Changes

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

=== 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]

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.Sa.[[Vimana Sthana]] 4/5-1][13]

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

=== ''Aptopdesha'': Clinical Significance [Cha.Sa.[[Vimana Sthana]] 4/6] ===

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

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

=== ''Pratyaksha'' ===

=== ''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]

''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). [Cha.Sa.[[Sutra Sthana]] 11/20]

=== Clinical application ===

=== 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]  

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

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

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

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

=== ''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]

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). [Cha.Sa.[[Sutra Sthana]] 11/7]

''Anumana'' depends on prior knowledge acquired through ''pratyaksha'' (direct observation) and ''yukti'' (logical reasoning) and is applicable when the patient is aware of ailments suffered in the past (medical history) that can aid in drawing inferences about his current afflictions. It can also be defined as new information or inference drawn on the basis of applying one’s intelligence on information drawn through ''pratyaksha''. It can be of three types:

''Anumana'' depends on prior knowledge acquired through ''pratyaksha'' (direct observation) and ''yukti'' (logical reasoning) and is applicable when the patient is aware of ailments suffered in the past (medical history) that can aid in drawing inferences about his current afflictions. It can also be defined as new information or inference drawn on the basis of applying one’s intelligence on information drawn through ''pratyaksha''. It can be of three types:

The physiology of sleep, effects, and indications – contraindications of day sleep, effects of night awakening, methods and measures to induce good sleep, causes of insomnia, classification of sleep etc. are discussed in detail in [[Sutra Sthana]] Chapter 21.   

The physiology of sleep, effects, and indications – contraindications of day sleep, effects of night awakening, methods and measures to induce good sleep, causes of insomnia, classification of sleep etc. are discussed in detail in [[Sutra Sthana]] Chapter 21.   

Semen is considered as one of the factors useful in promoting strength and self- control, increasing pleasure, as well as increasing awareness in celibates of the importance of abstinence (from sex), leading to salvation. (Ch. Su. 30/15). ''Shukra kshaya'' (depletion of ''shukra'') is considered as a causative factor for ''pratiloma kshaya''(emaciation), which in turn may cause ''rajayakshama'', hence it has to be preserved. (Ch. Ni.6/8).

Semen is considered as one of the factors useful in promoting strength and self- control, increasing pleasure, as well as increasing awareness in celibates of the importance of abstinence (from sex), leading to salvation. [Cha.Sa.[[Sutra Sthana]] 30/15] ''Shukra kshaya'' (depletion of ''shukra'') is considered as a causative factor for ''pratiloma kshaya''(emaciation), which in turn may cause ''rajayakshama'', hence it has to be preserved. [Cha. Sa.[[Nidana Sthana]] 6/8]

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.

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.

In Ayurvedic texts word ''bala'' is used as a synonym of ''ojas'' and also for immunity (''vyadhikshamatava''). Charak has considered normal ''kapha'' as ''bala''. ''Sahaja bala'' can be considered as innate immunity while ''yuktikrita bala'' can be considered as acquired immunity that can be achieved by various methods like good quality diet, exercise, vaccination etc.

In Ayurvedic texts word ''bala'' is used as a synonym of ''ojas'' and also for immunity (''vyadhikshamatava''). Charak has considered normal ''kapha'' as ''bala''. ''Sahaja bala'' can be considered as innate immunity while ''yuktikrita bala'' can be considered as acquired immunity that can be achieved by various methods like good quality diet, exercise, vaccination etc.

The assessment of ''sharirik bala'' (physical strength) is done by ''anumana'' (inference) by analyzing the capacity of an individual to do physical exercise (or his endurance) (Ch. Vi. 4/8).

The assessment of ''sharirik bala'' (physical strength) is done by ''anumana'' (inference) by analyzing the capacity of an individual to do physical exercise (or his endurance). [Cha.Sa.[[Vimana Sthana]] 4/8]

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.

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.

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

=== 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).

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). [Cha.Sa.[[Sutra Sthana]] 1/54]

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 intellect (''dhi"), patience ("dhruti''), memory (''smriti'') and 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.

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. (Cha.Sa.[[Sharira Sthana]] 1/95] Impairment of intellect (''dhi"), patience ("dhruti''), memory (''smriti'') and variations of natural seasons, advent of actions and unwholesome contact with the objects of senses are the causative factors of miseries (diseases). [Cha.Sa.[[Sharira Sthana]] 1/98] The details may be referred to in [[Sharira Sthana]] chapter 1.

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

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

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

==== ''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).

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. [Cha.Sa.[[Sharira Sthana]] 1/111-112]

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

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

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

=== 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).  

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. [Cha.Sa.[[Sutra Sthana]] 1/55]  

Apart from this classification, diseases are classified in various other ways. For instance, in the preceding chapter, diseases have been classified broadly as ''sadhya'' (curable) and ''asadhya'' (incurable). The sadhya diseases have been further classified into ''sukha sadhya'' (easily curable) and ''kriccha sadhya'' (curable with difficulty), while the ''asadhya'' have been classified into ''yapya'' (palliable) and ''anupakrama'' (non-treatable). ''Sadhya vyadhis'' have also been classified into ''alpa upaya sadhya'' (curable with mild treatment), ''madhya upaya sadhya'' (curable with moderate treatment) and ''utkristta upaya sadhya'' (curable with aggressive treatment modalities).

Apart from this classification, diseases are classified in various other ways. For instance, in the preceding chapter, diseases have been classified broadly as ''sadhya'' (curable) and ''asadhya'' (incurable). The sadhya diseases have been further classified into ''sukha sadhya'' (easily curable) and ''kriccha sadhya'' (curable with difficulty), while the ''asadhya'' have been classified into ''yapya'' (palliable) and ''anupakrama'' (non-treatable). ''Sadhya vyadhis'' have also been classified into ''alpa upaya sadhya'' (curable with mild treatment), ''madhya upaya sadhya'' (curable with moderate treatment) and ''utkristta upaya sadhya'' (curable with aggressive treatment modalities).

Charkapani has commented that three ''rogamarga'' 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. [Chakrapani on Cha.Sa.[[Sutra Sthana]] 11/48]  

Charkapani has commented that three ''rogamarga'' 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. [Chakrapani on Cha.Sa.[[Sutra Sthana]] 11/48]  

[[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''.

[[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. [Cha.Sa.[[Sutra Sthana]] 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''.

In contemporary medical science the symptoms of the diseases are mentioned according to involvement of the systems. For eg: diseases produced in respiratory tract are bronchitis, pneumonia, bronchiectasis, bronchial asthma etc. the presenting features of which are cough, expectoration, chest pain, dyspnoea etc.

In contemporary medical science the symptoms of the diseases are mentioned according to involvement of the systems. For eg: diseases produced in respiratory tract are bronchitis, pneumonia, bronchiectasis, bronchial asthma etc. the presenting features of which are cough, expectoration, chest pain, dyspnoea etc.

# Promotion of ''samadhi'' like state (yogic psychotherapy): ''Samadhi'' is the ultimate stage in the practice of ''yoga'', which is a state of unwavering concentration. Promoting ''samadhi'' in a diseased state is trying to minimize the mental fluctuations, reduce the waverings ultimately leading to focused and tranquilized mind. It is achieved through the application of various yogic techniques.   

# Promotion of ''samadhi'' like state (yogic psychotherapy): ''Samadhi'' is the ultimate stage in the practice of ''yoga'', which is a state of unwavering concentration. Promoting ''samadhi'' in a diseased state is trying to minimize the mental fluctuations, reduce the waverings ultimately leading to focused and tranquilized mind. It is achieved through the application of various yogic techniques.   

# ''Pratyatma chikitsa'' (individual psychotherapy): Each and every individual is having different body constitution (''deha prakriti''), mental constitution (''manas prakriti''), ''desha'' (habitat), ''kala'' (time), ''vaya'' (age), ''pratyatma jeevana vritta'' (Individual life situations). Therefore, every individual patient should be dealt as a separate individual and treatment decisions should be taken after considering all the above factors. Term ''purusampurusam viksaya'' (Ch. Su. 1/124) is used to emphasize the individualistic therapy in treatment of diseases in general and psychological problems in particular.

# ''Pratyatma chikitsa'' (individual psychotherapy): Each and every individual is having different body constitution (''deha prakriti''), mental constitution (''manas prakriti''), ''desha'' (habitat), ''kala'' (time), ''vaya'' (age), ''pratyatma jeevana vritta'' (Individual life situations). Therefore, every individual patient should be dealt as a separate individual and treatment decisions should be taken after considering all the above factors. Term ''purusampurusam viksaya'' (Ch. Su. 1/124) is used to emphasize the individualistic therapy in treatment of diseases in general and psychological problems in particular.

# ''Pratidvanda chikitsa'' (Replacement of Emotions): Replacement of emotions by opposite emotions (viz. ''kama'' for ''krodha'') is one of the approaches of ''sattvavajaya'' in [[Ayurveda]]. In the case of mental disorders resulting from an excess of desires, grief, delight, envy or greed, should be calmed down by bringing the influence of opposite emotions to bear on the prevailing one and neutralize it (C. Chi. 9/86).

# ''Pratidvanda chikitsa'' (Replacement of Emotions): Replacement of emotions by opposite emotions (viz. ''kama'' for ''krodha'') is one of the approaches of ''sattvavajaya'' in [[Ayurveda]]. In the case of mental disorders resulting from an excess of desires, grief, delight, envy or greed, should be calmed down by bringing the influence of opposite emotions to bear on the prevailing one and neutralize it. [Cha.Sa.[[Chikitsa Sthana]] 9/86]

# ''Aswasana'' (reassurance): Reassurance relieves fears, it boosts self confidence and promotes hope in a patient. The nature of the disease should be explained to the patients freely and frankly, so that the patient develops insight into the disease.  

# ''Aswasana'' (reassurance): Reassurance relieves fears, it boosts self confidence and promotes hope in a patient. The nature of the disease should be explained to the patients freely and frankly, so that the patient develops insight into the disease.  

IX. ''Suhrit vakya'' (friendly advice and guidance):  The patient’s relatives, well wishers, friends should give advice to the patient. The focus is given on fundamental matters as budgeting, personal hygiene and nutrition. Efforts are made to persuade the person to give up the unhealthy habits and replace them with healthy ones. The physician should explain the fundamental nature of the disturbance, importance of changed attitudes and positive thinking based on an improved philosophy of life.

IX. ''Suhrit vakya'' (friendly advice and guidance):  The patient’s relatives, well wishers, friends should give advice to the patient. The focus is given on fundamental matters as budgeting, personal hygiene and nutrition. Efforts are made to persuade the person to give up the unhealthy habits and replace them with healthy ones. The physician should explain the fundamental nature of the disturbance, importance of changed attitudes and positive thinking based on an improved philosophy of life.