Percussion and Fluid Thrill Diagnosis of Ascites in Ayurveda

I have been wanting to just start a whole catagory where I can throw short articles that are on things that the Western world of “science” has claimed their knowledge and it is really from the ancient Indian knowledge. The folowing articles are only to bring credit where credit is due.

Here is the first……

Lets start small.


From Charaka Samhita 13th chapter, the main text of Ayurveda from 300 BC


Signs and Symptoms of Udakodara (Ascites):
तस्य रूपाणि- अनन्नकाङ्क्षा पिपासा गुदस्राव शूल श्वास कास दौर्बल्यानि, अपि चोदरं नाना वर्णराजि सिरा सन्ततमुदकपूर्ण दृति क्षोभ संस्पर्शं भवति, एतदुदकोदरमिति विद्यात्||४७||
tasya rūpāṇi- anannakāṅkṣā pipāsā gudasrāva śūla śvāsa kāsa daurbalyāni, api codaraṃ nānā varṇarāji sirā santatamudakapūrṇa dṛti kṣobha saṃsparśaṃ bhavati, etadudakodaramiti vidyāt||47||

Signs and symptoms of Udakodara (Ascites):
Loss of appetite, morbid thirst, discharge from the anus, colic pain, dyspnoea, cough and general debility. Appearance of network of veins having different colors over abdomen and with percussion the abdomin feels as if it is a leather bag filled with water. This is called Udakodara (Ascites). [47]

This is the fluid frill test.

And then……..

तत्र अचिरोत्पन्नमनुपद्रवमनुदकम प्राप्तमुदरं त्वरमाणश्चिकित्सेत्; उपेक्षितानां ह्येषां दोषाः स्वस्थानादपवृत्ता परिपाकाद्द्रवीभूताः सन्धीन् स्रोतांसि चोपक्लेदयन्ति, स्वेदश्च बाह्येषु स्रोतःसु प्रतिहत गतिस्तिर्यगवतिष्ठमानस्तदेवोदकमाप्याययति; तत्र पिच्छोत्पत्तौ मण्डलमुदरं गुरु स्तिमितमाकोठितमशब्दं मृदुस्पर्शमपगतराजीकमाक्रान्तं नाभ्यामेवोपसर्पति|
तस्य रूपाणि- कुक्षेरतिमात्रवृद्धिः, सिरान्तर्धानगमनम्, उदकपूर्णदृतिसङ्क्षोभसंस्पर्शत्वं च||४८||
tatra acirotpannamanupadravamanudakamaprāptamudaraṃ tvaramāṇaścikitset; upekṣitānāṃ hyeṣāṃ doṣāḥ svasthānādapavṛttā paripākāddravībhūtāḥ sandhīn srotāṃsi copakledayanti, svedaśca bāhyeṣu srotaḥsu pratihatagatistiryagavatiṣṭhamānastadevodakamāpyāyayati; tatra picchotpattau maṇḍalamudaraṃ guru stimitamākoṭhitamaśabdaṃ (Percussion with no sound)
mṛdusparśamapagatarājīkamākrāntaṃ nābhyāmevopasarpati|
tasya rūpāṇi- kukṣeratimātravṛddhiḥ, sirāntardhānagamanam, udakapūrṇadṛtisaṅkṣobhasaṃsparśatvaṃ ca||48||

The physician should immediately treat this condition before the appearance of complications and before water accumulates in the abdomen. If the treatment is neglected, then the vitiated Doshas get displaced and become liquefied as a result of maturation, causes stiffness in the joints and channels of circulation and diverts sweat from the external channels. The water element moves sideways. It collects in abdominal cavity. This zigzag moving sweat adds to the quantity of water already accumulated in the abdomen. The appearance of this sticky liquid makes the abdomen dull when percussed and soft to touch. Then, the network of veins disappears. During this period, the umbilical region is primarily afflicted, and from there the disease spreads up into the remaining parts of the abdomen.

Signs and symptoms of this condition are as follows:
Excessive enlargement of the sides of the abdomen. Disappearance of the network of the veins and In palpation and percussion, the physician feels as if the abdomen is a leather sack filled with water. [48]


The percussion with no sound is nothing more than the shifting dullness examination test in modern medicine.


The following is out of a Western clinical diagnosis manual:


Palpation and percussion are used to evaluate ascites. A rounded, symmetrical contour of the abdomen with bulging flanks is often the first clue. Palpation of the abdomen in the patient with ascites will often demonstrate a doughy, almost fluctuant sensation. In advanced cases the abdominal wall will be tense due to distention from the contained fluid. Gas-filled intestines will float to the top of the fluid-filled abdomen. Thus, in the supine patient with ascites there should be periumbilical tympany with dullness in the flanks. One should mark the level of dullness on the skin and then turn the patient on one side for a full minute. A change in the level of dullness is termed shifting dullness and usually indicates more than 500 ml of ascitic fluid. Another physical sign of ascites is demonstration of a transmitted fluid wave. The patient or an assistant presses a hand firmly against the abdominal wall in the umbilical region. The examiner places the flat of the left hand on the right flank and then taps the left flank with his right hand. In the presence of ascites, a sharp tap will generate a pressure wave that will be transmitted to the left hand. Unfortunately, fat will also transmit a fluid wave, and there are frequent false-positives with this test. ” 1




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1 Ferguson CM. Inspection, Auscultation, Palpation, and Percussion of the Abdomen. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 93. Available from:






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