Difference between revisions of "Pramanatah Pariksha"

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==Introduction==
 
==Introduction==
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<p style='text-align:justify;'>Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body  parts.  In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.Vimana Sthana 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices.  
+
<p style='text-align:justify;'>Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body  parts.  In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.Vimana Sthana 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices. <p style="text-align:justify;">'''Derivation of pramana'''  The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’. [i]
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{{Infobox
 
{{Infobox
 
|title =  Contributors
 
|title =  Contributors
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|data8 = In process
 
|data8 = In process
 
}}
 
}}
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 +
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'''Derivation of  pariksha'''
 +
 +
The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.[ii] Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.
 +
 +
'''Synonyms'''
 +
 +
'''Praman and pariksha'''[iii]''''''
 +
 +
1. Examination or assessment tools (pariksha)
 +
 +
2. Causes ([[hetu]])
 +
 +
3. Means (sadhana)
 +
 +
4. Availability or achievement (upalabdhi)
 +
 +
5. Curiosity or zeal to acquire knowledge (jignyasa)
 +
 +
Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita [[Vimana Sthana]] 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.
 +
 +
=== Pramana in the context of ten fold assessment of patient (dashavidha pariksha): ===
 +
The word pramana is applied to denote assessment or measurement.
 +
 +
For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. [[Vimana Sthana]] 8/ 117]
 +
 +
Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. [[Sharira Sthana]] 7/15]
 +
 +
These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. [[Vimana Sthana]] 8/ 94]
 +
 +
'''Types'''
 +
 +
1.     Anguli pramana (measurements by fingers)
 +
 +
2.     Anjali Pramana (measurements by cup hallow formed by joining palms together)
 +
 +
'''Assessment criteria'''
 +
 +
'''1.     Anguli pramana'''
 +
 +
The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:
 +
 +
'''Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak''' [Cha. Sa. [[Sutra Sthana|Vimana Sthana]] 8/117]
 +
{| class="wikitable"
 +
|'''Organs'''
 +
|'''Height'''
 +
|'''Length'''
 +
|'''Breadth'''
 +
|'''Circumference'''
 +
|-
 +
|Feet
 +
|4
 +
|14
 +
|6
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Calf
 +
|<nowiki>-</nowiki>
 +
|18
 +
|<nowiki>-</nowiki>
 +
|16
 +
|-
 +
|Knee
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|16
 +
|-
 +
|Thigh
 +
|<nowiki>-</nowiki>
 +
|18
 +
|<nowiki>-</nowiki>
 +
|30
 +
|-
 +
|Testicle
 +
|<nowiki>-</nowiki>
 +
|6
 +
|<nowiki>-</nowiki>
 +
|8
 +
|-
 +
|Penis
 +
|<nowiki>-</nowiki>
 +
|6
 +
|<nowiki>-</nowiki>
 +
|5
 +
|-
 +
|Vagina
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|12
 +
|-
 +
|Waist
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|16
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Top of pelvis
 +
|10
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Abdomen
 +
|<nowiki>-</nowiki>
 +
|12
 +
|10
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Sides of chest
 +
|<nowiki>-</nowiki>
 +
|12
 +
|10
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between nipples
 +
|<nowiki>-</nowiki>
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Nipple
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Chest
 +
|12
 +
|<nowiki>-</nowiki>
 +
|24
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Heart
 +
|<nowiki>-</nowiki>
 +
|3
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Shoulders
 +
|<nowiki>-</nowiki>
 +
|8
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Shoulder blades
 +
|<nowiki>-</nowiki>
 +
|6
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Arm
 +
|<nowiki>-</nowiki>
 +
|16
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Fore-arm
 +
|<nowiki>-</nowiki>
 +
|15
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Hand
 +
|<nowiki>-</nowiki>
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Axilla
 +
|<nowiki>-</nowiki>
 +
|8
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Trika (sacrum including coccyx)
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Back
 +
|18
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Neck
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|22
 +
|-
 +
|Face
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|24
 +
|-
 +
|Mouth
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|5
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Chin
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Lips
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Ears
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between eyes
 +
|<nowiki>-</nowiki>
 +
|4*
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Nose
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Fore-head
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Head
 +
|16
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|32
 +
|-
 +
|Entire body
 +
|84
 +
|<nowiki>-</nowiki>
 +
|84**
 +
|<nowiki>-</nowiki>
 +
|}
 +
<nowiki>*</nowiki>distance between external angles of eyes
 +
 +
<nowiki>**</nowiki>when hands are fully outspread
 +
 +
The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.
 +
 +
'''Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut'''
 +
{| class="wikitable"
 +
|'''Organs'''
 +
|'''Height'''
 +
|'''Length'''
 +
|'''Breadth'''
 +
|'''Circumference'''
 +
|-
 +
|Great toe and second toe*
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Anterior part of foot
 +
|<nowiki>-</nowiki>
 +
|4
 +
|5
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Arch of foot
 +
|<nowiki>-</nowiki>
 +
|4
 +
|5
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Heel
 +
|<nowiki>-</nowiki>
 +
|5
 +
|4
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Foot
 +
|<nowiki>-</nowiki>
 +
|14
 +
|<nowiki>-</nowiki>
 +
|14
 +
|-
 +
|Ankle
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|14
 +
|-
 +
|Leg
 +
|<nowiki>-</nowiki>
 +
|18
 +
|<nowiki>-</nowiki>
 +
|14
 +
|-
 +
|Knee
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|14
 +
|-
 +
|Thigh
 +
|<nowiki>-</nowiki>
 +
|18
 +
|<nowiki>-</nowiki>
 +
|32
 +
|-
 +
|Testis
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Chin
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Teeth
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Anterior flaps of nose
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Root of ear
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Middle portion of eyes**
 +
|<nowiki>-</nowiki>
 +
|2
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Penis
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Mouth
 +
|<nowiki>-</nowiki>
 +
|4
 +
|4
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Nose
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Ear
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Forehead
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Neck
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|20
 +
|-
 +
|Distance between pupil of eyes
 +
|<nowiki>-</nowiki>
 +
|4
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Vagina
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|12
 +
|-
 +
|Distance between penis and umbilicus
 +
|<nowiki>-</nowiki>
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between umbilicus and heart
 +
|<nowiki>-</nowiki>
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between heart and neck
 +
|<nowiki>-</nowiki>
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between breasts
 +
|<nowiki>-</nowiki>
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Face
 +
|<nowiki>-</nowiki>
 +
|12
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Wrist
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|12
 +
|-
 +
|Forearm
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|12
 +
|-
 +
|Leg (centre of calf muscle)
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|16
 +
|-
 +
|Distance between shoulder and elbow
 +
|<nowiki>-</nowiki>
 +
|16
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between elbow and tip of middle finger
 +
|<nowiki>-</nowiki>
 +
|24
 +
 +
(24 angula = 1 Hasta)
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Upper limb
 +
|<nowiki>-</nowiki>
 +
|32
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between wrist and elbow
 +
|
 +
|16
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Hand
 +
|<nowiki>-</nowiki>
 +
|6
 +
|4
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between root of thumb and index finger
 +
|<nowiki>-</nowiki>
 +
|5
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between ear and outer corner of eyes
 +
|<nowiki>-</nowiki>
 +
|5
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Middle finger
 +
|<nowiki>-</nowiki>
 +
|5
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Index finger
 +
|<nowiki>-</nowiki>
 +
|4.5
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Ring finger
 +
|<nowiki>-</nowiki>
 +
|4.5
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Thumb
 +
|<nowiki>-</nowiki>
 +
|3.5
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Little finger
 +
|<nowiki>-</nowiki>
 +
|3.5
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Nostril
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|1/3
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between margin of hairs (above temples)  and middle of skull
 +
|<nowiki>-</nowiki>
 +
|11
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between margin of hairs at back of neck  and middle of skull
 +
|<nowiki>-</nowiki>
 +
|10
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Distance between two ears through back of neck
 +
|<nowiki>-</nowiki>
 +
|14
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Female chest***
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|18
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Male waist
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|18
 +
|<nowiki>-</nowiki>
 +
|-
 +
|Entire body (from feet to tip of middle finger  when a person stands straight with his hands raised upwards)
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|<nowiki>-</nowiki>
 +
|120
 +
|}
 +
<nowiki>*</nowiki>Third, fourth and little toe are successively one-fifth shorter than the previous toe.
 +
 +
     **Length of cornea= 1/3<sup>rd</sup> length of middle portion of eye
 +
 +
   Length of pupil=1/9<sup>th</sup> length of cornea
 +
 +
<nowiki>***</nowiki>Female pelvis is as broad as chest of male.
 +
 +
Ø  Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two Ayurveda scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.
 +
 +
Ø  Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.[iv] Although recent studies suggest that the breadth of finger can be approximated as 3⁄4<sup>th</sup> of an inch or 1⁄16<sup>th</sup> of a foot.[v] [vi]
 +
 +
 +
'''2.     Anjali pramana'''
 +
 +
Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity.  A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.[vii]
 +
 +
'''Table 3: Measurements of body components in swa-anjali pramana''' [Cha. Sa. [[Sutra Sthana|Sharir Sthana]] 7/115]
 +
 +
{| class="wikitable"
 +
|'''Body components'''
 +
|'''Volume'''
 +
|-
 +
|'''Udaka''' (aqueous element) a substance which is found in association with various  body parts/components of body. Example, it is seen mixed with faeces during  the occurrence of diarrhoea. It is also found in association with urine,  blood and other tissue elements of the body. It is spread all over the body  with its site in the external skin. Inside the skin, it is known as lasika  (lymph) which exudes through ulcers; when the body becomes hot, it comes out  from hair follicles in the form of sweat.
 +
|10
 +
|-
 +
|'''Rasa''' which is the first product of the ingested food after it is metabolised.
 +
|9
 +
|-
 +
|'''Rakta (blood)'''
 +
|8
 +
|-
 +
|'''Purisha (faeces)'''
 +
|7
 +
|-
 +
|'''Kapha'''
 +
|6
 +
|-
 +
|'''Pitta'''
 +
|5
 +
|-
 +
|'''Mutra (urine)      '''
 +
|4
 +
|-
 +
|'''Vasa''' (muscle fat)
 +
|3
 +
|-
 +
|'''Medas''' (fat)
 +
|2
 +
|-
 +
|'''Majja''' (bone marrow)
 +
|1
 +
|-
 +
|'''Mastishka''' (the fat like substance inside the skull''')'''
 +
|
 +
|-
 +
|'''Shukra''' (semen)
 +
|
 +
|-
 +
|'''Shleshmika oja''' (a type of oja)
 +
|
 +
|}
 +
'''Application of pramana in diagnosis of various diseases:'''
 +
 +
The equilibrium of dosha, dhatu (body tissues) and mala (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of rasa dhatu (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of rasa dhatu may result in nausea and salivation.
 +
 +
It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their panchabhautika composition (the five universal elements or panchamahabhuta). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.
 +
 +
'''Contemporary views:'''
 +
 +
Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the figure:
 +
----[i] Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.
 +
 +
[ii] Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.
 +
 +
[iii] Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.
 +
 +
[iv] Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". ''Current Science''. '''97'''
 +
 +
[v] Noah Webster; John Walker (1830). ''American dictionary of the English language''. digit: Converse. p. 247.
 +
 +
[vi] Ronald Edward Zupko (1985). ''A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century''. American Philosophical Society. pp. 109–10. <nowiki>ISBN 978-0-87169-168-2</nowiki>
 +
 +
[vii] Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.

Revision as of 11:20, 11 October 2023

Cite.png

Introduction

Pramanatah means measurement or proportion and pariksha means examination. The term pramanatah pariksha indicates examination by measurements or proportion. These are means to quantitatively express the proportions of the human body parts. In ancient era, the measurements were done by angula (fingers) and anjali (the cup shaped hallow formed by the joining of two palms together). These measurements are referred as anguli pramana and anjali pramana respectively. These measurements are individual specific. Though evolution of technology led to invention of accurate and precise measuring devices, still the ancient means of measurements via anguli and anjali maintain their clinical importance, being an easy, inexpensive, and scientifically justifiable mode of measurement. The anjali pramana is used for measuring the volume of fluid constituents, whereas anguli pramana is used for measuring the dimensions (length, breadth, height, circumference, distance between two points, etc). Pramana pariksha is one of the ten-fold clinical examinations of patient. [Cha.Sa.Vimana Sthana 8/94] Having well developed and proportionate body parts is one sign of good health. [Su.Sa.Sutra Sthana 15/40] Underdeveloped or overdeveloped body parts can lead to disease. The present chapter deals with concept and practices of pramana pariksha. The contemporary science also gives importance to anthropometric measurements and evaluation of body composition. It is assessed on the basis of the nutritional status of an individual. This chapter describes pramanatah pariksha, its application and importance in healthcare practices.

Derivation of pramana The word ‘praman’ is derived from Sanskrit verb ‘ma’ with prefix ‘pra’ where ‘ma’ dhatu means ‘to measure’. [i]

Contributors
Section/Chapter/topic Concepts & Contemporary Practices/Pramanatah pariksha
Authors Bhojani M. K. 1, Joglekar Aishwarya 1
Editor Deole Y.S.3
Affiliations

1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2 Rheumatologist, Orlando, Florida, U.S.A.

3 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails meera.samhita@aiia.gov.in, carakasamhita@gmail.com
Publisher Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication: October 12, 2023
DOI In process


Derivation of  pariksha

The word ‘pariksha’ is derived by combining two words. ‘Pari’ means ‘around’ and ‘Iksh’ menas ‘to see’.[ii] Thus pariksha means to look around or to do research. Hence ‘pramanatah pariksha’ means research or examination by measurements.

Synonyms

'Praman and pariksha[iii]'

1. Examination or assessment tools (pariksha)

2. Causes (hetu)

3. Means (sadhana)

4. Availability or achievement (upalabdhi)

5. Curiosity or zeal to acquire knowledge (jignyasa)

Pramana are described under the heading of vaada-marga. (methods of discussion). [Charak Samhita Vimana Sthana 8/ 27]. The vaada-marga are different tools or methods to establish the related facts and phenomena.

Pramana in the context of ten fold assessment of patient (dashavidha pariksha):

The word pramana is applied to denote assessment or measurement.

For example, anguli pramana (measurement based on the thickness of fingers) is used to denote measurements of body parts. [Cha. Sa. Vimana Sthana 8/ 117]

Anjali pramana (measurement based on the capacity of palms placed together) is used to denote the quantity of body fluids. [Cha. Sa. Sharira Sthana 7/15]

These constitute an examination of a person to assess normal or abnormal body constitution called ‘pramanatah pariksha’. [Cha. Sa. Vimana Sthana 8/ 94]

Types

1.     Anguli pramana (measurements by fingers)

2.     Anjali Pramana (measurements by cup hallow formed by joining palms together)

Assessment criteria

1.     Anguli pramana

The anguli pramana of body, body parts or organs mentioned by Ayurveda scholars are as follows:

Table 1: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Charak [Cha. Sa. Vimana Sthana 8/117]

Organs Height Length Breadth Circumference
Feet 4 14 6 -
Calf - 18 - 16
Knee - 4 - 16
Thigh - 18 - 30
Testicle - 6 - 8
Penis - 6 - 5
Vagina - - - 12
Waist - - 16 -
Top of pelvis 10 - - -
Abdomen - 12 10 -
Sides of chest - 12 10 -
Distance between nipples - 12 - -
Nipple - - 2 -
Chest 12 - 24 -
Heart - 3 - -
Shoulders - 8 - -
Shoulder blades - 6 - -
Arm - 16 - -
Fore-arm - 15 - -
Hand - 12 - -
Axilla - 8 - -
Trika (sacrum including coccyx) 12 - - -
Back 18 - - -
Neck 4 - - 22
Face 12 - - 24
Mouth - - 5 -
Chin - 4 - -
Lips - 4 - -
Ears - 4 - -
Distance between eyes - 4* - -
Nose - 4 - -
Fore-head - 4 - -
Head 16 - - 32
Entire body 84 - 84** -

*distance between external angles of eyes

**when hands are fully outspread

The circumference of organs like the calf region varies from place to place. Therefore, the circumference of the middle part of such organs should be measured. The term ‘trika’ stands for the region beginning from the tip of the coccyx up to the level of the upper border of iliac crest. The height of the head should be measured from the point from where the neck begins in the back.

Table 2: Measurement of organs in swa-angula pramana as are endowed with all good qualities by Sushrut

Organs Height Length Breadth Circumference
Great toe and second toe* - 2 - -
Anterior part of foot - 4 5 -
Arch of foot - 4 5 -
Heel - 5 4 -
Foot - 14 - 14
Ankle - - - 14
Leg - 18 - 14
Knee - - - 14
Thigh - 18 - 32
Testis - 2 - -
Chin - 2 - -
Teeth - 2 - -
Anterior flaps of nose - 2 - -
Root of ear - 2 - -
Middle portion of eyes** - 2 - -
Penis - 4 - -
Mouth - 4 4 -
Nose - 4 - -
Ear - 4 - -
Forehead - 4 - -
Neck - 4 - 20
Distance between pupil of eyes - 4 - -
Vagina - - - 12
Distance between penis and umbilicus - 12 - -
Distance between umbilicus and heart - 12 - -
Distance between heart and neck - 12 - -
Distance between breasts - 12 - -
Face - 12 - -
Wrist - - - 12
Forearm - - - 12
Leg (centre of calf muscle) - - - 16
Distance between shoulder and elbow - 16 - -
Distance between elbow and tip of middle finger - 24

(24 angula = 1 Hasta)

- -
Upper limb - 32 - -
Distance between wrist and elbow 16 - -
Hand - 6 4 -
Distance between root of thumb and index finger - 5 - -
Distance between ear and outer corner of eyes - 5 - -
Middle finger - 5 - -
Index finger - 4.5 - -
Ring finger - 4.5 - -
Thumb - 3.5 - -
Little finger - 3.5 - -
Nostril - - 1/3 -
Distance between margin of hairs (above temples) and middle of skull - 11 - -
Distance between margin of hairs at back of neck and middle of skull - 10 - -
Distance between two ears through back of neck - 14 - -
Female chest*** - - 18 -
Male waist - - 18 -
Entire body (from feet to tip of middle finger when a person stands straight with his hands raised upwards) - - - 120

*Third, fourth and little toe are successively one-fifth shorter than the previous toe.

     **Length of cornea= 1/3rd length of middle portion of eye

   Length of pupil=1/9th length of cornea

***Female pelvis is as broad as chest of male.

Ø  Certain differences are observed in the measurements of a human body via anguli pramana. The measurements described by the two Ayurveda scholars are the approximations of body parts of an ideal person. But criteria of idealness vary from person to person. For a person who is native of plains, a long height may be an ideal height. While for a person who is native of hilly areas, shorter height may be the ideal height. This difference in opinion may be the reason of variation in anguli pramana of Charak and Sushrut.

Ø  Dimensional analysis of the oldest engineered caves at the Barabar and Nagarjuni hills (dated to the Mauryan Period) has revealed that the basic length measure of one angula of that period was 1.763 cm.[iv] Although recent studies suggest that the breadth of finger can be approximated as 3⁄4th of an inch or 1⁄16th of a foot.[v] [vi]


2.     Anjali pramana

Ayurveda scholars described the volume of certain body components in anjali pramana. The quantities mentioned are their maximum normal quantity.  A study conducted in India found that the measure of one anjali for a woman is approximately 100 ml & for a man is approximately 135 ml.[vii]

Table 3: Measurements of body components in swa-anjali pramana [Cha. Sa. Sharir Sthana 7/115]

Body components Volume
Udaka (aqueous element) a substance which is found in association with various body parts/components of body. Example, it is seen mixed with faeces during the occurrence of diarrhoea. It is also found in association with urine, blood and other tissue elements of the body. It is spread all over the body with its site in the external skin. Inside the skin, it is known as lasika (lymph) which exudes through ulcers; when the body becomes hot, it comes out from hair follicles in the form of sweat. 10
Rasa which is the first product of the ingested food after it is metabolised. 9
Rakta (blood) 8
Purisha (faeces) 7
Kapha 6
Pitta 5
Mutra (urine)       4
Vasa (muscle fat) 3
Medas (fat) 2
Majja (bone marrow) 1
Mastishka (the fat like substance inside the skull)
Shukra (semen)
Shleshmika oja (a type of oja)

Application of pramana in diagnosis of various diseases:

The equilibrium of dosha, dhatu (body tissues) and mala (metabolic waste of body) is responsible for keeping a person healthy. Any derangement in pramana leads to disorders. Example depletion of rasa dhatu (plasma) causes precordial pain, palpitation, sense of emptiness and thirst, whereas increase in pramana of rasa dhatu may result in nausea and salivation.

It’s difficult to understand how the ancient Ayurveda scholars estimated the volume of body fluids. Ayurveda scholars had an understanding of qualities of substances based on their panchabhautika composition (the five universal elements or panchamahabhuta). The proportion or volume of a substance in most cases has a direct relationship with its qualities. For example, proportion of water present in a substance decides moisture content or dryness in it. In the absence of advanced medical techniques, how the volume of body fluids was measured in ancient times is a topic for research. Most probably the Ayurveda scholars estimated the qualities of fluid in body and thereafter assessed its volume inside the body.

Contemporary views:

Anthropometric measurements require understanding of anthropometric landmarks some of which can be shown in the figure:

[i] Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 284.

[ii] Dev R.R.K., editor, (1st ed.). Shabdakalpadrum, Kand 3. Delhi: Amar Publications, 2018; 67.

[iii] Gangadhar Commentary on Charak Samhita Sutrasthana, Taistraishaniya Adhyaya, 11/17, reprinted 2020, Chaukhamba Sanskrit Sansthan, Varanasi, page no 70.

[iv] Balasubramanian, R. (10 September 2009). "New Insights on metrology during Maurya period". Current Science. 97

[v] Noah Webster; John Walker (1830). American dictionary of the English language. digit: Converse. p. 247.

[vi] Ronald Edward Zupko (1985). A dictionary of weights and measures for the British Isles: the Middle Ages to the twentieth century. American Philosophical Society. pp. 109–10. ISBN 978-0-87169-168-2

[vii] Gadgil, Neha & Kulkarni, Akshar. (2019). An observational study to quantify the measure of Anjali Pramana -A pilot study. 1 Neha Dattatraya Gadgil, and.

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