Pratyaksha pramana

The word ‘pratyaksha pramana’ means first hand evidence. Pramana denotes sensory perception. Here the individual gains knowledge through the medium of sense organs. It is considered as the most primary and important tool for diagnosis, prognosis, inference, conclusion and treatment of the diseases according to Ayurveda. It is the means of acquiring knowledge through the medium of sense organs and self-experiences. The direct clinical examination of patient (pratyaksha pariksha) is vital for diagnosis of disease. It also involves the examination and assessment of complications (upadrava), and prognosis or impending death (arishta). The pacifying factors (upashaya) and aggravating factors (anupashaya) are observed by direct examination. Thus it forms the basis for anumana pramana. [Cha.Sa.Sutra Sthana 11/21]

Contributors

Section/Chapter/topic	Concepts/Pramana/Pratyaksha pramana
Authors	Bhojani M. K. 1, Joglekar A. A.2
Reviewer	Basisht G.3,
Editors	Deole Y.S.4 Basisht G.3
Affiliations	1 Department of Sharira Kriya, All India Institute of Ayurveda, New Delhi 2Department of Samhita Siddhant, All India Institute of Ayurveda, New Delhi 3 Rheumatologist, Orlando, Florida, U.S.A. 4 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 first publication:	January 20, 2022
DOI	10.47468/CSNE.2022.e01.s09.081

Etymology and derivation

The word ‘pratyaksha’ is derived from Sanskrit noun ‘aksha’ meaning ‘indriya’ or sense organs with prefix ‘pra’[Amarkosha]. 'Prati’ means expression or resemblance, while ‘aksha’ means sense organs.

Definition of pratyaksha

It is defined as cognition, definite (vyakta) and immediate (tadatva) knowledge arising from the conjugation of soul, senses, mind and the sense objects.[Cha.Sa.Sutra Sthana 11/20] (indriya-artha-sannikarsha) [Nyayasutra 1/1/14]. This perception is the knowledge devoid of doubt and error. The terms ‘Vyakta’ and ‘Tadatwa’ in the definition denote these characteristics. [Chakrapani on Cha.Sa.Sutra Sthana 11/20] Vyakta denotes pure or rightful knowledge devoid of doubt (samshaya), while the word ‘tadatwa’ denotes instantaneous knowledge obtained at the moment. This is devoid of memory or past knowledge (smriti).

Pratyaksha is knowledge obtained through senses (indriya) and mind (manas). [Cha.Sa.Vimana Sthana 4/4] Indriya pratyaksha involves conjugation of sense organs, mind and object. It is knowledge obtained through external source. Manas pratyaksha involves knowledge acquired by mind without conjugation of indriya with object or without sensorial perception. This resembles with insights or meditative knowledge. Manas pratyaksha is experience of happiness (sukhadi bhava), sorrow/distress (dukkha), desire(iccha) etc. by the mind itself. [Chakrapani on Cha.Sa. Vimana Sthana4/4]

Classification of knowledge obtained through pratyaksha

The knowledge obtained through pratyaksha can be full-fledged knowledge of an object with all its attributes (savikalpa) or Primary or non-determinate or non-conceptual perception (nirvikalpa). Savikalpa pratyaksha can again be divided as Direct (laukika) or Indirect (alaukika). As the indriya play a key role in obtaining the knowledge in case of pratyaksha pramana acharya Chakrapani has rightfully described the six types of indriya-arthasannikarsha (Conjugation or relation of sense organs and object of knowledge) given as below [Chakrapani on Cha.Sa.Sutra Sthana 11/20]

1. Sanyoga – conjunction of sense organ with object without knowing the detailed nature of the object. The examination of initial appearance of the patient or condition can be understood by this type of conjugation.
2. Sanyukta Samvaya- conjugation of sense organ with object along with knowledge of its nature and features. The concomitance (samvaya) of object and its attributes can also be determined with this type of sannikarsha. The further knowledge regarding the akruti or morphology of the patient e.g. built of patient i.e. sthulatwa or krishatwa i.e. obese or thin.
3. Sanyukta Samveta Samvaya- It is about inherited relationship between the attribute and the object which can be understood with this type of sannikarsha. For instance, the knowledge of colour of any object is testimony of this type of sannikarsha. E.g. The characteristics defining the obese (sthoulya) or lean (karshya) patient i.e. udara-sphika-stanachalana etc.
4. Samvaya - The relation between sound (shabda) and ear (karna) can be understood with this sannikarsha. This type of conjugation is used to comprehend the relationship between akasha mahabhuta and shabda guna. The logic behind the sensation of sound is explained by this type of sannikarsha.
5. Samveta Samvaya- Here the quality of the sound (shabdaguna) is understood as well. The knowledge about the quality of shabda or shabdatwa can be understood by this type of sannikarsha. For example, the kshamatwa , karkashatwa of voice is denoted by this type of sannikarsha.
6. Visheshya Visheshana Abhaava- The knowledge of unknown object is made with the help of this sannikarsha. For instance, the void or free space denotes the absence of solid object at that place. For instance, the presence of normalcy in body tissues (dhatu samya) or arogyalakshana denotes the absence of disease (roga).

Process of obtaining knowledge

The process of obtaining knowledge by direct perception involves the connection of soul (atma) with mind (mana) at first. Then the mind connects with the senses (indriya) to acquire proper knowledge of respective object.

Obstacles in direct perception

Following are the obstacles in the direct perception of knowledge.

1. If the object is too far (ati-durat), or too close (atisannikrushtat) to the senses
2. If there is hindrance (avarana) to perception of knowledge
3. If the senses are weak or not functioning properly (karana daurbalyat)
4. If the mind is unstable or not concentrated to gain knowledge (mano-anavasthanat)
5. If there are too many similar objects (samanabhiharat)
6. If there is overshadowing (abhibhavat)
7. If the objects are too minute or subtler to sense (saukshmyat) [Cha.Sa.Sutra Sthana 11/8]

Classification of sensory perception (indriya pratyaksha)

The sensory perception (indriya pratyaksha) can be classified into five types based on the sense organ (indriya) involved

• Auditory perception (shrotra pratyaksha)
• Tactile perception (sparshana or twacha pratyaksha)
• Visual perception (chakshusha pratyaksha)
• Gustation or lingual perception (rasana pratyaksha)
• Olfactory perception (ghranaja pratyaksha)

Importance of concept

Direct perception is extensively employed for clinical examination of patient, disease and identification of raw as well as prepared drugs.

Application in clinical examination of patient and disease

The physician gains knowledge about the status of patient condition and disease manifestation with the help of pratyaksha pramana through sense organs. [Cha.Sa.Vimana Sthana 4/7] This constitutes six types of clinical examination (shadvidhapariksha) with addition of interrogation to know details of diseases.[Su.Sa. Sutra Sthana 10/4]

1) Auditory perception/ auscultation / percussion (shrotra pariksha)

Auditory perception is useful to understand pathology in various conditions through the medium of sound (shabda).

E.g.-

• Gurgling sound in intestines (antrakujana) or examination of intestinal peristalsis
• Crepitus in joints, cracking or popping sounds in joints (sandhisphutanaanguliparvana)
• Assessment of voice of the patient (swaravishesha)
• Other specific sounds like hiccups, breath, cough, burping (shariropagatashabda)

The modern technological advancement led to invention of many instruments that help to assess these sounds. Stethoscope is instrument vital for auscultation of lung (for pulmonary sounds), auscultation of heart for cardiac sounds, abdominal auscultation for peristalsis, bruits etc. Ultrasonography technique also uses the sound waves as a medium for the detection of internal organ pathology. Many methods are also being developed to perform voice assessment using different imaging techniques.

2) Tactile perception / palpation (sparshana or twacha pratyaksha)

The physician palpates patients for examination. Here the tactile perception (or sparshanendriya) is medium to gain knowledge about normal or abnormal characters of the body. The heat/hotness (aushnya), coldness (shaitya), softness (mardava), hardness (kathinya), smoothness (shlakshna), roughness (kharata) can be perceived. Thus the temperature, skin texture, dryness, roughness of the skin, different organs, hair and lesions on the body can be assessed with the help of this pratyaksha. For instance, coldness of body (gatra-shaitya) indicates depletion of pitta dosha (kshaya); hotness (aushnya) indicates fever (jwara). Soft skin (twak mardava) is the characteristic of pitta and kapha dominant prakriti. Hardness (kathinya) is mentioned in ascites (udara), splenomegaly (pleeha), prostatic enlargement (asthila). Smoothness (shlakshnata) is characteristic of kapha prakriti, while roughness (kharata) of skin, hairs etc. is seen in vata prakriti individuals. It is comparable with the palpation of the body to understand the body temperature, pulse diagnosis, tenderness, rigidity, lump or growth, lymphadenopathy, organomegaly, size of palpable organs, its borders, surface etc.

3) Visual inspection (darshana or chakshushya pratyaksha)

Through the medium of visual perception (chakshu indriya) or netra, the complexion (varna), shape, location, appearance, form (sansthana), size or measurements (pramana), altered complexion (chhaya), normalcy (prakriti), abnormal characteristics (vikriti), good nourished built (upachaya), malnourished built (apachaya) can be assessed. The advent of investigation techniques like endoscopy, proctoscopy, fundoscopy, colonoscopy, X-ray techniques ultrasonography, microscopy, electron microscopy, CT (computer tomography) scans and MRI (magnetic resonance imaging) have made the visual inspection (darshana pariksha) more precise.

Visual inspection is done to assess the abnormalities like pallor, cyanosis, oedema, petechial hemorrhage, skin lesions, deformities etc.

4) Gustation (rasanapariksha)

This examination is applicable for the purpose of organoleptic and taste threshold studies. In clinical practice, this can’t be done by physician himself. It is done indirectly either by interrogation or by inspection/inference. It is not subjected to direct perception by the examiner but can be ascertained by inference (anumana pramana). Following phenomena can be observed by means of this method-

1. Yuka sansparshena shareeravairasya: Repulsion of parasites or organisms like lice from the patient’s body indicates the impairment of body physiology resulting in the attraction or repulsion of the insects from the body.
2. Makshikopasarpanena shariramadhurya: Attraction of flies towards patient indicates excessive sweetness (atimadhurya) in the body
3. Lohitapitta sandeha: The differentiation between the vitiated and pure blood is done by this technique. It is also indicated in the differential diagnosis of conditions like bleeding disorders (raktapitta). To determine the nature of the blood, whether pure or vitiated, it should be fed to dog or crows. Acceptance or consumption of blood indicates purity, while rejection refers to impurity.
4. Aruchi, aasyavairasya: The impairment of taste of the patient can be assessed by the method of interrogation.
5. Mutre pippilikaabhisarpana: As indicated in diabetes with obstinate urinary disorders (prameha), this refers to the excessive sweetness in urine (mutra) and body.

5) Olfactory perception (ghrana pratyaksha or gandha pariksha)

In this method, olfactory perception helps to examine the smell of body fluids or body odour. The olfactory perception is used to determine the abnormality. For instance, the blood (rakta) and menstrual blood (artava) have specific smell of blood (vistra gandha), oja has smell of parched or fried grain (laja gandha), reproductive fluids (shukra) has smell similar to honey (madhu gandha). The discharges from wound (vrana strava) are of 14 types having smells like purulent, foul smell, unpleasant smell.

Halitosis or bad breath is the common feature of dental problems, diabetes etc. Urine and feces have their typical ammoniac smell and deviation from same may indicate abnormality. Similarly foul-smelling discharge from wounds, sinuses, vagina etc. indicates underlying pathology. The putrefaction indicates the release of foul smell from the body is feature of cell death.

Assessment of other important parameters:

Besides the above-mentioned types of sensory perception many other entities can be assessed using the direct examination (pratyaksha pramana).

Table 1: Other factors that can be determined with the help of Pratyaksha pramana

Ayu (life and lifespan)	For assessment of age (vaya), bad prognostic signs (arishta lakshana)
Dosha	For assessment of function (karma), symptoms of vitiation, hypo-function of dosha, dhatu and mala; natural and pathological sites (sthana) of dosha.
Bala (strength)	Ten types of examination (dashavidhapariksha bhava) assess the strength of the patient (rugnabala), status of dosha (doshabala) and severity of disease (vyadhibala). These are based on the pratyaksha pramana.
Aushadha and dravya pariksha (standard medicine)	Structure, morphology of the herb used (swarupa), action (karma) of the drug, organoleptic examination of herb
Yantra shashtra pariksha (Examination of the surgical instruments)	The appearance of surgical instruments (Yantra swarupa), use of instrument (karma) can be known by pratyaksha pramana. Yogyavidhi (ancient technique of simulation-based surgical learning) is also an example of the same.

As a tool for teaching and learning methodology

Pratyakshapramana, being direct perception and experiential type of knowledge, has wide application for both learning and teaching of various concepts of Ayurveda. One who is able to attain both practical and theoretical knowledge becomes successful physician. [Su.Sa.Sharira Sthana 5/48] Thus, a surgeon should dissect the human cadaver to know anatomical aspects of every organ in the body before performing surgeries. Mere theoretical knowledge cannot be successful in treatment of the patient and can tend to cause potential harm to the health of patient. [Su.Sa.Sutra Sthana 3/48] The importance of practical knowledge of the physician is highlighted. Extensive practical experience (drishtakarma), proficiency in performing different types of procedures (kriyavana) are important qualities of a physician (Vaidya). [Cha.Sa. Sutra Sthana 9/4-6] The education system explained in Ayurveda is largely based on the direct observational knowledge obtained through the medium of pratyakshapramana. Thus, teaching of Ayurveda and its principles should be based on the practical application of the concepts. The effect of treatment on the patients, the conditions like dosha-avastha, vyadhi- avastha should be observed by the students of Ayurveda themselves to acquire complete knowledge of Ayurveda. This method can be correlated with the psychomotor domain of the bloom’s taxonomy.

As research tool

All the pramana are the tools to unravel the knowledge regarding the unknown phenomena through systematic and logical steps. Pratyakshapramana refers to the knowledge acquirement by direct observation or practical experiences. The primary collection of data involves application of pratyakshapramana, in which the researcher notes the phenomena directly observed by him/her. This is essential part of different randomised controlled studies, case studies and observational studies.

Contemporary approach

It is believed that the physicians that are well versed with the art of physical examination are more likely to make correct diagnosis. Thus, the direct observation made by the examining physician plays key role in diagnosis and treatment. With the advent of advancement in the field of diagnostic technologies, patient management has been revolutionized. The invention of various radiological and imaging techniques like X-ray, MRI, CT Scan, Angiography, USG and Doppler, endoscopy, laparoscopy techniques has changed the face of modern medicine. These all help to assess and witness the internal human pathology that otherwise can escape the physical examination. These are the examples of extended application of pratyaksha pramana as they help to visualize the body mechanism. The development pertaining to interactive learning and teaching techniques is also an application of pratyaksha pramana. The practical or hands on sessions in different workshops are examples of the same.

Limitations of pratyaksha pramana

The scope of direct observation is very limited for an individual, as there are infinite and unknown phenomena that cannot be assessed by pratyaksha alone.[Cha.Sa.Sutra Sthana 11/7] There are hindrances to acquirement of knowledge through the medium of pratyaksha as mentioned earlier. Thus, many times it is necessary to combine the knowledge from all sources like authoritative statements (aaptopadesha), analogy (upamana), inference (anumana), logical reasoning (yukti) to acquire correct knowledge regarding any phenomena. One who might have practical experience regarding different treatment procedures and surgical interventions, but lacks theoretical and fundamental knowledge cannot succeed in endeavors and does not gain validation from peers and authority. [Su. Sa. Sutra Sthana 3/49] Thus, the knowledge of pratyaksha should be combined with the theoretical study to obtain precision and proficiency in treatment.

Research articles

1. Dilip Kumar G in his editorial note for the Journal of Natural & Ayurvedic Medicine has discussed the basic concept of pratyaksha along with the exceptions for direct observations.
2. Prashant Kumar Jhas explained the concept of pratyakshapramana in purview of Indian philosophy and epithetical basis of the same.
3. Brooks in his article, “Epistemology and Embodiment: Diagnosis and the Senses in Classical Ayurvedic Medicine” explained the application of epistemology and philosophy for the purpose of diagnosis of different diseases according to Ayurveda.
4. R. Bhat explained the concept of pratyaksha to understand the disease pathology according to contemporary science by explanation of various terms related to the concept.
5. Bhalerao S. discussed that observational and instrumentation skills can be correlated as extension of knowledge of pratyaksha and form the psychomotor domain of blooms taxonomy.
6. Aparna S. et al. has explained the consideration of pratyaksha badhakara bhava as method to rectify the knowledge obtained through pratyaksha.
7. Ankita A. has explored the role of different pramana as research tools considering the pratyaksha pramana as tool for data collection and observation.

Related chapters

Tistraishaniya Adhyaya, Rogabhishagjitiya Vimana, Trividha Roga Vishesha Vijnaniya Vimana Adhyaya, Pramana, Anumana pramana,Aaptopadesha pramana,Yukti pramana, Upamana pramana, Apamarga Tanduliya Adhyaya, Concepts and Contemporary Practices.

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