Jivha Pariksha – An Ayurvedic Diagnostic tool: A Review

© 2024 Vandana Sharma, et al . This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). ( https://creativecommons.org/licenses/by/4.0/ ) REVIEW ARTICLE Jivha Pariksha – An Ayurvedic Diagnostic tool: A Review Vandana Sharma 1 , Chhaju Ram Yadav 2 , Sarika Yadav 3 1 PG Scholar, Department of Kriya Sharir, National Institute of Ayurveda, Deemed University, Jaipur, Rajasthan, India 2 Dean (Research) and Head, Department of Kriya Sharir, National Institute of Ayurveda, Deemed University, Jaipur, Rajasthan, India 3 Assistant Professor, Department of Kriya Sharir, National Institute of Ayurveda, Deemed University, Jaipur, Rajasthan, India ABSTRACT Introduction: The tongue is the most convenient approach to observe changes in the body’s fundamental components and assess disease progression. The Ayurvedic Samhita lists several types of Rogi Pariksha that can be used to diagnose the disease. The Ashtavidha Pariksha is described by Acharya Yogratnakar . Jivha Pariksha is one among them. Jivha Pariksha involves shape, color, moisture, movement, and the coating on the tongue. Jivha Pariksha reveals our main constitution (normal Prakriti ), imbalance of dosha , state of Agni (digestive fire), and Koshtha ( Annavaha srotas ). According to Ayurveda Agnimandya (hypo functioning of digestive fire) is the root cause of all diseases. Saam Jivha (Coated tongue) indicates the presence of Ama (undigested food) in the digestive system. Thick coating indicates the progression of the disease so Jivha Pariksha is very important in the diagnosis as well as prognosis of various diseases Aim: To Study the significance of Jivha Pariksha in diagnostic tools Objectives: To Study the importance of Jivha Pariksha in diagnostic methodology from Ayurveda texts and its application in diagnosing various diseases Materials and Methods: This is a conceptual study for which various Ayurveda and modern texts, Samhitas , published articles, research papers, and information available on the internet are used Discussion: Jivha Pariksha is very important in routine patient examination as it is a part of Ashtvidha Pariksha . During examination, one should know the tongue’s shape, color, and coat. For appropriate disease diagnosis and treatment, a proficient understanding of Jivha Parikhsha is required Result: Jivha Pariksha is a very important tool in Ayurveda for the diagnosis and prognosis of disease. The Jivha Pariksha is a significant diagnostic and prognostic tool in the medical field Conclusion: Jivha Pariksha is a very important tool in Ayurveda for the diagnosis and prognosis of disease. The Jivha Pariksha is a significant diagnostic and prognostic tool in the medical field 1. INTRODUCTION A precise diagnosis is essential for the effective management of any disease. Acharyas’s profound observations and understanding resulted in the development of several methods. Ayurveda defines several methods for examination known as “ Rogi Pareeksha ,” including Dwividha Pareeksha (two-fold examination), Trividha Pareeksha (threefold examination), and Ashtavidha Pareeksha [1,2] (eight-fold examination) . The Asthavidha Pariksha , or eight-fold examination, is a crucial diagnostic method in Corresponding Author: Vandana Sharma, MD, Scholar of PG, Department of Kriya Sharir, National Institute of Ayurveda, Jaipur, Rajasthan, India. Email: vandysharma 1233@gmail.com Ayurveda used to identify the various factors contributing to diseases. It involves evaluating and conducting tests on patients based on eight specific parameters to determine the underlying causes of their conditions. Ashta Sthana Pariksha includes the examination of Nadi (pulse), Mala (stools), Mutra (urine), Jivha (tongue), Shabda (ears), Sparsh (skin), Drik (eyes), and Akruti (physical) [3,4] Tongue examination is an important aspect of Ayurveda , and the tongue can provide information about the health status of a person. Jivha Pariksha helps to assess the imbalance of dosha and the status of Agni . The imbalance of Dosha and Agni Dushti are the main part of the pathophysiology of various diseases [5] ARTICLE INFO Article history: Received on: 03-07-2024 Accepted on: 14-08-2024 Published on: 31-08-2024 Key words : Ashtavidha Pariksha, Ayurveda, Jivha Pariksha, Tongue Examination International Research Journal of Ayurveda & Yoga Vol. 7(8), pp. 21-25, August, 2024 Available online at http://irjay.com ISSN: 2581-785 X DOI: 10.48165/IRJAY.2024.70804

Sharma, et al .: Jivha Pariksha 2024; 7(8):21-25 22 The tongue should be observed for its shape, color, moisture, movement, and the coating over it. Production of Ama (undigested food) in the digestive system is indicated by Saam Jivha (Coated), as the tongue is a mirror of the digestive system and other diseases. Ama is derived from undigested, unabsorbed, or unassimilated food because of Agnimandya. [6] The presence of Ama (toxins) in the stomach and small intestine is indicated by coating in the middle region of the tongue. The presence of Ama (toxins) in the large intestine is indicated by a coating on the back of the tongue [7] 2. ASTHAVIDHA PARIKSHA [8] The eight components of the Asthavidha Pariksha are as follows: 2.1. Nadi Pariksha (Pulse Examination) Nadi Pariksha , or pulse examination, involves assessing parameters such as rate, volume, tension, and pulsation type. This examination considers the condition of Dosha relative to factors such as age, gender, constitution, time of day, season, physical activity, and dietary habits 2.2. Mala Pariksha (Stool Examination) The condition of the digestive system is commonly indicated by the characteristics of stool 2.3. Mutra Pariksha (Urine Examination) Urine is evaluated based on its appearance, clarity, volume, color, and other relevant characteristics 2.4. Jivha Pariksha (Tongue Examination) During the examination of the tongue, evaluation encompasses the assessment of taste perception, color variations, and the texture of its surface. These observations provide significant insights into the individual’s digestive well-being and potential health conditions 2.5. Sparsha Pariksha (Touch) Touch can be examined by palpation and percussion. Palpation plays a crucial role in assessing tenderness, temperature fluctuations, texture modifications, and changes in the contour of body structures 2.6. Shabda Pariksha (Sound Examination) The examination focuses on assessing the quality and characteristics of patient voices, which vary based on the psychosomatic constitution of individuals 2.7. Druk Pariksha (Vision Examination) The alterations in color, expression, and other manifestations reflect the characteristics of the underlying pathological condition, aiding in the determination of diagnosis and prognosis 2.8. Akriti Pariksha (Stature) The general appearance of patients may change in the presence of neurological disorders, nutritional disturbances, disabilities, and similar conditions 3. JIVHA PARIKSHA Jivha is called Rasanendriya [9] as it is an organ of taste. It is formed of Jala Mahabhuta [10] predominantly, Kapha dosha , Rakta , and Mamsa dhatu. [11] Jivha Pariksha is one of the Ashta Sthana Pareeksha Vidhi as explained by Yogaratnakara 4. HEALTHY TONGUE [12] It is Shuchi (clean; doesn’t release an unpleasant smell or taste) and Shlakshan (neither too dry nor too moist). There is no dilating or distention of the veins beneath the tongue. Color – Shyavarakta (Uniformly pink, similar skinned chicken or pale red) Shape – Tanu (neither too thick nor too thin and has even width or shape been oval) Moisture – Shlakshan (A healthy tongue is moist) Coating – Nirlipta or Ishatlipta (Thin transparent or white coating) Movement – Akampa (That is when the tongue protrudes it is steady) (Tables 1-5) 5. EXAMINATION OF TONGUE [13] Examination of the tongue should be done early in the morning before brushing or cleaning the mouth. The factors that are studied in the examination of the tongue are Prakrut Avastha (healthy or physiological state), Vikrut Avastha (pathological state), Varna (color), Pramana (size), Jivhatala (surface), Chalana (movement), and Upalepa (coating) ∑ The examination of the tongue should be conducted with the patient in a seated or supine position ∑ Advise the patient to open their mouth and extend their tongue for optimal visibility ∑ Thoroughly assess the surface texture, size, coloration, coating, and other pertinent characteristics of the tongue to ascertain the patient’s overall health status ∑ The essential tools required for evaluating intraoral structures are a mouth mirror and a strong illuminating light source ∑ Initially, a thorough examination of the oral cavity is conducted. Subsequently, both the dorsal and ventral surfaces of the tongue are inspected ∑ The patient is instructed to extend their tongue and move it laterally during examination ∑ Cotton or gauze is used to stabilize the tongue, facilitating the assessment of its color, shape, size, and surface characteristics ∑ A tongue depressor is employed to depress the tongue and inspect the circumvallate papillae and tongue base for any abnormalities ∑ Additional observations include alterations such as papillary atrophy or hypertrophy, ulceration, fissures, and edema ∑ It is crucial to document any pathological or physiological changes observed. Tongue palpation should be conducted using a gloved hand for a thorough assessment 6. JIVHA LAKSHANA ACCORDING TO DOSHA [12] Jivha Pariksha helps to assess the imbalance of dosha in the body. Acharya Yogaratnakar explained the characteristics of Jivha according to Dosha As stated earlier during tongue examination, one should examine the size, color, surface, and movements these are as follows 6.1. Size The tongue is considered healthy when it is adequately long and wide, smooth, slender, and exhibits a normal coloration [14] However,

Sharma, et al .: Jivha Pariksha 2024; 7(8):21-25 23 there are certain medical conditions where the tongue can be either elongated or shortened [15,16] 6.2. Color A tongue in good health usually shows a pinkish-red [17] coloration, although some individuals may present with a coppery tint [18] Various diseases exhibit distinct tongue colors. Here are the examples of different tongue colors associated with various diseases [12] 6.3. Dryness (Ruksha) Acharya Sushruta mentioned the specific character of a healthy tongue is Snigdh . [18] In Vikratavastha , the tongue becomes dry due to conditions such as dehydration, coma, hemorrhage, atropine use, mouth breathing, Sjogren’s syndrome, uremia, and increased Vata dosha. [12,16] 6.4. Surface According to Acharya Charak , a healthy tongue should exhibit the qualities of Shalkshan and Tanu . Here are several examples of an unhealthy tongue condition [12] 6.5. Pigmentation In a healthy state, the tongue exhibits its natural coloration, but in cases of illness, it may become pigmented. Such conditions include Addison’s disease, Nelson’s syndrome, Peutz-Jegher’s syndrome, chronic cachexia, and malnutrition [16] 7. MOVEMENTS [12] 1. Slow rhythmic tremor stopping on voluntary extrusion of tongue in Kampavata (Parkinsonism), Adhajihvika (backward and forward), and trombone tremor of GPI 2. Lizard tongue: (Jack-in-the-box or watch spring tongue, Jihva Vepana in rheumatic chorea. Trushna nirodhaja daha 3. Deviated tongue: Hypoglossal nerve paralysis, malignant infiltration, Mukhapaka (severe ulceration), Ardhita or Pakshaghata (facial paralysis) 4. Sthabda jihva (Immobile tongue): Bilateral lingual paralysis, bulbar palsy, syringomyelia. Sluggish and slow protrusion in mental retardation. The increasingly slow movement in myasthenia gravis, Jihvasthambha 8. SOME CONDITIONS EXPLAINED IN THE AYURVED SAMHITA ∑ In Prameha Poorvarupa there is a thick coating on the tongue [21] ∑ According to Acharya Vagbhat , children who experience chest discomfort tend to bite their own tongues [22] 9. DISCUSSION As everyone knows, a physician must be proficient in taking a patient’s history and performing a thorough examination to proper diagnosis of the disease. The accurate diagnosis of a disease is the result of a competent history taking and appropriate examination. Numerous diseases can be identified based on their characteristic features. As previously described, the tongue has several typical features as well. Ayurvedic diagnosis includes analysis of the Jivha (tongue) in addition to Nadi (pulse), Mala (stools), Mutra (urine), Shabda (ears), Sparsha (skin), Druk (eyes), and Akriti (physical). Because it reflects the state of the body’s internal organs, the tongue is known to be the mirror of the digestive system. However, the tongue is the most neglected part of the zone of interest. It is mandatory to examine the tongue during the routine physical examination of a patient. The tongue should be examined in daylight to avoid wrong observations. We may standardize the examination process by using various hardware equipment and computer-assisted tongue picture development, which is a necessity in the modern age 10. CONCLUSION Jivha Pariksha is non-invasive, easy, and important in clinical examinations to understand overall health. The tongue is a reflection of what is happening inside the body. The tongue examination is indispensable to knowing Sama , Nirama and Vruddi , Kshaya Avastha of the dosha , and finally in the Sapekshanidana (diagnosis) of the disease. There are several diseases we can diagnose from tongue examination so we can say that tongue examination is an important tool for the diagnosis 11. ACKNOWLEDGMENTS Nil 12. AUTHORS’ CONTRIBUTIONS All the authors contributed equally to the design and execution of the article 13. FUNDING Nil 14. ETHICAL APPROVALS This manuscript does not require ethical approval as it is a review study 15. CONFLICTS OF INTEREST Nil 16. DATA AVAILABILITY This is an original manuscript and all data are available for only review purposes from the authors 17. PUBLISHERS NOTE This journal remains neutral with regard to jurisdictional claims in published institutional affiliation REFERENCES 1. Agnivesha JT. Rogabhishagjitiyam. Charaka Samhita (Charaka and Dridhabala with Chakrapani). Varanasi, India: Chowkhamba Prakashan; 2007. p. 274 2. Byadgi PS, Kumar S. View of Charaka on roga and rogi pariksha for the vyadhivinischaya (diagnosis of diseases). Int J Res Ayurveda Pharm 2011;2:694-7 3. Tripathi I, Tripathi D. Yogaratnakara, Krishnadasa Ayurveda Series 54. Varanasi: Chaukhambha Prakashana; 2007. p. 4 4. Byadgi PS. Rogi Pareeksha and Roga Pareeksha. Parameswarappas Ayurvediya Vikriti Vigyan & Roga Vigyan. 1 st ed., Vol. 1. Varanasi:

Sharma, et al .: Jivha Pariksha 2024; 7(8):21-25 24 Chaukhambha Sanskrit Sansthan; 2007. p. 376 5. Sharma AK. Rogvidnyana Evam Vikruti Vidnyana. Vol. 1. Varanasi: Chaukhambha Visvabharati; 2019. p. 103 6. Sharma AK. Rogvidnyana Evam Vikruti Vidnyana. Vol. 1. Varanasi: Chaukhambha Visvabharati; 2019. p. 192 7. Sadhana M. Jivha Pariksha - One of the Diagnostic Tools in Ayurveda: A Review. Available from: https://www.ijrap.net [Last accessed on 2024 May 22] 8. Tripathi I, Tripathi DS. Yogaratnakar with Vaidyaprabha Hindi Commentary. 4 th ed. Varanasi: Chaukhamba Krishnadas Academy; 2013. p. 4 9. Trikamji J. Acharya Charak Samhita by Agnivesha. Sharir Sthana. Ch. 7/7. Varanasi: Chaukhambha Orientalia; 2015. p. 337 10. Yadav T. Sushruta Samhita of Sushruta with the Nibandhasangraha; Commentary of Shri Dalhanacharya. Sharir Sthana. Ch. 1/7. Varanasi: Chaukhambha Orientalia; 2021. p. 339 11. Yadav T. Sushruta Samhita of Sushruta with the Nibandhasangraha Commentary of Shri Dalhanacharya. Sharir Sthana. Ch. 4/28. Varanasi: Chaukhambha Orientalia; 2021. p. 357 12. Yunus M, Kadegaon M, Kotrannavar VS. Tongue, it’s examination and clinical implication. Int J Res Ayurveda Pharm 2016;7:154-5 13. David CM, Soujanya LK, Ramnarayan BK, Alekhya K, Suprith LK, Karayat G. Investigation for diseases of tongue: A review. J Adv Clin Res Insights 2018;5:78-83 14. Trikamji J. Charak Samhita by Agnivesha. Acharya. Ch. 8/51. Sharir Sthana. Varanasi: Chaukhambha Orientalia; 2015. p. 350 15. Waghe DS. Dr. Waghe’s Integrated Approach to Clinical Methods in Ayurveda. 1 st ed. Tongue Examination. Nagpur: Rastra Gaurav Publication; 2022. p. 97 16. Alagappan R. Manual of Practical Medicine. 6 th ed. New Delhi: Jaypee Brothers Publication; 2018. p. 10 17. Gupta A. Ashtang Hrudyam. Vidyotini Commentary. 13 th ed. Sharir Sthana, 3/111. Varanasi: Chaukhamba Sanskrit Samsthana; 2000. p. 195 18. Yadav T. Sushruta Samhita of Sushruta with the Nibandhasangraha Commentary of Shri Dalhanacharya. Sutra Sthana 35/16. Varanasi: Chaukhambha Orientalia; 2021. p. 152 19. Shastri K. Charakasamhita, revised by Chraka and Drdhabla with the ayurveda Dipika commentary of Chakrapanidatta and with Vidyotini Hindi commentary by chaukambha sanskrit Sansthana. In: Pandey G, editor. A.M.S Part 2. 8 th ed. Varanasi: Chaukhamba Bharati Academy; 2004. p. 91 20. Tripati B. Madhava Nidana with Madhukosha Commentary, Edited with Vimala Madhudhara Hindi Commentary. Vol. 2. Varanasi: Chaukamba Surbharati Prakhashan; 2017. p. 320 21. Garde GK. Vagbhat Samhita. Uttarsthan. Vol. 3. Varanasi: Chaukhamba Publication; 2018. p. 362 22. Garde GK. Vagbhat Samhita. Uttarsthan. Varanasi: Chaukhamba Publication; 2018. p. 357 How to cite this article: Sharma V, Yadav CR, Yadav S. Jivha Pariksha – An Ayurvedic Diagnostic tool: A Review. IRJAY. [online] 2024;7(8);21-25 Available from : https://irjay.com DOI link - https://doi.org/10.48165/IRJAY.2024.70804

Sharma, et al .: Jivha Pariksha 2024; 7(8):21-25 25 Table 1: Characters of Jivha according to Dosha Dosha Jivha Lakshana Vataja blackish or brown, rough, and fissured Pittaja Red, Yellow, and Blue Kaphaja White and Slimy Sannipataj Black and thorny eruptions Dvandvaja Mixed features Table 2: Examples of Dirghjivha and Hrisvajivha in various diseases Dirghajivha (macroglossia) Hriswajivha (microglossia) Acromegaly Cretinism Myxedema Lymphangioma Amyloidosis Down’s syndrome tumors angioedema Bijadosha Pseudobulbar palsy Facial Hemiarthopathy Starvation Marked dehydration Bijadosha Table 3: The different colors of the tongue in various diseases Shwetabha (Pale) Anemia, malnutrition, Vatajakshaya , Pandu Paridagdha (Redraw/Angry looking) Sprue, pellagra, severe and untreated diabetes, prolonged febrile illness. Pittaja vruddi , Sannipataja jwara Shweta (White) Lichen planus, HIV, small number of non-HIV infected immunocompromised individuals, Khapakshaya , Ojakshaya Neela (Blue) Central cyanosis, Kaphavruddi , Madatyaya A sadhya Lakshana Purple Polycythemia vera, Pittavruddi Dark red or bluish-red Polycythemia vera, riboflavin deficiency, Raktavruddi Strawberry ( Paridagdha ) scarlet fever, Kawasaki’s disease, and toxic shock syndrome, Sannipataja Jwara [19] Peeta (Yellow) rarely in jaundice, Kamala , kumbakamala , pandu [20] Krishna (Black) fungus infection, iron, bismuth, opium, or tobacco, Vatavruddi Furred tongue ( Liptajihwa / upadehajihwa ) in all febrile illnesses especially typhoid, heavy smoke, poor oral hygiene, Sannipataja jwara , Amlapitta , Prameha Poorvarupa Table 4: Various examples of tongue surfaces observed in different conditions Atitanu (Smooth or bald tongue) Iron-deficiency anemia, pernicious anemia, B complex deficiency, or malabsorption. Kapha vaishamya Kharajihva / kantakajihva (Fissured tongue) Vitamin B complex deficiency, acute glossitis, acromegaly, congenital scrotal tongue. Tridoshaja Scarred tongue Scars on the tongue may be traumatic, secondary to ulcer from tongue-biting as in epilepsy, Abhigataja Mushroom like tongue Sore tongue covered with whitish slough in acid poisoning Table 5: Presents various states of the tongue corresponding to different Graha Roga Skandapsmar Graha [21] The child bites his or her tongue Shwana Graha [21] The child bites his or her tongue Shakuni Graha [21] The child got a wound on the tongue and a soft or hard palate Shushkarewati Graha [21] The child gets pit on the middle of the tongue

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