Pramanatah Pariksha

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.

Contributors

Section/Chapter/topic	Concepts & Contemporary Practices/Pramanatah Pariksha
Authors	Bhojani M. K. 1, Joglekar Aishwarya 1
Editor	Deole Y.S.3
Affiliations	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
Correspondence emails	meera.samhita@aiia.gov.in, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	October 12, 2023
DOI	10.47468/CSNE.2023.e01.s09.158

Derivation of pramana

The word ‘pramana’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’

Derivation of  pariksha

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’. Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

Synonyms

'Pramana and pariksha

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. Vimana Sthana 8/117]

Organs	Height	Length	Breadth	Circumference
Feet	4	14	6	-
Calf	-	18	-	16
Knee	-	4	-	16
Thigh	-	18	-	30
Testicle	-	6	-	8
Penis	-	6	-	5
Vagina	-	-	-	12
Waist	-	-	16	-
Top of pelvis	10	-	-	-
Abdomen	-	12	10	-
Sides of chest	-	12	10	-
Distance between nipples	-	12	-	-
Nipple	-	-	2	-
Chest	12	-	24	-
Heart	-	3	-	-
Shoulders	-	8	-	-
Shoulder blades	-	6	-	-
Arm	-	16	-	-
Fore-arm	-	15	-	-
Hand	-	12	-	-
Axilla	-	8	-	-
Trika (sacrum including coccyx)	12	-	-	-
Back	18	-	-	-
Neck	4	-	-	22
Face	12	-	-	24
Mouth	-	-	5	-
Chin	-	4	-	-
Lips	-	4	-	-
Ears	-	4	-	-
Distance between eyes	-	4*	-	-
Nose	-	4	-	-
Fore-head	-	4	-	-
Head	16	-	-	32
Entire body	84	-	84**	-

*distance between external angles of eyes

**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

Organs	Height	Length	Breadth	Circumference
Great toe and second toe*	-	2	-	-
Anterior part of foot	-	4	5	-
Arch of foot	-	4	5	-
Heel	-	5	4	-
Foot	-	14	-	14
Ankle	-	-	-	14
Leg	-	18	-	14
Knee	-	-	-	14
Thigh	-	18	-	32
Testis	-	2	-	-
Chin	-	2	-	-
Teeth	-	2	-	-
Anterior flaps of nose	-	2	-	-
Root of ear	-	2	-	-
Middle portion of eyes**	-	2	-	-
Penis	-	4	-	-
Mouth	-	4	4	-
Nose	-	4	-	-
Ear	-	4	-	-
Forehead	-	4	-	-
Neck	-	4	-	20
Distance between pupil of eyes	-	4	-	-
Vagina	-	-	-	12
Distance between penis and umbilicus	-	12	-	-
Distance between umbilicus and heart	-	12	-	-
Distance between heart and neck	-	12	-	-
Distance between breasts	-	12	-	-
Face	-	12	-	-
Wrist	-	-	-	12
Forearm	-	-	-	12
Leg (centre of calf muscle)	-	-	-	16
Distance between shoulder and elbow	-	16	-	-
Distance between elbow and tip of middle finger	-	24 (24 angula = 1 Hasta)	-	-
Upper limb	-	32	-	-
Distance between wrist and elbow		16	-	-
Hand	-	6	4	-
Distance between root of thumb and index finger	-	5	-	-
Distance between ear and outer corner of eyes	-	5	-	-
Middle finger	-	5	-	-
Index finger	-	4.5	-	-
Ring finger	-	4.5	-	-
Thumb	-	3.5	-	-
Little finger	-	3.5	-	-
Nostril	-	-	1/3	-
Distance between margin of hairs (above temples) and middle of skull	-	11	-	-
Distance between margin of hairs at back of neck and middle of skull	-	10	-	-
Distance between two ears through back of neck	-	14	-	-
Female chest***	-	-	18	-
Male waist	-	-	18	-
Entire body (from feet to tip of middle finger when a person stands straight with his hands raised upwards)	-	-	-	120

*Third, fourth and little toe are successively one-fifth shorter than the previous toe.

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

   Length of pupil=1/9^th length of cornea

***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. Although recent studies suggest that the breadth of finger can be approximated as 3⁄4^th of an inch or 1⁄16^th of a foot.

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.

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

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.

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. 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/

In relation to anthropometry

Pramantaha pariksha is like anthropometry (the systematic measurement of the 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.

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.

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. 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. 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. Kalpa Sthana 8/9], aragvadhadi arishta [Cha. Sa. Kalpa Sthana 8/15] and lodhra sura (beverage prepared from Symplocos racemosa) [Cha. Sa. 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.

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.

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.

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. 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.