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| | |title=Rogabhishagjitiya Vimana | | |title=Rogabhishagjitiya Vimana |
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| | #Examination of [[Prakriti]] and ''vikriti'' according to [[dosha]], | | #Examination of [[Prakriti]] and ''vikriti'' according to [[dosha]], |
| | #Description of eight type of ''sara'' (essence of body tissues), | | #Description of eight type of ''sara'' (essence of body tissues), |
| − | #Compactness, structure and body mass, | + | #Compactness, structure and body m |
| − | #Measurement of body parts,
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| − | #Specific suitability of a person,
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| − | #''Sattva'' (mental strength),
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| − | #Power of digestion and assimilation,
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| − | #Exercise endurance and
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| − | #Age.
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| − | *Knowledge of seven types of [[Prakriti]] and their features are necessary to understand normal state of body.
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| − | *The factors such as constitution of sperm and ovum, the time (of conception) and status of health of uterus, diet and lifestyle of mother (during pregnancy), and interaction of [[mahabhuta]] determine the basic constitution ([[Prakriti]]) of fetus ([[garbha]]). The genetic map of an individual is determined by these factors.
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| − | *[[Kapha]] is naturally unctuous (''snigdha''), smooth (''shlakshna''), soft (''mridu''), sweet (''madhura''), essence (''sara''), dense (''sandra''), slow acting (''manda''), stable (''stimita''), heavy (''guru''), cold (''sheeta''), slimy (''vijjala'') and clear (''acchah'').
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| − | *[[Pitta]] is naturally hot (''ushna''), sharply/acutely acting (''tikshna''), liquid (''drava''), of fleshy smell (''visram''), sour (''amla'') and pungent (''katu'').
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| − | *[[Vata]] is naturally rough (''ruksha''), light (''laghu''), mobile (''chala''), abundant (''bahu''), swift (''shighra''), cold (''sheeta''), coarse (''parusha'') and non-slimy (''vishada'').
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| − | *Pathological condition (''vikriti'') needs to be evaluated to be able to provide effective treatment. The disorder should be examined in terms of the strength of the cause ([[hetu]]), [[dosha]] (vitiating intermediary factors), ''dushya'' (vitiated factors), constitution ([[Prakriti]]), place (''desha''), time (''kala'') and the symptoms. These factors determine the severity of disease.
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| − | *Eight types of ''sara'' (best quality of body tissues) determine the strength of body tissues. Indeed, innate immunity of body tissues depends upon ''sara'', and it can be examined by the given features.
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| − | *Assessment of ''samhanana'' (compactness) is important to examine the differentiation and organization of muscle, fat, bones. These determine the strength of person.
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| − | *Analyzing the compactness (''samhanana''), proportionate relation of different parts (''pramana''), suitability (''satmya''), mental state (''sattva''), intake and digestive capacity (''ahara''), exercise tolerance (''vyayama'') and age (''vaya'') helps the physician to classify the strength of the patient into three categories viz. superior (''pravara''), medium (''madhya'') and inferior (''avara''). It is on this basis that physician decides to give strong (''tikshna''), mild (''mridu'') and moderate (''madhya'') medicaments.
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| − | *The basic unit to measure the body parts is height, breadth and circumference of one’s own finger (''anguli''). This is used in personified medicine to determine one’s own standard proportion of body parts. There cannot be a single standard for overall population.
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| − | *Assessment of [[satmya]] (suitability) determines the overall diet and lifestyle of an individual and this affects lifespan of the person.
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| − | *The mental strength is important to assess the behavioral response of patient to disease. It is essential to assess mental strength in every disease, because, a person having big stature may pretend a mild disease as like a critical condition and physician may be misled to incorrect diagnosis.
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| − | *The physiological and psychological functions depend upon age of a person. Similarly, there is dominance of a specific [[dosha]] according to [[dosha]]. [[Kapha]] is dominant is childhood, [[pitta]] in adulthood and [[vata]] in old age. If there is pathological dominance of a particular [[dosha]] in a certain age, then there will be changes according to respective [[dosha]]. Thus, the lifespan will differ as per [[dosha]] dominance in respect to age.
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| − | *The severity of morbidity depends upon degree of [[dosha]] aggravation. Medicaments shall be prescribed considering severity of morbidity and strength of patient.
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| − | *Purificatory therapies need to be performed at appropriate time of the year (''kala'') which is divided into six ''ritus'', namely ''hemant'' (early winter), ''grishma'' (summer) and ''varsha'' (rainy season) these are the three season characterized by cold, heat and rains. In between them there are other three seasons having common characters as ''pravrita'' (early rain), ''sharad'' (autumn) and ''vasanta'' (spring). Last three are termed as ''sadharan ritu'' during which purificatory (''shodhana'') treatment can be done.
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| − | Similarly, medicine should be given at appropriate time to the patient (''kala'') and when not to be given (''akala'').
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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.
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| − | == Vidhi Vimarsha (Applied Inferences) ==
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| − | 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.
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| − | === Selection of medical treatise ===
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| − | 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.
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| − | === Ideal presentation of text ===
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| − | 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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| − | The conclusions of explanation should be perfect and unalterable. The principles mentioned in text should be the same from beginning to the end.
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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.
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| − | === Qualities of a teacher ===
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| − | 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]].
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| − | === Qualities of an ideal student ===
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| − | 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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| − | He should follow ''sadvritta'' and should be respectful to teacher so as to gain more and more knowledge in each aspect of life. He should engage in frequent academic dialogue with fellow students and teachers. His mind should be focused on his goal. He should have fixed aim of attaining the knowledge about the topic. Student should concentrate on acquiring good qualities and should participate in extra curricular activities like sports and debate etc. Retaining power of the student should be good.
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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.
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| − | === Medical ethics and social behaviors of a doctor ===
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| − | 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.
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| − | === Conferences (acquiring cumulative wisdom) ===
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| − | 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.
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| − | === Examination of patient ===
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| − | It is important to assess physical and mental state of the patient and the nature of medicine for treatment.
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| − |
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| − | === [[Prakriti]] examination ===
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| − | 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.
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| − | === ''Sara'' examination ===
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| − | 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]] [Cha.Sa.[[Sutra Sthana]] 28], special importance is given to ''mamsa'' (muscle), ''shonita'' (blood) and ''asthi dhatu'' (bone) in ''Vyadhikshamatva'' (immunity) which needs to be researched more.
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| − | === [[Satmya]] (suitability) ===
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| − | 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.
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| − | === The ideal time for purification procedures ===
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| − | 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).
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| − | === Examination of stage of disease ===
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| − | ''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 [[dosha]] 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.
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| − | === Examination of psyche of patient ===
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| − | ''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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| − | Symptoms of severely diseased and mildly diseased are mentioned in seventh chapter of [[Vimana Sthana]].
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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.
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| − | === Assessment of ''ahara shakti'' (intake capacity) ===
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| − | ''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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| − | ''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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| − | == Related articles ==
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| − | [[Pramana]], [[Tantrayukti]], [[Prakriti]], [[Purusha]],[[Satmya]],
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| − | === Reference books for further reading ===
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| − | 1. Charak Samhita by Agnivesha Edited By Yadavji Trikamji Acharya-Munshiram Manoharlal Publishers Pvt. Ltd. 4th Edition.
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| − | 2. Sushruta Samhita of Sushruta Edited By Yadavji Trikamji Acharya- Chaukhamba Orientalia, Varanasi- 6th Edition.
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| − | 3. Astanga Hrudaya By Vagbhat-Chaukhamba Publication
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| − | 4. Caraka Samhita (Text With English Translation & Critical Exposition Based On Cakrapani Datta Ayurved Dipika) By R K Sharma And Bhagwan Dash, Chowkhamba Sanskrit Series Office, Varanasi.
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| − | 5. Basic Principles Of [[Ayurveda]], Padarth Vijnana By Prof. Yogesh Chandra Mishra- Chaukhamba Sanskrit Bhawan, Varanasi.
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| − | 6. Padarth Vigyan By Dr Krishnamurthy- Chaukhamba Sanskrit Bhawan, Varanasi.
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| − | 7. Tarka Sangraha- Chaukhamba Sanskrit Bhawan, Varanasi.
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