Trividha Roga Vishesha Vijnaniya Vimana: Difference between revisions

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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.[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'' (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.  

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

तत्राप्तोपदेशो नामाप्तवचनम्| आप्ता ह्यवितर्कस्मृतिविभागविदो निष्प्रीत्युपतापदर्शिनश्च| तेषामेवङ्गुणयोगाद्यद्वचनं तत् प्रमाणम्| अप्रमाणं पुनर्मत्तोन्मत्तमूर्खरक्तदुष्टादुष्टवचनमिति ; प्रत्यक्षं तु खलु तद्यत् स्वयमिन्द्रियैर्मनसा चोपलभ्यते| अनुमानं खलु तर्को युक्त्यपेक्षः||४||

tatrāptōpadēśō nāmāptavacanam| āptā hyavitarkasmr̥tivibhāgavidō niṣprītyupatāpadarśinaśca| tēṣāmēvaṅguṇayōgādyadvacanaṁ tat pramāṇam| apramāṇaṁ punarmattōnmattamūrkharaktaduṣṭāduṣṭavacanamiti ; pratyakṣaṁ tu khalu tadyat svayamindriyairmanasā cōpalabhyatē| anumānaṁ khalu tarkō yuktyapēkṣaḥ||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.  

''Anumana'' or inference is the indirect knowledge based on [[Apamarga Tanduliya Adhyaya#'''Yukti Pramana and Yuktivyapashraya Chikitsa(Rational therapeutics)'''|''Yukti'' i.e. reasoning, logic and experiments]]. [4]

त्रिविधेन खल्वनेन ज्ञानसमुदायेन पूर्वं परीक्ष्य रोगं सर्वथा सर्वमथोत्तरकालमध्यवसानमदोषं भवति, न हि ज्ञानावयवेन कृत्स्ने ज्ञेये ज्ञानमुत्पद्यते| त्रिविधे त्वस्मिन् ज्ञानसमुदये पूर्वमाप्तोपदेशाज्ज्ञानं, ततः प्रत्यक्षानुमानाभ्यां परीक्षोपपद्यते| किं ह्यनुपदिष्टं पूर्वं यत्तत् प्रत्यक्षानुमानाभ्यां परीक्षमाणो विद्यात्| तस्माद्द्विविधा परीक्षा ज्ञानवतां प्रत्यक्षम्, अनुमानं च;त्रिविधा वा सहोपदेशेन||५||

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]

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:

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

* ''Yoni'': Source of ''doshas''

* ''Vriddhi sthana kshayam'' (Increased, decreased, balanced): Whether ''dosha, dhatu'' and ''mala'' are increased, decreased, or in balance

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

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.

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):

* ''Moham avigyanena''- ignorance, has no skills, without occupation, remains idol.

* ''Shokam dainyena''- grief by poverty of thinking

* ''Smriti smarnena''- memory by recalling ability

* ''Satmya upshayena''- habituation by suitability  

* ''Dosha pramana''- quantity of morbidity by potential causative factors

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]

* 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).

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.  

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.  

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.

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.