types. The foul smelling pitta is responsible for body odour. Infections may lead to suppuration easily . Skin eruptions and rashes are common. Excessive sweating coupled with body heat may give rise to fungal infections. The body heat is also responsible for premature greying and baldness. Pitta Prakriti people get provoked quickly. Anger management is always an issue for them. This leads to undue stress and mental disorders. The amla swabhava of pitta causes Amlapitta or Hyperacidity. Hunger and thirst endurance is quite poor. Daha or dehydration is common. Mouth Ulcers, Bleeding disorders, Burning sensation in any part of the body are commonly encountered in pitta prakriti individuals. On the positive side they are less prone to Colds, Sinusitis, Asthma and Joint stiffness.

3. Susceptibility of Kapha Prakriti individuals to kapha Related Disorders.

The cold and dense quality of kapha makes these individuals prone to respiratory diseases like Rhinitis, Sinusitis and Bronchitis. The slowness or Mandatwa of kapha keeps the metabolism at a lower than optimum level. Hence this prakriti type is prone to metabolic disorders like Diabetes, Obesity and Hypothyroidism. The Gurutwa aspect of kapha causes Oedema in the body. On the positive side, they have good stamina and stable mind set. Physical exercises help them immensely.

The Many advantages of adhering to Prakriti Pareeksha.

1. This unique concept when applied in practice leads to proper diagnosis of Roga or disease.

2. Proper diagnosis leads to satisfactory treatment

3. Educating the patient on his Prakriti type enables him to take measures to prevent diseases in future.

4. There is little scope for adverse reaction or undesirable side effects with this approach.

5. It builds a healthy doctor-patient relationship. The patient realizes the effort put in by the physician in understanding him and hence is very cooperative during the course of treatment.

6. It reduces financial burden on the patient. When a doctor carefully evaluates Prakriti by physical examination and interrogation, the need for costly laboratory investigations reduces.

7. The complaints of patients in psycho-somatic diseases cannot be verified or confirmed by laboratory investigations. Prakriti pareeksha and Vikruti pareeksha are the only options in such cases.

The basic aim of treatment in Ayurveda is restoration of equilibrium of doshas rather than curing of disease, prakriti pareeksha is one of the most important tools employed by an Ayurvedic physician in management of diseases. Each patient is an individual, not a case, requiring an individualized plan of treatment for Ayurveda as a scientific systems adopts a person centric approach not a disease centric one. This is the hallmark of Ayurveda and this is what makes it the safest and most effective therapy.

References:
1. Charaka Samhita, Volume II by R.K.Sharma, Bhagavan Dash, published by Chaukamba Sanskrit series Office, Varanasi.
2. The charaka Samhita Volume I, Jaikrishnadas Ayurveda Series 151, by Chaukamba Orientalia, Varanasi
3. Sushrata Samhita, Part-I , Chaukhamba Sanskrit Sansthan,varanasi

This article is written under the guidance of HOD Vd. Kalyani Jadhav and GUIDE-Vd.Kavita Deshmukh Sumatibhai Shah Ayurved Collage Hadapsar, Pune 28