Changes

|title=Trividha Roga Vishesha Vijnaniya Vimana

|title=Trividha Roga Vishesha Vijnaniya Vimana

|titlemode=append

|titlemode=append

|keywords=Aptopadesha, Pratyaksha, Anumana, Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools, Ayurveda, Indian system of medicine, charak samhita.

|keywords=Aptopadesha, Pratyaksha, Anumana, Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools, Ayurveda, Indian system of medicine, charak samhita, yogesh deole, gopal basisht, caraka samhita online, caraka, Ayurvedic system, evidence based medicine, evidence generation in medical records, case recording

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

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

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

<p style="text-align:justify;">This chapter deals with three methods of clinical examinations useful for understanding specific characteristics of diseases. These three methods are [[aptopadesha]] (authoritative instructions), [[Pratyaksha pramana|pratyaksha]] (direct observation) and [[Anumana pramana|anumana]] (inference). These methods play a pivotal role not only in the diagnosis of a disease, but also 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 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. </br>

<p style="text-align:justify;">This chapter deals with three methods of clinical examinations useful for understanding specific characteristics of diseases. These three methods are [[aptopadesha]] (authoritative instructions), [[Pratyaksha pramana|pratyaksha]] (direct observation) and [[Anumana pramana|anumana]] (inference). These methods play a pivotal role not only in the diagnosis of a disease, but also 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 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. </br>

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

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

</p>

</p>

== Introduction ==

== Introduction ==

<div style="text-align:justify;">

<div style="text-align:justify;">

[[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.[Cha.Sa. [[Sutra Sthana]] 11/17] These four specific methods of examination are [[aptopadesha]] (knowledge from authoritative person and scriptures), ''pratyaksha'' (direct observation), ''anumana'' (inference) and [[Yukti pramana|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'' [Cha.Sa. [[Vimana Sthana]] 4/3-4]. 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.[Cha.Sa. [[Sutra Sthana]] 11/17] These four specific methods of examination are [[aptopadesha]] (knowledge from authoritative person and scriptures), [[Pratyaksha pramana|Pratyaksha]] (direct observation), [[Anumana pramana|Anumana]] (inference) and [[Yukti pramana|yukti]] (logic based interpretation). For clinical examination of a patient, [[yukti pramana]] is included in [[Anumana pramana|Anumana]] because inference should be included in ''tarka'' (logic) and [[Yukti pramana|yukti]] [Cha.Sa. [[Vimana Sthana]] 4/3-4]. The author did not feel the need for [[Yukti pramana|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 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. [Cha.Sa. [[Vimana Sthana]] 4/11]  

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 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. [Cha.Sa. [[Vimana Sthana]] 4/11]  

</div></div>

</div></div>

                  

                  

Specific features of diseases can be determined in three ways – by means of ''aptopadesha'' (authoritative instruction), ''pratyaksha'' (direct observation), and ''anumana'' (inference). [3]

Specific features of diseases can be determined in three ways – by means of [[Aaptopadesha pramana|aptopadesha]] (authoritative instruction), [[Pratyaksha pramana|Pratyaksha]] (direct observation), and [[Anumana pramana|Anumana]] (inference). [3]

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

<div style="text-align:justify;">

<div style="text-align:justify;">

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 pramana|Pratyaksha]] (direct observations), and [[Anumana pramana|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. [[Aaptopadesha pramana|aptopadesha]], [[Pratyaksha pramana|Pratyaksha]]'' and [[Anumana pramana|Anumana]]. In other words, it could be said that if a physician possesses the textual knowledge ([[Aaptopadesha pramana|Aptopadesha]] ) then, for him, there are only two methods of examinations. [5]

</div>

</div>

</div></div>

</div></div>

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

* ''Prakopanam'' : provoking factors, viz. process of the vitiation of the ''doshas''

* ''Prakopanam'' : provoking factors, viz. process of the vitiation of the ''doshas''

<div style="text-align:justify;">

<div style="text-align:justify;">

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 pramana|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 ====

<div style="text-align:justify;">

<div style="text-align:justify;">

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):

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 pramana|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.

</div></div>

</div></div>

As far as possible, all factors should be discussed in their entirety. After examining the disease by ''aptopadesha'', the physician should obtain knowledge regarding the nature of disease and the therapies required therefore. [10]

As far as possible, all factors should be discussed in their entirety. After examining the disease by [[Aaptopadesha pramana|aptopadesha]], the physician should obtain knowledge regarding the nature of disease and the therapies required therefore. [10]

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

== 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 [[Aaptopadesha pramana|aptopadesha]] (authoritative knowledge), [[Pratyaksha pramana|Pratyaksha]] (physical examination by direct observation) and [[Anumana pramana|Anumana]] (interpretation, evaluation and assessment).

== Vidhi Vimarsha (Applied Inferences) ==

== Vidhi Vimarsha (Applied Inferences) ==

==== Authoritative instructions (Aptopadesha) ====

==== Authoritative instructions (Aptopadesha) ====

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 ([[Aaptopadesha pramana|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 perception (Pratyaksha) ====

==== Direct perception (Pratyaksha) ====

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.  

Knowledge by direct perception ([[Pratyaksha pramana|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 pramana|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 ====

=== Contemporary methods ===

=== 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.

Examinations like inspection, palpation, percussion and auscultation are part of direct perception ([[Pratyaksha pramana|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) ===

=== Principles of knowledge of new diseases (anukta vyadhi) ===