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Line 2: − + + + + − − <big>'''Abstract'''</big> − − <div style="text-align:justify;">This chapter deals with three methods of clinical examinations useful for understanding specific characteristics of diseases. These three methods are aptopadesha (authoritative instructions), pratyaksha (direct observation) and anumana (inference). These methods play a pivotal role not only in the diagnosis of a disease, but also in understanding whatever is knowable. In the beginning, one should faithfully go through the available authoritative literature available in that field of study. As per the guidelines of the literature, the physician should then proceed to perceive the direct observations, by his own senses. Many aspects of an ailment which are not perceivable by senses can be inferred by logic based on scriptures and by consulting experts. In this chapter, a set of assessment criteria has been provided for each method including pointers that help in determining what is to be examined by which method, how should something be examined, and what is to be inferred and on what basis, along with the authoritative sources of knowledge. </div> − − '''Keywords''': ''Aptopadesha, Pratyaksha, Anumana,'' Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools. − </div> − Line 26:
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Line 425: − ''Trividharogavisheshavijnaniyam'' solely deals with the methods of clinical examination of the patient. Various types of examinations viz. ''rogapariksha, rogipariksha, trividha pariksha, shadvidha pariksha, ashtavidha pariksha'', and ''dashavidha pariksha'' are described in [[Ayurveda]] for the examination of the patient and the diagnosis of the disease. All these examinations do not go beyond the ''trividha pariksha'' described in this chapter. ''Aptopadesha'' gives all the details of the disease i.e. its causative factors, pathogenesis and treatment and thus, provides all the theoretical knowledge of the disease which is helpful during clinical examination. ''Pratyaksha'' deals with direct examination of the patient by the physician. The physician has to use all his senses during the examination, in which he has to look for various signs and symptoms, changes in the color etc. Any information collected through ''anumana'' and ''pratyaksha'' cannot provide all the details of existing pathologies in the body. Now the physician has to use his own intellect and tries to establish the relation between the signs and symptoms and the likely pathologies in the body. He has to use his logic and reasoning and apply it properly in finalizing the vitiated ''doshas'' in the body. ''Anumana'' helps the physician to deduce and draw inferences where it is not possible to visualize or see, in order to draw certain conclusions or understand causation of an ailment. − Charak has described the entire clinical examination in this chapter. There is no fourth tool required for clinical examination except ''aptopadesha, pratyaksha'' and ''anumana''. In [[Ayurveda]], emphasis is given to the use of the five senses in examining a patient. First hand information gathered through the physical examination by five senses is critical to the process of diagnosis. These three types of examinations are also used to assess bad prognosis of the disease and to identify the ''arishta'' (signs and symptoms of imminent death) also.<ref> Agnivesha, Charak, Dridhabala, Charak Samhita Indriyasthana Adhyaya 1/4, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 354. </ref> + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + − Examinations like inspection, palpation, percussion and auscultation are part of ''pratyaksha pariksha''. Nowadays, various new techniques like X-ray, USG, CT Scan, MRI etc. are in use that help augment ''pratyaksha pariksha''. Abnormal findings suggest the underlying pathologies in the body with the use of ''anumana pariksha''. But over-dependence on technology has made the doctors move away from the use of their sensory perception and from prima facie clinical diagnosis. Excessive use of technology makes the process of diagnosis more complicated, costly and time consuming. The most important disadvantage of using technology is that it is reducing the use of logic and reasoning (''yukti'') by a physician. It also has influence on the doctor patient relationship. The most important thing which has been described by Charak is to enter in to the soul of the patient to make correct diagnosis and is somewhere missing due to excessive use of technology. Proper use of ''trividha pariksha'' by a physician with required use of technology, will help him to reach up to the diagnosis immediately, correctly and will also be cost effective to the patient. − == References == − <references/> −
Trividha Roga Vishesha Vijnaniya Vimana (view source)
Revision as of 11:01, 19 July 2021
, 11:01, 19 July 2021→Updates from Ayurveda texts
|title=Trividha Roga Vishesha Vijnaniya Vimana
|title=Trividha Roga Vishesha Vijnaniya Vimana
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|keywords=Aptopadesha, Pratyaksha, Anumana, Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools
|keywords=Aptopadesha, Pratyaksha, Anumana, Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools, Ayurveda, Indian system of medicine, charak samhita.
|description=Vimana Sthana Chapter 4. Three methods for knowledge of disease
|description=Vimana Sthana Chapter 4. Three methods for knowledge of disease
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<big>'''Vimana Sthana Chapter 4. Three methods for knowledge of disease '''</big>
<big>'''Vimana Sthana Chapter 4. Three methods for knowledge of disease '''</big>
{{Infobox
{{Infobox
|title = Trividha Roga Vishesha Vijnaniya Vimana
|title = Trividha Roga Vishesha Vijnaniya Vimana
|label5 = Other Sections
|label5 = Other Sections
|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
|data6 = Dwivedi R.B., Gujarathi R.
|label7 = Reviewer
|data7 = Paliwal M., Sapra U.
|label8 = Editors
|data8 = Pol A., Deole Y.S., Basisht G.
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s03.005 10.47468/CSNE.2020.e01.s03.005]
}}
<big>'''Abstract'''</big>
<div style="text-align:justify;">This chapter deals with three methods of clinical examinations useful for understanding specific characteristics of diseases. These three methods are aptopadesha (authoritative instructions), pratyaksha (direct observation) and anumana (inference). These methods play a pivotal role not only in the diagnosis of a disease, but also in understanding whatever is knowable. In the beginning, one should faithfully go through the available authoritative literature available in that field of study. As per the guidelines of the literature, the physician should then proceed to perceive the direct observations, by his own senses. Many aspects of an ailment which are not perceivable by senses can be inferred by logic based on scriptures and by consulting experts. In this chapter, a set of assessment criteria has been provided for each method including pointers that help in determining what is to be examined by which method, how should something be examined, and what is to be inferred and on what basis, along with the authoritative sources of knowledge. </div>
'''Keywords''': ''Aptopadesha, Pratyaksha, Anumana,'' Diagnosis, Authoritative instructions, Direct observations, inference, examination methods and tools.
</div>
== Introduction ==
== Introduction ==
<div style="text-align:justify;">
<div style="text-align:justify;">
[[Ayurveda]] has emphasized the importance, need and application of examination, and has stressed that even truth should be examined first and only then should be accepted. In [[Sutra Sthana]], Chapter 11, four methods of examination of all existing and non-existing subjects of knowledge to be examined have been given<ref>Cha Charak Samhita Sutrasthana Adhyaya 11/17, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 70. </ref>. These four specific methods of examination are ''aptopadesha'' (knowledge from authoritative person and scriptures), ''pratyaksha'' (direct observation), ''anumana'' (inference) and ''yukti'' (logic based interpretation). For clinical examination of a patient, ''yukti pramana'' is included in ''anumana'' because inference should be included in ''tarka'' (logic) and ''yukti''<ref> Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/3, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 247. </ref> <ref> Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/4, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 247. </ref>. The author did not feel the need for ''yukti'' to be done separately in clinical experiment, therefore three fold (''trividha'') method of examination has been described.
[[Ayurveda]] has emphasized the importance, need and application of examination, and has stressed that even truth should be examined first and only then should be accepted. In [[Sutra Sthana]], Chapter 11, four methods of examination of all existing and non-existing subjects of knowledge to be examined have been given.[Cha.Sa. [[Sutra Sthana]] 11/17]. These four specific methods of examination are ''aptopadesha'' (knowledge from authoritative person and scriptures), ''pratyaksha'' (direct observation), ''anumana'' (inference) and ''yukti'' (logic based interpretation). For clinical examination of a patient, ''yukti pramana'' is included in ''anumana'' because inference should be included in ''tarka'' (logic) and ''yukti'' [Cha.Sa. [[Vimana Sthana]] 4/3-4]. The author did not feel the need for ''yukti'' to be done separately in clinical experiment, therefore three-fold (''trividha'') method of examination has been described.
There are, however, limitations to these tools because all the three examinations should be applied, though sequentially (described later in the chapter), since one cannot rely completely on any one of these examinations. A wise physician should use all the three tools together for a thorough assessment of the disease and then reach the final diagnosis. A physician who understands and exercises such practice does not commit any mistake in the treatment of the patients. <ref> Agnivesha, Charak, Dridhabala, Charak Samhita Vimanasthana Adhyaya 4/11, Edited by Jadavaji Trikamji, Fifth Edition, Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 249. </ref>
There are, however, limitations to these tools because all the three examinations should be applied, though sequentially (described later in the chapter), since one cannot rely completely on any one of these examinations. A wise physician should use all three tools together for a thorough assessment of the disease and then reach the final diagnosis. A physician who understands and exercises such practice does not commit any mistake in the treatment of the patients. [Cha.Sa. [[Vimana Sthana]] 4/11]
It is also interesting to know that these three methods of examination have been defined (with little difference) in [[Sutra Sthana]] 11th chapter [[Tistraishaniya]] too. On the basis of critical analysis of the subject, it could be opined that the description of three examination methods in [[Vimana Sthana]] is much more scientific and applicable in clinical methods while the description of [[Sutra Sthana]] chapter [[Tistraishaniya]] is applicable in other fields.
It is also interesting to know that these three methods of examination have been defined (with little difference) in [[Sutra Sthana]] 11th chapter [[Tistraishaniya]] too. On the basis of critical analysis of the subject, it could be opined that the description of three examination methods in [[Vimana Sthana]] is much more scientific and applicable in clinical methods while the description of [[Sutra Sthana]] chapter [[Tistraishaniya]] is applicable in other fields.
</div></div>
</div></div>
Now we shall expound the chapter "Trividha Roga Vishesha Vijnaniya Vimana" (Three methods for knowledge of disease). Thus said Lord Atreya. [1-2]
=== Three methods for knowledge of disease ===
=== Three methods for knowledge of disease ===
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तत्राप्तोपदेशो नामाप्तवचनम्| आप्ता ह्यवितर्कस्मृतिविभागविदो निष्प्रीत्युपतापदर्शिनश्च| तेषामेवङ्गुणयोगाद्यद्वचनं तत् प्रमाणम्| अप्रमाणं पुनर्मत्तोन्मत्तमूर्खरक्तदुष्टादुष्टवचनमिति ; प्रत्यक्षं तु खलु तद्यत् स्वयमिन्द्रियैर्मनसा चोपलभ्यते| अनुमानं खलु तर्को युक्त्यपेक्षः||४||
तत्राप्तोपदेशो नामाप्तवचनम्|
आप्ता ह्यवितर्कस्मृतिविभागविदो निष्प्रीत्युपतापदर्शिनश्च| तेषामेवङ्गुणयोगाद्यद्वचनं तत् प्रमाणम्| अप्रमाणं पुनर्मत्तोन्मत्तमूर्खरक्तदुष्टादुष्टवचनमिति ;
प्रत्यक्षं तु खलु तद्यत् स्वयमिन्द्रियैर्मनसा चोपलभ्यते|
अनुमानं खलु तर्को युक्त्यपेक्षः||४||
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tatrāptōpadēśō nāmāptavacanam| āptā hyavitarkasmr̥tivibhāgavidō niṣprītyupatāpadarśinaśca| tēṣāmēvaṅguṇayōgādyadvacanaṁ tat pramāṇam| apramāṇaṁ punarmattōnmattamūrkharaktaduṣṭāduṣṭavacanamiti ; pratyakṣaṁ tu khalu tadyat svayamindriyairmanasā cōpalabhyatē| anumānaṁ khalu tarkō yuktyapēkṣaḥ||4||
tatrāptōpadēśō nāmāptavacanam|
āptā hyavitarkasmr̥tivibhāgavidō niṣprītyupatāpadarśinaśca| tēṣāmēvaṅguṇayōgādyadvacanaṁ tat pramāṇam| apramāṇaṁ punarmattōnmattamūrkharaktaduṣṭāduṣṭavacanamiti ;
pratyakṣaṁ tu khalu tadyat svayamindriyairmanasā cōpalabhyatē|
anumānaṁ khalu tarkō yuktyapēkṣaḥ||4||
tatrAptopadesho nAmAptavacanam|
tatrAptopadesho nAmAptavacanam|
teShAmeva~gguNayogAdyadvacanaM tat pramANam|
teShAmeva~gguNayogAdyadvacanaM tat pramANam|
apramANaM punarmattonmattamUrkharaktaduShTAduShTavacanamiti ;
apramANaM punarmattonmattamUrkharaktaduShTAduShTavacanamiti ;
pratyakShaM tu khalu tadyatsvayamindriyairmanasA copalabhyate|
pratyakShaM tu khalu tadyatsvayamindriyairmanasA copalabhyate|
anumAnaM khalu tarko yuktyapekShaH||4||
anumAnaM khalu tarko yuktyapekShaH||4||
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Authoritative instructions are the teachings of ''apta'' (persons who are the most reliable). ''Apta'' are free from doubts, their memory is unimpaired, they know things in their entirety by determinate experience. They see things without any attachment or affection (''nishpriti'' and ''nirupatapa''). Because of these qualities, what they say is authentic. On the other hand, statements- true or false- made by intoxicated, mad, illiterate people and people with attachments are not to be considered as authoritative.
Authoritative instructions are the teachings of ''apta'' (persons who are the most reliable). ''Apta'' are free from doubts, their memory is unimpaired, they know things in their entirety by determinate experience. They see things without any attachment or affection (''nishpriti'' and ''nirupatapa''). Because of these qualities, what they say is authentic. On the other hand, statements- true or false- made by intoxicated, mad, illiterate people and people with attachments are not to be considered as authoritative.
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''Pratyaksha'' or direct observation is that which is comprehensible by an individual through his own senses and mind.
''Pratyaksha'' or direct observation is that which is comprehensible by an individual through his own senses and mind.
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त्रिविधेन खल्वनेन ज्ञानसमुदायेन पूर्वं परीक्ष्य रोगं सर्वथा सर्वमथोत्तरकालमध्यवसानमदोषं भवति, न हि ज्ञानावयवेन कृत्स्ने ज्ञेये ज्ञानमुत्पद्यते| त्रिविधे त्वस्मिन् ज्ञानसमुदये पूर्वमाप्तोपदेशाज्ज्ञानं, ततः प्रत्यक्षानुमानाभ्यां परीक्षोपपद्यते| किं ह्यनुपदिष्टं पूर्वं यत्तत् प्रत्यक्षानुमानाभ्यां परीक्षमाणो विद्यात्| तस्माद्द्विविधा परीक्षा ज्ञानवतां प्रत्यक्षम्, अनुमानं च;त्रिविधा वा सहोपदेशेन||५||
त्रिविधेन खल्वनेन ज्ञानसमुदायेन पूर्वं परीक्ष्य रोगं सर्वथा सर्वमथोत्तरकालमध्यवसानमदोषं भवति, न हि ज्ञानावयवेन कृत्स्ने ज्ञेये ज्ञानमुत्पद्यते|
त्रिविधे त्वस्मिन् ज्ञानसमुदये पूर्वमाप्तोपदेशाज्ज्ञानं, ततः प्रत्यक्षानुमानाभ्यां परीक्षोपपद्यते|
किं ह्यनुपदिष्टं पूर्वं यत्तत् प्रत्यक्षानुमानाभ्यां परीक्षमाणो विद्यात्|
तस्माद्द्विविधा परीक्षा ज्ञानवतां प्रत्यक्षम्, अनुमानं च;त्रिविधा वा सहोपदेशेन||५||
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==== Gustatory examinations can be inferred by following observations ====
==== Gustatory examinations can be inferred by following observations ====
Taste of the various tissues in the body of the patient are undoubtedly the objects of the gustatory sense organ and can be ascertained by inference and not by direct observation. Therefore, the taste in the mouth of the patient should be ascertained by interrogation. For example, sweet taste of the body can be inferred when flies are attracted towards the body. In the case of bleeding from the body, if there is a doubt about the nature of the blood, it should be resolved by giving the blood to dogs and crow to taste. Intake of the blood by dogs and crows is indicative of its purity and rejection by these animals indicates that the blood is vitiated by ''pitta'', i.e. the patient is suffering from ''raktapitta''. Similarly, other tastes in the patient’s body can be inferred.
Taste of the various tissues in the body of the patient are undoubtedly the objects of the gustatory sense organ and can be ascertained by inference and not by direct observation. Therefore, the taste in the mouth of the patient should be ascertained by interrogation. For example, sweet taste of the body can be inferred when flies are attracted towards the body. In the case of bleeding from the body, if there is a doubt about the nature of the blood, it should be resolved by giving the blood to dogs and crow to taste. Intake of the blood by dogs and crows is indicative of its purity and rejection by these animals indicates that the blood is vitiated by [[pitta]], i.e. the patient is suffering from ''raktapitta''. Similarly, other tastes in the patient’s body can be inferred.
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==== By olfactory examinations ====
==== By olfactory examinations ====
* ''Sangya namgrahanena''- mental awakening instantaneous identification
* ''Sangya namgrahanena''- mental awakening instantaneous identification
* ''Smriti smarnena''- memory by recalling ability
* [[Smriti]] smarnena- memory by recalling ability
* ''Hriyam apatrapnena''- shy by drooping of eyelids.
* ''Hriyam apatrapnena''- shy by drooping of eyelids.
* ''Bhakti deshen''- liking a place, person and surroundings with opportunistic intentions.
* ''Bhakti deshen''- liking a place, person and surroundings with opportunistic intentions.
* ''Satmya upshayena''- habituation by suitability
* [[Satmya]] upshayena- habituation by suitability
* ''Vyadhi vedanaya''- diseases by symptomatology
* ''Vyadhi vedanaya''- diseases by symptomatology
* ''Goodha linga vyadhi''- mysterious diseases by therapeutic measures
* ''Goodha linga vyadhi''- mysterious diseases by therapeutic measures
* ''Dosha pramana''- quantity of morbidity by potential causative factors
* [[Dosha]] pramana- quantity of morbidity by potential causative factors
* ''Aysha kshaya''- near death signs of imminent death (''Arishta'')
* ''Aysha kshaya''- near death signs of imminent death (''Arishta'')
* ''Granyastu mridu darunatwam''- abdominal comforts and discomforts by sleep quality and by interrogations. [8]
* ''Granyastu mridu darunatwam''- abdominal comforts and discomforts by sleep quality and by interrogations. [8]
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=== Importance of three fold examination ===
=== Importance of three fold examination ===
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== Vidhi Vimarsha (Applied Inferences) ==
== Vidhi Vimarsha (Applied Inferences) ==
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=== Methods of clinical examination ===
This chapter solely deals with the methods of clinical examination of the patient. Various types of examinations viz. examination of disease (roga pariksha), patient (rogi pariksha), three types of examination (trividha pariksha), six types (shadvidha pariksha), eight types (ashtavidha pariksha), and ten types (dashavidha pariksha) are described in [[Ayurveda]] for the examination of the patient and the diagnosis of the disease. All these examinations can be included under umbrella of three types (trividha pariksha) described in this chapter.
==== Authoritative instructions (Aptopadesha) ====
The experience based knowledge by authorities (aptopadesha) gives all the details of the disease i.e. its causative factors, pathogenesis and treatment and thus, provides all the theoretical knowledge of the disease which is helpful during clinical examination.
==== Direct perception (Pratyaksha) ====
Knowledge by direct perception (pratyaksha) deals with direct examination of the patient by the physician. The physician has to use all his senses during the examination, in which he has to look for various signs and symptoms, changes in the color etc. Any information collected through inference (anumana) and direct perception (pratyaksha) provide only limited details of existing pathologies in the body. Now the physician has to use his own intellect and tries to establish the relation between the signs and symptoms and the likely pathologies in the body. He has to use his logic and reasoning and apply it properly in finalizing the vitiated [[dosha]] in the body.
==== Inference ====
Inference (anumana) helps the physician to deduce and draw inferences, where it is not possible to visualize or see, in order to draw certain conclusions or understand causation of an ailment.
The methods of clinical examination are comprehensively described in this chapter. In [[Ayurveda]], emphasis is given to the use of the five senses in examining a patient. First hand information gathered through the physical examination by five senses is critical to the process of diagnosis. These three types of examinations are also used to assess bad prognosis of the disease and to identify the [[arishta]] (signs and symptoms of imminent death) also. [Cha.Sa. [[Indriya Sthana]] 1/4]
=== Updates from Ayurveda texts ===
In other texts of Ayurveda, various references of one type, two types, three types, four types, six types, eight types, ten types, eleven types, and twelve types of examination of the patient are described. Some important are as given below:
i)In Sushruta samhita,three fold like inspection(darshana), palpation (sparshana) and interrogation (prashana) are described. Six fold examination (5 sense ([[indriya]]) and interrogation (prashana pareeksha)) is also described.
ii)Yogaratnakar text describes eight fold examination viz. pulse(nadi), bowel habit/stool examination ([[mala]]), urine examination ([[mutra]]), tongue (jihwa), sound (shabda), touch (sparsha), sight (drik) and features (akriti). This is widely used in general examination of the patient.
=== Contemporary methods ===
Examinations like inspection, palpation, percussion and auscultation are part of direct perception (pratyaksha pariksha). Nowadays, various new techniques like X-ray, USG, CT Scan, MRI etc. are in use that augment direct perception. Abnormal findings suggest the underlying pathologies in the body with the use of inference (anumana pariksha). But over-dependence on technology has made the doctors move away from the use of their sensory perception and from prima facie clinical diagnosis. Excessive use of technology makes the process of diagnosis more complicated, costly and time consuming. The most important disadvantage of using technology is that it is reducing the use of logic and reasoning ([[yukti]]) by a physician. It also has influence on the doctor patient relationship. The most important thing which has been described is to perceive in to the soul of the patient to make correct diagnosis and is somewhere missing due to excessive use of technology. Proper use of the three types (trividha pariksha) by a physician with required use of technology, will help him to reach up to the diagnosis immediately, correctly and will also be cost effective to the patient.
=== Principles of knowledge of new diseases (anukta vyadhi) ===
The disease which are not described in the Ayurveda texts or newly introduced disease can be identified by applying the principles described in this chapter. It can be applied for knowing the complete details of the newer diseases including treatment.
=== Fundamental principles of clinical research ===
This chapter also mentions fundamental principles of clinical research. The methods of diagnosis of disease and examination of patient can be applied in clinical research.
=== Scope of further research ===
There is a wide scope of research on the following topics and concepts described in this chapter:
# Principle of Clinical Research in Ayurveda
# Clinical Diagnosis in Ayurveda
# Principle of development of tools for examination of the patients
# Principle of detailed description of newer/unknown diseases
=== Related chapters ===
[[Tistraishaniya Adhyaya]] , [[Rogabhishagjitiya Vimana]]
== Further reading ==
# Patwardhan B, Warude D, Pushpangadan P, Bhatt N. Ayurveda and traditional Chinese medicine: -A comparative overview. Evid Based Complement Alternat Med. 2005;2:465–73.
# Trochim, William M. The Research Methods Knowledge Base. 2nd ed.
# Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clinical trials. (1-74).Health Technol Assess. 1998;2:i–iv.
# Streiner DL, Norman GR. 3rd ed. New York: Oxford University Press Inc; 2003. Health Measurement Scales: A Practical Guide to Their Development and Use.
# Dunn G. 2nd ed. London, UK: Arnold; 2004. Statistical Evaluation of Measurement Errors: Design and Analysis of Reliability Studies.
# Lee SW, Jang ES, Lee J, Kim JY. Current researches on the methods of diagnosing sasang constitution: An overview. Evid Based Complement Alternat Med. 2009;6:43–9.
# Joshua AM, Celermajer DS, Stockler MR. Beauty is in the eye of the examiner: Reaching agreement about physical signs and their value. Intern Med J. 2005;35:178–87.
# O’Brien KA, Birch S. A review of the reliability of traditional East Asian medicine diagnoses. J Altern Complement Med. 2009;15:353–66.
# Zaslawski C. Clinical reasoning in traditional Chinese medicine: Implications for clinical research. Clin Acupunct Orient Med. 2003;4:94–101.
# Brenner H. Measures of differential diagnostic value of diagnostic procedures. J Clin Epidemiol. 1996;49:1435–9.
# Kraemer HC. Newbury Park, California: Sage; 1992. Evaluating Medical Tests: Objective and Quantitative Guidelines.
# Gregory RJ. 5th ed. Boston, MA: Pearson; 2007. Psychological testing: History, principles, and applications.
# Saini KK, Sehgal RK, Sethi BL. Evaluation of general classes of reliability estimators often used in statistical analyses of quasi-experimental designs. AIP Conf Proc. 2008;1052:58–62.
# de Vet HC, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59:1033–9.
# Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. Int J Nurs Stud. 2011;48:661–71.
# Mattu GS, Perry TL, Jr, Wright JM. Comparison of the oscillometric blood pressure monitor (BPM-100(Beta)) with the auscultatory mercury sphygmomanometer. Blood Press Monit. 2001;6:153–9.
# Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.
# Yoo JH, Kim JW, Kim KK, Kim JY, Koh BH, Lee EJ. Sasangin diagnosis questionnaire: Test of reliability. J Altern Complement Med. 2007;13:111–22.
# Abramson JH. New York: Churchill Livingstone; 1990. Surveys Methods in Community Medicine; p. 138.]
# Jang E, Baek Y, Park K, Lee S. Could the Sasang constitution itself be a risk factor of abdominal obesity? BMC Complement Altern Med. 2013;13:72.
# Kurande VH, Waagepetersen R, Toft E, Prasad R, Raturi L. Repeatability of pulse diagnosis and body constitution diagnosis in traditional indian ayurveda medicine. Glob Adv Health Med. 2012;1:34–40.
# Kurande VH, Waagepetersen R, Toft E, Prasad R. Reliability of pulse diagnosis in traditional indian ayurveda medicine. 8th Annual Congress of the International Society for Complementary Medicine Research (ISCMR). Res Complement Med/Forsch Komplementmed. 2013;20(Suppl 1):1–9.
# Kim M, Cobbin D, Zaslawski C. Traditional Chinese medicine tongue inspection: An examination of the inter-and intrapractitioner reliability for specific tongue characteristics. J Altern Complement Med. 2008;14:527–36.
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# McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Meth. 1996;1:30e46.]
# Fleiss JL, Levin B, Paik MC. 3rd ed. Hoboken, NJ: Wiley; 2003. Statistical Methods for Rates and Proportions.]
# Viera AJ, Garrett JM. Understanding interobserver agreement: The kappa statistic. Fam Med. 2005;37:360–3.
# Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
# Cohen J. Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–20.]
# Altman DG. London: Chapman and Hall; 1996. Practical Statistics for Medical Research.]
# Brar BS, Chhibber R, Srinivasa VM, Dearing BA, McGowan R, Katz RV. Use of Ayurvedic diagnostic criteria in Ayurvedic clinical trials: A literature review focused on research methods. J Altern Complement Med. 2012;18:20–8.]
# Sharma AK, Kumar R, Mishra A, Gupta R. Problems associated with clinical trials of ayurvedic medicines. Braz J Pharmacogn. 2010;20:276–81.
# Bhushan P, Kalpana J, Arvind C. Classification of human population based on HLA gene polymorphism and the concept of Prakriti in Ayurveda. J Altern Complement Med. 2005;11:349–53.
# Prasher B, Negi S, Aggarwal S, Mandal AK, Sethi TP, Deshmukh SR, et al. Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurveda. J Transl Med. 2008;6:48.
# Rastogi S. Development and validation of a Prototype Prakriti Analysis Tool (PPAT): Inferences from a pilot study. Ayu. 2012;33:209–18.
# Jang E, Kim JY, Lee H, Kim H, Baek Y, Lee S. A study on the reliability of sasang constitutional body trunk measurement. Evid Based Complement Alternat Med 2012. 2012 604842.
# Ryu H, Lee H, Kim H, Kim J. Reliability and validity of a cold-heat pattern questionnaire for traditional Chinese medicine. J Altern Complement Med. 2010;16:663–7.
# Dhruva A, Adler S, Weaver J, Acree M, Miaskowski C, Abrams D, et al. Mixed methods approaches in whole systems research: a study of ayurvedic diagnostics. BMC Complement Altern Med. 2012;12(Suppl 1):378.
# King E, Cobbin D, Walsh S, Ryan D. The reliable measurement of radial pulse characteristics. Acupunct Med. 2002;20:150–9.
# Kim J, Han GJ, Choi BH, Park JW, Park K, Yeo IK, et al. Development of differential criteria on tongue coating thickness in tongue diagnosis. Complement Ther Med. 2012;20:316–22.
# MacPherson H, Thorpe L, Thomas K, Campbell M. Acupuncture for low back pain: Traditional diagnosis and treatment of 148 patients in a clinical trial. Complement Ther Med. 2004;12:38–44.
# Zell B, Hirata J, Marcus A, Ettinger B, Pressman A, Ettinger KM. Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners. Menopause. 2000;7:129–34.
# Sung JJ, Leung WK, Ching JY, Lao L, Zhang G, Wu JC, et al. Agreements among traditional Chinese medicine practitioners in the diagnosis and treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;20:1205–10.
# Coeytaux RR, Chen W, Lindemuth CE, Tan Y, Reilly AC. Variability in the diagnosis and point selection for persons with frequent headache by traditional Chinese medicine acupuncturists. J Altern Complement Med. 2006;12:863–72.
# Prlic HM, Lehman AJ, Cibere J, Sodhi V, Varma S, Sukumaran T, et al. Agreement among Ayurvedic practitioners in the identification and treatment of three cases of inflammatory arthritis. Clin Exp Rheumatol. 2003;21:747–52.
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# Furst DE, Venkatraman MM, McGann M, Manohar PR, Booth-LaForce C, Sarin R, et al. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol. 2011;17:185–92.
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# Zhang GG, Singh B, Lee W, Handwerger B, Lao L, Berman B. Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: Effect of training. J Altern Complement Med. 2008;14:381–6.
# Perloff D, Grim C, Flack J, Frolich ED, Hill M, McDonald M, et al. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88:2460–7.
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