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=== Introduction ===

=== Introduction ===

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Ayurveda has emphasized the importance, need and application of examination, and has stressed that even truth should be examined first and only then should be accepted. In [[Sutra Sthana]], Chapter 11, four methods of examination of all existing and non-existing subjects of knowledge to be examined have been given<ref> Agnivesha, Charaka, Dridhabala, Charaka Samhita Sutrasthana Adhyaya 11/17, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 70. </ref>. These four specific methods of examination are ''aptopadesha'' (knowledge from authoritative person and scriptures), ''pratyaksha'' (direct observation), ''anumana'' (inference) and ''yukti'' (logic based interpretation). For clinical examination of a patient, ''yukti pramana'' is included in ''anumana'' because inference should be included in ''tarka'' (logic) and ''yukti''<ref> Agnivesha, Charaka, Dridhabala, Charaka Samhita Vimanasthana Adhyaya 4/3, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 247. </ref> <ref> Agnivesha, Charaka, Dridhabala, Charaka Samhita Vimanasthana Adhyaya 4/4, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 247. </ref>. The author did not feel the need for ''yukti'' to be done separately in clinical experiment, therefore three fold (''trividha'') method of examination has been described.  

Ayurveda has emphasized the importance, need and application of examination, and has stressed that even truth should be examined first and only then should be accepted. In [[Sutra Sthana]], Chapter 11, four methods of examination of all existing and non-existing subjects of knowledge to be examined have been given<ref> Agnivesha, Charak, Dridhabala, Charak Samhita Sutrasthana Adhyaya 11/17, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 70. </ref>. These four specific methods of examination are ''aptopadesha'' (knowledge from authoritative person and scriptures), ''pratyaksha'' (direct observation), ''anumana'' (inference) and ''yukti'' (logic based interpretation). For clinical examination of a patient, ''yukti pramana'' is included in ''anumana'' because inference should be included in ''tarka'' (logic) and ''yukti''<ref> Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/3, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 247. </ref> <ref> Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/4, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 247. </ref>. The author did not feel the need for ''yukti'' to be done separately in clinical experiment, therefore three fold (''trividha'') method of examination has been described.  

There are, however, limitations to these tools because all the three examinations should be applied, though sequentially (described later in the chapter), since one cannot rely completely on any one of these examinations. A wise physician should use all the three tools together for a thorough assessment of the disease and then reach the final diagnosis. A physician who understands and exercises such practice does not commit any mistake in the treatment of the patients. <ref> Agnivesha, Charaka, Dridhabala, Charaka Samhita Vimanasthana Adhyaya 4/11, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 249. </ref>  

There are, however, limitations to these tools because all the three examinations should be applied, though sequentially (described later in the chapter), since one cannot rely completely on any one of these examinations. A wise physician should use all the three tools together for a thorough assessment of the disease and then reach the final diagnosis. A physician who understands and exercises such practice does not commit any mistake in the treatment of the patients. <ref> Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/11, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 249. </ref>  

It is also interesting to know that these three methods of examination have been defined (with little difference) in [[Sutra Sthana]] 11th chapter [[Tistraishaniya]] too. On the basis of critical analysis of the subject, it could be opined that the description of three examination methods in [[Vimana Sthana]] is much more scientific and applicable in clinical methods while the description of [[Sutra Sthana]] chapter [[Tistraishaniya]] is applicable in other fields.

It is also interesting to know that these three methods of examination have been defined (with little difference) in [[Sutra Sthana]] 11th chapter [[Tistraishaniya]] too. On the basis of critical analysis of the subject, it could be opined that the description of three examination methods in [[Vimana Sthana]] is much more scientific and applicable in clinical methods while the description of [[Sutra Sthana]] chapter [[Tistraishaniya]] is applicable in other fields.

tadyathA- agniM jaraNashaktyA parIkSheta, balaM vyAyAmashaktyA, shrotrAdInishabdAdyarthagrahaNena, mano~arthAvyabhicaraNena, vij~jAnaM vyavasAyena, rajaHsa~ggena,mohamavij~jAnena, krodhamabhidroheNa, shokaM dainyena, harShamAmodena, prItiM toSheNa, bhayaMviShAdena, dhairyamaviShAdena, vIryamutthAnena  , avasthAnamavibhrameNa,shraddhAmabhiprAyeNa, medhAM grahaNena, sa~jj~jAM nAmagrahaNena, smRutiM smaraNena,hriyamapatrapaNena, shIlamanushIlanena, dveShaM pratiShedhena, upadhimanubandhena [3] ,dhRutimalaulyena, vashyatAM vidheyatayA, vayobhaktisAtmyavyAdhisamutthAnAnikAladeshopashayavedanAvisheSheNa, gUDhali~ggaM vyAdhimupashayAnupashayAbhyAM,doShapramANavisheShamapacAravisheSheNa, AyuShaH kShayamariShTaiH, upasthitashreyastvaMkalyANAbhiniveshena, amalaM sattvamavikAreNa, grahaNyAstu mRududAruNatvaMsvapnadarshanamabhiprAyaM dviShTeShTasukhaduHkhAni [4] cAturapariprashnenaiva vidyAditi||8||

tadyathA- agniM jaraNashaktyA parIkSheta, balaM vyAyAmashaktyA, shrotrAdInishabdAdyarthagrahaNena, mano~arthAvyabhicaraNena, vij~jAnaM vyavasAyena, rajaHsa~ggena,mohamavij~jAnena, krodhamabhidroheNa, shokaM dainyena, harShamAmodena, prItiM toSheNa, bhayaMviShAdena, dhairyamaviShAdena, vIryamutthAnena  , avasthAnamavibhrameNa,shraddhAmabhiprAyeNa, medhAM grahaNena, sa~jj~jAM nAmagrahaNena, smRutiM smaraNena,hriyamapatrapaNena, shIlamanushIlanena, dveShaM pratiShedhena, upadhimanubandhena [3] ,dhRutimalaulyena, vashyatAM vidheyatayA, vayobhaktisAtmyavyAdhisamutthAnAnikAladeshopashayavedanAvisheSheNa, gUDhali~ggaM vyAdhimupashayAnupashayAbhyAM,doShapramANavisheShamapacAravisheSheNa, AyuShaH kShayamariShTaiH, upasthitashreyastvaMkalyANAbhiniveshena, amalaM sattvamavikAreNa, grahaNyAstu mRududAruNatvaMsvapnadarshanamabhiprAyaM dviShTeShTasukhaduHkhAni [4] cAturapariprashnenaiva vidyAditi||8||

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Charaka observed that the objects known by direct perceptions are very limited, whereas the range of inference is fairly vast in areas that are not known by our means of perception, i.e., sense organs. Here, reasoning and logic already stated in scriptures need to be used. The following subjects could be understood through ''anumana'' (inference):

Charak observed that the objects known by direct perceptions are very limited, whereas the range of inference is fairly vast in areas that are not known by our means of perception, i.e., sense organs. Here, reasoning and logic already stated in scriptures need to be used. The following subjects could be understood through ''anumana'' (inference):

* ''Agnim jaran shaktya''- Digestion by quality and quantity of food taken and digested or not digested.

* ''Agnim jaran shaktya''- Digestion by quality and quantity of food taken and digested or not digested.

ityagnivēśakr̥tē tantrē  carakapratisaṁskr̥tē vimānasthānē  trividharōgaviśēṣavijñānīyaṁ  vimānaṁ  nāma caturthō'dhyāyaḥ||4||  

ityagnivēśakr̥tē tantrē  carakapratisaṁskr̥tē vimānasthānē  trividharōgaviśēṣavijñānīyaṁ  vimānaṁ  nāma caturthō'dhyāyaḥ||4||  

    

    

Thus ends the fourth chapter of [[Vimana Sthana]] on “The determination of the three factors for understanding the specific characteristics of diseases” of Agnivesha’s work as redacted by Charaka.

Thus ends the fourth chapter of [[Vimana Sthana]] on “The determination of the three factors for understanding the specific characteristics of diseases” of Agnivesha’s work as redacted by Charak.

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

''Trividharogavisheshavijnaniyam'' solely deals with the methods of clinical examination of the patient. Various types of examinations viz. ''rogapariksha, rogipariksha, trividha pariksha, shadvidha pariksha, ashtavidha pariksha'', and ''dashavidha pariksha'' are described in  Ayurveda for the examination of the patient and the diagnosis of the disease. All these examinations do not go beyond the ''trividha pariksha'' described in this chapter. ''Aptopadesha'' gives all the details of the disease i.e. its causative factors, pathogenesis and treatment and thus, provides all the theoretical knowledge of the disease which is helpful during clinical examination. ''Pratyaksha'' deals with direct examination of the patient by the physician. The physician has to use all his senses during the examination, in which he has to look for various signs and symptoms, changes in the color etc. Any information collected through ''anumana'' and ''pratyaksha'' cannot provide all the details of existing pathologies in the body. Now the physician has to use his own intellect and tries to establish the relation between the signs and symptoms and the likely pathologies in the body. He has to use his logic and reasoning and apply it properly in finalizing the vitiated ''doshas'' in the body. ''Anumana'' helps the physician to deduce and draw inferences where it is not possible to visualize or see, in order to draw certain conclusions or understand causation of an ailment.  

''Trividharogavisheshavijnaniyam'' solely deals with the methods of clinical examination of the patient. Various types of examinations viz. ''rogapariksha, rogipariksha, trividha pariksha, shadvidha pariksha, ashtavidha pariksha'', and ''dashavidha pariksha'' are described in  Ayurveda for the examination of the patient and the diagnosis of the disease. All these examinations do not go beyond the ''trividha pariksha'' described in this chapter. ''Aptopadesha'' gives all the details of the disease i.e. its causative factors, pathogenesis and treatment and thus, provides all the theoretical knowledge of the disease which is helpful during clinical examination. ''Pratyaksha'' deals with direct examination of the patient by the physician. The physician has to use all his senses during the examination, in which he has to look for various signs and symptoms, changes in the color etc. Any information collected through ''anumana'' and ''pratyaksha'' cannot provide all the details of existing pathologies in the body. Now the physician has to use his own intellect and tries to establish the relation between the signs and symptoms and the likely pathologies in the body. He has to use his logic and reasoning and apply it properly in finalizing the vitiated ''doshas'' in the body. ''Anumana'' helps the physician to deduce and draw inferences where it is not possible to visualize or see, in order to draw certain conclusions or understand causation of an ailment.  

Charaka has described the entire clinical examination in this chapter. There is no fourth tool required for clinical examination except ''aptopadesha, pratyaksha'' and ''anumana''. In Ayurveda, emphasis is given to the use of the five senses in examining a patient. First hand information gathered through the physical examination by five senses is critical to the process of diagnosis. These three types of examinations are also used to assess bad prognosis of the disease and to identify the ''arishta'' (signs and symptoms of imminent death) also.<ref> Agnivesha, Charaka, Dridhabala, Charaka Samhita Indriyasthana Adhyaya 1/4, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 354. </ref>  

Charak has described the entire clinical examination in this chapter. There is no fourth tool required for clinical examination except ''aptopadesha, pratyaksha'' and ''anumana''. In Ayurveda, emphasis is given to the use of the five senses in examining a patient. First hand information gathered through the physical examination by five senses is critical to the process of diagnosis. These three types of examinations are also used to assess bad prognosis of the disease and to identify the ''arishta'' (signs and symptoms of imminent death) also.<ref> Agnivesha, Charak, Dridhabala, Charak Samhita Indriyasthana Adhyaya 1/4, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 354. </ref>  

Examinations like inspection, palpation, percussion and auscultation are part of ''pratyaksha pariksha''. Nowadays, various new techniques like X-ray, USG, CT Scan, MRI etc. are in use that help augment ''pratyaksha pariksha''. Abnormal findings suggest the underlying pathologies in the body with the use of ''anumana pariksha''. But over-dependence on technology has made the doctors move away from the use of their sensory perception and from prima facie clinical diagnosis. Excessive use of technology makes the process of diagnosis more complicated, costly and time consuming. The most important disadvantage of using technology is that it is reducing the use of logic and reasoning (''yukti'') by a physician. It also has influence on the doctor patient relationship. The most important thing which has been described by Charaka is to enter in to the soul of the patient to make correct diagnosis and is somewhere missing due to excessive use of technology. Proper use of ''trividha pariksha'' by a physician with required use of technology, will help him to reach up to the diagnosis immediately, correctly and will also be cost effective to the patient.

Examinations like inspection, palpation, percussion and auscultation are part of ''pratyaksha pariksha''. Nowadays, various new techniques like X-ray, USG, CT Scan, MRI etc. are in use that help augment ''pratyaksha pariksha''. Abnormal findings suggest the underlying pathologies in the body with the use of ''anumana pariksha''. But over-dependence on technology has made the doctors move away from the use of their sensory perception and from prima facie clinical diagnosis. Excessive use of technology makes the process of diagnosis more complicated, costly and time consuming. The most important disadvantage of using technology is that it is reducing the use of logic and reasoning (''yukti'') by a physician. It also has influence on the doctor patient relationship. The most important thing which has been described by Charak is to enter in to the soul of the patient to make correct diagnosis and is somewhere missing due to excessive use of technology. Proper use of ''trividha pariksha'' by a physician with required use of technology, will help him to reach up to the diagnosis immediately, correctly and will also be cost effective to the patient.

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=== References ===

=== References ===