A review on Purisha Pariksha in Ayurveda

Abstract

Stool examination is an important laboratory investigative tool in medicine, which is used to understand the health and disease condition of a person. It is also included in Ashtasthana Pariksha. The factors which are described under Ashtasthana Pariksha indicate that these are the body parts or metabolic products, where there will be changes when a person suffers from diseases. Observing these changes, the diagnosis can be made, or these can help as tools in diagnosing a disease. The changes pertaining to Purisha (stool) have been described under various disease conditions in Brihattrayi but are scattered. Hence, a study is aimed to compile all such scattered data related to changes in stool in various disease conditions by following the scheme of Sushruta's Shadvidha Pariksha (6-fold examination). This will provide the first-hand information about the changes in stool and will act as a guide to diagnose the disease. Jala Nimajjana Purisha Pariksha is also another tool through which the status of Agni and the presence of Ama can be detected.

Introduction

In Ayurveda, Dosha-Dhatu-Mala concept is important to understand the body functions. Malas are the metabolic end products those are to be excreted. Malas are divided into two major parts that is Sharirika Mala (body wastes) and Dhatu Mala (metabolic wastes). Sharirika Mala is further classified into three parts that is Mutra (urine), Purisha (stool), and Sweda (sweat); and Dhatu Malas are further classified into seven types.[1] Purisha comes under Sharirika Mala. Both Purisha and Mutra are formed from the food.[2] After digestion, the Sarabhaga (nutrient portion) gets absorbed and the remaining undigested part becomes solid and that is called as Purisha. If Malas are not excreted from the body, the metabolic process will be impaired and this will ultimately lead to the formation of malformed tissues and diseases. Purisha Pariksha (stool examination) is included in Ashtasthana Pariksha.[3] In Ayurvedic texts, examination of stool is limited mainly up to the examination of physical characteristics such as color, quantity, odor, froth, and consistency. Besides these, a specialized technique of stool examination, i.e., Jala Nimajjana Purisha Pariksha has been described to detect the presence of Ama thereby inferring the status of Agni in the body.[4,5,6]

All the three classics of Brihattrayi were studied thoroughly, and the descriptions pertaining to Purisha were collected systematically. These observations were critically analyzed and grouped under specific headings under the scheme of Shadvidha Pariksha (6-fold examination) of Sushruta to provide the first-hand information about the diagnosis of diseases.[7]

Characteristics of normal Purisha

Characteristics of normal stool in terms of physical characteristics such as Gandha (odor), Sparsha (touch), Varna (color), and Vaishadya (unstickiness/clear) are not described separately in the ancient and medieval period texts of Ayurveda, but stool examination has been given due importance in context of the diseases. Only Pramana (quantity) of Purisha has been described by Acharya Charaka as Sapta Anjali Pramana.[8]

Importance of Purisha Pariksha

Purisha Pariksha as such gives information about so many physiological and pathological states of the body as listed below:

• Status of Agni (digestive fire)

• Symptoms of abnormal Doshas (body humors)

• Prognosis of diseases

• Presence of parasites.[9]

Method of Examination

There are two methods of Purisha Pariksha described in Ayurveda:

1. Physical examination of stool

2. Jala Nimajjana Purisha Pariksha to detect the presence of Ama.

Physical examination of stool

A great detail regarding the changes in physical characteristics of stool has been described under various diseases in Brihattrayi.

Chakshusha Pariksha (inspection)

Through Chakshusha Pariksha, one can assess color, consistency, presence of froth, abnormal constituents, etc.

Examination of color

The Pitta Dosha according to Ayurveda is responsible for the production of colors. Tridoshas also play an important role in affecting the color of stool as well as other parts of body. Vitiation of Doshas causes changes in different color. Some of the changes in color of Purisha is the characteristic features of several diseases [Table 1].

Table 1.

Change in color of stool in various diseases

Presence of froth

Froth in stool according to Ayurveda is due to Vata Dosha. The froth in stool is observed in different pathological states and diseases, which are Vata predominant [Table 2].

Table 2.

Presence of froth in stool in different pathological conditions/diseases

Changes in consistency

The consistency of the stool in terms of Sandra (dense), Baddha/Vibaddha (solid), Drava (watery), Bhinna (looseness), and Shushka (dryness) is observed in various types of disease conditions. The consistency Sandra is mainly due to Kapha Dosha, Badddha/Vibaddha, and Shushka is due to Vata Dosha and Drava, and Bhinna Purisha is due to the predominance of Pitta Dosha. Few disease conditions, where changes in consistency of stool observed, are presented in Table 3.

Table 3.

Changes in consistency of stool in various diseases

Ghranaja Pariksha (examination by odor)

By Ghranaja Pariksha, the odor of the stool can be examined. Changes in odor of stool also can provide information about the altered pathological state of Agni. Various types of odors have been described in the context of various diseases. Amagandhi (smell of Ama), Visragandhi (smell of raw meat), and Kunapagandhi (smell of dead body) are the typical odors found in many diseases [Table 4].

Table 4.

Change in odor of stool in various diseases

Sparsha Pariksha

Under this, Sheetata (coldness), Ushnata (hotness), Snigdhata (unctuousness), and Rukshata (roughness) of stool can be taken into consideration. Thus, on the basis of differences in touch only; one can diagnose the altered state or the diseases [Table 5]. However, practically, it is very difficult to assess.

Table 5.

Change in Sparsha (touch) of stool in various diseases

Prashna Pariksha (interrogation)

Prashna Pariksha is an important method of examination, which gives a lot of information about the condition of the patient. The same may be applied to obtain information related to frequency and amount of stool and associated symptoms such as pain [Tables 6 and 7].

Table 6.

Abnormal quantities/frequency of stool in various diseases

Table 7.

Type of pain during defecation in various diseases

Jala Nimajjana Purisha Pariksha (examination of stool by dipping in water)

This is the only objective method which was used in ancient times to detect the presence of Ama in stool. Ama is considered as an important cause not only for the gastrointestinal disorders but also as the cause of many systemic diseases such as Jvara and Amavata. To detect the early presence of Ama, a special methodology was used that is Jala Nimajjana Purisha Pariksha. In this method, by observing the behaviour of stool, i.e., whether it sinks or floats in water is noted down. If stool sinks, it indicates the presence of Ama. If it floats, then Ama is absent in stool.[10]

If the method analyzed critically as described in the text, it is observed that there are so many variables, which may alter the result if done by different persons. The probable variables, which may alter the results, are:

• Quality of water

• Quantity of water

• Testing container

• Quantity and consistency of stool

• Method of dropping stool.

Hence, the method should be standardized to obtain a reproducible result by taking into consideration of the above parameters. After standardization, it may be an instant method to detect the Ama in the stool.

Discussion

Ayurveda considers Dosha, Dhatu, and Mala as foundation of the body.[2] Mala is produced as a by-product of our daily activities. If Mala is not excreted from the body, the metabolic process will be impaired leading to the formation of malformed tissues. They are important for normal physiology of the body and each of them carries specific functions. Malas enable nutrition as well as the elimination of wastes from the body.

Purisha Pariksha has been given due importance in the ancient period, and it has been described in Ashtasthana Pariksha. Purisha, which is one of the main metabolic products of the body, shows changes in its characters in diseased conditions. These changes in Purisha in terms of its Rasa, Gandha, and Varna are described in various diseases along with other signs and symptoms. On review, only the scattered references were found about the changes in characters of Purisha in all the Samhitas.

Based on the scattered descriptions in the Samhitas, the abnormal physical characters of the stool may be classified in terms of abnormalities in Varna (color), presence of froth, consistency, Gandha (odor), Sparsha (touch), Matra (quantity and frequency), and associated factors such as pain. These abnormal characters may be used to diagnose various types of diseases or pathological conditions. Analysis of abnormalities in color of the stool indicates appearance of Krishna (black), Shyava (gray), and Aruna Varnas (reddish) in Vata predominant diseases, as vitiated Vata brings these colors. Similarly, the Shukla Varna (white) is seen in Kapha predominant diseases as Shukla Varna is the manifestation of vitiated Kapha. When Pitta is vitiated, it brings the changes Rakta Varna (red).

It is observed that the diseases having Kapha predominance show Sandra (dense) in consistency which is possibly due to the Sandra Guna (dense quality) of Kapha. Baddha/Vibaddha consistency are observed in the diseases mostly having Vata predominance and this may be due to the Shoshaka Guna (absorptive quality) of Vata, which absorbs the Kledamasha (liquid part) of the stool when vitiated. Similarly, when Pitta is vitiated it changes the consistency of the stool into Drava (liquid) due to its Drava Guna [Table 3].

Amagandha is due to the formation of Ama due to altered pathological states of Agni. Ama is mainly formed due to Mandagni, and the Amagandhi stool is observed in Amatisara. When Pitta and Shelshma Doshas vitiate, then they bring the changes in odor of the stool as Visragandhi, which is seen mainly in Paittika Arsha and Shleshmika Atisara. Kunapagandha is manifested when Tridoshas are vitiated and it is observed in the diseases, which is due to the vitiation of Tridosha that is Chidrodara [Table 4]. The various changes in stool due to vitiation of Dosha may manifest in the form of changes in touch as Sheeta (cold), Snigdha (unctuous), Ushna (hot), and Ruksha (rough). Sheeta and Snigdha are due to the vitiation of Kapha Dosha and mainly observed in Kapha predominant diseases due to its Sheeta and Snigdha Guna. Similarly, Ushna and Ruksha Sparsha are due to the vitiation of Pitta and Vata Dosha, respectively, due to their respective quality [Table 5].

Alpa Purisha (less in quantity) is due to mainly vitiation of Vata Dosha due to its Ruksha and Khara (coarseness) Guna. Hence, Alpa and Alpa Alpa Purisha is mainly seen in Vata predominant diseases. Similarly Atipravritti may be seen either in the disease having Pitta or Kapha predominant diseases due to their Drava and Kleda Guna, respectively [Table 6].

Besides the above description regarding the abnormalities in physical characters of Purisha, one important method of examination to know the presence of Ama in Purisha has been described under the Jala Nimajjana Pariksha in the context of few diseases such as Atisara and Grahani in almost all the Samhitas and in the texts of medieval period. This method is a definite and instant method to detect the presence of Ama in stool by observing the sinking and floating behavior of the stool on water. However, to get a reproducible result, it should be standardized.

Conclusion

Stool is an important by-product of the metabolism and reflects the changes occurring in the body in different pathological and diseased conditions. Hence, this has been given third place in Ashtasthana Pariksha after Nadi and Mutra. Abnormal changes in stool pertaining to its color, smell, consistency, frequency, and quantity have been described in various disease conditions. An attempt has been made to collect these scattered references from Samhitas at one place and one can refer these changes in stool for diagnosis of various disease conditions.

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Conflicts of interest

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