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Rogabhishagjitiya Vimana (view source)

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

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<div style="text-align:justify;">This comprehensive and detailed chapter deals with assessment criteria of standard quality treatise, the teacher and the disciple, the means for receiving the knowledge from the treatise, method of discussion and its types- friendly or hostile, result of discussion, worth considering or worth discarding. It describes examination of ten entities to understand the state of health of the patient before starting the treatment. For providing treatment, physician should consider the strength of patient, severity of disease, ~~prakriti~~ (constitution), vikriti (nature of abnormalities), potency of drugs, season for purification therapy, and the status of the patients in context to use of drugs. Thus, this chapter gives a glimpse of how advanced the medical education in India was over two thousand years ago and how well the phenomenon of health was understood and managed. </div>

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<div style="text-align:justify;">This comprehensive and detailed chapter deals with assessment criteria of standard quality treatise, the teacher and the disciple, the means for receiving the knowledge from the treatise, method of discussion and its types- friendly or hostile, result of discussion, worth considering or worth discarding. It describes examination of ten entities to understand the state of health of the patient before starting the treatment. For providing treatment, physician should consider the strength of patient, severity of disease, [[Prakriti]] (constitution), vikriti (nature of abnormalities), potency of drugs, season for purification therapy, and the status of the patients in context to use of drugs. Thus, this chapter gives a glimpse of how advanced the medical education in India was over two thousand years ago and how well the phenomenon of health was understood and managed. </div>

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'''Keywords''': Preceptor, student, teaching methodology, learning methods, discussion techniques, examination techniques of patient, ~~''prakriti''~~, ''sara'', purification therapies, pharmacovigilance.

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'''Keywords''': Preceptor, student, teaching methodology, learning methods, discussion techniques, examination techniques of patient, [[Prakriti]], ''sara'', purification therapies, pharmacovigilance.

</div>

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Similarly, for the physician to improve his medical knowledge ''karana'', (reasoning/doer) ''karana'' (knowledge of means), ''karyayoni'' (objective), ''karya'' (action), ''karyaphala'' (attainment of objective and happiness), ''anubandha'' (after effect), ''desha'' (habitat/patient), ''kala'' (year and phase of disease), ''pravritti'' (initiation of therapy) and ''upaya'' (proper management) are necessary.

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Complete knowledge of patient’s condition is required before starting the treatment, which is done by tenfold examination. The specific investigations to be considered are ''desha'' (place-habitat and patient’s body), ~~''prakṛiti''~~ and ''vikriti'' according to ''dosha'', ''sara'' (essence of body tissues), compactness, structure and body mass, measurement of body parts, specific suitability of a person, ''sattva'' (mental status), power of digestion and assimilation, exercise endurance and age.

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Complete knowledge of patient’s condition is required before starting the treatment, which is done by tenfold examination. The specific investigations to be considered are ''desha'' (place-habitat and patient’s body), [[prakriti]] and ''vikriti'' according to [[dosha]], ''sara'' (essence of body tissues), compactness, structure and body mass, measurement of body parts, specific suitability of a person, ''sattva'' (mental status), power of digestion and assimilation, exercise endurance and age.

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Seven types of ~~''prakriti''~~ and their features are explained to understand normal state of body, whereas the pathological condition is termed as ''vikriti''. These factors help the physician to classify the strength of the patient into three categories viz. superior (''pravar''), medium (''madhya'') and inferior (''avar''). It is on this basis that physician decides to give strong (''tikshna''), mild (''mridu'') and moderate (''madhya'') medicaments. The appropriate time for purification therapies is explained with reasoning. Similarly, medicine should be given at appropriate time to the patient (''kala'') and when not to be given (''akala''). Lastly initiation of therapy (''pravritti'') and excellance of physician etc. ''chatuspada'' (''upaya'') have been explained.

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Seven types of [[Prakriti]] and their features are explained to understand normal state of body, whereas the pathological condition is termed as ''vikriti''. These factors help the physician to classify the strength of the patient into three categories viz. superior (''pravar''), medium (''madhya'') and inferior (''avar''). It is on this basis that physician decides to give strong (''tikshna''), mild (''mridu'') and moderate (''madhya'') medicaments. The appropriate time for purification therapies is explained with reasoning. Similarly, medicine should be given at appropriate time to the patient (''kala'') and when not to be given (''akala''). Lastly initiation of therapy (''pravritti'') and excellance of physician etc. ''chatuspada'' (''upaya'') have been explained.

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All the above ten examinations help in deciding the actual and specific treatment like ''vamana, virechana, asthapana, anuvasana'' and ''shirovirechana''. Therefore, in the concluding part of the chapter drugs useful for ''vamana'' and ''virechana'' have been enlisted. In case of ''asthapana'' as per the condition of patient and disease the drug classification can be innumerable therefore to prevent the ''ativistara'' (prolonged deliberation/expansion). Drugs are classified on the basis of ''rasa'' into six groups for example ''madhura rasa'' drugs having ''madhura vipaka'' and ''madhur prabhava'' are classified into ''madhur skanda'' so is the case with other five ''rasa''. The physician has been given freedom to permutate and combine drugs as per requirement in patient and its availability.

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All the above ten examinations help in deciding the actual and specific treatment like [[vamana]], [[virechana]], asthapana, anuvasana and ''shirovirechana''. Therefore, in the concluding part of the chapter drugs useful for [[vamana]] and [[virechana]] have been enlisted. In case of ''asthapana'' as per the condition of patient and disease the drug classification can be innumerable therefore to prevent the ''ativistara'' (prolonged deliberation/expansion). Drugs are classified on the basis of ''rasa'' into six groups for example ''madhura rasa'' drugs having ''madhura vipaka'' and ''madhur prabhava'' are classified into ''madhur skanda'' so is the case with other five ''rasa''. The physician has been given freedom to permutate and combine drugs as per requirement in patient and its availability.

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The same ''asthapana gana'' (group of drugs for non-unctuous enema) can be fortified with specific ''sneha'' as per ''dosha'' and be administered as ''anuvasana''. ''Taila'' for ''vata, vasa'' and ''majja'' for ''kapha'' and ''ghrita'' for ''pitta''. Lastly drugs useful in ''shirovirechana'' have been explained along with the part of the plant (flower, fruit, bark etc.) to be used.

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The same ''asthapana gana'' (group of drugs for non-unctuous enema) can be fortified with specific ''sneha'' as per [[dosha]] and be administered as ''anuvasana''. ''Taila'' for [[vata]], vasa and majja for [[kapha]] and ''ghrita'' for [[pitta]]. Lastly drugs useful in ''shirovirechana'' have been explained along with the part of the plant (flower, fruit, bark etc.) to be used.

For the purpose of accurate diagnosis and treatment one must have complete knowledge for which this chapter is designed.

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''Sthapana'' is establishing the same proposition on firm ground with the help of ''hetu'' (reason), ''drishtanta'' (instance), ''upanaya'' (correlation) and ''nigamana'' (conclusion). First there is proposition (''pratijna'') and then establishment (''sthapana'') because what can be established (nothing) in absence of proposition? For instance, ‘''purusha'' is eternal’ – this is proposition, reason (''hetu'') is - ‘because of not being created’; instance (''drishtanta'') is – ‘as sky’; correlation (''upanaya'') is – ‘as the sky is uncreated and is eternal so is ''purusha''’; conclusion (''nigamana'') is - ‘therefore, ''purusha'' is eternal.’[31]

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''Sthapana'' is establishing the same proposition on firm ground with the help of [[hetu]] (reason), ''drishtanta'' (instance), ''upanaya'' (correlation) and ''nigamana'' (conclusion). First there is proposition (''pratijna'') and then establishment (''sthapana'') because what can be established (nothing) in absence of proposition? For instance, ‘[[purusha]] is eternal’ – this is proposition, reason ([[hetu]]) is - ‘because of not being created’; instance (''drishtanta'') is – ‘as sky’; correlation (''upanaya'') is – ‘as the sky is uncreated and is eternal so is [[purusha]]’; conclusion (''nigamana'') is - ‘therefore, [[purusha]] is eternal.’[31]

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==== 10. ''Pratishthapana'' (counter-assertion) ====

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''Pratishthapana'' is giving a contrary statement to the opponent’s proposition. For instance, ‘self is non-eternal’ is proposition (''pratijna''); reason (''hetu'') is-‘because of being perceived by senses’; instance (''drishtanta'') is – ‘as pitcher’; correlation (''upanaya'') is – ‘as pitcher is perceived by senses and is non-eternal so is ‘self’; conclusion (''nigamana'') is – therefore, self is non eternal.[32]

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''Pratishthapana'' is giving a contrary statement to the opponent’s proposition. For instance, ‘self is non-eternal’ is proposition (''pratijna''); reason ([[hetu]]) is-‘because of being perceived by senses’; instance (''drishtanta'') is – ‘as pitcher’; correlation (''upanaya'') is – ‘as pitcher is perceived by senses and is non-eternal so is ‘self’; conclusion (''nigamana'') is – therefore, self is non eternal.[32]

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==== 11. ''Hetu'' (cause) ====

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==== 11. [[Hetu]] (cause) ====

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''Uttara'' is the statement made in opposition (heterogeneous) to the homologous nature shown between ''hetu'' and ''karya'' and vice versa. For instance , if somebody says – disorders are similar to cause, as ''shitaka'' disease has similar causes like exposure to snow and cold wave, the opponent may say – disorders are dissimilar to cause as burning sensation, heat, sloughing and suppuration of body parts are caused by cold wave which is dissimilar. This is ''uttara'' (rejoinder) with contrary statements.[36]

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''Uttara'' is the statement made in opposition (heterogeneous) to the homologous nature shown between [[hetu]] and ''karya'' and vice versa. For instance , if somebody says – disorders are similar to cause, as ''shitaka'' disease has similar causes like exposure to snow and cold wave, the opponent may say – disorders are dissimilar to cause as burning sensation, heat, sloughing and suppuration of body parts are caused by cold wave which is dissimilar. This is ''uttara'' (rejoinder) with contrary statements.[36]

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==== 16. ''Siddhanta'' (theory/doctrine) ====

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*'''''Sarvatantra siddhanta''''' is that which is accepted universally by all the treatises such as – there are causes, there are diseases and there are remedies for the curable disorders.

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*'''''Pratitantra siddhanta''''' is that which is not universal in nature and is held by only one of the treatises such as – in other treatises there are eight ''rasas'' but here are six; here are the five sense organs while in other texts there are six sense organs; per other texts all diseases are caused by ''vata'', etc. , but in this text they are considered to be caused by ''vata'' and other ''dosha'' as well as ~~''bhutas''~~.

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*'''''Pratitantra siddhanta''''' is that which is not universal in nature and is held by only one of the treatises such as – in other treatises there are eight ''rasas'' but here are six; here are the five sense organs while in other texts there are six sense organs; per other texts all diseases are caused by [[vata]], etc. , but in this text they are considered to be caused by [[vata]] and other [[dosha]] as well as [[bhuta]].

*'''''Adhikarana siddhanta''''' is that which is established by implication of other proofs. Such as – the emancipated cannot show any good or bad consequent effect of deeds because of absence of desires. This proves the effects of deeds, emancipation, presence of self and the other world.

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*'''''Abhyupagama siddhanta''''' is that which is held up by physicians temporarily and hypothetically during debate though the idea is unproved, untested, uninstructed and irrational such as – proposing that ''dravya'' is predominant or ''guna'' or properties are predominant or ''veerya'' is predominant.

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*'''''Abhyupagama siddhanta''''' is that which is held up by physicians temporarily and hypothetically during debate though the idea is unproved, untested, uninstructed and irrational such as – proposing that ''dravya'' is predominant or [[guna]] or properties are predominant or ''veerya'' is predominant.

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These are four types of doctrines. [37]

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''Shabda'' is an aggregate of letters. This is of four types – ''drishtartha, adrishtartha, satya,'' and ''anrita''.

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''Drishtartha'' is that which connotes observable meanings; such as ''dosha'' are aggravated by three etiological factors; they are pacified by six therapeutic measures; the sense objects are perceived through the sense organs.

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''Drishtartha'' is that which connotes observable meanings; such as [[dosha]] are aggravated by three etiological factors; they are pacified by six therapeutic measures; the sense objects are perceived through the sense organs.

''Adrishtartha'' is that which connotes unobservable ideas, such as the other world exists; there is emancipation.

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''Anrita'' is contrary to ''satya'' (that which is not consistent with facts).[38]

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==== 18. ''Pratyaksha'' (direct perception) ====

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''Anumana'' is the reasoning supported by invariable concomitance such as the knowledge of ''agni'' (is examined) by the power of digestion; that of strength of a person by examining the power to exercise, auditory organ etc. by the ability of perception of sound, etc.[40]

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''Anumana'' is the reasoning supported by invariable concomitance such as the knowledge of [[agni]] (is examined) by the power of digestion; that of strength of a person by examining the power to exercise, auditory organ etc. by the ability of perception of sound, etc.[40]

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==== 20. ''Aitihya'' (traditional instruction) ====

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''Vyavasaya'' is resolution or firm decision, such as- this disease is certainly ~~''vataja''~~ and this is the medicament for this.[47]

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''Vyavasaya'' is resolution or firm decision, such as- this disease is certainly [[vata]]ja and this is the medicament for this.[47]

==== 27. ''Arthaprapti'' ( attainment of meaning) ====

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''Sambhava'' is that from which something is originated, such as six ~~dhatus~~ from which foetus has origin, disease have origin from unwholesome things and health have origin from wholesome things.[49]

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''Sambhava'' is that from which something is originated, such as six [[dhatu]] from which foetus has origin, disease have origin from unwholesome things and health have origin from wholesome things.[49]

==== 29. ''Anuyojya'' (censurable) ====

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''Vakyadosha'' (syntactical defects), in this context, is of five types – ''nyunam, adhikam, anarthakam, aparthakam, viruddham''. Without these there is no damage to the contextual sense.

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#''Nyunam'' (semantic deficiency) such as – if there is lack of even one of the five – proposition (''pratijna''), reason (''hetu''), instance (''udaharan''), correlation (''upanaya'') and conclusion (''nigaman'') or if there be many reasons and only one reason is resorted to for proving something than it is defined as ''nyunam''.

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#''Nyunam'' (semantic deficiency) such as – if there is lack of even one of the five – proposition (''pratijna''), reason ([[hetu]]), instance (''udaharan''), correlation (''upanaya'') and conclusion (''nigaman'') or if there be many reasons and only one reason is resorted to for proving something than it is defined as ''nyunam''.

#Adhikam (superfluity) is just contrary to nyunam such as while talking about [[Ayurveda]] one says about some irrelevant texts such as that composed by Barhaspatyam or Aushana or even if relevant it is repeated unnecessarily than the repetition (''punarikti'') also comes under ''adhikam'' (superfluity). Repetition (''punarikta'') is of two types – ''arthapunaruktam'' (semantic repetition) and ''shabdapunaruktam'' (verbal repetition). The former (''arthapunaruktam'') consists of the repetition of the same idea by different synonymous words such as ''bheshajam, aushadham'' and ''sadhanam'' and the repetition of the same word such as, ''bheshaja'' is called as ''shabdapunaruktam''.

#''Anarthakam'' (nonessential statement) is that where there is only jumble of alphabets devoid of any sense. ''Aparthakam'' is deprivation of meaning due to lack of mutual connection of otherwise meaningful words such as, ''chakra-na(ta)kra-vamsha-vajra-nishakara''.

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Now convention (''samaya'') is of three types – ''Ayurvedic samaya, yajnika samaya,'' (ritual) and ethical (''mokshashastrika''). Ayurvedic ''samaya'' (ayurvedic convention) such as four aspects of health care, ''yajnika samaya'' (ritual convention) such as animals are to be sacrificed by persons following rituals, ''mokshashastrika'' (ethical convention) such as non-violence towards all creatures. The statement incongruous in respect of the respective convention is taken as ''viruddha'' (incongruity). Thus are the ''vakyadosha'' (syntactical defects).[54]

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====34.''Vakyaprashamsa'' (syntactical excellence) ====

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''Ahetu'' is of three types – ''prakaranasamah, samshayasamaḥ, varnyasama''.

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''Prakaranasama ahetu'' is like saying – ‘the ''atma'' (soul) other than the body is eternal.’ On this opponent says that ‘because the self is other than the body, it is eternal, then as the body is non-eternal the dissimilar self must be eternal. This is ''ahetu'' (fallacious reason) because here the ''paksha'' (minor term) itself has been used as reason.

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''Prakaranasama ahetu'' is like saying – ‘the [[atma]] (soul) other than the body is eternal.’ On this opponent says that ‘because the self is other than the body, it is eternal, then as the body is non-eternal the dissimilar self must be eternal. This is ''ahetu'' (fallacious reason) because here the ''paksha'' (minor term) itself has been used as reason.

''Samshayasama ahetu'' the reason similar to doubt is that which though being cause of doubt is used as cause of eliminating the same such as, if someone says only a part of [[Ayurveda]] , it creates doubt as to whether he is a physician or not; On this opponent says – ‘as he has said a part of [[Ayurveda]], he is a physician.’ The doubt can not be the cause of removing the same.

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''Varnyasam ahetu''- the reason (''hetu'') given is similar to object and not different from the object, such as somebody says – ''buddhi'' (intellect) is non-eternal because of the absence of touch like ''shabda'' (sound). Here both ''buddhi'' (intellect) and ''shabda'' (sound)are objects; hence because of the absence of difference between them, the reason is similar to object and as such is fallacious.[57]

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''Varnyasam ahetu''- the reason ([[hetu]]) given is similar to object and not different from the object, such as somebody says – [[buddhi]] (intellect) is non-eternal because of the absence of touch like ''shabda'' (sound). Here both [[buddhi]] (intellect) and ''shabda'' (sound)are objects; hence because of the absence of difference between them, the reason is similar to object and as such is fallacious.[57]

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==== 37. ''Atitakala'' (delayed performance) ====

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''Upalambha'' is pointing out defects in causality as explained earlier under the heading ''hetu'' fallacious or apparent reason which is unable to prove the ''sadhya''.[59]

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''Upalambha'' is pointing out defects in causality as explained earlier under the heading [[hetu]] fallacious or apparent reason which is unable to prove the ''sadhya''.[59]

==== 39. ''Parihara'' (refuting defects) ====

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''Parihara'' is refuting the above points out of defects, such as the signs of life are available constantly till the life is in the body, and are not available after it goes out. Therefore, the ''atma'' (self) is different from the body and is eternal.[60]

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''Parihara'' is refuting the above points out of defects, such as the signs of life are available constantly till the life is in the body, and are not available after it goes out. Therefore, the [[atma]] (self) is different from the body and is eternal.[60]

==== 40. ''Pratijnahani'' (change of proposition) ====

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''Pratijnahani'' is defined as when one gives up the original proposition after having been questioned. For instance, somebody puts proposition in the beginning as, the self (''purusha'') is eternal, but when questioned says that it is non-eternal then such change of proposition after questioning is called as ''Pratijnahani''.[61]

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''Pratijnahani'' is defined as when one gives up the original proposition after having been questioned. For instance, somebody puts proposition in the beginning as, the self ([[purusha]]) is eternal, but when questioned says that it is non-eternal then such change of proposition after questioning is called as ''Pratijnahani''.[61]

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==== 41. ''Abhyanujna'' (acceptance) ====

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''Hetvantara'' is that where some imperfect reason (~~''vikritahetu''~~) is stated instead of perfect reason (~~''prakritahetu''~~). [63]

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''Hetvantara'' is that where some imperfect reason (vikrita[[hetu]]) is stated instead of perfect reason (prakrita[[hetu]]). [63]

==== 43. ''Arthantara'' (statement of irrelevant meaning) ====

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Previously explained ''karana'' etc. ten entities are elaborately discussed in relation to specific features of therapeutics diseases ten entities are to be examined such as physician acts like a doer (''karana''),drugs act like instrument (''karan''), imbalance of ''dhatu'' (''karyayoni''), balance of ''dhatu'' (''karya''), attainment of health and happiness (''karyaphala''), life-span (''anubandha''), land as well as patient (''desha''), year and phase of disease (''kala''), initiation of therapy (''pravritti'') and excellence of physician etc. and proper management (''upaya'').[84]

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Previously explained ''karana'' etc. ten entities are elaborately discussed in relation to specific features of therapeutics diseases ten entities are to be examined such as physician acts like a doer (''karana''),drugs act like instrument (''karan''), imbalance of [[dhatu]] (''karyayoni''), balance of [[dhatu]] (''karya''), attainment of health and happiness (''karyaphala''), life-span (''anubandha''), land as well as patient (''desha''), year and phase of disease (''kala''), initiation of therapy (''pravritti'') and excellence of physician etc. and proper management (''upaya'').[84]

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Earlier, physician has been mentioned as doer (''karana''). ''Bhishak'' is the one who should be able to win over the diseases and expert in applying the ideas of the aphorisms and knows the pros and cons of life (science) properly from all aspects. He should know how to bring about balance between ~~''dhatus''~~ (''dhatu samya''), must be learned, trained in scriptures and qualified enough for the same and has received practical training and expertise in duties. He should be introspective, desirous of maintaining balance of all ~~''dhatus''~~, considering the consequence of treatment in appropriate patients, with proper qualities of management, with due considerations of one’s own capabilities and limitations.

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Earlier, physician has been mentioned as doer (''karana''). ''Bhishak'' is the one who should be able to win over the diseases and expert in applying the ideas of the aphorisms and knows the pros and cons of life (science) properly from all aspects. He should know how to bring about balance between [[dhatu]] ([[dhatu]] samya), must be learned, trained in scriptures and qualified enough for the same and has received practical training and expertise in duties. He should be introspective, desirous of maintaining balance of all [[dhatu]], considering the consequence of treatment in appropriate patients, with proper qualities of management, with due considerations of one’s own capabilities and limitations.

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The physician endowed with the following qualities is capable of bringing forth the equilibrium of ~~''dhatus''~~: clear scientific knowledge , practical knowledge, alert, purity, skill, and possession of all required equipment, with proper sense perceptions (all sense and motor organs), acquaintance with human constitution and the knowledge of the course of action. [86]

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The physician endowed with the following qualities is capable of bringing forth the equilibrium of [[dhatu]]: clear scientific knowledge , practical knowledge, alert, purity, skill, and possession of all required equipment, with proper sense perceptions (all sense and motor organs), acquaintance with human constitution and the knowledge of the course of action. [86]

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The medicament has been mentioned here as instrument (''karana'') which serves as equipment for the physician making effort for effective balance of ~~''dhatus''~~ particularly different from the entities ending with procedure (original source, inclination, place, time and procedure). In view of agents applied medicament or therapy is advocated as of two types – spiritual (''daivavyapashraya'') and rational (''yuktivyapashayam'').

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The medicament has been mentioned here as instrument (''karana'') which serves as equipment for the physician making effort for effective balance of [[dhatu]] particularly different from the entities ending with procedure (original source, inclination, place, time and procedure). In view of agents applied medicament or therapy is advocated as of two types – spiritual (''daivavyapashraya'') and rational (''yuktivyapashayam'').

In spiritual therapy, incantation, roots, gems, auspicious rites, expiation, fasting, blessings, bowing, visit to temples(sacred places) etc. are employed.

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==== Assessment of disequilibrium of ''dhatu'' ====

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==== Assessment of disequilibrium of [[dhatu]]====

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The original source is disequilibrium of ~~''dhatus''~~ known by the emergence of signs of the disorder. Examination regarding this and the material cause of the disorder consists of the observation of the characters of their diminution or aggravation and also of those denoting curability, incurability, mildness and severity of the disorder.[88]

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The original source is disequilibrium of [[dhatu]] known by the emergence of signs of the disorder. Examination regarding this and the material cause of the disorder consists of the observation of the characters of their diminution or aggravation and also of those denoting curability, incurability, mildness and severity of the disorder.[88]

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==== Assessment of equilibrium of ''dhatu'' ====

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==== Assessment of equilibrium of [[dhatu]] ====

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Action (''karya'') is to bring about equilibrium of ~~''dhatus''~~ and its feature is absence of disease. Its examination is based on following criteria: alleviation of the disorder, normalcy of voice and complexion, nourishment of body, increase in strength, desire for food, relish at meal time, proper and timely digestion of the ingested food, timely sleep, non-appearance of abnormal dreams, easy awakening, easy elimination of urine, feces and semen, overall normalcy of mind, intellect and sense organs and associated with no other unhealthy features.[89]

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Action (''karya'') is to bring about equilibrium of [[dhatu]] and its feature is absence of disease. Its examination is based on following criteria: alleviation of the disorder, normalcy of voice and complexion, nourishment of body, increase in strength, desire for food, relish at meal time, proper and timely digestion of the ingested food, timely sleep, non-appearance of abnormal dreams, easy awakening, easy elimination of urine, feces and semen, overall normalcy of mind, intellect and sense organs and associated with no other unhealthy features.[89]

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The place of living and patients’ body constitutes the field of action (''karya desha'').

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Assessment of place of living is done with a view considering the patient and medicine. Regarding patient the things to be considered are – in which area patient is born, grown or diseased; in that particular area, the people mostly have such diet, such lifestyle, such behavior and conduct, such strength, such mind setup, this particular things are naturally accustomed, these are the wrong habits/ or the domination of ''dosha'', liking, area associated disorders, these are the wholesome entities and unwholesome entities for the people. The knowledge regarding place of living examination about drugs will be described in [[Kalpa Sthana]] section. [92-93]

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Assessment of place of living is done with a view considering the patient and medicine. Regarding patient the things to be considered are – in which area patient is born, grown or diseased; in that particular area, the people mostly have such diet, such lifestyle, such behavior and conduct, such strength, such mind setup, this particular things are naturally accustomed, these are the wrong habits/ or the domination of [[dosha]], liking, area associated disorders, these are the wholesome entities and unwholesome entities for the people. The knowledge regarding place of living examination about drugs will be described in [[Kalpa Sthana]] section. [92-93]

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Patient is the substratum of the act (''karyadesha''). Examination of the patient is conducted for the knowledge of life span or the degree of strength and morbidity. The variations in dosage and potency of prescribed drugs is according to the degree of morbidity and the degree of strength of patient, because if potent drug is administered suddenly by a physician having not been examined properly, it may kill the weak patient; the weak patients are not able to bear intensely potent drugs which are predominant in ''agni'' and ''vayu'' or cauterization, application of alkali and surgical operation. They may cause instantaneous death due to unbearable and over intense impulse of the drug. Keeping this fact in mind, the physician should treat the weak patient with drug which is not harmful, mild, delicate, and progressively strong in order, without complication and not creating any emergent condition, particularly ladies, because they have unstable, soft, bare and timid heart, they are mostly delicate, weak and dependent on others. On the other hand, the drugs having low potency and applied by one who has not been examined properly in strong patients having severe disorder becomes ineffective. Hence the patient should be examined in respect of constitution (''prakriti''), morbidty (''vikriti''), constitution of ''dhatu'' (''sara''), compactness (''samhanana''), measurement (''pramana''), suitability (''satmya''), psyche (''sattva''), power of intake and digestion of food (''aharashakti''), power of exercise (''vyayamashakti'') and age (''vaya'') for the knowledge of the degree of strength.[94]

+

Patient is the substratum of the act (''karyadesha''). Examination of the patient is conducted for the knowledge of life span or the degree of strength and morbidity. The variations in dosage and potency of prescribed drugs is according to the degree of morbidity and the degree of strength of patient, because if potent drug is administered suddenly by a physician having not been examined properly, it may kill the weak patient; the weak patients are not able to bear intensely potent drugs which are predominant in [[agni]] and [[vayu]] or cauterization, application of alkali and surgical operation. They may cause instantaneous death due to unbearable and over intense impulse of the drug. Keeping this fact in mind, the physician should treat the weak patient with drug which is not harmful, mild, delicate, and progressively strong in order, without complication and not creating any emergent condition, particularly ladies, because they have unstable, soft, bare and timid heart, they are mostly delicate, weak and dependent on others. On the other hand, the drugs having low potency and applied by one who has not been examined properly in strong patients having severe disorder becomes ineffective. Hence the patient should be examined in respect of constitution ([[prakriti]]), morbidty (''vikriti''), constitution of [[dhatu]] (''sara''), compactness (''samhanana''), measurement (''pramana''), suitability (''satmya''), psyche (''sattva''), power of intake and digestion of food (''aharashakti''), power of exercise (''vyayamashakti'') and age (''vaya'') for the knowledge of the degree of strength.[94]

</div>

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−

Explanation regarding factors ''prakriti'' etc. are explained henceforth– the constitution (''prakriti'') associated with fetus (''garbha'') is determined by constitution of sperm and ovum, the time (of conception) and status of health of uterus, diet and lifestyle of mother (during pregnancy) and interaction of ~~''mahabhutas''~~. Body humors (''dosha''), one or more than one which predominates in these factors gets attached to the fetus which is called physical or ''doshika'' constitution (''dosha prakriti'') of human beings which is emerged from the initial stage of fetus. Hence some persons are constitutionally having predominance of ''kapha''(''shleshma'') some ~~''pittala''~~, some ~~''vatala''~~ some having, combined ''dosha'' and some with balanced ~~''dhatus''~~. Their characters are described here. [95]

+

Explanation regarding factors [[prakriti]] etc. are explained henceforth– the constitution ([[prakriti]]) associated with fetus ([[garbha]]) is determined by constitution of sperm and ovum, the time (of conception) and status of health of uterus, diet and lifestyle of mother (during pregnancy) and interaction of [[mahabhuta]]. Body humors ([[dosha]]), one or more than one which predominates in these factors gets attached to the fetus which is called physical or ''doshika'' constitution ([[dosha]] [[prakriti]]) of human beings which is emerged from the initial stage of fetus. Hence some persons are constitutionally having predominance of [[kapha]](''shleshma'') some [[pitta]]la, some [[vata]]la some having, combined [[dosha]] and some with balanced [[dhatu]]. Their characters are described here. [95]

</div>

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−

''Shleshma'' is unctuous (''snigdha''), smooth (''shlakshna''), soft (''mridu''), sweet (''madhura''), essence (''sara''), dense (''sandra''), slow acting (''manda''), stable (''stimita''), heavy (''guru''), cold (''sheeta''), slimy (''vijjala'') and clear (''acchah''). Because of its unctuousness the person with predominance of ''kapha'' has unctuous organs; due to smoothness smooth organs; due to softness he has pleasing, delicate and fair organs; due to sweetness person has abundant semen, libido and more progeny; due to nature of essence excellent person has compact and stable body; due to density, all organs are well developed and perfect; due to slowness, dull/ slow in activities, diet and speech; due to stability delayed initiation, irritation and slow in change of attitude /(disorders are slowly progressive); due to heaviness movements are supported with essence and stability; due to coldness little hunger, thirst, heat and perspiration, due to sliminess well united and strong joint ligaments, due to clarity clear eyes, face with clear and unctuous complexion and affectionate voice. Because of presence of these qualities the ''kapha'' dominated personality(''shleshmala'') persons are strong, wealthy, learned, brave, calm and long lived.[96]

+

''Shleshma'' is unctuous (''snigdha''), smooth (''shlakshna''), soft (''mridu''), sweet (''madhura''), essence (''sara''), dense (''sandra''), slow acting (''manda''), stable (''stimita''), heavy (''guru''), cold (''sheeta''), slimy (''vijjala'') and clear (''acchah''). Because of its unctuousness the person with predominance of [[kapha]] has unctuous organs; due to smoothness smooth organs; due to softness he has pleasing, delicate and fair organs; due to sweetness person has abundant semen, libido and more progeny; due to nature of essence excellent person has compact and stable body; due to density, all organs are well developed and perfect; due to slowness, dull/ slow in activities, diet and speech; due to stability delayed initiation, irritation and slow in change of attitude /(disorders are slowly progressive); due to heaviness movements are supported with essence and stability; due to coldness little hunger, thirst, heat and perspiration, due to sliminess well united and strong joint ligaments, due to clarity clear eyes, face with clear and unctuous complexion and affectionate voice. Because of presence of these qualities the [[kapha]] dominated personality(''shleshmala'') persons are strong, wealthy, learned, brave, calm and long lived.[96]

</div>

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−

''Pitta'' is hot (''ushna''), sharply/acutely acting (''tikshna''), liquid (''drava''), of fleshy smell (''visram''), sour (''amla'') and pungent (''katu''). Due to hotness, the persons having predominance of ''pitta'' are intolerant to heat, vulnerable to disorders due to heat delicate and beautiful body, plenty of moles, freckles, black-moles and pimples, excessive hunger and thirst, early appearance of wrinkles, graying and falling of hairs, mostly soft, scanty and brown beard/mustaches, hairs; due to sharpness/acuteness, sharply acting and valor, intense digestive power, intake of plenty of food and drink, lack of endurance, frequently eating; due to liquidity, lax and soft joints and muscles, excess perspiration, urination and defecation; due to fleshy smell foul smell in axilla, mouth, head and body; due to pungency and sourness there is less semen, libido and few progeny; because of presence of these qualities persons having predominance of pitta are moderate in strength, lifespan, knowledge, understanding, wealth and means.[97]

+

[[Pitta]] is hot (''ushna''), sharply/acutely acting (''tikshna''), liquid (''drava''), of fleshy smell (''visram''), sour (''amla'') and pungent (''katu''). Due to hotness, the persons having predominance of [[pitta]] are intolerant to heat, vulnerable to disorders due to heat delicate and beautiful body, plenty of moles, freckles, black-moles and pimples, excessive hunger and thirst, early appearance of wrinkles, graying and falling of hairs, mostly soft, scanty and brown beard/mustaches, hairs; due to sharpness/acuteness, sharply acting and valor, intense digestive power, intake of plenty of food and drink, lack of endurance, frequently eating; due to liquidity, lax and soft joints and muscles, excess perspiration, urination and defecation; due to fleshy smell foul smell in axilla, mouth, head and body; due to pungency and sourness there is less semen, libido and few progeny; because of presence of these qualities persons having predominance of [[pitta]] are moderate in strength, lifespan, knowledge, understanding, wealth and means.[97]

</div>

−

===== Characteristics of ''vata prakriti'' =====

+

===== Characteristics of [[vata]] [[prakriti]] =====

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</div></div>

−

''Vata'' is rough (''ruksha''), light (''laghu''), mobile (''chala''), abundant (''bahu''), swift (''shighra''), cold (''sheeta''), coarse (''parusha'') and non-slimy (''vishada'').

+

[[Vata]] is rough (''ruksha''), light (''laghu''), mobile (''chala''), abundant (''bahu''), swift (''shighra''), cold (''sheeta''), coarse (''parusha'') and non-slimy (''vishada'').

−

Due to roughness the persons with predominance of ''vata'' have rough, underdeveloped and short stature, constant rough, weak, low, adhered and hoarse voice, wakeful; due to lightness, light and fickle movements, activities, diet and speech; due to mobility, unstable joints, eye brows, jaw, lips, tongue, head, shoulder, hands and feet; due to abundance, talkativeness and visually abundance of tendons and venous network; due to swiftness hasty initiation, quick irritation and disorder, quick in fear attachment and disenchantment, quick in acquisition but with a poor memory (retention); due to coldness intolerance to cold, continuously infliction with cold, shivering and stiffness; due to coarseness, coarse hairs, beard-mustaches, hairs, nails, teeth, face, hands and feet, due to non-sliminess cracked body parts and constant sound in joints during movement. Because of presence of these qualities the persons having predominance of ''vata'' have mostly low degree of strength, life-span, progeny, means and wealth. [98]

+

Due to roughness the persons with predominance of [[vata]] have rough, underdeveloped and short stature, constant rough, weak, low, adhered and hoarse voice, wakeful; due to lightness, light and fickle movements, activities, diet and speech; due to mobility, unstable joints, eye brows, jaw, lips, tongue, head, shoulder, hands and feet; due to abundance, talkativeness and visually abundance of tendons and venous network; due to swiftness hasty initiation, quick irritation and disorder, quick in fear attachment and disenchantment, quick in acquisition but with a poor memory (retention); due to coldness intolerance to cold, continuously infliction with cold, shivering and stiffness; due to coarseness, coarse hairs, beard-mustaches, hairs, nails, teeth, face, hands and feet, due to non-sliminess cracked body parts and constant sound in joints during movement. Because of presence of these qualities the persons having predominance of [[vata]] have mostly low degree of strength, life-span, progeny, means and wealth. [98]

</div>

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</div></div>

−

And due to combination of ~~''doshas''~~, characters are found accordingly.[99]

+

And due to combination of [[dosha]], characters are found accordingly.[99]

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</div></div>

−

In persons having equilibrium of all ~~''dhatus''~~, the characters of all of the three are found. Thus one should examine the constitution.[100]

+

In persons having equilibrium of all [[dhatu]], the characters of all of the three are found. Thus one should examine the constitution.[100]

==== Assessment of ''vikriti'' (disorder) ====

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−

Patient examination should be done with respect of ''vikriti'' as well. ''Vikriti'' is ''vikara'' (disorder or pathological manifestation). The disorder should be examined in terms of the strength of the cause (''hetu''), ''dosha''(vitiating factors), ''dushya''(vitiated factors), constitution (''prakriti''), place (''desha''), time (''kala'') and the symptoms. The severity of the disease cannot be known without knowing the strength of the cause etc. factors. The disease having common ''dushya'', constitution, place and time along with strong cause and severity of symptoms is more, then such diseases are severe. The contrary is mild. The moderate disease has similarity in one of the ''dosha'', ''dushya'' etc. and as such moderate strength of cause and severity of symptoms.[101]

+

Patient examination should be done with respect of ''vikriti'' as well. ''Vikriti'' is ''vikara'' (disorder or pathological manifestation). The disorder should be examined in terms of the strength of the cause ([[hetu]]), [[dosha]](vitiating factors), ''dushya''(vitiated factors), constitution ([[prakriti]]), place (''desha''), time (''kala'') and the symptoms. The severity of the disease cannot be known without knowing the strength of the cause etc. factors. The disease having common ''dushya'', constitution, place and time along with strong cause and severity of symptoms is more, then such diseases are severe. The contrary is mild. The moderate disease has similarity in one of the [[dosha]], ''dushya'' etc. and as such moderate strength of cause and severity of symptoms.[101]

</div>

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</div>

−

===== Characteristics of ''rakta sara'' (best quality of blood tissue) =====

+

===== Characteristics of [[rakta dhatu]] sara (best quality of blood tissue) =====

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</div></div>

−

In persons with essence of ''rakta'' have their ear, eye, face, tongue, nose, lips, palms, soles, nails, forehead and genitals to be unctuous, red, beautiful and shining. This essence indicates happiness, sharp intellect, magnanimity, tenderness, moderate strength, lack for endurance and intolerance to heat.[104]

+

In persons with essence of [[rakta dhatu]] have their ear, eye, face, tongue, nose, lips, palms, soles, nails, forehead and genitals to be unctuous, red, beautiful and shining. This essence indicates happiness, sharp intellect, magnanimity, tenderness, moderate strength, lack for endurance and intolerance to heat.[104]

−

===== Characteristics of ''mamsa sara'' (best quality of muscular tissue) =====

+

===== Characteristics of [[mamsa dhatu]] sara (best quality of muscular tissue) =====

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−

The persons having essence of ''mamsa'' have their temples (''shankha''), forehead (''lalata''), nape (''krikatika''), eyes (''akshi''), cheek (''ganda''), jaws (''hanu''), neck (''griva''), shoulder (''skandha''), abdomen (''udara''), axillae (''kaksha''), chest (''vaksha''), hands (''pani''), feet (''pada'')and joints (''sandhi'') well developed with firm, heavy and good looking muscles. This essence indicates forbearance, restraint, and lack of greed, wealth, knowledge, happiness, simplicity, health, strength and longevity.[105]

+

The persons having essence of [[mamsa dhatu]] have their temples (''shankha''), forehead (''lalata''), nape (''krikatika''), eyes (''akshi''), cheek (''ganda''), jaws (''hanu''), neck (''griva''), shoulder (''skandha''), abdomen (''udara''), axillae (''kaksha''), chest (''vaksha''), hands (''pani''), feet (''pada'')and joints (''sandhi'') well developed with firm, heavy and good looking muscles. This essence indicates forbearance, restraint, and lack of greed, wealth, knowledge, happiness, simplicity, health, strength and longevity.[105]

</div>

−

===== Characteristics of ''meda sara'' (best quality of lipid tissues) =====

+

===== Characteristics of [[meda dhatu]] sara (best quality of lipid tissues) =====

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</div></div>

−

The person endowed with essence of ''meda'' have significant unctuousness specifically in complexion, voice, eyes, hair, skin hairs, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[106]

+

The person endowed with essence of [[meda dhatu]] have significant unctuousness specifically in complexion, voice, eyes, hair, skin hairs, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[106]

−

===== Characteristics of ''asthi sara'' (best quality of bone) =====

+

===== Characteristics of [[asthi dhatu]] sara(best quality of bone) =====

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</div></div>

−

Person with ''asthi sara'' has prominent heels (''parshni''), ankles (''gulpha''), knee joint (''janu''), elbows (''aratni''), collarbones (''jatru''), chin (''chibuka''), head (''shira''), flanks (''parshva'') and joints and also bones and teeth. Such persons are excess enthusiastic, very active, enduring, having strong and firm body as well as longevity.[107]

+

Person with [[asthi dhatu]] sara has prominent heels (''parshni''), ankles (''gulpha''), knee joint (''janu''), elbows (''aratni''), collarbones (''jatru''), chin (''chibuka''), head (''shira''), flanks (''parshva'') and joints and also bones and teeth. Such persons are excess enthusiastic, very active, enduring, having strong and firm body as well as longevity.[107]

−

===== Characteristics of ''majja sara''(best quality of bone marrow tissue) =====

+

===== Characteristics of [[majja dhatu]] sara(best quality of bone marrow tissue) =====

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</div></div>

−

The persons with soft body parts, strong, unctuous complexion and sweet voice, prominent (''sthula''), long (''dirgha'') and rounded joints should be known as ~~''majjasara''~~ (or the essence of''majja''). They are long-lived, strong and endowed with learning ability, wealth, understanding, progeny and respectful image.[108]

+

The persons with soft body parts, strong, unctuous complexion and sweet voice, prominent (''sthula''), long (''dirgha'') and rounded joints should be known as [[majja dhatu]] sara(or the essence of''majja''). They are long-lived, strong and endowed with learning ability, wealth, understanding, progeny and respectful image.[108]

−

===== Characteristics of ''shukra sara''(best quality of reproductive tissues) =====

+

===== Characteristics of [[shukra dhatu]] sara(best quality of reproductive tissues) =====

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−

The ''shukra sara'' (having essence in form of reproductive tissues) individuals are gentle and charming (''saumya''), charming and gentle look (''saumyaprekshina''), have beautiful eyes as if filled with milk (''kshirapurnalochana''), immensely exhilarated (''praharshabahula''), teeth are unctuous, rounded, firm, even and compact; having pleasant and unctuous complexion and voice, brilliant, having prominent buttocks.

+

The [[shukra dhatu]] sara (having essence in form of reproductive tissues) individuals are gentle and charming (''saumya''), charming and gentle look (''saumyaprekshina''), have beautiful eyes as if filled with milk (''kshirapurnalochana''), immensely exhilarated (''praharshabahula''), teeth are unctuous, rounded, firm, even and compact; having pleasant and unctuous complexion and voice, brilliant, having prominent buttocks.

They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor and progeny.[109]

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−

The ''sattva sara'' persons are endowed with memory (''smriti''), devotion (''bhakti''), are grateful (''kritajna''), knowledgeable (''prajna''), cleanliness (''shuchi''), enthusiastic (''mahotsaha''), skillful (''daksha''), courageous (''dhira''), fighting in battle with valor, free from anxiety (''tyaktavishada''), having well-organized activities and highly intellectual abilities engaged in virtuous act.

+

The ''sattva sara'' persons are endowed with memory ([[smriti]]), devotion (''bhakti''), are grateful (''kritajna''), knowledgeable (''prajna''), cleanliness (''shuchi''), enthusiastic (''mahotsaha''), skillful (''daksha''), courageous (''dhira''), fighting in battle with valor, free from anxiety (''tyaktavishada''), having well-organized activities and highly intellectual abilities engaged in virtuous act.

Their characters are explained by their qualities mentioned above. [110]

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−

Physician may sometimes take wrong decision only by looking at the patient such as the patient is strong because of being corpulent, he is weak because of leanness, he is very strong because of possessing big body and he is very weak because of possessing small body. But it is observed that some persons having small body and leanness are strong like the small ants carrying a big load. This is the reason why essence (''sarata'') of ~~''dhatus''~~ is to be examined before understanding the ''bala'' of a patient.[115]

+

Physician may sometimes take wrong decision only by looking at the patient such as the patient is strong because of being corpulent, he is weak because of leanness, he is very strong because of possessing big body and he is very weak because of possessing small body. But it is observed that some persons having small body and leanness are strong like the small ants carrying a big load. This is the reason why essence (''sarata'') of [[dhatu]] is to be examined before understanding the ''bala'' of a patient.[115]

</div>

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−

Examination in respect to suitability by practice (''satmya'') should also be done. Suitable is that, which being used constantly has wholesome effect, those suited to ghee, milk, oil and meat soup, and to all ''rasas'' are strong, enduring and long-lived. On the contrary, those suited to rough diet and single rasa are often weak, unenduring, and short-lived and are with little means. Those having mixed suitability have medium strength.[118]

+

Examination in respect to suitability by practice ([[satmya]]) should also be done. Suitable is that, which being used constantly has wholesome effect, those suited to ghee, milk, oil and meat soup, and to all ''rasas'' are strong, enduring and long-lived. On the contrary, those suited to rough diet and single rasa are often weak, unenduring, and short-lived and are with little means. Those having mixed suitability have medium strength.[118]

</div>

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Examination of a person with respect to age should be done as the state of body corresponds to the length of time. Age is broadly divided into three stages viz. childhood, middle age and old age.

−

Childhood is determined upto the age of sixteen years when ~~''dhatus''~~ are immature, sexual characters are not manifested the body is delicate, unenduring with incomplete strength and predominance of ''kapha dhatu''.

+

Childhood is determined upto the age of sixteen years when [[dhatu]] are immature, sexual characters are not manifested the body is delicate, unenduring with incomplete strength and predominance of [[kapha]] [[dhatu]].

−

This again is perceived in two subtypes viz. ~~''dhatus''~~ in developing stage up to sixteen years and fickle mind up to thirty years.

+

This again is perceived in two subtypes viz. [[dhatu]] in developing stage up to sixteen years and fickle mind up to thirty years.

−

The middle age is characterized by strength, energy, virility, valor, acquisition, retention, recollection, speech, understanding and qualities of all ~~''dhatus''~~ having developed properly; with proper physical and mental strength, without degeneration in qualities of ~~''dhatus''~~, with predominance of ''pitta dhatu'' and is up to sixty years.

+

The middle age is characterized by strength, energy, virility, valor, acquisition, retention, recollection, speech, understanding and qualities of all [[dhatu]] having developed properly; with proper physical and mental strength, without degeneration in qualities of [[dhatu]], with predominance of [[pitta]] [[dhatu]] and is up to sixty years.

−

Later is the old age up to one hundred years. During this period ~~''dhatus''~~, sense organs, strength, energy, virility, prowess, acquisition, retention, recollection, speech and understanding generally or gradually degenerate, this phase is predominated by ''vayu''. During this stage the measure of life span is one hundred years.

+

Later is the old age up to one hundred years. During this period [[dhatu]], sense organs, strength, energy, virility, prowess, acquisition, retention, recollection, speech and understanding generally or gradually degenerate, this phase is predominated by [[vayu]]. During this stage the measure of life span is one hundred years.

−

There are persons who lived longer or shorter than that, in such cases, one should determine the three divisions of age on the basis of strength of the factors like ''prakriti'' etc. except ''vikriti'' and also by the features of different periods of life span.[122]

+

There are persons who lived longer or shorter than that, in such cases, one should determine the three divisions of age on the basis of strength of the factors like [[prakriti]] etc. except ''vikriti'' and also by the features of different periods of life span.[122]

</div>

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−

Thus, the strength of the entities like ''prakriti'', etc. barring ''vikriti'' should be determined in three divisions – superior, medium and inferior. According to severity of morbidity (''vikriti'') the three degrees of strength of ''dosha'' are inferred. In accordance with the medicaments should also be divided into three degrees i.e. strong, mild and moderate in regard to ''dosha''.[123]

+

Thus, the strength of the entities like [[prakriti]], etc. barring ''vikriti'' should be determined in three divisions – superior, medium and inferior. According to severity of morbidity (''vikriti'') the three degrees of strength of [[dosha]] are inferred. In accordance with the medicaments should also be divided into three degrees i.e. strong, mild and moderate in regard to [[dosha]].[123]

</div>

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</div></div>

−

Purification therapies such as emesis etc. are applied in seasons having similar characters(as of physiological vitiation of ''dosha'') and are stopped in other seasons. The seasons having similar characters are the most convenient ones and are not harmful to body and drugs because of moderate cold, heat and rains, while others, due to excessive cold, heat and rains are inconvenient ones and harmful to body and the drugs.[126]

+

Purification therapies such as emesis etc. are applied in seasons having similar characters(as of physiological vitiation of [[dosha]]) and are stopped in other seasons. The seasons having similar characters are the most convenient ones and are not harmful to body and drugs because of moderate cold, heat and rains, while others, due to excessive cold, heat and rains are inconvenient ones and harmful to body and the drugs.[126]

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</div></div>

−

During ''hemanta'' (early winter) the body is affected by excessive cold and as such is distressed, exposed to excessively cold wind, is too much roughed and dry, and with ~~''doshas''~~ adhered; on the other hand, the drugs administered for evacuation are hot by nature which become mild in potency due to exposure to excessively cold wind. Hence in conjunction of both these, the evacuative therapy becomes ineffective and the body is inflicted with the ''vatika'' complication.

+

During ''hemanta'' (early winter) the body is affected by excessive cold and as such is distressed, exposed to excessively cold wind, is too much roughed and dry, and with [[dosha]] adhered; on the other hand, the drugs administered for evacuation are hot by nature which become mild in potency due to exposure to excessively cold wind. Hence in conjunction of both these, the evacuative therapy becomes ineffective and the body is inflicted with the ''vatika'' complication.

−

During summer season the body afflicted by excessive heat becomes distressed exposed to excessively hot winds too much lax and with excessively lignified ~~''doshas''~~; the drugs, on the other hand, administered for evacuation being hot in nature become more intense because of exposure to heat; hence in conjunction of both these, the evacuative therapy produces effects in excess and the body also gets complication like thirst etc.

+

During summer season the body afflicted by excessive heat becomes distressed exposed to excessively hot winds too much lax and with excessively lignified [[dosha]]; the drugs, on the other hand, administered for evacuation being hot in nature become more intense because of exposure to heat; hence in conjunction of both these, the evacuative therapy produces effects in excess and the body also gets complication like thirst etc.

During rainy season, when the sky is pervaded with cloud and water the sun, the moon and the stars are hidden and there are torrential rains. The earth is covered with mud and water; the body of living beings is moistened and the entire herbal wealth is damaged in nature, the evacuative measures become dull in action and the human bodies sluggish in recovery due to exposure to wind associated with moisture and clouds.

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</div></div>

−

In situation where symptoms of both indication and contraindication conjoined, one should decide (the treatment protocol) after proper examination of dominant or recessive condition of ''dosha''. The diseases mentioned in treatises are in respect of their treatment as general rule or exception. Hence it is said that one should take action after considering the dominant or recessive condition of ''dosha''. [134]

+

In situation where symptoms of both indication and contraindication conjoined, one should decide (the treatment protocol) after proper examination of dominant or recessive condition of [[dosha]]. The diseases mentioned in treatises are in respect of their treatment as general rule or exception. Hence it is said that one should take action after considering the dominant or recessive condition of [[dosha]]. [134]

==== List of medicines used in therapeutic emesis ====

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*Complete knowledge of patient’s condition is required before starting the treatment, which is done by tenfold examination. These ten entities are:

#''Desha'' (place) which is of two types – habitat and patient’s body;

−

#Examination of ~~''prakriti''~~ and ''vikriti'' according to ''dosha'',

+

#Examination of [[Prakriti]] and ''vikriti'' according to [[dosha]],

#Description of eight type of ''sara'' (essence of body tissues),

#Compactness, structure and body mass,

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#Exercise endurance and

#Age.

−

*Knowledge of seven types of ~~''prakriti''~~ and their features are necessary to understand normal state of body.

+

*Knowledge of seven types of [[Prakriti]] and their features are necessary to understand normal state of body.

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*The factors such as constitution of sperm and ovum, the time (of conception) and status of health of uterus, diet and lifestyle of mother (during pregnancy), and interaction of ~~''mahabhutas''~~ determine the basic constitution (~~''prakriti''~~) of fetus (''garbha''). The genetic map of an individual is determined by these factors.

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*The factors such as constitution of sperm and ovum, the time (of conception) and status of health of uterus, diet and lifestyle of mother (during pregnancy), and interaction of [[mahabhuta]] determine the basic constitution ([[Prakriti]]) of fetus ([[garbha]]). The genetic map of an individual is determined by these factors.

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*~~''Shleshma''~~ is naturally unctuous (''snigdha''), smooth (''shlakshna''), soft (''mridu''), sweet (''madhura''), essence (''sara''), dense (''sandra''), slow acting (''manda''), stable (''stimita''), heavy (''guru''), cold (''sheeta''), slimy (''vijjala'') and clear (''acchah'').

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*[[Kapha]] is naturally unctuous (''snigdha''), smooth (''shlakshna''), soft (''mridu''), sweet (''madhura''), essence (''sara''), dense (''sandra''), slow acting (''manda''), stable (''stimita''), heavy (''guru''), cold (''sheeta''), slimy (''vijjala'') and clear (''acchah'').

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*''Pitta'' is naturally hot (''ushna''), sharply/acutely acting (''tikshna''), liquid (''drava''), of fleshy smell (''visram''), sour (''amla'') and pungent (''katu'').

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*[[Pitta]] is naturally hot (''ushna''), sharply/acutely acting (''tikshna''), liquid (''drava''), of fleshy smell (''visram''), sour (''amla'') and pungent (''katu'').

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*''Vata'' is naturally rough (''ruksha''), light (''laghu''), mobile (''chala''), abundant (''bahu''), swift (''shighra''), cold (''sheeta''), coarse (''parusha'') and non-slimy (''vishada'').

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*[[Vata]] is naturally rough (''ruksha''), light (''laghu''), mobile (''chala''), abundant (''bahu''), swift (''shighra''), cold (''sheeta''), coarse (''parusha'') and non-slimy (''vishada'').

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*Pathological condition (''vikriti'') needs to be evaluated to be able to provide effective treatment. The disorder should be examined in terms of the strength of the cause (''hetu''), ''dosha'' (vitiating intermediary factors), ''dushya'' (vitiated factors), constitution (~~''prakriti''~~), place (''desha''), time (''kala'') and the symptoms. These factors determine the severity of disease.

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*Pathological condition (''vikriti'') needs to be evaluated to be able to provide effective treatment. The disorder should be examined in terms of the strength of the cause ([[hetu]]), [[dosha]] (vitiating intermediary factors), ''dushya'' (vitiated factors), constitution ([[Prakriti]]), place (''desha''), time (''kala'') and the symptoms. These factors determine the severity of disease.

*Eight types of ''sara'' (best quality of body tissues) determine the strength of body tissues. Indeed, innate immunity of body tissues depends upon ''sara'', and it can be examined by the given features.

*Assessment of ''samhanana'' (compactness) is important to examine the differentiation and organization of muscle, fat, bones. These determine the strength of person.

*Analyzing the compactness (''samhanana''), proportionate relation of different parts (''pramana''), suitability (''satmya''), mental state (''sattva''), intake and digestive capacity (''ahara''), exercise tolerance (''vyayama'') and age (''vaya'') helps the physician to classify the strength of the patient into three categories viz. superior (''pravara''), medium (''madhya'') and inferior (''avara''). It is on this basis that physician decides to give strong (''tikshna''), mild (''mridu'') and moderate (''madhya'') medicaments.

*The basic unit to measure the body parts is height, breadth and circumference of one’s own finger (''anguli''). This is used in personified medicine to determine one’s own standard proportion of body parts. There cannot be a single standard for overall population.

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*Assessment of ''satmya'' (suitability) determines the overall diet and lifestyle of an individual and this affects lifespan of the person.

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*Assessment of [[satmya]] (suitability) determines the overall diet and lifestyle of an individual and this affects lifespan of the person.

*The mental strength is important to assess the behavioral response of patient to disease. It is essential to assess mental strength in every disease, because, a person having big stature may pretend a mild disease as like a critical condition and physician may be misled to incorrect diagnosis.

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*The physiological and psychological functions depend upon age of a person. Similarly, there is dominance of a specific ''dosha'' according to ''dosha''. ''Kapha'' is dominant is childhood, ''pitta'' in adulthood and ''vata'' in old age. If there is pathological dominance of a particular ''dosha'' in a certain age, then there will be changes according to respective ''dosha''. Thus, the lifespan will differ as per ''dosha'' dominance in respect to age.

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*The physiological and psychological functions depend upon age of a person. Similarly, there is dominance of a specific [[dosha]] according to [[dosha]]. [[Kapha]] is dominant is childhood, [[pitta]] in adulthood and [[vata]] in old age. If there is pathological dominance of a particular [[dosha]] in a certain age, then there will be changes according to respective [[dosha]]. Thus, the lifespan will differ as per [[dosha]] dominance in respect to age.

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*The severity of morbidity depends upon degree of ''dosha'' aggravation. Medicaments shall be prescribed considering severity of morbidity and strength of patient.

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*The severity of morbidity depends upon degree of [[dosha]] aggravation. Medicaments shall be prescribed considering severity of morbidity and strength of patient.

*Purificatory therapies need to be performed at appropriate time of the year (''kala'') which is divided into six ''ritus'', namely ''hemant'' (early winter), ''grishma'' (summer) and ''varsha'' (rainy season) these are the three season characterized by cold, heat and rains. In between them there are other three seasons having common characters as ''pravrita'' (early rain), ''sharad'' (autumn) and ''vasanta'' (spring). Last three are termed as ''sadharan ritu'' during which purificatory (''shodhana'') treatment can be done.

Similarly, medicine should be given at appropriate time to the patient (''kala'') and when not to be given (''akala'').

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*Purification therapies shall be performed as per the seasonal vitiation of respective ''dosha''. The medicines shall be administered considering stage of disease and appropriate time as per the morbidity.

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*Purification therapies shall be performed as per the seasonal vitiation of respective [[dosha]]. The medicines shall be administered considering stage of disease and appropriate time as per the morbidity.

== Vidhi Vimarsha (Applied Inferences) ==

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It is important to assess physical and mental state of the patient and the nature of medicine for treatment.

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=== ''Prakriti'' examination ===

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=== [[Prakriti]] examination ===

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The ''prakriti'' or basic constitution is very important to be investigated to know overall health status of a person. The place of birth, place of living, place of work is important for identifying the ethnic habits, suitability, and external causes of a disease. Accordingly, the do’s and don’ts in terms of diet and lifestyle are prescribed, that is the integral part of Ayurvedic prescription. Currently, concept of ''prakriti'' is being investigated further in personalized medicine to know the genotype and phenotype of an individual and predicting certain disorders in view of prevention.

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The [[prakriti]] or basic constitution is very important to be investigated to know overall health status of a person. The place of birth, place of living, place of work is important for identifying the ethnic habits, suitability, and external causes of a disease. Accordingly, the do’s and don’ts in terms of diet and lifestyle are prescribed, that is the integral part of Ayurvedic prescription. Currently, concept of [[prakriti]] is being investigated further in personalized medicine to know the genotype and phenotype of an individual and predicting certain disorders in view of prevention.

=== ''Sara'' examination ===

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=== [[Satmya]] (suitability) ===

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The effect of a drug depends upon its interaction with the body tissues. If it is not suitable to the body tissues, then adverse reaction may occur or drug may not be effective. Drug resistance also needs to be considered under the heading of ''satmya'' because it is observed that to a person who has developed resistance to certain antibiotics does not offer response to such medicament thus not attaining successful result in the person. Nowadays culture study is used to understand the usefulness of antibiotics in the patient. Therefore the suitability of the patient must be considered before prescribing a medicine.

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The effect of a drug depends upon its interaction with the body tissues. If it is not suitable to the body tissues, then adverse reaction may occur or drug may not be effective. Drug resistance also needs to be considered under the heading of [[satmya]] because it is observed that to a person who has developed resistance to certain antibiotics does not offer response to such medicament thus not attaining successful result in the person. Nowadays culture study is used to understand the usefulness of antibiotics in the patient. Therefore the suitability of the patient must be considered before prescribing a medicine.

=== The ideal time for purification procedures ===

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=== Examination of stage of disease ===

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''Aturavastha'' or the phase of disease in patient also matters in treatment as seen in context of ''jwara'' wherein in ''kashaya'' (decoction) should not be administered for seven days or till amapachana does not take place. This interprets that the body of patient shall be able to metabolize the drugs. In case of ''jwara'', the ~~''doshas''~~ are too vitiated with the poor status of ''agni'', therefore the body is unable to metabolize even the drugs also. Therefore ''langhana'' (fasting) is the first treatment in ''jwara''. In nutshell, the medicines shall be prescribed considering the phase of disease and status of the patient.

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''Aturavastha'' or the phase of disease in patient also matters in treatment as seen in context of ''jwara'' wherein in ''kashaya'' (decoction) should not be administered for seven days or till amapachana does not take place. This interprets that the body of patient shall be able to metabolize the drugs. In case of ''jwara'', the [[dosha]] are too vitiated with the poor status of [[agni]], therefore the body is unable to metabolize even the drugs also. Therefore [[langhana]] (fasting) is the first treatment in ''jwara''. In nutshell, the medicines shall be prescribed considering the phase of disease and status of the patient.

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Nowadays, various software and decision support systems are available to help physicians regarding the diagnosis. Various subjective assessment scales to examine ''sara'' and questionnaires to assess ~~''prakriti''~~ are available to know the status of patient.

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Nowadays, various software and decision support systems are available to help physicians regarding the diagnosis. Various subjective assessment scales to examine ''sara'' and questionnaires to assess [[Prakriti]] are available to know the status of patient.

=== Examination of psyche of patient ===

Anaghas

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Rogabhishagjitiya Vimana (view source)

Revision as of 17:40, 20 July 2021

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