Introduction {#sec1-1}
============

In Ayurveda, *Dosha-Dhatu-Mala* concept is important to understand the body functions. *Malas* are the metabolic end products those are to be excreted. *Malas* are divided into two major parts that is *Sharirika Mala* (body wastes) and *Dhatu Mala* (metabolic wastes). *Sharirika Mala* is further classified into three parts that is *Mutra* (urine), *Purisha* (stool), and *Sweda* (sweat); and *Dhatu Malas* are further classified into seven types.\[[@ref1]\] *Purisha* comes under *Sharirika Mala*. Both *Purisha* and *Mutra* are formed from the food.\[[@ref2]\] After digestion, the *Sarabhaga* (nutrient portion) gets absorbed and the remaining undigested part becomes solid and that is called as *Purisha*. If *Malas* are not excreted from the body, the metabolic process will be impaired and this will ultimately lead to the formation of malformed tissues and diseases. *Purisha Pariksha* (stool examination) is included in *Ashtasthana Pariksha*.\[[@ref3]\] In Ayurvedic texts, examination of stool is limited mainly up to the examination of physical characteristics such as color, quantity, odor, froth, and consistency. Besides these, a specialized technique of stool examination, i.e., *Jala Nimajjana Purisha Pariksha* has been described to detect the presence of *Ama* thereby inferring the status of *Agni* in the body.\[[@ref4][@ref5][@ref6]\]

All the three classics of *Brihattrayi* were studied thoroughly, and the descriptions pertaining to *Purisha* were collected systematically. These observations were critically analyzed and grouped under specific headings under the scheme of *Shadvidha Pariksha* (6-fold examination) of Sushruta to provide the first-hand information about the diagnosis of diseases.\[[@ref7]\]

Characteristics of normal *Purisha* {#sec1-2}
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Characteristics of normal stool in terms of physical characteristics such as *Gandha* (odor), *Sparsha* (touch), *Varna* (color), and *Vaishadya* (unstickiness/clear) are not described separately in the ancient and medieval period texts of Ayurveda, but stool examination has been given due importance in context of the diseases. Only *Pramana* (quantity) of *Purisha* has been described by Acharya Charaka as *Sapta Anjali Pramana*.\[[@ref8]\]

Importance of *Purisha Pariksha* {#sec1-3}
================================

*Purisha Pariksha* as such gives information about so many physiological and pathological states of the body as listed below:

Status of *Agni* (digestive fire)Symptoms of abnormal *Doshas* (body humors)Prognosis of diseasesPresence of parasites.\[[@ref9]\]

Method of Examination {#sec1-4}
=====================

There are two methods of *Purisha Pariksha* described in Ayurveda:

Physical examination of stool*Jala Nimajjana Purisha Pariksha* to detect the presence of *Ama*.

Physical examination of stool {#sec2-1}
-----------------------------

A great detail regarding the changes in physical characteristics of stool has been described under various diseases in *Brihattrayi*.

### Chakshusha Pariksha (inspection) {#sec3-1}

Through *Chakshusha Pariksha*, one can assess color, consistency, presence of froth, abnormal constituents, etc.

Examination of color

The *Pitta Dosha* according to Ayurveda is responsible for the production of colors. *Tridoshas* also play an important role in affecting the color of stool as well as other parts of body. Vitiation of *Doshas* causes changes in different color. Some of the changes in color of *Purisha* is the characteristic features of several diseases \[[Table 1](#T1){ref-type="table"}\].

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Change in color of stool in various diseases

![](AYU-36-125-g001)

Presence of froth

Froth in stool according to Ayurveda is due to *Vata Dosha*. The froth in stool is observed in different pathological states and diseases, which are *Vata* predominant \[[Table 2](#T2){ref-type="table"}\].

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Presence of froth in stool in different pathological conditions/diseases

![](AYU-36-125-g002)

Changes in consistency

The consistency of the stool in terms of *Sandra* (dense), *Baddha*/*Vibaddha* (solid), *Drava* (watery), *Bhinna* (looseness), and *Shushka* (dryness) is observed in various types of disease conditions. The consistency *Sandra* is mainly due to *Kapha Dosha*, *Badddha*/*Vibaddha*, and *Shushka* is due to *Vata Dosha* and *Drava*, and *Bhinna Purisha* is due to the predominance of *Pitta Dosha*. Few disease conditions, where changes in consistency of stool observed, are presented in [Table 3](#T3){ref-type="table"}.

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Changes in consistency of stool in various diseases

![](AYU-36-125-g003)

### Ghranaja Pariksha (examination by odor) {#sec3-2}

By *Ghranaja Pariksha*, the odor of the stool can be examined. Changes in odor of stool also can provide information about the altered pathological state of *Agni*. Various types of odors have been described in the context of various diseases. *Amagandhi* (smell of *Ama*), *Visragandhi* (smell of raw meat), and *Kunapagandhi* (smell of dead body) are the typical odors found in many diseases \[[Table 4](#T4){ref-type="table"}\].

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Change in odor of stool in various diseases

![](AYU-36-125-g004)

### Sparsha Pariksha {#sec3-3}

Under this, *Sheetata* (coldness), *Ushnata* (hotness), *Snigdhata* (unctuousness), and *Rukshata* (roughness) of stool can be taken into consideration. Thus, on the basis of differences in touch only; one can diagnose the altered state or the diseases \[[Table 5](#T5){ref-type="table"}\]. However, practically, it is very difficult to assess.

###### 

Change in *Sparsha* (touch) of stool in various diseases

![](AYU-36-125-g005)

### Prashna Pariksha (interrogation) {#sec3-4}

*Prashna Pariksha* is an important method of examination, which gives a lot of information about the condition of the patient. The same may be applied to obtain information related to frequency and amount of stool and associated symptoms such as pain \[Tables [6](#T6){ref-type="table"} and [7](#T7){ref-type="table"}\].

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Abnormal quantities/frequency of stool in various diseases

![](AYU-36-125-g006)

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Type of pain during defecation in various diseases

![](AYU-36-125-g007)

### *Jala Nimajjana Purisha Pariksha* (examination of stool by dipping in water) {#sec3-5}

This is the only objective method which was used in ancient times to detect the presence of *Ama* in stool. *Ama* is considered as an important cause not only for the gastrointestinal disorders but also as the cause of many systemic diseases such as *Jvara* and *Amavata*. To detect the early presence of *Ama*, a special methodology was used that is *Jala Nimajjana Purisha Pariksha*. In this method, by observing the behaviour of stool, i.e., whether it sinks or floats in water is noted down. If stool sinks, it indicates the presence of *Ama*. If it floats, then *Ama* is absent in stool.\[[@ref10]\]

If the method analyzed critically as described in the text, it is observed that there are so many variables, which may alter the result if done by different persons. The probable variables, which may alter the results, are:

Quality of waterQuantity of waterTesting containerQuantity and consistency of stoolMethod of dropping stool.

Hence, the method should be standardized to obtain a reproducible result by taking into consideration of the above parameters. After standardization, it may be an instant method to detect the *Ama* in the stool.

Discussion {#sec1-5}
==========

Ayurveda considers *Dosha*, *Dhatu*, and *Mala* as foundation of the body.\[[@ref2]\] *Mala* is produced as a by-product of our daily activities. If *Mala* is not excreted from the body, the metabolic process will be impaired leading to the formation of malformed tissues. They are important for normal physiology of the body and each of them carries specific functions. *Malas* enable nutrition as well as the elimination of wastes from the body.

*Purisha Pariksha* has been given due importance in the ancient period, and it has been described in *Ashtasthana Pariksha*. *Purisha*, which is one of the main metabolic products of the body, shows changes in its characters in diseased conditions. These changes in *Purisha* in terms of its *Rasa*, *Gandha*, and *Varna* are described in various diseases along with other signs and symptoms. On review, only the scattered references were found about the changes in characters of *Purisha* in all the *Samhitas*.

Based on the scattered descriptions in the *Samhitas*, the abnormal physical characters of the stool may be classified in terms of abnormalities in *Varna* (color), presence of froth, consistency, *Gandha* (odor), *Sparsha* (touch), *Matra* (quantity and frequency), and associated factors such as pain. These abnormal characters may be used to diagnose various types of diseases or pathological conditions. Analysis of abnormalities in color of the stool indicates appearance of *Krishna* (black), *Shyava* (gray), and *Aruna Varnas* (reddish) in *Vata* predominant diseases, as vitiated *Vata* brings these colors. Similarly, the *Shukla Varna* (white) is seen in *Kapha* predominant diseases as *Shukla Varna* is the manifestation of vitiated *Kapha*. When *Pitta* is vitiated, it brings the changes *Rakta Varna* (red).

It is observed that the diseases having *Kapha* predominance show *Sandra* (dense) in consistency which is possibly due to the *Sandra Guna* (dense quality) of *Kapha*. *Baddha*/*Vibaddha* consistency are observed in the diseases mostly having *Vata* predominance and this may be due to the *Shoshaka Guna* (absorptive quality) of *Vata*, which absorbs the *Kledamasha* (liquid part) of the stool when vitiated. Similarly, when *Pitta* is vitiated it changes the consistency of the stool into *Drava* (liquid) due to its *Drava Guna* \[[Table 3](#T3){ref-type="table"}\].

*Amagandha* is due to the formation of *Ama* due to altered pathological states of *Agni*. *Ama* is mainly formed due to *Mandagni*, and the *Amagandhi* stool is observed in *Amatisara*. When *Pitta* and *Shelshma Doshas* vitiate, then they bring the changes in odor of the stool as *Visragandhi*, which is seen mainly in *Paittika Arsha* and *Shleshmika Atisara*. *Kunapagandha* is manifested when *Tridoshas* are vitiated and it is observed in the diseases, which is due to the vitiation of *Tridosha* that is *Chidrodara* \[[Table 4](#T4){ref-type="table"}\]. The various changes in stool due to vitiation of *Dosha* may manifest in the form of changes in touch as *Sheeta* (cold), *Snigdha* (unctuous), *Ushna* (hot), and *Ruksha* (rough). *Sheeta* and *Snigdha* are due to the vitiation of *Kapha Dosha* and mainly observed in *Kapha* predominant diseases due to its *Sheeta* and *Snigdha Guna*. Similarly, *Ushna* and *Ruksha Sparsha* are due to the vitiation of *Pitta* and *Vata Dosha*, respectively, due to their respective quality \[[Table 5](#T5){ref-type="table"}\].

*Alpa Purisha* (less in quantity) is due to mainly vitiation of *Vata Dosha* due to its *Ruksha* and *Khara* (coarseness) *Guna*. Hence, *Alpa* and *Alpa Alpa Purisha* is mainly seen in *Vata* predominant diseases. Similarly *Atipravritti* may be seen either in the disease having *Pitta* or *Kapha* predominant diseases due to their *Drava* and *Kleda Guna*, respectively \[[Table 6](#T6){ref-type="table"}\].

Besides the above description regarding the abnormalities in physical characters of *Purisha*, one important method of examination to know the presence of *Ama* in *Purisha* has been described under the *Jala Nimajjana Pariksha* in the context of few diseases such as *Atisara* and *Grahani* in almost all the *Samhitas* and in the texts of medieval period. This method is a definite and instant method to detect the presence of *Ama* in stool by observing the sinking and floating behavior of the stool on water. However, to get a reproducible result, it should be standardized.

Conclusion {#sec1-6}
==========

Stool is an important by-product of the metabolism and reflects the changes occurring in the body in different pathological and diseased conditions. Hence, this has been given third place in *Ashtasthana Pariksha* after *Nadi* and *Mutra*. Abnormal changes in stool pertaining to its color, smell, consistency, frequency, and quantity have been described in various disease conditions. An attempt has been made to collect these scattered references from Samhitas at one place and one can refer these changes in stool for diagnosis of various disease conditions.

Financial support and sponsorship {#sec2-2}
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Nil.

Conflicts of interest {#sec2-3}
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There are no conflicts of interest.
