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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.
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DOI: 10.4103/0974-8520.175536
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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:
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.[4-6]
Review Article
A review on Purisha Pariksha in Ayurveda
Rajesh Uikey, Anukul Chandra Kar1
Department of Vikriti Vigyan, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University,
Varanasi, Uttar Pradesh, 1Lecturer, Department of Roga Nidan and Vikriti Vigyan, Shubhdeep Ayurveda Medical
College and Hospital, Datoda, Indore, Madhya Pradesh, India
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 rst-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.
Key words: Agni, Ama, Jala Nimajjana, Mala, Purisha Pariksha, stool examination
© 2015 AYU (An International Quarterly Journal of Research in Ayurveda) | 125
Official publication of Institute For Post Graduate Teaching & Research in Ayurveda,Jamnagar | Published by Wolters Kluwer - Medknow
Address for correspondence: Prof. Anukul Chandra Kar,
Head, Dept. of Vikriti Vigyan, Faculty of Ayurveda, IMS,
Banaras Hindu University, Varanasi - 221 005,
Uttar Pradesh, India.
E-mail: karanukul@rediffmail.com How to cite this article: Uikey R, Kar AC. A review on Purisha Pariksha in
Ayurveda. Ayu 2015;36:125-9.
This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
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For reprints contact: reprints@medknow.com
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Uikey and Kar: Purisha Pariksha in Ayurveda
126 AYU | Apr-Jun 2015 | Vol 36 | Issue 2
• 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].
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].
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.
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].
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.
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].
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
Table 1: Change in color of stool in various diseases
Types of color Diseases involved
Krishna Varna
(black color)
Vatika Arsha, Vatika Gulma, Kumbha
Kamala, Paittaka Atisara, and Vata
Prakopa
Shyava, Aruna
Varna (gray and
reddish color)
Vatika Udara Roga, Vatika Arsha, Vatika
Atisara, Vata Prakopa, Vataja Gulma,
Vataja Jvara, and Vataja Pandu
Shukla Varna
(white color)
Shlesmika Jwara, Shlesmika Udararoga,
Shlesmika Arsha, Shlesmika Pandu,
Shakhashrita Kamala, Shlesmika
Atisara, Sahaja Arsha, Jalodara,
Kaphaja Gulma, and Kahaja Visarpa
Rakta Varna
(red color)
Kamala, Pittaja Atisara, Raktapitta,
Sahaja Arsha, and Chhidrodara
Table 2: Presence of froth in stool in different
pathological conditions/diseases
Froth Pathological condition
Presence of froth Vataja Arsha
Vatika Atisara
Vataja Grahani
Table 3: Changes in consistency of stool in various
diseases
Consistency
of stool
Diseases involved
Sandra (dense) Kaphaja Atisara, and Sahaja Arsha
Baddha/
Vibaddha (solid)
Asadhya Pandu, Vataja Prameha,
Udararoga, Baddhodara, Purishavrita
Vata, Ashuddha Dugdhapana Sevana,
Tridosha Dushti, Tikshnagni, Vataja
Atisara, Vataja Visarpa, Vataja
Jwara, Sahaja Arsha, Vataja Arsha,
Mahashvasa, and Malavirita Vata
Drava (watery) Paittika Arsha, Vatika Grahani, Asadhya
Atisara, and Mandagni
Bhinna (loose) Paittika Arsha, Shlesmika Grahani,
Kshayaja Kasa, Kaphavirita Apanavayu,
Pittaja Murchha, Vega Sandharanjanya
Yakshma, and Arsha Samanya Lakshana
Shushka (dry) Vataja Grahani and Sahaja Arsha
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Uikey and Kar: Purisha Pariksha in Ayurveda
AYU | Apr-Jun 2015 | Vol 36 | Issue 2 127
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
Table 4: Change in odor of stool in various diseases
Odor of stool Diseases involved
Durgandhita (foul smell) Shleshmika Atisara,
Paittika Pandu, Asadhya
Sannipataja Chhardi, Ama
Purisha, Purishavaha
Srotodusti, and Vid Vighata
Visragandhi (smell of raw meat) Paittika Arsha and
Shleshmika Atisara
Atidurgandhita (extremely
foul smell)
Paittika Atisara and
Paittika Arsha
Amagandhi (smell of Ama)Amatisara
Kunapagandhi (smell of
dead body)
Chhidrodara and Sahaja
Arsha
Kunapa, Puya, Ama
Matsyagandhi (smell of dead
body, pus, Ama, and sh)
Sannipataja Atisara
Mahatputigandhi
(putreed smell)
Jalodara
Nirgandha or Sagandha
(without or with odor)
Agantuja Atisara
Table 5: Change in Sparsha (touch) of stool in
various diseases
Type of Sparsha Diseases involved
Sheeta (cold) Ajirna and Shleshmika Atisara
Ushna (hot) Paittika Arsha
Snigdha (unctuous) Shleshmika Arsha and Kaphaja Atisara
Ruksha (rough) Vataja Jwara and Vataja Atisara
Table 6: Abnormal quantities/frequency of stool in
various diseases
Quantity or frequency
of stool
Diseases involved
Alpa (less in quantity) Sannipataja Jwara, Pandu, Vataja
Atisara, Vataja Pakva Atisara,
Purishavaha srotodushti, and
Devonmatta Purusha
Atipravritti (more
frequency and quantity)
Paittika Atisara, Amatisara,
Sannipataja Atisara, and Asadhya
Atisara
Sanga (less frequency) Vataja Gulma, Apana Vayuavrudha,
Atisara Purva Rupa, Shuska Yoni,
Udararoga, Asamyak Virechana,
Vata Ashthila, Mutra Jathara,
Udararoga, and Baddhodara
Alpa Alpa (less in
quantity and frequency)
Vatika Atisara, Shlesmika Atisara,
Pravahika, Vatika Grahani,
Chhidrodara, and Purishavaha
Srotodushti
Muhurmuhu (frequent) Vataja Grahani and Vataja Atisara
Bheda (loose) Kshayaja Yakshma, Ayathabala
Samarambha Janya Yakshma, and
Vegasandharana Janya Yakshma
Krichhra Mala
Pravritti (passing
stool with difculty)
Vataja Ashmari, Vid Vighata,
Amashaya Krudha Vayu, and
Pakwashaya Krudha Vayu
Sashabda Mala
Pravritti (passing
stool with sound)
Vataja Arsha, Ama Atisara,
Purishavaha Sroto Dushti, Purisha
Kshaya, and Vataja Grahani
Table 7: Type of pain during defecation in various
diseases
Type of pain Diseases involved
Sashula (with pain) Amatisara
Sashula Sadaha (with pain
and burning)
Paittika Atisara
Parikartika (gripping pain) Vataja Atisara
Pravahana (tenesmus) Pravahika
Shula, Gudasrava (discharge
from anus with pain)
Jalodara
Chirat Dukham (passing with
difculty)
Vataja Grahani
Sashula Pravahana
(tenesmus with pain)
Kaphaja Arsha, Kaphaja
Atisara, and Pravahika
Kunthana (painful strain) Samatisara and Visamagni
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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.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Uikey and Kar: Purisha Pariksha in Ayurveda
AYU | Apr-Jun 2015 | Vol 36 | Issue 2 129
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... Nearly 50% of the cases were assessed as Madhyam Koshtha Rajesh Ukey and Anukul Chandrakar in the article "A review on Purisha Pariksha in Ayurveda" also reported that Purisha Pariksha is one important method of examination to know the presence of Aama in Purisha, and it has been described under the Jala Nimajjana Pariksha. [15] This method is a definite and instant method to detect the presence of Aama in stool by observing the sinking and floating behavior of the stool on water. ...
Article
In Ayurved; Astasthana pariksha is one of the important examinations to find the various causes behind diseases. In Ayurvedic text, different methods have been described for diagnosis of various aspect of disease, the Purisa pariksha (Stool examination) is one of them. Purisa pariksha is the main laboratory investigation tool which is necessary to diagnosis the disease described under samanya pariksha regarding the abnormalities in terms of col- or, odor, quality, consistency etc. In all ancient days, the identification of ama is used to be done by purisa parik- sha only. This review article aims to focus on the importance of Purisa pariksha. This conceptual study is helpful in the management of various progressive chronic diseases. Keywords: Astasthana pariksha, Mala pariksha, Purisa pariksha, Stool.
Article
Full-text available
Sushruta Samhita of Sushruta, Sutrasthana, Ch. 46, Ver. 528. 9 th ed. Varanasi: Chaukhambha Orientalia
  • Yt Acharya
Acharya YT, editor. Sushruta Samhita of Sushruta, Sutrasthana, Ch. 46, Ver. 528. 9 th ed. Varanasi: Chaukhambha Orientalia; 2007. p. 253.
Varanasi: Chaukhambha Prakashan
  • Bs Shastri
  • Yogaratnakara
  • Ashtasthana Purvardha
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Shastri BS, editor. Yogaratnakara, Purvardha, Ashtasthana Nirikshanam, Ver. 1. Reprint ed. Varanasi: Chaukhambha Prakashan; 2009. p. 5.
Astanga Hridayam of Vagbhatta, Nidanasthana, Ch. 8, Ver. 15. 9 th ed. Varanasi: Chaukhambha Orientalia
  • Pv Sharma
Sharma PV, editor. Astanga Hridayam of Vagbhatta, Nidanasthana, Ch. 8, Ver. 15. 9 th ed. Varanasi: Chaukhambha Orientalia; 2005. p. 496.
Astanga Samgraha of Vagbhatta, Sutrasthana, Ch. 1, Ver. 19. Reprint ed. Varanasi: Chowkhambha Sanskrit Series Office
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Mishra J, Translator. Astanga Samgraha of Vagbhatta, Sutrasthana, Ch. 1, Ver. 19. Reprint ed. Varanasi: Chowkhambha Sanskrit Series Office; 2008. p. 6.
Astanga Samgraha of Vagbhatta, Nidanasthana, Ch. 8, Ver. 14, Reprint ed. Varanasi: Chowkhambha Sanskrit Series Office
  • J Mishra
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Mishra J, Translator. Astanga Samgraha of Vagbhatta, Nidanasthana, Ch. 8, Ver. 14, Reprint ed. Varanasi: Chowkhambha Sanskrit Series Office; 2008. p. 387.