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Line 404: − + − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + − 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. [Cha.Sa. [[Indriya Sthana]] 1/4] − 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.
Trividha Roga Vishesha Vijnaniya Vimana (view source)
Revision as of 11:26, 2 September 2020
, 11:26, 2 September 2020→Vidhi Vimarsha (Applied Inferences)
The experience based knowledge by authorities (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.
The experience based knowledge by authorities (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.
==== Direct observation (Pratyaksha) ====
==== Direct perception (Pratyaksha) ====
Knowledge by direct observation (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.
Knowledge by direct perception (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 inference (anumana) and direct perception (pratyaksha) provide only limited 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 [[dosha]] in the body.
==== Inference ====
Inference (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.
The methods of clinical examination are comprehensively described in this chapter. 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. [Cha.Sa. [[Indriya Sthana]] 1/4]
=== Updates from Ayurveda texts ===
In other texts of Ayurveda, various references of one type, two types, three types, four types, six types, eight types, ten types, eleven types, and twelve types of examination of the patient are described. Some important are as given below:
i)In Sushruta samhita,three fold like inspection(darshana), palpation (sparshana) and interrogation (prashana) are described. Six fold examination (5 sense (indriya) and interrogation (prashana pareeksha)) is also described.
ii)Yogaratnakar text describes eight fold examination viz. pulse(nadi), bowel habit/stool examination (mala), urine examination (mutra), tongue (jihwa), sound (shabda), touch (sparsha), sight (drik) and features (akriti). This is widely used in general examination of the patient.
=== Contemporary methods ===
Examinations like inspection, palpation, percussion and auscultation are part of direct perception (pratyaksha pariksha). Nowadays, various new techniques like X-ray, USG, CT Scan, MRI etc. are in use that augment direct perception. Abnormal findings suggest the underlying pathologies in the body with the use of inference (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 is to perceive in to the soul of the patient to make correct diagnosis and is somewhere missing due to excessive use of technology. Proper use of the three types (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.
=== Principles of knowledge of new diseases (anukta vyadhi) ===
The disease which are not described in the Ayurveda texts or newly introduced disease can be identified by applying the principles described in this chapter. It can be applied for knowing the complete details of the newer diseases including treatment.
=== Fundamental principles of clinical research ===
This chapter also mentions fundamental principles of clinical research. The methods of diagnosis of disease and examination of patient can be applied in clinical research.
=== Scope of further research ===
There is a wide scope of research on the following topics and concepts described in this chapter:
# Principle of Clinical Research in Ayurveda
# Clinical Diagnosis in Ayurveda
# Principle of development of tools for examination of the patients
# Principle of detailed description of newer/unknown diseases
=== Related chapters ===
[[Tistraishaniya Adhyaya]] , [[Rogabhishagjitiya Vimana]]
== Further reading ==
# Patwardhan B, Warude D, Pushpangadan P, Bhatt N. Ayurveda and traditional Chinese medicine: -A comparative overview. Evid Based Complement Alternat Med. 2005;2:465–73.
# Trochim, William M. The Research Methods Knowledge Base. 2nd ed.
# Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clinical trials. (1-74).Health Technol Assess. 1998;2:i–iv.
# Streiner DL, Norman GR. 3rd ed. New York: Oxford University Press Inc; 2003. Health Measurement Scales: A Practical Guide to Their Development and Use.
# Dunn G. 2nd ed. London, UK: Arnold; 2004. Statistical Evaluation of Measurement Errors: Design and Analysis of Reliability Studies.
# Lee SW, Jang ES, Lee J, Kim JY. Current researches on the methods of diagnosing sasang constitution: An overview. Evid Based Complement Alternat Med. 2009;6:43–9.
# Joshua AM, Celermajer DS, Stockler MR. Beauty is in the eye of the examiner: Reaching agreement about physical signs and their value. Intern Med J. 2005;35:178–87.
# O’Brien KA, Birch S. A review of the reliability of traditional East Asian medicine diagnoses. J Altern Complement Med. 2009;15:353–66.
# Zaslawski C. Clinical reasoning in traditional Chinese medicine: Implications for clinical research. Clin Acupunct Orient Med. 2003;4:94–101.
# Brenner H. Measures of differential diagnostic value of diagnostic procedures. J Clin Epidemiol. 1996;49:1435–9.
# Kraemer HC. Newbury Park, California: Sage; 1992. Evaluating Medical Tests: Objective and Quantitative Guidelines.
# Gregory RJ. 5th ed. Boston, MA: Pearson; 2007. Psychological testing: History, principles, and applications.
# Saini KK, Sehgal RK, Sethi BL. Evaluation of general classes of reliability estimators often used in statistical analyses of quasi-experimental designs. AIP Conf Proc. 2008;1052:58–62.
# de Vet HC, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59:1033–9.
# Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. Int J Nurs Stud. 2011;48:661–71.
# Mattu GS, Perry TL, Jr, Wright JM. Comparison of the oscillometric blood pressure monitor (BPM-100(Beta)) with the auscultatory mercury sphygmomanometer. Blood Press Monit. 2001;6:153–9.
# Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.
# Yoo JH, Kim JW, Kim KK, Kim JY, Koh BH, Lee EJ. Sasangin diagnosis questionnaire: Test of reliability. J Altern Complement Med. 2007;13:111–22.
# Abramson JH. New York: Churchill Livingstone; 1990. Surveys Methods in Community Medicine; p. 138.]
# Jang E, Baek Y, Park K, Lee S. Could the Sasang constitution itself be a risk factor of abdominal obesity? BMC Complement Altern Med. 2013;13:72.
# Kurande VH, Waagepetersen R, Toft E, Prasad R, Raturi L. Repeatability of pulse diagnosis and body constitution diagnosis in traditional indian ayurveda medicine. Glob Adv Health Med. 2012;1:34–40.
# Kurande VH, Waagepetersen R, Toft E, Prasad R. Reliability of pulse diagnosis in traditional indian ayurveda medicine. 8th Annual Congress of the International Society for Complementary Medicine Research (ISCMR). Res Complement Med/Forsch Komplementmed. 2013;20(Suppl 1):1–9.
# Kim M, Cobbin D, Zaslawski C. Traditional Chinese medicine tongue inspection: An examination of the inter-and intrapractitioner reliability for specific tongue characteristics. J Altern Complement Med. 2008;14:527–36.
# O’Brien KA, Abbas E, Movsessian P, Hook M, Komesaroff PA, Birch S. Investigating the reliability of Japanese toyohari meridian therapy diagnosis. J Altern Complement Med. 2009;15:1099–105.
# Wickström G, Bendix T. The “Hawthorne effect” – What did the original Hawthorne studies actually show? Scand J Work Environ Health. 2000;26:363–7.]
# McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Meth. 1996;1:30e46.]
# Fleiss JL, Levin B, Paik MC. 3rd ed. Hoboken, NJ: Wiley; 2003. Statistical Methods for Rates and Proportions.]
# Viera AJ, Garrett JM. Understanding interobserver agreement: The kappa statistic. Fam Med. 2005;37:360–3.
# Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
# Cohen J. Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–20.]
# Altman DG. London: Chapman and Hall; 1996. Practical Statistics for Medical Research.]
# Brar BS, Chhibber R, Srinivasa VM, Dearing BA, McGowan R, Katz RV. Use of Ayurvedic diagnostic criteria in Ayurvedic clinical trials: A literature review focused on research methods. J Altern Complement Med. 2012;18:20–8.]
# Sharma AK, Kumar R, Mishra A, Gupta R. Problems associated with clinical trials of ayurvedic medicines. Braz J Pharmacogn. 2010;20:276–81.
# Bhushan P, Kalpana J, Arvind C. Classification of human population based on HLA gene polymorphism and the concept of Prakriti in Ayurveda. J Altern Complement Med. 2005;11:349–53.
# Prasher B, Negi S, Aggarwal S, Mandal AK, Sethi TP, Deshmukh SR, et al. Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurveda. J Transl Med. 2008;6:48.
# Rastogi S. Development and validation of a Prototype Prakriti Analysis Tool (PPAT): Inferences from a pilot study. Ayu. 2012;33:209–18.
# Jang E, Kim JY, Lee H, Kim H, Baek Y, Lee S. A study on the reliability of sasang constitutional body trunk measurement. Evid Based Complement Alternat Med 2012. 2012 604842.
# Ryu H, Lee H, Kim H, Kim J. Reliability and validity of a cold-heat pattern questionnaire for traditional Chinese medicine. J Altern Complement Med. 2010;16:663–7.
# Dhruva A, Adler S, Weaver J, Acree M, Miaskowski C, Abrams D, et al. Mixed methods approaches in whole systems research: a study of ayurvedic diagnostics. BMC Complement Altern Med. 2012;12(Suppl 1):378.
# King E, Cobbin D, Walsh S, Ryan D. The reliable measurement of radial pulse characteristics. Acupunct Med. 2002;20:150–9.
# Kim J, Han GJ, Choi BH, Park JW, Park K, Yeo IK, et al. Development of differential criteria on tongue coating thickness in tongue diagnosis. Complement Ther Med. 2012;20:316–22.
# MacPherson H, Thorpe L, Thomas K, Campbell M. Acupuncture for low back pain: Traditional diagnosis and treatment of 148 patients in a clinical trial. Complement Ther Med. 2004;12:38–44.
# Zell B, Hirata J, Marcus A, Ettinger B, Pressman A, Ettinger KM. Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners. Menopause. 2000;7:129–34.
# Sung JJ, Leung WK, Ching JY, Lao L, Zhang G, Wu JC, et al. Agreements among traditional Chinese medicine practitioners in the diagnosis and treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;20:1205–10.
# Coeytaux RR, Chen W, Lindemuth CE, Tan Y, Reilly AC. Variability in the diagnosis and point selection for persons with frequent headache by traditional Chinese medicine acupuncturists. J Altern Complement Med. 2006;12:863–72.
# Prlic HM, Lehman AJ, Cibere J, Sodhi V, Varma S, Sukumaran T, et al. Agreement among Ayurvedic practitioners in the identification and treatment of three cases of inflammatory arthritis. Clin Exp Rheumatol. 2003;21:747–52.
# Miller TP, Brennan TA, Milstein A. How can we make more progress in measuring physicians’ performance to improve the value of care? Health Aff (Millwood) 2009;28:1429–37.
# Patwardhan K, Gehlot S, Singh G, Rathore HC. Global challenges of graduate level Ayurvedic education: A survey. Int J Ayurveda Res. 2010;1:49–54.
# Furst DE, Venkatraman MM, McGann M, Manohar PR, Booth-LaForce C, Sarin R, et al. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol. 2011;17:185–92.
# Tuijn S, Janssens F, Robben P, van den Bergh H. Reducing interrater variability and improving health care: A meta-analytical review. J Eval Clin Pract. 2012;18:887–95.
# Zhang GG, Lee WL, Lao L, Bausell B, Berman B, Handwerger B. The variability of TCM pattern diagnosis and herbal prescription on rheumatoid arthritis patients. Altern Ther Health Med. 2004;10:58–63.
# Zhang GG, Lee W, Bausell B, Lao L, Handwerger B, Berman B. Variability in the traditional Chinese medicine (TCM) diagnoses and herbal prescriptions provided by three TCM practitioners for 40 patients with rheumatoid arthritis. J Altern Complement Med. 2005;11:415–21.
# Zhang GG, Singh B, Lee W, Handwerger B, Lao L, Berman B. Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: Effect of training. J Altern Complement Med. 2008;14:381–6.
# Perloff D, Grim C, Flack J, Frolich ED, Hill M, McDonald M, et al. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88:2460–7.
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