Changes

== Vidhi Vimarsha (Applied Inferences) ==

== Vidhi Vimarsha (Applied Inferences) ==

''Vimana'' literally means measurement, so this section gives the physical as well pathological parameters for the measurement of various entities like ''dosha, dhatu, agni, srotasa'' etc. In the present chapter method of classification of diseases is given on the basis of prognosis, severity, site of origin, cause and location. Physicians are directed to diagnose the disease as primary or secondary one on the basis of vitiated ''doshas'' and treatment given. Primary ''doshas'' manifest their respective diseases when they are aggravated. On the other hand, the sub-ordinate ''dosha'' manifests their respective symptoms only when they are stimulated by the primary ''dosha''. In other words, in view of their un-manifested symptoms, subordinate ''dosha'', do not get aggravated by the factor responsible for their aggravation as mentioned in the texts nor do they get alleviated by the therapy prescribed specially for them. They get alleviated only when the therapy prescribed for primary ''dosha'' is administered. That is to say the aggravation and alleviation of subordinate ''doshas'' are affected by the causative factors and therapies, other than their own. This is because they share the attributes of the ''dosha'', of primary nature to some extent. For example, in the autumn season ''pitta'' is vitiated primarily and ''kapha'' secondarily due to sour ''vipaka'' of water etc. This is because sour taste is responsible for the vitiation of both. For the treatment of primary ''doshas'', viz. ''pitta'', ghee boiled with bitter drugs is employed; bitter taste, by nature, alleviates the subordinate ''dosha'', viz. ''kapha'' also. ''Anubandhya'' and, ''anubandha'' are the technical terms for primary and secondary diseases respectively known to scholar adapt in the medical science.

=== Methods of disease classification ===

After the description of the classification of diseases, ''agni'' is described which is essential for the maintenance of the body. The term ''sharireshu'' indicates that ''agni'' (factors or enzymes responsible for digestion and metabolism) residing all over the body. However, in subsequent elaboration, ''agni'' residing in the gastrointestinal tract is described because this ''agni'' regulates the aggravation or abatement of all the other ''agnis'' (Chikitsa 15:39). ''Agnis'' belonging to regular or balanced category are the most beneficial for a healthy living; still ''agnis'' belonging to the sharp category are given priority in the order of description because of their importance in as much as they are capable of tolerating all types of irregularities. Balanced (''sama'') condition of ''vata, pitta,'' and ''kapha'' during their natural states and when they are aggravated, accompanies regular or balanced ''agnis''. The term ''prakriti'' (meaning natural state) has different other meaning as well. Because of these two factors and with a view to specifying the intention, Acharya has used the term ''prakritisthanam'' along with ''vatapittashleshmana''. In the case of an individual having the dominance of ''vata'' in his constitution, ''agni'' becomes irregular only when the sites of ''agnis'' in his body are afflicted by ''vata'' and not otherwise. Similar is the explanation for the changes in the ''agnis'' in individuals having the dominance of ''pitta'' and ''kapha'' in their constitution. The concept of ''prakriti'' is also described in the chapter in the context of disease. It is worth mentioning that the ''prakriti'' described in this chapter is in reference to the diseased state i.e. ''vikrita avastha''. [1-2]

The word ''Vimana'' literally means measurement, so this section gives the physical as well pathological parameters for the measurement of various entities like [[dosha]], [[dhatu]], [[agni]], [[srotas]] etc. In the present chapter method of classification of diseases is given on the basis of prognosis, severity, site of origin, cause and location. Physicians are directed to diagnose the disease as primary or secondary one on the basis of vitiated [[dosha]] and treatment given.  

Classification of various diseases on five parameters is described and then gives a generalized method for classification of disease on the basis of grief as a universal symptom. Here it is important to note that he uses the term grief instead of pain to identify the disease. The word grief (''dukha'') signifies both mental as well as physical trouble. Thus more emphasis is given on the fact that both the component of a disease i.e. somatic and psychic should be equally treated for successful management. Description of the causative ''doshas'' for mental diseases and their relation with physical ''doshas'' is given. In the same context the psychosomatic diseases are described. Chronic somatic diseases cause psychological diseases and chronic psychological diseases leads to somatic diseases i.e. both are intermingled and have cause and effect relationship.  

Primary [[dosha]] manifest their respective diseases when they are aggravated. On the other hand, the sub-ordinate [[dosha]] manifests their respective symptoms only when they are stimulated by the primary [[dosha]]. In other words, in view of their un-manifested symptoms, subordinate [[dosha]], do not get aggravated by the factor responsible for their aggravation as mentioned in the texts nor do they get alleviated by the therapy prescribed specially for them. They get alleviated only when the therapy prescribed for primary [[dosha]] is administered. That is to say the aggravation and alleviation of subordinate [[dosha]] are affected by the causative factors and therapies, other than their own. This is because they share the attributes of the [[dosha]], of primary nature to some extent. For example, in the autumn season [[pitta]] is vitiated primarily and [[kapha]] secondarily due to sour [[vipaka]] of water etc. This is because sour taste is responsible for the vitiation of both. For the treatment of primary [[dosha]], viz. [[pitta]], ghee boiled with bitter drugs is employed; bitter taste, by nature, alleviates the subordinate [[dosha]], viz. [[kapha]] also. 'Anubandhya'' and, ''anubandha'' are the technical terms for primary and secondary diseases respectively known to scholar adapt in the medical science.

Modern scientific research supports this age-old tenet of medical wisdom. Walter Cannon in 1920, documented the physiological changes in body as a response to stressors through hormones called catecholamines. This was further researched by Hans Selye to pioneer the field of stress research. He described the close relation between body and mind with various articles on stress affecting humans biologically. Biofeedback is found effective in the treatment of various psycho-somatic disorders. Dean Ornish and his colleagues also worked upon the concept to integrate ''yoga'', meditation for designing protocol for stress management in a medical center<ref> Sourced  from http://www.bravewell.org/integrative_medicine/philosophical_foundation/mind_and_body_connection/ accessed on 18/06/2017  </ref>. 

=== Role of [[prakriti]] ===

International classification of diseases and related health problems is a system that classifies disease on the basis of interpretation and comparison of mortality and morbidity data across globe<ref> Sourced from http://www.who.int/classifications/icd/revision/en/ accessed on 26/06/2017  </ref>.  

The term [[prakriti]] (meaning natural state) has different other meaning as well. Because of these two factors and with a view to specifying the intention, Acharya has used the term ''prakritisthanam'' along with ''vatapittashleshmana''.  In the case of an individual having the dominance of [[vata]] in his constitution, [[agni]] becomes irregular only when the sites of [[agni]] in his body are afflicted by [[vata]] and not otherwise. Similar is the explanation for the changes in the [[agni]] in individuals having the dominance of [[pitta]] and [[kapha]] in their constitution. The concept of [[prakriti]] is also described in the chapter in the context of disease. It is worth mentioning that the [[prakriti]] described in this chapter is in reference to the diseased state i.e. ''vikrita avastha''. [verses 1-2]

The relation between ''agni'' and disease process is essential to be understood. Impairment of ''agni'' is a cause of accumulation of various toxic products inside body leading to disease. ''Agni'' includes all processes of digestion and metabolism taking at gross level, tissue level, micro-cellular level. Hence it needs a special emphasis while treating a disease. Diagnosis of ''agni'' of a person is one of key factor in understanding disease. The following charts 1,2 and 3 shows various types of ''agni'' and its related processes in ayurvedic perspective.  

 

Determination of psychosomatic constitution, as well as disease susceptibility of an individual in population through genetic trait, is known as [[prakriti]]. [[Prakriti]] is a broad term that encompasses all the three genotype, phenotype as well as endophenotype.  The concept of [[prakriti]] in [[Ayurveda]] is related to the bio-characteristic of an individual in healthy state and its vulnerability for particular diseases. According to [[Ayurveda]], [[prakriti]] of an individual once determined at the time of fertilization remains unchanged throughout life though it is well influenced by environment. Role of environment in determination of [[prakriti]] during prenatal period is as important as postnatal period. Reviewing the human embryology, it can be postulated that the three primitive germinal layers namely ectoderm, mesoderm and endoderm can be correlated with ''vatika, paittika'' and ''kaphaja'' trait. According to [[Ayurveda]] at the time of fertilization the ''doshika prakriti'' is determined by the ''doshika'' predominance of [[shukra]] (sperm) and [[shonita]] (ovum) that represent the fastidious genetic alignment of chromosomes in sperm and ovum and decide the genetic trait of zygote. Robust research is being conducted to study the link between [[prakriti]] and genes.

 

 

 

Classification of various diseases on five parameters is described and then gives a generalized method for classification of disease on the basis of grief as a universal symptom. Here it is important to note that the term grief is used instead of pain to identify the disease. The word grief (''dukha'') signifies both mental as well as physical trouble. Thus more emphasis is given on the fact that both the component of a disease i.e. somatic and psychic should be equally treated for successful management. Description of the causative [[dosha]] for mental diseases and their relation with physical [[dosha]] is given. In the same context the psychosomatic diseases are described. Chronic somatic diseases cause psychological diseases and chronic psychological diseases leads to somatic diseases i.e. both are intermingled and have cause and effect relationship.

 

 

The relation between [[agni]] and disease process is essential to be understood. Impairment of [[agni]] is a cause of accumulation of various toxic products inside body leading to disease. [[Agni]] includes all processes of digestion and metabolism taking at gross level, tissue level, micro-cellular level. Hence it needs a special emphasis while treating a disease. Diagnosis of [[agni]] of a person is one of key factor in understanding disease.  

 

 

The following charts 1,2 and 3 shows various types of [[agni]] and its related processes in ayurvedic perspective.  

</div>  

</div>  

[[File:Chart 1.png]]

[[File:Chart 1.png]]

=== Chart 1:  Different types of ''Agni''===

=== Chart 1:  Different types of [[Agni]]===

[[File:Chart 2.png]]

[[File:Chart 2.png]]

=== Chart 2: Factors involved in ''Agni'' process ===

=== Chart 2: Factors involved in [[Agni]] process ===

[[File:Chart 3.png]]

[[File:Chart 3.png]]

=== Chart 3: Diagrammatic representation of importance of ''Agni'' ===

=== Chart 3: Diagrammatic representation of importance of [[Agni]] ===

<div style="text-align:justify;">

<div style="text-align:justify;">

In [[Nidana Sthana]] Chapter 4 ([[Prameha Nidana]]), Acharya says that the development of disease is multifactorial and it depends upon both the virulence of pathogens (''nidana'') as well as host response (''dushya''). Response of the host can be quantified by using ''prakriti'' as a parameter. [13]

 

Current scientific research supports this age-old tenet of medical wisdom. Walter Cannon in 1920, documented the physiological changes in body as a response to stressors through hormones called catecholamines. This was further researched by Hans Selye to pioneer the field of stress research. He described the close relation between body and mind with various articles on stress affecting humans biologically. Biofeedback is found effective in the treatment of various psycho-somatic disorders. Dean Ornish and his colleagues also worked upon the concept to integrate ''yoga'', meditation for designing protocol for stress management in a medical center<ref> Sourced  from http://www.bravewell.org/integrative_medicine/philosophical_foundation/mind_and_body_connection/ accessed on 18/06/2017  </ref>.  

 

International classification of diseases and related health problems is a system that classifies disease on the basis of interpretation and comparison of mortality and morbidity data across globe<ref> Sourced from http://www.who.int/classifications/icd/revision/en/ accessed on 26/06/2017 </ref>.  

=== Applied aspect for future research ===

=== Applied aspect for future research ===

#Scientific validation of term ''prakriti'' and standardization of ''doshika'' and ''manasa prakriti''.

#Scientific validation of term [[prakriti]] and standardization of ''doshika'' and ''manasa prakriti''.

#Preparation of protocol for the classification of diseases on the basis of ''vata, pitta'' and ''kapha''.

#Preparation of protocol for the classification of diseases on the basis of [[vata]], [[pitta]] and [[kapha]].

#Standardization of Parameters for the characterization of ''agni'' into ''manda, tikshana'' and ''vishama''.

#Standardization of Parameters for the characterization of [[agni]] into ''manda, tikshana'' and ''vishama''.

#Classification of disease, patient as well as management on the basis of ''prakriti'' and its scientific validation.

#Classification of disease, patient as well as management on the basis of [[prakriti]] and its scientific validation.

=== Future Scope for Research ===

=== Future Scope for Research ===

#Searching genetic trait for different ''prakriti'' and disease susceptibility accordingly.

#Searching genetic trait for different [[prakriti]] and disease susceptibility accordingly.

#Standardization of ''Jathragni, Bhutagni'' and ''Dhatvagni''.

#Standardization of ''Jatharagni, Bhutagni'' and ''Dhatvagni''.

=== Further reading ===

=== Further reading ===