|Year : 2022 | Volume
| Issue : 4 | Page : 516-523
Standardization of Purisha Pariksha with special reference to Jala Nimajjan Vidhi
Rajesh Uikey1, Anukul Chandra Kar2
1 Department of Rog Nidan Evam Vikriti Vigyan, Government Dhanwantari Ayurved College and Hospital, Ujjain, Madhya Pradesh, India
2 Department of Rog Nidan Evam Vikriti Vigyan, Faculty of Ayurved, IMS Banaras Hindu University, Varanasi, Uttar Pradesh, India
|Date of Submission||27-Dec-2019|
|Date of Decision||18-Feb-2020|
|Date of Acceptance||07-Jul-2020|
|Date of Web Publication||26-Feb-2022|
53 Nageshwar Dham Colony, Ujjain, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Backgroud: Jala-Nimajjan Purisha Pariksha is an ancient method that has been described in all most all the Samhitas, which was done to assess the presence of Ama (undigested substance) in the stool. Ama is an important factor which is considered generally as the root cause of all the diseases. So, this technique was considered as an important tool to ascertain the presence of Ama in the stool. This is a simple method in which stool mass is dropped on water and observation is being made whether stool floats or sinks. If stool sinks, then it is associated with Ama or otherwise if it floats, then it is Nirama (digested substance). Aim: The aim of the study was to standardize the procedure of Jal-Nimajjan Purisha Pariksha. Materials and Methods: The present study is broadly divided into two parts: Part-I a pilot study for standardization of Jala-Nimajjan Purisha Pariksha in terms of physical parameters And Part-II: study on features of Jala-Nimajjan Purisha Pariksha in apparently healthy volunteers along with routine and microscopic examination of stool. Thirty apparently healthy volunteers were selected from BHU campus. Results: This study showed a significant result in correlation with textual descriptions of Ayurveda regarding Agni and Purisha Pariksha. Statistically, Chi-square test was applied to obtained data and analyzed by SPSS software version 6. Conclusion: This method is more important because it can detect the Ama before its manifestation of symptoms in the whole body. Whenever there is abnormality of Agni in the body, it has a direct effect on digestion. If Agni does not work properly, then Ama is produced in the intestine. Stool is the first excretory substance produced as a result of digestion. If any changes occur in the bowel, it will be seen first in stool and can be detected by Jala-Nimajjan Purisha Pariksha.
Keywords: Agni (digestive power), Ama, Jala-Nimajjan Purisha Pariksha, Mala pariksha, Purisha Pariksha, Stool examination etc.
|How to cite this article:|
Uikey R, Kar AC. Standardization of Purisha Pariksha with special reference to Jala Nimajjan Vidhi. Med J DY Patil Vidyapeeth 2022;15:516-23
| Introduction|| |
In Ayurveda, the clinical examinations are broadly classified into Roga and Rogi Pariksha. Several methods of Roga Rogi Pariksha such as Dashavidha Pariksha, (tenfold examination) and Astasthana Pariksha (eightfold examination) are described in Ayurvedic classics. Mutra Pariksha (urine examination) and Purisha Pariksha (stool examination) were the main laboratory investigative tools in the past and were included under Astasthana Pariksha. The factors which are described under Astasthana 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 done or these can act as supportive factors to diagnose the disease.
There is no direct description of Purisha Pariksha under a separate chapter in Ayurvedic texts, but scattered references are available regarding the abnormalities in terms of its color, odor, consistency, quantity, froth, and mucous, etc., pertaining to various diseases. Rather, a unique method of Jala-Nimajjan Purisha Pariksha has been described in all most all the Samhitas. This method was practiced probably up to the medieval period, but gradually, as time progresses, this test has not given so importance as the chemical and microscopic examination of the stool has taken its place. All the researches have thrown light on the physical aspects of Purisha Pariksha, but no one has tried to standardize the above technique so that further work could be done to establish this technique.
If the technique is critically analyzed, it is found that there are so many variables in this method, which can produce a difference in the results. These variables are materials of the testing container, dispensing instrument, type of water, height of dropping of stool, and duration of the test after collection, etc., Any diagnostic technique, if not standardized for the variables, then the result will not be reproducible. Hence, it is important as a first step to standardize the technique of any diagnostic method. Considering the above, an attempt has been made to standardize all the variable parameters of this technique as well as to study its features in apparently healthy volunteers.
| Materials and Methods|| |
The present study is broadly divided into two parts. In the first part, a pilot study was carried out to standardize the variable parameters in four healthy volunteers. In standardization, procedures were planned to standardize various parameters such as testing container, type of water, volume of water, and height of stool dispensing. In the second part, after standardization, this study was carried out in 30 healthy volunteers who were selected from the hostel of Banaras Hindu University(BHU) campus. This study was passed by the Institutional Ethical Committee vide Letter No. Dean/2010-11/346, dated February 18, 2010.
- Age 20–30 years both male and female
- Having the same diet pattern
- Apparently healthy and having no drug history at least for 7 days.
- Not willing to participate in the study
- Taking unwholesome diet
- Suffering from any disease.
The analysis of data was done using the SPSS (Statistical software SPSS version 6.0, IBM statistics, 2009) software version 6. For Nominal, ordinal variable and intragroup comparison, Pearson Chi-square test was used.
Part I – To standardize procedure of Jal-Nimajjan Purisha pariksha
While describing the procedure of Jala-Nimajjan Purisha Pariksha, Brihattrayi Samhitas have not mentioned the collection time, amount of stool, volume of water, etc., but mentioned that quality of stool which should be “Bina atidrvasanghatashaityashleshmapradushnata cha” means – stool should not be in very liquid form, not very hard, not very cold, and not mixed with mucous. In standardization of the procedure, it was planned to standardize various aspects of Jala-nimajjan Purisha Pariksha, namely testing container, quality of water, volume of water, height of the stool from where it should be dropped, amount of stool, duration between collection and performance of test, and dispensing of stool.
- For stool sample, the volunteers were asked about their digestion and those having normal digestion were asked to collect the first morning sample in the container supplied. The plastic container having wide mouth and capacity of 30 ml made by polypropylene was chosen for the collection of stool. This disposable container was used for collecting a sample to avoid contamination. This container had tight fitting cap which prevents leaking during transportation. Volunteers were given container for stool collection along with a plastic spoon and were instructed to deposit the sample within 1 h of collection. Stool was examined in daylight for physical parameters like Rupa (consistency), Varna (color), mucous, blood, and parasites by the naked eye. pH of the sample was noted by dipping pH paper in stool for few seconds. Color change in pH paper was interpreted by matching the color with standard scale
- In Samhitas, it is mentioned that water should be taken for Jala-Nimajjan Pariksha but not mentioned about the quality of water. Probably, they might have used the water available with them. Hence, to see whether the quality of water affects test results or not, the test was performed in normal tap water and distilled water with the same stool sample and observations were noted down
- In Ayurvedic texts, it has been said that this test should be done in water, but how much amount of water should be taken, to check whether different volumes of water affect the result or not, the test was performed with different volumes of water that is 60, 80, and 90 ml of water with a same stool sample. Maximum volume of 90 ml of water was taken for examination to keep sufficient volume for the displacement of water. Since 100 ml glass cylinder with graduation mark was easily available in market and it was transparent to take the reading, it was selected for the purpose
- Regarding container, no special features about the material of the container are mentioned in the text. As stool displaces water after dropped in water, so transparent material like glass cylinder with graduation marks representing 1 mark as 1 ml was used and the results were noted
- The height from which stool should be dropped is not mentioned in Ayurvedic texts. Hence, whether height affects the result or not, the stool was dropped from various heights, i.e., 5 cm, 10 cm, and 15 cm from the upper level of water and observations were noted down
- Volume of stool was also not mentioned in the texts. Since more volume will displace more water, a constant minimum volume of 2 ml was dispensed to note the result
- Duration between collection and performance of test: To see whether different time gaps between collection and performance of test affect result or not, the test was performed at different times after collection that is in hourly interval up to 3 h with the same stool sample
- The method of dispensing was not described, i.e., how to put a stool on water. So, to dispense a constant volume of stool, a cut mouth disposable 2 ml plastic syringe was used to dispense stool on water.
Part II – To study Jala-Nimajjan Purisha Pariksha in apparently healthy individuals along with routine and microscopic examination of stool
Thirty apparently healthy volunteers were selected from the hostel of BHU campus those were having the same diet pattern and having no drug history for at least 1 week. The assessment of Agni of volunteers before performing the Jala-Nimajjan Purisha Pariksha was done on the basis of the parameters given by Acharya Sushrut in Sutrasthana and was recorded in specially designed pro forma prepared for the purpose [Figure 1].
Physical examination of stool
Rupa (consistency), Varna (color), mucous, blood, and parasites were observed by the naked eye. Gandha (odor) of the stool was smelled and noted down in the pro forma.
Chemical examination of stool
Chemical examination of the stool involved the observation of pH and occult blood.
pH testing method
Normal pH of stool was slightly acidic to slightly alkaline.
pH paper (2–10) was required for the test.
- Dip pH paper in a small quantity of the fecal material
- Observe the color
- Compare with the color chart and record the pH [Figure 2].
Test for occult blood in stool
Peroxidase type action of hemoglobin in the blood (present in a stool specimen) converts hydrogen peroxide to water and nascent oxygen. This oxygen oxidizes benzidine (in acidic medium) to form a green-colored complex.
1. Glass slide, 2. applicator sticks, 3. glacial acetic acid, 4. hydrogen peroxide, and 5. benzidine powder were required for the occult blood test.
- Take a pinch of benzidine powder in a small test tube
- Acidify it with 2–3 drop of glacial acetic acid and mix well
- Add about 1.0 ml of hydrogen peroxide and mix well
- Place a small quantity of stool specimen on a clean and dry glass
- Place one or two drops of the benzidine–glacial acetic acid–Hydrogen peroxide mixture on the stool sample on the glass slide
- Observe the change in color
- Observe the presence and absence of color in the test. If green color appears, it means occult blood is present in the sample [Figure 3].
Jala-Nimajjan Purisha Pariksha
For Jala-Nimajjan Pariksha, first of all, the surface tension of normal water and distilled water was recorded. As the next step, water was taken in 100 ml glass measuring cylinder up to mark of 90 ml. Two milliliter of stool was loaded in a syringe and was pushed in water from a height of 5 cm from the level of water. Observations were recorded as soon as the stool becomes stable [Figure 4].
1. Glass slides, 2. coversslips, 3. normal saline, 4. Lugol's Iodine solution, 5. saturated saline solution, and 6. small bottle were required for microscopic examination.
Saline specimen preparation
Place one drop of normal saline on the glass slide.
Take a little fecal material using an applicator stick and mix with a drop of normal saline.
Place a coverslip over it to avoid the formation of air bubbles while placing the coverslip.
Iodine specimen preparation
- Place a drop of Lugol's iodine on the other slide of the slide.
- Mix little fecal material with a drop of iodine solution.
- Place a coverslip on it.
It was examined under the microscope to note the presence of cells, crystals, vegetable matters, animal matters, undigested ingredients, ova, cysts, parasites, etc [Figure 5].
Assessment of Ama
The physical symptoms of Ama as described in Ayurvedic texts were observed and noted the behavior of stool on the surface of water as described below:
- Surface tension of water
- Level of the water before examination in ml
- Lower meniscus of the level of water displaced if stool floats (in ml)
- Amount of water displaced (in ml), i.e., c-b
- Lower meniscus of level of water displaced if stool sinks (in ml)
- Amount of water displaced (in ml), i.e., e-b.
According to Ayurveda, if stool floats in water that is Nirama Purisha and if sinks in water, it is called Sama Purisha.
| Observations and Results|| |
Standardization of Jala-Nimajjan Purisha Pariksha
It was observed that capacity and material of testing container does not affect the water displacement whether stool floats or sinks. The stool sample shows the displacement of equal amount of water, i.e., 4 ml both in glass and plastic containers. The different qualities of water did not show any difference in the result. The different volumes of water also did not affect the result in the displacement of water. Hence, 90 ml of water was taken for further study to have a minimum gap above the water level. The variation in the height of dropping the stool did not show any difference in the displacement of water. Hence, maximum 5 cm height from the water level was taken for further study. A minimum volume of 2 ml stool was used for this study. The test was performed after 1 h interval each time with the same stool sample of 2 ml each. The time gap between the collection and performance of the test did not show any difference in water displacement.
To study Jala-Nimajjan Purisha Pariksha in apparently healthy individuals along with routine and microscopic examination of stool
Fifty percent of cases having Samagni followed by 50% of cases having Vishamagni were found. The stool sample of volunteers having Samagni had the tendency toward floating on water, whereas the samples of volunteers having Vishamagni had the tendency toward sinking of stool on water. On statistical calculation, the relation between the type of Agni and the behavior of stool was found highly significant [Table 1].
Out of 30 volunteers, 23.3% were observed having stool mixed with mucus and 76.7% volunteers were observed without mucous in stool. The stool samples having no mucous were found either sinking or floating on water, but all the stool samples having mucous were found sinking on water, and on statistical calculation, the presence of mucous and the sinking of stool were found highly significant [Table 2].
Undigested food particles were present in 63.3% of the cases. When statistical calculation was done to observe any relation between the presence or absence of undigested particle with sinking and floating features of stool on water, it was found highly significant [Table 3].
|Table 3: Undigested particles versus behavior of stool in healthy volunteers (n=30)|
Click here to view
[Table 4] shows that the stool of 53.7% of the volunteers was found acidic that of 23.3% neutral, followed by 23.3% alkaline. Although the stool samples having acidic pH had the tendency toward sinking in water, but on statistical calculation, the relation of pH with the floating or sinking feature of stool was not found significant.
The displacement of water was ranging from 2 to 4 ml when stool floated on water and the mean was 3.53 ml. Similarly, the displacement of water was ranging from 2to 8 ml when stool sank in water and the mean displacement was 4.35 ml. When statistically analyzed, this difference in the displacement of water was highly significant [Table 5].
| Discussion|| |
On the basis of above-standardized parameters, the plastic container having wide mouth may be used for transportation of the stool sample as it has a tight cap which prevents leaking of sample and contamination. Glass cylinder having a capacity of 100 ml having graduated marks in 1 ml up to 100 ml may be used as a testing container. The normal tap water may be taken for conducting the procedure. To have a minimum gap between the height of dropping and water level, 90 ml of water should be taken as the maximum volume of water in a 100 ml capacity testing container. Stool should be dropped from a maximum height of 5 cm from the water level to avoid fluctuation in the water level. A minimum volume of 2 ml of stool sample may be used to conduct this procedure. The procedure should be conducted within 1 h of collection though more duration does not affect the result. It should be adhered to avoid any further contamination with bacteria, etc., The disposable 2 ml plastic syringe may be used to dispense the stool by cutting its mouth to make it wide open. This will facilitate the easy passage of stool without much pressure as pressure may affect the result. Following the above-standardized parameters, the Jala Nimajjan Purisha Pariksha was done in apparently healthy volunteers to establish a normal value of water displacement when stool is with Ama and without Ama.
In a study on features of Jala-nimajjan Purisha Pariksha, Samagni and Vishamagni were found in 50% of the cases each. On analysis, it was observed that the stool sample of volunteers having Samagni had the tendency toward floating on water and the Vishamagni leads to the sinking of stool in water. These relations were found to be statistically highly significant. Maximum cases had showed a tendency toward sinking as compared to floating. This proves that the Vishamagni produces Ama.
Mucous in stool was found in maximum cases, probably due to the status of Agni as Vishamagni. When it was analyzed statistically, a highly significant result was observed between the presence of mucous and the sinking behavior of stool. This proves that the mucous is nothing but the Ama. The presence of undigested food particles was also seen in 63% of the cases. This may be due to either delay in digestion which depends on the status of Agni. When analyzed statistically, it was observed highly significant relation between the presence of undigested particle and the sinking behavior of stool. Hence, it can be said that undigested particle may be taken as Sthula form of Ama. The pH of stool of 53.3% volunteers was found acidic that of 23.3% neutral, followed by 23.3% Alkaline. The acidic pH may be due to the defect in carbohydrate metabolism. Although the samples having acidic pH showed a tendency toward sinking in water, the difference in sinking and floating feature of stool due to difference in pH was not statistically significant.
The water displacement ranged from 2 to 4 ml with a mean value of 3.53 ml when stool floated on water, but it was ranged from 2 ml to 8 ml with a mean value of 4.35 ml when stool sank in water. The sinking of stool will naturally displace more water, but the sinking signifies the presence of Ama in the stool. When the difference in the displacement of water was analyzed, it was highly significant. Hence, it can be said that when the displacement of water is within 4 ml, then the stool is Nirama and when the displacement of water if more than 4 ml, then the stool is associated with Ama.
The Agni which digests the food properly consumed at the usual time is known as Samagni (normal digestive power) and it is due to normalcy of all the Dosas. However, there are three types of agni, which are functioning improperly are known as Vishamagni due to aggravation of Vata, Tikshangni due to aggravation of Pitta, and Mandagni due to aggravation of Shleshma. When these three kinds of Agnis stated above are present, digestion of food will not be proper. In Mandagni, the food will be Apaka (inadequately digested or not digested at all), in case of Tikshangni, it will be Dagdhapaka (over burn), and in case of Visamagni, it will be Pakva and Apakva (a mixture of digested and undigested) and also different from one period of digestion to the other. which is known as Ama.
According to the status of Agni, it was found that nobody is internally fully healthy because a normal lifestyle has been changed and people adopted the sedentary lifestyle. Body indicative signals relay time to time due to changes in internal cellular environment and metabolism of the body such as nausea, feeling heaviness, loss of appetite, changes in body secretions, and the waste products, which are manifested very late. However, through the Jal-Nimajjan Purisha Pariksha, we can know it very early because it is considered as an important tool to ascertain the presence of Ama in the stool. On the basis of above observations, it is suggested that Samavastha of stool can be detected on the basis of sinking behavior of stool, but other supportive tools such as pH of stool, presence of mucous in stool, and the undigested particle should also be taken into consideration. Hence, if the stool is having acidic pH, presence of mucous along with the undigested particle and if stool displaces 4 ml or more of water, then it can be definitely said that the stool is Sama [Figure 6]. Due to disturbances in Agni, if the ingested food is not properly digested and these undigested food particles which arise out of such impaired digestion are stayed in the bowel, they undergo changes and yield Vidagdha substance, i.e., Ama. Due to this Vidagdha substance, stool becomes more acidic and they also irritate the lumen of the bowel resulting in increase of more mucus. The presence of these undigested particle and mucus is responsible for sinking of stool in the water and displaces more water. If the stool is having alkaline pH, the undigested particle and mucous are absent, and if it displaces 2–4 ml of water, then it can be said that the stool is Nirama [Figure 7].
| Conclusion|| |
Jal-Nimanjjan Purisha Pariksha may be used as an objective tool for detecting the status of Agni and Ama in the healthy and diseased persons. Sama stool detected on the basis of standardized parameters such as physical character of stool, presence of mucous, acidic pH of stool, sinking behavior of stool on surface of water, and presence undigested food particles in stool indicates the status of Agni as Samagni, Vishamagni, or Mandagni. Accordingly, early treatment can be planned to prevent the generalized manifestation of Ama-related diseases. However, the parameters which were standardized need further evaluation in a greater number of cases to establish the above observations.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]