Dasha vidha Pareeksha.pptx Dr Akshay Shetty

This preentation deals with Dasha Vidha Pareeksha

1. DASHAVIDHA /ROGI BALA/ATURA BALA/DOSHABALA PRAMANA PAREEKSHA Dr Akshay Shetty Associate Professor SSRAMC &H Inchal

2. Contents 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 2

3. Objectives 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 3

4. बलस्य दोषस्य च प्रमाणं बलदोषप्रमाणम्| Chakrapani Ca.Vi 8/93 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 4

5. तस्मादातुरंपरीक्षेतप्रकृतितश्च, विकृतितश्च, सारतश्च, संहननतश्च, प्रमाणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च, वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः||९४|| Ca.Vi 8 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 5

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7. आतुरस्तुखलुकार्यदेशः| तस्यपरीक्षाआयुषःप्रमाणज्ञानहेतोर्वास्याद्, बलदोषप्रमाणज्ञानहेतोर्वा| तत्रतावदियंबलदोषप्रमाणज्ञानहेतोः; दोषप्रमाणानुरूपोहिभेषजप्रमाणविकल्पोबलप्रमाणविशेषापेक्षोभवति| सहसाह्यतिबलमौषधमपरीक्षकप्रयुक्तमल्पबलमातुरमतिपातयेत्; नह्यतिबलान्याग्नेयवायवीयान्यौषधान्यग्निक्षारशस्त्रकर्माणिवाशक्यन्तेऽल्पबलैःसोढुम्; असह्यातितीक्ष्णवेगत्वाद्धितानिसद्यःप्राणहराणिस्युः| 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 7

8. एतच्चैवकारणमपेक्षमाणाहीनबलमातुरमविषादकरैर्मृदुसुकुमारप्रायैरुत्तरोत्तरगुरुभिरविभ्रमैरनात्ययिकैश्चोपचरन्त्यौषधैः; विशेषतश्चनारीः, ताह्यनवस्थितमृदुविवृतविक्लवहृदयाःप्रायःसुकुमार्योऽबलाःपरसंस्तभ्याश्च| तथाबलवतिबलवद्व्याधिपरिगतेस्वल्पबलमौषधमपरीक्षकप्रयुक्तमसाधकमेवभवति| 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 8

9. Patient is the substratum of the act ( karyadesha ). Examination of the patient is conducted for the knowledge of life span or the degree of strength and morbidity. The variations in dosage and potency of prescribed drugs is according to the degree of morbidity and the degree of strength of patient, because if potent drug is administered suddenly by a physician having not been examined properly, it may kill the weak patient; The weak patients are not able to bear intensely potent drugs which are predominant in  agni  and  vayu  or cauterization, application of alkali and surgical operation. They may cause instantaneous death due to unbearable and over intense impulse of the drug. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 9

10. Keeping this fact in mind, the physician should treat the weak patient with drug which is not harmful, mild, delicate, and progressively strong in order, without complication and not creating any emergent condition, particularly ladies, because they have unstable, soft, bare and timid heart, they are mostly delicate, weak and dependent on others. On the other hand, the drugs having low potency and applied by one who has not been examined properly in strong patients having severe disorder becomes ineffective. Hence the patient should be examined in respect of constitution (prakriti), morbidty ( vikriti ), constitution of dhatu ( sara ), compactness ( samhanana ), measurement ( pramana ), suitability ( satmya ), psyche (sattva), power of intake and digestion of food ( aharashakti ), power of exercise ( vyayamashakti ) and age ( vaya ) for the knowledge of the degree of strength 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 10

11. Thus the strength of individuals can be classified depending upon the superiority, mediocrity and inferiority of the above mentioned factors, viz. prakruti (Physical constitution), sara etc. except vikruti or morbidity. Ten-fold examinations should be done to understand the overview of patient’s condition in relation to diseases person must be carried out scientifically and methodically in a systemic planned manner to get a derisible and satisfying successful results. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 11

12. देशस्तुभूमिरातुरश्च||९२|| तत्रभूमिपरीक्षाआतुरपरिज्ञानहेतोर्वास्यादौषधपरिज्ञानहेतोर्वा|  Ca.Vi 8 Here desha is of 2 types- Bhumi desha (place) Aatura desha (patient) Examination of patient is conducted for the knowledge of lifespan or degree of strength. Weak patients are not able to bear intensely potent drugs. On the other hand, the drug having low potency and potency and applied to strong patients having severe disorders becomes ineffective. Hence the patients should be examined by dasha vidha pareeksha 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 12

13. Prakriti parikisha Prakruti-Pareekshna is an integral part of Dashavidha Pareeksha . It includes both Shareer & Manasik Bhavas. Bala (strength), Agni (digestive fire), Satwa (mental strength) and Satmya (beneficial to health) are nothing but constituents of Prakruti . Prakriti is the Swabhava or nature of an individual and it is an inherent characteristic. Foetus is dependent on many factors such as Prakriti of Shukra (sperm), Shonit (ovum), Kala (time of conception) and Garbhashaya (uterus). 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 13

14. Prakriti is also affected by the food habits and life style followed by the mother at the time of conception and during the entire gestational period. These factors are in turn completely dependent on the Dosha . Thus, foetus is dependent on the Dosha and its Prakriti is decided by the predominant Dosha / Doshas at the time of conception. The one or more Doshas predominant in the above said factors forms the Janmajaat Dosha Prakriti (body constitution by birth) of the foetus. Hence some persons are of Kapha / Pitta/ Vata constitution or balanced Tridoshaja constitution by birth 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 14

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18. The favourable and unfavorable things ( Pathyapathya ) for particular type of Prakriti could be advised to the individual on the basis of Prakriti. E.g. The Vata Prakriti individual should not consume dry, rough, cold, astringent substances. Rather one should take oily, warm, sweet substances. Similarly, Pitta Prakriti individual should avoid hot, sour, salty substances and the social environment that will raise his anger. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 18

19. Kaphaj individuals should be asked to take regular exercise and to avoid cold environment. Equally balanced ( Sama ) Prakriti is usually healthy and remain disease free and even if gets diseased; recovers soon. So, knowledge of Prakriti has prime importance in both healthy and diseased persons 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 19

20. Recently, few studies observed genetic bases for prakruti . Construct of prakruti has been correlated to human leukocyte antigen (HLA) gene polymorphism. Biochemical profiles and hematological parameters exhibited differences between prakruti types. A significant association between CYP2C19 genotype and major classes of prakruti types was observed. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 20

21. Another study showed platelet aggregatory response, and its inhibition by aspirin varied in the different prakruti subtypes. This prakruti related evidence is likely to have a significant impact on personalized medicine. However, there is a lack of quantitative studies such as reliability of prakruti assessment Based on the combination of one or more bioentities , seven types of prakruti are described as vataja , pittaja , kaphaja , vatakaphaja , vatapittaja , pittakaphaja , and vatapittakaphaja . Prakruti analysis helps in prioritizing any nurturing, preventive, and curative regimen specific to an individual. Thus, prakruti -based prescription helps to enhance the therapeutic effect of a regimen and to reduce the unwanted effects of the drug 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 21

22. Vikriti Pareeksha विकृतितश्चेतिविकृतिरुच्यतेविकारः| तत्रविकारंहेतु-दोष-दूष्य-प्रकृति-देश-काल-बलविशेषैर्लिङ्गतश्चपरीक्षेत, नह्यन्तरेणहेत्वादीनांबलविशेषंव्याधिबलविशेषोपलब्धिः| यस्यहिव्याधेर्दोष-दूष्य-प्रकृति-देश-काल-बलसाम्यंभवति, महच्चहेतुलिङ्गबलं, सव्याधिर्बलवान्भवति; तद्विपर्ययाच्चाल्पबलः; मध्यबलस्तुदोषदूष्यादीनामन्यतमसामान्याद्धेतुलिङ्गमध्यबलत्वाच्चोपलभ्यते||१०१|| 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 22

23. Patient examination should be done with respect of  vikriti  as well.  Vikriti  is  vikara  (disorder or pathological manifestation). The disorder should be examined in terms of the strength of the cause ( hetu ),  dosha (vitiating factors),  dushya (vitiated factors), constitution (prakriti), place ( desha ), time ( kala ) and the symptoms. The severity of the disease cannot be known without knowing the strength of the cause etc. factors. The disease having common  dushya , constitution, place and time along with strong cause and severity of symptoms is more, then such diseases are severe. The contrary is mild. The moderate disease has similarity in one of the  dosha ,  dushya  etc. and as such moderate strength of cause and severity of symptoms 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 23

24. In brief vikriti refers to morbidity of the susceptible individual and it is also helps to ascertain the strength of the pathogenesis factors responsible for the manifestation of disease and also helps to predict the prognosis of the disease. The vikriti pareeksha is stated for dosha Bala pramana of atura . For the assessment of vyadhi – hetu (cause), dosha , dusya , prakruti , desha , kala and Bala must be observed with their sub-types also. The vyadhi Bala is assessed by the intensity of etiology ( hetu ), symptoms of diseases parameters. They are collectively described as the conditions namely of easily curable ( sukhsadhya ), moderately curable ( krichsadhya ) and in-curable ( asadhya ) 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 24

25. Sara Pareeksha सारतश्चेतिसाराण्यष्टौपुरुषाणांबलमानविशेषज्ञानार्थमुपदिश्यन्ते; तद्यथा- त्वग्रक्तमांसमेदोऽस्थिमज्जशुक्रसत्त्वानीति||१०२|| Moreover a patient should be examined in respect of  sara  i.e. (best qualities of body tissues). There are eight types of  sara  in human beings which are described here for the knowledge of degree of strength such as – tvak , rakta , mamsa , meda , asthi , majja , shukra  and  sattva 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 25

26. The eight components of Sara are examined and levelled in terms of relative qualities viz. Pravara (Excellent or superior) Madhyama (Medium) Avara (Inferior) 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 26

27. Aim of Sara Pareeksha is assessment of Bala (strength) of children in accordance to Ayurveda. In reference to Sara, we observe or assess the Bala or strength of body parts and their functions as per the Dhatu (as the organs or body parts are formed from the Dhatu, so the qualities of Dhatu reflect the strength of specific organ/s, body parts etc. and their function. Therefore, with the help of Sara examination we assess the functional and anatomical qualities of the specific Dhatu forming organs or body parts). We also evaluate the strength of memory, intellect; illness and temperature bearing capacity, age assessment, knowledge, patience, money or immovable property retaining capacity (richness/poor/prosperity) etc. and plan the treatment accordingly 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 27

28. According to modern knowledge sara can be considered as the optimum degree of genetic code of an individual’s DNA with respect to particular dhatu. Genetic code is the system of storage of genetic information’s is chromosomes of living cells that instructs the machinery for polypeptide synthesis to insert a living cells that instruct the machinery for polypeptide synthesis to insert a particular amino acid in response to the nucleotide sequence of genetic material. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 28

29. In our body every individual’s DNA has the different genetic code. So, we can say, the quality of Dhatus of every individual will depend upon the genetic code of the individual’s DNA. If the genetic code of the individual’s DNA with respect to that dhatu is optimum, the formation of the particular dhatu in the body will be of very good quality. Sarva sara purusha has the optimum degree of the genetic code with respect to all dhatus 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 29

30. Samhanana pareeksha संहननतश्चेतिसंहननं, संहतिः], संयोजनमित्येकोऽर्थः| तत्रसमसुविभक्तास्थि, सुबद्धसन्धि, सुनिविष्टमांसशोणितं, सुसंहतंशरीरमित्युच्यते| तत्रसुसंहतशरीराःपुरुषाबलवन्तः, विपर्ययेणाल्पबलाः, मध्यत्वात्संहननस्यमध्यबलाभवन्ति||११६|| 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 30

31. Samhanana , Samhati and Sama -Yojana are the synonyms. Compactness of the body is known as Samhanana . It reflects the compactness qualities of the body. In other words, compactness varies person to person. According to body compactness, Samhanana is classified as Pravara Madhya Avara 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 31

32. Samhanana helps in prevention of diseases Criteria for the assessment of the Samhanana or Samhati or Samyojana . The person, who fulfills the following criteria, is known to have well proportionate body. Smooth-uniformly well-defined bones Well-fixed joints Well oriented or placed muscles Well circulated blood in younger children These features should be considered in accordance to growth for age 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 32

33. Pravara samhanana –Symmetrical and well demarcated bones, well joints, well bound muscles blood, strong built , excellent strength Madhyama samhanana Moderately symmetrical and demarcated bones, moderately joints, moderately bound muscles blood, moderately built , moderately strength Avara samhanana –Weakly Symmetrical and demarcated bones, Weakly joints, Weakly bound muscles blood, Weak built , Weak strength 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 33

34. Pramana Pariksha One should examine the body measurements. The Utsedh (Height), Wistar (breadth) and Yama (length) of the body parts should be measured in terms of one's own fingers ( Angul ). The entire body measures eighty four fingers in height and also in breadth such individuals possess longevity, strength, immunity, happiness, supremacy, wealth and other desired facilities. Those having body with less or more measurement have qualities contrary to these The person having normal measurements are endowed with longevity, physical strength, immunity, happiness, luxury, wealth and other desired things. Those having short or long body than normal are devoid of above said virtues 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 34

35. For clinical assessment it can be subdivided into Pravara Pramana - standard measurement criteria excellently height, length and breadth. Madhyama pramana - standard measurement criteria moderately height, length and breadth. Avarapramana - standard measurement criteria lesser extent height, length and breadth. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 35

36. Satmya Pareeksha One should also examine the compatibility of the patient to various things. Compatible are those things which on constant use have wholesome effect on the body. Satmya here refers to Oka Satmya which is habitual adaptations made by the body to the administered potentially antigenic material. It is like conditioning the body to adapt to the certain things which are not usually well tolerated by the body by practicing it daily. For e.g., butter is not tolerated by many people. But by making it a habit, one can overcome the intolerance. Allergic response may occur if one is not compatible to certain things 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 36

37. According to Dalhana , Satmya is of two types: Aahar . Satmya (Dietary compatibility) and Vihar Satmya (Lifestyle compatibility). Aahar Satmya is again divided into six types those are Eka (one), Dauo (Two), Tri (three), Chatur (Four), Pancha (Five), Shad (Six) Ras Satmya Vihar Satmya is divided into Kayik Vyayam (Body exercise), Vachik Vyayam (Speech exercise), Mansik Vyayam (Mental exercise). Habits and addiction play important role in the development of disease. Addiction of tobacco in any form can lead to ischemic heart disease. Smoking can also lead to COPD. Addiction of alcohol can lead to cirrhosis of liver. Hence, history regarding habits and addictions should be carefully sought 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 37

38. Satva Pareeksha Psyche is the Mana. Mind or psyche along with the soul controls the body of a person. Satva Pareeksha is a Manobala or mental stamina examination. Satva is of three types- Pravara or anybody having excellent psyche does not puzzled by the onset of disease originated pain and tolerate well in comparison to other types of Satva . Least tolerance, for the similar degree of painful condition in a disease, is found in Avara (least capacity) Satva child/person. Madhya Satva person can perform the work after counseling , while an Avara Satva person/child does not satisfy by self or any other and has intolerance to mild disease, suffered with fear, greediness etc. and becomes unconscious just by looking blood etc. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 38

39. Ahara shakti आहारशक्तितश्चेतिआहारशक्तिरभ्यवहरणशक्त्याजरणशक्तयाचपरीक्ष्या; बलायुषीह्याहारायत्ते||१२०|| The Ahar Shakti should be examined by assessing Abhyavaran Shakti (One's ability to eat the given quantity of food) Jaran Shakti (One's ability to digest the given quantity of food). It is tested and interpreted by Pravar (High), Avar (Low), Madhyam (Medium) value 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 39

40. Sama Agni (Good digestive fire) individuals remain in balanced state and hence remain healthy. Tikshn Agni (High digestive fire) individual as can digest everything in little time also relatively remains healthy. But if they continue to consume Pitta increasing aetiology then they are likely to suffer from disease like Bhasmak Roga (Bulimia), Amlapitta (GERD) etc. Mandagni (weak digestive fire) individuals are prone to diseases Vishamagni (abnormal digestive fire) individuals are always unhealthy and have gastric trouble. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 40

41. Vyayama Shakti व्यायामशक्तितश्चेति व्यायामशक्तिरपि कर्मशक्त्या परीक्ष्या| कर्मशक्त्या ह्यनुमीयते बलत्रैविध्यम् ||१२१|| कर्म भारवहनादि, तत्र शक्तिः कर्मशक्तिः||१२१|| The vyayama shakti(power of exercise) should be examined by the capacity for work. Vyayama shakti is an important component of dasa vidha pareeksha . It is alone a competent for assessment of bala . For the assessment of vyayama shakti three parameters were selected which are breath holding exercise, stepping exercise, measurement of basal pulse rate 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 41

42. Pravara vyayama shakti - Individual possess a excellent exercise endurance. To advice rehabilitation programme person should have a good power of exercise. These persons able to do a physiotherapy technique without much difficulty, this helps for faster recovery. These kinds of individual are able to perform heavy exercise. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 42

43. Madhyama vyayama shakti–Individual possess a moderate power of exercise. Person follows the physiotherapeutic technique moderately as a result it hampers the quicker relief. Moderate medicaments must be prescribed to gain desirable results 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 43

44. Avara vyayama shakti-Individual possess a mild power of exercise. These people are unable to follow the physiotherapeutic technique even up to slighter extent. This hastens the slower recovery. Mild medicaments are suitable to gain good results 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 44

45. Vaya Pareeksha वयस्तश्चेति कालप्रमाणविशेषापेक्षिणी हि शरीरावस्था वयोऽभिधीयते| तद्वयो यथास्थूलभेदेन  त्रिविधं- बालं, मध्यं, जीर्णमिति| तत्र बालमपरिपक्वधातुमजातव्यञ्जनं सुकुमारमक्लेशसहमसम्पूर्णबलं श्लेष्मधातुप्रायमाषोडशवर्षं, विवर्धमानधातुगुणं पुनः प्रायेणानवस्थितसत्त्वमात्रिंशद्वर्षमुपदिष्टं;  08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 45

46. मध्यं पुनः समत्वागतबलवीर्यपौरुषपराक्रमग्रहणधारणस्मरणवचनविज्ञानसर्वधातुगुणं बलस्थितमवस्थितसत्त्वमविशीर्यमाणधातुगुणं पित्तधातुप्रायमाषष्टिवर्षमुपदिष्टम्; अतः परं हीयमानधात्विन्द्रियबलवीर्यपौरुषपराक्रमग्रहणधारणस्मरणवचनविज्ञानं भ्रश्यमानधातुगुणं वायुधातुप्रायं क्रमेण जीर्णमुच्यते आवर्षशतम्| वर्षशतं खल्वायुषः प्रमाणमस्मिन् काले; सन्ति च पुनरधिकोनवर्षशतजीविनोऽपि मनुष्याः; तेषां विकृतिवर्ज्यैः प्रकृत्यादिबलविशेषैरायुषो लक्षणतश्च प्रमाणमुपलभ्य वयसस्त्रित्वं विभजेत्||१२२|| 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 46

47. Vaya is defined as the state of the body corresponding to the length of time that has passed since birth. Age is broadly divided into three stages – Bala (childhood) Madhya (middle age) Jeerna (old age). 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 47

48. Childhood is determined up to sixteen years when the dhatus are immature, sexual character are not manifested; the body is delicate, unstable with incomplete strength and predominant in kapha dosha . This again with dhatus in developing stages and unstable mind remains up to thirty years. Mild medicaments may be employed. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 48

49. The middle age is assessed by strength, energy, virility, acquisition, retention, recollection, speech, understanding and qualities of all dhatus having reached the normal limit, with proper physical and mental strength, without degeneration in qualities of dhatus, with predominance of pitta dhatu and is up to 60 years. Stronger medicaments may be employed to gain the success 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 49

50. Old age is up to one hundred years. There is diminution of dhatus strength of sense organs, energy, manliness, valor , power of understanding, retention, memorizing, speech and analyzing facts. There is gradual diminution in qualities of dhatus and dominance of vata . During this age the measure of life span is one hundred years. There are persons who live longer or shorter than that in such cases, one should determine the three divisions of age on the basis of strength of the factors like prakruti , sara etc. except vikruti and also characters of different periods of life span. 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 50

51. Summary 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 51

52. References Charaka samhita Sushruta samhita Shashirekha H K, Sushant Sukumar Bargale Importance Of Dasha Vidha Pareeksha In Clinical Practice Journal of Ayurveda and Holistic Medicine | March, 2014 | Volume 2 | Issue 3 Dr. Manish Kumar Importance Of Dashavidh Pareeksha World Journal of Pharmaceutical and Medical Research 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 52

53. THANK YOU 08/02/2024 DASHA VIDHA PAREEKSHA (Dr Akshay Shetty) 53