LIMITATION OF TAILA BINDUPARIKSHA IN CRITICALLY ILL PATIENTS BV Prasanna 1, Nagaraj S 2, Subramanya P 3, Mahesh Hirulal 4

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1 Research Article Internional Ayurvedic Medical Journal ISSN: LIMITATION OF TAILA BINDUPARIKSHA IN CRITICALLY ILL PATIENTS BV Prasanna 1, Nagaraj S 2, Subramanya P 3, Mahesh Hirulal 4 1 Professor and Former HOD 2 Professor and HOD 3 Assistant Professor 4 P.G. scholar Dept of RogaNidan, SDMCA, Udupi, Karnaka, India ABSTRACT Ashtavidhapariksha (8 Sets of Examinion) are contribution of Ayurveda towards examinion of pient. Mutrapariksha (Urine Examinion) is one among them which plays an important role in diagnosis and prognosis of disease. Mutrapariksha (Urine Examinion) gives an idea of dosha involved, disease and prognosis of disease. Especially Tailabindupariksha (Oil drop examinion) helps in diagnosis of disease and also in predicion of prognosis. Tailabindupariksha (Oil drop examinion)is one of observions practiced in the medieval period and used as diagnostic and prognostic tool. However in the modern era diagnostic methods have significantly changed and the art of ancient methods have become almost obsolete. Study was undertaken with the following objectives: 1) Validity of Tailabindupariksha (Oil drop examinion) in prognosis of critically ill Pients. 2) Comparison of prognostic criteria in critically ill pients between Ayurveda methods and the modern methods of assessment. 3) Standardizion of Tailabindupariksha (Oil drop examinion).outcome: Comparing the observions of both Group-A and Group-B there is no significant changes in spreading and splitting time of oil drop. The range of normal, fast and slow spreading and splitting time of oil drop cannot be made by this study because of inconsistence distribution of da. There are no significant changes in area covered by oil drop when compared between both groups. The different directional movements told in classics like towards east, west etc. are not mched with any sample of this study. Maximum of oil drop took the circular shape. Remaining shapes did not mched with any shapes of classical explanions. It is concluded th there is no significant resemblance of observions in Tailabindupariksha (Oil drop examinion) of critically ill pients to the classical explanion of Tailabindupariksha (Oil drop examinion). Many factors like trement interventions, collection of urine, preservion, timing, method of test may have influenced on results of Tailabindupariksha (Oil drop examinion). Keywords:Tailabindupariksha (Oil drop examinion), critically ill. INTRODUCTION Ayurveda explains about prognosis by many aspects like sadhyasadhyhaofvyadhi, arista lakshana (Fal signs and symptoms), ojokshaya etc. Trividhapariksha(3 sets of examinion), Dashavidhapariksha(10 sets of examinion), Dvadashapariksha(12 sets of examinion) and Astavidhapariksha( 8 set of examinion)are different tools for diagnosis and prognosis of disease. Prognosis of disease mainly depends on available trement protocol given time. Assessment of prognosis is needed to facilite the clinical decision making for choice of proper trement. The predic-

2 2332 tion of prognosis helps in pient and family educion and counseling. Tailabindupariksha(Oil drop examinion)is a technique added to the system of Ayurveda aftersamhitakala(after 12 AD) and becameobsoleteinthe present era. No explanion about Tailabindupariksha(Oil drop examinion) in ancient textslikecharakasamhita, Sushruthsamhita, AstangaHrudayais questioning the utility of Tailabindupariksha(Oil drop examinion). The description of Tailabindupariksha(Oil drop examinion)gives the idea of diagnosis and prognosis of disease by behaviors of Tailabindu like shapes movements etc. The present studies were done with the main intensions to see the utility of Tailabindupariksha (Oil drop examinion) in critically ill pients and compare the prognostic criteria of Ayurveda and contemporary medical system. OBJECTIVES OF THE STUDY 1. Validity of Tailabindupariksha(Oil drop examinion)in prognosis of critically ill Pients. 2. Comparison of prognostic criteria in critically ill pients between Ayurveda methods and the modern methods of assessment. 3. Standardizion of Tailabindupariksha(Oil drop examinion). CONCEPT OF TAILA BINDU PARIK- SHA The wise physician should collect urine in morning. The mid-stream urine has to be collected in kachapara (Glass vessel), avoiding the first stream and last stream of urine. Then he has to wait for 4 Ghika (about 2hours). After the rise a drop of oil has to be dropped in to urine by use of a Truna(Grass). Then carefully he has to observe the behavior of oil, movement of oil and shapes of oil 1,2,3,4. With this he can make the diagnosis and predict the prognosis. Prognosis by movement of oil drop 1,2,3,4 If the oil spreads fast then disease is curable. If it don t spread then it is difficult to cure and if oil drop sinks in the urine then it is incurable. Indicion of dosha by different shapes 1,2,3,4 In vadosha vitiion urine color will be neelavarna and oil drop shows the movement like snake. In pitta dosha vitiion urine color will be peeta or raktavarna, oil drop will give shape like Chhra (umbrella). In kaphadoshavitiion urine will be like wer and oil drop will show the shape like pearl. Indicions by different directions 1,2,3,4 When oil is dropped it may move into different direction, which will indice the prognosis.if oil drop moves to east then pient will get relief. If oil spreads to south direction person will become healthy after a course of jvara(fever). If it moves to north, then definitely person will become free from disease. If oil spreads towards west then person will get sukha(happy) and aarogya(health). If the oil drop moves to Eshaanya(North- East) then person will die in a month. If oil moves to aaganeya or nairuthya(south- West) and if oil drop splits then person will die definitely. If oil drop moves to vaayavya(north-west) then also person will die. Indicions by different shapes 1,2,3,4 When oil is droped in to urine sample it may show some shapes which will indice the prognosis. If oil drop takes the shapes ofkurma(tortois), buffalo, headless body, split body,shastra(surgical instrument),khadga(sward),dhanus(bow),tr ishula, shrugala(jakle),sarpa(snake),vrishchika(sc orpion), mushika(r),marjara(c), vyaghra(tiger), marka(monkey), simha(lion), four,three or two legged

3 animal then it indice incurabelity of weighted, disease-specific diagnostic cegory. disease.if oil drop shows shapes like Upded versions of the APACHE hamsa(swan), lotus, chamara, torana, scoring system (APACHE III and parva (mountain), elephant, tree, APACHE IV) have been published. umbrella and house then person can be cured. Diagnosis on colour of urine 1,2,3,4 APACHE III is derived from a larger dabase than APACHE II and utilizes a daily clinical upde protocol to provide daily In ajirnandulodhak like urine will be modificion of predicted mortality. seen, in navinajvaradhumravarna, in APACHE IV uses a modified stistical vapittajvaradhuma and wer like urine, in vakaphajjvarashwetha, in kapha pitta jvararaktacolour urine will be seen. Bhoota dosha 1,2,3,4 If oil drop takes the shape of chalini thenit model of logistic regression; it is the most recently released version of this scoring system. METHODOLOGY It is a Clinical observional study. 50 is indicion of kula dosha(genetical healthy male volunteersweretaken as disorder). If it takes the shape of human being or skull then person should be considered as affected by bhoota dosa. Apache II Scoring System 5 The APACHE II system is the most commonly used SOI scoring system in North group-aand50 pients who are suffering from critical illness were selected as group-b Instrumentions A standard instruments and procedure is used throughout study. America. Age, type of ICU admission (after elective surgery vs. nonsurgical or after Shape and size of pra- Circular, glass Petri-dish of 8 inch emergency surgery), a chronic health problem score, and 12 physiologic variables Volume of urine- Mid steam urine 200ml (the most severely abnormal of each in the Size of oil drop- 12 micro liter first 24 hour of ICU admission) are used to derive a score. The predicted hospital mortality Heightfrom which oil is dropped- 1 cm above the surface of urine is derived from a formula th takes Time of Tailabindupariksha(Oil drop into account the APACHE II score, the examinion)- need for emergency surgery, and a Sample no Collection time Procedure time AM At rise as per panchanga(calender) 2 8AM 10 AM 3 12 noon 2PM 4 4 PM 6 PM Preparions of healthy volunteer and pient A day before procedure, explanion and instructions are given to healthy volunteers and are asked to avoid protein rich diet, roots specially beet root, alcohols, vitamin and protein supplements. At night they are asked to take sufficient quantity of wer. After voiding urine for every sample volunteers are again asked to take normal quantity of wer. They are instructed to collect mid-stream urine each time. Most of critically ill pients are cheterized. Hospital nurses and pient tenders 2333

4 are instructed to continue input methods as per advice of consultant. No modificions are done in input like wer intake, vitamins and protein supplementions. The cheter cleanliness is also seen, if it is too old and with sedimention new cheter is inserted. Before 3 to 4 hours of collection of urine cheter is clamped. Cheters are released and avoid the first steam urine. Middle stream urine is collected for Tailabindupariksha(Oil drop examinion). Procedure Urine will be kept for settlement in Petri dish. 12 micro litersoftilaila(sesame oil)is taken in pipette and pipette is fixed tostandard height with a help of a stand. A drop of tilaila (Sesame oil) is dropped center of Petri dish and observions are noted. Observions Spreading time-it is the time taken for oil to spread on surface of urine. Stop wch is started exactly the time of dropping oil drop and noted up to settlement of a particular shape. Splitting time-it is the time taken by oil drop to split after a particular shape. Area covered- Area covered by oil is noted with the background diagram. The diagram is drawn as a multiple square boxes of 0.5cm. Area is noted from center of Petri dish up to maximum area covered by oil drop. Directional movement- The direction of movement of oil drop is noted with help of compass box. Shape- The shape of oil is noted as circular or ill defined. Shape resembling to any object is also noted. Precautions Some precautions are taken while doing Tailabindupariksha(Oil drop examinion). To avoid interference of air Tailabindupariksha(Oil drop examinion)is carried out in closed room and fans are switched off. Horizontal calibrion is done to see the uniformity of ground level. The instruments like Petri dish and urine containers are sterilized by hot air oven time to time. Observions 1) Distribution of 50 Healthy volunteers and 50 critically ill pients according to the urine colour Table no: 1: Group-A: Healthy volunteers Urine Colour rise 4Pm Yellow Pale yellow Dark yellow Table no: 2: Group-A: Critically ill pients 2334

5 Urine Colour 2335 Pale Yellow Dark yellow Among 200 urine samples of 50 healthy volunteers, maximum of 89 urine colour was pale yellow. Among 200 urine samples of 50 critically ill pients, maximum of 40 urine colour was yellow. Spreading Time Tests (200) Tests (200) rise 2) Distribution of 50 healthy volunteers and 50 critically ill pients according to spreading time of tailabindu(oil drop). Table no: 3: Group A: Healthy volunteers 6Pm Table no: 4: Group B: Critically ill pients Spreading Time Tests (200) rise rise 6Pm Among 200 Tailabindupariksha(Oil drop examinion)of 50 healthy volunteers showed the maximum of 45.5 showed spreading time between 21 to 30 onds. In maximum of 42, 50, 46 and 44 same spreading time was noted tests time of rise, 10AM, 2PM and 6PM respectively. 4Pm Yellow In critically ill pients maximum 45 of them spreading time is observed between 21 to 30 onds. In maximum of 52, 42, 44 and 42 same spreading time was noted tests time of rise, 10AM, 2PM and 6PM respectively. 3) Distribution of 50 healthy volunteers and 50 critically ill pients accord-

6 Spliting Time ing tosplittingtimeoftialabindu(oil drop). rise Table no: 5: Group-A: Healthy volunteers 6Pm Table no: 6: Group-B: Critically ill pients Spliting Time Tests (200) rise 6Pm

7 Among 200 Tailabindupariksha of 50 healthy volunteers in a maximum of 24.5 oil drop splits within 41-50onds.In maximum of 26, 28,24 and 20 oil drop were splits within onds of tests rise,10am,2pm and 6PM respectively. Among the 50 critically ill pients in a maximum 23 of splitting time is observed between 41 to 50 onds. Maximum of 28, 20 and 24 splitting time is observed between51 to 60 onds time of rise, 10AM and 6PM respectively. Test 2PM showed maximum i,e 26 splitting time between 41 to 50 onds. 4) Distribution of 50 healthy volunteers and 50 critically pients according to area covered by tailabindu. Table no: 7: Group-A: Healthy volunteers Area covered 6Pm rise 2cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm Table no: 8: Group-B: Critically ill pients 2337

8 Area covered Tests (200) rise 6Pm 2cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm cm Among 200 Tailabindupariksha of 50 healthy volunteers in a maximum of 16 oil drop was covered the area of 5cm. In maximum of 18,16, 16 and 20 oil drop were covered the area of 3cm,5cm,5cm and 6 cm each, and 6cm rise,10am,2pm and 6PM respectively. Among 200 Tailabindupariksha of 50 critically ill pients in a maximum of 16.5 oil drop covered the area of 6cm.In maximum of 18, 22,16 and 22oil drop were covered the area of 4.5 cm, 5 cm,6 cm and 6cm rise,10am,2pm and 6PM respectively 5) Distribution of 50 healthy volunteers and critically ill pients according to directional of movement of tailabindu(oil drop). Table no: 9: Group-A: Healthy volunteers Group-BCritically ill pients 2338

9 Direction No of Uniform Irregular 6 3 Percentage Among 200 Tailabindupariksha(Oil Drop examinion)of 50 healthy volunteers,in a maximum of 97 oil drop had uniform spread.. Among 200 tailabindupariksha(oil Drop examinion)of50 critically ill pients,in a maximum of 84.5 oil drop haduniform spread. 6) Distribution of 50 healthy volunteers and 50 critically ill pients according to shape of tailabind(oil drop). Table no: 10: Group-A: Healthy volunteersgroup-b Critically ill pients Shape No of Circular Percentage Ill defined 6 3 Among 200 Tailabindupariksha(Oil drop examinion)of 50 healthy volunteers, maximum of 97 oil drop took circular shape. Among 200 Tailabindupariksha(Oil drop examinion)of 50 critically ill pients, Direction No of maximum of 84.5 oil drop took circular shape. 7) APACHE-II Physiology score wise distribution of 50 critically ill pients Table no: 11 Group-B Critically ill pients Score No of pients Percentage ) Glasgow coma scale wise distribution of 50 critically ill pients Table no: 12 Group-B Critically ill pients Score No of pts Percentage < > ) APACHE-II Score wise distribution of 50 critically ill pients Table no: 13 Group-B Critically ill pients Percentage Uniform Irregular Shape No of Percentage Circular Ill defined

10 2340 Score No of pts Percentage tion)between healthy volunteers and critically DISCUSSION ill pients groups. Urine color: Area covered bytailabindu (Oil Urine colour mainly depends on urobilinogen, drop):among 200 Tailabindupariksha(Oil Normal urine color varies from pale drop examinion)of 50 healthy volunteers yellow to dark yellow.in critically ill pients in maximum of 16 oil drop was covered maximum 40 yellow color urine is the area of 5cm. observed. The IV fluids, electrolyte supplements, Among 200 Tailabindupariksha(Oil drop diuretics and multivitamin injec- examinion)of 50 healthy volunteers in tions will change the urine color. Urine maximum of 16.5 oil drop covered the color and volume are major indictors of area of 6cm. hydrion of tissues and renal functions. There is no consistency for area covered Spreading time: by oil drop, which ranged from 2cm to It is told th if the oil drop spreads fast 10cm so da cannot be generalized. then disease is curable. If it does not Direction of movement of tailabindu(oil spread then it is difficult to cure and if oil drop): When oil is dropped centre of drop sinks in the urine then it is incurable. Petri dish it will spread to peripheral area Even though there is no range for fast and uniformly, if it spreads more towards one slow spreading, this study shows th there direction or if oil drop shifts to other direction is no significant change in spreading time from centre is noted as irregular. of Tailabindupariksha(Oil drop examinion)between Among healthy volunteers 97 and in healthy volunteers and criti- critically ill pients group84.5,itis uni- cally ill pients groups. form directional spread. The different directional Splitting time: Among 200 Tailabindupariksha(Oil movements told in classics like drop examinion)of 50 towards east, west etc don t mch with healthy volunteers maximum of 24.5 any sample of this study. showed splitting time between 41 to 50 Shape oftailabindu (oil drop):when oil is onds. In maximum of 26, 28, 24 dropped centre it will take circular shape and 20 same spreading time was noted after spread. Different shapes explained in tests time of rise, 10AM, 2PM and classic are not observed in this present 6PM respectively. study. Among healthy volunteers group In critically ill pients maximum 23 of 97tailabindu (oil drop) took circular splitting time is observed between 41 to 50 shape and in critically ill pients group onds. Maximum of 28, 20 and took the circular shape. Remaining splitting time is observed between51 to 60 shapes not mched with any shapes of onds time of rise, 10AM and classical explanions. 6PM respectively. In 26 test 2PM CONCLUSION showed splitting time between 41 to 50 It can be concluded th there is no onds. This study shows th there is no significant resemblance of observions in Tailabindupariksha(Oil drop significant change in splitting time of Tailabindupariksha(Oil drop examina-

11 2341 examinion)of critically ill pients to the classical explanion of Tailabindupariksha(Oil drop examinion). Many factors like trement interventions, collection of urine, preservion, timing, method of test may have influenced on results of Tailabindupariksha(Oil drop examinion). The assessment of dosha, dushya, srothas, rogamarga, ojas, jnanendriya, karmendriyaandarishtalakshana in critically ill pients holds good even in present scenario. The contemporary trend in assessment of critical illness is mainly inclined towards physical examinions, biochemical parameters, invasive and non-invasive techniques, which help for better prediction of prognosis and for prompt interventions. REFERENCES 1. VaidyaIndradevtripi, Dayashankartripi. Yogarnakara, VaidyaPrabha: 2 nd ed. KrishnadasAcademy,Varanasi,2007. Pp 874, Pg no Basavraj, Basavrajiyam, Govardhan Sharma changani, Chowkhambasamskritprhistan, 2005, Varanasi. Pp 423, page no Vangasena, VangasenaSamhita/Chikistasarasangraha, Dr.NirmalSaxena, Vol 2, Chowkhamba Sanskrit series office, 2004, Varanasi. Pp no 1326, page no TrimallaBhta, Yogharangini, Dr. Nirmalsaxena, Chaukhamba Sanskrit bhavan, 2007, Varanasi. Pp no 514, page no Dan L. Longo,Dennis L. Kasper Editors,Harrison'sPRINCIPLES OF IN- TERNAL MEDICINE,Eighteenth Edition E-Book, copy right The McGraw- Hill Companies, Inc,2012,part 12 chapter 267. CORRESPONDING AUTHOR Dr. Mahesh Hirulal drmaheshbhirulal@gmail.com Source of support: Nil Conflict of interest: None Declared