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Tistraishaniya Adhyaya (view source)

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→‎Sanskrit text, Transliteration and English Translation

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=== Introduction ===

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== Introduction ==

Longevity is the desire of most human beings - to lead a healthy and long life. There is also desire for wealth - to enjoy all the worldly pleasures and also spend on spiritual rituals. The process of birth and rebirth is a ''karmic'' cycle and the quality of an individual’s afterlife and the remaining part of his present life depends upon the good and bad deeds done in the life. As a result of good deeds, we can enjoy material (or heavenly) pleasures and lead healthy lives.

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===Sanskrit text, Transliteration and English Translation===

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==Sanskrit text, Transliteration and English Translation==

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Now we shall ~~explain~~ the chapter ~~on “Three desires~~ of ~~life”~~.

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Now we shall expound the chapter "Tistraishaniya" (Three Desires of Life and important triads). Thus said Lord Atreya. [1-2]

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Thus said Lord Atreya. [1-2]

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==== Three Desires ====

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=== Three Desires ===

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==== Desire of Life ====

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==== Desire for Life ====

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==== ''Pratyaksha'' and ''Apratyaksha'' ====

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=== ''Pratyaksha'' (Direct perception) and ''Apratyaksha''(Unknown) ===

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==== Views regarding ''Paranirmana'' (soul as the Creator of the Universe) ====

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=== Views regarding ''Paranirmana'' (soul as the Creator of the Universe) ===

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Consciousness is without any beginning or end, and being eternal it cannot be created by any other thing. Creation by something else refers to the creation of the body by the absolute ''atman'' (the supreme consciousness or the supreme soul), and is an acceptable view for the proponents of the theory of reincarnation. [13]

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==== ''Yadrichha'' or free will (power which is responsible for sudden occurrence of events in universe) ====

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=== ''Yadrichha'' or free will (power which is responsible for sudden occurrence of events in universe) ===

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An intelligent person should get rid of such nihilistic thoughts and should see the world through the light of the lamp of wisdom shown by wise men. [16]

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==== Four-fold examination ====

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=== Four-fold examination ===

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The intellect perceives things by combination of multiple factors, valid for past, present and future is termed as ''yukti'' (reasoning). This is helpful in fulfilling three basic objects of human life (''dharma'', i.e. duties, wealth, desire). [25]

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==== ~~Four~~-fold Examination ====

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==== Importance and applications of four-fold Examination ====

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==== Important Triads ====

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=== Important Triads ===

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Excessive cold or hot water bath, excessive massage, unction etc. constitutes overuse of tactile senses, not to use at all is non-utilization, touch of uneven places, trauma, dirty objects, ''bhuta-sansparsha'' (microscopic organisms causing diseases) is the wrong utilization of tactile senses. [37]

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==== Three Causes of Diseases ====

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===== Asatmyendriyarthasamyoga =====

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The sense of touch is present/pervades in all the senses, it is associated with mind. The mind is pervaded in sense of touch, the latter in turn in all senses. The ''anupashaya'' (unwholesome objects) of sensual faculties are divided into five types further sub divided into three each (non-utilization, over utilization, wrong utilization). This is known as ''asatmyendriyatha samyoga''. The favorable reaction of the senses is ''satmya'' (adaptation/wholesome conjunction of senses with their object). ||38||

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===== Prajnaparadha (intellectual defects) =====

कर्म वाङ्मनःशरीरप्रवृत्तिः|

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Three types of ''vikalpa'' (''atiyoga, ayoga'' and ''mithyayoga'') and three actions (speech, mind and body) comes under category of deeds done of ''prajnaparadha'' (intellectual defects). ||41||

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===== Kala or Parinama (time) =====

शीतोष्णवर्षलक्षणाः पुनर्हेमन्तग्रीष्मवर्षाः संवत्सरः, स कालः|

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Time span of a year is divided into ''sheeta'' (winter season), ''ushna'' (summer season) and rainy season. Which is further divided into six seasons namely ''hemanta- shishira'' (winter), ''vasanta- grishma'' (summer), ''varsha-sharada'' (rains). The manifestation of particular season in excess be regarded as ''kala atiyoga'' (excessive utilization), if season manifests in lesser measure, termed as ''ayoga'' (non-utilization). On the other hand, if manifestation of the season is contrary with normal, this is ''mithyayoga'' (wrong utilization) of the ''kala'' (season). [42]

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~~==== Three Causes of Diseases ====~~

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इत्यसात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः, परिणामश्चेति त्रयस्त्रिविधविकल्पा हेतवो विकाराणां; समयोगयुक्तास्तु प्रकृतिहेतवोभवन्ति||४३||

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''Shastrapranidhana'' (surgical procedures) includes excision, incision, puncturing, rupturing, scraping, uprooting, rubbing superficially with rough surface, suturing, probing, application of alkalis and leeches. [55]

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==== Process of identification of diseased state ====

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=== Process of identification of diseased state ===

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==== Summary ====

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=== Summary ===

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Thus ends the work by Agnivesha, redacted by Charak of [[Sutra Sthana]] eleventh chapter on “Three desires of life”. [11]

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==~~= ''~~Tattva Vimarsha~~'' /~~ Fundamental Principles ===

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== Tattva Vimarsha (Fundamental Principles) ==

* Three basic desires to be fulfilled are: ''Praneshana'' (desire for life), ''Dhaneshana'' (desire for wealth (livelihood)), ''Paralokeshana'' (desire for the other world (after death)). [3]

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==~~= ''~~Vidhi Vimarsha~~'' /~~ Applied Inferences ===

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== Vidhi Vimarsha (Applied Inferences) ==

Human being is most intelligent of all the living beings on this earth. After satisfying the basic needs for living i.e. food, clothing, shelter etc. humans tried to find out the reason behind their birth and what are the goals to be achieved in this life. The results of the search lead to the origin of ‘Philosophy’ to find the answer and to find solutions to the worldly sorrows. Animals eat, drink, reproduce and die, but humans are not like animals, they live in society, they have various duties to perform. To set the moral, social duties and also code of conduct to live in society, religion was developed, all the things exist in this world are respected, energies were worshiped and given extreme importance, many ancient scriptures were written which taught the way of leading life.

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[[Ayurveda]] is the art and science of life, it is ''astika darshana'' (believes in God). It is believed that human life is blessed and it is bestowed as a result of good deeds in many past lives. It is essential for humans to get involved in good deeds so that the life will be happier. The present chapter discusses the desires to be fulfilled in present birth and to achieve good life in next world after death. This chapter is designated as [[Tistraishaniya Adhyaya]]<ref>R. K. Sharma, Bhagwan Dash , Charak samhita (Text with English Translation & Critical Exposition based on Cakrapani Datta’s [[Ayurveda]] Dipika), Vol I, Chowkhamba Sanskrit Series Office, Varanasi, First Edition: 1976, ISBN: 81-7080-012-9, Sutra Sthana, Chapter 11. </ref>, (Tisra+ Eshana+Cha), the word ''tistraishana'' is formed by the union of ''tistra''+ ''eshana''. It begins with the description about three ''eshanas'' or pursuits of life, longevity, acquiring wealth and happiness in next world. ''eshantye anevishante eti aeshana''= ''echha'' <ref>Prof. K. R. Srikantha Murthy, Charak Samhita (English translation of the text along with commentary of Cakrapani data, Appendix etc.), Vol I, Sutra Sthana & Nidana Sthana, First edition -2004, Chaukhambha Orientalia, Varanasi. </ref> one which is searched and has some initiation.<ref name=ref3>L. D. Dwivedi, co-commentators: Dr. B.K. Dwivedi, Dr.P.K. Goswami, Charak samhita: by Sri. Chakrapani Datta ‘Ayurved Dipika’ vyakha and ‘Ayurved Dipika’ ki TatvaPrakashini hindi vyakha Tatha Yatra-Tatra Sri GangadharaViratna krita “Jalpakalpataru’ ki hindi vyakha aevum Sholakanusara Anukramanika sahita. Vol I, Sutra Sthana, Chowkhamba Krishnadas Academy, Varanasi, Edition I, Vik. Sam. 2064, year 2007, ISBN: 978-81-218-02326. </ref> <ref>Prof. Y.G.Joshi, Charak Samhita by, Sri Chakrapanidattavirachit [[Ayurveda]]Dipika vyakha, Marathi translation and Yashvant commentary (vol-I), Vaidmitra Prakashana, 709, Sadishavapeth, Pune-411030, first edition (5 oct 2003). </ref>

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==== Importance of Three ====

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=== Importance of Three ===

The concept of the Triad or Trinity can be found throughout the world in all dimensions of life and been in use across civilizations and cultures since time immemorial. It can be understood as a key to the integrity and interdependence of all existence. The ideas of concepts of three can found in philosophy, mathematics, physics, etc. in ancient as well as modern times.

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* Three lines of sacred ash worn by ''shaivites'' (or the followers of Shiva) on their foreheads

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==== Categories of three mentioned in ''Vedanta''<ref>Swami Sivananda “Categories in Vedanta” http://www.sivanandaonline.org/public_html/?cmd=displaysection&section_id=764 </ref> ====

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=== Categories of three mentioned in ''Vedanta''<ref>Swami Sivananda “Categories in Vedanta” http://www.sivanandaonline.org/public_html/?cmd=displaysection&section_id=764 </ref> ===

* Three types of ''Shariras'' or bodies: ''Sthula-sharira'' (gross physical body), ''sukshma'' or ''linga-sharira'' (subtle body), ''karana-sharira'' (causal body).

* The threefold nature of ''atman'' or ''brahman'': ''Sat'' (Truth/Existence), ''chit'' (Consciousness), ''ananda'' (bliss).

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As per the ''Bhela Samhita'' <ref>Dr. K. H.Krishnamurthy, Bhel Samhita – text with English translation, commentary and Critial notes, editor. Prof. P.V. Sharma, First Edition-2000, Choukhambha Visvabharati, Varanasi. </ref> (Sutra 15), the three objectives are ''pranaeshana'', ''dhanaeshana'' and ''dharmaeshana'' (performing religious acts). The first two desires are same as mentioned by Charak, while third ''dharmeshana'' is to follow the duties of individual towards one’s self, family, society, and realm, etc. abide by the moral and ethical traditions laid down in the scriptures, and maintain harmony between self and the society and environment, in general.

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==== Why is ''kamaeshana'' not included as a desire to be pursued? ====

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=== Why is ''kamaeshana'' not included as a desire to be pursued? ===

Chakrapani <ref>Kaviraj Shree Narendra Sengupta and LalaiChandra Sengupta, Charak Samhita by The Great Sage Bhagavata Agnivesha, thoroughly revised by Maharashi Charak & Dridhabala with [[Ayurveda]]dipika commentaries of Srimat Chakrapanidatta & Jalpakalpaturu explanatory notes & Annotations of Mahamohopadhyaya Sri Gangadhar Kaviratna Kaviraja, Sutra Sthana, Third Edition, Chowkambha Orientalia, Delhi, ISBN:978-81-89469-30-6, 978-81-89469-29-0-(set). </ref>raised a question, “Why is ''kamaeshana'' not mentioned?”. However, he goes on to give an explanation to this exclusion himself, writing that ''kamaeshana'' can be considered as an implicit activity in one’s pursuit of ''pranaeshana'' and ''dhanaeshana''. Since a person instinctively indulges in ''kama'', there is no need to explain it separately.

After knowing the goals for fulfilment of ''eshanas'', the question of reincarnation arises which is discussed after a detailed description of ''eshanas''.

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==== The Cause of Birth ====

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=== The Cause of Birth ===

Charak asks whether life exists after death or not. Some support the idea of rebirth or reincarnation on the basis of scriptures but others do not. If the cause of birth is only attributed to parents, it is accepting only that which is perceptible. If only ''swabhava'' (natural trait or instinct) is considered as a reason (which does not sound to be a compelling reason), it is denying the existence of God. ''Paranirmana'' is accepted as the cause for birth, since it considers the existence of God, and if ''yadrichcha'' (supernatural power) is the only reason attributed to birth, then it supports the theory of supernatural power but does not support the existence of God.

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==== Four ''Pariksha'' and their clinical significance ====

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=== Four ''Pariksha'' and their clinical significance ===

The theory of reincarnation is explained by means of fourfold ''parikshas'' (examinations)- ''aptopadesha, pratkysha, anumana'' and ''yukti''. These are considered to be the correct means of getting information regarding an individual’s birth and therefore, play a significant role in the diagnosis of diseases and deciding the course of treatment to be employed. In [[Vimana Sthana]], Charak considers the first three types of ''pariksha'', i.e., ''aptopdesha, pratyaksha'' and ''anumana'' as acceptable means of examination. One should first examine the patient with the help of all the ''parikshas'' and then diagnose the disease. One should acquire knowledge systematically through "aptopadesha" followed by ''pratyakhsha'' and ''anumana''. Use of all the three types of examination is recommended, and not any one of them alone [Cha.Vi 4/5-1][13]

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==== ''Aptopdesha'': Clinical Significance [Ch. Vi.4/6] ====

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=== ''Aptopdesha'': Clinical Significance [Ch. Vi.4/6] ===

Every disease should be studied carefully, with the help of the texts, from the standpoint of:

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# ''Pratikara, pravritti'' and ''nivritti''- Prescriptions and prohibitions in the treatment.

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==== ''Pratyaksha'' ====

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=== ''Pratyaksha'' ===

''Pratyaksha'' or direct perception / observation is the knowledge gained by the union of (coming together) of ''atman'', ''indriya'' (sense organs), ''manas'' (mind) and the ''indriyarthas'' (objects). [Ch.Su 11/20]

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==== Clinical application ====

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=== Clinical application ===

A Clinician desirous to gain knowledge about the disease by this examination should use his own sense organs, except his gustatory organ. [Ch. Vi. 4/7]

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===== ''Shrota Pratyaksha'' (auscultation / percussion) =====

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==== ''Shrota Pratyaksha'' (auscultation / percussion) ====

A physician has to hear the various sounds for this examination but ears cannot be directly applied over the body of the patient. An examination of the following can be done by means of these tests:

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Similarly, auscultation of thorax could be employed to examine pulmonary sounds and cardiac sounds, auscultation of abdomen for peristalsis, bruits, etc.

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===== ''Darshan pratyaksha'' (visual inspection) =====

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==== ''Darshan pratyaksha'' (visual inspection) ====

Visual inspection can be employed to draw some inference on the nature of various elements, such as edema, cyanosis, petechiae, skin lesions, abnormal movements, deformities, using the following cues:

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# Whatever else not mentioned here but could be visually observed.

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===== ''Rasapariksha'' (gustation-by inference) =====

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==== ''Rasapariksha'' (gustation-by inference) ====

“Tastes” of various factors in the body be ascertained by inference and not by direct observation:

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Nowadays various laboratory tests are available to diagnose this, such as blood glucose etc.

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===== ''Gandha Pariksha'' =====

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==== ''Gandha Pariksha'' ====

The physician should be able to smell normal and abnormal smells of the entire body of patient by olfactory sense organ.

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Various types of odor are recognizable from the breath. The odor of alcohol, and odor of diabetic ketoacidosis have been described as ‘sweet and sickly’. The odor in condition of uraemia is ‘ammonical or fishy,’ and hepatic failure is ‘mousy’. Halitosis is common in patients with poor dental hygiene and associated with chronic gingivitis. In suppurative conditions of lungs, breath may have putrid odor.

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===== ''Sparshana Pariksha'' (palpation) =====

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==== ''Sparshana Pariksha'' (palpation) ====

The physician has to touch the patient by his hand and do examination of normal and abnormal touches. Care should be taken, however, to ensure that the physician’s hand should not be too warm or cold. Also, palpation should be performed very gently. The examination done by this method helps in assessing rise of body temperature, palpation of pulse, any tenderness, guarding, rigidity, swelling, lump or growth, lymphadenopathy, palpation of organs to reveal organomegally, size of organ palpable, surface, borders, consistency, bruits etc.

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==== ''Anumana'' (estimation, or analysis) ====

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=== ''Anumana'' (estimation, or analysis) ===

The scope of perception has limitations and there are many ailments that cannot be perceived using sensory organs. Such imperceptible ailments can be diagnosed using ''agama'' (texts), ''anumana'' (inference) and ''yukti'' (reasoning). [Ch. Su 11/7]

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# General inference (present knowledge): For example, by seeing smoke one can have knowledge of fire.

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==== Clinical Application ====

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=== Clinical Application ===

Since there are many things that cannot be perceived using sensory organs alone, ''anumana'' or the power to deduce or infer is an important and effective tool that a physician may employ. Charak has enumerated the following factors to be observed by inference:

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# Similarly, condition of ''grahani'' (intestines), dreams, desires, likes- dislikes, happiness (or unhappiness), etc can be known by interrogation of the patient.

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==== ''Yukti'' ====

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=== ''Yukti'' ===

''Yukti'', or reasoning [Ch Su 11/25], is the fourth ''pariksha''. The intellect perceives things as an outcome of a combination of various factors by employing ''yukti''. ''Trivarga'' or ''dharma, artha'' and ''kama'' can be achieved by ''yukti''.

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The maintenance of healthy life is dependent on the lifestyle followed, hence the factors which are mandatory for sustenance of life are mentioned next.

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==== Three ''Upasthambhas'' ====

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=== Three ''Upasthambhas'' ===

The three ''upasthambhas'' or supporting pillars of body mentioned in this chapter are ''ahara'' (diet), ''swapna'' (sleep) and ''brahmacharya'' (celibacy). As diet is critical for the sustenance of life, it is the first of the three, followed by sleep and ''brahmacharya''. Importance of a healthy and wholesome diet (in [[Sutra Sthana]] , Chapter 27), various classification of dietary items (in [[Sutra Sthana]], Chapter 25), wholesome and unwholesome diets (in [[Sutra Sthana]], Chapter 25), the quantity of diet to be taken and the significance of a balanced diet (in [[Sutra Sthana]], Chapter 5,) eight factors responsible for digestion of food and ''ahara vidhi vidhana'' (rules for diet described in [[Vimana Sthana]] Chapter 1), ''ahara parinamkara bhavas'' (factors affecting diet digestion mentioned in [[Sharira Sthana]] chapter 6), the dietary regimen according to different seasons (in [[Sutra Sthana]] Chapter 6) and the description of incompatible foods (in [[Sutra Sthana]] chapter 26).

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When the appropriate use of these ''upasthambhas'' is practiced by an individual, he will be bestowed with excellence of strength. Hence, the next topic discussed is about ''bala'' or strength.

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==== Three types of ''bala'' (strength, immunity) ====

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=== Three types of ''bala'' (strength, immunity) ===

Strength is of three types i.e. ''sahaja'' (constitutional), ''kalaja'' (temporal) and ''yuktikrita'' (acquired):

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With the knowledge of strength and the factors useful in maintaining it, one can achieve better strength for leading a healthy and long life. But if strength is not good and one indulges in activities or dietary practices that weaken one’s strength or immunity, then the individual may get afflicted with diseases.

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==== Three ''ayatanas'' (causes of diseases) ====

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=== Three ''ayatanas'' (causes of diseases) ===

Three causes of ''nija'' (bodily) diseases are- ''asatmya indriyartha samyoga'' (''atiyoga, ayoga, mithyayoga'') (unwholesome contact of sense organs with objects), ''pragnyaparadha'' (intellectual blasphemy) and ''parinama'' (consequence). The three causes of all the somatic and psychological diseases are ''mithyayoga, ayoga'' and ''atiyoga'' of ''kala'' (time), ''buddhi'' (intellect) and ''indriyartha'' (objects of senses) (Ch. Su. 1/54).

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Desires are the root cause of all the miseries of life, and therefore, elimination of desires leads to eradication of all miseries. Just as a silkworm spins its thread around itself causing its own death, similarly, an ignorant person, bound to worldly miseries of his own creation, remains unhappy all his life. (Ch. Sa. 1/95). Impairment of ''dhi, dhruti'' and ''smriti'' (intellect, patience and memory), variations of natural seasons, advent of actions and unwholesome contact with the objects of senses are the causative factors of miseries (diseases) (Ch. Sa.1/ 98). The details may be referred to in [[Sharira Sthana]] chapter 1.

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===== ''Pragnaparadha'' (intellectual defects) =====

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==== ''Pragnaparadha'' (intellectual defects) ====

This includes forcible stimulation of natural urges. For example, excessive straining at passing stool may cause prolapsed rectum or rectal bleeding. Delay in treatment will aggravate the disease and complications may arise which may even cause death of the patient. Malice, vanity, fear, anger, greed, and ignorance may lead to psychological disorders.

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===== ''Kalaja Vyadhi'' =====

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==== ''Kalaja Vyadhi'' ====

Ailment caused by the variations of time or season. For example: diseases caused by the vitiation of ''vata dosha'' manifest during the final stage of digestion of food (afternoon and post midnight), and diseases caused by vitiated ''kapha dosha'' manifest during time of intake of food, forenoon and pre-mid night and those caused by the vitiation of ''pitta dosha'' manifest during initial stage of digestion, noon and midnight. The vitiation of three ''doshas'' during the three different stages of life are responsible for manifestation of diseases- ''kaphaja'' diseases during young age, ''pittaja'' diseases during the middle age and ''vataja'' diseases during old age (Ch. Sa. 1/111-112).

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===== ''Atiyoga'' or ''mithyayoga'' =====

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==== ''Atiyoga'' or ''mithyayoga'' ====

Diseases are caused due to unwholesome contact with senses. For example: ''atiyoga'' of the hearing, caused by exposure to excessively loud sounds, rough noise, terrifying noise, etc. may lead to hearing impairment. ''Atiyoga'' or ''mithyayoga'' of the eyes could be caused due to excessive exposure to bright light, or working for long hours in front of computers, etc., could lead to blindness. ''Atiyoga'' of sense of touch may result in diseases ranging from mild burns due to touching excessively hot objects, to amputation of limbs or death due to frostbite (when exposed to extreme cold), etc. Specific examples of ''mithyayoga'' of touch mentioned in the text include ''vishyukta vayu sparsha'', or exposure to toxic, poisonous vapors or air that could cause burns.

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==== Three classes of ''roga'' (diseases) ====

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=== Three classes of ''roga'' (diseases) ===

Classification of diseases helps in the process of diagnosis and the subsequent courses of treatment selected. In this particular chapter, diseases are classified by its underlying cause: ''nija'' (endogenous cause), ''agantuja'' (exogenous cause), and ''manas'' (psychological). ''Sharira'' (body) and ''manas'' (mind) are the ''ashraya'' (refuge, or home) of the diseases (Ch. Su.1/55).

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After gaining the knowledge about the classification of diseases, the routes of manifestation and the nomenclature of diseases must be known, hence the routes of disease manifestation are described.

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==== Three ~~''rogamargas''~~ (~~routes for~~ disease manifestation) ====

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=== Three rogamarga (pathways of disease manifestation) ===

In the process of ''sthana samshraya doshas'' after circulating all over the body, get accumulated in ''dushyas'' in particular ''strotas'', next step is ''dosha- dushya sammurchhana'', ''doshas'' vitiate the ''dushyas'' and first produce premonitory symptoms. The manifestation of symptoms of disease follows a route depending upon the movement of vitiated ''doshas'' inside the body and the involvement of ''strotas''. [[Ayurveda]] considers three ''rogamargas'' or ''rogayatana''/ routes for manifestation of diseases - ''shakha'' (''bahya rogamarga'': ''twachha'' and ''raktadi dhatus'' - periphery), ''marma asthisandhi'' (''madhyam rogamarga'': Vital organs, bones, joints & ligaments-tendons), ''kostha'' (''abhyantara rogamarga'': Gastrointestinal tract and central part of body). The diseases manifesting in particular ''rogamarga'' is also described.

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Charkapani has commented that three ''~~rogamargas~~'' <ref name=ref15>Mahamohpadhyaya Sri Gangadhar Kaviratna Kaviraja Edited & Revised by Kaviraj Shree Narendranath Sengupta & Lalai Sengupta, Charak Samhita by The Great Sage Bhagavata Agnivesha, thoroughly revised by Maharsi Charak & Dridhabala with [[Ayurveda]]dipika Commentaries of Srimat Chakrapani Datta & Jalpakalpataru Explanatory notes & Annotations, Sutra Sthana (First part), Chowkhambha Orientalia, Delhi, Third edition, ISBN: 978-81-89469-30-6. </ref> include ''marma asthi sandhi'' as one route, ''shakha'' nomenculature is given for the practical purpose, as the ''dhatus'' here are like the branches of tree. ''Twachha'' denotes here the ''rasa dhatu'' which is present in ''twachha''(skin), directly it is not stated as ''rasa'', as it is different from the ''rasa dhatu'' present in ''hridaya'' (heart). The vitiation of ''rasa'' residing in ''hridaya'' is considered in ''kostha'', also the vitiated ''rakta dhatu'' which is present in ''yakrita'' (liver) and ''pleeha'' (spleen). ''Ama sthana – amashaya'' (stomach), ''agni sthana'' (site of ''agni''- pancreas), site of digested food –''pakwashaya'' (terminal ileum and large intestine), ''mutrashaya'' (urinary bladder), ''rudhir sthana'' (''yakrita''-liver, ''pleeha''- spleen), ''hridaya'' (heart), ''unduka'' (caecum), ''phuphhupus'' (lungs) are considered as part of ''kostha'' (Su.Chi.2). ''Asthi sandhi'' stands for the joints and the tendons and ligaments. The description of ''rogamarga'' helps in knowing the prognosis of diseases.

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Charkapani has commented that three ''rogamarga'' <ref name=ref15>Mahamohpadhyaya Sri Gangadhar Kaviratna Kaviraja Edited & Revised by Kaviraj Shree Narendranath Sengupta & Lalai Sengupta, Charak Samhita by The Great Sage Bhagavata Agnivesha, thoroughly revised by Maharsi Charak & Dridhabala with [[Ayurveda]]dipika Commentaries of Srimat Chakrapani Datta & Jalpakalpataru Explanatory notes & Annotations, Sutra Sthana (First part), Chowkhambha Orientalia, Delhi, Third edition, ISBN: 978-81-89469-30-6. </ref> include ''marma asthi sandhi'' as one route, ''shakha'' nomenculature is given for the practical purpose, as the ''dhatus'' here are like the branches of tree. ''Twachha'' denotes here the ''rasa dhatu'' which is present in ''twachha''(skin), directly it is not stated as ''rasa'', as it is different from the ''rasa dhatu'' present in ''hridaya'' (heart). The vitiation of ''rasa'' residing in ''hridaya'' is considered in ''kostha'', also the vitiated ''rakta dhatu'' which is present in ''yakrita'' (liver) and ''pleeha'' (spleen). ''Ama sthana – amashaya'' (stomach), ''agni sthana'' (site of ''agni''- pancreas), site of digested food –''pakwashaya'' (terminal ileum and large intestine), ''mutrashaya'' (urinary bladder), ''rudhir sthana'' (''yakrita''-liver, ''pleeha''- spleen), ''hridaya'' (heart), ''unduka'' (caecum), ''phuphhupus'' (lungs) are considered as part of ''kostha'' (Su.Chi.2). ''Asthi sandhi'' stands for the joints and the tendons and ligaments. The description of ''rogamarga'' helps in knowing the prognosis of diseases.

[[Sutra Sthana]] Chapter 28 has explained the causes responsible for the movement of ''doshas'' from ''kostha'' to ''shakha''. Due to strenuous exercise, hyperfunctioning of ''agni'' (digestive power), non-observance of wholesome regimen and the pressure of vitiated ''vata'' ''dosha'' causes movement of ''doshas'' from ''kostha'' to ''shakhas'', they remain there till further aggravation. If already in stage of aggravation, then only they produce disease (Ch. Su.28/31-32). The factors responsible for the movement of ''doshas'' from ''shakha'' to ''kostha'' are also mentioned, aggravation of ''doshas'', increase in their fluidity, ''paka'' (suppuration), by the removal of the obstruction at the entrance of the channels and reduced pressure of ''vata dosha''. This knowledge helps in planning the treatment for the vitiated ''doshas'' accumulated in particular ''rogamarga''.

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When an individual gets ill, there is need of a physician therefore the qualities of physician are described to choose a good knowledgeable physician for better treatment.

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==== Three ~~''bhishaja''~~ (physicians)====

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=== Three bhishaga (physicians)===

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Three types of physicians are mentioned- ''Chhadmachara'' (Pseudophysician or Quack), ''siddhasadhit'' (feigned physician) and ''jivitabhisara'' (genuine physician). In the ancient times, there were people ~~practising~~ medicine without appropriate knowledge about the science, Charak has mentioned the qualities of physician to whom we should rely upon for treatment and to keep away from the quacks and the dangers of getting treated from them, even ~~loosing~~ life.

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Three types of physicians are mentioned- ''Chhadmachara'' (Pseudophysician or Quack), ''siddhasadhit'' (feigned physician) and ''jivitabhisara'' (genuine physician). In the ancient times, there were people practicing medicine without appropriate knowledge about the science, Charak has mentioned the qualities of a physician to whom we should rely upon for treatment and to keep away from the quacks and the dangers of getting treated from them, even losing a life.

[[Sutra Sthana]] Chapter 1 ([[Deerghanjiviteeya Adhyaya]]), verse 124<ref name=ref3/> states the qualities of good physician as, ‘one who examines the patient and in consonance with habitat, time, individual variations, applies appropriate medicine is best physician’. The medicine which can cure disease is best medicine and the physician who can give relief to the patients of their ailments is best physician. The wise person who aspires to be physician should acquire the qualities of physician, knowledge of science and also the practical knowledge of the diseases and medicine, to become life saver.

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After the detail description about the treating physician, three types of therapies are described.

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==== Three ''aushadha'' (therapies) ====

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=== Three aushadha (therapies) ===

Three types of therapies are mentioned: ''daivavyapashraya'' (spiritual therapy), ''yuktivyapasharaya'' (therapy based on reasoning) and ''satvavajaya'' (psychotherapy). In [[Sutra Sthana]] Chapter 1, verse 58, the treatment modalities for somatic diseases is ''daivavyapasharaya'' and for psychological diseases is ''satvavajaya'':

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===== ''Daivavyapasharaya'' <ref name=ref3/> <ref name=ref15/> <ref>Acharya Vidyadhara Shukla, Prof. Ravidutt Tripathi, Charak Samhita ofAgnivesha, elaborated by Charak and redacted by Dridhabala, Vol-I, edited with ‘Vaidyamanorama’ hindi commentary along with special deliberations, Chowkhambha Sanskrit Pratisthana, Delhi, second edition-2000. </ref>=====

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==== ''Daivavyapasharaya'' <ref name=ref3/> <ref name=ref15/> <ref>Acharya Vidyadhara Shukla, Prof. Ravidutt Tripathi, Charak Samhita ofAgnivesha, elaborated by Charak and redacted by Dridhabala, Vol-I, edited with ‘Vaidyamanorama’ hindi commentary along with special deliberations, Chowkhambha Sanskrit Pratisthana, Delhi, second edition-2000. </ref>====

This is the treatment for diseases arising due to ''purva janmakruta papa karma'' (sins of past life) or ''karmaja vyadhis'' (karmic ailments). This type of treatment was done in the ''Rigvedic'' period in majority and ''yuktivyapasharaya'' was neglected. The observance of ''yama'' (''ahimsa''(non violence), ''satya'' (truth), ''astaya''(not to steal), ''bramhacharya''(control over sexual desire),and ''aparigraha'' (accumulation of prosperities)) and ''niyama'' (''shaucha'' (cleanliness), ''santosha'' (satisfaction), ''tapas'' (conquest of all desires), ''swadhyaya'' (self-study), ''ishwara pranidhana'' (surrender to God)) is also part of this treatment. This form of treatment includes chanting mantras, wearing amulets on body, wearing gems, precious stones etc. performing auspicious rituals, offerings to God, oblations, ''homa'', following ''niyama, prayachhitta, upavasa, svastyayana, pranipata'' and going to holy places.

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Wearing gems is an age old practice and, per Vedic texts, can play a significant role in influencing human health, <ref>Dr. Shaikh Abbas Borhany, Gems Science in Islam: Its medicinal & Mystical value, published in Daily News- Pakistan, March 2010. </ref> Dr. Robert Frost revealed that gems have remedial properties, by wearing appropriate gems reduces pain, helps in allergies, improves coordination and even improves muscle strength.

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===== ''Yuktivyapasharaya'' <ref>[[Ayurveda]]charya Sri JayadevVidya Alankara, Charak Samhita – Maharshi Bhagvan Agnivesha pranita (Mahamuni Charak Pratisanskrita), Purva bhaga, Motilal Banarasidas, Delhi, ninth edition: 1975, reprint: 79, 86, 94, 98. </ref> =====

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==== ''Yuktivyapasharaya'' <ref>[[Ayurveda]]charya Sri JayadevVidya Alankara, Charak Samhita – Maharshi Bhagvan Agnivesha pranita (Mahamuni Charak Pratisanskrita), Purva bhaga, Motilal Banarasidas, Delhi, ninth edition: 1975, reprint: 79, 86, 94, 98. </ref> ====

This is the therapy done by the planned use of drugs, foods and regimen for the treatment of diseases caused by vitiation of bodily ''doshas''. This is widely practiced and is further classified into three types: ''Antahaparimarjana'' (internal purification), ''Bahirparimarjana'' (external purification) and ''Shastrapranidhana'' (surgical therapy). ''Antahaparimarjana'' is administered for the diseases of ''kostha'' also for the diseases of ''shakha'' to losen the vitiated ''doshas'' from ''shakha'' and bring them into ''kostha'', internal medications are prescribed oral drugs, ''vamana, virechana, basti, uttara basti, shirovirechana'' etc. ''Bahirparimarjana'' is the treatment for the diseases of ''shakha'', also ''bahaya snehana''- ''swedana'' or ''purvakarma'' is done for loosening the vitiated ''doshas'' from the ''shakhas'' and bring them into ''kostha'' for elimination. It is also done for skin disorders application of ''snehana, swedana, lepa,'' ointment, dusting powders and unctions etc. details of various formulations for skin disorders are well discussed in [[Sutra Sthana]], Chapter 3 ([[Aragvadhiya Adhyaya]]). ''Shastrapranidhana'', even though not mentioned in detail in Charak, is the treatment modality for various diseases not cured by medicinal treatment, for the diseases of exogenous factors like trauma, fractures also for diseases like ''arsha, arbuda, granthi'' etc.

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In [[Sutra Sthana]] Chapter 22, six types of therapies are mentioned viz ''langhana'' (to reduce), ''brimhana'' (to nourish), ''rukshana'' (to dry), ''snehana'' (to oleate), ''swedana'' (to fomentate) and ''sthambhana'' (astringent).

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===== ''Sattvavajaya'' =====

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==== ''Sattvavajaya'' ====

''Sattvavajaya'',<ref name=ref23/> or Psychotherapy, is one of the three principal categories of the approach to the patients care as described in Ayurvedic classics. In principle, ''sattvavajaya'' is applicable in varying forms in all kinds of diseases but it is essentially indicated in mental diseases.

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''Asatmyendriyartha samyoga'' (unwholesome contact of ''indriyarthas'') is regarded as one of the principal causes of diseases. The avoidance of over utilization, non utilization and wrong utilization, (''hina mithyatiyoga'') of ''chintya, vicharya, uhaya, dhyeya'' and ''samkalpa'' should help in the cure of psychiatric disorders. The word ''mano nigraha'' means control of mind this can both be subjective and objective. ‘Self control of mind’ is difficult task and needs a perfect combination of desire, determination and dedication.

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====== Dimensions of ''Sattvavajaya'' <ref>J.S. Tripathi, dimensions of sattvavajaya chikitsa (ayurvedic psychotherapy) and their clinical applications, Annals Ayurvedic Med. 2012: 1 (1 & 2) 31-38 </ref>======

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==== Dimensions of ''Sattvavajaya'' <ref>J.S. Tripathi, dimensions of sattvavajaya chikitsa (ayurvedic psychotherapy) and their clinical applications, Annals Ayurvedic Med. 2012: 1 (1 & 2) 31-38 </ref>====

# '''''Trivarga anveksana''''': The therapy of mental disorders is done by following the ''trivargas'' i.e. the ''dharma, artha'' and ''kama'' (virtue, wealth and pleasure). The person with mental aliment should be made to remain in touch with the experts of treating mental illnesses and to know about ''atma'' (self), ''desha'' (place), ''kala'' (time), ''shakti'' (strength) and capacity properly.

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</div>

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=== References ===

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== References ==

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~~=== Glossary ===~~

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~~#तिसस्रैषणa –tisrai aṣaṇīya- tisra ShaNIya = three desires~~

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~~#परलोक – paralōk – paraloka = world after death, heaven~~

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~~#आप्त – āptās – AptA = enlightened persons~~

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~~#प्रत्यक्ष -pratyakṣa- pratyakSha = direct perception~~

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~~#अनुमान – anumāna –anumAnaM =inference~~

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~~#युक्ति – yukti- yukti = reasoning~~

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~~#उपस्तम्भ –upastambhā- upastambhA = supporting pillars~~

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~~#प्रज्ञापराध – prajñāparādha - praj~jAparAdha = intellectual blasphesmy~~

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~~#आयतन –āyatan- Ayatan =Causes of diseases~~

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~~#भिषज- bhiṣaja- bhiShaja = physician~~

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