Why Ayurvedic Mala Pariksha is Important in Diagnosis?

Features of Prakrut Mala Pariksha

The features of Prakrut Mala (normal stools) are influenced by Prakruti (constitution), Agni (digestion capacity), vaya (age), kala (season), an individual’s physical exertion, psychological factors, etc.

• Samhata (well-formed stools)
• Sukha Pravrutti (easy evacuation)
• Peeta varna (yellow colored)
• Natisnigdha (not very sticky)
• Nati–alpa (not too less in quantity)
• Nati-bahu (not too much in quantity)
• Laghu (light)
• Durgandha (bad smell)
• One to two bowels per day.
• The normal quantity of Purisha in the classics mentioned is seven Anjali Pramana.

Significance of Mala Pariksha (stool examination)

Mala Pariksha signifies the status of Agni (digestion capacity), symptoms of vitiated dosha, presence of krimi (parasites), and the prognosis of the diseases. For instance, in the clinical condition of Rajayakshma, the strength of the patient is dependent on the strength of the purisha (stools).

Properties of mala (stools) as per different dosha

• Vata dosha – blackish colour, dry, hard, with the presence of froth.
• Pitta dosha – yellowish colour, with foul smell, mixed with blood, multiple frequencies.
• Kapha dosha – pale/ white colour stools with the presence of undigested food material, mucoid, odorless.
• Sannipata dosha – The stools are white/black/yellowish colored, constipated, loose stools, with a foul smell.

The examination of Purisha (stools)includes the different colors, odors, appearance, consistency, presence of froth, frequency of bowels, and type of pain during defecation in various clinical conditions.

Examination of colour, appearance, consistency, and presence of froth are the methods of Chakshurendriya Pariksha (inspection method).

Odour changes fall under Ghranendriya Pariksha (examination by odor), Sparsha differences in purisha are by the method of touch examination, frequency of bowel movements and, the type of pain during defecation come under interrogation method.

Colour changes seen in different diseases

• Shyava varna – brownish black colour stools are seen in Vataja Pandu (anemia due to Vata dosha), Vataja Arshas (hemorrhoids of Vata dosha), Vataja Atisara (diarrhea of Vata dosha origin), Vataja Udara roga (diseases of abdomen predominant in Vata dosha), Vataja Jwara (fever originated due to vata dosha), Vataja Gulma (abdominal tumor due to vata dosha).
• Shukla varna – white colour stools are the features of diseases viz, Sahaja Arshas (hemorrhoids due to genetic disorder), Kaphaja Jwara (fever due to Kapha dosha), Kaphaja Pandu (anemia due to Kapha dosha), Kaphaja Arshas (hemorrhoids of Kapha dosha), Jalodara (ascites), Kaphaja Atisara (diarrhea of Kapha dosha origin).
• Rakta varna – red colour stools are seen in Raktapitta (bleeding disorder), and Pittaja Atisara (diarrhoea due to Pitta dosha).
• Peeta varna – yellow colour stools are seen in Pittaja Jwara (fever of Pitta dosha), etc.

         Odor variations

• Durgandha – stools with a foul smell are characteristics of Kaphaja Atisara (diarrhea of Kapha dosha), Pittaja Pandu (anemia due to Pitta dosha), etc.
• Kunapagandhi – smell resembling a dead body is the feature of stools in Sahaja Arshas (hemorrhoids with genetic origin), etc.
• Atidurgandha – stools having an extremely foul smell are seen in Paittika Atisara and Arshas (diarrhea and hemorrhoids of Pitta dosha), etc.
• Visragandhi – the smell of raw meat is seen in the stools in Kaphaja Atisara (diarrhea of Kapha dosha), etc.

          Changes in consistency

• Drava and Bhinna mala is due to Pitta dosha
• Sandra mala is the predominance of Kapha dosha
• Baddha and Shushka mala are due to Vata dosha

Presence of the froth

• Froth is present in the stools in the conditions viz, Vataja Arshas (hemorrhoids of Vataja dosha), Vataja Atisara (diarrhea of Vataja dosha), etc.
• The froth resembling Mamsambu (meat-washed water) or varahasneha (fat of the pig) is characteristic of stools in Sannipataja Atisara (diarrhea of combination of tri dosha).

Sparsha Pariksha (examination of stools on touch)

• Ushna (hot) – Pittaja Arshas (hemorrhoids due to Pitta dosha)
• Sheeta (cold) – Ajeerna (indigestion) and Kaphaja Atisara (diarrhea due to Kapha dosha)
• Snigdha (unctuous) – Kaphaja Arshas (hemorrhoids due to Kapha dosha) and Kaphaja Atisara (diarrhea due to Kapha dosha)
• Ruksha (dry) – Vataja jwara (fever due to Vata dosha) and Vataja Atisara (diarrhea due to Vataja dosha)

Examination based on quantity and frequency

• Alpa (less in quantity) – Pandu (anemia), Vataja Atisara (diarrhea due to Vata dosha), etc.
• Bahu (more in quantity and more frequent) – Pittaja Atisara (diarrhea due to Pitta dosha), Asadhya Atisara (incurable diarrhea), etc.

Type of pain during defecation

• Sashula – defecation with pain is seen in Amatisara
• Sashula and Sadaha – pain and burning sensation during defecation is seen in Paittika Atisara (diarrhea due to Pitta dosha)
• Parikartika – tenesmus is seen in Pravahika (dysentry)
• Shula, Gudasrava – defecation with pain and discharge from the anus is a characteristic of Jalodara (ascites).

Jala Nimajjana Purisha Pariksha

This is the unique method of examination explained by Ayurveda experts. The test is to assess the presence of Ama (undigested food material) in the Purisha(stool). Ama forms the basis of the majority number of diseases and hence this method of examination can help diagnose the disease and plan the treatment. The sample of the stool should not be too dry, too cold, or too watery. The test is to dip the stool sample in water and observe the behavior of the stools in the water. Take the sample of the stool and dip it in clean water if the stool sinks in the water it indicates the presence of Ama while floating of the stool is the absence of Ama.

Arishta lakshana (bad prognostic signs and symptoms) in Purisha Pariksha

• Ati-krishna – excess blackish discoloration of the stools
• Ati-rakta – excess reddish discoloration of the stools
• Ati-shubhra – excess whitish discoloration of the stools
• Ati-peeta ­– excess yellowish discoloration of the stools
• Ati-pramana – excess quantity of the stools
• Chakrika yukta – the presence of plaques in the stools
• Bhrushoshma – feeling of excessive heat in the body.

Conclusion

Purisha Pariksha is the method of examination that helps to diagnose a disease and assess the functioning of the alimentary canal. In various clinical conditions, there are varied colors, odors, consistencies, frequencies, etc. of the stool. Jala Nimajjana Pariksha is the classical method of examination of the stools to know the presence of Ama. The methods of examination direct the examiner in not only the diagnosis but also the prognosis of the condition. Arishta Lakshana are the bad prognostic signs of Purisha (stools).

References

1. Uikey R, Kar AC. A review on Purisha Pariksha in Ayurveda. Ayu. 2015 Apr-Jun;36(2):125-9. doi: 10.4103/0974-8520.175536. PMID: 27011711; PMCID: PMC4784120.
2. A CONCEPTUAL REVIEW ON PURISHA (STOOL) PARIKSHA, International Ayurvedic Medical Journal, 2021 (June), page. 1243-1248.
3. AN OVERVIEW ON PURISHA PARIKSHA (EXAMINATION OF FECES), World Journal of Pharmaceutical and Medical Research, 2021, Volume 7, Issue 5, page. 115-118.
4. STUDY ON MALA PARIKSHA, World Journal of Advance Healthcare Research, 2019, Volume 3, Issue 2, page. 95-97.