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Rogabhishagjitiya Vimana (view source)

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=== Introduction ===

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== Introduction ==

The preceding chapter [[Vyadhita Rupiya Vimana]] the seventh chapter dealt with knowledge of diseased person. The present chapter guides an aspiring student who wishes to be a successful physician. It is important to know the scope, depth and reputation of the branch of health science to be studied which is obtained by ''shastra pariksha'' (review of literature). Secondly, the examination of the preceptor (''acharya'') who teaches the science of [[Ayurveda]] is important because it is he, who enlightens the students with the knowledge of the health science. The chapter further deals with means of learning of health sciences (''shastra upaya''), methodology of study (''adhyayana vidhi'') and teaching (''adhyapana'') along with when and how to begin academic session and Do’s and Dont’s by the student have been explained so that a student attains the depth of knowledge about the health science. It also details about medical ethics while in practice and guidelines for behaviour of doctor at a patient’s house.

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=== Sanskrit Text, Transliteration and English Translation ===

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== Sanskrit Text, Transliteration and English Translation ==

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Now we shall expound the chapter ~~on [[~~Rogabhishagjitiya Vimana]] (~~the methods~~ of conquering debate and disease). Thus said Lord Atreya. [1-2]

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Now we shall expound the chapter "Rogabhishagjitiya Vimana" (Methods of conquering debate and disease). Thus said Lord Atreya. [1-2]

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==== Selection of medical treatise ====

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== Selection of medical treatise ==

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==== Search of ideal preceptor ====

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== Search of ideal preceptor ==

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The teacher holding such qualities quickly inculcates physician’s qualities in his disciple as the seasonal cloud furnishes good crop in a suitable land. [4]

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==== Means of learning in medical science ====

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== Means of learning in medical science ==

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The means for enhancing depth of knowledge are- study, teaching and discussion with authorities. [6]

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==== Method of study ====

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== Method of study ==

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==== Characteristics of ideal student and method of teaching ====

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== Characteristics of ideal student and method of teaching ==

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*following all the instructions of the teacher and being attached to his teacher.[8]

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==== Commencement of academic session/teaching ====

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== Commencement of academic session/teaching ==

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The disciple should follow him. After offering oblations he should go round the fire keeping it to the right side, than ''brahmanas'' should recite ''svasti''. At the end, he should pay regards to the physicians in the society. [12]

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==== Code of conduct for medical student and professional ====

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== Code of conduct for medical student and professional ==

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==== Method of conducting discussion in seminars and symposia of experts ====

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== Method of conducting discussion in seminars and symposia of experts ==

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==== Two types of discussions ====

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== Two types of discussions ==

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Discussion with experts is of two types- friendly discussion and hostile discussion. [16]

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==== Friendly discussion ====

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== Friendly discussion ==

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==== Hostile discussion ====

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== Hostile discussion ==

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==== Three categories of opponent ====

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== Three categories of opponent ==

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The opponent may be of three types – superior, inferior or equal, according to the above mentioned qualities for discussion and not all aspects .[19]

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==== Types of assembly ====

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== Types of assembly ==

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==== Summary of discussion technique ====

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== Summary of discussion technique ==

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In a hostile discussion, one should speak reasonably and should not withdraw the words once spoken. A hostile speech gives rise to strong agitation in some persons. The agitated person, may do some unfavourable things or may speak some unwanted words. Hence the wise do not recommend quarrel in the assembly of noble persons. Thus one should perform in discussion initiated. [22-24]

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==== Guidelines for preparation before initiation and recording the debate ====

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== Guidelines for preparation before initiation and recording the debate ==

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The result of the discussion should be recorded like this; this is worth-speaking, this is not worth-speaking, therefore one has been defeated. [26]

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==== Terms for debate ====

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== Terms for debate ==

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These terms are worth-knowing for acquaintance of the course of discussion among physicians such as – ''vada, dravya, guna, karma, samanya, vishesha, samavaya, pratijna, sthapana, pratishthapana, hetu, drishtanta, upanaya, nigamana, uttara, siddhanta, shabda, pratyaksha, anumana, aitihya, aupamya, samshaya, prayojana, savyabhichara, jijnasa, vyavasaya, arthaprapti, sambhava, anuyojya, ananuyojya, anuyoga, pratyanuyoga, vakyadosha, vakyaprashamsa, chhala, ahetu, atitakala, upalambha, parihara, pratijnahani, abhyanujna, hetvantara, arthantara, nigrahasthana.'' [27]

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===== 1. ''Vada'' (debate) =====

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=== 1. ''Vada'' (debate) ===

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''Vitanda'' is opposite to ''jalpa''. For instance, one holds the view that rebirth exist while the other holds the view just against it. During such discussion (''vada''), they (participants) advance arguments in support of their own views and contradict the opponent’s view, this is ''jalpa''. ''Vitanda'' is opposite to ''jalpa'' in which the speaker without having any positive approach only finds faults in the opponent’s view point. [28]

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===== 2-7: ''Dravya'' to ''Samavaya'' =====

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=== 2-7: ''Dravya'' to ''Samavaya'' ===

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''Dravya, guna, karma, samanya, vishesha and samavaya''– these are mentioned earlier along with their definitions in ''shloka sthana'' ([[Sutra Sthana]] chapters). [29]

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===== 8. ''Pratijna'' (proposition) =====

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=== 8. ''Pratijna'' (proposition) ===

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''Pratijna''(proposition) is the statement which is to be proved. For instance, ''purusha'' is eternal. [30]

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===== 9. ''Sthapana'' (establishment) =====

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=== 9. ''Sthapana'' (establishment) ===

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''Sthapana'' is establishing the same proposition on firm ground with the help of ''hetu'' (reason), ''drishtanta'' (instance), ''upanaya'' (correlation) and ''nigamana'' (conclusion). First there is proposition (''pratijna'') and then establishment (''sthapana'') because what can be established (nothing) in absence of proposition? For instance, ‘''purusha'' is eternal’ – this is proposition, reason (''hetu'') is - ‘because of not being created’; instance (''drishtanta'') is – ‘as sky’; correlation (''upanaya'') is – ‘as the sky is uncreated and is eternal so is ''purusha''’; conclusion (''nigamana'') is - ‘therefore, ''purusha'' is eternal.’[31]

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===== 10. ''Pratishthapana'' (counter-assertion) =====

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=== 10. ''Pratishthapana'' (counter-assertion) ===

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''Pratishthapana'' is giving a contrary statement to the opponent’s proposition. For instance, ‘self is non-eternal’ is proposition (''pratijna''); reason (''hetu'') is-‘because of being perceived by senses’; instance (''drishtanta'') is – ‘as pitcher’; correlation (''upanaya'') is – ‘as pitcher is perceived by senses and is non-eternal so is ‘self’; conclusion (''nigamana'') is – therefore, self is non eternal.[32]

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===== 11. ''Hetu'' (cause) =====

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=== 11. ''Hetu'' (cause) ===

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''Hetu'' is the cause of knowledge such as ''pratyaksha'' (direct perception), ''anumana'' (inference), ''aitihya'' (traditional instruction) and ''aupamya'' (analogy). That which is revealed by these reasons is ''tattva'' (truth).[33]

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===== 12. ''Drishtanta'' (instance) =====

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=== 12. ''Drishtanta'' (instance) ===

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''Drishtanta'' is that which arouses alike understanding in the fools and the learned. It presents a picturesque image of the objective to be defined. For instance, hot like fire, fluid like water, stable like earth and illuminating like the sun, as the sun illuminates similarly the knowledge of the ''Sankhya'' is also illuminating. [34]

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===== 13-14. ''Upanaya'' (correlation) and ''Nigamana''(conclusion) =====

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=== 13-14. ''Upanaya'' (correlation) and ''Nigamana''(conclusion) ===

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''Upanaya'' and ''Nigamana'' are explained under the headings ''sthapana'' and ''pratishthapana''.[35]

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===== 15. ''Uttara'' (rejoinder) =====

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=== 15. ''Uttara'' (rejoinder) ===

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''Uttara'' is the statement made in opposition (heterogeneous) to the homologous nature shown between ''hetu'' and ''karya'' and vice versa. For instance , if somebody says – disorders are similar to cause, as ''shitaka'' disease has similar causes like exposure to snow and cold wave, the opponent may say – disorders are dissimilar to cause as burning sensation, heat, sloughing and suppuration of body parts are caused by cold wave which is dissimilar. This is ''uttara'' (rejoinder) with contrary statements.[36]

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===== 16. ''Siddhanta'' (theory/doctrine) =====

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=== 16. ''Siddhanta'' (theory/doctrine) ===

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These are four types of doctrines. [37]

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===== 17. ''Shabda'' (word/correct expression) =====

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=== 17. ''Shabda'' (word/correct expression) ===

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''Anrita'' is contrary to ''satya'' (that which is not consistent with facts).[38]

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===== 18. ''Pratyaksha'' (direct perception) =====

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=== 18. ''Pratyaksha'' (direct perception) ===

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''Pratyaksha'' is the knowledge which is directly perceived by the self and the sense organs. Self-perceived are pleasure, pain, desire, aversion etc., while sound etc. are perceived by the sense organs.[39]

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===== 19. ''Anumana'' (inference) =====

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=== 19. ''Anumana'' (inference) ===

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''Anumana'' is the reasoning supported by invariable concomitance such as the knowledge of ''agni'' (is examined) by the power of digestion; that of strength of a person by examining the power to exercise, auditory organ etc. by the ability of perception of sound, etc.[40]

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===== 20. ''Aitihya'' (traditional instruction) =====

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=== 20. ''Aitihya'' (traditional instruction) ===

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''Aitihya'' is the divine authoritative (or traditional) source of knowledge such as ''veda'' etc.[41]

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===== 21.''Aupamya'' (analogy) =====

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=== 21.''Aupamya'' (analogy) ===

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''Aupamya'' is the description of similarity between things such as analogy of ''dandaka'' (a disease in which body is rigid like rod) with ''danda'' (rod); that of ''dhanustambha'' (tetany) with bow and that of the health provider with the archer.[42]

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===== 22. ''Samshayah'' (uncertainity) =====

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=== 22. ''Samshayah'' (uncertainity) ===

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''Samshayaḥ'' is the state of indecision about the concerned entity. For instance, on observing that both types of persons having signs of longevity or not and they adopting the therapeutic measures or not – die early or live long life, therefore doubt arises as whether there is untimely death or not .[43]

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===== 23. ''Prayojana'' (purpose or intention) =====

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=== 23. ''Prayojana'' (purpose or intention) ===

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''Prayojana'' is that for which the actions is initiated. Such as – ‘if there is untimely death then I will use life-promoting measures and avoid the contrary ones. In such condition how would the untimely death subdue me?[44]

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===== 24. ''Savyabhichara'' (incompatible argument) =====

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=== 24. ''Savyabhichara'' (incompatible argument) ===

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''Savyabhichara''is that argument incompatible with the conclusion drawn from it, such as ‘this medicine may or may not be applicable to this disease.’[45]

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===== 25. ''Jijnasa'' (examination) =====

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=== 25. ''Jijnasa'' (examination) ===

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''Jijnasa'' is the examination. Such as- the examination of drugs will be described later on.[46]

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===== 26. ''Vyavasaya'' (resolution) =====

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=== 26. ''Vyavasaya'' (resolution) ===

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''Vyavasaya'' is resolution or firm decision, such as- this disease is certainly ''vataja'' and this is the medicament for this.[47]

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===== 27. ''Arthaprapti'' ( attainment of meaning) =====

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=== 27. ''Arthaprapti'' ( attainment of meaning) ===

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''Arthaprapti'' is that where another unsaid idea is conveyed by the said one, such as when one says that the disease is not to be managed with saturating therapy it implies that it is to be managed with desaturation therapy. He should not eat during day, implies that he should eat during night. [48]

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===== 28. ''Sambhava'' (source) =====

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=== 28. ''Sambhava'' (source) ===

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''Sambhava'' is that from which something is originated, such as six dhatus from which foetus has origin, disease have origin from unwholesome things and health have origin from wholesome things.[49]

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===== 29. ''Anuyojya'' (censurable) =====

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=== 29. ''Anuyojya'' (censurable) ===

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''Anuyojya''–is that where sentence is defective or has unspecified meaning inviting further questions, such as if somebody says ‘the disease is to be managed with evacuative therapy’ it invites further question as to ‘whether it is to be managed with emesis or purgation.[50]

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===== 30. ''Ananuyojya'' (incensurable) =====

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=== 30. ''Ananuyojya'' (incensurable) ===

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''Ananuyojya'' is contrary to the above. Such as this is incurable.[51]

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===== 31. ''Anuyoga'' (query with example) =====

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=== 31. ''Anuyoga'' (query with example) ===

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''Anuyoga'' is that which is put as query, wholly or partly, on the text or its part during discussion of experts for the test of learning, understanding, speaking and contradiction, such as on the statement of self eternal, somebody says, what is the reason, this is ''anuyoga''. [52]

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===== 32. ''Pratyanuyoga''(counter-question)=====

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=== 32. ''Pratyanuyoga''(counter-question)===

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''Pratyanuyoga'' is questioning the questions, such as when ''anuyoga'' i.e query has been raised then again questioning what is the reason of this query is called as ''pratyanuyoga'' .[53]

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=====33. ''Vakyadosha'' (syntactical defects)=====

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===33. ''Vakyadosha'' (syntactical defects)===

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Now convention (''samaya'') is of three types – ''Ayurvedic samaya, yajnika samaya,'' (ritual) and ethical (''mokshashastrika''). Ayurvedic ''samaya'' (ayurvedic convention) such as four aspects of health care, ''yajnika samaya'' (ritual convention) such as animals are to be sacrificed by persons following rituals, ''mokshashastrika'' (ethical convention) such as non-violence towards all creatures. The statement incongruous in respect of the respective convention is taken as ''viruddha'' (incongruity). Thus are the ''vakyadosha'' (syntactical defects).[54]

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=====34.''Vakyaprashamsa'' (syntactical excellence) =====

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===34.''Vakyaprashamsa'' (syntactical excellence) ===

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''Vakyaprashamsa'' (syntactical excellence) is that where the statement is free from deficiency (''anyunam'') and superfluity (''anadhikam''), is meaningful (''arthavat''), devoid of deprivation of meaning (''anaparthaka'') and incongruity (''aviruddham'') and comprehensible (''adhigatapadartham''). Further there is no room for any question. Such statement is commended. [55]

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===== 35. ''Chhala'' (knavery) =====

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=== 35. ''Chhala'' (knavery) ===

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''Samanya chhala'' (knavery in general), such as – when somebody says – medicament is for alleviating the disease. The other says – how do you say the existent is for alleviating the existent because disease is existent and also the medicament, if the existent is capable of alleviating the existent, then both cough and wasting being existent, cough may be able to alleviate wasting. This is a knavery in general. [56]

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===== 36. ''Ahetu'' (fallacious reason) =====

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=== 36. ''Ahetu'' (fallacious reason) ===

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''Varnyasam ahetu''- the reason (''hetu'') given is similar to object and not different from the object, such as somebody says – ''buddhi'' (intellect) is non-eternal because of the absence of touch like ''shabda'' (sound). Here both ''buddhi'' (intellect) and ''shabda'' (sound)are objects; hence because of the absence of difference between them, the reason is similar to object and as such is fallacious.[57]

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===== 37. ''Atitakala'' (delayed performance) =====

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=== 37. ''Atitakala'' (delayed performance) ===

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''Atitakala'' is that which actually was to be said earlier but is said later, and because of delayed presentation becomes unacceptable. For instance, if somebody does not defeat the opponent at the opportune moment but applies it on some other point later on, then, because of delayed application that becomes quite ineffective. [58]

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===== 38. ''Upalambha'' (pointing defects in causality) =====

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=== 38. ''Upalambha'' (pointing defects in causality) ===

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''Upalambha'' is pointing out defects in causality as explained earlier under the heading ''hetu'' fallacious or apparent reason which is unable to prove the ''sadhya''.[59]

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===== 39. ''Parihara'' (refuting defects) =====

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=== 39. ''Parihara'' (refuting defects) ===

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''Parihara'' is refuting the above points out of defects, such as the signs of life are available constantly till the life is in the body, and are not available after it goes out. Therefore, the ''atma'' (self) is different from the body and is eternal.[60]

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===== 40. ''Pratijnahani'' (change of proposition) =====

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=== 40. ''Pratijnahani'' (change of proposition) ===

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''Pratijnahani'' is defined as when one gives up the original proposition after having been questioned. For instance, somebody puts proposition in the beginning as, the self (''purusha'') is eternal, but when questioned says that it is non-eternal then such change of proposition after questioning is called as ''Pratijnahani''.[61]

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===== 41. ''Abhyanujna'' (acceptance) =====

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=== 41. ''Abhyanujna'' (acceptance) ===

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''Abhyanujna'' is acceptance of the desired as well as the undesired situations.[62]

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===== 42. ''Hetvantara'' (change in statement of cause) =====

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=== 42. ''Hetvantara'' (change in statement of cause) ===

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''Hetvantara'' is that where some imperfect reason (''vikritahetu'') is stated instead of perfect reason (''prakritahetu''). [63]

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===== 43. ''Arthantara'' (statement of irrelevant meaning) =====

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=== 43. ''Arthantara'' (statement of irrelevant meaning) ===

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''Arthantara'' is that where some other thing is said instead of the relevant one. For instance, one has to say the symptoms of ''jwara'' (fever) but instead he says those of ''prameha''.[64]

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===== 44.''Nigrahasthana'' (stage of defeat and its reasons) =====

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=== 44.''Nigrahasthana'' (stage of defeat and its reasons) ===

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Thus the terms used in course of debate are explained as proposed.[66]

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==== Importance of debate ====

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== Importance of debate ==

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</div>

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==== Ten means of knowledge for physician ====

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== Ten means of knowledge for physician ==

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Now I shall explain some topics for the knowledge of physicians because the wise commend initiation of all actions with prior knowledge. If after knowing well ''karana, karana, karyayoni, karya, karyaphala, anubandha, desha, kala, pravritti'' and ''upaya'' one proceeds for some action, he obtains the desired fruit and subsequent benefit in that without any great effort.[68]

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===== ''Karana'' (cause or doer) =====

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=== ''Karana'' (cause or doer) ===

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''Karana'' is defined as the one who does the action, he is the cause and doer.[69]

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===== ''Karana'' (means or equipments) =====

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=== ''Karana'' (means or equipments) ===

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''Karana'' is that which serves as means or equipment for the ''karana'' (doer) making effort for performing the action.[70]

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===== ''Karyayoni'' (source) =====

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=== ''Karyayoni'' (source) ===

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''Karyayoni'' is that which (intimate cause) is converted into action (''karya'') after transformation. [71]

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===== ''Karya'' (action) =====

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=== ''Karya'' (action) ===

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''Karya'' is that action which the doer performs with the objective of accomplishment. [72]

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===== ''Karyaphala'' (expected outcome) =====

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=== ''Karyaphala'' (expected outcome) ===

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''Karyaphala'' is the aim (expected outcome) with which the action is performed. [73]

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===== ''Anubandha''(consequence) =====

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=== ''Anubandha''(consequence) ===

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''Anubandha'' is that which essentially enjoins the doer as after-effect of the action, good or bad. [74]

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===== ''Desha''(place) =====

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=== ''Desha''(place) ===

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''Desha'' is location/ place.[75]

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===== ''Kala'' (time required for transformation) =====

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=== ''Kala'' (time required for transformation) ===

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''Kala'' is the one which undergoes transformation.[76]

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===== ''Pravritti'' (consistent efforts) =====

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=== ''Pravritti'' (consistent efforts) ===

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''Pravritti'' is the effort taken for the accomplishment of objective. This is also known as ''kriya, karma'' (action), ''yatna''(effort), ''karyasamarambha'' (commencement). [77]

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===== ''Upaya'' (means of successful management) =====

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=== ''Upaya'' (means of successful management) ===

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</div>

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==== Importance of ten fold examinations ====

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== Importance of ten fold examinations ==

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These ten entities should be examined first and thereafter one should proceed for action. Hence the physician desirous of taking up action should beforehand examine the entire situation by proper methods and then initiate the action(treatment). [79]

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==== Questions for discussion ====

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== Questions for discussion ==

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</div>

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==== Types of examinations ====

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== Types of examinations ==

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There are two types of examination for learned persons – direct perception (''pratyaksha'') and inference (''anumana''). These two along with the authoritative instruction constitute the examination. This examination is of two types or of three types including authoritative instruction (''upadesha'').[83]

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==== Ten factors for examination in therapeutics ====

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== Ten factors for examination in therapeutics ==

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So, these entities should be specifically examined with great emphasis.[85]

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==== Assessment of physician and qualities of good physician ====

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== Assessment of physician and qualities of good physician ==

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</div>

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==== Assessment of medicine and categories ====

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== Assessment of medicine and categories ==

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</div>

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==== Assessment of disequilibrium of ''dhatu'' ====

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== Assessment of disequilibrium of ''dhatu'' ==

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</div>

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==== Assessment of equilibrium of ''dhatu'' ====

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== Assessment of equilibrium of ''dhatu'' ==

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</div>

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==== Outcome of therapeutic management ====

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== Outcome of therapeutic management ==

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The result of the act (''karyaphala'') is attainment of happiness. It is featured as satisfaction of mind, intellect, sense organs and the body pleasure.[90]

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==== Consequence of therapeutic management ====

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== Consequence of therapeutic management ==

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After effect (''anubandha'') is life and it is characterized by union with ''prana''(vitality).[91]

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==== Field of action and its assessment ====

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== Field of action and its assessment ==

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</div>

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==== Examination of patient ====

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== Examination of patient ==

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</div>

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==== ''Prakriti pariksha'' (Assessment of basic constitution of patient) ====

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== ''Prakriti pariksha'' (Assessment of basic constitution of patient) ==

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</div>

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==== Characteristics of ''kapha prakriti'' ====

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== Characteristics of ''kapha prakriti'' ==

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</div>

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==== Characteristics of ''pitta prakriti'' ====

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== Characteristics of ''pitta prakriti'' ==

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</div>

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==== Characteristics of ''vata prakriti'' ====

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== Characteristics of ''vata prakriti'' ==

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In persons having equilibrium of all ''dhatus'', the characters of all of the three are found. Thus one should examine the constitution.[100]

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==== Assessment of ''vikriti'' (disorder) ====

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== Assessment of ''vikriti'' (disorder) ==

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</div>

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==== Assessment of ''sara'' (best qualities of body tissues) ====

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== Assessment of ''sara'' (best qualities of body tissues) ==

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Moreover a patient should be examined in respect of ''sara'' i.e. (best qualities of body tissues). There are eight types of ''sara'' in human beings which are described here for the knowledge of degree of strength such as –''tvak, rakta, mamsa, meda, asthi, majja, shukra'' and ''sattva''.[102]

−

===== Characteristics of ''twak sara'' (best quality of skin) =====

+

=== Characteristics of ''twak sara'' (best quality of skin) ===

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</div>

−

===== Characteristics of ''rakta sara'' (best quality of blood tissue) =====

+

=== Characteristics of ''rakta sara'' (best quality of blood tissue) ===

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In persons with essence of ''rakta'' have there ear, eye, face, tongue, nose, lips, palms, soles, nails, forehead and genitals to be unctuous, red, beautiful and shining. This essence indicates happiness, sharp intellect, magnanimity, tenderness, moderate strength, lack for endurance and intolerance to heat.[104]

−

===== Characteristics of ''mamsa sara'' (best quality of muscular tissue) =====

+

=== Characteristics of ''mamsa sara'' (best quality of muscular tissue) ===

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</div>

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===== Characteristics of ''meda sara'' (best quality of lipid tissues) =====

+

=== Characteristics of ''meda sara'' (best quality of lipid tissues) ===

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The person endowed with essence of ''meda'' have significant unctuousness specifically in complexion, voice, eyes, hair, skin hairs, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[106]

−

===== Characteristics of ''asthi sara'' (best quality of bone) =====

+

=== Characteristics of ''asthi sara'' (best quality of bone) ===

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Person with ''asthi sara'' has prominent heels (''parshni''), ankles (''gulpha''), knee joint (''janu''), elbows (''aratni''), collarbones (''jatru''), chin (''chibuka''), head (''shira''), flanks (''parshva'') and joints and also bones and teeth. Such persons are excess enthusiastic, very active, enduring, having strong and firm body as well as longevity.[107]

−

===== Characteristics of ''majja sara''(best quality of bone marrow tissue) =====

+

=== Characteristics of ''majja sara''(best quality of bone marrow tissue) ===

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The persons with soft body parts, strong, unctuous complexion and sweet voice, prominent (''sthula''), long (''dirgha'') and rounded joints should be known as ''majjasara'' (or the essence of''majja''). They are long-lived, strong and endowed with learning ability, wealth, understanding, progeny and respectful image.[108]

−

===== Characteristics of ''shukra sara''(best quality of reproductive tissues) =====

+

=== Characteristics of ''shukra sara''(best quality of reproductive tissues) ===

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</div>

−

===== Characteristics of ''sattva sara'' (best quality of mind) =====

+

=== Characteristics of ''sattva sara'' (best quality of mind) ===

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</div>

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==== Characteristics of ''sarva sara'' (best quality of all tissues) ====

+

== Characteristics of ''sarva sara'' (best quality of all tissues) ==

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</div>

−

==== Characteristics of ''Asara'' (no/low quality of tissues) ====

+

== Characteristics of ''Asara'' (no/low quality of tissues) ==

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And those persons having no or less essence of tissues are contrary to these individual.[112]

−

==== Characteristics of ''madhya sara''(moderate quality of tissues) ====

+

== Characteristics of ''madhya sara''(moderate quality of tissues) ==

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</div>

−

==== Assessment of ''samhanana'' (compactness) ====

+

== Assessment of ''samhanana'' (compactness) ==

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</div>

−

==== Assessment of ''pramana'' (proportion and measurements) ====

+

== Assessment of ''pramana'' (proportion and measurements) ==

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</div>

−

==== Assessment of ''satmya'' (suitability) ====

+

== Assessment of ''satmya'' (suitability) ==

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</div>

−

==== Assessment of ''Sattva'' (psyche/mental strength) ====

+

== Assessment of ''Sattva'' (psyche/mental strength) ==

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</div>

−

==== Assessment of ''aharashakti'' (power of assimilation) ====

+

== Assessment of ''aharashakti'' (power of assimilation) ==

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Examination regarding power for assimilation (''aharashakti'') is to be done in respect of power of ingestion as well as digestion. Strength and life depends on diet.[120]

−

==== Assessment of ''vyayamashakti'' (exercise capacity) ====

+

== Assessment of ''vyayamashakti'' (exercise capacity) ==

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In respect of capacity of exercise (''vyayamashakti'') examination should be done by the capactiy for work. In accordance with capacity for work strength is inferred as of three types (poor, moderate and good). [121]

−

==== Assessment of ''vaya'' (age) ====

+

== Assessment of ''vaya'' (age) ==

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</div>

−

==== Knowledge of lifespan ====

+

== Knowledge of lifespan ==

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In regard to knowledge of measure of life span, there is description of symptoms in Indriya sthana and Jatisutriya adhyaya (eighth chapter of sharira sthana).[124]

−

==== Assessment of ''Kala'' (time or stage or season) ====

+

== Assessment of ''Kala'' (time or stage or season) ==

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''Kala'' (time) has been considered of two types viz. year aspect and status of the patient. The year has been divided into two, three, six, twelve or even more parts according to nature of action (to be taken). Now, dividing into six, the action will be said. ''Hemanta'' (early winter), ''grishma'' (summer) and ''varsha'' (rainy season) these are the three seasons characterised by cold, heat and rains. In between them, there are other three seasons having common characters as ''pravrit'' (early rain), ''sharada'' (autumn) and ''vasanta'' (spring). ''Pravrit'' denotes the early rain; ''varsha'' is the continuation of the same. Thus, these six divisions of the seasons have been made for the purpose of evacuative therapy.[125]

−

==== Appropriate season for purification therapies ====

+

== Appropriate season for purification therapies ==

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Therefore, the measures like emesis etc. are stopped in the seasons ending with the rains (early winter, summer and rainy seasons) except in case of emergency. In emergency too, one should administer the therapy with great care after modifying the seasonal effects sufficiently by artificial means producing qualities contrary to the seasons and by making the measure appropriate in standard potency with variation in combination, processing and quantity. [127]

−

==== Stage of disease ====

+

== Stage of disease ==

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The status of the patient is also called as timely or untimely in relation the act being performed or not. Such as, in a certain condition one drug is untimely, and the other one is timely. This is also due to specific condition, hence the nomenclature of ''kala'' (timely) and ''akala'' (untimely) is given to the conditions of the patients. This is examined like this- the physician should observe all the conditions of the patient again and again in order to administer the correct therapy. The therapy administered after or before the (opportune) time is not effective because time determines the sufficiency to the administration of therapy.[128]

−

==== ''Pravritti'' (inclination or action) ====

+

== ''Pravritti'' (inclination or action) ==

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''Pravritti'' (inclination or action) is the initiation of the therapy which is characterized by the combination of physician, drug, patient and attendant in treatment. [129]

−

==== ''Upaya'' (management) ====

+

== ''Upaya'' (management) ==

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Thus these mentioned ten entities should be examined separately and sincerely.[131]

−

==== Objective of examination ====

+

== Objective of examination ==

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In situation where symptoms of both indication and contraindication conjoined, one should decide (the treatment protocol) after proper examination of dominant or recessive condition of ''dosha''. The diseases mentioned in treatises are in respect of their treatment as general rule or exception. Hence it is said that one should take action after considering the dominant or recessive condition of ''dosha''. [134]

−

==== List of medicines used in therapeutic emesis ====

+

== List of medicines used in therapeutic emesis ==

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*Decoction of ''shalmali, shalmalika, bhadraparni, elaparni, upodika, uddalaka, dhanvana, rajadana, upachitra, gopi (sariva), shringataka; pippali, pippalimula, chavya, chitraka, shringavera, sarshapa, phanita, kshira, kshara,'' salt with water and made into bolus and other eatables added with ''vartti kriya'' (suppository), powder, linctus, processed in lipids, extract, meat soup, gruel, (vegetable) soup, ''kambalika'' and milk should be administered to the patient requiring emesis according to prescribed procedure. These are, in brief, the pharmaceutical forms of emetic drugs, which are described in detail latter on in [[Kalpa Sthana]].[135]

−

==== List of medicines used in therapeutic purgation ====

+

== List of medicines used in therapeutic purgation ==

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*made into bolus and other eatables added with ''vartikriya'' (suppository), ''churna'' (powder), ''asava, leha'' (linctus), ''sneha'' (medicated fatty preparation), ''kashaya'' (decoction), ''mamsarasa'' (meat-soup), ''yusha'' (vegetable soup), ''kambalika'' (a kind of soup prepared from whey and green gram), ''yavagu'' (gruel), ''kshiropadheyan'' (milk administered), ''modaka'' (comparatively big tablet for high dose), and other forms of food preparation are to be used in patient requiring purgation. These are in brief the pharmaceutical preparation of purgative drugs, which will be further described in detail.[136]

−

==== List of medicines used in therapeutic non-unctuous enema ====

+

== List of medicines used in therapeutic non-unctuous enema ==

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That non-unctuous enema is of six types having single rasa as said by physician. Drugs possess mostly the combined ''rasa'' therefore grouping them in single group is not possible, hence the drugs included in ''madhura'' group mean those which are sweet, predominantly sweet, and sweet in ''vipaka'' or having effects similar to sweet drugs. This is same for other drugs also.[138]

−

==== ''Madhura skandha'' (group of sweet drugs) ====

+

== ''Madhura skandha'' (group of sweet drugs) ==

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The drugs mentioned in sweet group (''madhura skandha'') are ''jivaka, rushabhaka, jivanti, vira, amalaki, kakoli, kshirakakoli, mudgaparni, mashaparṇi, shalaparni, prushniparni, mashaparni, shalaparni, meda, mahameda, karkatashringi, shringataka, chinnaruha, cchatra, aticchatra, shravani, mahashravavani, sahadeva, vishvadeva, shukla, kshirashukla, bala, atibala, vidari, kshiravidari, kshudrasaha, mahasaha, rishyagandha, ashvagandha, vrishchira, punarnava, brihati, kantakari, korubuka, moraṭa, shwadamshtra, samharsha, shatavari, shaatapushpa, madhukapushpi, yashtimadhu, madhulika, mrudvika, kharjura, parushaka, atmagupta, pushkarabija, kasheruka, rajakasheruka, rajadana, kataka, kashmarya, shita, pakya, danapaki tala, kharjura, mastakam, ikshu, ikshuvalika, darbha, kusha, kasha, shali, gundrrtkataka, shaaramula, rajakshavaka, rushyaprokta, dvarada, bharadvaj, vanatrapushya, bhirupatri hamsapadi, kakanasa, kulinga, kshiravalli, kapolavalli, kapotavalli, somavalli'' and ''gopavalli''. These and such other drugs of sweet group should be taken. After cutting and breaking them into small pieces and washing with water properly, should be kept in a vessel. Adding to it milk diluted with half water should be cooked stirring till its major portion of water is absorbed, drugs are extracted and milk is not charred. The vessel should be brought down and the milk should be taken out of it and filtered well. This lukewarm milk added with ghee, oil, fat, marrow, salt and ''phanita'' should be used properly for enema by expert in ''vatika'' disorders. In ''paittika'' disorders, the same should be given cold and combined with honey and ghee. Thus, ends the sweet group of drugs. [139]

−

==== ''Amla skandha'' (group of sour drugs) ====

+

== ''Amla skandha'' (group of sour drugs) ==

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These and such other drugs of the sour group should be taken and after cutting and breaking into small pieces should be placed in a vessel along with liquids and be cooked. The lukewarm product added properly with oil, fat, ''majja'', salt and ''phanita'' should be used for enema in ''vatika'' disorders according to procedure by the expert physician. Thus, ends the sour group. [140]

−

==== ''Lavana skandha'' (group of salty drugs) ====

+

== ''Lavana skandha'' (group of salty drugs) ==

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In the salty group (''lavana skandha''), the drugs mentioned are – ''saindhava, sauvarchala, kala, vida, pakya, anupa, valukaila, maulaka, samudra, romaka, audbhida, aushara, pateyaka, pamshuja'' and others. These drugs added with sour or warm water along with fatty substance in lukewarm condition should be used for enema in ''vatika'' disorders according to procedure by the expert. This concludes the salty group of drugs. [141]

−

==== ''Katu skandha'' (group of pungent drugs) ====

+

== ''Katu skandha'' (group of pungent drugs) ==

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In pungent group (''katuka skandha'') the drugs included are – ''pippali, pippalimula, gajapippali, chavya, chitraka, shunţhi, maricha, ajamoda, ardraka, vidanga, dhanyaka, pilu, tejavati, ela, kushtha, bhallatakasthi, hinguniryasa, devadaru, mulaka, sarshapa, lashuna, karanja, shigru, madhu shigru, kharapushpa, bhustruna sumukha, surasa, kutheraka, arjaka, gandira, kalamalaka, parnasa, kshavaka, phanijjhaka,'' alkali, urines, and biles. These along with other similar drugs of group (pungent) should be taken and after cutting and breaking into pieces should be cooked with cow’s urine. This while lukewarm added with honey oil and salt should be used for enema in ''shlaishmika'' disorders according to procedure by experts. Thus ends the pungent group.[142]

−

==== ''Tikta skandha'' (group of bitter drugs) ====

+

== ''Tikta skandha'' (group of bitter drugs) ==

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The drugs mentioned in bitter group (''tikta skandha'') are – ''Chandana, nalada, aragvadha, naktamala, nimba, tumburu, kutaja, haridra, daruharidra, musta, murva, kiratatikta, katurohini, trayamana, karvellika, karira, karavira, kebuka, kathillaka, vrusha, mandukaparni, karkotaka, vartaku, karkasha, kakamachi, kakodumbarika, sushavi, ativisha, patola, kulaka, patha, guduchi, tip of vetra, vetasa, vikankata, bakula, somavalka, saptaparna, sumana, arka, avalguja, vacha, tagara, agaru, balaka'' and ''ushira'', along with other similar drugs of the bitter group should be taken and after cutting and breaking them into pieces and washing properly be cooked with water. The product when lukewarm should be added with honey, oil and salt to be used in enema for ''kaphaja'' disorders according to procedure by the expert. In ''paittika'' disorders the same should be used while cold and added with honey and ghee. This ends the bitter group.[143]

−

==== ''Kashaya skandha'' (group of astringent drugs) ====

+

== ''Kashaya skandha'' (group of astringent drugs) ==

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And the groups of drugs which are not advocated in certain disorders should be considered as those aggravating the same. Thus, these six groups of non-unctuous enema are described dividing them according to ''rasa''. [147-148]

−

====Guidelines for inclusion or exclusion of drugs====

+

==Guidelines for inclusion or exclusion of drugs==

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The wise physician should eliminate or exclude the drugs if it is not appropriate even if enumerated under the group and should add the appropriate one even if un-enumerated. In situation needed a group of drugs may be combined with other or several other groups based on the reasoning. The aphorism, though small, is able to provide wide knowledge to the wise like alms of a mendicant or seed of a farmer. The aphorism for the wise, gives rise to critical analysis and reasoning while on the other hand for the dull, it is better to follow the saying exactly. The physician following the said course succeeds in his endeavor or causes little risk because of the illustration being not too brief.[149]

−

==== List of drugs for unctuous enema ====

+

== List of drugs for unctuous enema ==

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Animal products are fat, marrow and ghee. Out of the oil, fat, marrow and ghee, excellence of applicability as unctuous enema in disorders of ''vata'' and ''kapha'', is determined in regressive order and progressive order in ''paittika'' disorders, so all are applicable in all disorders according to particular procedure and processing. [150]

−

==== List of drugs for nasal errhines ====

+

== List of drugs for nasal errhines ==

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*Bark of ''tejovati, varanga, ingudi, shobhanjana, bruhati'' and ''kantakarika.'' In this way according to substrate (of action) the nasal errhines is of seven types such as fruit, leaf, root, tuber, flower, exudation and bark; other saline, pungent bitter and astringent drugs which are wholesome to the sense organs and other unmentioned drugs may be used, according to condition needed for nasal errhines.[151]

−

==== Summary of chapter ====

+

== Summary of chapter ==

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Thus, gets end of eighth chapter on specific features of therapeutics of diseases in [[Vimana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. With this, [[Vimana Sthana]] (section on specific features) also comes to an end.

−

=== ''Tattva Vimarsha'' / Fundamental Principles===

+

== ''Tattva Vimarsha'' / Fundamental Principles==

*The ideal preceptor, ideal medical treatise and ideal student are considered as basic pillars for proper propagation of medical knowledge.

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*Purification therapies shall be performed as per the seasonal vitiation of respective ''dosha''. The medicines shall be administered considering stage of disease and appropriate time as per the morbidity.

−

=== ''Vidhi Vimarsha'' / Applied Inferences===

+

== ''Vidhi Vimarsha'' / Applied Inferences==

The text of [[Charak Samhita]] is several thousand years old. It provides holistic solutions for the people and society. World has changed since, with change in thinking, lifestyle and technological advancements but, many of the guiding principles are still applicable Following should be applicable now.

−

==== Selection of medical treatise ====

+

== Selection of medical treatise ==

In the last century, there has been significant change in how medical education is imparted, specially Ayurvedic education. Since olden times, Ayurvedic teacher would select a student and provide both theoretical and practical training by a process called ''Guru''/''shishya'' (student/teacher) relationship. Student was also guided how to select the medical treatise, criteria for which is described in the text above. These days, books are recommended by the faculty of medical schools according to the syllabus. Guidelines given in the text are still useful in selecting any worth reading book on a particular subject.

−

==== Ideal presentation of text ====

+

== Ideal presentation of text ==

Treatise should be such that is understood by all students with different levels of intelligence. Repetition of the same principles which only increases the exercise of studying should not be present. It should include a concise and accurate statement of fact or concept followed by explanation with supportive examples using common language words. The words used should not be difficult for hearing, spelling, remembering and use of infamous words should be avoided. The sentence used for explanation should give complete and correct meaning and sequencing should be in a way to achieve clear stepwise and comprehensive understanding of the topic. The chapter or subject should be well placed and related topic should follow in order. The content in the book should be very effective, attractive and giving complete knowledge without repetition. Various graphs, flow charts, diagrams pictures and color plates which generates interest within the readers should be included.

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In present context, the guidelines for writing a research paper or an article or a monograph include all the points mentioned in the text. The principles to write considering reader’s psyche are important and shall be followed for making a good treatise. [[Charak Samhita]] follows the same principles of presentation.

−

==== Qualities of a teacher ====

+

== Qualities of a teacher ==

Teacher influences the life of a student. A teacher should have complete theoretical and practical knowledge of [[Ayurveda]]. The qualities of an ideal teacher are described in the text. Furthermore, keeping the competency of medical education in mind, the teacher should have knowledge of contemporary sciences and should behave with care and unbiased to the students. Teacher should not be egoistic and jealous. He should enjoy his teaching and not feel burden of teaching even if he needs to repeat. He should understand the lifestyle, psychiatric and body constitution of his patients and convey the same to his students. Significance of each symptom and sign seen in patient should be noted with help of sense organs and the same clinical methods should be explained to the students.

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A good teacher plays significant role in making life of a student. Even today, in Ayurvedic practice, ''guru-shishya parampara'' (traditional learning through students staying with teachers) exists, that is the most effective method of learning practical applications of principles of [[Ayurveda]].

−

==== Qualities of an ideal student ====

+

== Qualities of an ideal student ==

Today, with the increasing demand of education for all, the students are taught in the classrooms in a group. However, the best teacher develops a one-to-one interaction with each student to make him inform about the knowledge. The student must possess some qualities and develop learning skills to receive the information and follow instructions given by teacher. Student should be physically and mentally able to perform his duties as a future physician, surgeon, teacher, and/or researcher.

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Inference made after discussion and considering both the positive and negative points, student should have such qualities of understanding what and which are the positive and negative effects of each and every action he does. Secondly, he should have sharp memory, broad minded and he should be forgiving and should help others.

−

==== Medical ethics and social behaviors of a doctor ====

+

== Medical ethics and social behaviors of a doctor ==

Manners and social behavior of doctor is very important. The doctor has prime importance in the society owing to his health-care responsibilities. Also, the medico-legal aspect while treating patient in emergency medical care, and treating patient of opposite gender must be kept in mind to avoid legal issues. The ethical code of conduct of the society or country where he/she lives shall be followed.

−

==== Conferences (acquiring cumulative wisdom) ====

+

== Conferences (acquiring cumulative wisdom) ==

In seminars and conferences, research papers and case reports are presented which help in acquiring knowledge to provide better care to the patients. Healthy discussion brings about growth in knowledge, increases enlightenment and is helpful in preparation for competition. Sharpness and clarity of knowledge is increased. Vocabulary is increased and also interpretation power is increased.

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The guidelines to be followed while participating in a discussion to make it more beneficial are described in the text. The points that should be considered while preparing a paper for presentation are applicable for effective communication.

−

==== Examination of patient ====

+

== Examination of patient ==

It is important to assess physical and mental state of the patient and the nature of medicine for treatment.

−

==== ''Prakriti'' examination ====

+

== ''Prakriti'' examination ==

The ''prakriti'' or basic constitution is very important to be investigated to know overall health status of a person. The place of birth, place of living, place of work is important for identifying the ethnic habits, suitability, and external causes of a disease. Accordingly, the do’s and don’ts in terms of diet and lifestyle are prescribed, that is the integral part of Ayurvedic prescription. Currently, concept of ''prakriti'' is being investigated further in personalized medicine to know the genotype and phenotype of an individual and predicting certain disorders in view of prevention.

−

==== ''Sara'' examination ====

+

== ''Sara'' examination ==

To evaluate immunity or bodie’s resistance to disease, ''sara'' or ‘or the best qualities of tissues needs to be examined. The constitutional essence helps to understand the immunity of the person. More the ''sarata'' of ''dhatu'', more is the immunological strength of the person. Analogue of ant helps to understand the significance of essence of ''dhatus''. And although small and lean in size is able to lift more than its weight due to ''asthisarata'' present in it. In [[Vividhashitpitiya Adhyaya]] of [[Sutra Sthana]] (chapter 28), special importance is given to ''mamsa'' (muscle), ''shonita'' (blood) and ''asthi dhatu'' (bone) in ''Vyadhikshamatva'' (immunity) which needs to be researched more.

−

==== ''Satmya'' (suitability) ====

+

== ''Satmya'' (suitability) ==

The effect of a drug depends upon its interaction with the body tissues. If it is not suitable to the body tissues, then adverse reaction may occur or drug may not be effective. Drug resistance also needs to be considered under the heading of ''satmya'' because it is observed that to a person who has developed resistance to certain antibiotics does not offer response to such medicament thus not attaining successful result in the person. Nowadays culture study is used to understand the usefulness of antibiotics in the patient. Therefore the suitability of the patient must be considered before prescribing a medicine.

−

==== The ideal time for purification procedures ====

+

== The ideal time for purification procedures ==

If in emergency ''shodhana'' has to be done in unsuitable weather, then the surroundings of the patient should be made such that it resembles the ''sadharan kala'', for example, if it is very cold then room should be adjusted with warmness and if it is very hot as in ''grishma'', then the temperature in the room should be reduced. Also a physician must use ''yukti'' and accordingly use or make the necessary ''dravyas'' ''sheeta'' or ''ushna'' by appropriate ''samyoga'' (combination), ''samskara'' (processing) and ''pramana'' (dose).

−

==== Examination of stage of disease ====

+

== Examination of stage of disease ==

''Aturavastha'' or the phase of disease in patient also matters in treatment as seen in context of ''jwara'' wherein in ''kashaya'' (decoction) should not be administered for seven days or till amapachana does not take place. This interprets that the body of patient shall be able to metabolize the drugs. In case of ''jwara'', the ''doshas'' are too vitiated with the poor status of ''agni'', therefore the body is unable to metabolize even the drugs also. Therefore ''langhana'' (fasting) is the first treatment in ''jwara''. In nutshell, the medicines shall be prescribed considering the phase of disease and status of the patient.

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Nowadays, various software and decision support systems are available to help physicians regarding the diagnosis. Various subjective assessment scales to examine ''sara'' and questionnaires to assess ''prakriti'' are available to know the status of patient.

−

==== Examination of psyche of patient ====

+

== Examination of psyche of patient ==

''Mana''/''satva'' (mind) is said to be ''tantraka'' (technical operator) as the one who is ''preraka'' (inspirer) or ''dharaka'' (owner). ''Mana'' is the initiator of all activity but it can carry out its action in conjunction with ''atma'' only. If ''mana'' is weak it is unable to tolerate the symptoms of disease and he/she exaggerates those. If the doctor makes the mistake of considering the inferior mental strength of patient with severe disease depending on presentation of symptoms and gives strong medicine then he may end up with complication.

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The mental status examination has a special importance in today’s medical practice. The physician has to modulate interaction with the patient, dose of medicine, potency of medicine considering the psychology of the patient. The physician who communicates better with the patient helps to heal disease naturally.

−

==== Assessment of ''ahara shakti'' (intake capacity) ====

+

== Assessment of ''ahara shakti'' (intake capacity) ==

''Aharashakti'' is not only the quantity of food intake, but also its digestive capacity. Quantity of food taken and digestive capacity of the person is to be considered. The assessment of ''agni'' is based upon the food intake capacity of the person. The proporation of body tissue depends upon intake of food and its assimilation inside body. This directly affects the health status. Hence, ''ahara shakti'' is important to be assessed.

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Further, if the patient is not responding to oral administration of drugs, then the parenteral or any other route of drug administration is to be chosen.

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==== Assessment of ''vyayama shakti'' (exercise endurance capacity) ====

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== Assessment of ''vyayama shakti'' (exercise endurance capacity) ==

''Vyayamashakti'' is described as ''bharvahanshakti'' i.e. capacity to work. People doing strenuous work or exercise have more forebearance and are strong. The capacity to exercise is directly related with the cardio-vascular, pulmonary, muscular and mental status of the patient, and hence it is linked with healthy lifespan. Nowadays, various stress tests are done for evaluation of these functions and are useful to determine the prognosis of disease to give guidance for necessary intervention.

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=== Glossary ===

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== Glossary ==

#Tadvidyasambhāsā –तद्विद्यसम्भाषा-is to discuss with such person who has studied the same science.

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#Āviklipta-अaaaasविक्लिप्तैः- Single drug use

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=== Reference books for further reading ===

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== Reference books for further reading ==

1. Charak Samhita by Agnivesha Edited By Yadavji Trikamji Acharya-Munshiram Manoharlal Publishers Pvt. Ltd. 4th Edition.

Agnivesha

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