Changes

=== Abstract ===

=== Abstract ===

This chapter deals with three clinical examinations useful for understanding the specific characteristics of diseases. These three methods are ''aptopadesha'' (authoritative instructions), ''pratyaksha'' (direct observation) and ''anumana'' (inference). These methods play a pivotal role not only in the diagnosis of a disease, but in understanding whatever is knowable. In the beginning, one should faithfully go through the available authoritative literature available in that field of study. As per the guidelines of the literature, the physician should then proceed to perceive the direct observations, by his own senses. Many aspects of an ailment which are not perceivable by senses can be inferred by logic based on scriptures and by consulting experts. In this chapter, a set of assessment criteria or rubric has been provided for each method including pointers that help in determining what is to be examined by which method, how should something be examined, and what is to be inferred and on what basis, along with the authoritative sources of knowledge.  

This chapter deals with three clinical examinations useful for understanding the specific characteristics of diseases. These three methods are ''aptopadesha'' (authoritative instructions), ''pratyaksha'' (direct observation) and ''anumana'' (inference). These methods play a pivotal role not only in the diagnosis of a disease, but in understanding whatever is knowable. In the beginning, one should faithfully go through the available authoritative literature available in that field of study. As per the guidelines of the literature, the physician should then proceed to perceive the direct observations, by his own senses. Many aspects of an ailment which are not perceivable by senses can be inferred by logic based on scriptures and by consulting experts. In this chapter, a set of assessment criteria or rubric has been provided for each method including pointers that help in determining what is to be examined by which method, how should something be examined, and what is to be inferred and on what basis, along with the authoritative sources of knowledge.  

'''Keywords''': ''Aptopadesha, Pratyaksha, Anumana,'' Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools.

'''Keywords''': ''Aptopadesha, Pratyaksha, Anumana,'' Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools.

 

=== Introduction ===

=== Introduction ===

 

[https://en.wikipedia.org/wiki/Ayurveda 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.  

[https://en.wikipedia.org/wiki/Ayurveda 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.  

It is also interesting to know that at both the places ([[Sutra Sthana]] 11th and [[Vimana Sthana]] 4th ) these three methods of examination have been defined (with little difference). 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]] 11th is applicable in other fields.

It is also interesting to know that at both the places ([[Sutra Sthana]] 11th and [[Vimana Sthana]] 4th ) these three methods of examination have been defined (with little difference). 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]] 11th is applicable in other fields.

 

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

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

pratyakShaM tu khalu tadyatsvayamindriyairmanasA  copalabhyate|  

pratyakShaM tu khalu tadyatsvayamindriyairmanasA  copalabhyate|  

anumAnaM khalu tarko yuktyapekShaH||4||

anumAnaM khalu tarko yuktyapekShaH||4||

 

Authoritative instructions are the teachings of ''apta'' (persons who are the most reliable). ''Apta'' are free from doubts, their memory is unimpaired, they know things in their entirety by determinate experience. They see things without any attachment or affection (''nishpriti'' and ''nirupatapa''). Because of these qualities, what they say is authentic. On the other hand, statements- true or false- made by intoxicated, mad, illiterate people and people with attachments are not to be considered as authoritative.  

Authoritative instructions are the teachings of ''apta'' (persons who are the most reliable). ''Apta'' are free from doubts, their memory is unimpaired, they know things in their entirety by determinate experience. They see things without any attachment or affection (''nishpriti'' and ''nirupatapa''). Because of these qualities, what they say is authentic. On the other hand, statements- true or false- made by intoxicated, mad, illiterate people and people with attachments are not to be considered as authoritative.  

 

''Pratyaksha'' or direct observation is that which is comprehensible by an individual through his own senses and mind.  

''Pratyaksha'' or direct observation is that which is comprehensible by an individual through his own senses and mind.  

kiM hyanupadiShTaM pUrvaM yattat pratyakShAnumAnAbhyAM parIkShamANo vidyAt|  

kiM hyanupadiShTaM pUrvaM yattat pratyakShAnumAnAbhyAM parIkShamANo vidyAt|  

tasmAddvividhA parIkShA j~jAnavatAM pratyakSham, anumAnaM ca; trividhA vA sahopadeshena||5||

tasmAddvividhA parIkShA j~jAnavatAM pratyakSham, anumAnaM ca; trividhA vA sahopadeshena||5||

 

First of all, one should examine the various aspects of diseases by employing all the three ''pramanas'' (i.e., the three methods of examination). Observations made on the nature of the disease thereafter are infallible. One cannot acquire authoritative knowledge about anything in all its aspects simply by examining it through a part of these “sources of knowledge”. Of all the sources of knowledge one should acquire knowledge in the beginning through authoritative instructions and, thereafter proceed to examine a thing through ''pratyaksha'' (direct observations), and ''anumana'' (inference). What is to be examined by “direct observations” and inference unless something can be studied prima facie. Hence, all the three methods of examination are always to be used in the sequence viz. ''aptopadesha, pratyaksha'' and ''anumana''. In other words, it could be said that if a physician possesses the textual knowledge (''aptopadesha'') then, for him, there are only two methods of examinations. [5]

First of all, one should examine the various aspects of diseases by employing all the three ''pramanas'' (i.e., the three methods of examination). Observations made on the nature of the disease thereafter are infallible. One cannot acquire authoritative knowledge about anything in all its aspects simply by examining it through a part of these “sources of knowledge”. Of all the sources of knowledge one should acquire knowledge in the beginning through authoritative instructions and, thereafter proceed to examine a thing through ''pratyaksha'' (direct observations), and ''anumana'' (inference). What is to be examined by “direct observations” and inference unless something can be studied prima facie. Hence, all the three methods of examination are always to be used in the sequence viz. ''aptopadesha, pratyaksha'' and ''anumana''. In other words, it could be said that if a physician possesses the textual knowledge (''aptopadesha'') then, for him, there are only two methods of examinations. [5]

 

==== Criteria of knowledge of disease ====

==== Criteria of knowledge of disease ====

tatrēdamupadiśanti buddhimantaḥ- rōgamēkaikamēvamprakōpaṇamēvaṁyōnimēvamutthānamēvamātmānamēvamadhiṣṭhānamēvaṁvēdanamēvaṁ saṁsthānamēvaṁśabdasparśarūparasagandhamēvamupadravamēvaṁvr̥ddhisthānakṣayasamanvitamēvamudarka mēvannāmānamēvaṁyōgaṁ vidyāt; tasminniyaṁ pratīkārārthā pravr̥ttirathavā nivr̥ttirityupadēśājjñāyatē||6||   

tatrēdamupadiśanti buddhimantaḥ- rōgamēkaikamēvamprakōpaṇamēvaṁyōnimēvamutthānamēvamātmānamēvamadhiṣṭhānamēvaṁvēdanamēvaṁ saṁsthānamēvaṁśabdasparśarūparasagandhamēvamupadravamēvaṁvr̥ddhisthānakṣayasamanvitamēvamudarka mēvannāmānamēvaṁyōgaṁ vidyāt; tasminniyaṁ pratīkārārthā pravr̥ttirathavā nivr̥ttirityupadēśājjñāyatē||6||   

                                            

                                            

tatredamupadishanti buddhimantaH-rogamekaikamevamprakopaNamevaMyonimevamutthAnamevamAtmAnamevamadhiShThAnamevaMvedanamevaMsaMsthAnamevaMshabdasparsharUparasagandhamevamupadravamevaMvRuddhisthAnakShayasamanvitamevamudarkamevannAmAnamevaMyogaM vidyAt; tasminniyaM pratIkArArthA pravRuttirathavA nivRuttirityupadeshAjj~jAyate||6||

tatredamupadishanti buddhimantaH-rogamekaikamevamprakopaNamevaMyonimevamutthAnamevamAtmAnamevamadhiShThAnamevaMvedanamevaMsaMsthAnamevaMshabdasparsharUparasagandham<br>evamupadravamevaMvRuddhisthAnakShayasamanvitamevamudarkamevannAmAnamevaMyogaM vidyAt; tasminniyaM pratIkArArthA pravRuttirathavA nivRuttirityupadeshAjj~jAyate||6||

Using the ''aptopadesha'' method of examination, one  acquires knowledge as described here using the following terms that wise men, or ''apta'', use to understand a disease:

Using the ''aptopadesha'' method of examination, one  acquires knowledge as described here using the following terms that wise men, or ''apta'', use to understand a disease:

pratyakShatastu khalu rogatattvaM bubhutsuH sarvairindriyaiH sarvAnindriyArthAnAturasharIragatAnparIkSheta, anyatra rasaj~jAnAt; tadyathA- antrakUjanaM, sandhisphuTanama~ggulIparvaNAM ca,svaravisheShAMshca, ye cAnye~api keciccharIropagatAH shabdAH syustA~jchrotreNa parIkSheta;varNasaMsthAnapramANacchAyAH  , sharIraprakRutivikArau, cakShurvaiShayikANi yAnicAnyAnyanuktAni tAni cakShuShA parIkSheta; rasaM tukhalvAturasharIragatamindriyavaiShayikamapyanumAnAdavagacchet, na hyasya pratyakSheNagrahaNamupapadyate, tasmAdAturapariprashnenaivAturamukharasaM vidyAt, yUkApasarpaNena tvasyasharIravairasyaM, makShikopasarpaNena sharIramAdhuryaM, lohitapittasandehe tu kiM dhArilohitaMlohitapittaM veti shvakAkabhakShaNAddhArilohitamabhakShaNAllohitapittamityanumAtavyam,evamanyAnapyAturasharIragatAn rasAnanumimIta; gandhAMstu khalu sarvasharIragatAnAturasyaprakRutivaikArikAn ghrANena parIkSheta; sparshaM ca pANinA prakRutivikRutiyuktam|  

pratyakShatastu khalu rogatattvaM bubhutsuH sarvairindriyaiH sarvAnindriyArthAnAturasharIragatAnparIkSheta, anyatra rasaj~jAnAt; tadyathA- antrakUjanaM, sandhisphuTanama~ggulIparvaNAM ca,svaravisheShAMshca, ye cAnye~api keciccharIropagatAH shabdAH syustA~jchrotreNa parIkSheta;varNasaMsthAnapramANacchAyAH  , sharIraprakRutivikArau, cakShurvaiShayikANi yAnicAnyAnyanuktAni tAni cakShuShA parIkSheta; rasaM tukhalvAturasharIragatamindriyavaiShayikamapyanumAnAdavagacchet, na hyasya pratyakSheNagrahaNamupapadyate, tasmAdAturapariprashnenaivAturamukharasaM vidyAt, yUkApasarpaNena tvasyasharIravairasyaM, makShikopasarpaNena sharIramAdhuryaM, lohitapittasandehe tu kiM dhArilohitaMlohitapittaM veti shvakAkabhakShaNAddhArilohitamabhakShaNAllohitapittamityanumAtavyam,evamanyAnapyAturasharIragatAn rasAnanumimIta; gandhAMstu khalu sarvasharIragatAnAturasyaprakRutivaikArikAn ghrANena parIkSheta; sparshaM ca pANinA prakRutivikRutiyuktam|  

iti pratyakShato~anumAnAdupadeshatashca  parIkShaNamuktam||7||

iti pratyakShato~anumAnAdupadeshatashca  parIkShaNamuktam||7||

 

A physician who wants to examine the patient and diagnose the disease through ''pratyaksha'' (direct observations) method of examination should examine with his own senses (all senses except the one relating to the gustatory organ, i.e., taste), in the body of the patient.  

A physician who wants to examine the patient and diagnose the disease through ''pratyaksha'' (direct observations) method of examination should examine with his own senses (all senses except the one relating to the gustatory organ, i.e., taste), in the body of the patient.  

Taste of the various tissues in the body of the patient are undoubtedly the objects of the gustatory sense organ and can be ascertained by inference and not by direct observation. Therefore, the taste in the mouth of the patient should be ascertained by interrogation. For example, sweet taste of the body can be inferred when flies are attracted towards the body. In the case of bleeding from the body, if there is a doubt about the nature of the blood, it should be resolved by giving the blood to dogs and crow to taste. Intake of the blood by dogs and crows is indicative of its purity and rejection by these animals indicates that the blood is vitiated by ''pitta'', i.e. the patient is suffering from ''raktapitta''. Similarly, other tastes in the patient’s body can be inferred.

Taste of the various tissues in the body of the patient are undoubtedly the objects of the gustatory sense organ and can be ascertained by inference and not by direct observation. Therefore, the taste in the mouth of the patient should be ascertained by interrogation. For example, sweet taste of the body can be inferred when flies are attracted towards the body. In the case of bleeding from the body, if there is a doubt about the nature of the blood, it should be resolved by giving the blood to dogs and crow to taste. Intake of the blood by dogs and crows is indicative of its purity and rejection by these animals indicates that the blood is vitiated by ''pitta'', i.e. the patient is suffering from ''raktapitta''. Similarly, other tastes in the patient’s body can be inferred.

 

===== By olfactory examinations =====

===== By olfactory examinations =====

ime tu khalvanye~apyevameva  bhUyo~anumAnaj~jeyA bhavanti bhAvAH|  

ime tu khalvanye~apyevameva  bhUyo~anumAnaj~jeyA bhavanti bhAvAH|  

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||

 

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):

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):

* ''Granyastu mridu darunatwam''- abdominal comforts and discomforts by sleep quality and by interrogations. [8]

* ''Granyastu mridu darunatwam''- abdominal comforts and discomforts by sleep quality and by interrogations. [8]

 

==== Summary ====

==== Summary ====

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi 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 [https://en.wikipedia.org/wiki/Ayurveda 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 [https://en.wikipedia.org/wiki/Ayurveda 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.  

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 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.

 

=== References ===

=== References ===

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