The Genius of Ayurvedic Diagnosis Dasa Vidha Pareeksha with Dr. Shyam Vishwanathan

Hello and namaskaram. I am Salila Sukumaran, the founder of AyurGamaya, an Ayurveda wellness concierge based in Mountain View, California. You are listening to the AyurGamaya podcast. Through these conversations with great karma yogis of Ayurveda, yoga, and other Vedic sciences, I wish to bring to you the treasures of India. If you are a beginner, my mission is to help you develop appreciation. If you are a practitioner, my goal is for you to become confident torchbearers of our immense legacy. May the gods and the gurus bless you. Today my guest is Dr. Shyam VL. Dr. Shyam is an award-winning doctor and acclaimed Ayurveda medical practitioner. He was the first approved and licensed Ayurveda practitioner by the Ministry of Health, United Arab Emirates, in 2003. He is Middle East's only Ayurveda doctor with an MD degree. Dr. Sham is a gold medalist in Bachelor of Ayurveda Medicine and Surgery from the Mahatma Gandhi University, India, and has obtained his master's in Shalya Tantra from Kerala University. He has also completed his MPhil in Business Management from Bixby and has gone on to do a fully certified spa management course from Cleopatra and Steiner Institute. Teaching has always been a passion with the practicing doctor, and he started his first assignment teaching Ayurveda to conventional doctors. In the year 2001, he moved to UAE, and in the course of his successful practice, he has garnered a clientele that comprises of celebrities, politicians, and country heads. He has since been featured in BBC, Star News, Nippon TV, and writes a weekly column in a magazine from a leading newspaper in the UAE, Friday Magazine from Gulf News. Besides his flourishing practice, Dr. Shyam also puts to good use his professional experience in setting up and operating Ayurvedic centers and spas. He has helped leaders in the hospitality industry— Kempinski, Le Meridien, the Hilton Group across Europe, Africa, Middle East, set up some of the best-run Ayurvedic spas. The awards that he has won stand testimony to his medical expertise. It is my pleasure to introduce Dr. Shyam to you.

Dr. Shyam, welcome to the Ayurgameya Podcast. It is such a pleasure and an honor to have you. You are a highly, highly, uh, respected physician from the UAE, and You hold several honors and awards. It is such a joy to have you here to explain to the listeners how important it is to diagnose properly in an Ayurvedic treatment. Now, any kind of healing treatment requires that the physician diagnoses, makes the reason for falling sick, why this person has this sensitivity, all that extremely clear for himself. So that a proper treatment plan can be created, can be tailored. How is the diagnosis in Ayurveda— how is it done differently from Western allopathic diagnosis?

Right. First of all, you know, thank you very much, Salila Sukumaran. You are taking a wonderful effort to disseminate, you know, the knowledge of Ayurveda. In US and across the globe. And thank you very much. Yeah, and coming to your question, see, Ayurveda gives, you know, a lot of importance to the diagnostic procedures. And Ayurveda says, roga madhau pariksheda, tad anandara maushadam, right? That means first diagnosis then only the medicine comes. So it says, you know, even if the physician is well-versed about the medicines, if he or she fails in the diagnosis, he may get a result, but that is only by chance, right? So the Ayurvedic diagnosis is so important in, in, in Ayurveda. However, This diagnosis, you know, is a challenge due to multiple factors involved in an Ayurvedic way. So it is an extremely complex process because there are several variables involved in it in a diagnosis.

The—

we know that, you know, the, the concept of Ayurveda, it moves around the concept of Vata, Pitta, and Kapha. The samya, or the balance of the Vata, Pitta, Kapha, it results in the health. And the vishamada, or the imbalance of Vata, Pitta, Kapha, results in the disease process, right? So now when I'm trying to compare, you know, the modern diagnosis versus the Ayurvedic diagnosis, and there are several doctors, you know, who translate the modern diagnosis into an Ayurvedic diagnosis, which might not work always. For example, there are, there are some doctors, you know, who might diagnose, you know, a viral bronchitis as a vata jakasa and a bacterial bronchitis as a pitta jakasa. Actually, this will not work in an ideal Ayurvedic management. And this is not the right way of diagnosis in Ayurveda, and it will surely make, you know, several mistakes also. I'll tell you an example. Please see, you take the case of a gouty arthritis. So some people, you know, they treat gout as vata rakta and a rheumatic fever as ama vata. But sometimes a condition of SLE, a systemic lupus erythematosus, may present with the symptoms of vada rekta. A condition like Sjögren's syndrome or a rheumatoid arthritis or a varicose ulcer might present the symptoms of vada rekta and Rheumatoid arthritis may present the symptoms of Ama Vata or Vata Rakta. So in Ayurveda, it's all about, you know, the, the spectrum of the diseases. For example, when you take the Jwara concept, it covers a lot of diseases which are associated with sandabo dehamanasaha. So whatever causes, you know, The febrile conditions or pain, dabam, sandabam, in the body and mind are considered as Jwara. When you are taking a condition like Raktabhita, several bleeding diseases can be considered or incorporated into a Raktabhita. Or when you are taking a, a condition like Gunma, which is an imbalance of Vata due to the Avaranam of Kapha, So a condition which is having a pain and an abnormal mass is considered as gunma. Or you take a condition like, you know, udara, right? Udara might have, you know, conditions which can be incorporated like ascites, uh, intestinal obstruction, uh, perforations in the digestive system. So in a modern diagnosis All these are different pathologies. Ascites is totally different from intestinal obstruction, right?

Right.

But when you look into the chapter Uddara, you can see conditions which resemble like ascites, which resemble like intestinal obstructions at different stages. So now, for example, you take, you know, a condition like, uh, kasa or cough.

Right.

You know, it will be present in, in a bronchitis. It will be present in a condition like allergy. It might be present in a condition like pneumonia. It might be present in a condition like malignancy or an autoimmune condition. So one may present with a dry cough, then we call it like Vata Kapha. And another one, when it is presenting it with an yellowish sputum, we call it pitta ghasa, right? Another one, you know, when it is presenting with a clear, thick mucus, we call it kapha ghasa, right? Right. So it is the same khasa, the same cough, uh, depending on the cause, depending on the stage, you know, different dosha involvement can be there, right? Right. So in an Ayurvedic way the diagnosis of a disease, it should be based on nidana, or the causes, the lakshana, or the signs and symptoms, and the samprapti, or the pathology.

Right.

And in addition, uh, can I talk a little, elaborate, or—

Absolutely, absolutely, please continue.

Right. See, Ayurveda also has a patient-centric approach Unlike the modern medicine. So naming of a disease alone is not enough as per Ayurveda. We need to understand which dosha is involved, which stage is that, which tadu is involved, right? Now what I have felt is that, you know, the Ayurvedic diagnosis is one of the, the most complex way of diagnosis which includes several permutation combinations, you know. Several times I feel like, you know, it's like playing a chess game, right?

Right, right.

And, uh, an experienced physician will make a, a strategy, will make a, a step-by-step action plan. And sometimes, you know, a physician might take, you know, 2 or 3 weeks to modify a pathological condition to a comfortable stage where he can administer medicine.

That is fascinating. That is fascinating. So you're almost like you're playing with the energies of vata, pitta, kapha, bringing it to a level where it can be now managed much better with the medicines, with what you have available.

Exactly, you said it right. I will tell you an example. See, imagine that, you know, you are treating a pitta disease. An experienced physician might convert the condition to a vata-pitta condition by certain medications. See, you are purposely modifying, you know, a pitta condition to a vata-pitta condition and then starting a ghee preparation.

Amazing, because then the body is able to absorb the ghee much better because it's in a vata state.

Correct, because ghee is, uh, it works well in the vata-pitta condition than in a pitta condition.

Got it, got it. This is fascinating, fascinating. So this is all part of the Dasha Vida Pariksha, right? Correct me if I'm wrong. The, the, you know, thinking of what is the kala, the karana, the desha, what is the upaya— is this is all part of the Dasha Vida Pariksha, isn't it?

Correct. See, uh, actually, you know, there is a, a systematic approach, you know, uh, to a diagnosis also. And out of that, you know, it is an easier tool which is proposed by the Charaka and Vagbhadra.

Right, right. Okay, so it's not the entire thing, it is just part of a spectrum of methodologies you use diagnose.

Correct, correct. So it is a part of the, uh, rogi, roga pariksha. So actually, you know, uh, a rogi is examined, you know, through inspection, uh, by looking at the patient, through palpation. Let it be nadi pariksha or mutra pariksha or mala pariksha or the jikwa pariksha, that is by inspection. Right, and by palpation and through the interrogation. While the roga varisha, you know, which is the examination of the patient and the disease, it is through the nidanam, that is the cause of the disease, premonitory signs and symptoms, signs and symptoms pathology, and upasheya, and through Wonderful.

Wow, I had no idea. So this is why someone should give at least an hour, hour and a half to a physician. And, uh, you know, when you go to an Ayurveda physician, it's not that, okay, I just get my medicine, take it at home, and it's done. No, right?

Correct. See, it is not only the dosha, uh, we need to understand, you know, which is imbalance, whether it is a vata or a pitta or a kapha. We need to understand this. We also need to understand the dosha vishesha, means, you know, which tissues the vata has imbalanced. I'll tell you an example. Vata imbalance in the recta thadu will produce a condition like vata recta. Vata imbalance in a muscle tissue will produce a condition like fibromyalgia, right? Vata imbalance, you know, in a medo thadu, in the fat tissue, might cause karsya or emaciation. Vata imbalance in the asthi tattva may produce osteoporosis, right? Vata imbalance in the reproductive tissue might cause amenorrhea or male reproductive issues, right? So the dosha vishesh is also very important, right?

Right, right.

Yeah.

And, uh, See, uh, while, uh, examining, you know, I mean, uh, it says, you know, there are two types of examination, uh, for a layman physician. One is through the, the direct perception, or, you know, it's Ayurveda call it like pratyaksha. For example, you know, you are seeing a case of psoriasis, you know, it has a pattern and it has a particular appearance. So by pratyaksha, by direct perception itself, a physician can tell you, you know, you are having a psoriasis or a sitmam or a kede pam kushtha. The second one is through the anumana, or through the inference. For example, you know, a patient is coming with dry cough. Dryness, it is a quality of the vata, right? Then you may call it like, you know, it is a vata kasa. So these two, the pratyaksha and the anumana, along with the, the authoritative instructions, constitute the examination. So without having the authoritative instruction, which is called upadesha, which is given by the ajaryas, vajhrada or charaka, you might not be able to apply the principles of pratyaksha or anumana into diagnosing a condition.

This is making me think that, you know, the samhitas— I'm sorry to interrupt you, please finish your thought.

Please go ahead, go ahead.

I'm thinking about the Charaka and Vagbhata, you know, even within the samhitas there is slight differences of these methodologies, of these diagnosis the, the, you know, the, the instructions given for proper diagnosis. Would you please explain a little bit more about that?

Right.

See, in Ayurveda, there are two schools of thoughts, you know. One is based on the general medicine, uh, which is represented by the, the Charaka Samhita, and the surgical school, you know, which is represented by the Sushruta Samhita, right? And they know, of course, you know, they have a clear distinction in terms of approaching a disease. One is more of a surgical school and the other one is more of a general medicine school.

Got it.

While in the, uh, writing of the book Vagbhadra of Ashtanga Hridaya by the Vagbhadra, he has included elements of both Charaka Samhita and Sushruta Samhita, and he has condensed the information also while writing the book, uh, Ashtanga Hridaya. And, uh, Vagkhada, being a devotee of the Buddha, you know, the philosophical school of Buddhism has also, uh, become a part of, uh, in the writing of the Ashtanga Hridaya.

Right.

While in the writing of the Charaka Samhita, you know, the philosophical school of Nyaya, Vaisheshika, Sankhya has influenced, you know, in the writing of the Charaka Samhita.

Amazing, right?

So, uh, see, uh, see, a medicine, you know, it has to be chosen according to the disease and for the deceased. It is the same, you know, by the Charaka and Vagbhatta, right? But the Charaka is little more elaborate in terms of explaining the, the 10 means of knowledge for a physician, or, you know, with regard to the Deshavidha Pariksha, Vagbhata has, you know, condensed those information. Yeah, slightly, right?

It's the hridaya, the condensation, the distillation of the information.

Correct, correct, correct. So, but Charaka is more detail into that. I can tell you, for example, when I went for my business school after my MD in Ayurveda, in the first class, we were taught about the basic functions of a manager. I was taught that he should know where we stand, he should know where we need to reach, He should have a team in hand, you know, who are motivated. He should have a Plan A, Plan B, and Plan C, right? He should have a control mechanism. He should do the planning, organizing, training, budgeting, etc., right?

Right.

That time, you know, I was actually thinking, why did I come to study these?

You already learned it in Ayurveda.

Exactly. Charaka has explained this, you know, beautifully, uh, but it was in the management of a disease process, right?

You're an executive manager of the disease, correct?

Exactly right. So, uh, before, you know, getting into, uh, this, the Savita Pariksha, uh, Charaka mentions about, you know, another, uh, 10 means of essential knowledge for a physician. Right, which is, you know, you were mentioning about the, the Karanam, Karanam, Karyam, Karya Yoni, etc. Actually, these are not the Savita Pariksha. These are, you know, the means of knowledge a physician should have.

Okay.

Or a business manager should have.

Okay, yeah, makes sense.

Interested to talk about it, or—

Absolutely, we can touch upon it briefly and then please, uh, please give us some more knowledge because a lot of that is on the internet as part of the Shabhidha Pariksha, right?

See, one is called, you know, Karanam, right? See, Karanam here is the physician itself, right? So it is defined as, you know, one who does the action. He is the cause and he is the doer. So a physician need to self-analyze, am I an expert, you know, for treating this condition?

Step 1.

Or is it a case, you know, which has to be referred to my Shalya Dandra expert friend?

Right, right.

And Karanam, that means, you know, uh, the, the drugs which we use in the treatment. Or the instrument which we use in a procedure is the karana. And the karya yoni is where we stand. For a physician, where we stand is the imbalance of the tattvas because it is a patient who is sitting in front of him, right? So where, where I stand is at the imbalance of the tattvas. Under the imbalance of the doshas, right? Now the action or the karya is to balance the doshas or to balance the tattvas, right? And what is the outcome of that action? That is the karya bala, that is the attainment of health and the happiness, right?

Right.

And Anubandha, that is the lifespan or the health span. It is the after effect of that, uh, the attainment of health and happiness, which Ayurveda calls it like Anubandha.

Beautiful.

The next one, it is very important, you know, in the context of the Deshavidha Pariksha. Charaka says Desha or Karya Desha. That means is the location or the place where the action has to be done. So, so the place is, you know, the patient, right? Or the place is, you know, where the patient lives, right? So the Dasavitapariksha is for the Karya Desha which is mentioned by the Charaka. So the deshavidha parisha, the tenfold examination, has to be done for the karya desha, which is the patient, right? And Ajare Charaka talks about, you know, kala in that context. Kala means, you know, that which undergoes transformation— the ear and the face and then, you know, it is the pravarti or the initiation of the therapy, and then it is a proper management or upaya, right? These are the, the 10 means, you know, a physician should know before starting the, uh, the condition.

You have mentioned many times the importance of prakriti pariksha in diagnosis, and you have used the words of the Vata energy, the Pitta energy, the Kapha energy. Would you please explain a little bit more about why it is important for the physician to understand the Prakriti Pariksha in diagnosis?

Right. See, this part, you know, we all might know already, you know, because it's a lot of discussion, you know, going around, you know, the Prakriti analysis. So it's easy to explain. Say, a Vata disease in a Vata body type is difficult to treat, while a Vata disease in a Kapha person might be easier to cure, right?

Nature is on your side, correct?

So different medicine, it has to be chosen according to the body type. But before getting into the details, you know, you need to understand that the body type of a person, it is determined by The shukla shonida factors, you know, that is the, the sperm and the ovum, the status of the garbhacharya, the diet and the activities of the mother, and the mahabhuda predominance, you know, at the time of fertilization contributes to the formation of one's body type.

Amazing.

And keep it in mind that the body type of a person will not change for the uh, entire life.

Hmm.

Signs and symptoms of the change in the body constitution is a poor prognosis. So on account of this, you know, this Shukra sthavana factors, Garbhashiya factors, diet and activities of the mother, you know, you know that, you know, we categorize into Vata, Pitta, Kapha, Vata Pitta, Pitta Kapha, Vata Kapha, and the Samapragardhis. Right, but in practice we might not get the sama prakritis. We get mostly duanda prakritis or the single prakritis. And the analysis of the prakriti or the body type, it gives an idea about the status of the health with refer— with, with regard to the characteristic of a person or the physical strength of a person, about the digestion of that person. About the metabolism of that person, about the immunity of that person, and about the predisposition of a disease condition. Because it's easy for a Vata person to get Vata diseases, right? Right. And you take another example, you know, in the scenario of COVID right? Different people have different symptoms.

Yeah, it's all over this virus, you know.

Yeah, this virus may cause different symptoms in different prakritis also.

Yeah, true, right? Very.

And the medicines or the shodhana therapy, it has to be selected, you know, according to the prakriti and according to the koshta of the person. So the prakriti is very important, you know, to customize a therapy or a medicine. It is very important, you know, to determine the prognosis of a condition. Say, like, you know, I said Vada disease in a Vada Pragati is difficult to treat, right?

Right.

So the application is very beautiful if you are interested. Imagine that, you know, a Pitta person is having a Vada disease. A Pitta person is having a Vada disease. Now, Ushna is good for Vada. Right, but in this context, correct, in this context, you know, we cannot use Ushnajagatsa because his prakriti is Pitta.

Got it, yes.

So what can we do in this context? So we need to go for Brahmana therapies, or we need to go for Tarpana therapies, and you need to go for the Mathura Rasa Pradhan Dravyas.

Yes.

Since it is a Vata disease in a Pitta person.

Got it. Yeah, yeah.

Look at another example.

Yeah, yeah.

Look at another example. Imagine that, you know, a Kapha person is having a Vata disease, right? So here we can use the Ushnajagatsa because Vata means sida, Kapha means sida.

Yeah.

So we can immediately go for Ushnajagatsa. But in this context, a treatment by the snechta, treatment by the oils, and the tarpana jikilsa or sandharpana jikilsa by the guru guna is contraindicated.

Yes, we don't want to nourish, we don't want to oleate. Correct. Yeah, now we want to do roksana.

Correct. Again, possibilities. Imagine that, you know, a pitta person is having a kapha disease. A Pitta person is having a Kapha disease, we cannot do Ushnaji Gitsa. Yeah, but we can do Ruksha Ji Gitsa because Kapha means niktam, Pitta means niktam. So you can do a Ruksha Ji Gitsa with Tikta Rasam or Kashaya Rasam.

Fascinating, it's very fascinating.

Right, yeah. So, but it is, uh, it, it's a bit difficult, you know, to diagnose, uh, the prakriti, uh, in a patient because several times the vikriti, it might mask the prakriti.

That was going to be my question. How do you determine the prakriti when somebody presents with a really all over the place vikriti?

Right, so the prakriti has to be assessed, you know, based on the, the pre-morbid state, that is before the disease, right? Yeah, see, an experienced physician, you know, might identify the prakriti of a person, you know, within minutes, right? But a student or a, a doctor, you know, who is just start practicing should take, you know, detail, you know, into, uh, writing, you know, what is the prakriti, you know, what was it 5 years before, what was it 10 years before, right? Right. So, uh, the prakriti assessment of the prakriti is, uh, extremely important, uh, in the diagnosis process. That is why, you know, I mean, prakriti is the first component of the Dasha Veda Pariksha.

Yeah, makes total sense. It was very important for me to understand my own prakriti to start adopting dinacharya to maintain my health. A lot of wellness management advocates and Ayurveda enthusiasts do the body quiz to understand their own prakriti, yet many people are against it, saying it is the right way is to go to an Ayurveda physician and get it properly diagnosed. What do you think about these practices that exist? I personally have benefited, and I am a huge advocate that everybody should know their prakriti so that they can use good methodologies to maintain their health, right?

It is very important. See, Ayurveda proposed, you know, a daily regimen and seasonal routines and dietary instructions. Right, but actually it has to be personalized according to the body type. See, for example, Ayurveda says, Brahma muhurte utishteh, that is, you know, one should wake up in the Brahma muhurta, right? So before, you know, setting the alarm for tomorrow at 5 o'clock, yeah, if it is a Kapha prakriti, he need to ensure that, you know, he got, you know, 8 hours of sleep. So he should go to bed, you know, by 9 PM. While, you know, if it is a Vata prakriti, even if he goes to bed at 11 o'clock, still, you know, it will be healthy for him. It's okay for him to wake up at 5 o'clock because he is still getting, you know, 6 hours or 7 hours of sleep.

Okay, right.

And for a Kapha person, you know, as I mentioned before, he might not require, you know, that much of oil therapies every day, right? While a Vata person might require it every day. Yes, you know, in the clinical part also it is very important. For example, a Vata person has a shorter lifespan, and a Vata person, you know, frequently suffer from the diseases, and the Vata person have, you know, the flickering mind. Yeah, well, on the other side, while on the other side, a Kapha person, uh, he or she lives long.

Yeah.

And suffers less from the diseases and more strength comparatively. So it will be easier, you know, maybe for an Ayurvedic doctor to treat a Kapha prakriti than a Vata prakriti.

Yeah, yeah, it is very fascinating how, how these basic energies— you know, once we intuitively get the basic energies, we become empowered to take care of our health till we come to a point where we absolutely have to bring in an expert like you to manage our health better, right?

It is very important to have a personalized consultation for assessing the prakriti. And Ayurveda gives a definition, you know, for a physician. A physician is the one who can differentiate a vikriti from the prakriti is a good physician.

Beautiful. Yes, right.

The physician who can differentiate a vikriti from prakriti is a wise physician.

Yeah, yeah. You were talking about sara, you were talking about the qualities of each dhatu. Would you speak a little bit more about it so that individuals who are listening, you know, clinicians who are listening, or even just people who are interested in Ayurveda can know, okay, this is how I know my shukra dhatu is at its optimal, my, uh, right, you know, maamsa dhatu is doing great. How would you please explain that a little bit more?

Right, see, uh, Sāra, it's a, it's a beautiful concept. Uh, the term Sāra, it is used in Ayurveda as a measure to assess the health of an individual. It says, uh, Sārāni ashtau bhrūṣaṇam melāmāna viśeṣa jñānārthaṁ upadiṣyande. That is to assess the, the strength or the health of an individual. See, before, you know, getting into this topic, you know, uh, see, for a disease to happen, you know, there are two essential factors. One is the imbalance of the vata, pitta, kapha, and second is called tadu vaigunya or the srodhu vaigunya, because the vata, pitta, kapha has to manifest in an impaired or in a weak tadu to produce a disease.

Yeah.

Imagine, uh, your, your tissues are all, all of excellent sara, right? They are of optimum health. Even if vata, pitta, kapha imbalances, it cannot manifest into a disease process.

True.

Because your tissues are all healthy.

Right.

Vata, Pitta, Kapha can manifest a disease only on a weak Sāra, Tādu.

Right, makes sense. Yeah, makes sense.

So unlike the Prakṛti, I mentioned, you know, the Prakṛti you cannot change for the entire life. Yeah, but Sāra is different. Sāra changes throughout the life. Is a result of sahaja bhavas are already there. The genetic factors are already there from the maternal, paternal side. You know, the sara is nourished, and sara, it is a result of aharabhava, means from the dietary habits, right? Thadu sarada, it is a result of viharabhava. That means, you know, one who follow a strict daily regimen and seasonal routine will have a better sara.

So we are not dinged when we are born with a certain prakriti, let's say like vata. We can still have optimal health if we watch out on our hara-vihara.

Exactly, because we nourish the sara. And tadu sarada, it is a result of agni. Tadu sarada is a result of srodhas. Tadu sarada, it changes according to the age of the person. Right? So keep it in mind that, you know, the essence of a particular Tattva is called the Saara, and Ojas is the essence of all the 7 Tattvas.

Hmm, that is very unique. I've never heard that explained like that before.

So Saara is the essence of a particular Tattva, And ojas is the essence of all the 7 tattvas. So ojas is the overall score of sara.

Hmm, so it's like you have individual marks in each subject and then you have the final tally.

Correct. So when you are, you know, making an overall score, you know, Ayurveda categorize the sara into pravarasara, that is superior, you know, who possesses optimal strength, self-confidence, you know, uh, suffers less from the diseases. All signs and symptoms of good ojas will be there, right? While on the other side, an inferior one, uh, will have less ojas. In such cases, a physician needs to assess the tadukshaya lakshanas. Whether, you know, he is suffering from any depletion or decrease of the Tattus.

What would be some signs for a general depletion of Tattus?

For example, you know, Tarsium, you take emaciation, right? You know that, you know, I mean, the muscle tissue is not of proper sara, right? Or, you know, the skin is of dryness. Dry skin or, you know, scandy hair, right, or hair falling, it indicates, you know, the rasa sara is not of good quality, right?

And these are some of the major concerns for people, especially during these stressful times. You know, they're losing hair, losing sleep, disturbances of the mind and health.

See, um, see, Ayurveda says, you know, uh, The assessment of Thara, of Sara, can be used as a tool to predict a disease process. For example, you know, I assess, you know, the Sarada of your body, a weak Sara for your Rektathadu, so that there might be a possibility that you might get a condition based on the Rektathadu. Let it be imbalanced by Vata, Pitta, or Kapha according to the Diddhanas, it might vary. So, uh, Sarvariksha is important to predict the disease, for assessing the immunity, for assessing the disease prognosis, for understanding the ojas. It is all very important.

Amazing.

See, so in a clinical diagnosis you, uh, need not to go for, you know, diagnose whether you are a rasa-dominated person or you are a rekta-dominated person. Rather, you know, you can sum up the overall score. See, uh, sara is, you know, majorly, uh, affected in several disease conditions also. So Ajadiya says, you know, you take vada vyathi or you could take a condition like Rajayakshma, or you take a condition like Pandu or Uddhara, the sara is depleted. So according to me, sara is, you know, is of much importance than the prakriti. That's what I feel several times.

Because you are looking at the individual components of the health.

Correct.

Yeah, yeah.

And if you can manage it at the individual places, then you have already brought it all up to optimal.

Correct, correct. So Rasayana is all about improving the sara of a person. That is the ultimate— that is the ultimate definition of Rasayana.

Yes, you're nourishing the dhatus at their very basic level.

Correct. So Rasayana is the science of nutrition, science of targeted nutrition.

Beautiful. Yes, makes sense now. Yeah, you have also mentioned the importance of geography and herbs and where the treatment itself is done as another very important part of your toolkit of how you tailor the treatments. Would you please explain a little bit more about that?

Correct. See, this is very, very important because, you know, I practice Ayurveda in India as well as in Dubai. So this is very important. See, in an Ayurvedic way, desha means, you know, the geographical location and the flora and the fauna of that patient's, you know, residing place. For example, you take, you know, treating a fibromyalgia condition in a wetland like Kerala, right? A physician, knowingly or unknowingly, will choose a kashaya or a medicine which is kushnavirya in nature, rukshaguna in nature, because It is a wetland, you know, I mean, we are used with that practice, right? But such a practice, it might not work in an arid land like Dubai.

100% makes sense, right? Yeah.

For example, uh, when I'm treating, you know, a myalgia condition, uh, in Kerala, kashayams, you know, like Varanadi kashayam, Rasna Saptakam kashayam, Rasneerendadi kashayam, you know, these are some of my favorites. While I'm treating that condition in Kerala. While, uh, giving the same medicine in Dubai, it might not work, right?

Right.

So, uh, so we need to understand whether it is a Jangala Desha or a Vada-predominated place, or a wetland, or if it is a Kapha-dominated place. By the Desha, you also need to understand which body part the disease has manifested. See, for example, you know, there are, uh, you take head region, it is considered as the Kapha Desha, right? For example, you get a migraine headache, which is considered as a Vata-Pitta-Dosha imbalance condition. So in a migraine condition we define that a Vata-Pitta imbalance has located in a Kapha Desha, which is the head, and has produced the disease. So my medicine will not be Vata-Pitta balancing since the Desha is the Chiras.

So amazing.

So I might go for a Pitta-Kapha balancing medicines in the first stage. Some medicines like Patyaksha Dangam, Patyaksha Tathriadi, or Amruthotharam in the first phase, ensuring that, you know, the Kapha is controlled there. Then you might treat for the Pitta and the Vata.

Amazing. It is just mind-blowing, the detail that goes into the analysis that you do. It's not a matter of looking at the symptoms and giving a medicine that goes and targets one part of the body. You have all these variables that are playing into your diagnosis. That's incredible, incredible.

So the Ayurvedic diagnosis is not just about, you know, naming the disease and suggesting a medicine from the therapeutic index. This is not the Ayurvedic way of treatment. See, Ayurveda says even if you do not name of— do not know the name of the disease, if you know which dosha is imbalanced, if you know which tattva is, uh, imbalanced there or involved there, if you know the causes of the disease, if you can understand the pathology of a disease, if we can understand which stage of the disease it is, you need not to name the disease, right?

Doesn't even matter, correct?

Because, yeah, new diseases will also come, right? Right. So Desha is very important. Uh, Kaala is also very important. I mean, uh, the season, right? Say, for example, you know, the treatment in winter for a particular disease will be different from treating a condition in summer, the other season, right?

Right. Yeah, right.

For example, you think of, you know, a Pitta disease which has occurred in a summer season. A Pitta disease which has occurred in a summer season The next season is the rainy, because rain, uh, the upcoming rainy and the autumn seasons provoke and imbalance Pitta. So you need to be, uh, specifically cautious about it, right? While a small Pitta disease which occurred in an autumn season, it might go by itself in the next season, which is winter. Hmm, yes, the kala is very important.

Fascinating, fascinating. Some of our listeners are clinicians, and from everything that you have shared, if there is anything that you want to kind of wrap it all up and share with them so they can start to use it in their practice that will help them, what would that be, Dr. Shyam?

Correct. See, we couldn't, you know, complete the entire Dasha Vitha Pariksha, right?

It's impossible. We'll have to be here for the whole day, right?

So to quickly wrap up, you know, I would say, you know, the Pragradi has to be assessed, uh, the Vigradi has to be assessed, Saara has to be assessed, uh, the Samhannana has to be assessed. And the pramana, the measurements, you know, it is very important, the anthropometric measurements. Now we know we use it in centimeter and kilogram. Earlier, you know, he was using, you know, swa anguli. So you measure, you know, the height, weight, body mass index, uh, the skinfold thickness, you know, you measure the body circumference, you know, all these were measured, you know, that time also.

Right, right. And the barometer is right here, your own anguli.

Correct. And, uh, habituation, that is an important element of the dashavitavariksha. The mental strength is an important element. Uh, aharashakti, uh, that is, you know, the quantity of consumption and the, the digestive power. Vyayamashakti is important. Why is it important? You know, there is a lot about, you know, the Dasavidha Pariksha. So what you can see here, to wrap up, you can see that, you know, there is an extensive list of examination, let it be a Trivitha Pariksha or an Ashtasthana Pariksha or a Dasavidha Pariksha, you know. But there are physicians, you know, who will do all these in 15 minutes also.

Yes, I have heard about physicians— I'm sorry, I'm excited to share this— that I have heard about some of the very venerated physicians from Kerala who would just diagnose by watching the patient walking to them, and they would say, this is what you have, right?

But this is with experience, right? This is with years of experience, and this is with the backing of the Samhitas. You know, you are able to quickly translate, you know, the Pratyaksham and Anumanam into a diagnosis process. But I would suggest, you know, the beginners and the students should do an elaborate assessment.

Yeah, right.

And we may need multiple sittings also with a patient. One sitting, you know, you might not get, you know, the entire details.

Yes.

So therefore, you know, don't be shy about, you know, I mean, taking 1 hour for a diagnosis or, you know, asking for 1 more sitting, right? So go through the same process, you know, the step-by-step process, but at some time, you know, you will also be diagnosing a condition in 15 minutes.

Hmm.

Few years later.

Yes, yes. Is there anything that you see that you wish was not being done that way? Is there anything, any practice that you see that is being taught in the schools or in the educational institutions that you feel is going away from the essence of Ayurveda? I recently had a client reach out to me and say that I went to an Ayurveda physician and he just gave me pills like ibuprofen and the allergy medication. And he was like, is this an Ayurveda physician even? So, you know, I had to then connect this gentleman to an Ayurveda physician, a proper Ayurveda physician. So I see that some of the students who come out of Ayurveda are practicing either kind of an amalgamation and they are not understanding the incredible depth and the powerful tools for diagnosis that classical Ayurveda equips them with, is there anything that you observe that you think can be made better?

If you just take, you know, the elements of, you know, the diagnosis, you can understand that, you know, it is a far superior science, you know, than the modern medical tools, you know, which is available. Right, right. So, uh, as you know, I mean, our Prime Minister Modi, you know, I mean, uh, says The first, you know, you need to have, you know, the confidence on our system of practice. You need to have the confidence on our science.

Yeah.

And secondly, you need to be proud about our samskruti. You need to be proud about our culture.

Yes, that's what we stand for.

Yes.

Then all this will, you know, fall into place automatically.

Beautifully said, Dr. Shyam. Thank you so much for your time. We know you are an extremely busy physician. Where can people reach you? How can they reach you and get some time with you? You are doing online consultations, or do you not have time for that?

Yeah, seldom I do online consultation, but I, I practice in the clinic. I'm based in Dubai. Uh, others can reach me on through my Instagram or, uh, through my Facebook. And that would be the easiest way. Instagram or Facebook is easiest now, right?

Yes, yes, thank you. And I will put all the information in the show notes. Thank you so much for spending time with us. It was such an honor and a pleasure. We wish you many, many years of great, great work in the world.

Thank you, Salila. I truly enjoyed, you know, talking with you.

Paramana damu vasudeva sutam devam. Kamsajanuramardhanam. Krishnamurti, Jagadguru. Krishnamurti, Jagadguru. Devaki Paramana Dhamma. Devaki Paramāṇu. Devaki Paramāṇu. Krishna Vālada. Oh, Krishna, Krishna, Krishna, Nīyam, Beganevaro.