Talk:Pramanatah Pariksha

2023-10-28T10:17:57Z

Adarshpm:

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Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). [[Pramana]] pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.[[Vimana Sthana]] 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of [[pramana]] pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
==Derivation of pramana==
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

==Derivation of pariksha==

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

==Synonyms==

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

==Pramana in the context of ten fold assessment of patient (dashavidha pariksha):==
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

==Types==

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

==Assessment criteria==

===1. Anguli pramana===

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of
middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb
and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer
corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
(above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears
through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle
finger when a person stands straight

with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two [[Ayurveda]] scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. [[index.php?title=Special:BookSources/9780871691682|ISBN 978-0-87169-168-2]]</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''[[Udakavaha Srotas|Udaka]]''' (aqueous element) a substance which is found
in association with various body parts/components of body.

Example, it is seen mixed with faeces during the occurrence of diarrhoea.

It is also found in association with urine, blood and other tissue elements

of the body. It is spread all over the body with its site in the external skin.

Inside the skin, it is known as lasika (lymph) which exudes through

ulcers; when the body becomes hot, it comes out from hair follicles

in the form of sweat.
|10
|-
|'''[[Rasa dhatu|Rasa]]''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''[[Rakta dhatu|Rakta]] (blood)'''
|8
|-
|'''[[Purisha]] (faeces)'''
|7
|-
|'''[[Kapha dosha|Kapha]]'''
|6
|-
|'''[[Pitta]]'''
|5
|-
|'''[[Mutra]] (urine) '''
|4
|-
|'''[[Vasa]]''' (muscle fat)
|3
|-
|'''[[Meda dhatu|Medas]]''' (fat)
|2
|-
|'''[[Majja]]''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|1/2
|-
|'''[[Shukra dhatu|Shukra]]''' (semen)
|1/2
|-
|'''Shleshmika [[Ojas|oja]]''' (a type of [[Ojas|oja]])
|1/2
|}

==Application of Pramana in diagnosis of various [[disease]]s==

The equilibrium of [[dosha]], [[dhatu]] (body tissues) and [[mala]] (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of [[rasa dhatu]] (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of [[rasa dhatu]] may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their [[Pancha mahabhuta|panchabhautika]] composition (the five universal elements or [[Pancha mahabhuta|panchamahabhuta]]). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

==Contemporary views:==

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the '''figure 1'''

The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.[[File:Image.png|thumb|646x646px|'''Figure 1: Anthropometric Landmarks''']]'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

'''4. Modified Thoracometer:'''The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

'''5. Small height rod:'''This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

'''6. Sliding Caliper:'''This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.

'''7. Caliper:'''This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

'''8. Soft metric tape:'''This tool is used for measuring girth dimensions.

==Importance of concept==
===In determining life span===

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. Sutra Sthana 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. Sthana 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. Sutra Sthana 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

===In preservation and promotion of health===

*Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

*Pramanatah pariksha is helpful in determining [https://pubmed.ncbi.nlm.nih.gov/15674762/ Basal Metabolic Index (BMI)]. The normal range for BMI is 19–24·9 kg/, overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ <ref>Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732</ref>

===In relation to [https://pubmed.ncbi.nlm.nih.gov/10865763/#:~:text=Anthropometry%20is%20a%20simple%20reliable,and%20skinfold%20thickness%20(SF). anthropometry]===

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

===Individualistic approach===

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

==Application of knowledge of pramanatah pariksha in contemporary practices==

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.<ref>Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.</ref>

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.<ref>Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki></ref>

===In diagnosis and prognosis===

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

===In management of diseases===

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

==Current researches==

'''1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):'''

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana.<ref>Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.</ref>

'''2. Scientific study of Charakokta anguli pramana in reference to human height:'''

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana.<ref>Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.</ref>

'''3. Anguli pramana in ayurveda - a method of measurement in ancient times:'''

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand.<ref>Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki></ref>

'''4. Concept of anguli pramana sharira and importance in Ayurveda:'''

The author translates the [[ayurveda]] terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies.<ref>Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620</ref> Some of these are:

* Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

* Skandha (shoulder joint)

* Aaratni (from elbow joint to little finger)

* Prabahu (from shoulder joint to elbow joint)

* Prapani (from elbow joint to wrist joint)

* Jangha (from knee joint to ankle joint)[length] [circumference]

* Uru (from hip joint to knee joint) [length] [circumference]

* Janu (knee joint) [circumference]

* Gulpha (ankle joint) [circumference]

* Parshni (Heels) [length] [breadth]

==Future scope of research==

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

*To know the landmarks of finger, the distance of breadth of finger

* Angula and Anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

*To find the appropriate anthropometric measurements based on geographic variations.

*To find average anthropometric measurements based on constitution (prakriti) of individuals.

*To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.

==References==

<references />

Pramanatah Pariksha

2023-10-28T10:15:50Z

Adarshpm:

{{CiteButton}}
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). [[Pramana]] pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.[[Vimana Sthana]] 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of [[pramana]] pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
==Derivation of pramana==
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

==Derivation of pariksha==

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

==Synonyms==

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

==Pramana in the context of ten fold assessment of patient (dashavidha pariksha):==
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

==Types==

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

==Assessment criteria==

===1. Anguli pramana===

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of
middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb
and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer
corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
(above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears
through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle
finger when a person stands straight

with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two [[Ayurveda]] scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. [[index.php?title=Special:BookSources/9780871691682|ISBN 978-0-87169-168-2]]</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''[[Udakavaha Srotas|Udaka]]''' (aqueous element) a substance which is found
in association with various body parts/components of body.

Example, it is seen mixed with faeces during the occurrence of diarrhoea.

It is also found in association with urine, blood and other tissue elements

of the body. It is spread all over the body with its site in the external skin.

Inside the skin, it is known as lasika (lymph) which exudes through

ulcers; when the body becomes hot, it comes out from hair follicles

in the form of sweat.
|10
|-
|'''[[Rasa dhatu|Rasa]]''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''[[Rakta dhatu|Rakta]] (blood)'''
|8
|-
|'''[[Purisha]] (faeces)'''
|7
|-
|'''[[Kapha dosha|Kapha]]'''
|6
|-
|'''[[Pitta]]'''
|5
|-
|'''[[Mutra]] (urine) '''
|4
|-
|'''[[Vasa]]''' (muscle fat)
|3
|-
|'''[[Meda dhatu|Medas]]''' (fat)
|2
|-
|'''[[Majja]]''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|1/2
|-
|'''[[Shukra dhatu|Shukra]]''' (semen)
|1/2
|-
|'''Shleshmika [[Ojas|oja]]''' (a type of [[Ojas|oja]])
|1/2
|}

==Application of Pramana in diagnosis of various [[disease]]s==

The equilibrium of [[dosha]], [[dhatu]] (body tissues) and [[mala]] (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of [[rasa dhatu]] (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of [[rasa dhatu]] may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their [[Pancha mahabhuta|panchabhautika]] composition (the five universal elements or [[Pancha mahabhuta|panchamahabhuta]]). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

==Contemporary views:==

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the '''figure 1'''

The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.[[File:Image.png|thumb|646x646px|'''Figure 1: Anthropometric Landmarks''']]'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

'''4. Modified Thoracometer:'''The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

'''5. Small height rod:'''This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

'''6. Sliding Caliper:'''This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.

'''7. Caliper:'''This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

'''8. Soft metric tape:'''This tool is used for measuring girth dimensions.

==Importance of concept==
===In determining life span===

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. Sutra Sthana 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. Sthana 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. Sutra Sthana 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

===In preservation and promotion of health===

*Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

*Pramanatah pariksha is helpful in determining [https://pubmed.ncbi.nlm.nih.gov/15674762/ Basal Metabolic Index (BMI)]. The normal range for BMI is 19–24·9 kg/, overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ <ref>Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732</ref>

===In relation to [https://pubmed.ncbi.nlm.nih.gov/10865763/#:~:text=Anthropometry%20is%20a%20simple%20reliable,and%20skinfold%20thickness%20(SF). anthropometry]===

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

===Individualistic approach===

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

==Application of knowledge of pramanatah pariksha in contemporary practices==

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.<ref>Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.</ref>

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.<ref>Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki></ref>

===In diagnosis and prognosis===

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

===In management of diseases===

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

==Current researches==

'''1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):'''

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana.<ref>Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.</ref>

'''2. Scientific study of Charakokta anguli pramana in reference to human height:'''

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana.<ref>Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.</ref>

'''3. Anguli pramana in ayurveda - a method of measurement in ancient times:'''

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand.<ref>Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki></ref>

'''4. Concept of anguli pramana sharira and importance in Ayurveda:'''

The author translates the [[ayurveda]] terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies.<ref>Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620</ref> Some of these are:

* Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

* Skandha (shoulder joint)

* Aaratni (from elbow joint to little finger)

* Prabahu (from shoulder joint to elbow joint)

* Prapani (from elbow joint to wrist joint)

* Jangha (from knee joint to ankle joint)[length] [circumference]

* Uru (from hip joint to knee joint) [length] [circumference]

* Janu (knee joint) [circumference]

* Gulpha (ankle joint) [circumference]

* Parshni (Heels) [length] [breadth]

==Future scope of research==

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

*To know the landmarks of finger, the distance of breadth of finger

* Angula and Anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

*To find the appropriate anthropometric measurements based on geographic variations.

*To find average anthropometric measurements based on constitution (prakriti) of individuals.

*To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.

==References==

<references />

Pakshaghata

2023-10-13T12:18:42Z

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Talk:Pakshaghata

2023-10-13T12:17:39Z

Adarshpm:

{{CiteButton}}
{{#seo:
|title=Pakshaghata
|titlemode=append
|keywords=Pakshaghata, hemiplegia, Charak samhita, carakasamhitaonline, Indian System of Medicine, Ayurveda, treatment of hemiplegia
|description=The conditon in which ama alomg with vitiated vata effects the joints
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
}}
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Diseases]]/[[Pakshaghata]]

|label2 = Authors
|data2 = Adarsh P. M. 1, Deole Y.S. 2

|label3 = Reviewer & Editor
|data3 = Basisht G.3

|label4 = Affiliations
|data4 = 1 [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India

3 Rheumatologist, Orlando, Florida, U.S.A.

|label6 = Correspondence emails
|data6 =dryogeshdeole@gmail.com, carakasamhita@gmail.com

|label7 = Publisher
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = Date of publication:
|data8 =October 10, 2023

|label9 = DOI
|data9 = In process
}}Hemiplegia (paralysis or hemiparesis) is known as ‘pakshaghata’ or ‘pakshavadha’ in [[Ayurveda]]. It is classified under [https://www.carakasamhitaonline.com/index.php?title=Maharoga_Adhyaya#Eighty_disorders_caused_due_to_vata_dosha 80 diseases] due only to the vitiation of ([[vata dosha]]) (nanatmaja [[Vatavyadhi Chikitsa|vata vyadhi]]). There is complete or partial paralysis of the arm, leg, and trunk on one side of the body. The most typical cause of hemiplegia is cerebrovascular [[wikipedia:Stroke|stroke]]. A stroke affecting the [[wikipedia:Corticospinal_tract|corticospinal tract]] results in [[wikipedia:Hemiparesis|hemiplegia]]. Other causes are trauma, diabetes, infections affecting the [[wikipedia:Nervous_system|nervous system]], [[wikipedia:Neoplasm|neoplasms]], [[wikipedia:Demyelinating_disease|demyelination disorders]], [[wikipedia:Birth_defect|congenital disorders]], [[wikipedia:Multiple_sclerosis|multiple sclerosis]], [[wikipedia:Parasomnia|parasomnia]] etc. As per [[Ayurveda]] pathophysiology, the vitiated [[vata dosha]] afflicts half of the body by causing desiccation of nerves or blood vessels (sira) and muscles or tendons (snayu). It finally results in the signs and symptoms of pakshaghata. [Cha.Sa. [[Chikitsa Sthana]] 53-55] [https://pubmed.ncbi.nlm.nih.gov/28157752/ Rehabilitation] is the primary treatment of hemiplegia to regain maximum function and quality of life. It includes both physical and [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476805/ occupational therapy.] Ayurvedic management is vatahara (pacification of [[vata dosha]]) in nature. It can improve motor functions by [[Vata dosha|vata]]<nowiki/>nulomana (proper elimination of flatus, faeces, urine etc., by proper functioning of [[vayu]]) and balya (which provides strength) forms of medications.

'''National Ayurveda Morbidity code:''' AAC-24

'''ICD code for:''' G81.90

==Causes ([[hetu]])==

Aggravating factors of ([[vata dosha]]) lead to [[wikipedia:Hemiparesis|hemiplegia]]. These include following:

*Excessive intake of ([[tikta]]) (bitter), ([[katu]]) (pungent) and ([[kashaya]]) (astringent) tastes.

*Consuming insufficient quantity of food

*Excess intake of food items having dry quality.

*Late-time food consumption

*Suppression and provocation of natural urges.

*Avoidance of sleep at night

*Excess talking in a loud tone

*Excessive application of purificatory therapies

*Fear, grief, excessive thinking

*Excess exercise and sexual intercourse beyond one’s capacity. [A. Hri.Nidana Sthana 1/14-15]<ref name=":0">Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy; 2000.</ref>

*Injury to vital organs ([[marma]]<nowiki/>ghata)

*Untreated chronic inflammations or infections

==Clinical features==

===General clinical features===
*Loss of motor function and pain on either side of the body (right or left)

*Slurring or loss of speech

*Contractions (spasticity) on the legs and hands on either side.

*Pricking pain or sharp pain in the body. [Cha.Sa. ([[Chikitsa Sthana]]) 28/53-55]

*Loss of activity (akarmanyata), and loss of sensation (achetana) of the affected side. [Su.Sa. Nidana Sthana 1/60-62]<ref name=":1">Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

===Dosha specific clinical features===
{| class="wikitable"
|'''Dosha associated'''
|'''Clinical features'''
|-
|([[Pitta]]) associated condition
|Burning sensation (daha)

Increase in body temperature (santapa)

Syncope (murcha)
|-
|Kapha associated condition
|Coldness (shaitya)

Swelling (([[shotha]]))

Heaviness (gurutva)
|}
[Ma.Ni.22/42]<ref name=":2">Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>

==Pathogenesis==

The vata dosha is aggravated due to two possible pathologies:

1. Depletion of body constituents ([[dhatu]] kshaya)

2. Obstruction or covering of [[Vata dosha|vata]] dosha by other [[dosha]] or body constituents ([[dhatu]], [[mala]])

These two causes provide a background for pathogenesis of [[Vata dosha|vata]] dominant diseases.

The aggravated [[Vata dosha|vata]] is lodged in vacant spaces or afflicted channels ([[Sroto Vimana|sroto]] vaigunya). Due to obstruction in its path or impaired movement, [[Vata dosha|vata]] dosha affects the [[indriya]] (sensory and motor organs) and leads to affliction of either side of the body. It also causes the desiccation of siras (nerves) and snayus (tendons), producing contractions of legs and hands on either side. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/43-45]

The different pathologies like [[wikipedia:Arteriosclerosis|arteriosclerosis]], [[wikipedia:Aneurysm|aneurysms]], and plaque formation in cerebrovascular system need to be understood in this view. These pathologies result in cerebrovascular accident, causing hemiplegia or [[wikipedia:Hemiparesis|hemiparesis]] (pakshaghata). [A. Hri.Nidana Sthana 15/5-6]<ref name=":0" />

==== Predisposing and contributing factors====
*Food and regimen that aggravate [[Vata dosha|vata]] dosha.

*Excess use of [[amla]] (sour substances) and [[lavana]] (salt)

*Increased serum cholesterol levels

*Uncontrolled hypertension and [[wikipedia:Diabetes|diabetes mellitus]]

*Improper management of infections and inflammation ([[ama]] sandharana)

*Unhealthy sleeping habits

*Stress, emotional disturbances, and obstruction of natural urges.

*Consumption of cold food and beverages.

==Clinical diagnosis==
*Review of past medical history

*Neurological examination.

*Imaging technique ( computerized tomography scan & magnetic resonance imaging )

*[[wikipedia:Electroencephalography|electroencephalogram]]

*Blood tests (complete blood count, Erythrocyte sedimentation rate, hemoglobin level, platelet count etc.)[D1]

*Based on clinical features of disease in [[Ayurveda]] as mentioned earlier

===Biomarkers for diagnosis and assessment of efficacy===

[[wikipedia:Diffusion_MRI|Diffusion tensor imaging (DTI)]], [[wikipedia:Diffusion_MRI|diffusion-weighted imaging (DWI)]], T1-weighted MRI, T2 weighted MRI are biomarkers used to measure the structure or injury, whereas Electroencephalography (EEG), [[wikipedia:Functional_magnetic_resonance_imaging|functional magnetic resonance imaging (fMRI)]], [[wikipedia:Magnetoencephalography|Magnetoencephalography (MEG)]], [[wikipedia:Positron_emission_tomography|Positron emission tomography (PET)]], [[wikipedia:Transcranial_magnetic_stimulation|Transcranial magnetic stimulation (TMS)]] etc. are biomarkers used to measure the function.

==Prognosis==

''' Table 2: Prognosis'''
{| class="wikitable"
|'''Clinical feature'''
|''' Prognosis'''
|-
|Association of [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] dosha
|Easily curable (sadhya)
|-
|Caused by [[Vata dosha|vata]] dosha only (kevalavata)
|Most difficult to cure (krichrasadhyatama)
|-
|Developed by depletion at tissue level (dhatukshaya kruta)
|Treatable but not curable (asadhya)
|-
|Vedanarahita (absence of pain)
|Pariharya (untreatable)
|-
|In bala (children), vridha (old age), garbhini (pregnant women),
[[Sutika Paricharya|sutika]](puerperal women), kshina (exhausted),

asruksrutha (developed by hemorrhage)
|Pariharya (untreatable)
|}
[Ma. Ni 22/43]<ref name=":2" />

==Management==

===Stagewise management of disease===

'''Ⅰ. Acute condition'''

Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion.

Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered. Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure.

Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

'''Ⅱ.Chronic condition'''

Multidisciplinary rehabilitation and the drugs for secondary prevention come under the management of post-stroke patients. Physiotherapy, modified constraint-induced movement therapy, and the use of various assistive devices such as brace chains. Wheelchairs and walkers are advised for the improvement of motor function, cognition, speech, and quality of life. Mental imagery and electrical stimulation for the movement of muscles are also combined with the above. Ayurvedic management can be done at this stage. A systemic approach in the management of pakshaghata is explained in classical textbooks. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/100] [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" /> [A.Hri. Chikitsa Sthana 21/44]<ref name=":0" />

===Principles of management===

The principles of management of pakshaghata consist of

*[[Vata dosha|Vata]] [[shamana]] (pacification of [[vata dosha]]) by [[Snehana (unction therapy)|snehana]] (therapeutic oleation) and [[swedana]] (therapeutic sudation)

*Vatanulomana (proper functioning of [[Vayu mahabhuta|vayu]]) by mridu [[samshodhana]] (Therapeutic purgation using drugs with mild potency) or [[avarana]] [[dosha]] [[shamana]] (pacification of [[dosha]] causing occlusion) by snigdha [[virechana]] (therapeutic purgation using unctuous drugs)

*Balya (strengthening) and regenerative therapies ([[rasayana]]) by therapeutic enemas.

===Therapies advised in pakshaghata===

'''1) [[Snehana (unction therapy)|Snehana]] (therapeutic oleation):'''

Snehana is administered externally as well as internally. Internal can be used for [[shamana]] (pacification) and [[shodhana]] (purification) purpose,whereas external application is used only for [[shamana]] (pacification) purpose. Shirobasti (keeping oil on head) and [[abhyanga]] (therapeutic massage) are the most commonly used external unctuous therapies in pakshaghata. [[Abhyanga]] with anu taila is considered best. [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''2)[[Swedana]] (therapeutic sudation):'''

[[Swedana]] can be used for pacification and purification purpose. Salvana upanaha [[sweda]] (poultice) and bashpa [[sweda]] are commonly advised in pakshaghata.

'''3)[[Virechana]] (therapeutic purgation):'''

[[Virechana]] is the principal purificatory procedure mentioned in pakshaghata management. [[Virechana]] with unctuous drug is especially mentioned in classics because [[Vata dosha|vata]] [[shamana]] (pacification of [[vata dosha]]) and [[Vata dosha|vatanulomana]] (proper functioning of vayu).

'''4)[[Anuvasana]] basti (therapeutic unctuous enema):'''

[[Anuvasana]] with bala taila is indicated in pakshaghata. [[Anuvasana]] basti can pacify [[vata dosha]] to rejuvenate the tissues may be helpful.

'''5)[[Asthapana basti]] (therapeutic decoction enema)''':

[[Asthapana basti]] can be administered when [[shodhana]] (purification) is required prior to [[Vata dosha|vata]] shamana (pacification of [[vata dosha]]).

[Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''6)[[Nasya]] (nasal medication)''': Ksheera bala taila avartita, Dhanwantara taila avartita are used for nasal administration. [[Nasya]] provides effect on the space occupying lesion. Research is required to generate evidence on the same.

===Currently used important herbal formulations===

'''[[Kashaya|Decoctions:]]'''

[https://www.ayurmedinfo.com/2012/04/29/dhanadanayanadi-kashayam-benefits-dosage-side-effects-ingredients-reference/ Dhanadanayanadi Kashaya] [Sahasrayoga 1/58]<ref name=":3">Dr.K.Nishteswar,Dr.R.Vidyanath. Sahasrayogam.3rd ed. Varanasi: Chowkhamba Krishnadas academy;2011</ref>, [https://www.ayurmedinfo.com/2012/05/05/prasarinyadi-kashayam-benefits-dosage-side-effects-ingredients/ Prasarinyadi Kashaya] [Sahasrayoga 1/59(1)]<ref name=":3" />, [https://www.easyayurveda.com/2009/12/04/sahacharadi-kashayam-natural-remedy-for-hip-pain-leg-pain-and-low-back-pain/ Sahacharadi Kashaya] [Sahasrayoga 1/59(2)]<ref name=":3" />, [https://www.ayurmedinfo.com/2012/05/05/rasonadi-kashayam-benefits-dosage-side-effects-ingredients/ Rasonadi kwatha] [Sahasrayoga 1/59(3)]<ref name=":3" /> [https://www.ayurmedinfo.com/2012/05/01/gandharvahasthadi-kashayam-benefits-dosage-side-effects-ingredients-reference/ Gandharvahastadi kwatha] [Sahasrayoga 1/59(4)]<ref name=":3" />, [https://www.ayurmedinfo.com/2012/02/15/maharasnadi-kashayam-benefits-dose-side-effects-ingredients-and-reference/ Maharasnadi kwatha] [Sahasrayoga 1/60]<ref name=":3" />, [https://www.ayurmedinfo.com/2012/02/14/ashtavargam-kashayam-benefits-dose-side-effects-ingredients/ Balasahacharadi Kashaya]. [Sahasrayoga 1/54]<ref name=":3" />

'''Churnas/Herbal powder mixtures'''

Saraswata churna[Sahasrayoga 4/72]<ref name=":3" />, Kolakulatthadi churna [(external application)[Ca.Sa. [[Sutra Sthana]] 3/18]

'''Tablets'''

Yogaraja guggulu [Sahasrayoga 8/3]<ref name=":3" />, Mahayogaraja guggulu [Sharngadhara Samhita. Madhyama khanda 7/56-59]<ref>Sarngadhara.Sarngadhara Samhita.Translated from Sanskrit by K.R Srikantha murthy.Varanasi.Chaukhambha orientalia;2009</ref>, Simhanada guggulu [Bhaishajya ratnavali ,amavata adhikara 130-135]<ref name=":4">Govindadasa.Bhaishajya ratnavali.Hindi commentary by Ambikadattasastri.Edited by Brahmashankar mishra.Varanasi:Chaukhambha prakashan;2011</ref>

'''Ghee/Oil'''

Kalyanaka ghrita [Sahasrayoga 2/81]<ref name=":3" />, Mahakalyanaka ghrita [Sahasrayoga 2/82]<ref name=":3" />, Saraswata ghrita [Sahasrayoga 2/92]<ref name=":3" />, Sarvamayantaka ghrita [Sahasrayoga 2/97]<ref name=":3" />, Dhanwantara taila [Sahasrayoga 3/109]<ref name=":3" />, Narayana taila [Bhaishajya Ratnavali Vatavyadhi 140-150]<ref name=":4" />, Mahanarayana taila [Bhaishajya Ratnavali. Vatavyadhi. 151-162], Ksheerabala taila [Sahasrayoga 3/110]<ref name=":3" />, Prabhanjana vimardana taila [Sahasrayoga 3/7]<ref name=":3" />, Bala-aswagandhadi taila [Sahasrayoga 13/117]<ref name=":3" />, Sahacharadi taila [Sahasrayoga 3/131]<ref name=":3" />, Bala taila [Sahasrayoga 3/68]<ref name=":3" />, Prasarini taila [Sahasrayoga 3/69]<ref name=":3" />, Erandataila [Ca.Sa. [[Sutra Sthana]] 13/12(1)], Gandharvahastadi erandataila [Sahasrayoga 1/59(4)]<ref name=":3" />.

'''Avaleha'''

Kalyana leha [Bhaishajya ratnavali. Swarabheda rogadhikara. 27-29]<ref name=":4" />

'''Ksheerapaka'''

Lasuna ksheerapaka [Ca.Sa. [[Chikitsa Sthana]] 5/94-95], Prasarinyadi ksheera Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Masha athmagupthadi ksheera (nasapana) [Chakradatta. Vatavyadi 27]<ref>Chakrapanidatta. Chakradatta. Edited and translated by Priya vrat sharma.Varanasi:Chaukhambha orientalia.2007</ref>, mashabaladi kwatha [Bhaishajya Ratnavali. Vatavyadhi adhikara 62-63]<ref name=":4" />

==Research on Ayurvedic formulations==

In a study involving 40 patients afflicted with post stroke aphasia, kalyana leha is found more effective than speech therapy on auditory and verbal comprehension as well as naming.<ref>Priyanka Patel (2017): A randomized controlled clinical trial on kalyana leha in the management of post stroke aphasia. Department of Kayachiktsa, Parul Institute of Ayurved, Limda.</ref>

==Research on Ayurvedic treatments==

A comparative clinical study was conducted among 31 patients of pakshaghata between [[virechana]] group and [[koshtha]] shuddhi group. Both of these groups have shown marked to moderate improvements in patients with a better percentage wise improvement in the [[virechana]] group.<ref>Pandya Asutosh (2003): A comparative study of Virechana Karma and Sramsana in the management of Pakshaghata.Department of Panchakarma, ITRA, Jamnagar.</ref>

A comparative study was done between snehayuktha [[virechana]] (therapeutic unctuous purgation) followed by [[shamana]] (pacification therapy) using ekangaveer rasa and [[shamana]] alone. Using Ekangaveer rasa among 30 patients of pakshaghata, it is evident that [[virechana]] followed by [[shamana]] is far more effective than [[shamana]] only in all aspects.<ref>Tripti Lokesh (2013): A comparative study of virechana (snehayukta virechana) & shamana chikitsa in pakshaghata. Department of panchakarma, Govt.Akhandanand Ayurveda college, Ahmedabad.</ref>

A comparative clinical trial for comparing the effect of kala [[basti]] and [[virechana]] in pakshaghata was conducted in 25 patients. Kala basti group has shown better improvement in outcomes compared to the [[virechana]] group.<ref>Vimal M Vekariya (2008): comparative study of virechana karma and kala basti in the management of pakshaghata. Department of Panchakarma, ITRA, Jamnagar.</ref>

In a clinical study involving 10 patients of pakshaghata, the treatments like [[abhyanga]], sarvanga shashtikashali pinda sweda and rajayapana basti were administered consecutively. It has shown significant improvement in slurred speech, spasticity of upper limb, spasticity of lower limb, pain and lose of movement.<ref>Manasa T. V, Kiran M. Goud, Lolashri S. J. (2019). A clinical study to evaluate the efficacy of rajayapana basti in pakshaghata. IAMJ: Volume 7, Issue 3, March - 2019 (www.iamj.in).</ref>

In a comparative clinical study conducted among 40 patients, kalabasti with dasamoola kashaya, yavanyadi kalka, and sahacharadi taila has shown better improvement both in subjective and objective parameters as compared to the group of [[nasya]] (nasal medication) with karpasasthyadi taila and group with [[shamana]] (pacification) drugs only.<ref>Dr. Sayeda Nikhat Inamdar, Dr. Prashanth A S, Dr. Rahul kumar. Clinical evaluation of basti and nasya in pakshaghata (hemiplegia). PIJAR/July-August-17/volume 1/Issue-6, ISSN:2456:4354
</ref>

==Case reports==

'''1.''' A case study of 63 years old male patient who has weakness on his left side of body and unable to walk was published. His diagnosis was haemorrhagic stroke presenting with left sided hemiplegia with acute intraparenchymal haemorrhage in C.T. brain. The Ayurvedic diagnosis of pakshaghata was made and managed with treatment principle which is mentioned by Acharya Charak. [[Snehana (unction therapy)|Snehana]], [[swedana]] and mridu [[virechana]] along with [[panchakarma]] procedures like [[shirodhara]], shiropichu and basti for 21 days. Samshamana aushadhis (oral medicines) and physiotherapy were adopted at various stages of the diseases. Maximum improvement was noticed in upper and lower extremity functions at the end of the treatment. Patient showed remarkable recovery in speech ability and mobility.<ref>Mohan, V., B, D., & Deva, S. (2021). Ayurvedic Management of Pakshaghata (Left Hemiplegia) – A Case study. International Journal of Ayurvedic Medicine, 12(3), 733–741. <nowiki>https://doi.org/10.47552/ijam.v12i3.1954</nowiki></ref>

'''2.''' In a case report of a 77-year-old male patient with complaints of sudden weakness in right side of the body including face, inability to stand, walk, slurring of speech in the past 2 days. The main treatments given are dhanyamladhara, [[abhyanga]], shashtika shali pinda sweda, [[matra basti]], [[nasya]], tailadhara along with [[shamana]] aushadhis in the above-mentioned order. The patients’ muscle power, tone, strength improved greatly and deep tendon reflexes regained the normal status. Patient was able to walk without any support at the end of treatment.<ref>Karthikeya Prasad, Manjusri. (2022). Pakshaghata – A case study. International Journal of Pharmaceutical Research and Applications. Volume 7, Issue 6 Nov-Dec 2022, pp: 687-690 www.ijprajournal.com ISSN: 2456-4494.</ref>

'''3.''' A case on management of stroke of a male patient aged 40 years with chief complaints of loss of function of the left upper & lower limb is reported. He was a diagnosed case of stroke based on clinical presentation and computerized tomography scan. [[Ayurveda]] medications were found to be effective in providing relief in chief complaints with improvement of overall health of the patient. Treatment protocol was [[Snehana (unction therapy)|snehana]], [[swedana]], mridu [[virechana]], [[basti]] karma, murdhni taila ([[shirodhara]]) along with internal medication which is mentioned by Acharya Sushruta.<ref>Santhosh kumar Bhatted, Uttamram Yadav. (2020). Treatment Protocol of Stroke (Pakshaghata) Through Ayurveda Medicine -A Case Study. International Journal of Health Sciences and Research. Vol.10; Issue: 1; January 2020 Website: www.ijhsr.org Case Study ISSN: 2249-9571.</ref>

<references/>

2023-10-13T10:35:25Z

Adarshpm: Blanked the page

Talk:Pakshaghata

2023-10-13T10:34:41Z

Adarshpm:

{{CiteButton}}
{{#seo:
|title=Pakshaghata
|titlemode=append
|keywords=Pakshaghata, hemiplegia, Charak samhita, carakasamhitaonline, Indian System of Medicine, Ayurveda, treatment of hemiplegia
|description=The conditon in which ama alomg with vitiated vata effects the joints
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
}}
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Diseases]]/[[Pakshaghata]]

|label2 = Authors
|data2 = Adarsh P. M. 1, Deole Y.S. 2

|label3 = Reviewer & Editor
|data3 = Basisht G.3

|label4 = Affiliations
|data4 = 1 [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India

3 Rheumatologist, Orlando, Florida, U.S.A.

|label6 = Correspondence emails
|data6 =dryogeshdeole@gmail.com, carakasamhita@gmail.com

|label7 = Publisher
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = Date of publication:
|data8 =October 10, 2023

|label9 = DOI
|data9 = In process
}}Hemiplegia (paralysis or hemiparesis) is known as ‘pakshaghata’ or ‘pakshavadha’ in ([[Ayurveda]]). It is classified under 80 diseases due only to the vitiation of ([[vata dosha]]) (nanatmaja [[Vatavyadhi Chikitsa|vata vyadhi]]). There is complete or partial paralysis of the arm, leg, and trunk on one side of the body. The most typical cause of hemiplegia is cerebrovascular stroke. A stroke affecting the corticospinal tract results in hemiplegia. Other causes are trauma, diabetes, infections affecting the nervous system, neoplasms, demyelination disorders, congenital disorders, multiple sclerosis, parasomnia etc. As per [[Ayurveda]] pathophysiology, the vitiated [[vata dosha]] afflicts half of the body by causing desiccation of nerves or blood vessels (sira) and muscles or tendons (snayu). It finally results in the signs and symptoms of [[wikipedia:Hemiparesis|pakshaghata]]. [Cha.Sa. [[Chikitsa Sthana]] 53-55] [https://pubmed.ncbi.nlm.nih.gov/28157752/ Rehabilitation] is the primary treatment of hemiplegia to regain maximum function and quality of life. It includes both physical and [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476805/ occupational therapy.] Ayurvedic management is vatahara (pacification of [[vata dosha]]) in nature. It can improve motor functions by [[Vata dosha|vata]]<nowiki/>nulomana (proper elimination of flatus, faeces, urine etc., by proper functioning of [[vayu]]) and balya (which provides strength) forms of medications.

'''National Ayurveda Morbidity code:''' AAC-24

'''ICD code for:''' G81.90

==Causes ([[hetu]])==

Aggravating factors of ([[vata dosha]]) lead to [[wikipedia:Hemiparesis|hemiplegia]]. These include following:

*Excessive intake of ([[tikta]]) (bitter), ([[katu]]) (pungent) and ([[kashaya]]) (astringent) tastes.

*Consuming insufficient quantity of food

*Excess intake of food items having dry quality.

*Late-time food consumption

*Suppression and provocation of natural urges.

*Avoidance of sleep at night

*Excess talking in a loud tone

*Excessive application of purificatory therapies

*Fear, grief, excessive thinking

*Excess exercise and sexual intercourse beyond one’s capacity. [A. Hri.Nidana Sthana 1/14-15]<ref name=":0">Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy; 2000.</ref>

*Injury to vital organs ([[marma]]<nowiki/>ghata)

*Untreated chronic inflammations or infections

==Clinical features==

===General clinical features===
*Loss of motor function and pain on either side of the body (right or left)

*Slurring or loss of speech

*Contractions (spasticity) on the legs and hands on either side.

*Pricking pain or sharp pain in the body. [Cha.Sa. ([[Chikitsa Sthana]]) 28/53-55]

*Loss of activity (akarmanyata), and loss of sensation (achetana) of the affected side. [Su.Sa. Nidana Sthana 1/60-62]<ref name=":1">Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

===Dosha specific clinical features===
{| class="wikitable"
|'''Dosha associated'''
|'''Clinical features'''
|-
|([[Pitta]]) associated condition
|Burning sensation (daha)

Increase in body temperature (santapa)

Syncope (murcha)
|-
|Kapha associated condition
|Coldness (shaitya)

Swelling (([[shotha]]))

Heaviness (gurutva)
|}
[Ma.Ni.22/42]<ref name=":2">Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>

==Pathogenesis==

The vata dosha is aggravated due to two possible pathologies:

1. Depletion of body constituents ([[dhatu]] kshaya)

2. Obstruction or covering of [[Vata dosha|vata]] dosha by other [[dosha]] or body constituents ([[dhatu]], [[mala]])

These two causes provide a background for pathogenesis of [[Vata dosha|vata]] dominant diseases.

The aggravated [[Vata dosha|vata]] is lodged in vacant spaces or afflicted channels ([[Sroto Vimana|sroto]] vaigunya). Due to obstruction in its path or impaired movement, [[Vata dosha|vata]] dosha affects the [[indriya]] (sensory and motor organs) and leads to affliction of either side of the body. It also causes the desiccation of siras (nerves) and snayus (tendons), producing contractions of legs and hands on either side. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/43-45]

The different pathologies like [[wikipedia:Arteriosclerosis|arteriosclerosis]], [[wikipedia:Aneurysm|aneurysms]], and plaque formation in cerebrovascular system need to be understood in this view. These pathologies result in cerebrovascular accident, causing hemiplegia or [[wikipedia:Hemiparesis|hemiparesis]] (pakshaghata). [A. Hri.Nidana Sthana 15/5-6]<ref name=":0" />

==== Predisposing and contributing factors====
*Food and regimen that aggravate [[Vata dosha|vata]] dosha.

*Excess use of [[amla]] (sour substances) and [[lavana]] (salt)

*Increased serum cholesterol levels

*Uncontrolled hypertension and [[wikipedia:Diabetes|diabetes mellitus]]

*Improper management of infections and inflammation ([[ama]] sandharana)

*Unhealthy sleeping habits

*Stress, emotional disturbances, and obstruction of natural urges.

*Consumption of cold food and beverages.

==Clinical diagnosis==
*Review of past medical history

*Neurological examination.

*Imaging technique ( computerized tomography scan & magnetic resonance imaging )

*[[wikipedia:Electroencephalography|electroencephalogram]]

*Blood tests (complete blood count, Erythrocyte sedimentation rate, hemoglobin level, platelet count etc.)[D1]

*Based on clinical features of disease in [[Ayurveda]] as mentioned earlier

===Biomarkers for diagnosis and assessment of efficacy===

[[wikipedia:Diffusion_MRI|Diffusion tensor imaging (DTI)]], [[wikipedia:Diffusion_MRI|diffusion-weighted imaging (DWI)]], T1-weighted MRI, T2 weighted MRI are biomarkers used to measure the structure or injury, whereas Electroencephalography (EEG), [[wikipedia:Functional_magnetic_resonance_imaging|functional magnetic resonance imaging (fMRI)]], [[wikipedia:Magnetoencephalography|Magnetoencephalography (MEG)]], [[wikipedia:Positron_emission_tomography|Positron emission tomography (PET)]], [[wikipedia:Transcranial_magnetic_stimulation|Transcranial magnetic stimulation (TMS)]] etc. are biomarkers used to measure the function.

==Prognosis==

''' Table 2: Prognosis'''
{| class="wikitable"
|'''Clinical feature'''
|''' Prognosis'''
|-
|Association of [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] dosha
|Easily curable (sadhya)
|-
|Caused by [[Vata dosha|vata]] dosha only (kevalavata)
|Most difficult to cure (krichrasadhyatama)
|-
|Developed by depletion at tissue level (dhatukshaya kruta)
|Treatable but not curable (asadhya)
|-
|Vedanarahita (absence of pain)
|Pariharya (untreatable)
|-
|In bala (children), vridha (old age), garbhini (pregnant women),
[[Sutika Paricharya|sutika]](puerperal women), kshina (exhausted),

asruksrutha (developed by hemorrhage)
|Pariharya (untreatable)
|}
[Ma. Ni 22/43]<ref name=":2" />

==Management==

===Stagewise management of disease===

'''Ⅰ. Acute condition'''

Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion.

Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered. Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure.

Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

'''Ⅱ.Chronic condition'''

Multidisciplinary rehabilitation and the drugs for secondary prevention come under the management of post-stroke patients. Physiotherapy, modified constraint-induced movement therapy, and the use of various assistive devices such as brace chains. Wheelchairs and walkers are advised for the improvement of motor function, cognition, speech, and quality of life. Mental imagery and electrical stimulation for the movement of muscles are also combined with the above. Ayurvedic management can be done at this stage. A systemic approach in the management of pakshaghata is explained in classical textbooks. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/100] [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" /> [A.Hri. Chikitsa Sthana 21/44]<ref name=":0" />

===Principles of management===

The principles of management of pakshaghata consist of

*[[Vata dosha|Vata]] [[shamana]] (pacification of [[vata dosha]]) by [[Snehana (unction therapy)|snehana]] (therapeutic oleation) and [[swedana]] (therapeutic sudation)

*Vatanulomana (proper functioning of [[Vayu mahabhuta|vayu]]) by mridu [[samshodhana]] (Therapeutic purgation using drugs with mild potency) or [[avarana]] [[dosha]] [[shamana]] (pacification of [[dosha]] causing occlusion) by snigdha [[virechana]] (therapeutic purgation using unctuous drugs)

*Balya (strengthening) and regenerative therapies ([[rasayana]]) by therapeutic enemas.

===Therapies advised in pakshaghata===

'''1) [[Snehana (unction therapy)|Snehana]] (therapeutic oleation):'''

Snehana is administered externally as well as internally. Internal can be used for [[shamana]] (pacification) and [[shodhana]] (purification) purpose,whereas external application is used only for [[shamana]] (pacification) purpose. Shirobasti (keeping oil on head) and [[abhyanga]] (therapeutic massage) are the most commonly used external unctuous therapies in pakshaghata. [[Abhyanga]] with anu taila is considered best. [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''2)[[Swedana]] (therapeutic sudation):'''

[[Swedana]] can be used for pacification and purification purpose. Salvana upanaha [[sweda]] (poultice) and bashpa [[sweda]] are commonly advised in pakshaghata.

'''3)[[Virechana]] (therapeutic purgation):'''

[[Virechana]] is the principal purificatory procedure mentioned in pakshaghata management. [[Virechana]] with unctuous drug is especially mentioned in classics because [[Vata dosha|vata]] [[shamana]] (pacification of [[vata dosha]]) and [[Vata dosha|vatanulomana]] (proper functioning of vayu).

'''4)[[Anuvasana]] basti (therapeutic unctuous enema):'''

[[Anuvasana]] with bala taila is indicated in pakshaghata. [[Anuvasana]] basti can pacify [[vata dosha]] to rejuvenate the tissues may be helpful.

'''5)[[Asthapana basti]] (therapeutic decoction enema)''':

[[Asthapana basti]] can be administered when [[shodhana]] (purification) is required prior to [[Vata dosha|vata]] shamana (pacification of [[vata dosha]]).

[Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''6)[[Nasya]] (nasal medication)''': Ksheera bala taila avartita, Dhanwantara taila avartita are used for nasal administration. [[Nasya]] provides effect on the space occupying lesion. Research is required to generate evidence on the same.

===Currently used important herbal formulations===

'''[[Kashaya|Decoctions:]]'''

Dhanadanayanadi [[Kashaya]] [Sahasrayoga 1/58]<ref name=":3">Dr.K.Nishteswar,Dr.R.Vidyanath. Sahasrayogam.3rd ed. Varanasi: Chowkhamba Krishnadas academy;2011</ref>, Prasarinyadi Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Sahacharadi Kashaya [Sahasrayoga 1/59(2)]<ref name=":3" />, Rasonadi kwatha [Sahasrayoga 1/59(3)]<ref name=":3" /> Gandharvahastadi kwatha [Sahasrayoga 1/59(4)]<ref name=":3" />, Maharasnadi kwatha [Sahasrayoga 1/60]<ref name=":3" />, Balasahacharadi Kashaya. [Sahasrayoga 1/54]<ref name=":3" />

'''Churnas/Herbal powder mixtures'''

Saraswata churna[Sahasrayoga 4/72]<ref name=":3" />, Kolakulatthadi churna [(external application)[Ca.Sa. [[Sutra Sthana]] 3/18]

'''Tablets'''

Yogaraja guggulu [Sahasrayoga 8/3]<ref name=":3" />, Mahayogaraja guggulu [Sharngadhara Samhita. Madhyama khanda 7/56-59]<ref>Sarngadhara.Sarngadhara Samhita.Translated from Sanskrit by K.R Srikantha murthy.Varanasi.Chaukhambha orientalia;2009</ref>, Simhanada guggulu [Bhaishajya ratnavali ,amavata adhikara 130-135]<ref name=":4">Govindadasa.Bhaishajya ratnavali.Hindi commentary by Ambikadattasastri.Edited by Brahmashankar mishra.Varanasi:Chaukhambha prakashan;2011</ref>

'''Ghee/Oil'''

Kalyanaka ghrita [Sahasrayoga 2/81]<ref name=":3" />, Mahakalyanaka ghrita [Sahasrayoga 2/82]<ref name=":3" />, Saraswata ghrita [Sahasrayoga 2/92]<ref name=":3" />, Sarvamayantaka ghrita [Sahasrayoga 2/97]<ref name=":3" />, Dhanwantara taila [Sahasrayoga 3/109]<ref name=":3" />, Narayana taila [Bhaishajya Ratnavali Vatavyadhi 140-150]<ref name=":4" />, Mahanarayana taila [Bhaishajya Ratnavali. Vatavyadhi. 151-162], Ksheerabala taila [Sahasrayoga 3/110]<ref name=":3" />, Prabhanjana vimardana taila [Sahasrayoga 3/7]<ref name=":3" />, Bala-aswagandhadi taila [Sahasrayoga 13/117]<ref name=":3" />, Sahacharadi taila [Sahasrayoga 3/131]<ref name=":3" />, Bala taila [Sahasrayoga 3/68]<ref name=":3" />, Prasarini taila [Sahasrayoga 3/69]<ref name=":3" />, Erandataila [Ca.Sa. [[Sutra Sthana]] 13/12(1)], Gandharvahastadi erandataila [Sahasrayoga 1/59(4)]<ref name=":3" />.

'''Avaleha'''

Kalyana leha [Bhaishajya ratnavali. Swarabheda rogadhikara. 27-29]<ref name=":4" />

'''Ksheerapaka'''

Lasuna ksheerapaka [Ca.Sa. [[Chikitsa Sthana]] 5/94-95], Prasarinyadi ksheera Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Masha athmagupthadi ksheera (nasapana) [Chakradatta. Vatavyadi 27]<ref>Chakrapanidatta. Chakradatta. Edited and translated by Priya vrat sharma.Varanasi:Chaukhambha orientalia.2007</ref>, mashabaladi kwatha [Bhaishajya Ratnavali. Vatavyadhi adhikara 62-63]<ref name=":4" />

==Research on Ayurvedic formulations==

In a study involving 40 patients afflicted with post stroke aphasia, kalyana leha is found more effective than speech therapy on auditory and verbal comprehension as well as naming.<ref>Priyanka Patel (2017): A randomized controlled clinical trial on kalyana leha in the management of post stroke aphasia. Department of Kayachiktsa, Parul Institute of Ayurved, Limda.</ref>

==Research on Ayurvedic treatments==

A comparative clinical study was conducted among 31 patients of pakshaghata between [[virechana]] group and [[koshtha]] shuddhi group. Both of these groups have shown marked to moderate improvements in patients with a better percentage wise improvement in the [[virechana]] group.<ref>Pandya Asutosh (2003): A comparative study of Virechana Karma and Sramsana in the management of Pakshaghata.Department of Panchakarma, ITRA, Jamnagar.</ref>

A comparative study was done between snehayuktha [[virechana]] (therapeutic unctuous purgation) followed by [[shamana]] (pacification therapy) using ekangaveer rasa and [[shamana]] alone. Using Ekangaveer rasa among 30 patients of pakshaghata, it is evident that [[virechana]] followed by [[shamana]] is far more effective than [[shamana]] only in all aspects.<ref>Tripti Lokesh (2013): A comparative study of virechana (snehayukta virechana) & shamana chikitsa in pakshaghata. Department of panchakarma, Govt.Akhandanand Ayurveda college, Ahmedabad.</ref>

A comparative clinical trial for comparing the effect of kala [[basti]] and [[virechana]] in pakshaghata was conducted in 25 patients. Kala basti group has shown better improvement in outcomes compared to the [[virechana]] group.<ref>Vimal M Vekariya (2008): comparative study of virechana karma and kala basti in the management of pakshaghata. Department of Panchakarma, ITRA, Jamnagar.</ref>

In a clinical study involving 10 patients of pakshaghata, the treatments like [[abhyanga]], sarvanga shashtikashali pinda sweda and rajayapana basti were administered consecutively. It has shown significant improvement in vakstambha, padasankocha, hastakankocha, shula and Cheshta nivritti.<ref>Manasa T. V, Kiran M. Goud, Lolashri S. J. (2019). A clinical study to evaluate the efficacy of rajayapana basti in pakshaghata. IAMJ: Volume 7, Issue 3, March - 2019 (www.iamj.in).</ref>

In a comparative clinical study conducted among 40 patients, kalabasti with dasamoola kashaya, yavanyadi kalka, and sahacharadi taila has shown better improvement both in subjective and objective parameters as compared to the group of [[nasya]] (nasal medication) with karpasasthyadi taila and group with [[shamana]] (pacification) drugs only.<ref>Dr. Sayeda Nikhat Inamdar, Dr. Prashanth A S, Dr. Rahul kumar. Clinical evaluation of basti and nasya in pakshaghata (hemiplegia). PIJAR/July-August-17/volume 1/Issue-6, ISSN:2456:4354
</ref>

==Case reports==

'''1.''' A case study of 63 years old male patient who has weakness on his left side of body and unable to walk was published. His diagnosis was haemorrhagic stroke presenting with left sided hemiplegia with acute intraparenchymal haemorrhage in C.T. brain. The Ayurvedic diagnosis of pakshaghata was made and managed with treatment principle which is mentioned by Acharya Charak. [[Snehana (unction therapy)|Snehana]], [[swedana]] and mridu [[virechana]] along with [[panchakarma]] procedures like [[shirodhara]], shiropichu and basti for 21 days. Samshamana aushadhis (oral medicines) and physiotherapy were adopted at various stages of the diseases. Maximum improvement was noticed in upper and lower extremity functions at the end of the treatment. Patient showed remarkable recovery in speech ability and mobility.<ref>Mohan, V., B, D., & Deva, S. (2021). Ayurvedic Management of Pakshaghata (Left Hemiplegia) – A Case study. International Journal of Ayurvedic Medicine, 12(3), 733–741. <nowiki>https://doi.org/10.47552/ijam.v12i3.1954</nowiki></ref>

'''2.''' In a case report of a 77-year-old male patient with complaints of sudden weakness in right side of the body including face, inability to stand, walk, slurring of speech in the past 2 days. The main treatments given are dhanyamladhara, [[abhyanga]], shashtika shali pinda sweda, [[matra basti]], [[nasya]], tailadhara along with [[shamana]] aushadhis in the above-mentioned order. The patients’ muscle power, tone, strength improved greatly and deep tendon reflexes regained the normal status. Patient was able to walk without any support at the end of treatment.<ref>Karthikeya Prasad, Manjusri. (2022). Pakshaghata – A case study. International Journal of Pharmaceutical Research and Applications. Volume 7, Issue 6 Nov-Dec 2022, pp: 687-690 www.ijprajournal.com ISSN: 2456-4494.</ref>

'''3.''' A case on management of stroke of a male patient aged 40 years with chief complaints of loss of function of the left upper & lower limb is repored. He was a diagnosed case of stroke based on clinical presentation and brain computed tomography-scan. In the case, [[Ayurveda]] medications were found to be effective in providing relief in chief complaint with improvement of overall health of the patient. Treatment protocol was [[Snehana (unction therapy)|snehana]], [[swedana]], mridu [[virechana]], [[basti]] karma, murdhni taila ([[shirodhara]]) along with internal medication which is mentioned by Acharya Sushruta.<ref>Santhosh kumar Bhatted, Uttamram Yadav. (2020). Treatment Protocol of Stroke (Pakshaghata) Through Ayurveda Medicine -A Case Study. International Journal of Health Sciences and Research. Vol.10; Issue: 1; January 2020 Website: www.ijhsr.org Case Study ISSN: 2249-9571.</ref>

<references/>

Pakshaghata

2023-10-13T10:33:26Z

Adarshpm:

{{CiteButton}}
{{#seo:
|title=Pakshaghata
|titlemode=append
|keywords=Pakshaghata, hemiplegia, Charak samhita, carakasamhitaonline, Indian System of Medicine, Ayurveda, treatment of hemiplegia
|description=The conditon in which ama alomg with vitiated vata effects the joints
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
}}
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Diseases]]/[[Pakshaghata]]

|label2 = Authors
|data2 = Adarsh P. M. 1, Deole Y.S. 2

|label3 = Reviewer & Editor
|data3 = Basisht G.3

|label4 = Affiliations
|data4 = 1 [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India

3 Rheumatologist, Orlando, Florida, U.S.A.

|label6 = Correspondence emails
|data6 =dryogeshdeole@gmail.com, carakasamhita@gmail.com

|label7 = Publisher
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = Date of publication:
|data8 =October 10, 2023

|label9 = DOI
|data9 = In process
}}Hemiplegia (paralysis or hemiparesis) is known as ‘pakshaghata’ or ‘pakshavadha’ in ([[Ayurveda]]). It is classified under 80 diseases due only to the vitiation of ([[vata dosha]]) (nanatmaja [[Vatavyadhi Chikitsa|vata vyadhi]]). There is complete or partial paralysis of the arm, leg, and trunk on one side of the body. The most typical cause of hemiplegia is cerebrovascular stroke. A stroke affecting the corticospinal tract results in hemiplegia. Other causes are trauma, diabetes, infections affecting the nervous system, neoplasms, demyelination disorders, congenital disorders, multiple sclerosis, parasomnia etc. As per [[Ayurveda]] pathophysiology, the vitiated [[vata dosha]] afflicts half of the body by causing desiccation of nerves or blood vessels (sira) and muscles or tendons (snayu). It finally results in the signs and symptoms of [[wikipedia:Hemiparesis|pakshaghata]]. [Cha.Sa. [[Chikitsa Sthana]] 53-55] [https://pubmed.ncbi.nlm.nih.gov/28157752/ Rehabilitation] is the primary treatment of hemiplegia to regain maximum function and quality of life. It includes both physical and [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476805/ occupational therapy.] Ayurvedic management is vatahara (pacification of [[vata dosha]]) in nature. It can improve motor functions by [[Vata dosha|vata]]<nowiki/>nulomana (proper elimination of flatus, faeces, urine etc., by proper functioning of [[vayu]]) and balya (which provides strength) forms of medications.

'''National Ayurveda Morbidity code:''' AAC-24

'''ICD code for:''' G81.90

==Causes ([[hetu]])==

Aggravating factors of ([[vata dosha]]) lead to [[wikipedia:Hemiparesis|hemiplegia]]. These include following:

*Excessive intake of ([[tikta]]) (bitter), ([[katu]]) (pungent) and ([[kashaya]]) (astringent) tastes.

*Consuming insufficient quantity of food

*Excess intake of food items having dry quality.

*Late-time food consumption

*Suppression and provocation of natural urges.

*Avoidance of sleep at night

*Excess talking in a loud tone

*Excessive application of purificatory therapies

*Fear, grief, excessive thinking

*Excess exercise and sexual intercourse beyond one’s capacity. [A. Hri.Nidana Sthana 1/14-15]<ref name=":0">Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy; 2000.</ref>

*Injury to vital organs ([[marma]]<nowiki/>ghata)

*Untreated chronic inflammations or infections

==Clinical features==

===General clinical features===
*Loss of motor function and pain on either side of the body (right or left)

*Slurring or loss of speech

*Contractions (spasticity) on the legs and hands on either side.

*Pricking pain or sharp pain in the body. [Cha.Sa. ([[Chikitsa Sthana]]) 28/53-55]

*Loss of activity (akarmanyata), and loss of sensation (achetana) of the affected side. [Su.Sa. Nidana Sthana 1/60-62]<ref name=":1">Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

===Dosha specific clinical features===
{| class="wikitable"
|'''Dosha associated'''
|'''Clinical features'''
|-
|([[Pitta]]) associated condition
|Burning sensation (daha)

Increase in body temperature (santapa)

Syncope (murcha)
|-
|Kapha associated condition
|Coldness (shaitya)

Swelling (([[shotha]]))

Heaviness (gurutva)
|}
[Ma.Ni.22/42]<ref name=":2">Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>

==Pathogenesis==

The vata dosha is aggravated due to two possible pathologies:

1. Depletion of body constituents ([[dhatu]] kshaya)

2. Obstruction or covering of [[Vata dosha|vata]] dosha by other [[dosha]] or body constituents ([[dhatu]], [[mala]])

These two causes provide a background for pathogenesis of [[Vata dosha|vata]] dominant diseases.

The aggravated [[Vata dosha|vata]] is lodged in vacant spaces or afflicted channels ([[Sroto Vimana|sroto]] vaigunya). Due to obstruction in its path or impaired movement, [[Vata dosha|vata]] dosha affects the [[indriya]] (sensory and motor organs) and leads to affliction of either side of the body. It also causes the desiccation of siras (nerves) and snayus (tendons), producing contractions of legs and hands on either side. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/43-45]

The different pathologies like [[wikipedia:Arteriosclerosis|arteriosclerosis]], [[wikipedia:Aneurysm|aneurysms]], and plaque formation in cerebrovascular system need to be understood in this view. These pathologies result in cerebrovascular accident, causing hemiplegia or [[wikipedia:Hemiparesis|hemiparesis]] (pakshaghata). [A. Hri.Nidana Sthana 15/5-6]<ref name=":0" />

==== Predisposing and contributing factors====
*Food and regimen that aggravate [[Vata dosha|vata]] dosha.

*Excess use of [[amla]] (sour substances) and [[lavana]] (salt)

*Increased serum cholesterol levels

*Uncontrolled hypertension and [[wikipedia:Diabetes|diabetes mellitus]]

*Improper management of infections and inflammation ([[ama]] sandharana)

*Unhealthy sleeping habits

*Stress, emotional disturbances, and obstruction of natural urges.

*Consumption of cold food and beverages.

==Clinical diagnosis==
*Review of past medical history

*Neurological examination.

*Imaging technique ( computerized tomography scan & magnetic resonance imaging )

*[[wikipedia:Electroencephalography|electroencephalogram]]

*Blood tests (complete blood count, Erythrocyte sedimentation rate, hemoglobin level, platelet count etc.)[D1]

*Based on clinical features of disease in [[Ayurveda]] as mentioned earlier

===Biomarkers for diagnosis and assessment of efficacy===

[[wikipedia:Diffusion_MRI|Diffusion tensor imaging (DTI)]], [[wikipedia:Diffusion_MRI|diffusion-weighted imaging (DWI)]], T1-weighted MRI, T2 weighted MRI are biomarkers used to measure the structure or injury, whereas Electroencephalography (EEG), [[wikipedia:Functional_magnetic_resonance_imaging|functional magnetic resonance imaging (fMRI)]], [[wikipedia:Magnetoencephalography|Magnetoencephalography (MEG)]], [[wikipedia:Positron_emission_tomography|Positron emission tomography (PET)]], [[wikipedia:Transcranial_magnetic_stimulation|Transcranial magnetic stimulation (TMS)]] etc. are biomarkers used to measure the function.

==Prognosis==

''' Table 2: Prognosis'''
{| class="wikitable"
|'''Clinical feature'''
|''' Prognosis'''
|-
|Association of [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] dosha
|Easily curable (sadhya)
|-
|Caused by [[Vata dosha|vata]] dosha only (kevalavata)
|Most difficult to cure (krichrasadhyatama)
|-
|Developed by depletion at tissue level (dhatukshaya kruta)
|Treatable but not curable (asadhya)
|-
|Vedanarahita (absence of pain)
|Pariharya (untreatable)
|-
|In bala (children), vridha (old age), garbhini (pregnant women),
[[Sutika Paricharya|sutika]](puerperal women), kshina (exhausted),

asruksrutha (developed by hemorrhage)
|Pariharya (untreatable)
|}
[Ma. Ni 22/43]<ref name=":2" />

==Management==

===Stagewise management of disease===

'''Ⅰ. Acute condition'''

Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion.

Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered. Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure.

Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

'''Ⅱ.Chronic condition'''

Multidisciplinary rehabilitation and the drugs for secondary prevention come under the management of post-stroke patients. Physiotherapy, modified constraint-induced movement therapy, and the use of various assistive devices such as brace chains. Wheelchairs and walkers are advised for the improvement of motor function, cognition, speech, and quality of life. Mental imagery and electrical stimulation for the movement of muscles are also combined with the above. Ayurvedic management can be done at this stage. A systemic approach in the management of pakshaghata is explained in classical textbooks. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/100] [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" /> [A.Hri. Chikitsa Sthana 21/44]<ref name=":0" />

===Principles of management===

The principles of management of pakshaghata consist of

*[[Vata dosha|Vata]] [[shamana]] (pacification of [[vata dosha]]) by [[Snehana (unction therapy)|snehana]] (therapeutic oleation) and [[swedana]] (therapeutic sudation)

*Vatanulomana (proper functioning of [[Vayu mahabhuta|vayu]]) by mridu [[samshodhana]] (Therapeutic purgation using drugs with mild potency) or [[avarana]] [[dosha]] [[shamana]] (pacification of [[dosha]] causing occlusion) by snigdha [[virechana]] (therapeutic purgation using unctuous drugs)

*Balya (strengthening) and regenerative therapies ([[rasayana]]) by therapeutic enemas.

===Therapies advised in pakshaghata===

'''1) [[Snehana (unction therapy)|Snehana]] (therapeutic oleation):'''

Snehana is administered externally as well as internally. Internal can be used for [[shamana]] (pacification) and [[shodhana]] (purification) purpose,whereas external application is used only for [[shamana]] (pacification) purpose. Shirobasti (keeping oil on head) and [[abhyanga]] (therapeutic massage) are the most commonly used external unctuous therapies in pakshaghata. [[Abhyanga]] with anu taila is considered best. [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''2)[[Swedana]] (therapeutic sudation):'''

[[Swedana]] can be used for pacification and purification purpose. Salvana upanaha [[sweda]] (poultice) and bashpa [[sweda]] are commonly advised in pakshaghata.

'''3)[[Virechana]] (therapeutic purgation):'''

[[Virechana]] is the principal purificatory procedure mentioned in pakshaghata management. [[Virechana]] with unctuous drug is especially mentioned in classics because [[Vata dosha|vata]] [[shamana]] (pacification of [[vata dosha]]) and [[Vata dosha|vatanulomana]] (proper functioning of vayu).

'''4)[[Anuvasana]] basti (therapeutic unctuous enema):'''

[[Anuvasana]] with bala taila is indicated in pakshaghata. [[Anuvasana]] basti can pacify [[vata dosha]] to rejuvenate the tissues may be helpful.

'''5)[[Asthapana basti]] (therapeutic decoction enema)''':

[[Asthapana basti]] can be administered when [[shodhana]] (purification) is required prior to [[Vata dosha|vata]] shamana (pacification of [[vata dosha]]).

[Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''6)[[Nasya]] (nasal medication)''': Ksheera bala taila avartita, Dhanwantara taila avartita are used for nasal administration. [[Nasya]] provides effect on the space occupying lesion. Research is required to generate evidence on the same.

===Currently used important herbal formulations===

'''[[Kashaya|Decoctions:]]'''

Dhanadanayanadi [[Kashaya]] [Sahasrayoga 1/58]<ref name=":3">Dr.K.Nishteswar,Dr.R.Vidyanath. Sahasrayogam.3rd ed. Varanasi: Chowkhamba Krishnadas academy;2011</ref>, Prasarinyadi Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Sahacharadi Kashaya [Sahasrayoga 1/59(2)]<ref name=":3" />, Rasonadi kwatha [Sahasrayoga 1/59(3)]<ref name=":3" /> Gandharvahastadi kwatha [Sahasrayoga 1/59(4)]<ref name=":3" />, Maharasnadi kwatha [Sahasrayoga 1/60]<ref name=":3" />, Balasahacharadi Kashaya. [Sahasrayoga 1/54]<ref name=":3" />

'''Churnas/Herbal powder mixtures'''

Saraswata churna[Sahasrayoga 4/72]<ref name=":3" />, Kolakulatthadi churna [(external application)[Ca.Sa. [[Sutra Sthana]] 3/18]

'''Tablets'''

Yogaraja guggulu [Sahasrayoga 8/3]<ref name=":3" />, Mahayogaraja guggulu [Sharngadhara Samhita. Madhyama khanda 7/56-59]<ref>Sarngadhara.Sarngadhara Samhita.Translated from Sanskrit by K.R Srikantha murthy.Varanasi.Chaukhambha orientalia;2009</ref>, Simhanada guggulu [Bhaishajya ratnavali ,amavata adhikara 130-135]<ref name=":4">Govindadasa.Bhaishajya ratnavali.Hindi commentary by Ambikadattasastri.Edited by Brahmashankar mishra.Varanasi:Chaukhambha prakashan;2011</ref>

'''Ghee/Oil'''

Kalyanaka ghrita [Sahasrayoga 2/81]<ref name=":3" />, Mahakalyanaka ghrita [Sahasrayoga 2/82]<ref name=":3" />, Saraswata ghrita [Sahasrayoga 2/92]<ref name=":3" />, Sarvamayantaka ghrita [Sahasrayoga 2/97]<ref name=":3" />, Dhanwantara taila [Sahasrayoga 3/109]<ref name=":3" />, Narayana taila [Bhaishajya Ratnavali Vatavyadhi 140-150]<ref name=":4" />, Mahanarayana taila [Bhaishajya Ratnavali. Vatavyadhi. 151-162], Ksheerabala taila [Sahasrayoga 3/110]<ref name=":3" />, Prabhanjana vimardana taila [Sahasrayoga 3/7]<ref name=":3" />, Bala-aswagandhadi taila [Sahasrayoga 13/117]<ref name=":3" />, Sahacharadi taila [Sahasrayoga 3/131]<ref name=":3" />, Bala taila [Sahasrayoga 3/68]<ref name=":3" />, Prasarini taila [Sahasrayoga 3/69]<ref name=":3" />, Erandataila [Ca.Sa. [[Sutra Sthana]] 13/12(1)], Gandharvahastadi erandataila [Sahasrayoga 1/59(4)]<ref name=":3" />.

'''Avaleha'''

Kalyana leha [Bhaishajya ratnavali. Swarabheda rogadhikara. 27-29]<ref name=":4" />

'''Ksheerapaka'''

Lasuna ksheerapaka [Ca.Sa. [[Chikitsa Sthana]] 5/94-95], Prasarinyadi ksheera Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Masha athmagupthadi ksheera (nasapana) [Chakradatta. Vatavyadi 27]<ref>Chakrapanidatta. Chakradatta. Edited and translated by Priya vrat sharma.Varanasi:Chaukhambha orientalia.2007</ref>, mashabaladi kwatha [Bhaishajya Ratnavali. Vatavyadhi adhikara 62-63]<ref name=":4" />

==Research on Ayurvedic formulations==

In a study involving 40 patients afflicted with post stroke aphasia, kalyana leha is found more effective than speech therapy on auditory and verbal comprehension as well as naming.<ref>Priyanka Patel (2017): A randomized controlled clinical trial on kalyana leha in the management of post stroke aphasia. Department of Kayachiktsa, Parul Institute of Ayurved, Limda.</ref>

==Research on Ayurvedic treatments==

A comparative clinical study was conducted among 31 patients of pakshaghata between [[virechana]] group and [[koshtha]] shuddhi group. Both of these groups have shown marked to moderate improvements in patients with a better percentage wise improvement in the [[virechana]] group.<ref>Pandya Asutosh (2003): A comparative study of Virechana Karma and Sramsana in the management of Pakshaghata.Department of Panchakarma, ITRA, Jamnagar.</ref>

A comparative study was done between snehayuktha [[virechana]] (therapeutic unctuous purgation) followed by [[shamana]] (pacification therapy) using ekangaveer rasa and [[shamana]] alone. Using Ekangaveer rasa among 30 patients of pakshaghata, it is evident that [[virechana]] followed by [[shamana]] is far more effective than [[shamana]] only in all aspects.<ref>Tripti Lokesh (2013): A comparative study of virechana (snehayukta virechana) & shamana chikitsa in pakshaghata. Department of panchakarma, Govt.Akhandanand Ayurveda college, Ahmedabad.</ref>

A comparative clinical trial for comparing the effect of kala [[basti]] and [[virechana]] in pakshaghata was conducted in 25 patients. Kala basti group has shown better improvement in outcomes compared to the [[virechana]] group.<ref>Vimal M Vekariya (2008): comparative study of virechana karma and kala basti in the management of pakshaghata. Department of Panchakarma, ITRA, Jamnagar.</ref>

In a clinical study involving 10 patients of pakshaghata, the treatments like [[abhyanga]], sarvanga shashtikashali pinda sweda and rajayapana basti were administered consecutively. It has shown significant improvement in vakstambha, padasankocha, hastakankocha, shula and Cheshta nivritti.<ref>Manasa T. V, Kiran M. Goud, Lolashri S. J. (2019). A clinical study to evaluate the efficacy of rajayapana basti in pakshaghata. IAMJ: Volume 7, Issue 3, March - 2019 (www.iamj.in).</ref>

In a comparative clinical study conducted among 40 patients, kalabasti with dasamoola kashaya, yavanyadi kalka, and sahacharadi taila has shown better improvement both in subjective and objective parameters as compared to the group of [[nasya]] (nasal medication) with karpasasthyadi taila and group with [[shamana]] (pacification) drugs only.<ref>Dr. Sayeda Nikhat Inamdar, Dr. Prashanth A S, Dr. Rahul kumar. Clinical evaluation of basti and nasya in pakshaghata (hemiplegia). PIJAR/July-August-17/volume 1/Issue-6, ISSN:2456:4354
</ref>

==Case reports==

'''1.''' A case study of 63 years old male patient who has weakness on his left side of body and unable to walk was published. His diagnosis was haemorrhagic stroke presenting with left sided hemiplegia with acute intraparenchymal haemorrhage in C.T. brain. The Ayurvedic diagnosis of pakshaghata was made and managed with treatment principle which is mentioned by Acharya Charak. [[Snehana (unction therapy)|Snehana]], [[swedana]] and mridu [[virechana]] along with [[panchakarma]] procedures like [[shirodhara]], shiropichu and basti for 21 days. Samshamana aushadhis (oral medicines) and physiotherapy were adopted at various stages of the diseases. Maximum improvement was noticed in upper and lower extremity functions at the end of the treatment. Patient showed remarkable recovery in speech ability and mobility.<ref>Mohan, V., B, D., & Deva, S. (2021). Ayurvedic Management of Pakshaghata (Left Hemiplegia) – A Case study. International Journal of Ayurvedic Medicine, 12(3), 733–741. <nowiki>https://doi.org/10.47552/ijam.v12i3.1954</nowiki></ref>

'''2.''' In a case report of a 77-year-old male patient with complaints of sudden weakness in right side of the body including face, inability to stand, walk, slurring of speech in the past 2 days. The main treatments given are dhanyamladhara, [[abhyanga]], shashtika shali pinda sweda, [[matra basti]], [[nasya]], tailadhara along with [[shamana]] aushadhis in the above-mentioned order. The patients’ muscle power, tone, strength improved greatly and deep tendon reflexes regained the normal status. Patient was able to walk without any support at the end of treatment.<ref>Karthikeya Prasad, Manjusri. (2022). Pakshaghata – A case study. International Journal of Pharmaceutical Research and Applications. Volume 7, Issue 6 Nov-Dec 2022, pp: 687-690 www.ijprajournal.com ISSN: 2456-4494.</ref>

'''3.''' A case on management of stroke of a male patient aged 40 years with chief complaints of loss of function of the left upper & lower limb is repored. He was a diagnosed case of stroke based on clinical presentation and brain computed tomography-scan. In the case, [[Ayurveda]] medications were found to be effective in providing relief in chief complaint with improvement of overall health of the patient. Treatment protocol was [[Snehana (unction therapy)|snehana]], [[swedana]], mridu [[virechana]], [[basti]] karma, murdhni taila ([[shirodhara]]) along with internal medication which is mentioned by Acharya Sushruta.<ref>Santhosh kumar Bhatted, Uttamram Yadav. (2020). Treatment Protocol of Stroke (Pakshaghata) Through Ayurveda Medicine -A Case Study. International Journal of Health Sciences and Research. Vol.10; Issue: 1; January 2020 Website: www.ijhsr.org Case Study ISSN: 2249-9571.</ref>

<references/>

Pakshaghata

2023-10-13T07:14:21Z

Adarshpm:

{{CiteButton}}
{{#seo:
|title=Pakshaghata
|titlemode=append
|keywords=Pakshaghata, hemiplegia, Charak samhita, carakasamhitaonline, Indian System of Medicine, Ayurveda, treatment of hemiplegia
|description=The conditon in which ama alomg with vitiated vata effects the joints
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
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{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Diseases]]/[[Pakshaghata]]

|label2 = Authors
|data2 = Adarsh P. M. 1, Deole Y.S. 2

|label3 = Reviewer & Editor
|data3 = Basisht G.3

|label4 = Affiliations
|data4 = 1 [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India

3 Rheumatologist, Orlando, Florida, U.S.A.

|label6 = Correspondence emails
|data6 =dryogeshdeole@gmail.com, carakasamhita@gmail.com

|label7 = Publisher
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = Date of publication:
|data8 =October 10, 2023

|label9 = DOI
|data9 = In process
}}Hemiplegia (paralysis or hemiparesis) is known as ‘pakshaghata’ or ‘pakshavadha’ in ([[Ayurveda]]). It is classified under 80 diseases due only to the vitiation of ([[vata dosha]]) (nanatmaja [[Vatavyadhi Chikitsa|vata vyadhi]]). There is complete or partial paralysis of the arm, leg, and trunk on one side of the body. The most typical cause of hemiplegia is cerebrovascular stroke. A stroke affecting the corticospinal tract results in hemiplegia. Other causes are trauma, diabetes, infections affecting the nervous system, neoplasms, demyelination disorders, congenital disorders, multiple sclerosis, parasomnia etc. As per [[Ayurveda]] pathophysiology, the vitiated [[vata dosha]] afflicts half of the body by causing desiccation of nerves or blood vessels (sira) and muscles or tendons (snayu). It finally results in the signs and symptoms of [[wikipedia:Hemiparesis|pakshaghata]]. [Cha.Sa. [[Chikitsa Sthana]] 53-55] [https://pubmed.ncbi.nlm.nih.gov/28157752/ Rehabilitation] is the primary treatment of hemiplegia to regain maximum function and quality of life. It includes both physical and [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476805/ occupational therapy.] Ayurvedic management is vatahara (pacification of [[vata dosha]]) in nature. It can improve motor functions by [[Vata dosha|vata]]<nowiki/>nulomana (proper elimination of flatus, faeces, urine etc., by proper functioning of [[vayu]]) and balya (which provides strength) forms of medications.

'''National Ayurveda Morbidity code:''' AAC-24

'''ICD code for:''' G81.90

==Causes ([[hetu]])==

Aggravating factors of ([[vata dosha]]) lead to [[wikipedia:Hemiparesis|hemiplegia]]. These include following:

*Excessive intake of ([[tikta]]) (bitter), ([[katu]]) (pungent) and ([[kashaya]]) (astringent) tastes.

*Consuming insufficient quantity of food

*Excess intake of food items having dry quality.

*Late-time food consumption

*Suppression and provocation of natural urges.

*Avoidance of sleep at night

*Excess talking in a loud tone

*Excessive application of purificatory therapies

*Fear, grief, excessive thinking

*Excess exercise and sexual intercourse beyond one’s capacity. [A. Hri.Nidana Sthana 1/14-15]<ref name=":0">Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy; 2000.</ref>

*Injury to vital organs ([[marma]]<nowiki/>ghata)

*Untreated chronic inflammations or infections

==Clinical features==

===General clinical features===
*Loss of motor function and pain on either side of the body (right or left)

*Slurring or loss of speech

*Contractions (spasticity) on the legs and hands on either side.

*Pricking pain or sharp pain in the body. [Cha.Sa. ([[Chikitsa Sthana]]) 28/53-55]

*Loss of activity (akarmanyata), and loss of sensation (achetana) of the affected side. [Su.Sa. Nidana Sthana 1/60-62]<ref name=":1">Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

===Dosha specific clinical features===
{| class="wikitable"
|'''Dosha associated'''
|'''Clinical features'''
|-
|([[Pitta]]) associated condition
|Burning sensation (daha)

Increase in body temperature (santapa)

Syncope (murcha)
|-
|Kapha associated condition
|Coldness (shaitya)

Swelling (([[shotha]]))

Heaviness (gurutva)
|}
[Ma.Ni.22/42]<ref name=":2">Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>

==Pathogenesis==

The vata dosha is aggravated due to two possible pathologies:

1. Depletion of body constituents ([[dhatu]] kshaya)

2. Obstruction or covering of [[Vata dosha|vata]] dosha by other [[dosha]] or body constituents ([[dhatu]], [[mala]])

These two causes provide a background for pathogenesis of [[Vata dosha|vata]] dominant diseases.

The aggravated [[Vata dosha|vata]] is lodged in vacant spaces or afflicted channels ([[Sroto Vimana|sroto]] vaigunya). Due to obstruction in its path or impaired movement, [[Vata dosha|vata]] dosha affects the [[indriya]] (sensory and motor organs) and leads to affliction of either side of the body. It also causes the desiccation of siras (nerves) and snayus (tendons), producing contractions of legs and hands on either side. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/43-45]

The different pathologies like arteriosclerosis, aneurysms, and plaque formation in cerebrovascular system need to be understood in this view. These pathologies result in cerebrovascular accident, causing hemiplegia or hemiparesis (pakshaghata). [A. Hri.Nidana Sthana 15/5-6]<ref name=":0" />

==== Predisposing and contributing factors====
*Food and regimen that aggravate [[Vata dosha|vata]] dosha.

*Excess use of [[amla]] (sour substances) and [[lavana]] (salt)

*Increased serum cholesterol levels

*Uncontrolled hypertension and diabetes mellitus

*Improper management of infections and inflammation ([[ama]] sandharana)

*Unhealthy sleeping habits

*Stress, emotional disturbances, and obstruction of natural urges.

*Consumption of cold food and beverages.

==Clinical diagnosis==
*Review of past medical history

*Neurological examination.

*Imaging technique ( computerized tomography scan & magnetic resonance imaging )

*electroencephalogram

*Blood tests (complete blood count, Erythrocyte sedimentation rate, hemoglobin level, platelet count etc.)[D1]

*Based on clinical features of disease in [[Ayurveda]] as mentioned earlier

===Biomarkers for diagnosis and assessment of efficacy===

Diffusion tensor imaging (DTI), diffusion-weighted imaging (DWI), T1-weighted MRI, T2 weighted MRI are biomarkers used to measure the structure or injury, whereas Electroencephalography (EEG), functional magnetic resonance imaging (fMRI), Magnetoencephalography (MEG), Positron emission tomography (PET), Transcranial magnetic stimulation (TMS) etc. are biomarkers used to measure the function.

==Prognosis==

''' Table 2: Prognosis'''
{| class="wikitable"
|'''Clinical feature'''
|''' Prognosis'''
|-
|Association of [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] dosha
|Easily curable (sadhya)
|-
|Caused by [[Vata dosha|vata]] dosha only (kevalavata)
|Most difficult to cure (krichrasadhyatama)
|-
|Developed by depletion at tissue level (dhatukshaya kruta)
|Treatable but not curable (asadhya)
|-
|Vedanarahita (absence of pain)
|Pariharya (untreatable)
|-
|In bala (children), vridha (old age), garbhini (pregnant women),
[[Sutika Paricharya|sutika]](puerperal women), kshina (exhausted),

asruksrutha (developed by hemorrhage)
|Pariharya (untreatable)
|}
[Ma. Ni 22/43]<ref name=":2" />

==Management==

===Stagewise management of disease===

'''Ⅰ. Acute condition'''

Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion. Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered . [D1] Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure. Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

'''Ⅱ.Chronic condition'''

Multidisciplinary rehabilitation and the drugs for secondary prevention come under the management of post-stroke patients. Physiotherapy, modified constraint-induced movement therapy, and the use of various assistive devices such as brace chains. Wheelchairs and walkers are advised for the improvement of motor function, cognition, speech, and quality of life. Mental imagery and electrical stimulation for the movement of muscles are also combined with the above. Ayurvedic management can be done at this stage. A systemic approach in the management of pakshaghata is explained in classical textbooks. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/100] [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" /> [A.Hri. Chikitsa Sthana 21/44]<ref name=":0" />

===Principles of management===

The principles of management of pakshaghata consist of

*[[Vata dosha|Vata]] [[shamana]] (pacification of [[vata dosha]]) by [[Snehana (unction therapy)|snehana]] (therapeutic oleation) and [[swedana]] (therapeutic sudation)

*Vatanulomana (proper functioning of [[Vayu mahabhuta|vayu]]) by mridu [[samshodhana]] (Therapeutic purgation using drugs with mild potency) or [[avarana]] [[dosha]] [[shamana]] (pacification of [[dosha]] causing occlusion) by snigdha [[virechana]] (therapeutic purgation using unctuous drugs)

*Balya (strengthening) and regenerative therapies ([[rasayana]]) by therapeutic enemas.

===Therapies advised in pakshaghata===

'''1) [[Snehana (unction therapy)|Snehana]] (therapeutic oleation):'''

Snehana is administered externally as well as internally. Internal can be used for [[shamana]] (pacification) and [[shodhana]] (purification) purpose,whereas external application is used only for [[shamana]] (pacification) purpose. Shirobasti (keeping oil on head) and [[abhyanga]] (therapeutic massage) are the most commonly used external unctuous therapies in pakshaghata. [[Abhyanga]] with anu taila is considered best. [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''2)[[Swedana]] (therapeutic sudation):'''

[[Swedana]] can be used for pacification and purification purpose. Salvana upanaha [[sweda]] (poultice) and bashpa [[sweda]] are commonly advised in pakshaghata.

'''3)[[Virechana]] (therapeutic purgation):'''

[[Virechana]] is the principal purificatory procedure mentioned in pakshaghata management. [[Virechana]] with unctuous drug is especially mentioned in classics because [[Vata dosha|vata]] [[shamana]] (pacification of [[vata dosha]]) and [[Vata dosha|vatanulomana]] (proper functioning of vayu).

'''4)[[Anuvasana]] basti (therapeutic unctuous enema):'''

[[Anuvasana]] with bala taila is indicated in pakshaghata. [[Anuvasana]] basti can pacify [[vata dosha]] to rejuvenate the tissues may be helpful.

'''5)[[Asthapana basti]] (therapeutic decoction enema)''':

[[Asthapana basti]] can be administered when [[shodhana]] (purification) is required prior to [[Vata dosha|vata]] shamana (pacification of [[vata dosha]]).

[Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''6)[[Nasya]] (nasal medication)''': Ksheera bala taila avartita, Dhanwantara taila avartita are used for nasal administration. [[Nasya]] provides effect on the space occupying lesion. Research is required to generate evidence on the same.

===Currently used important herbal formulations===

'''[[Kashaya|Decoctions:]]'''

Dhanadanayanadi [[Kashaya]] [Sahasrayoga 1/58]<ref name=":3">Dr.K.Nishteswar,Dr.R.Vidyanath. Sahasrayogam.3rd ed. Varanasi: Chowkhamba Krishnadas academy;2011</ref>, Prasarinyadi Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Sahacharadi Kashaya [Sahasrayoga 1/59(2)]<ref name=":3" />, Rasonadi kwatha [Sahasrayoga 1/59(3)]<ref name=":3" /> Gandharvahastadi kwatha [Sahasrayoga 1/59(4)]<ref name=":3" />, Maharasnadi kwatha [Sahasrayoga 1/60]<ref name=":3" />, Balasahacharadi Kashaya. [Sahasrayoga 1/54]<ref name=":3" />

'''Churnas/Herbal powder mixtures'''

Saraswata churna[Sahasrayoga 4/72]<ref name=":3" />, Kolakulatthadi churna [(external application)[Ca.Sa. [[Sutra Sthana]] 3/18]

'''Tablets'''

Yogaraja guggulu [Sahasrayoga 8/3]<ref name=":3" />, Mahayogaraja guggulu [Sharngadhara Samhita. Madhyama khanda 7/56-59]<ref>Sarngadhara.Sarngadhara Samhita.Translated from Sanskrit by K.R Srikantha murthy.Varanasi.Chaukhambha orientalia;2009</ref>, Simhanada guggulu [Bhaishajya ratnavali ,amavata adhikara 130-135]<ref name=":4">Govindadasa.Bhaishajya ratnavali.Hindi commentary by Ambikadattasastri.Edited by Brahmashankar mishra.Varanasi:Chaukhambha prakashan;2011</ref>

'''Ghee/Oil'''

Kalyanaka ghrita [Sahasrayoga 2/81]<ref name=":3" />, Mahakalyanaka ghrita [Sahasrayoga 2/82]<ref name=":3" />, Saraswata ghrita [Sahasrayoga 2/92]<ref name=":3" />, Sarvamayantaka ghrita [Sahasrayoga 2/97]<ref name=":3" />, Dhanwantara taila [Sahasrayoga 3/109]<ref name=":3" />, Narayana taila [Bhaishajya Ratnavali Vatavyadhi 140-150]<ref name=":4" />, Mahanarayana taila [Bhaishajya Ratnavali. Vatavyadhi. 151-162], Ksheerabala taila [Sahasrayoga 3/110]<ref name=":3" />, Prabhanjana vimardana taila [Sahasrayoga 3/7]<ref name=":3" />, Bala-aswagandhadi taila [Sahasrayoga 13/117]<ref name=":3" />, Sahacharadi taila [Sahasrayoga 3/131]<ref name=":3" />, Bala taila [Sahasrayoga 3/68]<ref name=":3" />, Prasarini taila [Sahasrayoga 3/69]<ref name=":3" />, Erandataila [Ca.Sa. [[Sutra Sthana]] 13/12(1)], Gandharvahastadi erandataila [Sahasrayoga 1/59(4)]<ref name=":3" />.

'''Avaleha'''

Kalyana leha [Bhaishajya ratnavali. Swarabheda rogadhikara. 27-29]<ref name=":4" />

'''Ksheerapaka'''

Lasuna ksheerapaka [Ca.Sa. [[Chikitsa Sthana]] 5/94-95], Prasarinyadi ksheera Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Masha athmagupthadi ksheera (nasapana) [Chakradatta. Vatavyadi 27]<ref>Chakrapanidatta. Chakradatta. Edited and translated by Priya vrat sharma.Varanasi:Chaukhambha orientalia.2007</ref>, mashabaladi kwatha [Bhaishajya Ratnavali. Vatavyadhi adhikara 62-63]<ref name=":4" />

==Research on Ayurvedic formulations==

In a study involving 40 patients afflicted with post stroke aphasia, kalyana leha is found more effective than speech therapy on auditory and verbal comprehension as well as naming.<ref>Priyanka Patel (2017): A randomized controlled clinical trial on kalyana leha in the management of post stroke aphasia. Department of Kayachiktsa, Parul Institute of Ayurved, Limda.</ref>

==Research on Ayurvedic treatments==

A comparative clinical study was conducted among 31 patients of pakshaghata between [[virechana]] group and [[koshtha]] shuddhi group. Both of these groups have shown marked to moderate improvements in patients with a better percentage wise improvement in the [[virechana]] group.<ref>Pandya Asutosh (2003): A comparative study of Virechana Karma and Sramsana in the management of Pakshaghata.Department of Panchakarma, ITRA, Jamnagar.</ref>

A comparative study was done between snehayuktha [[virechana]] (therapeutic unctuous purgation) followed by [[shamana]] (pacification therapy) using ekangaveer rasa and [[shamana]] alone. Using Ekangaveer rasa among 30 patients of pakshaghata, it is evident that [[virechana]] followed by [[shamana]] is far more effective than [[shamana]] only in all aspects.<ref>Tripti Lokesh (2013): A comparative study of virechana (snehayukta virechana) & shamana chikitsa in pakshaghata. Department of panchakarma, Govt.Akhandanand Ayurveda college, Ahmedabad.</ref>

A comparative clinical trial for comparing the effect of kala [[basti]] and [[virechana]] in pakshaghata was conducted in 25 patients. Kala basti group has shown better improvement in outcomes compared to the [[virechana]] group.<ref>Vimal M Vekariya (2008): comparative study of virechana karma and kala basti in the management of pakshaghata. Department of Panchakarma, ITRA, Jamnagar.</ref>

In a clinical study involving 10 patients of pakshaghata, the treatments like [[abhyanga]], sarvanga shashtikashali pinda sweda and rajayapana basti were administered consecutively. It has shown significant improvement in vakstambha, padasankocha, hastakankocha, shula and Cheshta nivritti.<ref>Manasa T. V, Kiran M. Goud, Lolashri S. J. (2019). A clinical study to evaluate the efficacy of rajayapana basti in pakshaghata. IAMJ: Volume 7, Issue 3, March - 2019 (www.iamj.in).</ref>

In a comparative clinical study conducted among 40 patients, kalabasti with dasamoola kashaya, yavanyadi kalka, and sahacharadi taila has shown better improvement both in subjective and objective parameters as compared to the group of [[nasya]] (nasal medication) with karpasasthyadi taila and group with [[shamana]] (pacification) drugs only.<ref>Dr. Sayeda Nikhat Inamdar, Dr. Prashanth A S, Dr. Rahul kumar. Clinical evaluation of basti and nasya in pakshaghata (hemiplegia). PIJAR/July-August-17/volume 1/Issue-6, ISSN:2456:4354
</ref>

==Case reports==

'''1.''' A case study of 63 years old male patient who has weakness on his left side of body and unable to walk was published. His diagnosis was haemorrhagic stroke presenting with left sided hemiplegia with acute intraparenchymal haemorrhage in C.T. brain. The Ayurvedic diagnosis of pakshaghata was made and managed with treatment principle which is mentioned by Acharya Charak. [[Snehana (unction therapy)|Snehana]], [[swedana]] and mridu [[virechana]] along with [[panchakarma]] procedures like [[shirodhara]], shiropichu and basti for 21 days. Samshamana aushadhis (oral medicines) and physiotherapy were adopted at various stages of the diseases. Maximum improvement was noticed in upper and lower extremity functions at the end of the treatment. Patient showed remarkable recovery in speech ability and mobility.<ref>Mohan, V., B, D., & Deva, S. (2021). Ayurvedic Management of Pakshaghata (Left Hemiplegia) – A Case study. International Journal of Ayurvedic Medicine, 12(3), 733–741. <nowiki>https://doi.org/10.47552/ijam.v12i3.1954</nowiki></ref>

'''2.''' In a case report of a 77-year-old male patient with complaints of sudden weakness in right side of the body including face, inability to stand, walk, slurring of speech in the past 2 days. The main treatments given are dhanyamladhara, [[abhyanga]], shashtika shali pinda sweda, [[matra basti]], [[nasya]], tailadhara along with [[shamana]] aushadhis in the above-mentioned order. The patients’ muscle power, tone, strength improved greatly and deep tendon reflexes regained the normal status. Patient was able to walk without any support at the end of treatment.<ref>Karthikeya Prasad, Manjusri. (2022). Pakshaghata – A case study. International Journal of Pharmaceutical Research and Applications. Volume 7, Issue 6 Nov-Dec 2022, pp: 687-690 www.ijprajournal.com ISSN: 2456-4494.</ref>

'''3.''' A case on management of stroke of a male patient aged 40 years with chief complaints of loss of function of the left upper & lower limb is repored. He was a diagnosed case of stroke based on clinical presentation and brain computed tomography-scan. In the case, [[Ayurveda]] medications were found to be effective in providing relief in chief complaint with improvement of overall health of the patient. Treatment protocol was [[Snehana (unction therapy)|snehana]], [[swedana]], mridu [[virechana]], [[basti]] karma, murdhni taila ([[shirodhara]]) along with internal medication which is mentioned by Acharya Sushruta.<ref>Santhosh kumar Bhatted, Uttamram Yadav. (2020). Treatment Protocol of Stroke (Pakshaghata) Through Ayurveda Medicine -A Case Study. International Journal of Health Sciences and Research. Vol.10; Issue: 1; January 2020 Website: www.ijhsr.org Case Study ISSN: 2249-9571.</ref>

<references/>

Pakshaghata

2023-10-13T05:49:58Z

Adarshpm:

{{CiteButton}}
{{#seo:
|title=Pakshaghata
|titlemode=append
|keywords=Pakshaghata, hemiplegia, Charak samhita, carakasamhitaonline, Indian System of Medicine, Ayurveda, treatment of hemiplegia
|description=The conditon in which ama alomg with vitiated vata effects the joints
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
}}
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Diseases]]/[[Pakshaghata]]

|label2 = Authors
|data2 = Adarsh P. M. 1, Deole Y.S. 2

|label3 = Reviewer & Editor
|data3 = Basisht G.3

|label4 = Affiliations
|data4 = 1 [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India

3 Rheumatologist, Orlando, Florida, U.S.A.

|label6 = Correspondence emails
|data6 =dryogeshdeole@gmail.com, carakasamhita@gmail.com

|label7 = Publisher
|data7 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India

|label8 = Date of publication:
|data8 =October 10, 2023

|label9 = DOI
|data9 = In process
}}Hemiplegia (paralysis or hemiparesis) is known as ‘pakshaghata’ or ‘pakshavadha’ in ([[Ayurveda]]). It is classified under 80 diseases due only to the vitiation of ([[vata dosha]]) (nanatmaja [[Vatavyadhi Chikitsa|vata vyadhi]]). There is complete or partial paralysis of the arm, leg, and trunk on one side of the body. The most typical cause of hemiplegia is cerebrovascular stroke. A stroke affecting the corticospinal tract results in hemiplegia. Other causes are trauma, diabetes, infections affecting the nervous system, neoplasms, demyelination disorders, congenital disorders, multiple sclerosis, parasomnia etc. As per [[Ayurveda]] pathophysiology, the vitiated [[vata dosha]] afflicts half of the body by causing desiccation of nerves or blood vessels (sira) and muscles or tendons (snayu). It finally results in the signs and symptoms of pakshaghata. [Cha.Sa. [[Chikitsa Sthana]] 53-55] Rehabilitation is the primary treatment of hemiplegia to regain maximum function and quality of life. It includes both physical and occupational therapy. Ayurvedic management is vatahara (pacification of [[vata dosha]]) in nature. It can improve motor functions by [[Vata dosha|vata]]<nowiki/>nulomana (proper elimination of flatus, faeces, urine etc., by proper functioning of [[vayu]]) and balya (which provides strength) forms of medications.

'''National Ayurveda Morbidity code:''' AAC-24

'''ICD code for:''' G81.90

==Causes ([[hetu]])==

Aggravating factors of ([[vata dosha]]) lead to hemiplegia. These include following:

*Excessive intake of ([[tikta]]) (bitter), ([[katu]]) (pungent) and ([[kashaya]]) (astringent) tastes.

*Consuming insufficient quantity of food

*Excess intake of food items having dry quality.

*Late-time food consumption

*Suppression and provocation of natural urges.

*Avoidance of sleep at night

*Excess talking in a loud tone

*Excessive application of purificatory therapies

*Fear, grief, excessive thinking

*Excess exercise and sexual intercourse beyond one’s capacity. [A. Hri.Nidana Sthana 1/14-15]<ref name=":0">Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy; 2000.</ref>

*Injury to vital organs ([[marma]]<nowiki/>ghata)

*Untreated chronic inflammations or infections

==Clinical features==

===General clinical features===
*Loss of motor function and pain on either side of the body (right or left)

*Slurring or loss of speech

*Contractions (spasticity) on the legs and hands on either side.

*Pricking pain or sharp pain in the body. [Cha.Sa. ([[Chikitsa Sthana]]) 28/53-55]

*Loss of activity (akarmanyata), and loss of sensation (achetana) of the affected side. [Su.Sa. Nidana Sthana 1/60-62]<ref name=":1">Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

===Dosha specific clinical features===
{| class="wikitable"
|'''Dosha associated'''
|'''Clinical features'''
|-
|([[Pitta]]) associated condition
|Burning sensation (daha)

Increase in body temperature (santapa)

Syncope (murcha)
|-
|Kapha associated condition
|Coldness (shaitya)

Swelling (([[shotha]]))

Heaviness (gurutva)
|}
[Ma.Ni.22/42]<ref name=":2">Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>

==Pathogenesis==

The vata dosha is aggravated due to two possible pathologies:

1. Depletion of body constituents ([[dhatu]] kshaya)

2. Obstruction or covering of [[Vata dosha|vata]] dosha by other [[dosha]] or body constituents ([[dhatu]], [[mala]])

These two causes provide a background for pathogenesis of [[Vata dosha|vata]] dominant diseases.

The aggravated [[Vata dosha|vata]] is lodged in vacant spaces or afflicted channels ([[Sroto Vimana|sroto]] vaigunya). Due to obstruction in its path or impaired movement, [[Vata dosha|vata]] dosha affects the [[indriya]] (sensory and motor organs) and leads to affliction of either side of the body. It also causes the desiccation of siras (nerves) and snayus (tendons), producing contractions of legs and hands on either side. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/43-45]

The different pathologies like arteriosclerosis, aneurysms, and plaque formation in cerebrovascular system need to be understood in this view. These pathologies result in cerebrovascular accident, causing hemiplegia or hemiparesis (pakshaghata). [A. Hri.Nidana Sthana 15/5-6]<ref name=":0" />

==== Predisposing and contributing factors====
*Food and regimen that aggravate [[Vata dosha|vata]] dosha.

*Excess use of [[amla]] (sour substances) and [[lavana]] (salt)

*Increased serum cholesterol levels

*Uncontrolled hypertension and diabetes mellitus

*Improper management of infections and inflammation ([[ama]] sandharana)

*Unhealthy sleeping habits

*Stress, emotional disturbances, and obstruction of natural urges.

*Consumption of cold food and beverages.

==Clinical diagnosis==
*Review of past medical history

*Neurological examination.

*Imaging technique ( computerized tomography scan & magnetic resonance imaging )

*electroencephalogram

*Blood tests (complete blood count, Erythrocyte sedimentation rate, hemoglobin level, platelet count etc.)[D1]

*Based on clinical features of disease in [[Ayurveda]] as mentioned earlier

===Biomarkers for diagnosis and assessment of efficacy===

Diffusion tensor imaging (DTI), diffusion-weighted imaging (DWI), T1-weighted MRI, T2 weighted MRI are biomarkers used to measure the structure or injury, whereas Electroencephalography (EEG), functional magnetic resonance imaging (fMRI), Magnetoencephalography (MEG), Positron emission tomography (PET), Transcranial magnetic stimulation (TMS) etc. are biomarkers used to measure the function.

==Prognosis==

''' Table 2: Prognosis'''
{| class="wikitable"
|'''Clinical feature'''
|''' Prognosis'''
|-
|Association of [[Kapha dosha|kapha]] and [[Pitta dosha|pitta]] dosha
|Easily curable (sadhya)
|-
|Caused by [[Vata dosha|vata]] dosha only (kevalavata)
|Most difficult to cure (krichrasadhyatama)
|-
|Developed by depletion at tissue level (dhatukshaya kruta)
|Treatable but not curable (asadhya)
|-
|Vedanarahita (absence of pain)
|Pariharya (untreatable)
|-
|In bala (children), vridha (old age), garbhini (pregnant women),
[[Sutika Paricharya|sutika]](puerperal women), kshina (exhausted),

asruksrutha (developed by hemorrhage)
|Pariharya (untreatable)
|}
[Ma. Ni 22/43]<ref name=":2" />

==Management==

===Stagewise management of disease===

'''Ⅰ. Acute condition'''

Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion. Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered . [D1] Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure. Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

'''Ⅱ.Chronic condition'''

Multidisciplinary rehabilitation and the drugs for secondary prevention come under the management of post-stroke patients. Physiotherapy, modified constraint-induced movement therapy, and the use of various assistive devices such as brace chains. Wheelchairs and walkers are advised for the improvement of motor function, cognition, speech, and quality of life. Mental imagery and electrical stimulation for the movement of muscles are also combined with the above. Ayurvedic management can be done at this stage. A systemic approach in the management of pakshaghata is explained in classical textbooks. [Cha.Sa. [[Chikitsa Sthana|Chikitsa]] Sthana 28/100] [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" /> [A.Hri. Chikitsa Sthana 21/44]<ref name=":0" />

===Principles of management===

The principles of management of pakshaghata consist of

*[[Vata dosha|Vata]] [[shamana]] (pacification of [[vata dosha]]) by [[Snehana (unction therapy)|snehana]] (therapeutic oleation) and [[swedana]] (therapeutic sudation)

*Vatanulomana (proper functioning of [[Vayu mahabhuta|vayu]]) by mridu [[samshodhana]] (Therapeutic purgation using drugs with mild potency) or [[avarana]] [[dosha]] [[shamana]] (pacification of [[dosha]] causing occlusion) by snigdha [[virechana]] (therapeutic purgation using unctuous drugs)

*Balya (strengthening) and regenerative therapies ([[rasayana]]) by therapeutic enemas.

===Therapies advised in pakshaghata===

'''1) [[Snehana (unction therapy)|Snehana]] (therapeutic oleation):'''

Snehana is administered externally as well as internally. Internal can be used for [[shamana]] (pacification) and [[shodhana]] (purification) purpose,whereas external application is used only for [[shamana]] (pacification) purpose. Shirobasti (keeping oil on head) and [[abhyanga]] (therapeutic massage) are the most commonly used external unctuous therapies in pakshaghata. [[Abhyanga]] with anu taila is considered best. [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''2)[[Swedana]] (therapeutic sudation):'''

[[Swedana]] can be used for pacification and purification purpose. Salvana upanaha [[sweda]] (poultice) and bashpa [[sweda]] are commonly advised in pakshaghata.

'''3)[[Virechana]] (therapeutic purgation):'''

[[Virechana]] is the principal purificatory procedure mentioned in pakshaghata management. [[Virechana]] with unctuous drug is especially mentioned in classics because [[Vata dosha|vata]] [[shamana]] (pacification of [[vata dosha]]) and [[Vata dosha|vatanulomana]] (proper functioning of vayu).

'''4)[[Anuvasana]] basti (therapeutic unctuous enema):'''

[[Anuvasana]] with bala taila is indicated in pakshaghata. [[Anuvasana]] basti can pacify [[vata dosha]] to rejuvenate the tissues may be helpful.

'''5)[[Asthapana basti]] (therapeutic decoction enema)''':

[[Asthapana basti]] can be administered when [[shodhana]] (purification) is required prior to [[Vata dosha|vata]] shamana (pacification of [[vata dosha]]).

[Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" />

'''6)[[Nasya]] (nasal medication)''': Ksheera bala taila avartita, Dhanwantara taila avartita are used for nasal administration. [[Nasya]] provides effect on the space occupying lesion. Research is required to generate evidence on the same.

===Currently used important herbal formulations===

'''[[Kashaya|Decoctions:]]'''

Dhanadanayanadi [[Kashaya]] [Sahasrayoga 1/58]<ref name=":3">Dr.K.Nishteswar,Dr.R.Vidyanath. Sahasrayogam.3rd ed. Varanasi: Chowkhamba Krishnadas academy;2011</ref>, Prasarinyadi Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Sahacharadi Kashaya [Sahasrayoga 1/59(2)]<ref name=":3" />, Rasonadi kwatha [Sahasrayoga 1/59(3)]<ref name=":3" /> Gandharvahastadi kwatha [Sahasrayoga 1/59(4)]<ref name=":3" />, Maharasnadi kwatha [Sahasrayoga 1/60]<ref name=":3" />, Balasahacharadi Kashaya. [Sahasrayoga 1/54]<ref name=":3" />

'''Churnas/Herbal powder mixtures'''

Saraswata churna[Sahasrayoga 4/72]<ref name=":3" />, Kolakulatthadi churna [(external application)[Ca.Sa. [[Sutra Sthana]] 3/18]

'''Tablets'''

Yogaraja guggulu [Sahasrayoga 8/3]<ref name=":3" />, Mahayogaraja guggulu [Sharngadhara Samhita. Madhyama khanda 7/56-59]<ref>Sarngadhara.Sarngadhara Samhita.Translated from Sanskrit by K.R Srikantha murthy.Varanasi.Chaukhambha orientalia;2009</ref>, Simhanada guggulu [Bhaishajya ratnavali ,amavata adhikara 130-135]<ref name=":4">Govindadasa.Bhaishajya ratnavali.Hindi commentary by Ambikadattasastri.Edited by Brahmashankar mishra.Varanasi:Chaukhambha prakashan;2011</ref>

'''Ghee/Oil'''

Kalyanaka ghrita [Sahasrayoga 2/81]<ref name=":3" />, Mahakalyanaka ghrita [Sahasrayoga 2/82]<ref name=":3" />, Saraswata ghrita [Sahasrayoga 2/92]<ref name=":3" />, Sarvamayantaka ghrita [Sahasrayoga 2/97]<ref name=":3" />, Dhanwantara taila [Sahasrayoga 3/109]<ref name=":3" />, Narayana taila [Bhaishajya Ratnavali Vatavyadhi 140-150]<ref name=":4" />, Mahanarayana taila [Bhaishajya Ratnavali. Vatavyadhi. 151-162], Ksheerabala taila [Sahasrayoga 3/110]<ref name=":3" />, Prabhanjana vimardana taila [Sahasrayoga 3/7]<ref name=":3" />, Bala-aswagandhadi taila [Sahasrayoga 13/117]<ref name=":3" />, Sahacharadi taila [Sahasrayoga 3/131]<ref name=":3" />, Bala taila [Sahasrayoga 3/68]<ref name=":3" />, Prasarini taila [Sahasrayoga 3/69]<ref name=":3" />, Erandataila [Ca.Sa. [[Sutra Sthana]] 13/12(1)], Gandharvahastadi erandataila [Sahasrayoga 1/59(4)]<ref name=":3" />.

'''Avaleha'''

Kalyana leha [Bhaishajya ratnavali. Swarabheda rogadhikara. 27-29]<ref name=":4" />

'''Ksheerapaka'''

Lasuna ksheerapaka [Ca.Sa. [[Chikitsa Sthana]] 5/94-95], Prasarinyadi ksheera Kashaya [Sahasrayoga 1/59(1)]<ref name=":3" />, Masha athmagupthadi ksheera (nasapana) [Chakradatta. Vatavyadi 27]<ref>Chakrapanidatta. Chakradatta. Edited and translated by Priya vrat sharma.Varanasi:Chaukhambha orientalia.2007</ref>, mashabaladi kwatha [Bhaishajya Ratnavali. Vatavyadhi adhikara 62-63]<ref name=":4" />

==Research on Ayurvedic formulations==

In a study involving 40 patients afflicted with post stroke aphasia, kalyana leha is found more effective than speech therapy on auditory and verbal comprehension as well as naming.<ref>Priyanka Patel (2017): A randomized controlled clinical trial on kalyana leha in the management of post stroke aphasia. Department of Kayachiktsa, Parul Institute of Ayurved, Limda.</ref>

==Research on Ayurvedic treatments==

A comparative clinical study was conducted among 31 patients of pakshaghata between [[virechana]] group and [[koshtha]] shuddhi group. Both of these groups have shown marked to moderate improvements in patients with a better percentage wise improvement in the [[virechana]] group.<ref>Pandya Asutosh (2003): A comparative study of Virechana Karma and Sramsana in the management of Pakshaghata.Department of Panchakarma, ITRA, Jamnagar.</ref>

A comparative study was done between snehayuktha [[virechana]] (therapeutic unctuous purgation) followed by [[shamana]] (pacification therapy) using ekangaveer rasa and [[shamana]] alone. Using Ekangaveer rasa among 30 patients of pakshaghata, it is evident that [[virechana]] followed by [[shamana]] is far more effective than [[shamana]] only in all aspects.<ref>Tripti Lokesh (2013): A comparative study of virechana (snehayukta virechana) & shamana chikitsa in pakshaghata. Department of panchakarma, Govt.Akhandanand Ayurveda college, Ahmedabad.</ref>

A comparative clinical trial for comparing the effect of kala [[basti]] and [[virechana]] in pakshaghata was conducted in 25 patients. Kala basti group has shown better improvement in outcomes compared to the [[virechana]] group.<ref>Vimal M Vekariya (2008): comparative study of virechana karma and kala basti in the management of pakshaghata. Department of Panchakarma, ITRA, Jamnagar.</ref>

In a clinical study involving 10 patients of pakshaghata, the treatments like [[abhyanga]], sarvanga shashtikashali pinda sweda and rajayapana basti were administered consecutively. It has shown significant improvement in vakstambha, padasankocha, hastakankocha, shula and Cheshta nivritti.<ref>Manasa T. V, Kiran M. Goud, Lolashri S. J. (2019). A clinical study to evaluate the efficacy of rajayapana basti in pakshaghata. IAMJ: Volume 7, Issue 3, March - 2019 (www.iamj.in).</ref>

In a comparative clinical study conducted among 40 patients, kalabasti with dasamoola kashaya, yavanyadi kalka, and sahacharadi taila has shown better improvement both in subjective and objective parameters as compared to the group of [[nasya]] (nasal medication) with karpasasthyadi taila and group with [[shamana]] (pacification) drugs only.<ref>Dr. Sayeda Nikhat Inamdar, Dr. Prashanth A S, Dr. Rahul kumar. Clinical evaluation of basti and nasya in pakshaghata (hemiplegia). PIJAR/July-August-17/volume 1/Issue-6, ISSN:2456:4354
</ref>

==Case reports==

'''1.''' A case study of 63 years old male patient who has weakness on his left side of body and unable to walk was published. His diagnosis was haemorrhagic stroke presenting with left sided hemiplegia with acute intraparenchymal haemorrhage in C.T. brain. The Ayurvedic diagnosis of pakshaghata was made and managed with treatment principle which is mentioned by Acharya Charak. [[Snehana (unction therapy)|Snehana]], [[swedana]] and mridu [[virechana]] along with [[panchakarma]] procedures like [[shirodhara]], shiropichu and basti for 21 days. Samshamana aushadhis (oral medicines) and physiotherapy were adopted at various stages of the diseases. Maximum improvement was noticed in upper and lower extremity functions at the end of the treatment. Patient showed remarkable recovery in speech ability and mobility.<ref>Mohan, V., B, D., & Deva, S. (2021). Ayurvedic Management of Pakshaghata (Left Hemiplegia) – A Case study. International Journal of Ayurvedic Medicine, 12(3), 733–741. <nowiki>https://doi.org/10.47552/ijam.v12i3.1954</nowiki></ref>

'''2.''' In a case report of a 77-year-old male patient with complaints of sudden weakness in right side of the body including face, inability to stand, walk, slurring of speech in the past 2 days. The main treatments given are dhanyamladhara, [[abhyanga]], shashtika shali pinda sweda, [[matra basti]], [[nasya]], tailadhara along with [[shamana]] aushadhis in the above-mentioned order. The patients’ muscle power, tone, strength improved greatly and deep tendon reflexes regained the normal status. Patient was able to walk without any support at the end of treatment.<ref>Karthikeya Prasad, Manjusri. (2022). Pakshaghata – A case study. International Journal of Pharmaceutical Research and Applications. Volume 7, Issue 6 Nov-Dec 2022, pp: 687-690 www.ijprajournal.com ISSN: 2456-4494.</ref>

'''3.''' A case on management of stroke of a male patient aged 40 years with chief complaints of loss of function of the left upper & lower limb is repored. He was a diagnosed case of stroke based on clinical presentation and brain computed tomography-scan. In the case, [[Ayurveda]] medications were found to be effective in providing relief in chief complaint with improvement of overall health of the patient. Treatment protocol was [[Snehana (unction therapy)|snehana]], [[swedana]], mridu [[virechana]], [[basti]] karma, murdhni taila ([[shirodhara]]) along with internal medication which is mentioned by Acharya Sushruta.<ref>Santhosh kumar Bhatted, Uttamram Yadav. (2020). Treatment Protocol of Stroke (Pakshaghata) Through Ayurveda Medicine -A Case Study. International Journal of Health Sciences and Research. Vol.10; Issue: 1; January 2020 Website: www.ijhsr.org Case Study ISSN: 2249-9571.</ref>

<references/>

Pramanatah Pariksha

2023-10-13T05:41:12Z

Adarshpm: Blanked the page

Talk:Pramanatah Pariksha

2023-10-13T05:40:32Z

Adarshpm:

{{CiteButton}}
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.[[Vimana Sthana]] 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
==Derivation of pramana==
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

==Derivation of pariksha==

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

==Synonyms==

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

==Pramana in the context of ten fold assessment of patient (dashavidha pariksha):==
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

==Types==

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

==Assessment criteria==

===1. Anguli pramana===

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of
middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb
and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer
corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
(above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears
through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle
finger when a person stands straight

with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two [[Ayurveda]] scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''[[Udakavaha Srotas|Udaka]]''' (aqueous element) a substance which is found
in association with various body parts/components of body.

Example, it is seen mixed with faeces during the occurrence of diarrhoea.

It is also found in association with urine, blood and other tissue elements

of the body. It is spread all over the body with its site in the external skin.

Inside the skin, it is known as lasika (lymph) which exudes through

ulcers; when the body becomes hot, it comes out from hair follicles

in the form of sweat.
|10
|-
|'''[[Rasa dhatu|Rasa]]''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''[[Rakta dhatu|Rakta]] (blood)'''
|8
|-
|'''[[Purisha]] (faeces)'''
|7
|-
|'''[[Kapha dosha|Kapha]]'''
|6
|-
|'''[[Pitta]]'''
|5
|-
|'''[[Mutra]] (urine) '''
|4
|-
|'''[[Vasa]]''' (muscle fat)
|3
|-
|'''[[Meda dhatu|Medas]]''' (fat)
|2
|-
|'''[[Majja]]''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|1/2
|-
|'''[[Shukra dhatu|Shukra]]''' (semen)
|1/2
|-
|'''Shleshmika [[Ojas|oja]]''' (a type of [[Ojas|oja]])
|1/2
|}

==Application of pramana in diagnosis of various diseases:==

The equilibrium of [[dosha]], [[dhatu]] (body tissues) and [[mala]] (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of [[rasa dhatu]] (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of [[rasa dhatu]] may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their [[Pancha mahabhuta|panchabhautika]] composition (the five universal elements or [[Pancha mahabhuta|panchamahabhuta]]). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

==Contemporary views:==

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the '''figure 1'''

The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.[[File:Image.png|thumb|646x646px|'''Figure 1: Anthropometric Landmarks''']]'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

'''4. Modified Thoracometer:'''The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

'''5. Small height rod:'''This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

'''6. Sliding Caliper:'''This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.

'''7. Caliper:'''This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

'''8. Soft metric tape:'''This tool is used for measuring girth dimensions.

==Importance of concept==
===In determining life span===

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. Sutra Sthana 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. Sthana 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. Sutra Sthana 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

===In preservation and promotion of health===

*Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

*Pramanatah pariksha is helpful in determining [https://pubmed.ncbi.nlm.nih.gov/15674762/ Basal Metabolic Index (BMI)]. The normal range for BMI is 19–24·9 kg/, overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ <ref>Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732</ref>

===In relation to [https://pubmed.ncbi.nlm.nih.gov/10865763/#:~:text=Anthropometry%20is%20a%20simple%20reliable,and%20skinfold%20thickness%20(SF). anthropometry]===

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

===Individualistic approach===

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

==Application of knowledge of pramanatah pariksha in contemporary practices==

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.<ref>Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.</ref>

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.<ref>Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki></ref>

===In diagnosis and prognosis===

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

===In management of diseases===

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

==Current researches==

'''1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):'''

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana.<ref>Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.</ref>

'''2. Scientific study of Charakokta anguli pramana in reference to human height:'''

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana.<ref>Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.</ref>

'''3. Anguli pramana in ayurveda - a method of measurement in ancient times:'''

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand.<ref>Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki></ref>

'''4. Concept of anguli pramana sharira and importance in Ayurveda:'''

The author translates the [[ayurveda]] terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies.<ref>Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620</ref> Some of these are:

* Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

* Skandha (shoulder joint)

* Aaratni (from elbow joint to little finger)

* Prabahu (from shoulder joint to elbow joint)

* Prapani (from elbow joint to wrist joint)

* Jangha (from knee joint to ankle joint)[length] [circumference]

* Uru (from hip joint to knee joint) [length] [circumference]

* Janu (knee joint) [circumference]

* Gulpha (ankle joint) [circumference]

* Parshni (Heels) [length] [breadth]

==Future scope of research:==

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

* To know the landmarks of finger, the distance of breadth of finger

* Angula and anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

* To find the appropriate anthropometric measurements based on geographic variations.

* To find average anthropometric measurements based on constitution (prakriti) of individuals.

* To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.

Pramanatah Pariksha

2023-10-13T05:39:05Z

Adarshpm:

{{CiteButton}}
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.[[Vimana Sthana]] 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
==Derivation of pramana==
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

==Derivation of pariksha==

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

==Synonyms==

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

==Pramana in the context of ten fold assessment of patient (dashavidha pariksha):==
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

==Types==

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

==Assessment criteria==

===1. Anguli pramana===

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of
middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb
and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer
corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
(above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears
through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle
finger when a person stands straight

with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two [[Ayurveda]] scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''[[Udakavaha Srotas|Udaka]]''' (aqueous element) a substance which is found
in association with various body parts/components of body.

Example, it is seen mixed with faeces during the occurrence of diarrhoea.

It is also found in association with urine, blood and other tissue elements

of the body. It is spread all over the body with its site in the external skin.

Inside the skin, it is known as lasika (lymph) which exudes through

ulcers; when the body becomes hot, it comes out from hair follicles

in the form of sweat.
|10
|-
|'''[[Rasa dhatu|Rasa]]''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''[[Rakta dhatu|Rakta]] (blood)'''
|8
|-
|'''[[Purisha]] (faeces)'''
|7
|-
|'''[[Kapha dosha|Kapha]]'''
|6
|-
|'''[[Pitta]]'''
|5
|-
|'''[[Mutra]] (urine) '''
|4
|-
|'''[[Vasa]]''' (muscle fat)
|3
|-
|'''[[Meda dhatu|Medas]]''' (fat)
|2
|-
|'''[[Majja]]''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|1/2
|-
|'''[[Shukra dhatu|Shukra]]''' (semen)
|1/2
|-
|'''Shleshmika [[Ojas|oja]]''' (a type of [[Ojas|oja]])
|1/2
|}

==Application of pramana in diagnosis of various diseases:==

The equilibrium of [[dosha]], [[dhatu]] (body tissues) and [[mala]] (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of [[rasa dhatu]] (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of [[rasa dhatu]] may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their [[Pancha mahabhuta|panchabhautika]] composition (the five universal elements or [[Pancha mahabhuta|panchamahabhuta]]). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

==Contemporary views:==

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the '''figure 1'''

The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.[[File:Image.png|thumb|646x646px|'''Figure 1: Anthropometric Landmarks''']]'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

'''4. Modified Thoracometer:'''The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

'''5. Small height rod:'''This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

'''6. Sliding Caliper:'''This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.

'''7. Caliper:'''This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

'''8. Soft metric tape:'''This tool is used for measuring girth dimensions.

==Importance of concept==
===In determining life span===

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. Sutra Sthana 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. Sthana 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. Sutra Sthana 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

===In preservation and promotion of health===

*Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

*Pramanatah pariksha is helpful in determining [https://pubmed.ncbi.nlm.nih.gov/15674762/ Basal Metabolic Index (BMI)]. The normal range for BMI is 19–24·9 kg/, overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ <ref>Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732</ref>

===In relation to [https://pubmed.ncbi.nlm.nih.gov/10865763/#:~:text=Anthropometry%20is%20a%20simple%20reliable,and%20skinfold%20thickness%20(SF). anthropometry]===

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

===Individualistic approach===

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

==Application of knowledge of pramanatah pariksha in contemporary practices==

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.<ref>Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.</ref>

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.<ref>Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki></ref>

===In diagnosis and prognosis===

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

===In management of diseases===

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

==Current researches==

'''1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):'''

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana.<ref>Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.</ref>

'''2. Scientific study of Charakokta anguli pramana in reference to human height:'''

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana.<ref>Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.</ref>

'''3. Anguli pramana in ayurveda - a method of measurement in ancient times:'''

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand.<ref>Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki></ref>

'''4. Concept of anguli pramana sharira and importance in Ayurveda:'''

The author translates the [[ayurveda]] terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies.<ref>Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620</ref> Some of these are:

* Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

* Skandha (shoulder joint)

* Aaratni (from elbow joint to little finger)

* Prabahu (from shoulder joint to elbow joint)

* Prapani (from elbow joint to wrist joint)

* Jangha (from knee joint to ankle joint)[length] [circumference]

* Uru (from hip joint to knee joint) [length] [circumference]

* Janu (knee joint) [circumference]

* Gulpha (ankle joint) [circumference]

* Parshni (Heels) [length] [breadth]

==Future scope of research:==

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

* To know the landmarks of finger, the distance of breadth of finger

* Angula and anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

* To find the appropriate anthropometric measurements based on geographic variations.

* To find average anthropometric measurements based on constitution (prakriti) of individuals.

* To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.

Pramanatah Pariksha

2023-10-13T05:34:54Z

Adarshpm:

{{CiteButton}}
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.[[Vimana Sthana]] 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
==Derivation of pramana==
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

==Derivation of pariksha==

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

==Synonyms==

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

==Pramana in the context of ten fold assessment of patient (dashavidha pariksha):==
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

==Types==

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

==Assessment criteria==

===1. Anguli pramana===

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of
middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb
and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer
corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
(above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears
through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle
finger when a person stands straight

with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two [[Ayurveda]] scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''[[Udakavaha Srotas|Udaka]]''' (aqueous element) a substance which is found
in association with various body parts/components of body.

Example, it is seen mixed with faeces during the occurrence of diarrhoea.

It is also found in association with urine, blood and other tissue elements

of the body. It is spread all over the body with its site in the external skin.

Inside the skin, it is known as lasika (lymph) which exudes through

ulcers; when the body becomes hot, it comes out from hair follicles

in the form of sweat.
|10
|-
|'''[[Rasa dhatu|Rasa]]''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''[[Rakta dhatu|Rakta]] (blood)'''
|8
|-
|'''[[Purisha]] (faeces)'''
|7
|-
|'''[[Kapha dosha|Kapha]]'''
|6
|-
|'''[[Pitta]]'''
|5
|-
|'''[[Mutra]] (urine) '''
|4
|-
|'''[[Vasa]]''' (muscle fat)
|3
|-
|'''[[Meda dhatu|Medas]]''' (fat)
|2
|-
|'''[[Majja]]''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|1/2
|-
|'''[[Shukra dhatu|Shukra]]''' (semen)
|1/2
|-
|'''Shleshmika [[Ojas|oja]]''' (a type of [[Ojas|oja]])
|1/2
|}

==Application of pramana in diagnosis of various diseases:==

The equilibrium of [[dosha]], [[dhatu]] (body tissues) and [[mala]] (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of [[rasa dhatu]] (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of [[rasa dhatu]] may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their [[Pancha mahabhuta|panchabhautika]] composition (the five universal elements or [[Pancha mahabhuta|panchamahabhuta]]). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

==Contemporary views:==

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the '''figure 1'''

The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.[[File:Image.png|thumb|646x646px|'''Figure 1: Anthropometric Landmarks''']]'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

'''4. Modified Thoracometer:'''The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

'''5. Small height rod:'''This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

'''6. Sliding Caliper:'''This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.

'''7. Caliper:'''This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

'''8. Soft metric tape:'''This tool is used for measuring girth dimensions.

==Importance of concept==
===In determining life span===

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. Sutra Sthana 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. Sthana 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. Sutra Sthana 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

===In preservation and promotion of health===

*Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

*Pramanatah pariksha is helpful in determining [https://pubmed.ncbi.nlm.nih.gov/15674762/ Basal Metabolic Index (BMI)]. The normal range for BMI is 19–24·9 kg/, overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ <ref>Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732</ref>

===In relation to [https://pubmed.ncbi.nlm.nih.gov/10865763/#:~:text=Anthropometry%20is%20a%20simple%20reliable,and%20skinfold%20thickness%20(SF). anthropometry]===

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

===Individualistic approach===

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

==Application of knowledge of pramanatah pariksha in contemporary practices==

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.<ref>Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.</ref>

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.<ref>Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki></ref>

===In diagnosis and prognosis===

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

===In management of diseases===

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

==Current researches==

'''1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):'''

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana.<ref>Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.</ref>

'''2. Scientific study of Charakokta anguli pramana in reference to human height:'''

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana.<ref>Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.</ref>

'''3. Anguli pramana in ayurveda - a method of measurement in ancient times:'''

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand.<ref>Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki></ref>

'''4. Concept of anguli pramana sharira and importance in Ayurveda:'''

The author translates the ayurveda terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies.<ref>Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620</ref> Some of these are:

* Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

* Skandha (shoulder joint)

* Aaratni (from elbow joint to little finger)

* Prabahu (from shoulder joint to elbow joint)

* Prapani (from elbow joint to wrist joint)

* Jangha (from knee joint to ankle joint)[length] [circumference]

* Uru (from hip joint to knee joint) [length] [circumference]

* Janu (knee joint) [circumference]

* Gulpha (ankle joint) [circumference]

* Parshni (Heels) [length] [breadth]

==Future scope of research:==

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

* To know the landmarks of finger, the distance of breadth of finger

* Angula and anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

* To find the appropriate anthropometric measurements based on geographic variations.

* To find average anthropometric measurements based on constitution (prakriti) of individuals.

* To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.

Pramanatah Pariksha

2023-10-13T05:19:28Z

Adarshpm:

{{CiteButton}}
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.Vimana Sthana 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
==Derivation of pramana==
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

==Derivation of pariksha==

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

==Synonyms==

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

==Pramana in the context of ten fold assessment of patient (dashavidha pariksha):==
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

==Types==

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

==Assessment criteria==

===1. Anguli pramana===

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of
middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb
and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer
corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
(above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears
through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle
finger when a person stands straight

with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two Ayurveda scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''Udaka''' (aqueous element) a substance which is found
in association with various body parts/components of body.

Example, it is seen mixed with faeces during the occurrence of diarrhoea.

It is also found in association with urine, blood and other tissue elements

of the body. It is spread all over the body with its site in the external skin.

Inside the skin, it is known as lasika (lymph) which exudes through

ulcers; when the body becomes hot, it comes out from hair follicles

in the form of sweat.
|10
|-
|'''Rasa''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''Rakta (blood)'''
|8
|-
|'''Purisha (faeces)'''
|7
|-
|'''Kapha'''
|6
|-
|'''Pitta'''
|5
|-
|'''Mutra (urine) '''
|4
|-
|'''Vasa''' (muscle fat)
|3
|-
|'''Medas''' (fat)
|2
|-
|'''Majja''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|1/2
|-
|'''Shukra''' (semen)
|1/2
|-
|'''Shleshmika oja''' (a type of oja)
|1/2
|}

==Application of pramana in diagnosis of various diseases:==

The equilibrium of dosha, dhatu (body tissues) and mala (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of rasa dhatu (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of rasa dhatu may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their panchabhautika composition (the five universal elements or panchamahabhuta). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

==Contemporary views:==

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the figure 1

The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.[[File:Image.png|thumb|646x646px|'''Figure 1: Anthropometric Landmarks''']]'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

'''4. Modified Thoracometer:'''The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

'''5. Small height rod:'''This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

'''6. Sliding Caliper:'''This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.

'''7. Caliper:'''This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

'''8. Soft metric tape:'''This tool is used for measuring girth dimensions.

==Importance of concept==
===In determining life span===

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. [[Sutra Sthana]] 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. [[Sutra Sthana|Sthana]] 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. [[Sutra Sthana]] 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

===In preservation and promotion of health===

*Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

*Pramanatah pariksha is helpful in determining Basal Metabolic Index (BMI). The normal range for BMI is 19–24·9 kg/, overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ <ref>Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732</ref>

===In relation to anthropometry===

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

===Individualistic approach===

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

==Application of knowledge of pramanatah pariksha in contemporary practices==

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.<ref>Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.</ref>

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.<ref>Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki></ref>

===In diagnosis and prognosis===

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

===In management of diseases===

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

==Current researches==

'''1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):'''

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana.<ref>Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.</ref>

'''2. Scientific study of Charakokta anguli pramana in reference to human height:'''

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana.<ref>Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.</ref>

'''3. Anguli pramana in ayurveda - a method of measurement in ancient times:'''

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand.<ref>Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki></ref>

'''4. Concept of anguli pramana sharira and importance in Ayurveda:'''

The author translates the ayurveda terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies.<ref>Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620</ref> Some of these are:

* Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

* Skandha (shoulder joint)

* Aaratni (from elbow joint to little finger)

* Prabahu (from shoulder joint to elbow joint)

* Prapani (from elbow joint to wrist joint)

* Jangha (from knee joint to ankle joint)[length] [circumference]

* Uru (from hip joint to knee joint) [length] [circumference]

* Janu (knee joint) [circumference]

* Gulpha (ankle joint) [circumference]

* Parshni (Heels) [length] [breadth]

==Future scope of research:==

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

* To know the landmarks of finger, the distance of breadth of finger

* Angula and anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

* To find the appropriate anthropometric measurements based on geographic variations.

* To find average anthropometric measurements based on constitution (prakriti) of individuals.

* To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.

Talk:Pramanatah Pariksha

2023-10-13T05:17:21Z

Adarshpm:

Pramanatah Pariksha

2023-10-12T12:09:38Z

Adarshpm: Blanked the page

Talk:Pramanatah Pariksha

2023-10-12T12:08:46Z

Adarshpm:

{{CiteButton}}
{{#seo:
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.Vimana Sthana 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
==Derivation of pramana==
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

==Derivation of pariksha==

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

==Synonyms==

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

==Pramana in the context of ten fold assessment of patient (dashavidha pariksha):==
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

==Types==

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

==Assessment criteria==

===1. Anguli pramana===

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of
middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb
and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer
corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
(above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs
at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears
through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle
finger when a person stands straight

with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two Ayurveda scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''Udaka''' (aqueous element) a substance which is found
in association with various body parts/components of body.

Example, it is seen mixed with faeces during the occurrence of diarrhoea.

It is also found in association with urine, blood and other tissue elements

of the body. It is spread all over the body with its site in the external skin.

Inside the skin, it is known as lasika (lymph) which exudes through

ulcers; when the body becomes hot, it comes out from hair follicles

in the form of sweat.
|10
|-
|'''Rasa''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''Rakta (blood)'''
|8
|-
|'''Purisha (faeces)'''
|7
|-
|'''Kapha'''
|6
|-
|'''Pitta'''
|5
|-
|'''Mutra (urine) '''
|4
|-
|'''Vasa''' (muscle fat)
|3
|-
|'''Medas''' (fat)
|2
|-
|'''Majja''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|1/2
|-
|'''Shukra''' (semen)
|1/2
|-
|'''Shleshmika oja''' (a type of oja)
|1/2
|}

==Application of pramana in diagnosis of various diseases:==

The equilibrium of dosha, dhatu (body tissues) and mala (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of rasa dhatu (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of rasa dhatu may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their panchabhautika composition (the five universal elements or panchamahabhuta). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

==Contemporary views:==

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the figure 1

The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.[[File:Image.png|thumb|646x646px|'''Figure 1: Anthropometric Landmarks''']]'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

'''4. Modified Thoracometer:'''The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

'''5. Small height rod:'''This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

'''6. Sliding Caliper:'''This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.

'''7. Caliper:'''This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

'''8. Soft metric tape:'''This tool is used for measuring girth dimensions.

==Importance of concept==
===In determining life span===

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. [[Sutra Sthana]] 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. [[Sutra Sthana|Sthana]] 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. [[Sutra Sthana]] 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

===In preservation and promotion of health===

*Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

*Pramanatah pariksha is helpful in determining Basal Metabolic Index (BMI). The normal range for BMI is 19–24·9 kg/, overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ <ref>Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732</ref>

===In relation to anthropometry===

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

===Individualistic approach===

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

==Application of knowledge of pramanatah pariksha in contemporary practices==

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.<ref>Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.</ref>

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.<ref>Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki></ref>

===In diagnosis and prognosis===

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

===In management of diseases===

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

==Current researches==

'''1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):'''

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana.<ref>Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.</ref>

'''2. Scientific study of Charakokta anguli pramana in reference to human height:'''

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana.<ref>Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.</ref>

'''3. Anguli pramana in ayurveda - a method of measurement in ancient times:'''

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand.<ref>Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki></ref>

'''4. Concept of anguli pramana sharira and importance in Ayurveda:'''

The author translates the ayurveda terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies.<ref>Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620</ref> Some of these are:

* Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

* Skandha (shoulder joint)

* Aaratni (from elbow joint to little finger)

* Prabahu (from shoulder joint to elbow joint)

* Prapani (from elbow joint to wrist joint)

* Jangha (from knee joint to ankle joint)[length] [circumference]

* Uru (from hip joint to knee joint) [length] [circumference]

* Janu (knee joint) [circumference]

* Gulpha (ankle joint) [circumference]

* Parshni (Heels) [length] [breadth]

==Future scope of research:==

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

* To know the landmarks of finger, the distance of breadth of finger

* Angula and anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

* To find the appropriate anthropometric measurements based on geographic variations.

* To find average anthropometric measurements based on constitution (prakriti) of individuals.

* To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.

2023-10-12T11:14:03Z

Adarshpm: /* 2. Anjali pramana */

{{CiteButton}}
{{#seo:
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.Vimana Sthana 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
===Derivation of pramana===
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

===Derivation of pariksha===

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

===Synonyms===

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

===Pramana in the context of ten fold assessment of patient (dashavidha pariksha):===
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

===Types===

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

===Assessment criteria===

====1. Anguli pramana====

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs (above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle finger when a person stands straight with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

 Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two Ayurveda scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2</ref>

====2. Anjali pramana====

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''Udaka''' (aqueous element) a substance which is found in association with various body parts/components of body. Example, it is seen mixed with faeces during the occurrence of diarrhoea. It is also found in association with urine, blood and other tissue elements of the body. It is spread all over the body with its site in the external skin. Inside the skin, it is known as lasika (lymph) which exudes through ulcers; when the body becomes hot, it comes out from hair follicles in the form of sweat.
|10
|-
|'''Rasa''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''Rakta (blood)'''
|8
|-
|'''Purisha (faeces)'''
|7
|-
|'''Kapha'''
|6
|-
|'''Pitta'''
|5
|-
|'''Mutra (urine) '''
|4
|-
|'''Vasa''' (muscle fat)
|3
|-
|'''Medas''' (fat)
|2
|-
|'''Majja''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|
|-
|'''Shukra''' (semen)
|
|-
|'''Shleshmika oja''' (a type of oja)
|
|}

===Application of pramana in diagnosis of various diseases:===

The equilibrium of dosha, dhatu (body tissues) and mala (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of rasa dhatu (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of rasa dhatu may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their panchabhautika composition (the five universal elements or panchamahabhuta). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

'''Contemporary views:'''

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the figure:
----The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.

'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

4. Modified Thoracometer:The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

5. Small height rod:This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

6. Sliding Caliper:This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.====

7. Caliper:This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

8. Soft metric tape:This tool is used for measuring girth dimensions.

'''Importance of concept'''

'''In determining life span'''

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. [[Sutra Sthana]] 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. [[Sutra Sthana|Sthana]] 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. [[Sutra Sthana]] 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

'''In preservation and promotion of health'''

· Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

· Pramanatah pariksha is helpful in determining Basal Metabolic Index (BMI). The normal range for BMI is 19–24·9 kg/ , overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ .[i]

'''In relation to anthropometry'''

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

'''Individualistic approach'''

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

'''Application of knowledge of pramanatah pariksha in contemporary practices'''

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.[ii]

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.[iii]

'''In diagnosis and prognosis'''

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

'''In management of diseases'''

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

'''Current researches'''

1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana. [iv]

2. Scientific study of Charakokta anguli pramana in reference to human height:

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana. [v]

3. Anguli pramana in ayurveda - a method of measurement in ancient times:

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand. [vi]

4. Concept of anguli pramana sharira and importance in Ayurveda:

The author translates the ayurveda terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies. [vii] Some of these are:

· Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

· Skandha (shoulder joint)

· Aaratni (from elbow joint to little finger)

· Prabahu (from shoulder joint to elbow joint)

· Prapani (from elbow joint to wrist joint)

· Jangha (from knee joint to ankle joint)[length] [circumference]

· Uru (from hip joint to knee joint) [length] [circumference]

· Janu (knee joint) [circumference]

· Gulpha (ankle joint) [circumference]

· Parshni (Heels) [length] [breadth]

'''Future scope of research:'''

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

· To know the landmarks of finger, the distance of breadth of finger

· Angula and anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

· To find the appropriate anthropometric measurements based on geographic variations.

· To find average anthropometric measurements based on constitution (prakriti) of individuals.

· To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.
----[i] Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732

[ii] Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.

[iii] Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki>

[iv]Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.

[v]Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.

[vi] Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki>

[vii] Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620

Pramanatah Pariksha

2023-10-12T11:13:04Z

Adarshpm:

{{CiteButton}}
{{#seo:
Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.Vimana Sthana 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. {{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Contemporary Practices/[[Pramanatah pariksha]]
|label2 = Authors
|data2 = Bhojani M. K. 1, Joglekar Aishwarya 1
|label3 = Editor
|data3 = Deole Y.S.3
|label4 = Affiliations
|data4 = 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|label5 = Correspondence emails
|data5 = meera.samhita@aiia.gov.in, carakasamhita@gmail.com
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 =October 12, 2023
|label8 = DOI
|data8 = In process
}}
===Derivation of pramana===
The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.</ref>

===Derivation of pariksha===

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.<ref>Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.</ref> Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

===Synonyms===

'''Praman and pariksha''<ref>Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.</ref>

1. Examination or assessment tools (pariksha)

2. Causes ([[hetu]])

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

===Pramana in the context of ten fold assessment of patient (dashavidha pariksha):===
The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]

===Types===

1. Anguli pramana (measurements by fingers)

2. Anjali Pramana (measurements by cup hallow formed by joining palms together)

===Assessment criteria===

====1. Anguli pramana====

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Feet
|4
|14
|6
|<nowiki>-</nowiki>
|-
|Calf
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|16
|-
|Knee
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|16
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|30
|-
|Testicle
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|8
|-
|Penis
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|5
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|-
|Top of pelvis
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Abdomen
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Sides of chest
|<nowiki>-</nowiki>
|12
|10
|<nowiki>-</nowiki>
|-
|Distance between nipples
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nipple
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|-
|Chest
|12
|<nowiki>-</nowiki>
|24
|<nowiki>-</nowiki>
|-
|Heart
|<nowiki>-</nowiki>
|3
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulders
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Shoulder blades
|<nowiki>-</nowiki>
|6
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Arm
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-arm
|<nowiki>-</nowiki>
|15
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Axilla
|<nowiki>-</nowiki>
|8
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Trika (sacrum including coccyx)
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Back
|18
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|22
|-
|Face
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|24
|-
|Mouth
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Lips
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ears
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between eyes
|<nowiki>-</nowiki>
|4*
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Fore-head
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Head
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|32
|-
|Entire body
|84
|<nowiki>-</nowiki>
|84**
|<nowiki>-</nowiki>
|}
<nowiki>*</nowiki>distance between external angles of eyes

<nowiki>**</nowiki>when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
{| class="wikitable"
|'''Organs'''
|'''Height'''
|'''Length'''
|'''Breadth'''
|'''Circumference'''
|-
|Great toe and second toe*
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior part of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Arch of foot
|<nowiki>-</nowiki>
|4
|5
|<nowiki>-</nowiki>
|-
|Heel
|<nowiki>-</nowiki>
|5
|4
|<nowiki>-</nowiki>
|-
|Foot
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|14
|-
|Ankle
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Leg
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|14
|-
|Knee
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|14
|-
|Thigh
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|32
|-
|Testis
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Chin
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Teeth
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Anterior flaps of nose
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Root of ear
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle portion of eyes**
|<nowiki>-</nowiki>
|2
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Penis
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Mouth
|<nowiki>-</nowiki>
|4
|4
|<nowiki>-</nowiki>
|-
|Nose
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ear
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Forehead
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Neck
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|20
|-
|Distance between pupil of eyes
|<nowiki>-</nowiki>
|4
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Vagina
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Distance between penis and umbilicus
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between umbilicus and heart
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between heart and neck
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between breasts
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Face
|<nowiki>-</nowiki>
|12
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Wrist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Forearm
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|12
|-
|Leg (centre of calf muscle)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|16
|-
|Distance between shoulder and elbow
|<nowiki>-</nowiki>
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between elbow and tip of middle finger
|<nowiki>-</nowiki>
|24

(24 angula = 1 Hasta)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Upper limb
|<nowiki>-</nowiki>
|32
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between wrist and elbow
|
|16
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Hand
|<nowiki>-</nowiki>
|6
|4
|<nowiki>-</nowiki>
|-
|Distance between root of thumb and index finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between ear and outer corner of eyes
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Middle finger
|<nowiki>-</nowiki>
|5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Index finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Ring finger
|<nowiki>-</nowiki>
|4.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Thumb
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Little finger
|<nowiki>-</nowiki>
|3.5
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Nostril
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|1/3
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs (above temples) and middle of skull
|<nowiki>-</nowiki>
|11
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between margin of hairs at back of neck and middle of skull
|<nowiki>-</nowiki>
|10
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Distance between two ears through back of neck
|<nowiki>-</nowiki>
|14
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|Female chest***
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Male waist
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|18
|<nowiki>-</nowiki>
|-
|Entire body (from feet to tip of middle finger when a person stands straight with his hands raised upwards)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|120
|}
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.

**Length of cornea= 1/3rd length of middle portion of eye

 Length of pupil=1/9th length of cornea

<nowiki>***</nowiki>Female pelvis is as broad as chest of male.

Ø Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two Ayurveda scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.<ref>Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''</ref> Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.<ref>Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.</ref><ref>Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2</ref>

===2. Anjali pramana===

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity. A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.<ref>Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.</ref>

'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]

{| class="wikitable"
|'''Body components'''
|'''Volume'''
|-
|'''Udaka''' (aqueous element) a substance which is found in association with various body parts/components of body. Example, it is seen mixed with faeces during the occurrence of diarrhoea. It is also found in association with urine, blood and other tissue elements of the body. It is spread all over the body with its site in the external skin. Inside the skin, it is known as lasika (lymph) which exudes through ulcers; when the body becomes hot, it comes out from hair follicles in the form of sweat.
|10
|-
|'''Rasa''' which is the first product of the ingested food after it is metabolised.
|9
|-
|'''Rakta (blood)'''
|8
|-
|'''Purisha (faeces)'''
|7
|-
|'''Kapha'''
|6
|-
|'''Pitta'''
|5
|-
|'''Mutra (urine) '''
|4
|-
|'''Vasa''' (muscle fat)
|3
|-
|'''Medas''' (fat)
|2
|-
|'''Majja''' (bone marrow)
|1
|-
|'''Mastishka''' (the fat like substance inside the skull''')'''
|
|-
|'''Shukra''' (semen)
|
|-
|'''Shleshmika oja''' (a type of oja)
|
|}
===Application of pramana in diagnosis of various diseases:===

The equilibrium of dosha, dhatu (body tissues) and mala (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of rasa dhatu (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of rasa dhatu may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their panchabhautika composition (the five universal elements or panchamahabhuta). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

'''Contemporary views:'''

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the figure:
----The advancement in technology led to development of many anthropometric tools. Some of them are as follows:

'''1. Anthropometer:''' Anthropometer measures vertical dimensions of the human body. The instrument consists of three aluminium square profiles and a double-sided measuring system with a reading scale. The long axis of the instrument is mounted with a telescopic round sleeve with a double-sided groove that features a dimension reading index. The sleeve is mounted with a sliding needle, whose tip is applied to the appropriate anthropometric point.

'''2. Spreading Caliper:''' Spreading Caliper is used to measure dimensions of the head and selected body width or depth dimensions in children (e.g. biacromial width, biiliocristal width, bispinal width, bitrochanteric width, transverse width of chest, biepicondylar width of humerus, biepicondylar width of femur).

'''3. Pelvimeter:''' Pelvimeter used for measuring the width and depth dimensions of the adult population.

4. Modified Thoracometer:The instrument primarily serves for easy determination of the length of the foot. While measuring the foot length, the subject stands with his/her feet slightly apart, with the weight distributed evenly on both legs. The axis of the instrument is parallel to the inner edge of the foot, the bent toes need to be pressed against the floor.

5. Small height rod:This instrument is primarily designated to determine selectedvertical dimensions of the lower extremity (e.g. sphyrion height).

6. Sliding Caliper:This instrument is designed to determine selected dimensions of the head (e.g. morphological facial height, nasal height and width, the distance between the inner/outer eye corners, lower jaw height, mouth width, hand width, foot width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp ends are used for determining the dimensions of skeletal material.====

7. Caliper:This instrument measures skinfold thickness. The instrument has two arms, of which one is calibrated scale. The base of this arm features a circular opening for the index or middle finger. The other (sliding) arm with a slot for measurement of the skinfold thickness has a base with a larger circular opening for the thumb.

8. Soft metric tape:This tool is used for measuring girth dimensions.

'''Importance of concept'''

'''In determining life span'''

Any deviation from the normal measurements possibly points towards an anatomical or genetical anomaly, which may consequently reduce the life span of the person. According to Ayurveda scholars, a person with tip of the nose raised lives a maximum life span of 70 years [Su. Sa. [[Sutra Sthana]] 35/8]; and a person whose phalanges are short, penis enormously bigger positioned upwards from its normal place, nose higher and gums visible while laughing or talking lives a maximum life span of 25 years only. [Su. Sa. [[Sutra Sthana|Sthana]] 35/9-11] Contrarily, if a man or woman, endowed with standard body and body organ measurements, then he attains long life and prosperity [Su. Sa. [[Sutra Sthana]] 35/16-17]. It is also postulated that if the height of person in standing position is equal to the arm span of that person, than this person is said to possess sama sharira (body with optimum proportion of measurements of body parts). A sama sharira person is endowed with longevity, strength, ojas (the essence of all seven dhatus or tissues, that is vital for life), happiness, power, wealth, and virtues. [Cha. Sa. [[Sutra Sthana|Viman Sthana]] 8/117]

'''In preservation and promotion of health'''

· Pramanataha pariksha is helpful in identification of four (too tall, too dwarf, too fat or too emaciated) among eight of the undesirable constituents. [Cha. Sa. [[Sutra Sthana]] 21/3] A person aspiring good health shall make possible efforts to reach close to the standards measurements. For example, reducing weight for an obese person is possible by suitable diet and exercise. However, increasing height of a dwarf adult or decreasing height in tall person is not possible by medical management.

· Pramanatah pariksha is helpful in determining Basal Metabolic Index (BMI). The normal range for BMI is 19–24·9 kg/ , overweight is 25–29·9 kg/ , and obesity ≥ 30 kg/ .[i]

'''In relation to anthropometry'''

Pramantaha pariksha is like anthropometry (the '''systematic measurement of th'''e physical properties of the human body, primarily dimensional descriptors of body size and shape). Anthropometry, along with physical measurement of human body, also takes into consideration the body weight, body parts, human physical appearance and physical attractiveness.

'''Individualistic approach'''

Anguli pramana of body and body parts of an individual is determined by measuring the utsedha (height), ayama (length), vistara (breadth) by taking his own finger’s (swaanguli) breadth, as unit of measurement. The breadth of one finger is counted as one angula, and so on. The anguli pramana is used for measurement of length, breadth, height, circumference, etc, in contrast to anjali pramana, which is the measurement of volume. One anjali pramana is the maximum volume of a liquid that can be held in the cup formed by joining of the two palms of an individual together. This volume is one anjali for that particular individual (swa-anjali). Measurements of body and body parts depend on sex, race, geographical location, nutrition, exposure to disease, genetics and physical activity. Hence swa-angula and swa-anjali pramana give individualistic information rather than a generalized one. These pramana do not vary according to above mentioned conditions.

'''Application of knowledge of pramanatah pariksha in contemporary practices'''

Surgeons use pramanatah pariksha in determining important landmarks in person’s body. By knowing the distance of key areas on the surgeon’s hand, he can measure critical distances, saving time.

A few key measurements are noted as follows: -

1. The width of the surgeon’s index finger = ≈2 cm

2. The length from the tip of the thumb to the interphalangeal joint = ≈3.5 cm

3. The length from the tip of the thumb to the metacarpophalangeal joint = ≈6.5 cm.[ii]

Each surgeon should check these distances on his or her hand to know exactly what each landmark represents.

One of the examples in which pramanatah pariksha is utilized by clinicians is 3-3-2 rule. Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers.

'''3:''' The measurement of 3 fingers between the upper and lower teeth of a patient's open mouth indicates the ease of accessing the airway through the oral opening.

'''3:''' A measurement of 3 fingers from the anterior tip of the mandible to the anterior neck estimates the volume of the submandibular space.

'''2:''' A measurement of 2 fingers between the floor of the mandible and the thyroid notch on the anterior neck determines the location of the larynx relative to the base of the tongue.[iii]

'''In diagnosis and prognosis'''

Pramana is mentioned as one of the ten investigations regarding patients, and it can be used for estimation of strength (physical, psychological, immunological) of patients. [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/94].

'''In management of diseases'''

No two individual are completely alike physically, physiologically, psychologically, or in vital reactions, and thus the dose of drugs varies from person to person. A child or a person with lower body stature requires less dose of a drug as compared to an adult or person with big body stature. The volume of anjali varies in proportion with the size of the individual. Ancient scholars utilized this factor. Example, maximum oral dose of peeluparnyadi oil is mentioned as 1 anjali [Cha. Sa. [[Sutra Sthana|Chikitsa Sthana]] 27/42]. If two persons, one of smaller body stature (hence smaller volume in his 1 anjali) and one of bigger body stature (hence bigger volume in his 1 anjali) consume this oil of volume of their 1 anjali pramana, then automatically the person with smaller volume will consume smaller quantity of oil and person of bigger stature will consume more quantity of oil. Some other drugs whose doses, or the doses of their composition drugs are mentioned in anjali pramana are amalatas (''Cassia'' ''fistula''). [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/9], aragvadhadi arishta [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 8/15] and lodhra sura (beverage prepared from ''Symplocos racemosa'') [Cha. Sa. [[Sutra Sthana|Kalpa Sthana]] 9/9].

'''Current researches'''

1. Anguli pramana as a tool for assessment of health status with reference to body mass index (B.M.I.):

An observational study for correlation between anguli pramana and BMI was carried out on 30 healthy individuals between age group 18-55 years from Himalayiya Ayurvedic Medical College & Hospital, Dehradun. In this study, it was observed that if the health status of an individual was altered, either in terms of increased or decreased figures of BMI, then their swa-anguli pramana deviated from standard values of mentioned swa-anguli pramana. [iv]

2. Scientific study of Charakokta anguli pramana in reference to human height:

In this study, anthropometric measurements by finger were taken and exact site of particular finger in a manner to execute “anguli sthana nishchiti” (demarcation points for measurement by anguli pramana) was determined. The data of aayama (height) and vistaara (arm span) of the 100 volunteers was recorded and statistically analysed. After comparing the anguli pramana obtained at 78 different sites of both hands, it was established that measurement of anguli pramana at the site of medio-lateral proximal interphalangeal joint of middle finger of right and left hand, would be most accurate in estimating anguli pramana. [v]

3. Anguli pramana in ayurveda - a method of measurement in ancient times:

This study directed that anguli pramana measurement should be done at the site of medio-lateral proximal interphalangeal joint of middle finger of right or left hand. [vi]

4. Concept of anguli pramana sharira and importance in Ayurveda:

The author translates the ayurveda terminologies of demarcation points for describing pramanatah pariksha in ayurveda texts into modern anatomical terminologies. [vii] Some of these are:

· Shira (heads circumference) the maximum distance round the head with the tape placed above the eyebrow ridges and positioned over the greatest posterior projection at the back of the head.

· Skandha (shoulder joint)

· Aaratni (from elbow joint to little finger)

· Prabahu (from shoulder joint to elbow joint)

· Prapani (from elbow joint to wrist joint)

· Jangha (from knee joint to ankle joint)[length] [circumference]

· Uru (from hip joint to knee joint) [length] [circumference]

· Janu (knee joint) [circumference]

· Gulpha (ankle joint) [circumference]

· Parshni (Heels) [length] [breadth]

'''Future scope of research:'''

There is a wide scope of research in perspective of pramantah pariksha. Some of these topics are as follows:

· To know the landmarks of finger, the distance of breadth of finger

· Angula and anjali, can other body parts (like arm length, palm’s breadth, etc) too be used as an individualistic approach for anthropometric measurements.

· To find the appropriate anthropometric measurements based on geographic variations.

· To find average anthropometric measurements based on constitution (prakriti) of individuals.

· To find the correlation of health and life span of the persons with standard anthropometric measurements and persons with variation in anthropometric measurements.
----[i] Xavier Pi-Sunyer, F. (2000). Obesity: Criteria and classification. Proceedings of the Nutrition Society, 59(4), 505-509. doi:10.1017/S0029665100000732

[ii] Frey, Jordan & Zide, Barry. (2020). Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. Plastic and Reconstructive Surgery - Global Open. Publish Ahead of Print. 1. 10.1097/GOX.0000000000002791.

[iii] Sharma S, Patel R, Hashmi MF, et al. 3-3-2 Rule. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK493235/</nowiki>

[iv]Bahuguna M, Vaidh S. Anguli Pramana as a Tool for Assessment of Health Status w.r.t. BMI. WJPR. 2022 Apr;11(5):2083-2089. doi: 10.20959/wjpr20225-23931. ISSN 2277– 7105.

[v]Muley SK, Surve AA, Bhingare SD. Scientific study of Charakokta Anguli Pramana in reference to human height. Ayu. 2013 Oct;34(4):356-60. doi: 10.4103/0974-8520.127709. PMID: 24696571; PMCID: PMC3968696.

[vi] Dr. Radheshyam Sharma. (2020). Anguli Pramana in Ayurveda - A method of measurement in Ancient time. ''Journal of Ayurveda and Integrated Medical Sciences'', ''5''(01), 122-125. <nowiki>https://doi.org/10.21760/jaims.v5i01.825</nowiki>

[vii] Mishra B. Concept of Anguli Pramana Sharir and Importance in Ayurveda. IJIRMF 2016 July;3(7):279-281. ISSN – 2455-0620