Lab role in pk

Significance of Laboratory Investigations in Panchakarma
Significance of Laboratory
Investigations in PanchakarmaInvestigations in Panchakarma
@ KARMASADHANA – National Webinar
Taranath Govt Ayurvedic Medical
College Ballari on 19 06 2020
Ayurmitra Nadi Guru
College, Ballari on 19‐06‐2020
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Ayurmitra Nadi Guru
Prof KSR Prasad (Technoayurveda)( y )
Professor & Head, Panchakarma, LN Ayurved College, Bhopal, MP
9290566566/9503227966
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
technoayurveda@yahoo.com

Introduction01
Introduction01
• As the patient approaches in the Panchakarma
OPD or any, at first we need to differentiate
l h d d dHealthy and disease condition
• Ayurveda has adopted many diagnostic tools such
as Dasha vidha pariksha Ashtasthana Parikshaas Dasha vidha pariksha, Ashtasthana Pariksha,
Panchalakshana Nidana Pariksha, etc
• But when we are in 21st Century Medical y
Practices we adopted the contemporary tools of
examination for accuracy and easy approach in
diagnosis that do not support Ayurveda Principlesdiagnosis that do not support Ayurveda Principles

Cross Road Philosophy02
• Few decades back, the Cross Road philosophy
Cross Road Philosophy 02
came out on discussion. It has the modalities of –
– Ayurveda diagnosis & Ayurveda Treatment
• Ideal
– Ayurveda diagnosis & Allopathic Treatment
N fi i h i i l• Not fit in to the principles
– Allopathic Diagnosis & Allopathic Treatment
• Not applicable for Ayurvedic field• Not applicable for Ayurvedic field
– Allopathic Diagnosis & Ayurveda Treatment
• Alternative application for the present day pp p y

Background01
• There are more than 4,000 different diagnostic tests
available today
Background01
• highly‐skilled technicians, and specialized personnel to
interpret results drawn from sophisticated methods in
Laboratories
• serious challenges exist with assessing new tests
– Drug Administration (FDA) clearance
E id d t ti f f t & ff ti– Evidence demonstration for safety & effectiveness
– Cost effectiveness
• Ultimate principle is  Screening – Monitoring –
Diagnosing
• Following ICPC ( International Classification of Primary
Care) codes and recommended Investigations are in needCare) codes and recommended Investigations  are in need

What are Investigations03
• Investigations are the procedures that involve
l f bl d h
What are Investigations 03
testing a sample of blood, urine, or other
material from the body under Physics and
Chemistry scientific principles with reproducibleChemistry scientific principles with reproducible
parameters
• Investigations can help to determine ‐Investigations can help to determine
– A Diagnosis,
– Plan of Managementg
– Check to see if treatment is working (Prognosis) or
– Monitor the disease over time (Evaluation)

Diagnostic Test04
• A diagnostic test is a procedure performed to
f d h f d
Diagnostic Test04
confirm or determine the presence of disease in
an individual suspected of having a particular
diseasedisease
• Usually it is prescribed after the interrogation and
Examination of patient keeping in view of derivedExamination of patient keeping in view of derived
signs and symptoms or any other observations
• Example is ‐ using molecular diagnostic test to p g g
examine a patient suspected of having a
lymphoma

Types of Investigations05
• Commonly we come across –
Types of Investigations 05
– Common Pathological Investigations – Urine, etc
– Haemetalogal Investigations – CBC, ESR, etcg g , ,
– Biochemical Investigations – RBS, Bl. Urea, etc
– Serological Investigations – Tridot, etcSerological Investigations Tridot, etc
– Radiological Investigations – X‐Ray, CT Scan, etc
– Microbiology Investigations – Culture etcMicrobiology Investigations Culture, etc
– Nuclear medicine Investigations – specific tests

Reasons for Ordering a Laboratory Test01
• There are 4 major legitimate reasons for ordering
Reasons for Ordering a Laboratory Test01
a laboratory test:
• 1. Diagnosis (to rule in or rule out a diagnosis).
• 2. Monitoring (eg, the effect of drug therapy).
• 3. Screening (eg, for congenital hypothyroidism3. Screening (eg, for congenital hypothyroidism
via neonatal thyroxine testing).
• 4 Research (to understand the patho‐physiology4. Research (to understand the patho physiology
of a particular disease process).

Introduction01
Introduction01

What is our stand in Management06
• When we go through our practices, we come
What is our stand in Management 06
across –
– Dosha (Humor) oriented Medical Management ( ) g
– Vyadhi (Disease) oriented Medical Management
– Lakshana (symptom) oriented Medical ( y p )
Management
– Arishta (Complication) oriented Medical ( p )
Management

Dosha & Investigations07
• To assess Dosha we are considering the –
Dosha & Investigations07
– Prakruki assessment – which is unique from the
day of birth –
• A non pathological entity or considered as Genetic entity
– Nadi Pariksha, in which we observe cardiac output
blood impulses interpreted to the pathological
alterations of Dosha
• What biochemical or laboratory investigations
are in vogue for Dosha assessment are – NONE

Vyadhi & Investigations08
• Disease evaluation is done basically on Dosha
Dushya Sammurchana
Vyadhi & Investigations08
Dushya Sammurchana –
• Nanatmaja and Samanyaja
• Disease diagnosis is through Pancha Lakshana• Disease diagnosis is through Pancha Lakshana
Nidana
• State of disease is assessed or conformed
through Ashtastana Pariksha
• Prognosis based on signs and symptoms of
Arishta LakshanaArishta Lakshana
– Possibility of developing or converting the present day
Lab techniques to our disease Principle is acceptable

Lakshana & Investigations09
• Any symptom based on its appearance can
Lakshana & Investigations09
offer a validation procedure
• Jwara is tapa – raise of temperature because
of expelling the Jathara Ushma
– Can be measurable through units of
• Centigrade ‐ C
• Fahrenheit ‐ F
• Kelvin ‐ KKelvin K
• Rankine ‐ R
• Reaumur ‐ Re

Arishta & Investigations10
• Arishta / Complications are also symptoms &
Arishta & Investigations10
Signs
• Many times a clinician depends upon
i ti ti h l t l t d POinvestigations such as serum electrolytes and PO2
& PCO2 to asses the Arishta condition
• The adaptations of these measurable units• The adaptations of these measurable units
require Ayurveda Arishta symptoms validation
• The perceptional explanations of AsishtaThe perceptional explanations of Asishta
Lakshana given are subjected for validation and
experimentation with suitable parameters

Prakruti11
• Prakruti translated as constitution is‐
1. Birth time inherited fixed Genetic (Purusha) constitution
Prakruti11
1. Birth time inherited fixed Genetic (Purusha) constitution
2. Diseased (Rogi) constitution (altered by Food &
Environment)
3. Disease (Vyadhi) constitution (acquired by metabolism or
External origin)
– We do not consider Birth Time Constitution for evaluatingWe do not consider Birth Time Constitution for evaluating
Disease either of the way like Nadi Pariksha
• In a clinical situation we need to evaluate the presence of
Ch t h d i ll th M di i d l ff tChatushpada especially the Medicine or procedural effect
– we term the constitution and effect of Dravya i.e. Dravya
Prakruti / Pravrutti under Rasa‐Panchaka & constituents
evaluation

Focus on Prakruti12
• Jata (Birth Time) Prakruti can be elicited as –
Focus on Prakruti12
– Charaka described Prakruti is translated better as
Genetic demographic data as it is considering –
• “Jati” – to know racial problems
• “Kula” to be considered as the Familial problems includes
even occupational issues p
• “Desha” refer to the country of born and living
• “Kaala” the season and circadian rhythmus influences
• “Vaya” is Age ‐ relations in the pathological manifestations
• Pratyatma Niyata has to understand it as a fundamental
physiological constitutionp y g

Assessment13
• The evolution and assessments of
Assessment 13
Investigation in Ayurveda can be grouped as –
– Disease Diagnostic or Progression
– Disease Prognostic or Risk (Arishta Lakshana)
– Health Restoration (Swastha Paribhasha)
( bh )– Drug action assessment (Dravya Prabhava)
– Process effect evaluation or Phalashruti validation
Ul i l h Di i P i d• Ultimately they are Diagnostic, Prognostic and
Effect Validation Investigative Tools

Diagnosis & Prognostic14
• Many serological investigations are disease centered –
T id t t t t
Diagnosis & Prognostic14
Tridot test, etc
• Cardiac profile includes many Blood test that
individually or cumulatively draw the conclusionindividually or cumulatively draw the conclusion
– Troponin (muscle protein), CKMB (creatinene kinase),
hsCRP etc can establish risk and propose line of
management alsomanagement also
• Liver Function Test is specifically of test for prognostic
and diagnostic conditions are Organ centered g g
• As per the disease diagnosis, prognosis and
assessment, it is a concern that we have contemporary
l b t t h i d tili th klaboratory techniques and utilize them as markers

Use of Diagnostic Test01
Use of Diagnostic Test01

Test Assessment01
Test Assessment01
A Policy Primer on , June 2011

Test Example01
Test Example01

ICPC Codes01
ICPC Codes01
International Classification of Primary Care
Laboratory tests in general practice
KCE reports 59C
Federaal Kenniscentrum voor de Gezondheidszorg
Centre fédéral dÊexpertise des soins de santé
B l i H lth C K l d C t
Belgian Health Care Knowledge Centre
2007

Drug / Procedure assessment15
• Ayurveda do require a set of investigations or
Drug / Procedure assessment 15
measurable parameters for assessing the
Medicine and Procedure
• This output can not be mere symptomatic
Disease pacification to say on Prabhava
– The Prabhava also should be a measurable
parameter like Jwarahara, Mootrala, Hrudya, in
terms of parametersterms of parameters
• Same way the Phalasruti of the Panchakarma
procedure is brought to measurable Unitsprocedure is brought to measurable Units

Example ‐ Differential Count01
Example Differential Count 01
Increased Decreased
Neutrophils Acute bacterial infection NeutropeniaNeutrophils Acute bacterial infection,
Acute stress
Pregnancy
Neutropenia
Aplastic anemia
Widespread bacterial or viral
Inflammation (IBS or RA)
Trauma
infection
Recent chemotherapy or
radiation therapy
Lymphocytes Chronic bacterial infection
Hepatitis
multiple myeloma
Bone marrow damage
HIV, tuberculosis, or hepatitis
infectionp y
Mumps or Measles
Lymphocytic leukemia /
Lymphoma
Leukemia and/or after
chemotherapy or radiation
treatments
Lymphoma treatments

Example ‐ Differential Count01
Example Differential Count 01
Increased
Monocytes  Chronic inflammatory disease (IBS)
 Infection (parasitic bacterial or viral)
 Collagen vascular disease, such as lupus,
vasculitis, or RA
 Leukemia
Eosinophils  Allergic disordersp g
 Parasites
 Tumors
 Gastrointestinal (GI) disorders Gastrointestinal (GI) disorders
 Skin inflammation
Basophils  Food allergy
 Inflammation
 Inflammation

Before Panchakarma Investigation16
– Hemoglobin %
Before Panchakarma Investigation 16
– Differential count
– Vital Examination
– Check List

Snehana17
Snehana17

Abhyanga18
Abhyanga18

Vamana19
Vamana19

Verechana20
Verechana20

Conclusion01
• Now it is fair to conclude that –
W h d l d h I i i
Conclusion 01
– We have to develop or adopt the Investigation
Methodology to obtain accuracy in diagnosis with
reproducible objective parameters of Assessmentreproducible objective parameters of Assessment
– Panchakarma assessment is based upon –
• Reversal of Dosha to Normalcy• Reversal of Dosha to Normalcy,
• Organs to their functions,
• Tissues to their utility y
– So, to establish Evidence Based Ayurveda Medicine
we need to follow Laboratory investigations in
Ayurveda

01
Thank You01 Thank You

Lab role in pk

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