Defination Normal value Hypo and Hyperr condition Instrument and their part Different method of Ayurvedic and modern part of Blood pressure Pulse examination Stool examination Urine examination Eye examination Tongue examination Touch examinationm Size examination Nose examination

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Clinical Examination: Complete Reference Guide

(Modern Medicine + Ayurvedic - Ashtavidha Pariksha)

AYURVEDIC FOUNDATION: Ashtavidha Pariksha (Eight-Fold Examination)

In Ayurveda, the eight standard methods of patient examination are collectively called Ashtavidha Pariksha:

#	Sanskrit	Meaning
1	Nadi	Pulse examination
2	Mutra	Urine examination
3	Mala	Stool examination
4	Jihva	Tongue examination
5	Shabda	Voice/speech examination
6	Sparsha	Touch/skin examination
7	Drik (Chakshu)	Eye examination
8	Akrti	Size/appearance examination

Each examination reflects the state of the three doshas: Vata, Pitta, and Kapha.

1. BLOOD PRESSURE (Rakta Chap)

Definition

Blood pressure (BP) is the force exerted by circulating blood against the walls of arteries. It is expressed as systolic/diastolic in mmHg.

Normal Values

Category	Systolic (mmHg)	Diastolic (mmHg)
Normal	< 120	< 80
Elevated	120-129	< 80
Stage 1 Hypertension	130-139	80-89
Stage 2 Hypertension	≥ 140	≥ 90
Hypertensive Crisis	> 180	> 120
Hypotension	< 90	< 60

Hypo and Hyper Conditions

Hypertension (high BP):

Primary (essential) - most common, no identifiable cause
Secondary - renal disease, endocrine disorders (Cushing's, pheochromocytoma), coarctation of aorta
Complications: stroke, heart failure, renal failure, retinopathy

Hypotension (low BP, SBP < 90 mmHg):

Hypovolemic (dehydration, blood loss)
Cardiogenic (heart pump failure)
Distributive (septic, anaphylactic, neurogenic shock)
Orthostatic (drops >20 mmHg systolic on standing)
Signs: dizziness, syncope, poor peripheral perfusion, cold extremities

Instrument and Parts: Sphygmomanometer

Mercury Sphygmomanometer:

Manometer (mercury column with scale)
Inflatable cuff (bladder inside)
Rubber bulb (inflation)
Control valve (release)
Tubing

Aneroid Sphygmomanometer:

Dial gauge (mechanical spring)
Cuff and bladder
Bulb and valve
Stethoscope (separate, used to hear Korotkoff sounds)

Digital/Electronic BP Monitor:

Oscillometric sensor
LCD display
Memory function
Automated cuff inflation

Ancillary instrument: Stethoscope - placed over the brachial artery to auscultate Korotkoff sounds.

Methods of Measurement

Auscultatory Method (most standard):

Patient seated, arm at heart level
Wrap cuff around upper arm (2-3 cm above antecubital fossa)
Inflate to ~20-30 mmHg above expected systolic
Slowly deflate (2 mmHg/sec)
Systolic = first Korotkoff sound (K1)
Diastolic = disappearance of sounds (K5)

Korotkoff Sound Phases:

K1: first tapping sound (systolic BP)
K2: swooshing sound
K3: louder thumping
K4: muffling of sound
K5: complete disappearance (diastolic BP)

Other Methods:

Palpatory method (less accurate, gives only systolic)
Oscillometric (digital devices)
Ambulatory BP Monitoring (ABPM) - 24-hour monitoring
Automated Office BP (AOBP)
Invasive arterial line (ICU/surgical setting - most accurate)

Ayurvedic View

Blood pressure is linked to Vyana Vata (the vata responsible for circulation). Hypertension correlates with Vata-Pitta aggravation causing excessive force on vessel walls.

2. PULSE EXAMINATION (Nadi Pariksha)

Definition

Pulse is the rhythmic expansion and recoil of an artery wall caused by each heartbeat. It reflects heart rate, rhythm, volume, and character.

Normal Values

Age Group	Normal Pulse Rate (bpm)
Newborn (0-3 months)	100-150
Infant (3-6 months)	90-120
Infant (6-12 months)	80-120
Child (1-10 years)	70-130
Adults	60-100
Trained athletes	40-60

Normal pulse characteristics:

Rate: 60-100 bpm
Rhythm: regular
Volume: normal/full
Character: smooth upstroke
Tension: normal

Hypo and Hyper Conditions

Tachycardia (> 100 bpm): fever, anemia, hyperthyroidism, anxiety, heart failure, shock Bradycardia (< 60 bpm): athlete's heart, hypothyroidism, heart block, raised intracranial pressure, vagal stimulation

Abnormal pulse types:

Pulsus parvus et tardus - slow upstroke, low amplitude (aortic stenosis)
Water-hammer/Corrigan's pulse - bounding, rapidly collapsing (aortic regurgitation)
Pulsus alternans - alternating strong/weak beats (severe LV dysfunction)
Pulsus paradoxus - drops >10 mmHg on inspiration (cardiac tamponade, severe asthma)
Dicrotic pulse - double palpable beat (shock, vasoconstriction)
Bisferiens pulse - two peaks in systole (mixed aortic valve disease)

Sites of Pulse Examination (Modern)

Radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis, temporal

Instrument

Stethoscope (apical pulse / auscultation)
Pulse oximeter (detects pulse + SpO2)
Clock/watch with seconds

Method

Patient relaxed, forearm slightly pronated
Palpate radial artery with 2nd, 3rd, 4th fingers
Count for 60 seconds (or 15 sec x 4)
Note: rate, rhythm, volume, character, vessel wall

Carotid artery: examined with finger pads, identifying amplitude and contour - most useful for assessing waveform character (tardus/parvus, bounding, etc.) - Fuster and Hurst's The Heart, 15th Edition

Ayurvedic Nadi Pariksha

Site: Radial artery (wrist), 3 fingers placed just below the thumb base

Index finger = Vata (Sarpa/cobra gait - quick, irregular, cold)
Middle finger = Pitta (Manduka/frog gait - jumping, elastic, hot)
Ring finger = Kapha (Hamsa/swan gait - slow, broad, cool)

Dosha	Gati (Movement)	Vega (Rate bpm)	Bala (Force)	Character
Vata	Sarpa (Cobra)	80-95	Low	Cold, rough, irregular
Pitta	Manduka (Frog)	70-80	High	Hot, elastic, regular
Kapha	Hamsa (Swan)	50-60	Moderate	Warm-cool, soft, regular

Best time: early morning, empty stomach

3. URINE EXAMINATION (Mutra Pariksha)

Definition

Urine examination (urinalysis) is the physical, chemical, and microscopic analysis of urine to detect disease.

Normal Values

Parameter	Normal
Color	Pale yellow to amber
Clarity	Clear
pH	4.5-8.0 (average 6.0)
Specific gravity	1.005-1.030
Protein	Negative (< 150 mg/day)
Glucose	Negative
Ketones	Negative
Blood	Negative
Bilirubin	Negative
Urobilinogen	0.1-1.0 EU/dL
WBCs	0-5/HPF
RBCs	0-3/HPF
Casts	Occasional hyaline
Bacteria	None
Volume (24hr)	800-2000 mL

Hypo and Hyper Conditions

Abnormality	Significance
Proteinuria	Nephrotic syndrome, glomerulonephritis, diabetes
Glycosuria	Diabetes mellitus, renal glycosuria
Hematuria	UTI, stones, tumor, trauma
Ketonuria	Diabetic ketoacidosis, starvation
Bilirubinuria	Hepatitis, obstructive jaundice
Oliguria (< 400 mL/day)	Dehydration, acute kidney injury
Polyuria (> 2500 mL/day)	Diabetes mellitus/insipidus, diuretics
Anuria (< 100 mL/day)	Severe renal failure, obstruction
Pyuria	UTI, pyelonephritis

Instruments

Urinometer (specific gravity - float in urine)
Refractometer (specific gravity - more accurate)
Dipstick/reagent strips (chemical analysis)
Microscope (microscopic analysis)
pH meter or litmus paper
Centrifuge (sediment preparation)
Graduated cylinder (volume)

Methods (Modern)

Physical examination - color, clarity, smell, volume
Chemical examination - dipstick (protein, glucose, blood, pH, SG, ketones, bilirubin, nitrites, leukocyte esterase)
Microscopic examination - centrifuge sample, examine sediment for cells, casts, crystals, bacteria
Bacteriological - midstream clean-catch for culture and sensitivity

Ayurvedic Mutra Pariksha (Tailabindu Pariksha)

The oil drop test (Tailabindu Pariksha) is the classical Ayurvedic urine examination:

Collect urine in early morning in a clean vessel
Place a drop of sesame oil on the surface
Observe the spread and movement

Oil Drop Pattern	Interpretation
Spreads immediately, thin	Vata disease, easily curable
Spreads in middle, pearl-like	Pitta disease
Sits on surface, breaks into pearls	Kapha disease
Sinks immediately	Very serious/incurable condition
Moves towards east	Curable
Moves in all directions	Difficult to cure

Normal urine color in Ayurveda: golden yellow (like gingelly/sesame oil)

4. STOOL EXAMINATION (Mala Pariksha)

Definition

Stool (fecal) examination is the physical, chemical, and microscopic analysis of feces to detect gastrointestinal, hepatic, and parasitic disease.

Normal Values

Parameter	Normal
Color	Brown (due to stercobilin)
Consistency	Formed, soft
Odor	Characteristic (not offensive)
Blood	Absent
Mucus	Absent
Pus	Absent
Parasites	Absent
Fat	< 7 g/day (no gross steatorrhea)
Frequency	3/day to 3/week
pH	7.0-7.5

Hypo and Hyper Conditions

Finding	Significance
Melena (black, tarry)	Upper GI bleed (peptic ulcer, varices)
Hematochezia (fresh blood)	Lower GI bleed (hemorrhoids, colitis, carcinoma)
Pale/clay-colored	Obstructive jaundice, bile duct block
Steatorrhea (greasy, bulky)	Malabsorption, chronic pancreatitis (neutral fat + muscle fibers)
Mucus + blood	Ulcerative colitis, amebic dysentery
Rice water	Cholera
Occult blood	Silent GI bleeding - tested by Guaiac/FOB test
Parasites	Worm infestations (roundworm, hookworm)
Diarrhea	Infection, IBD, malabsorption
Constipation	Low fiber, hypothyroid, obstruction

Instruments

Collection container (clean, wide-mouth)
Microscope (microscopic examination)
Guaiac/FOBT card (occult blood)
Glass slides and coverslips
Centrifuge
Formalin (preservation)

Methods (Modern)

Macroscopic - color, consistency, blood, mucus, parasites
Microscopic - RBC, WBC, parasites (ova and cysts), fat globules, muscle fibers, undigested food
Chemical - occult blood (Guaiac test/FOBT), fat estimation
Bacteriological - culture for pathogens
Concentration techniques - for detecting parasites

S Das Manual on Clinical Surgery: "Melena indicates peptic ulcer with haemorrhage. In chronic pancreatitis there will be neutral fat (steatorrhoea) and striated muscle fibres (creatorrhoea) in the stool. Blood and mucus is a feature of ulcerative colitis."

Ayurvedic Mala Pariksha

Dosha	Stool Character
Vata	Dry, hard, dark, scanty, constipated, gas, painful
Pitta	Loose, yellowish/greenish, foul-smelling, burning sensation
Kapha	Mucoid, slimy, pale, heavy, sticky

5. EYE EXAMINATION (Drik/Chakshu Pariksha)

Definition

Eye examination is clinical assessment of the visual system and ocular structures to detect local and systemic disease.

Normal Values

Parameter	Normal
Visual acuity	6/6 (20/20)
Visual fields	Full (peripheral ~180°)
Pupils	Equal, round, reactive to light (PEARL)
Pupil size	2-6 mm in normal light
Eye movements	Full in all 6 directions
Intraocular pressure	10-21 mmHg
Fundus	Clear disc, cup:disc ratio < 0.5
Cornea	Clear
Sclera	White
Conjunctiva	Pink, moist

Hypo and Hyper Conditions

Finding	Significance
Jaundiced sclera	Liver disease (jaundice)
Pale conjunctiva	Anemia
Roth spots (fundus)	Infective endocarditis
Papilledema	Raised ICP
Kayser-Fleischer rings	Wilson's disease
Arcus senilis	Hypercholesterolemia (if < 45 years)
Proptosis	Hyperthyroidism (Graves'), tumor
Miosis (small pupils)	Opioid toxicity, Horner's syndrome
Mydriasis (dilated)	Anticholinergic drugs, 3rd nerve palsy
Nystagmus	Cerebellar/vestibular disorders
Fundal changes	Hypertensive/diabetic retinopathy

Instruments

Ophthalmoscope (direct/indirect) - fundus examination
Slit lamp - anterior segment
Tonometer (Schiotz/Goldman) - IOP measurement
Snellen chart - visual acuity
Ishihara plates - color vision
Pen torch - pupil reflexes, general inspection
Prism - strabismus measurement

Methods (Modern)

Visual acuity - Snellen chart (each eye separately)
Visual fields - confrontation, perimetry
Pupillary reflexes - direct and consensual light reflex
Eye movements - versions (pursuit), saccades, convergence, ductions
External examination - lids, conjunctiva, cornea, sclera
Fundoscopy - disc, vessels, macula, periphery
Slit lamp - anterior chamber, lens
Intraocular pressure - tonometry

Bradley and Daroff's Neurology: Components include visual acuity, versions (pursuit, saccades, muscle overaction), convergence, ductions, alignment, pupils, lid examination, vestibulo-ocular reflexes, and Bell phenomenon.

Ayurvedic Drik Pariksha

Dosha	Eye Appearance
Vata	Dry, dull, small, sunken, dark circles, twitching
Pitta	Red, inflamed, burning, sensitive to light, yellowish tinge
Kapha	Moist, oily, large, white sclera, heavy/droopy lids, mucoid discharge

6. TONGUE EXAMINATION (Jihva Pariksha)

Definition

Tongue examination involves inspection of the tongue's color, surface, coating, moisture, and movement to assess systemic and local disease.

Normal Values

Pink, moist, smooth dorsal surface
Thin white coating (normal)
No ulcers, no tremors
Midline protrusion (no deviation)
Papillae normal (filiform, fungiform, circumvallate)

Hypo and Hyper Conditions

Finding	Significance
Pale tongue	Anemia
Red/beefy tongue	B12/folate deficiency (glossitis)
Central cyanosis	Cardiac/respiratory failure
Yellow coating	Liver disease, jaundice
Dry tongue	Dehydration
Furred/coated	Fever, GI disturbance, smoking
Deviated tongue	Hypoglossal nerve (CN XII) palsy
Tremors	Hyperthyroidism, neurological disease
Strawberry tongue	Scarlet fever, Kawasaki disease
Geographic tongue	Benign migratory glossitis
Leukoplakia	Pre-malignant
Macroglossia	Hypothyroidism, acromegaly, amyloidosis
Smooth (atrophic)	Iron deficiency, B12 deficiency

Instrument

Pen torch (illumination)
Tongue depressor
Mirror (for indirect examination)
Gloves

Methods (Modern)

Ask patient to protrude tongue in midline
Note: color, shape, symmetry, deviation
Inspect surface: coating, papillae, lesions, ulcers
Assess moisture
Note any tremors or involuntary movements
Palpate if lesion present (gloved finger)

Ayurvedic Jihva Pariksha

Dosha	Tongue Appearance
Vata	Dry, rough, cracked, dark/brownish, thin, trembling
Pitta	Red, inflamed, burning, yellowish coat, sharp sensation
Kapha	Pale, thick white/gray coating, moist/slimy, swollen
Ama (toxins)	Thick, sticky coat, foul smell
Niram (no toxins)	Clean, thin coat, no odor

7. TOUCH EXAMINATION (Sparsha Pariksha)

Definition

Sparsha Pariksha refers to tactile examination of the patient's skin and body, assessing temperature, texture, moisture, tenderness, and turgor.

Normal Values

Skin warm, smooth, moist
No pitting on pressure
Normal turgor (skin snap back <2 sec)
No tenderness on palpation
Capillary refill < 2 seconds

Hypo and Hyper Conditions

Finding	Significance
Cold, clammy	Shock, hypoperfusion
Hot, dry	High fever, hyperthermia
Cold extremities	Peripheral vascular disease
Pitting edema	Cardiac/renal/hepatic failure, hypoalbuminemia
Reduced turgor	Dehydration
Tenderness	Inflammation, infection, organ pathology
Crepitus	Subcutaneous emphysema, fractures
Lymphadenopathy	Infection, malignancy

Instruments

Stethoscope (tactile fremitus)
Percussion hammer
Tuning fork (vibration sense)
Pin/cotton (sensory testing)
Thermometer (objective temperature)

Methods (Modern)

Palpation - superficial and deep
Skin temperature - dorsum of examiner's hand
Skin turgor - pinch test
Capillary refill - compress nail bed
Tactile fremitus - vocal resonance on chest
Lymph node palpation
Tenderness assessment - rebound, guarding

Ayurvedic Sparsha Pariksha

Dosha	Skin Character
Vata	Dry, rough, cold, thin, cracked, dark
Pitta	Hot, soft, oily, reddish, sweaty, sensitive
Kapha	Cool, smooth, moist, oily, thick, soft, pale

8. SIZE EXAMINATION (Akrti Pariksha)

Definition

Akrti Pariksha is assessment of the patient's general physique, body build, proportions, and overall appearance.

Normal Values

BMI: 18.5-24.9 kg/m²
Waist circumference: Men < 90 cm, Women < 80 cm
Normal body proportions (arm span ≈ height)
No gross deformity, normal gait and posture

Hypo and Hyper Conditions

Finding	Significance
Underweight (BMI <18.5)	Malnutrition, malabsorption, malignancy, TB
Overweight (BMI 25-30)	Metabolic risk
Obese (BMI >30)	Diabetes, hypertension, heart disease
Short stature	Growth hormone deficiency, hypothyroid, Turner syndrome
Tall stature	Marfan syndrome, gigantism
Cachexia	Cancer, chronic infection
Disproportionate limbs	Rickets, achondroplasia
Cushinoid features	Corticosteroid excess
Acromegalic features	GH excess (large hands, jaw, feet)

Instruments

Weighing scale
Stadiometer (height)
Measuring tape (waist, limb length)
BMI chart

Methods (Modern)

General inspection - nutritional status, pallor, jaundice, cyanosis, clubbing, edema
Height and weight - calculate BMI
Waist circumference
Arm span measurement
Body proportions (upper to lower segment ratio)

Ayurvedic Akrti Pariksha

Dosha	Body Build
Vata	Thin, light, dry skin, small frame, variable weight, poor muscle mass
Pitta	Medium build, moderate muscle, warm skin, athletic
Kapha	Large frame, heavy, strong bones, thick skin, slow metabolism

9. NOSE EXAMINATION (Nasika/Ghrana Pariksha)

Definition

Nasal examination assesses the external nose, nasal passages, mucosa, septum, turbinates, and olfactory function.

Normal Values

Patent bilateral airway
Pink, moist nasal mucosa
Intact, midline septum
No discharge, no polyps
Normal olfaction (smell)
Turbinates non-congested

Hypo and Hyper Conditions

Finding	Significance
Anosmia (loss of smell)	COVID-19, head injury, Parkinson's, cribriform plate fracture
Hyposmia	Upper respiratory infection, zinc deficiency
Epistaxis	Hypertension, trauma, bleeding disorders, nasopharyngeal carcinoma
Nasal polyps	Allergic rhinitis, aspirin sensitivity, chronic sinusitis
Deviated septum	Trauma, developmental
Flared nostrils	Respiratory distress
Saddle-nose deformity	TB, Wegener's granulomatosis, congenital syphilis, trauma
Purulent discharge	Sinusitis, foreign body
Clear watery discharge	Allergy, CSF rhinorrhea
Rhinophyma	Rosacea, chronic alcoholism

Instruments

Nasal speculum (Thudichum's) - widens nostrils for inspection
Pen torch/headlight
Mirror (warmed, for airway patency - Glatzel mirror test)
Nasoscope/Rhinoscope
Endoscope (rigid/flexible) - for detailed posterior examination
Tuning fork (olfaction testing with standard odors)

Methods (Modern)

External inspection - shape, symmetry, deformity, skin lesions
Anterior rhinoscopy - nasal speculum + light: septum, inferior/middle turbinates, floor, discharge, polyps
Posterior rhinoscopy - mirror examination of nasopharynx
Nasal endoscopy - detailed view of all structures
Olfactory testing - identify common odors (coffee, cloves, vanilla)
Glatzel mirror test - fogging pattern tests airway patency
Nasal airflow - separate each nostril

Ayurvedic Nasika Pariksha (Ghrana)

Dosha	Nasal/Olfactory Signs
Vata	Dry nasal mucosa, loss of smell, dry crusting
Pitta	Inflamed mucosa, nosebleeds, hypersensitivity to strong smells
Kapha	Congestion, excess mucus, reduced sense of smell, polyps

Nasya (nasal oil instillation) is a key Ayurvedic therapeutic intervention for nasal and brain health.

QUICK SUMMARY TABLE: All Examinations

Examination	Modern Instrument	Normal Value	Hypo Condition	Hyper Condition
Blood Pressure	Sphygmomanometer + Stethoscope	120/80 mmHg	Hypotension (<90/60)	Hypertension (≥140/90)
Pulse	Watch + fingers / Pulse oximeter	60-100 bpm	Bradycardia (<60)	Tachycardia (>100)
Urine	Urinometer, dipstick, microscope	See table above	Oliguria/Anuria	Polyuria
Stool	Microscope, FOBT	Brown, formed	Constipation	Diarrhea
Eye	Ophthalmoscope, Snellen chart	6/6 vision, PEARL pupils	Amblyopia/vision loss	Raised IOP (glaucoma)
Tongue	Torch, depressor	Pink, moist, midline	Atrophic glossitis	Macroglossia
Touch/Skin	Hands, tuning fork	Warm, elastic, no edema	Cold/clammy (shock)	Pitting edema
Size/Appearance	Scale, stadiometer	BMI 18.5-24.9	Underweight	Obese
Nose	Nasal speculum, torch	Patent, pink mucosa	Anosmia	Rhinitis/polyps

Sources:

Fuster and Hurst's The Heart, 15th Edition - arterial pulse examination and abnormal waveforms
Bradley and Daroff's Neurology in Clinical Practice - eye examination components
S Das Manual on Clinical Surgery - stool examination
Smith and Tanagho's General Urology, 19th Edition - urine examination
Ayurvedic framework from PMC Ashtavidha Pariksha review and Tailabindu Pariksha study

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