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Rogabhishagjitiya Vimana (view source)

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|title=Rogabhishagjitiya Vimana
 
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<big>'''Vimana Sthana Chapter 8. Methods of conquering debate and disease '''</big>
 
<big>'''Vimana Sthana Chapter 8. Methods of conquering debate and disease '''</big>
 
{{Infobox
 
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|data5 = [[Sutra Sthana]], [[Nidana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
 
|data5 = [[Sutra Sthana]], [[Nidana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
 
|label6 = Translator and commentator
 
|label6 = Translator and commentator
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|data6 = Dubey S.D., Singh A.N., Singh A., Singh A., Samant A., Deole Y. S.
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|data6 = Dubey S.D., Singh A.N., Samant A., [[Yogesh Deole|Deole Y. S.]]
 
|label7 = Reviewer  
 
|label7 = Reviewer  
 
|data7  = Khandel S.K., Ram J.P.
 
|data7  = Khandel S.K., Ram J.P.
 
|label8 = Editors
 
|label8 = Editors
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|data8  = Khandel S.K., Deole Y.S., Basisht G.
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|data8  = Khandel S.K., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
 
|label9 = Year of publication  
 
|label9 = Year of publication  
 
|data9 =  2020
 
|data9 =  2020
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<big>'''Abstract'''</big>
 
<big>'''Abstract'''</big>
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<p 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. </br>
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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>
      
'''Keywords''': Preceptor, student, teaching methodology, learning methods, discussion techniques, examination techniques of patient, [[Prakriti]], ''sara'', purification therapies, pharmacovigilance.
 
'''Keywords''': Preceptor, student, teaching methodology, learning methods, discussion techniques, examination techniques of patient, [[Prakriti]], ''sara'', purification therapies, pharmacovigilance.
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The preceding chapter [[Vyadhita Rupiya Vimana]] the seventh chapter dealt with knowledge of diseased person. The present chapter guides an aspiring student who wishes to be a successful physician. It is important to know the scope, depth and reputation of the branch of health science to be studied which is obtained by ''shastra pariksha'' (review of literature). Secondly, the  examination of the preceptor (''acharya'') who teaches the science of [[Ayurveda]] is important because it is he, who enlightens the students with the knowledge of the health science. The chapter further deals with means of learning of health sciences (''shastra upaya''), methodology of study (''adhyayana vidhi'') and teaching (''adhyapana'') along with when and how to begin academic session and Do’s and Dont’s by the student have been explained so that a student attains the depth of knowledge about the health science. It also details about medical ethics while in practice and guidelines for behaviour of doctor at a patient’s house.   
 
The preceding chapter [[Vyadhita Rupiya Vimana]] the seventh chapter dealt with knowledge of diseased person. The present chapter guides an aspiring student who wishes to be a successful physician. It is important to know the scope, depth and reputation of the branch of health science to be studied which is obtained by ''shastra pariksha'' (review of literature). Secondly, the  examination of the preceptor (''acharya'') who teaches the science of [[Ayurveda]] is important because it is he, who enlightens the students with the knowledge of the health science. The chapter further deals with means of learning of health sciences (''shastra upaya''), methodology of study (''adhyayana vidhi'') and teaching (''adhyapana'') along with when and how to begin academic session and Do’s and Dont’s by the student have been explained so that a student attains the depth of knowledge about the health science. It also details about medical ethics while in practice and guidelines for behaviour of doctor at a patient’s house.   
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Along with study (''adhyayana'') and teaching (''adhyapana'') it is the seminar and symposia of experts (''tadvidya sambhasha'') which is essential to improve the quality of knowledge. Types of seminar/symposium, possible types of attendees, how to deal with them for most benefit and rules are mentioned. The description addresses essential information about discussion at a symposium. Those are:  when to discuss? where to discuss? what to discuss? how to discuss? and what will be the final conclusion?
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Along with study (''[[adhyayana]]'') and teaching (''adhyapana'') it is the seminar and symposia of experts (''tadvidya sambhasha'') which is essential to improve the quality of knowledge. Types of seminar/symposium, possible types of attendees, how to deal with them for most benefit and rules are mentioned. The description addresses essential information about discussion at a symposium. Those are:  when to discuss? where to discuss? what to discuss? how to discuss? and what will be the final conclusion?
    
The methodology of discussion to be done with the types of assembly. During unfriendly discussion (''vigrihya'') 44 terms such as ''vada'' etc. are worth knowing for the course of discussion among physician. These ''vada marga'' not only help in winning discussion but improves knowledge and enhances the thinking.
 
The methodology of discussion to be done with the types of assembly. During unfriendly discussion (''vigrihya'') 44 terms such as ''vada'' etc. are worth knowing for the course of discussion among physician. These ''vada marga'' not only help in winning discussion but improves knowledge and enhances the thinking.
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These terms are worth-knowing for acquaintance of the course of discussion among physicians such as – ''vada, dravya, guna, karma, samanya, vishesha, samavaya, pratijna, sthapana, pratishthapana, hetu, drishtanta, upanaya, nigamana, uttara, siddhanta, shabda, pratyaksha, anumana, aitihya, aupamya, samshaya, prayojana, savyabhichara, jijnasa, vyavasaya, arthaprapti, sambhava, anuyojya, ananuyojya, anuyoga, pratyanuyoga, vakyadosha, vakyaprashamsa, chhala, ahetu, atitakala, upalambha, parihara, pratijnahani, abhyanujna, hetvantara, arthantara, nigrahasthana.'' [27]
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These terms are worth-knowing for acquaintance of the course of discussion among physicians such as – ''vada, [[dravya]], [[guna]], [[karma]], [[samanya]], [[vishesha]], [[samavaya]], pratijna, sthapana, pratishthapana, [[hetu]], drishtanta, upanaya, nigamana, uttara, siddhanta, [[shabda]], pratyaksha, anumana, aitihya, aupamya, samshaya, prayojana, savyabhichara, jijnasa, vyavasaya, arthaprapti, sambhava, anuyojya, ananuyojya, anuyoga, pratyanuyoga, vakyadosha, vakyaprashamsa, chhala, ahetu, atitakala, upalambha, parihara, pratijnahani, abhyanujna, hetvantara, arthantara, nigrahasthana.'' [27]
 
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==== 1. ''Vada'' (debate) ====
 
==== 1. ''Vada'' (debate) ====
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''Vitanda'' is opposite to ''jalpa''. For instance, one holds the view that rebirth exist while the other holds the view just against it. During such discussion (''vada''), they (participants) advance arguments in support of their own views and contradict the opponent’s view, this is ''jalpa''. ''Vitanda'' is opposite to ''jalpa'' in which the speaker without having any positive approach only finds faults in the opponent’s view point. [28]
 
''Vitanda'' is opposite to ''jalpa''. For instance, one holds the view that rebirth exist while the other holds the view just against it. During such discussion (''vada''), they (participants) advance arguments in support of their own views and contradict the opponent’s view, this is ''jalpa''. ''Vitanda'' is opposite to ''jalpa'' in which the speaker without having any positive approach only finds faults in the opponent’s view point. [28]
 
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==== 2-7: ''Dravya'' to ''Samavaya'' ====
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==== 2-7: ''[[Dravya]]'' to ''[[Samavaya]]'' ====
 
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''Dravya, guna, karma, samanya, vishesha and samavaya''– these are mentioned earlier along with their definitions in ''shloka sthana'' ([[Sutra Sthana]] chapters). [29]
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''[[Dravya]], [[guna]], [[karma]], [[samanya]], [[vishesha]] and [[samavaya]]''– these are mentioned earlier along with their definitions in ''shloka sthana'' ([[Sutra Sthana]] chapters). [29]
    
==== 8. ''Pratijna'' (proposition) ====
 
==== 8. ''Pratijna'' (proposition) ====
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These are four types of doctrines. [37]
 
These are four types of doctrines. [37]
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==== 17. ''Shabda'' (word/correct expression) ====
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==== 17. ''[[Shabda]]'' (word/correct expression) ====
 
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''Shabda'' is an aggregate of letters. This is of four types – ''drishtartha, adrishtartha, satya,'' and ''anrita''.  
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''[[Shabda]]'' is an aggregate of letters. This is of four types – ''drishtartha, adrishtartha, satya,'' and ''anrita''.  
    
''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.  
 
''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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''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.  
 
''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.  
   −
''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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आतुरस्तुखलुकार्यदेशः| तस्यपरीक्षाआयुषःप्रमाणज्ञानहेतोर्वास्याद्, बलदोषप्रमाणज्ञानहेतोर्वा| तत्रतावदियंबलदोषप्रमाणज्ञानहेतोः; दोषप्रमाणानुरूपोहिभेषजप्रमाणविकल्पोबलप्रमाणविशेषापेक्षोभवति| सहसाह्यतिबलमौषधमपरीक्षकप्रयुक्तमल्पबलमातुरमतिपातयेत्; नह्यतिबलान्याग्नेयवायवीयान्यौषधान्यग्निक्षारशस्त्रकर्माणिवाशक्यन्तेऽल्पबलैःसोढुम्; असह्यातितीक्ष्णवेगत्वाद्धितानिसद्यःप्राणहराणिस्युः| एतच्चैवकारणमपेक्षमाणाहीनबलमातुरमविषादकरैर्मृदुसुकुमारप्रायैरुत्तरोत्तरगुरुभिरविभ्रमैरनात्ययिकैश्चोपचरन्त्यौषधैः; विशेषतश्चनारीः, ताह्यनवस्थितमृदुविवृतविक्लवहृदयाःप्रायःसुकुमार्योऽबलाःपरसंस्तभ्याश्च| तथाबलवतिबलवद्व्याधिपरिगतेस्वल्पबलमौषधमपरीक्षकप्रयुक्तमसाधकमेवभवति| तस्मादातुरंपरीक्षेतप्रकृतितश्च, विकृतितश्च, सारतश्च, संहननतश्च, प्रमाणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च, वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः||९४||  
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आतुरस्तुखलुकार्यदेशः|  
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तस्यपरीक्षाआयुषःप्रमाणज्ञानहेतोर्वास्याद्, बलदोषप्रमाणज्ञानहेतोर्वा|  
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तत्रतावदियंबलदोषप्रमाणज्ञानहेतोः; दोषप्रमाणानुरूपोहिभेषजप्रमाणविकल्पोबलप्रमाणविशेषापेक्षोभवति|  
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सहसाह्यतिबलमौषधमपरीक्षकप्रयुक्तमल्पबलमातुरमतिपातयेत्; नह्यतिबलान्याग्नेयवायवीयान्यौषधान्यग्निक्षारशस्त्रकर्माणिवाशक्यन्तेऽल्पबलैःसोढुम्; असह्यातितीक्ष्णवेगत्वाद्धितानिसद्यःप्राणहराणिस्युः|  
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एतच्चैवकारणमपेक्षमाणाहीनबलमातुरमविषादकरैर्मृदुसुकुमारप्रायैरुत्तरोत्तरगुरुभिरविभ्रमैरनात्ययिकैश्चोपचरन्त्यौषधैः; विशेषतश्चनारीः, ताह्यनवस्थितमृदुविवृतविक्लवहृदयाःप्रायःसुकुमार्योऽबलाःपरसंस्तभ्याश्च|  
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तथाबलवतिबलवद्व्याधिपरिगतेस्वल्पबलमौषधमपरीक्षकप्रयुक्तमसाधकमेवभवति|  
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तस्मादातुरंपरीक्षेतप्रकृतितश्च, विकृतितश्च, सारतश्च, संहननतश्च, प्रमाणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च, वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः||९४||  
 
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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]
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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]
 
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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]].  
 
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.  
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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 [[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.  
 
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.  
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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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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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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.
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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.  
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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.  
 
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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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]
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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 ====
 
==== 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:
 
*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;
 
#''Desha'' (place) which is of two types – habitat and patient’s body;
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#Examination of ''prakriti'' and ''vikriti'' according to ''dosha'',  
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#Examination of [[Prakriti]] and ''vikriti'' according to [[dosha]],  
 
#Description of eight type of ''sara'' (essence of body tissues),
 
#Description of eight type of ''sara'' (essence of body tissues),
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#Compactness, structure and body mass,
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#Compactness, structure and body m
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#Measurement of body parts,
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#Specific suitability of a person,
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#''Sattva'' (mental strength),
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#Power of digestion and assimilation,
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#Exercise endurance and
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#Age.
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*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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*''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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*''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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*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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*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.
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*Assessment of ''samhanana'' (compactness) is important to examine the differentiation and organization of muscle, fat, bones. These determine the strength of person.
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*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.
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*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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*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 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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*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.
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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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== Vidhi Vimarsha (Applied Inferences) ==
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The text of [[Charak Samhita]] is several thousand years old. It provides holistic solutions for the people and society. World has changed since, with change in thinking, lifestyle and technological advancements but, many of the guiding principles are still applicable Following should be applicable now.
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=== Selection of medical treatise ===
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In the last century, there has been significant change in how medical education is imparted, specially Ayurvedic education. Since olden times, Ayurvedic teacher would select a student and provide both theoretical and practical training by a process called ''Guru''/''shishya'' (student/teacher) relationship. Student was also guided how to select the medical treatise, criteria for which is described in the text above. These days, books are recommended by the faculty of medical schools according to the syllabus. Guidelines given in the text are still useful in selecting any worth reading book on a particular subject.
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=== Ideal presentation of text ===
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Treatise should be such that is understood by all students with different levels of intelligence. Repetition of the same principles which only increases the exercise of studying should not be present. It should include a concise and accurate statement of fact or concept followed by explanation with supportive examples using common language words. The words used should not be difficult for hearing, spelling, remembering and use of infamous words should be avoided. The sentence used for explanation should give complete and correct meaning and sequencing should be in a way to achieve clear stepwise and comprehensive understanding of the topic. The chapter or subject should be well placed and related topic should follow in order. The content in the book should be very effective, attractive and giving complete knowledge without repetition. Various graphs, flow charts, diagrams pictures and color plates which generates interest within the readers should be included.
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The conclusions of explanation should be perfect and unalterable. The principles mentioned in text should be the same from beginning to the end.
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In present context, the guidelines for writing a research paper or an article or a monograph include all the points mentioned in the text. The principles to write considering reader’s psyche are important and shall be followed for making a good treatise. [[Charak Samhita]] follows the same principles of presentation.
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=== Qualities of a teacher ===
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Teacher influences the life of a student. A teacher should have complete theoretical and practical knowledge of [[Ayurveda]]. The qualities of an ideal teacher are described in the text. Furthermore, keeping the competency of medical education in mind, the teacher should have knowledge of contemporary sciences and should behave with care and unbiased to the students. Teacher should not be egoistic and jealous. He should enjoy his teaching and not feel burden of teaching even if he needs to repeat. He should understand the lifestyle, psychiatric and body constitution of his patients and convey the same to his students. Significance of each symptom and sign seen in patient should be noted with help of sense organs and the same clinical methods should be explained to the students.
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A good teacher plays significant role in making life of a student. Even today, in Ayurvedic practice, ''guru-shishya parampara'' (traditional learning through students staying with teachers) exists, that is the most effective method of learning practical applications of principles of [[Ayurveda]].
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=== Qualities of an ideal student ===
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Today, with the increasing demand of education for all, the students are taught in the classrooms in a group. However, the best teacher develops a one-to-one interaction with each student to make him inform about the knowledge. The student must possess some qualities and develop learning skills to receive the information and follow instructions given by teacher. Student should be physically and mentally able to perform his duties as a future physician, surgeon, teacher, and/or researcher.
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He should follow ''sadvritta'' and should be respectful to teacher so as to gain more and more knowledge in each aspect of life. He should engage in frequent academic dialogue with fellow students and teachers. His mind should be focused on his goal. He should have fixed aim of attaining the knowledge about the topic. Student should concentrate on acquiring good qualities and should participate in extra curricular activities like sports and debate etc. Retaining power of the student should be good.
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Inference made after discussion and considering both the positive and negative points, student should have such qualities of understanding what and which are the positive and negative effects of each and every action he does. Secondly, he should have sharp memory, broad minded and he should be forgiving and should help others.
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=== Medical ethics and social behaviors of a doctor ===
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Manners and social behavior of doctor is very important. The doctor has prime importance in the society owing to his health-care responsibilities. Also, the medico-legal aspect while treating patient in emergency medical care, and treating patient of opposite gender must be kept in mind to avoid legal issues. The ethical code of conduct of the society or country where he/she lives shall be followed.
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=== Conferences (acquiring cumulative wisdom) ===
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In seminars and conferences, research papers and case reports are presented which help in acquiring knowledge to provide better care to the patients. Healthy discussion brings about growth in knowledge, increases enlightenment and is helpful in preparation for competition. Sharpness and clarity of knowledge is increased. Vocabulary is increased and also interpretation power is increased.
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The guidelines to be followed while participating in a discussion to make it more beneficial are described in the text.  The points that should be considered while preparing a paper for presentation are applicable for effective communication.
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=== Examination of patient ===
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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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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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=== ''Sara'' examination ===
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To evaluate immunity or bodie’s resistance to disease, ''sara'' or ‘or the best qualities of tissues needs to be examined. The constitutional essence helps to understand the immunity of the person. More the ''sarata'' of ''dhatu'', more is the immunological strength of the person. Analogue of ant helps to understand the significance of essence of ''dhatus''. And although small and lean in size is able to lift more than its weight due to ''asthisarata'' present in it. In [[Vividhashitpitiya Adhyaya]]  [Cha.Sa.[[Sutra Sthana]] 28], special importance is given to ''mamsa'' (muscle), ''shonita'' (blood) and ''asthi dhatu'' (bone) in ''Vyadhikshamatva'' (immunity) which needs to be researched more.
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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 ideal time for purification procedures ===
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If in emergency ''shodhana'' has to be done in unsuitable weather, then the surroundings of the patient should be made such that it resembles the ''sadharan kala'', for example, if it is very cold then room should be adjusted with warmness and if it is very hot as in ''grishma'', then the temperature in the room should be reduced.  Also a physician must use ''yukti'' and accordingly use or make the necessary ''dravyas'' ''sheeta'' or ''ushna'' by appropriate ''samyoga'' (combination), ''samskara'' (processing) and ''pramana'' (dose).
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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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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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=== Examination of psyche of patient ===
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''Mana''/''satva'' (mind) is said to be ''tantraka'' (technical operator) as the one who is ''preraka'' (inspirer) or ''dharaka'' (owner). ''Mana'' is the initiator of all activity but it can carry out its action in conjunction with ''atma'' only. If ''mana'' is weak it is unable to tolerate the symptoms of disease and he/she exaggerates those. If the doctor makes the mistake of considering the inferior mental strength of patient with severe disease depending on presentation of symptoms and gives strong medicine then he may end up with complication.
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Symptoms of severely diseased and mildly diseased are mentioned in seventh chapter of [[Vimana Sthana]].
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The mental status examination has a special importance in today’s medical practice. The physician has to modulate interaction with the patient, dose of medicine, potency of medicine considering the psychology of the patient. The physician who communicates better with the patient helps to heal disease naturally.
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=== Assessment of ''ahara shakti'' (intake capacity) ===
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''Aharashakti'' is not only the quantity of food intake, but also its digestive capacity. Quantity of food taken and digestive capacity of the person is to be considered. The assessment of ''agni'' is based upon the food intake capacity of the person. The proporation of body tissue depends upon intake of food and its assimilation inside body. This directly affects the health status. Hence, ''ahara shakti'' is important to be assessed.
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Further, if the patient is not responding to oral administration of drugs, then the parenteral or any other route of drug administration is to be chosen.
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=== Assessment of ''vyayama shakti'' (exercise endurance capacity) ===
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''Vyayamashakti'' is described as ''bharvahanshakti'' i.e. capacity to work. People doing strenuous work or exercise have more forebearance and are strong. The capacity to exercise is directly related with the cardio-vascular, pulmonary, muscular and mental status of the patient, and hence it is linked with healthy lifespan. Nowadays, various stress tests are done for evaluation of these functions and are useful to determine the prognosis of disease to give guidance for necessary intervention.
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=== Reference books for further reading ===
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1. Charak Samhita by Agnivesha Edited By Yadavji Trikamji Acharya-Munshiram Manoharlal Publishers Pvt. Ltd. 4th Edition.
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2. Sushruta Samhita of Sushruta  Edited By Yadavji Trikamji Acharya- Chaukhamba Orientalia, Varanasi- 6th Edition.
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3. Astanga Hrudaya By Vagbhat-Chaukhamba Publication
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4. Caraka Samhita (Text With English Translation & Critical Exposition Based On Cakrapani Datta Ayurved Dipika) By R K Sharma And Bhagwan Dash, Chowkhamba Sanskrit Series Office, Varanasi.
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5. Basic Principles Of [[Ayurveda]], Padarth Vijnana By Prof. Yogesh Chandra Mishra- Chaukhamba Sanskrit Bhawan, Varanasi.
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6. Padarth Vigyan By Dr Krishnamurthy- Chaukhamba Sanskrit Bhawan, Varanasi.
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7. Tarka Sangraha- Chaukhamba Sanskrit Bhawan, Varanasi.
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