|Year : 2012 | Volume
| Issue : 4 | Page : 149-150
Clinical diagnosis in Ayurveda: Challenges and solutions
P Ram Manohar
Managing Editor, Ancient Science of Life, Director and CSO, AVP Research Foundation, Coimbatore, India
|Date of Web Publication||18-Feb-2013|
P Ram Manohar
Managing Editor, Ancient Science of Life, Director and CSO, AVP Research Foundation, Coimbatore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Manohar P R. Clinical diagnosis in Ayurveda: Challenges and solutions. Ancient Sci Life 2012;31:149-50
Ayurvedic nosology is based on the concepts of pathology that are different from those of the International Classification of Diseases (ICD). A comprehensive Ayurvedic classification and nomenclature of diseases has not yet been developed in contemporary academic environs of Ayurveda, albeit attempts have been made to create working lists and even to find the correlation between Ayurvedic disease terminologies and the ICD nomenclature .
In the present scenario, there is a need to develop a comprehensive classification and nomenclature for diseases from the Ayurvedic perspective. It would make sense to refer to this as the Ayurvedic Classification of Diseases (ACD). This is indispensable for effective communication within the community of Ayurveda.
We are in such a situation today that we need to use both ICD and ACD when reporting clinical outcomes in Ayurveda. Without modern scientific terminology of diseases, it may become difficult to not only communicate effectively, but also to negotiate with regulatory authorities, insurance, and mainstream science. On the other hand, if we ignore the Ayurvedic classification and nomenclature of diseases, we are at the risk of losing the unique individualized multimodal approach of Ayurveda to maintain health and treat diseases.
Ayurveda and modern medicine are derived from different epistemological and ontological premises. Therefore, the approach to diagnosis of diseases as well as nomenclature differs. It is quite impossible to make one to one correlations or pick up equivalent terms. For example, anemia in modern medicine is not exactly Pāndu, which in a broader sense includes many other clinical conditions. Similarly, Prameha is not exactly diabetes mellitus. On the other hand, there are many diseases that can be correlated in a fairly straightforward manner. Hemorrhoids and fistula in ano are examples, which correlate well with the conditions known as Arsas and Bhagandara, respectively, in Ayurveda.
In fact, there seems to be three categories of diseases that we can arrive at when we think of the possibility of correlating Ayurvedic and modern disease nomenclature. First of all, there are the diseases that match in description such that a one-to-one correlation is possible. Then there are the diseases that seem to strike resemblance but cannot be correlated as exact equivalents. Finally, there are the disease entities described either in Ayurveda or in modern medicine, which seem to be not mentioned at all in the other system. For example, it is difficult to find an equivalent for Raktapitta in modern medicine. Similarly, Ayurvedic equivalents are not found for conditions like multiple sclerosis and Guillain-Barre syndrome.
The problem gets compounded with differences of opinion amongst the Ayurvedic physicians. For example, there are some physicians who would consider Pāndu as anemia, while others would include even conditions like leukemia under this disease. There are yet other physicians who correlate hypothyroidism with Pāndu. The difference of opinion between the Ayurvedic physicians of Kerala and those from the north of India regarding rheumatoid arthritis is a well-known example. The former consider this condition to be Vātarakta, while the latter equate it with āmavāta. Some physicians consider cancer to be a type of Vidradhi, which is otherwise understood to be a huge abscess. Others consider cancer to be Arbuda, and there are also those who opine that conditions like Gulma also resemble cancer in certain stages of the disease. These opinions add to the confusion rather than create clarity in these matters.
As a preliminary exercise, it would be helpful to even list the names of diseases that would fall under the above categories pointing out difficulties in correlation, which could be taken up for further studies.
At this juncture, a pertinent question may be raised regarding the updating of the Ayurvedic nomenclature of diseases. For that matter, is there a scope at all to update Ayurvedic nosology? The classical texts are explicit when it comes to nomenclature of diseases. The Caraka Samhitā mentions that the teaching targets both listed (ukta gada) and unlisted (anukta gada) diseases.  The implication is that the text deals with the principles of etiology and pathology of diseases. With this understanding, the physician is expected to study and discover treatment strategies for the unlisted diseases. Over the centuries, the later textbooks have indeed documented new diseases by coining new names and describing symptomatology and treatment.
We can find that diseases can be classified once again into three categories from this viewpoint. Broadly, there are the diseases that have been listed in the texts (ukta gada) and the ones that have not been listed (anukta gada). Some of the listed diseases can be identified exactly as described in the texts. We may call these diseases as yathokta vyadhi. There are diseases that have some semblance to textual descriptions but are not exactly matching with the clinical presentation. These diseases may be called as ayathokta vyadhi.
Yet another preliminary exercise would be to create a list of the yathokta, ayathokta, and anukta categories of diseases.
These exercises would provide the background for developing an adapted system of nomenclature for diseases in Ayurveda, which would be internally consistent and also allow a working correlation with modern nomenclature of diseases to the extent possible.
Ayurvedic texts strongly emphasize that it is not necessary to name every disease.  The understanding of the disease in terms of nidāna (etiology), dosa (dysfunction), and dūsya (target tissues) as well as the stages of progress of the disease was considered to be crucial in succeeding in the treatment. For diseases that have not been named or listed in the texts, it would make sense to attempt to derive Ayurvedic descriptions based on the above principles. 
The need for Ayurvedic nomenclature and classification of diseases is obviously to preserve the individualized approach to treatment. Without an Ayurvedic diagnosis, it is difficult for an Ayurvedic physician to visualize a complete Ayurvedic treatment. When the disease is diagnosed in terms of modern medicine, Ayurvedic physicians tend to apply the principles of modern medical treatment when choosing Ayurvedic therapies. For example, if a condition is diagnosed as anemia instead of Pāndu, the physician tends to choose medications like Mandūra Vataka or Lohasava to target the iron deficiency, whereas the majority of the formulations mentioned in Pāndu do not work on this principle.
On the other hand, modern diagnosis and treatment outcome measures may be helpful in objectively assessing response to Ayurvedic treatment, and especially to engage in dialog with the scientific community. However, in clinical studies, this approach may create difficulties for the treating Ayurvedic physician because he/she cannot depend on the modern diagnosis to derive the individualized multimodal treatments, which will vary from patient to patient even if the modern medical diagnosis is the same for all patients and is comparable at the baseline. Ayurvedic treatments are based on a reflexive, recursive, and iterative algorithm. Yet another pitfall is that reliance on modern outcome measures may result in neglecting the outcome measures that would help in understanding overall effect of patient-centered care.
While ICD nomenclature cannot be ignored by Ayurvedic physicians, one cannot escape from the fact that Ayurvedic physicians need to develop an internally consistent system of disease nomenclature and classification, which will enable physicians to arrive at Ayurvedic diagnosis of a disease and thereby a whole medical system strategy for treatment. It is also desirable that studies are done on consistency of diagnosis amongst physicians in the Ayurvedic community to identify consensus and differences on diagnosis and treatment.
These issues need to be taken up by clinicians, academicians, and researchers, and incorporated into research programs of Ayurveda.
| References|| |
|1.||English equivalents of Ayurvedic clinical conditions and diseases. The Ayurvedic Pharmacopeia of India, Part I, Vol. I., 1st ed. New Delhi: Govt. of India; 2001 p. 235. |
|2.||Yadavji TA, editor. Caraka Samhita. Varanasi: Chaukhamba Subharati Prakashan; 2008. p. 646. |
|3.||Murthy KRS, Translator. Vaghbhata's Ashtanga Hrdayam. Varanasi: Krishnadas Academy; 1996. p. 179. |
|4.||Murthy KRS, Translator. Vaghbhata's Ashtanga Hrdayam. Varanasi: Krishnadas Academy; 1996. p. 179. |