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|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

|description=Vimana Sthana Chapter 4. Three-fold clinical examination for comprehensive diagnosis of diseases

|description=Vimana Sthana Chapter 4. Three methods for knowledge of disease

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<big>'''Vimana Sthana Chapter 4. Three-fold clinical examination for comprehensive diagnosis of diseases '''</big>

<big>'''Vimana Sthana Chapter 4. Three methods for knowledge of disease '''</big>

<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

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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, 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.  

[[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.  

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

==Sanskrit Text, Transliteration and English Translation==

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We shall now expound the chapter on the “Three-fold Examination Method and its tools”, for a complete diagnosis of a disease. Thus said Lord Atreya. [1-2]

We shall now expound the chapter "Trividha Roga Vishesha Vijnaniya Vimana" (Three methods for knowledge of disease). Thus said Lord Atreya. [1-2]

                    

                    

==== Three methods for knowledge of disease ====

=== Three methods for knowledge of disease ===

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

=== Criteria of knowledge of disease ===

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Using the above framework, one could gather all the knowledge necessary of a disease [6]

Using the above framework, one could gather all the knowledge necessary of a disease [6]

==== Knowledge by direct perception ====

=== Knowledge by direct perception ===

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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.  

===== The following should be examined by auscultation =====

==== The following should be examined by auscultation ====

* ''Antrakoojanam'': Gurgling sound in the intestine indicating sound of movement;

* ''Antrakoojanam'': Gurgling sound in the intestine indicating sound of movement;

* ''Sandhisphutanam'': Crackling sound in the joints including those in the fingers;

* ''Sandhisphutanam'': Crackling sound in the joints including those in the fingers;

===== The following are perceived by auditory measures =====

==== The following are perceived by auditory measures ====

* ''Swara visheshana'': Voice patterns of the patient; and

* ''Swara visheshana'': Voice patterns of the patient; and

* ''Shabda'':  Such other sounds in the body of the patient which are normally found in the human body like respiratory and cardiovascular sounds and also the sounds which are produced through percussion and auscultation etc.

* ''Shabda'':  Such other sounds in the body of the patient which are normally found in the human body like respiratory and cardiovascular sounds and also the sounds which are produced through percussion and auscultation etc.

===== By tactile perceptions =====

==== By tactile perceptions ====

The physician should touch various body parts of the patients, and examine signs of abnormality in terms of the body temperature, skin texture (rough- unctuous), presence of moisture (dry-wet), eruptions, pitting, tenderness, etc.

The physician should touch various body parts of the patients, and examine signs of abnormality in terms of the body temperature, skin texture (rough- unctuous), presence of moisture (dry-wet), eruptions, pitting, tenderness, etc.

===== By visual examination =====

==== By visual examination ====

* Colour, shape, measurement and complexion;

* Colour, shape, measurement and complexion;

* Others which can be examined visually like signs of the disease, lustre and appearance of the body and other organs (inspection method of examination from top to bottom of the person)

* Others which can be examined visually like signs of the disease, lustre and appearance of the body and other organs (inspection method of examination from top to bottom of the person)

===== Gustatory examinations can be inferred by following observations =====

==== Gustatory examinations can be inferred by following observations ====

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.

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

==== By olfactory examinations ====

Normal and abnormal smells of the entire body of the patient should be examined by the olfactory sense organ. [7]

Normal and abnormal smells of the entire body of the patient should be examined by the olfactory sense organ. [7]

===== Knowledge by inference =====

==== Knowledge by inference ====

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* ''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]

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==== Importance of three fold examination ====

=== Importance of three fold examination ===

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When a physician who, even if well versed in knowledge of the disease and its treatment does not try to enter into the heart of the patient by virtue of the light of his knowledge, he will not be able to treat the disease. [12]

When a physician who, even if well versed in knowledge of the disease and its treatment does not try to enter into the heart of the patient by virtue of the light of his knowledge, he will not be able to treat the disease. [12]

==== Summary ====

=== Summary ===

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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.

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'' / Fundamental Principles===

== Tattva Vimarsha (Fundamental Principles) ==

* Diagnosis of a disease should be done thoroughly using the ''trividha pariksha'' consisting of ''aptopadesha'' (authoritative knowledge), ''pratyaksha'' (physical examination by direct observation) and ''anumana'' (interpretation, evaluation and assessment).

* Diagnosis of a disease should be done thoroughly using the ''trividha pariksha'' consisting of ''aptopadesha'' (authoritative knowledge), ''pratyaksha'' (physical examination by direct observation) and ''anumana'' (interpretation, evaluation and assessment).

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

== Vidhi Vimarsha (Applied Inferences) ==

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''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.  

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.

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 ==

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