• Users Online: 44
  • Print this page
  • Email this page


 
 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 41-50

A critical appraisal of Lakshanadhyaya of Kashyapa Samhita with special reference to pediatric examination


1 Department of KB, IPGT and RA, Jamnagar, India
2 Department of Kriya Sharir, GJP-IASR, Anand, Gujarat, India

Date of Submission28-Aug-2020
Date of Decision07-Oct-2020
Date of Acceptance10-Oct-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
Sagar M Bhinde
303, Naimisharanyam Apartment, Khodiyar Colony, Jamnagar, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_30_20

Rights and Permissions
  Abstract 


Kashyapa Samhita is the only Ayurveda classical text, which deals exclusively with pediatric anatomy, physiology, pathology, and its management. Out of which, chapter number 28 - Lakshanadhyaya has a detailed description of anatomical and physiological features of the child and correlated it with clinical, professional, social, and spiritual fortunes. But, Lakshanadhyaya is incomplete at the end. Objective: To reveal the clinical importance of features mentioned in Lakshanadhyaya and to provide probable justification for particular future predictions given in Lakshanadhyaya. Data Source: Lakshanadhyaya of Kashyapa Samhita published by Chaukhambha Sanskrit Sansthan, Varanasi. Materials and Methods: Relevant materials were searched from sources such as published books, journals, and the Internet. A critical review was done over the same. Result: Acharya Kashyapa has predicted the quality and quantity of life by assessment of anatomical and physiological features of the child from birth till adolescence. All clinical points such as signs of gestational maturity (by examining the skin, hair, movement, and genitals), anthropometry (size of body parts), secondary sex characters (such as pubic hair, breast, and genitals), and systemic examinations (such as per vaginal, per rectal, musculoskeletal, and per abdomen examinations) are covered in Lakshanadhyaya. Conclusion: This article highlights that time to time examination of a child helps to predict their future life. The abdomen, vagina, nail, scrotum, penis, hair, joints, back, gait, etc., are important areas of examination for early detection of impending clinical manifestation.

Keywords: Future prediction, Kashyapa Samhita, Lakshanadhyaya, pediatric examination


How to cite this article:
Bhinde SM, Shilwant A. A critical appraisal of Lakshanadhyaya of Kashyapa Samhita with special reference to pediatric examination. J Ayurveda 2021;15:41-50

How to cite this URL:
Bhinde SM, Shilwant A. A critical appraisal of Lakshanadhyaya of Kashyapa Samhita with special reference to pediatric examination. J Ayurveda [serial online] 2021 [cited 2021 Apr 13];15:41-50. Available from: http://www.journayu.in/text.asp?2021/15/1/41/311917




  Introduction Top


Kashyapa Samhita has given importance to pediatric anatomy, physiology, ailment, and its management. Currently, Sutra Sthana is not available as a whole and chapter number 28 – Lakshanadhyaya is also incomplete at the end. As per initial Shloka, the whole chapter is based on five questions asked by Vruddha Jivaka to Bhagavan Kashyapa. The main and first question was – “With what features the children are of long life?” In line with this question, Acharya Kashyapa has given an extensive description of the feature of different parts of the body and its relation with upcoming life. Clinical points such as signs of maturity (by examining the skin, hair, movement, and genitals), secondary sex characters (such as pubic hair and genitals), anthropometry (size of body parts), and systemic examinations (such as per vaginal, per rectal, musculoskeletal, and per abdomen examinations) are covered in this chapter along with its future prediction.

In addition to the above, this chapter also deals with features of happy, unhappy, short life, features of different psyches, and features of good or despicable body. However, these points are incomplete in text and not related to pediatric examination and hence not analyzed here.

Objectives

The objectives of this study were as follows:

  1. To reveal the clinical importance of features mentioned in Lakshanadhyaya
  2. To provide probable justification for particular future predictions given in Lakshanadhyaya.



  Materials and Methods Top


Lakshanadhyaya of Kashyapa Samhita published by Chaukhambha Sanskrit Sansthan, Varanasi, edition reprint 2009 (ISBN 81-86937-67-6) was kept in center for this review. Relevant materials were searched and collected from other Samhita, published books, journals, and Internet web searches. After thoroughly going through all the sources, a critical review was done over the same which is tried to be elaborated through this manuscript.

Remarks and comments on individual features have been mentioned in the tabular form [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6],[Table 7],[Table 8],[Table 9],[Table 10],[Table 11],[Table 12],[Table 13],[Table 14],[Table 15]. Probable clinical importance of Kashyapokta (mentioned in Lakshanadhyaya) physical feature is mentioned in the tables in column number 4, after reviewing the abovesaid literatures. Probable justification of Kashyapokta future prediction is given in the tables in column number 3. However, there are certain areas where authors could not make connections and accept the limitation of the review study.
Table 1: Future prediction through physical features of nails and its probable clinical importance

Click here to view
Table 2: Future prediction through physical features of soles and its probable clinical importance

Click here to view
Table 3: Future prediction through physical features of heel and its probable clinical importance

Click here to view
Table 4: Future prediction through physical features of feet and its probable clinical importance

Click here to view
Table 5: Future prediction through physical features of ankle and its probable clinical importance

Click here to view
Table 6: Future prediction through physical features of lower leg and leg and its probable clinical importance

Click here to view
Table 7: Future prediction through physical features of knee, thighs, and buttocks and its probable clinical importance

Click here to view
Table 8: Future prediction through physical features of ischial tuberosity and pelvis and its probable clinical importance

Click here to view
Table 9: Future prediction through physical features of scrotum and penis and its probable clinical importance

Click here to view
Table 10: Future prediction through physical features of vagina (along with cervix) and its probable clinical importance

Click here to view
Table 11: Future prediction through physical features of abdomen and umbilicus and its probable clinical importance

Click here to view
Table 12: Future prediction through physical features of flanks and its probable clinical importance

Click here to view
Table 13: Future prediction through physical features of shoulders and axilla and its probable clinical importance

Click here to view
Table 14: Future prediction through physical features of arms and its probable clinical importance

Click here to view
Table 15: Future prediction through physical features of gait and its probable clinical importance

Click here to view



  Results Top


The aim of Ayurveda is to attain a longer and healthy life span. The main tool to assess overall health status and intern life span is physical examination. The importance of examination increases by many folds in pediatric patients, as baby cannot complain their pain and discomfort and hence history taking could not help for reaching the diagnosis.[1] By time to time examination, one may detect latent congenital deformity, early signs of illness and able to assess the status of growth and development, which may help in timely management. Hence, almost every ancient treatise has given importance to examination and postulated number of assessment criteria. According to Acharya Charaka, newborn should be examined after performing Namakarana Samskara (naming ceremony), i.e., on the 10th day of life.[2] Physical examination given by Acharya Sushruta[3] is mainly related to adults, but up to some extent, it can also be applied to children. However, Acharya Kashyapa has elaborated clinical examination starting from newborn to adolescence along with future prediction in a chapter of Sutra Sthana, namely Lakshanadhyaya, in which examination starts from the foot to the hair of the scalp.

As mentioned in [Table 1], Acharya Kashyapa has given the detailed physical features of the nail along with future prediction. These features are important to detect clinical conditions such as Dhatu Sarata, anemia, koilonychia, CHD, autoimmune disorders, Vitamin B7 and calcium deficiency, and fungal infection of the nail bed.

As mentioned in [Table 2], Acharya Kashyapa has given the detailed physical features of soles along with future prediction. These features indicate about the status of Asthi Majja Sarata, cardiovascular and lung function, anemia, gestational maturity, and disease like xeroderma pigmentosum.

As mentioned in [Table 3], examination of the heel could help to identify the status of Sama Pramana Sharira and to rule out congenital deformities such as congenital talipes equinovarus (CTEV) and vertical talus.

As per [Table 4], feet are an important examination area to identify Asthi, Majja, Mamsa Sarata, and pedal edema and to rule out congenital defects such as TARP syndrome, CTEV, and vertical talus.

Physical features mentioned by Acharya Kashyapa are important to identify rickets and mucopolysaccharidosis kind of join disorders in children [Table 5].

Physical examinations of the leg mentioned in Lakshanadhyaya are important for early identification of Duchenne muscular dystrophy, elephantiasis, and Deep venous thrombosis (DVT) [Table 6].

Acharya Kashyapa has mentioned that well covered knees; fleshy with deep seated veins and smooth thighs; and rounded, symmetrical buttocks without any pathological lesion are normal features of the knee, thigh, and buttocks and hence baby becomes praiseworthy [Table 7].

As per Acharya Kashyapa, deep, hairless, symmetrical ischial tuberosity and comparatively larger chest in boys and larger waist in girls are normal features and hence baby with these features will be praiseworthy in the future [Table 8].

As per Acharya Kashyapa, reddish, pink, hairy, corpulent scrotum having shape similar to bull, donkey, horse, goat, and sheep is normal and is praiseworthy. Soft, long, erected, big, coppery, uncovered glance, large prepuce, large meatus, broad and cart-shaped penis is normal [Table 9].

As per Acharya Kashyapa, cart-shaped and corpulent vagina is related to good fortune. These features are helpful to assess uterine prolapse, dyspareunia, relative sterility, vaginismus, repeated vaginal infections, cervix atrophy postmenopause, cervical cancer, Bartholin's gland cyst, vulvar varicosity, etc., [Table 10].

As per [Table 11], well or slightly protuberant, not laxed, not hard, and not very big abdomen is a sign of good health and may lead to a praiseworthy status in the future. The umbilicus having features such as deep, slightly turned toward the right side with rounded protuberant edges, and free from hair, veins, and folds is indicative of normalcy. Features of Guda (anus) should be understood as per features of the umbilicus only.

Physical features of the flank, mentioned by Acharya Kashyapa, are important to assess obesity, posture deformities such as kyphosis, lordosis, and scoliosis, mucopolysaccharidosis, and Turner syndrome [Table 12].

As mentioned in [Table 13], elevated shoulder in males and lax in females are normal features. Elevated, big, corpulent, and well-made axilla should be considered as normal.

As per [Table 14], arms thick at upper portion and tapering gradually, with well-covered elbow and long enough, which touches the knee joints, are feature of normalcy.

As per [Table 15], a person's gait like intoxicated elephant, bull, lion, tiger, and swan is considered as normal and the rest of the other are indicative of pathology.


  Discussion Top


Acharya Kashyapa has elaborated physical examination along with future prediction in Lakshanadhyaya starting from newborns till adolescents. This article is an attempt to equip the physician with a foresight to suspect and diagnose the unapparent systemic associations through detailed examination. This simple examination is cost-effective and requires minimal time for both the clinician and the patient.

Detailed examination of nails is precisely given in Lakshanadhyaya, as nails are in contact with the periosteum of the phalangeal bone and hence good indicators of metabolic changes occurring in the body. Therefore, the physiological and pathological processes of blood and bone might influence the nail mineral content and hence provide an important clue for early diagnosis.[27]

Physical features of soles and feet can be updated with newer examination tools such as the Foot Posture Index,[28] Arch Height Index,[29] and Talar Tilt Physical Examination.[30] The heel bisector line should also be assessed to evaluate for foot deformities such as metatarsus adductus, a cause of intoeing. Method of assessment of the heel bisector line is with the subject prone and knees flexed at 90°, consider an imaginary straight line from the heel to the forefoot. Normally, the line that bisects the heel falls on the second toe. In conditions like metatarsus adductus, the line falls on the third, fourth, and fifth toes according to severity.[31]

During examination of lower extremities [Table 6], in addition to given physical features, various colors can also be inspected to find any venous insufficiency (bluish, purple discoloration) and vascular changes such as ischemia, cellulitis, sepsis, and gangrene (dark blue-black discoloration). Muscle tone can be examined for flaccidity (hypotonia) and spasticity (hypertonia).

During per abdomen examination, Kashyapa Acharya has given detailed features of abdominal folds, which is related to good fortune till it remains within four. If abdominal folds are too many, then that is for less wealth and short life. These folds appear because of the accumulation of adipose tissue, indicative of obesity, and if obesity is severe, then they will lead to bad fortune for that baby, if not intervened by proper medication [Table 11].

In Lakshanadhyaya, physical features related to Ashta Nindita Purusha (eight types of the despicable body) are correlated with fortunes like poor or wonderer, that might be because people will not accept such persons, and hence, persons have to keep wondering here and there and remain poor.

Examination features of hairy scrotum, erect penis, vagina, and hairy axilla indicate that Lakshanadhyaya is not only for the examination of newborn, but it also covers adolescent age. Description of gait also indicates that Acharya Kashyapa has given importance to examine developmental milestone too, as baby achieves walking milestone at the age of 1 year.

Limitation of the study

Within this limited literary review, the authors could not give probable justification that how physical features of nail (thick, white, irregular) and anatomical features of ischial tuberosity (hairy and curly toward the right side) can predict the future spiritual life of a baby. The authors could not be found the clinical relevance of very hairy vagina mentioned for widowhood and hairy shoulder mentioned for future businessman, porter, and gambler and hence may be considered as a matter of further research. Discussion about lines of the wrist and fortune prediction from its number is also available, which is not touched here, as this seems more related to the palmistry science and less with clinical conditions.


  Conclusion Top


Physical examination of the child to know the longevity and future life has also been discussed by Acharya Charaka[32] and Acharya Vagbhata.[33],[34],[35],[36] However, these authors have limited their description to measurement/inspection of few body parts excluding reproductive organs, voice, respiration, gate, etc., function. However, Acharya Kashyapa has dealt with all the aspects of pediatric examination from newborns to adolescents like nail, abdomen, vaginal, scrotum, penis, hair, various joints, back, gait, etc., along with the prediction of their future life. Future prediction is giving the idea of their health (and helps for early detection of impending clinical manifestation), wealth, and social and family appraisal. This indicates that basic instincts governing future life can be examined by the erudite pediatrician.

As, lifestyle and civilization of current era is different than the ancient era of Kashyapa Samhita, the future prediction related to health is only important and feasible and the rest of the predictions cannot be made in current days. But possible correlations and its practice in routine clinics might help to identify the present and future problems of the pediatric patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Pandita Hemaraja Sharma, Kashyapa Samhita, Reprint, Chaukhambha Sanskrita Samsthana, Varanasi 2008, Sutra Sthana Chapter 25 verse 4 Pg no. 33.  Back to cited text no. 1
    
2.
Charaka Samhita, Sharira Sthana. Jatisutriya Shariram, 8/51. Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 10 Jul 2020].  Back to cited text no. 2
    
3.
Susrut Samhita, Sutra Sthana. Aturopkramaniyadhyaya, 35/12. Available from: http://niimh.nic.in/ebooks/esushrut. [Last accessed on 10 Jul 2020].  Back to cited text no. 3
    
4.
Charaka Samhita, Viman Sthana, Rogabhishagjitiya Vimana, 8/107. Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 10 Jul 2020].  Back to cited text no. 4
    
5.
Sushrut Samhita, Sutra Sthana, Aturopkramaniyadhyaya, 35/16. Available from: http://niimh.nic.in/ebooks/esushrut. [Last accessed on 10 Jul 2020].  Back to cited text no. 5
    
6.
Patel DP, Swink SM, Castelo-Soccio L. A review of the use of biotin for hair loss. Skin Appendage Disord 2017;3:166-9.  Back to cited text no. 6
    
7.
Kaul S, Yadav S, Dogra S. Treatment of dermatophytosis in elderly, children, and pregnant women. Indian Dermatol Online J 2017;8:310-8.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Chiriac A, Brzezinski P, Foia L, Marincu I. Chloronychia: Green nail syndrome caused by Pseudomonas aeruginosa in elderly persons. Clin Interv Aging 2015;10:265-7.  Back to cited text no. 8
    
9.
Pitukweerakul S, Pilla S. Terry's nails and Lindsay's nails: Two nail abnormalities in chronic systemic diseases. J Gen Intern Med 2016;31:970.  Back to cited text no. 9
    
10.
Srivastava CM. Samudrik Shastra. Delhi, India: Manoj Publications; 2004.  Back to cited text no. 10
    
11.
Nugteren A. Bare feet and sacred ground: Viṣṇu was here. Religions 2018;9:224.  Back to cited text no. 11
    
12.
Damoulaki-Sfakianski E, Robertson A, Gordero L. Skin creases on the sole of the foot as a physical index of maturity: Comparison between Caucasian and Negro infants. Pediatrics 1972;50:483-5.  Back to cited text no. 12
    
13.
Black JO. Xeroderma pigmentosum. Head Neck Pathol 2016;10:139-44.  Back to cited text no. 13
    
14.
Mark M, Matthew BD. Congenital vertical talus. J Am Acad Orthop Surg 2015;23:604-11.  Back to cited text no. 14
    
15.
Charaka Samhita, Viman Sthana, Rogabhishagjitiya Vimana, 8/119. Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 10 Jul 2020].  Back to cited text no. 15
    
16.
Sushrut Samhita, Sutra Sthana, Aturopkramaniyadhyaya, 35/38. Available from: http://niimh.nic.in/ebooks/esushrut. [Last accessed on 10 Jul 2020].  Back to cited text no. 16
    
17.
Charaka Samhita, Sutra Sthana, Ashtoninditiyoadhyaya, 21/3. Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 10 Jul 2020].  Back to cited text no. 17
    
18.
Arora A. Self-Assessment and Review of Pediatrics. 3rd ed. Delhi, India: Pulse Publication; 2011. p. 46.  Back to cited text no. 18
    
19.
Colmenares-Bonilla D, Colin-Gonzalez C, Gonzalez-Segoviano A, Esquivel Garcia E, Vela-Huerta MM, Lopez-Gomez FG. Diagnosis of mucopolysaccharidosis based on history and clinical features: Evidence from the bajio region of Mexico. Cureus 2018;10:e3617.  Back to cited text no. 19
    
20.
Santhanam I. Neurology. In: Illustrated Textbook of Pediatrics. Ch. 21., 1st ed. Delhi, India: Jaypee Brother Medical Publishers; 2018. p. 871.  Back to cited text no. 20
    
21.
Sushrut Samhita, Sutra Sthana. Aturopkramaniyadhyaya, 35/18. Available from: http://niimh.nic.in/ebooks/esushrut. [Last accessed on 10 Jul 2020].  Back to cited text no. 21
    
22.
Das S, editor. A Manual on Clinical Surgery. Ch. 3., 10th ed. Kolkata: Published by D R Das; 2013. p. 54.  Back to cited text no. 22
    
23.
Singh M, editor. Care of the Newborn, Renal disorders. Ch. 21., Revised 8th ed., New Delhi: CBS Publishers and Distributers; 2016. p. 412.  Back to cited text no. 23
    
24.
Charaka Samhita, Sharira Sthana, Jatisutriya Shariram, 8/23-24. Available from: http://niimh.nic.in/ebooks/echara. [Last Accessed on 10 Jul 2020].  Back to cited text no. 24
    
25.
More KL, Dalley AF, Agur AM, editors. Moore Clinically Oriented Anatomy. 7th ed. (South Asian Edition). New Delhi: Published by Wolters Klower (India) Pvt Ltd; 2013. p. 683.  Back to cited text no. 25
    
26.
Charaka Samhita, Vimana Sthana, Rogabhishagjitiya Vimana, 8/98. Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 10 Jul 2020].  Back to cited text no. 26
    
27.
Saeedi P, Shavandi A, Meredith-Jones K. Nail Properties and Bone Health: A Review. J Funct Biomater 2018;9:31.  Back to cited text no. 27
    
28.
Lee JS, Kim KB, Jeong JO, Kwon NY, Jeong SM. Correlation of foot posture index with plantar pressure and radiographic measurements in pediatric flatfoot. Ann Rehabil Med 2015;39:10-7.  Back to cited text no. 28
    
29.
Butler RJ, Hillstrom H, Song J, Richards CJ, Davis IS. Arch height index measurement system. J Am Podiatr Med Assoc 2008;98:102-6.  Back to cited text no. 29
    
30.
Talar tilt. Wheeless' Textbook of Orthopaedics, presented by Duke Orthopaedics. Available from: http://www.wheelessonline.com. [Last accessed on 2021 Mar 09].  Back to cited text no. 30
    
31.
Marshall N, Ward E, Williams CM. The identification and appraisal of assessment tools used to evaluate metatarsus adductus: A systematic review of their measurement properties. J Foot Ankle Res 2018;11:25.  Back to cited text no. 31
    
32.
Charaka Samhita, Sharira Sthana, Jatisutriya Shariram, 8/51. Available from: http://niimh.nic.in/ebooks/echara. [Last accessed on 12 July 2020].  Back to cited text no. 32
    
33.
Shashilekha Sanskrit Commentary on Astanga Samgraha, 3rd Edition, Chaukhambha Sanskrit Series Office, Varanasi 2012, Sharira Sthana, Chapter 8 verse 32 P. 332.  Back to cited text no. 33
    
34.
Shashilekha Sanskrit Commentary on Astanga Samgraha, 3rd Edition, Chaukhambha Sanskrit Series Office, Varanasi 2012, Uttaratantra, Chapter 1 verse 31 P. 620.  Back to cited text no. 34
    
35.
Sastri Paradkar HS, editor. Astang Hrdaya of Vadbhata, Sharira Sthana. Ch. 3., Ver. 107., Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2015. p. 406.  Back to cited text no. 35
    
36.
Sastri Paradkar HS, Astang Hridaya, Reprint Edition, Chaukhambha Sanskrit Sansthan, Varanasi 2015, Uttar Sthana Chapter 1 verse 24 P. 779.  Back to cited text no. 36
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed90    
    Printed0    
    Emailed0    
    PDF Downloaded21    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]