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{{#seo:

|title=Tistraishaniya Adhyaya

|titlemode=append

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|keywords=Eshanas, desires, pramanas, means of knowledge, pariksha, trayo upastambhas, trividha bala, triyo roga ayatana, trividha rogas, trayo rogamargas, trividha bhisahaja, trividha aushadha, triads of pillars of life, disease pathways, types of diseases, physician types, therapeutics, modalities

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|keywords=Eshanas, desires, pramanas, means of knowledge, pariksha, trayo upastambhas, trividha bala, triyo roga ayatana, trividha rogas, trayo rogamargas, trividha bhisahaja, trividha aushadha, triads of pillars of life, disease pathways, types of diseases, physician types, therapeutics, modalities, Ayurveda, Indian system of medicine, charak samhita.

|description=Sutra Sthana Chapter 11.The Three Desires of Life and important triads

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=carak samhita

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|type=article

}}

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<big>'''Sutra Sthana Chapter 11.The Three Desires of Life and important triads '''</big>

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~~<big>'''Abstract'''</big>~~

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<div style="text-align:justify;">Having or expressing desires is a human trait, and only human beings aspire to fulfil them. This chapter explains three basic desires in human beings- longevity, wealth (or materialistic comforts), and a blissful afterlife. The guidelines to fulfil them during one’s life leading to a healthy and righteous life are also given in this chapter, hence it comes under the tetrad of guidelines of healthcare management. It also guides to treat a patient with physical and/or mental disease and describes eight triads. The theories of reincarnation and creation of universe are discussed and explained. Four means for getting absolute knowledge (pariksha viz.examination, pratyaksha (clearly perceivable), anumana (Inference based on evidence) and yukti (logical management) and their role in establishing the theory of reincarnation are described in detail. A physician can use these methods to know about disease (roga) and patient (rogi) completely and can choose appropriate courses of treatment, with suitable drugs. </div>

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'''Keywords''': ''Eshanas'', desires, ''pramanas'', means of knowledge, ''pariksha, trayo upastambhas, trividha bala, triyo roga ayatana,'' trividha rogas, trayo rogamargas, trividha bhisahaja, trividha aushadha,'' triads of pillars of life, disease pathways, types of diseases, physician types, therapeutics, modalities.

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~~</div>~~

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{{Infobox

|title = Tistraishaniya Adhyaya

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|label5 = Other Sections

|data5 = [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|data6 = Tiwari P.

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|label7 = Reviewer

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|data7 = Panja A., Godatwar P.

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|label8 = Editors

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|data8 = Dixit U., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.013 10.47468/CSNE.2020.e01.s01.013]

}}

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<big>'''Abstract'''</big>

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<p style="text-align:justify;">Having or expressing desires is a human trait, and only human beings aspire to fulfil them. This chapter explains three basic desires in human beings- longevity, wealth (or materialistic comforts), and a blissful afterlife. The guidelines to fulfil them during one’s life leading to a healthy and righteous life are also given in this chapter, hence it comes under the tetrad of guidelines of healthcare management. It also guides to treat a patient with physical and/or mental disease and describes eight triads. The theories of reincarnation and creation of universe are discussed and explained. Four means for getting absolute knowledge (pariksha viz.examination, pratyaksha (clearly perceivable), anumana (Inference based on evidence) and yukti (logical management) and their role in establishing the theory of reincarnation are described in detail. A physician can use these methods to know about disease (roga) and patient (rogi) completely and can choose appropriate courses of treatment, with suitable drugs. </br>

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'''Keywords''': ''Eshanas'', desires, ''pramanas'', means of knowledge, ''pariksha, trayo upastambhas, trividha bala, triyo roga ayatana,'' trividha rogas, trayo rogamargas, trividha bhisahaja, trividha aushadha,'' triads of pillars of life, disease pathways, types of diseases, physician types, therapeutics, modalities.

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</p>

== Introduction ==

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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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Prior chapters dealt with maintainence of health and cure for diseases. The aim of a healthy life is for attainment of happiness/ bliss in this world and the world after death. The chapter begins with a description about three basic desires of human life, which should be fulfilled during one’s lifetime - longevity, material comforts, and a blissful after-life. Charak has stated about the methods and means to ~~fulfil~~ these ''eshanas'', or desires: ''Pranaeshana''~~, or the desire for longevity~~ can be achieved by following a healthy lifestyle. ''Dhanaeshana''~~, or the desire for earning~~ may be fulfilled by adopting appropriate and ethical means of livelihood. A wealthy person is respected by the society, therefore earning is essential for maintaining health as well as to perform various spiritual rituals to ~~fulfil~~ the third desire, i.e. ''Parlokeshaeshana'', to get happiness in the next world after death. The third desire is vague, since there are no means to perceive life after death for an individual. On this subject, there are two schools of thoughts - ''astik'', or theism (belief in a supernatural power responsible for creation of the world), and atheism (belief that there is no God or believing only objects or experiences that can be perceived). Different opinions about creation are explained according to different schools of thought. It is concluded that there is existence of many things in this universe even though they are not directly perceptible, so their existence cannot be denied, and therefore the theory of reincarnation cannot be denied unless proven otherwise.

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Prior chapters dealt with maintainence of health and cure for diseases. The aim of a healthy life is for attainment of happiness/ bliss in this world and the world after death. The chapter begins with a description about three basic desires of human life, which should be fulfilled during one’s lifetime - longevity, material comforts, and a blissful after-life. Charak has stated about the methods and means to fulfill these ''eshanas'', or desires: The desire for longevity ''Pranaeshana''can be achieved by following a healthy lifestyle. The desire for earning ''Dhanaeshana'' may be fulfilled by adopting appropriate and ethical means of livelihood. A wealthy person is respected by the society, therefore earning is essential for maintaining health as well as to perform various spiritual rituals to fulfill the third desire, i.e. ''Parlokeshaeshana'', to get happiness in the next world after death. The third desire is vague, since there are no means to perceive life after death for an individual. On this subject, there are two schools of thoughts - ''astik'', or theism (belief in a supernatural power responsible for creation of the world), and atheism (belief that there is no God or believing only objects or experiences that can be perceived). Different opinions about creation are explained according to different schools of thought. It is concluded that there is existence of many things in this universe even though they are not directly perceptible, so their existence cannot be denied, and therefore the theory of reincarnation cannot be denied unless proven otherwise.

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The four ''pariksha'' or fourfold methods for getting correct knowledge are explained viz. ''aptopadesha'' (authoritative/scriptural testimony), ''pratyaksha''(direct observation by senses), ''anumana''(inference) by guessing, and ''yukti''(reasoning) by applying intelligence. These four ~~''pariksha''~~ are defined vividly and their importance in establishing the theory of reincarnation is explained. Afterwards, the factors in maintenance of good health are described~~, three~~ ''upastambhas''(~~supporting pillars of life)-~~ ''ahara''~~(food~~), ''swapna''~~(sleep~~) and bramhacharya ~~(celibacy~~). By following these well regulated lifestyle factors, the body is bestowed with strength, increasing the three forms of ''bala'' (strength, immunity~~) –~~ ''sahaja'' ~~(constitutional~~ strength, immunity), ''kalaja'' ~~(seasonal strength, immunity~~) and ''yuktikrita'' ~~(acquired immunity~~). Various diseases may arise if there is stress, unhealthy lifestyle, or through the effects of unhealthy season over the mind and the body. Further this chapter briefly describes three basic causes of diseases, three disease pathways, three types of treatments and therapies, three categories of physicians based on their qualities.

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The four ''pariksha'' or fourfold methods for getting correct knowledge are explained viz. ''aptopadesha'' (authoritative/scriptural testimony), ''pratyaksha''(direct observation by senses), ''anumana''(inference) by guessing, and ''yukti''(reasoning) by applying intelligence. These four methods are defined vividly and their importance in establishing the theory of reincarnation is explained. Afterwards, the factors in maintenance of good health are described. Three supporting pillars of life or ''upastambhas'' are food (''ahara''), sleep (''swapna'') and celibacy (bramhacharya). By following these well regulated lifestyle factors, the body is bestowed with strength, increasing the three forms of strength, immunity (''bala'') – constitutional strength, immunity (''sahaja''), seasonal strength, immunity (''kalaja'') and acquired immunity (''yuktikrita''). Various diseases may arise if there is stress, unhealthy lifestyle, or through the effects of unhealthy season over the mind and the body. Further this chapter briefly describes three basic causes of diseases, three disease pathways, three types of treatments and therapies, three categories of physicians based on their qualities.

</div>

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</div></div>

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Now we shall ~~explain~~ the chapter ~~on “Three desires~~ of ~~life”~~. Thus said Lord Atreya. [1-2]

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

=== Three Desires ===

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A person having sound mind, intellect, physical strength, energy and psychological strength, one who is desirous of attaining benefits in this world and the other world (after death), should try to ~~fulfil~~ three desires. These desires are- desire for (long and healthy) life, desire for wealth (livelihood), and desire for a blissful life in the other world (after death). [3]

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A person having sound mind, intellect, physical strength, energy and psychological strength, one who is desirous of attaining benefits in this world and the other world (after death), should try to fulfill three desires. These desires are- desire for (long and healthy) life, desire for wealth (livelihood), and desire for a blissful life in the other world (after death). [3]

</div>

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Of these three desires, the most important one is the desire for life. Why? Because with the end of life, everything comes to an end. To ~~fulfil~~ this desire, a healthy person should follow a healthy regimen or lifestyle and a diseased person should try to get relief from the diseased state. The methods of health management and modes of treatment of diseases have been described in the preceding chapters and will be discussed further in the coming chapters. Thus, the first desire for life is explained. [4]

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Of these three desires, the most important one is the desire for life. Why? Because with the end of life, everything comes to an end. To fulfill this desire, a healthy person should follow a healthy regimen or lifestyle and a diseased person should try to get relief from the diseased state. The methods of health management and modes of treatment of diseases have been described in the preceding chapters and will be discussed further in the coming chapters. Thus, the first desire for life is explained. [4]

</div>

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The third desire is the aspiration for a virtuous life in the other world (life after death. There is some ~~scepticism~~ regarding this desire). What happens after death? Does rebirth occur? Why are there doubts regarding reincarnation? Lord Atreya says that there are people who believe in perceptible things and do not believe in imperceptible things. ''Acharyas'' (teachers) who have faith in the ''shastras'' believe in the theory of reincarnation even when they have not perceived or experienced it. But there is skepticism because of differences in opinion. Among the “believing” ''acharyas'', some attribute the role of ‘parents or ancestors’, some on ''swabhava''(personality or nature of the individual), some on the role of the ''paranirman'' (impersonal soul), while some on ''yadruchha'' ( free will or external powers responsible for sudden occurrences of events in the universe) in the process of reincarnation. Because of so many opinions and schools of thought, there is skepticism with regards to the theory of reincarnation, whether it exists or not. [6]

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The third desire is the aspiration for a virtuous life in the other world (life after death. There is some skepticism regarding this desire). What happens after death? Does rebirth occur? Why are there doubts regarding reincarnation? Lord Atreya says that there are people who believe in perceptible things and do not believe in imperceptible things. ''Acharyas'' (teachers) who have faith in the ''shastras'' believe in the theory of reincarnation even when they have not perceived or experienced it. But there is skepticism because of differences in opinion. Among the “believing” ''acharyas'', some attribute the role of ‘parents or ancestors’, some on ''swabhava''(personality or nature of the individual), some on the role of the ''paranirman'' (impersonal soul), while some on ''yadruchha'' ( free will or external powers responsible for sudden occurrences of events in the universe) in the process of reincarnation. Because of so many opinions and schools of thought, there is skepticism with regards to the theory of reincarnation, whether it exists or not. [6]

</div>

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The natural theory of birth is that the six ''dhatus'' (five basic elements- ''prithvi, apa, tejas, vayu, akasha'' and the ''atman'' (soul)) possess specific qualities, and that the combination and separation of these basic elements, conditioned by the actions of the ''atman'', determines the qualities of the individual at birth. [12]

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The natural theory of birth is that the six ''dhatus'' (five basic elements- ''[[prithvi]], [[apa]], [[tejas]], [[vayu]], [[akasha]]'' and the ''[[atman]]'' (soul)) possess specific qualities, and that the combination and separation of these basic elements, conditioned by the actions of the ''[[atman]]'', determines the qualities of the individual at birth. [12]

</div>

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</div></div>

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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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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]

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

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Those who are enlightened and knowledgeable are absolutely free from ''rajas'' and ''tamas'' (psychological ''~~doshas~~''). By virtue of this, they possess knowledge of ''trikala'' (past, present and future) and are known as authorities (''aptas''). They are also known as the wise and the enlightened (''vibuddha'') persons. Their words are considered absolute truth without any doubt. As they are free from ''rajas'' and ''tamas'', how could they tell lie? [18-19]

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Those who are enlightened and knowledgeable are absolutely free from ''rajas'' and ''tamas'' (psychological ''[[dosha]]s''). By virtue of this, they possess knowledge of ''trikala'' (past, present and future) and are known as authorities (''aptas''). They are also known as the wise and the enlightened (''vibuddha'') persons. Their words are considered absolute truth without any doubt. As they are free from ''rajas'' and ''tamas'', how could they tell lie? [18-19]

</div>

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Water, ploughed land ~~piece~~, seeds and the season in which particular seeds are sown, when combined together, result in a crop. Similarly, combination of six factors (''pancha mahabhuta'' and ''atman'') is responsible for formation of a fetus in the uterus. Fire is produced by lower-fire-drill, upper-fire drill and the act of drilling or churning done by a person. In a similar manner, the treatment of disease is possible by applying the fourfold therapeutics measures (The ''vaidya'', medicines, paramedical staff, and the patient). [23-24]

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Water, ploughed piece of land, seeds and the season in which particular seeds are sown, when combined together, result in a crop. Similarly, combination of six factors (''[[pancha mahabhuta]]'' and ''[[atman]]'') is responsible for formation of a fetus in the uterus. Fire is produced by lower-fire-drill, upper-fire drill and the act of drilling or churning done by a person. In a similar manner, the treatment of disease is possible by applying the fourfold therapeutics measures (The ''vaidya'', medicines, paramedical staff, and the patient). [23-24]

</div>

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Reasoning supporting rebirth: the ''garbha'' (embryo) is formed by the combination of six ''~~dhatus~~'' (''pancha ~~mahabhutas~~'' and ''atman''). Doer and the instrument when do come together results in manifestation of action. The results which we get are because of the actions done, no results if no action done. The germination occurs because of seed, the result always corresponds to the action, and seed cannot bring out heterogeneous product. This is reasoning. [32]

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Reasoning supporting rebirth: the ''[[garbha]]'' (embryo) is formed by the combination of six ''[[dhatu]]s'' (''[[pancha mahabhuta]]s'' and ''[[atman]]''). Doer and the instrument when do come together results in manifestation of action. The results which we get are because of the actions done, no results if no action done. The germination occurs because of seed, the result always corresponds to the action, and seed cannot bring out heterogeneous product. This is reasoning. [32]

</div>

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Three supporting pillars of life: ''Ahara'' (food), ''nidra'' (sleep) and observance of ''bramhacharya'' ( celibacy/control of senses). By the wisdom of well regulated support of these three pillars one can get body with strength, good complexion and proper growth and this continues throughout life, provided person does not get involved in regimens which are detrimental for health, these are discussed in this chapter. [35]

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Three supporting pillars of life: ''[[Ahara]]'' (food), ''[[nidra]]'' (sleep) and observance of ''bramhacharya'' ( celibacy/control of senses). By the wisdom of well regulated support of these three pillars one can get body with strength, good complexion and proper growth and this continues throughout life, provided person does not get involved in regimens which are detrimental for health, these are discussed in this chapter. [35]

</div>

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</div></div>

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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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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) =====

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===== [[Prajnaparadha]] (intellectual defects) =====

कर्म वाङ्मनःशरीरप्रवृत्तिः|

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</div></div>

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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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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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</div></div>

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The ''asatmyaindriyarthsamyoga'' (unwholesome union) of the sense organs with their objects, ''prajnaparadha'' (intellectual defect) and ''parinama'' (seasonal effects) along with three types (''atiyoga'', ''ayoga'' and ''mithyayoga'') are the three causes of diseases.

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The ''asatmyaindriyarthsamyoga'' (unwholesome union) of the sense organs with their objects, ''[[prajnaparadha]]'' (intellectual defect) and ''parinama'' (seasonal effects) along with three types (''atiyoga'', ''ayoga'' and ''mithyayoga'') are the three causes of diseases.

''Samyoga'' (proper utilization) of sense organs, actions and time are beneficial for maintenance of health. [43]

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</div></div>

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All the objects in this universe have ''bhava'' (presence) and ''abhava'' (absence) which can be recognized by their ''yoga'' (proper maintenance), ''ayoga'' (non utilization), ''atiyoga'' (excessive utilization) and ''mithyayoga'' (improper utilization). Because ''bhava'' needs ''yukti'' (reasoning) for recognition but ''abhava'' does not depend on ''yukti''. [44]

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All the objects in this universe have ''bhava'' (presence) and ''abhava'' (absence) which can be recognized by their ''yoga'' (proper maintenance), ''ayoga'' (non utilization), ''atiyoga'' (excessive utilization) and ''mithyayoga'' (improper utilization). Because ''bhava'' needs ''yukti'' (reasoning) for recognition but ''[[abhava]]'' does not depend on ''yukti''. [44]

==== Three Types of Diseases ====

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</div></div>

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There are three types of diseases – ''Nija'' (endogenous), ''agantuja'' (exogenous) and ''manasa'' (psychological). ''Nija vyadhi'' (endogenous diseases) are caused by vitiation of body ''~~doshas~~'' (''vata, pitta'' and ''kapha''). ''Agantuja'' (exogenous diseases) are caused ''bhuta'' (invisible organisms), poisonous substances, wind, fire and trauma. ''Manasa'' (psychological diseases) are caused by conflict between not getting the desired things and getting non desired things. [45]

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There are three types of diseases – ''Nija'' (endogenous), ''agantuja'' (exogenous) and ''manasa'' (psychological). ''Nija vyadhi'' (endogenous diseases) are caused by vitiation of body ''[[dosha]]s'' (''[[vata]], [[pitta]]'' and ''[[kapha]]''). ''Agantuja'' (exogenous diseases) are caused ''bhuta'' (invisible organisms), poisonous substances, wind, fire and trauma. ''Manasa'' (psychological diseases) are caused by conflict between not getting the desired things and getting non desired things. [45]

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A wise person even if suffering from psychological disease should consider carefully what is beneficial and what is harmful for health. One should discard the harmful or unwholesome regimens and do the beneficial work regarding the ''dharma'' (virtue), ''artha'' (wealth) and ''kama'' (desire). In this world happiness or sorrow cannot occur without these three. That is why one should try to indulge in doing beneficial work and discard the harmful one. One should serve the intellect. Also, try to acquire knowledge about ''atman''(self), ''desha'' (place), ''kala''(time), ''bala''(strength), ''shakti''(potential/capacity). [46]

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A wise person even if suffering from psychological disease should consider carefully what is beneficial and what is harmful for health. One should discard the harmful or unwholesome regimens and do the beneficial work regarding the ''dharma'' (virtue), ''artha'' (wealth) and ''kama'' (desire). In this world happiness or sorrow cannot occur without these three. That is why one should try to indulge in doing beneficial work and discard the harmful one. One should serve the intellect. Also, try to acquire knowledge about ''[[atman]]''(self), ''desha'' (place), ''[[kala]]''(time), ''bala''(strength), ''shakti''(potential/capacity). [46]

</div>

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''Pakshavadha'' (hemiplegia), ''graha'' (stiffness), ''apatanaka'' (convulsion disorder), ''ardita'' (facial palsy), ''sosha'' (cachexia), ''rajayakshma'' (tuberculosis), ''asthisandhishula'' (pain in bone joints), ''gudabhramsha'' (prolapsed rectum), and diseases of head, heart and urinary bladder are the diseases of middle pathway for disease manifestation.

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''Jwara'' (fever), ''atisara'' (diarrhea), ''chhardi'' (vomiting), ''alasaka'' (sluggish intestines/ paralytic ileus), ''visuchika'' (cholera), ''kasa'' (cough), ''shwasa'' (dyspnoea), ''hikka'' (hiccups), ''anaha'' (obstructed flatulence), ''udara'' ( abdominal disorders), ''pliha roga'' (diseases of spleen), internal ''visarpa'' (skin disease/ swelling which quickly spreads), ''shvayathu'' (internal swelling), ''gulma'' (abdominal ~~lumpss~~), ''arsha'' (internal piles), and ''vidradhi'' (internal abscess) are the diseases of internal pathway for disease manifestation. [49]

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''[[Jwara]]'' (fever), ''atisara'' (diarrhea), ''chhardi'' (vomiting), ''alasaka'' (sluggish intestines/ paralytic ileus), ''visuchika'' (cholera), ''[[kasa]]'' (cough), ''shwasa'' (dyspnoea), ''hikka'' (hiccups), ''anaha'' (obstructed flatulence), ''udara'' ( abdominal disorders), ''pliha roga'' (diseases of spleen), internal ''visarpa'' (skin disease/ swelling which quickly spreads), ''shvayathu'' (internal swelling), ''gulma'' (abdominal lumps), ''arsha'' (internal piles), and ''vidradhi'' (internal abscess) are the diseases of internal pathway for disease manifestation. [49]

</div>

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</div></div>

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Bodily ''~~doshas~~'' (''vata, pitta, kapha'') vitiation leads to manifestation of disease, three types of therapies are necessary to be applied to the body:

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Bodily ''[[dosha]]s'' (''[[vata]], [[pitta]], [[kapha]]'') vitiation leads to manifestation of disease, three types of therapies are necessary to be applied to the body:

*''Antahaparimarjana'' (internal cleansing),

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Basic desires/pursuits (''pranaeshana, dhanaeshana'' and ''paralokaeshana''), supporting pillars (''ahara, swapna'' and ''brahmacharya''), three folds strength (''sahaja, kalaja'' and ''yuktikrita''), causes of disease (''asatmya indriyartha samyoga'', ''pragnyaparadha'' and ''parinama''), diseases (''nija, agantu'' and ''manasa''), pathways for manifestation of disease (''shakha'', ''marma asthi sandhi'' and ''koshtha''), physicians (pseudo physician, feigned physician and genuine physician), therapies (''daivavyapashraya'', ''yuktivyapasharaya'' and ''sattvavjaya'') or ''antahparimarjana'' (internal cleansing), ''bahiparimarjana'' (external cleansing), ''shastrapranidhana'' (surgical procedures), triads of eight factors described in this chapter by wise sage Krishna Atreya. Everything is (virtue, wealth and desire) all are dependent on these eight factors. [64-65]

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Basic desires/pursuits (''pranaeshana, dhanaeshana'' and ''paralokaeshana''), supporting pillars (''[[ahara]], swapna'' and ''brahmacharya''), three folds strength (''sahaja, kalaja'' and ''yuktikrita''), causes of disease (''asatmya indriyartha samyoga'', ''[[pragnyaparadha]]'' and ''parinama''), diseases (''nija, agantu'' and ''manasa''), pathways for manifestation of disease (''shakha'', ''marma asthi sandhi'' and ''koshtha''), physicians (pseudo physician, feigned physician and genuine physician), therapies (''daivavyapashraya'', ''yuktivyapasharaya'' and ''sattvavjaya'') or ''antahparimarjana'' (internal cleansing), ''bahiparimarjana'' (external cleansing), ''shastrapranidhana'' (surgical procedures), triads of eight factors described in this chapter by wise sage Krishna Atreya. Everything is (virtue, wealth and desire) all are dependent on these eight factors. [64-65]

</div>

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== Tattva Vimarsha (Fundamental Principles) ==

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* 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]

+

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

* There is very limited scope for direct perception of everything. The scope of indirect knowledge is very vast. [7]

* Consciousness is without any beginning. Being eternal, it cannot be created by any other thing. Creation of body by the absolute atman (supreme soul) is acceptable view. [13]

* All the worldly objects can be divided into two categories, truth/existence and false/non-existence. There are four methods of examination- scripts or texts (words of persons with high intellect or sages), direct perception (direct observance), inference and reasoning. [17]

−

* ''Apta'' (authority), who are enlightened and knowledgeable are absolutely free from the ''rajas'' and ''tamas'' (psychological ''~~doshas~~''). [18-19]

+

* ''Apta'' (authority), who are enlightened and knowledgeable are absolutely free from the ''rajas'' and ''tamas'' (psychological ''[[dosha]]s''). [18-19]

* The interconnection of soul, sense objects, mind and intellect is very important for knowledge by direct perception. [20]

* Reasoning shall be based on decision made by intellect based upon combination of multiple factors, valid for past, present and future. [25]

* Rebirth theory can be proved based on the scriptural evidences, perception, inference and reasoning.

−

* Treatment of psychological diseases includes following the conduct related to ''dharma'' (virtue/eternal duty), ''artha'' (wealth) and ''kama'' (desire), ~~serving persons who are having~~ knowledge of psychological diseases and follow their instructions, and obtaining the knowledge about self. [47]

+

* Treatment of psychological diseases includes, following the conduct related to ''dharma'' (virtue/eternal duty), ''artha'' (wealth) and ''kama'' (desire), by receiving guidance from experts with knowledge of psychological diseases and follow their instructions, and obtaining the knowledge about self. [47]

−

* Three important types of treatment modalities are ''daivavyapashraya'' ~~(divine or spiritual therapy~~), ''yuktivyapashraya'' ~~(therapy based on reasoning~~) and ''sattvavajaya'' ~~(psychotherapy~~). ''Daivavyapasharaya'' includes ''mantra'' chanting, medicine, wearing gems, auspicious offerings, oblations, gifts, offerings to sacred fire, following spiritual rules, atonement, fasting, chanting of auspicious hymns, obeisance to gods, visit to holy places, etc. ''Yuktivyapashyraya'' includes proper dietetic regimen, medicine planning. ''Sattvavajaya'' is withdrawal of mind from harmful objects. [54]

+

* Three important types of treatment modalities are, divine or spiritual therapy (''daivavyapashraya''), therapy based on reasoning (''yuktivyapashraya'') and psychotherapy (''sattvavajaya''). ''Daivavyapasharaya'' includes ''mantra'' chanting, medicine, wearing gems, auspicious offerings, oblations, gifts, offerings to sacred fire, following spiritual rules, atonement, fasting, chanting of auspicious hymns, obeisance to gods, visit to holy places, etc. ''Yuktivyapashyraya'' includes proper dietetic regimen, medicine planning. ''Sattvavajaya'' is withdrawal of mind from harmful objects. [54]

</div>

The zest of the various important topics discussed in this chapter is as follows.

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|-

| rowspan="1" style="text-align: left;" | Three ''upasthambha'' (supporting pillars of life)

−

| rowspan="1" style="text-align: left;" | ''1.Ahara''(diet)<br>2.''Swapna''(sleep)<br>3.''Bramhacharya''(celibacy)

+

| rowspan="1" style="text-align: left;" | ''1.[[Ahara]]''(diet)<br>2.''Swapna''(sleep)<br>3.''Bramhacharya''(celibacy)

|-

| rowspan="1" style="text-align: left;" | Three types of ''bala'' (strength)

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|-

| rowspan="1" style="text-align: left;" | Three ''ayatanas'' (causes of diseases)''

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| rowspan="1" style="text-align: left;" | ''1.Asatmyaindriyarthasamyoga(atiyoga, ayoga, mithyayoga)<br>2.~~Pragnyaparadha~~'' (intellectual defects)<br>3.''Parinam'' (time)

+

| rowspan="1" style="text-align: left;" | ''1.Asatmyaindriyarthasamyoga(atiyoga, ayoga, mithyayoga)<br>2.[[Prajnaparadha]]'' (intellectual defects)<br>3.''Parinam'' (time)

|-

| rowspan="1" style="text-align: left;" | Three ''rogas''(diseases)

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The desires in human life were recognized and the modes to fulfillment were determined. The present chapter describes about three basic pursuits of life; these are to live long, to earn wealth and attainment of happiness in next world. Longevity can be achieved by following healthy lifestyle, desire for earning may be fulfilled by adopting appropriate and rightful means of livelihood, various spiritual acts and good deeds for the society are to be performed to fulfill the third desire to get happiness in after life. The main ''tattva'' of this chapter are the three desires and rest of the ''tattvas'' are mentioned to support for achievement of these desires.

−

To maintain health, triad of ''upasthambha'' ~~(supporting pillars~~) are advised~~, if~~ the ''upasthambhas'' are properly followed then one is bestowed with good physical strength, the triad of ''balas'' (strength) is mentioned. If someone is ~~involved in~~ ''nidana sevana'' ~~(exposure~~ to ~~etiological factors) diseases will~~ occur~~, so the triad of causative factors is explained,~~ these factors ~~may lead to diseases which~~ are again of three types. ~~These diseases~~ manifest ~~in body~~ by three routes, to ~~cure the diseases~~ physician is necessary~~, so to check best of physicians three~~ types of physicians are described. ~~When~~ good physician ~~is selected, he will try to cure~~ the disease by ~~the means of~~ various therapies, which are of three types~~, when~~ the ~~bodily~~ ''~~doshas~~'' get vitiated and cause diseases, then, three types of therapies can be done to cure those diseases is explained. In this manner every factor described in this chapter is interrelated with each other.

+

To maintain health, triad of "supporting pillars (''upasthambha'') are advised. If the ''upasthambhas'' are properly followed then one is bestowed with good physical strength, the triad of ''balas'' (strength) is mentioned. If someone is exposed to etiolgical factors of disease (''nidana sevana'', disease is likely to occur. these factors are again of three types. Diseases manifest by three routes, to treat a disease competent physician is necessary. Three types of physicians are described. A good physician treats the disease by various therapies, which are of three types. When the body ''[[dosha]]s'' get vitiated and cause diseases, then, three types of therapies can be done to cure those diseases is explained. In this manner every factor described in this chapter is interrelated with each other.

−

[[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>

=== Importance of Three ===

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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.

−

In Hinduism, the number three has great importance in religious studies as well as in rituals and various vedic texts since the number symbolizes the Holy Trinity of ''Brahma, Vishnu,'' and ''Shiva'' (or ''Mahesh'') and their associated powers (also considered the universal order) of creation, preservation, and destruction respectively. From the viewpoint of creation, one is God, the second is ''~~prakriti~~'', and together they manifest the rest of the creation. The Triad or Trinity also symbolizes the unity of body, mind and spirit. The concept of "three" or "triad" is referenced very frequently across cultures and traditions , and the various triads described in vedic texts include:

+

In Hinduism, the number three has great importance in religious studies as well as in rituals and various vedic texts since the number symbolizes the Holy Trinity of ''Brahma, Vishnu,'' and ''Shiva'' (or ''Mahesh'') and their associated powers (also considered the universal order) of creation, preservation, and destruction respectively. From the viewpoint of creation, one is God, the second is ''[[Prakriti]]'', and together they manifest the rest of the creation. The Triad or Trinity also symbolizes the unity of body, mind and spirit. The concept of "three" or "triad" is referenced very frequently across cultures and traditions , and the various triads described in vedic texts include:

−

* Three qualities or ''guna'' of mind: ''Sattva, rajas'' and ''tamas''

+

* Three qualities or ''[[guna]]'' of mind: ''Sattva, rajas'' and ''tamas''

* Three layers of nature: Light, fire, and darkness

−

* Three states of being: ~~Immanent~~, transcendent, and the absolute

+

* Three states of being: Inherent, transcendent, and the absolute

* Three divisions of time: Past, present, and future

* Three periods of day: Morning, noon, and evening

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* Three ''granthis'' or knots of the heart: ''Avidya'' (ignorance), ''kama'' (desire), and ''karma'' (action).

* Three defects of the ''jiva'' are: ''Mala'' (impurities), ''vikshepa'' (distraction), ''avarana'' (veil of ignorance).

−

* Three ''~~gunas~~'' or qualities of ''~~prakriti~~'': ''Sattva'' (purity), ''rajas'' (activity), ''tamas'' (darkness).

+

* Three ''[[guna]]s'' or qualities of ''[[Prakriti]]'': ''Sattva'' (purity), ''rajas'' (activity), ''tamas'' (darkness).

* Three types of ''karmas'': ''Sanchita'' (accumulated), ''prarabdha'' (originated), ''agami'' (future).

* ''Bhedas'' or differences are three: ''Svagata'' (individual), ''svajatiya'' (in own society), ''dvijatiya'' (different society).

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* Three fold nature of the individual (''Vyasmi'') person (''jiva''): ''Vishva, taijasa, prajna''.

−

In geometry, two straight lines cannot possibly enclose any space or form a plane figure. Neither can two plane surfaces form a solid. Three lines are necessary to form a ~~plane~~ figure, and three dimensions of length, breadth, and height, are necessary to form a solid (a cube, for instance). Three, therefore, stands for that which is solid, real, substantial, complete, and entire. <ref>"The Symbolism and Spiritual Significance of the Number Three", http://www.greatdreams.com/three/three.htm </ref>

+

In geometry, two straight lines cannot possibly enclose any space or form a plane figure. Neither can two plane surfaces form a solid. Three lines are necessary to form a plain figure, and three dimensions of length, breadth, and height, are necessary to form a solid (a cube, for instance). Three, therefore, stands for that which is solid, real, substantial, complete, and entire. <ref>"The Symbolism and Spiritual Significance of the Number Three", http://www.greatdreams.com/three/three.htm </ref>

−

''Brihadaranyaka Upanishad'' (B. U. 4/4/22) states three ''eshanas'' or desires of a person from a social context: ''Putraeshana'' (desire to have son), ''vittaeshana'' (to earn) and ''lokaeshana''(recognition by society).<ref>~~Dr. Brahmanand~~ Tripathi, Charak ~~Samhita of Agnivesha, elaborated by Charak & Dridhabala edited with ‘Charak- Chandrika’ Hindi commentary along with special deliberations, 5th edition 1997,~~ Sutra Sthana, ~~Chapter~~ 11, Chaukhambha Surbharati Prakashan~~, Varanasi~~. </ref> Vedic traditions are patriarchal, where the first desire of a married person is to have a son. The son gets the family name and the tradition passes down through all future generations. The son is also supposed to do all the religious rituals after the death of a person. Ancient societies were primarily agrarian and relied on physical strength, which necessitated the presence of male children in a family. Thus, the desire for son could be justified.

+

''Brihadaranyaka Upanishad'' (B. U. 4/4/22) states three ''eshanas'' or desires of a person from a social context: ''Putraeshana'' (desire to have son), ''vittaeshana'' (to earn) and ''lokaeshana''(recognition by society).<ref>Tripathi B, Charak. Sutra Sthana, Cha.11 Tistraishaniya Adhyaya. In: Brahmanand Tripathi, Editor. Charaka Chandrika Charak Samhita.5th ed. Varanasi: Chaukhambha Surbharati Prakashan;1997.</ref> Vedic traditions are patriarchal, where the first desire of a married person is to have a son. The son gets the family name and the tradition passes down through all future generations. The son is also supposed to do all the religious rituals after the death of a person. Ancient societies were primarily agrarian and relied on physical strength, which necessitated the presence of male children in a family. Thus, the desire for son could be justified.

The second desire is to earn, since wealth is required to maintain a healthy lifestyle, perform spiritual rituals, as well as give alms – an important aspect of vedic traditions. A wealthy person is respected in society.

−

The third desire is ''lokaeshana'', or the desire for recognition in society. To get respect and happiness in this world, one should societal traditions and rules laid down for the self and for one’s conduct within the community, maintaining harmony with others, including with animals and the environment. One has to follow the path of eternal duty to keep pace with the rest of the world.

+

The third desire is ''lokaeshana'', or the desire for recognition in society. To get respect and happiness in this world, one should follow societal traditions and rules laid down for the self and for one’s conduct within the community, maintaining harmony with others, including with animals and the environment. One has to follow the path of eternal duty to keep pace with the rest of the world.

In Vedanta, ''eshanas'' or desires are three: ''Daraishana'' (desire for wife), ''putraishana'' (desire for son), and ''vittaishana'' (desire for wealth).[5] As societies evolved, the institution of marriage was created, with the primary purpose of formalizing the union of man and woman. To further the growth of societies, a desire to get an ideal wife who could manage homes and give birth to healthy and able children became an important objective of any household. After the development of religious consciousness, marriage was not only became a social need but also an eternal duty of every individual. In Hinduism, marriage is regarded as a religious sacrament in which a man and a woman are bound with permanent relationship for physical, social, and spiritual purposes of ''dharma'', procreation and sexual pleasure. When the theory regarding “three debts” evolved- first to god, second to sages and saints, and third to ancestors – the institution of marriage gained even greater importance and sanctity, since it was through marriage, through the process of jointly raising the family in accordance with moral and ethical principles, that one could repay the “debt to ancestors”. Marriage is regarded as a sacrifice, per vedic traditions, and a person who does not marry is said to be “one without sacrifice.” ''Taittiriya Brahmana'' says, “Person who does not have wife is without sacrifice.” A married life is considered essential for the growth of an individual’s personality. ''Upanishad'' had established the ''ashram'' theory that institutionalized four ''ashrams'' or phases in an individual’s life, to be followed in a sequential manner:

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

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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.

+

Chakrapani 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. [Chakrapani on Cha.Sa.[[Sutra Sthana]] 11/3]

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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=== 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:

# ''Prakopana-hetu'' (etiological factors of the disease)

−

# ''Yoni-doshas'' involved.

+

# ''Yoni-doshas'' involved.????

# ''Utthana''- mode of manifestation

−

# ''Atman''-nature of disease (seriousness or acuteness)

+

# ''[[Atman]]''-nature of disease (seriousness or acuteness)

# ''Adhisthana''-Location in organs of body & mind

# ''Vedana''-Type of pain

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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]

+

''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 ===

−

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) ====

−

~~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~~:

+

Modern technological advancements like stethoscope, ultrasound etc.have significantly improved the methods of clinical diagnosis. Following methods are still helpful in certain situations:

−

# ''Antrakujana''- gurgling sound from intestines

+

# ''Antrakujana''- gurgling sound from intestines.

# ''Sandhisphutana anguliparvana''- cracking sounds in joints, including small joints.

# ''Swaravishesha''-voice of the patient

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# “Taste” of the mouth of a patient: By interrogation

# Impairment of “taste” of an individual: could be inferred by the behavior of parasites like lice (if instead of getting drawn to a person, they get repelled by it), or if someone attracts flies or ants (implying “sweet taste” emanated by the patient)

−

# Bleeding from the body: doubts about the nature of blood can be resolved by giving it to dog and crow. Its intake indicates its purity and rejection indicates that the blood is vitiated by ''pitta dosha'' and the patient is suffering from ''raktapitta''.

+

# Bleeding from the body: doubts about the nature of blood can be resolved by giving it to dog and crow. Its intake indicates its purity and rejection indicates that the blood is vitiated by ''[[pitta]] [[dosha]]'' and the patient is suffering from ''raktapitta''.

# Similarly other tastes can be inferred.

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

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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.

+

The physician has to touch the patient by his hand and do examination of normal and abnormal area. 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.

=== ''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:

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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:

−

# ''Agni'' (digestive fire), from the power of digestion

+

# ''[[Agni]]'' (digestive fire), from the power of digestion

# ''Bala'' (strength), from capacity for exercise.

# Condition of senses- from their capacity to perceive the respective objects

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# Age, liking, adaptation, disease, cause of disease from stage of life, habitat, conduciveness, symptoms, pain respectively.

# Disease in latent phase can be diagnosed by therapies which would alleviate or aggravate the symptoms of disease.

−

# Vitiation of ''~~doshas~~'' from the quantity of provocating factors

+

# Vitiation of ''[[dosha]]s'' from the quantity of provocating factors

# Approaching death from prognostic signs

# Prosperity from initiation of useful work

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=== ''Yukti'' ===

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''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''.

+

''Yukti'', or reasoning [Cha.Sa.[[Sutra Sthana]] 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''.

Example:

# Harvest–due to combination of water, tilling operation, seeds and season.

−

# By combining of ''panchamahabhuta'' and ''chetana, garbha'' is formed (or conceived).

+

# By combining of ''[[panchamahabhuta]]'' and ''chetana, [[garbha]]'' is formed (or conceived).

# Treatment is possible by the combination of ''chatushpada''.

−

''Yukti'' is especially important in the process of planning the course of treatment of a disease. The knowledge of ''hetu, ~~doshas~~'' vitiated, ''strotas'' involved, type of ''strotas dushti'', stage of disease manifestation etc. will help the physician to decide the treatment modalities.

+

''Yukti'' is especially important in the process of planning the course of treatment of a disease. The knowledge of ''hetu, [[dosha]]s'' vitiated, ''strotas'' involved, type of ''strotas dushti'', stage of disease manifestation etc. will help the physician to decide the treatment modalities.

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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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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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).

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.

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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).

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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.

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

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# '''''Sahaja bala''''': It is an inherent characteristic property of an individual and is present since birth. It can be attributed to an equilibrium state of ''~~doshas~~'' and does not require any extraneous factor for its improvement.

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# '''''Sahaja bala''''': It is an inherent characteristic property of an individual and is present since birth. It can be attributed to an equilibrium state of ''[[dosha]]s'' and does not require any extraneous factor for its improvement.

# '''''Kalaja bala''''': It is dependent on seasonal variations and age of the person. Weakness prevails in ''adanakala'' (depleting strength-summer season), gaining of strength progressively is observed in ''visarga kala'' (increasing strength-winter season) and in middle of these two seasons, strength is moderate and this form of ''bala'' peaks during one’s middle age.

# '''''Yuktikrita''''': Acquired strength or immunity is attained by healthy practices related to diet like ghee, meat, milk etc. and activities such as proper rest, exercise etc. It can also be improved by the use of rejuvenation therapies.

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In Ayurvedic texts word ''bala'' is used as a synonym of ''ojas'' and also for ''vyadhikshamatava'' ~~(immunity~~). 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.

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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.

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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).

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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.

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

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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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Three causes of ''nija'' (bodily) diseases are- ''asatmya indriyartha samyoga'' (''atiyoga, ayoga, mithyayoga'') (unwholesome contact of sense organs with objects), ''[[prajnaparadha]]'' (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]

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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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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) ====

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

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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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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 ''[[dosha]]s'' 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'' ====

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

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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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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).

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The [[Charak Samhita]] also provides classifications and counts of diseases by the organs afflicted or their causative factors. For example, in [[Sutra Sthana]] Chapter 19 (''Astodariyadhyaya''), a count of all disease systems has been provided (that were known at that time), grouped by organs afflicted. These 48 diseases have been grouped into 8 types of ''udara rogas'', 8 types of ''mutraghata'', 7 ''kushthas'', 7 ''pidikas'', 6 ''atisara'', 5 ''gulma'', 5 ''kasa'', 5 ''swasa'', etc. Similarly, in [[Sutra Sthana]] Chapter 20, 4 types of diseases are mentioned according to the causative factor- ''agantuja'' (exogenous), ''vataja, pittaja'' and ''kaphaja''. ''Nanatmaja vikaras'' of ''vata'' are of 80 types; those of ''pitta'' are of 40 types; and ''kapha'' are of 20 types.

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The [[Charak Samhita]] also provides classifications and counts of diseases by the organs afflicted or their causative factors. For example, in [[Sutra Sthana]] Chapter 19 (''Astodariyadhyaya''), a count of all disease systems has been provided (that were known at that time), grouped by organs afflicted. These 48 diseases have been grouped into 8 types of ''udara rogas'', 8 types of ''mutraghata'', 7 ''kushthas'', 7 ''pidikas'', 6 ''atisara'', 5 ''gulma'', 5 ''kasa'', 5 ''swasa'', etc. Similarly, in [[Sutra Sthana]] Chapter 20, 4 types of diseases are mentioned according to the causative factor- ''agantuja'' (exogenous), ''vataja, pittaja'' and ''kaphaja''. ''Nanatmaja vikaras'' of ''[[vata]]'' are of 80 types; those of ''[[pitta]]'' are of 40 types; and ''[[kapha]]'' are of 20 types.

In [[Vimana Sthana]] Chapter 6, ''Dasharoganikadhyaya'', diseases are classified by their ''prabhava'' (effect) into 10 types, by curability into two types (''sadhya'' (curable) and ''asadhya'' (incurable)), by their ''bala'' (strength) of ''vyadhi'' (disease) into two types (''mridu'' (mild) and ''daruna'' (severe)), by their ''adhisthana'' (location) into two types (''manasika'' (psychic) and ''sharirik'' (somatic)), according to cause into ''nija'' (endogenous) and ''agantuja'' ( exogenous), according to ''ashaya bheda'' (organ of origin) into ''amashaya samuttha'' (originating from stomach) and ''pakwasaya samuttha'' (originating from large intestines).

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

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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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In the process of ''sthana samshraya [[dosha]]s'' after circulating all over the body, get accumulated in ''[[dushya]]s'' in particular ''strotas'', next step is ''[[dosha]]- [[dushya]] sammurchhana'', ''[[dosha]]s'' vitiate the ''[[dushya]]s'' and first produce premonitory symptoms. The manifestation of symptoms of disease follows a route depending upon the movement of vitiated ''[[dosha]]s'' 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 ''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.

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Charkapani has commented that three ''rogamarga'' include ''marma asthi sandhi'' as one route, ''shakha'' nomenculature is given for the practical purpose, as the ''[[dhatu]]s'' 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]

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[[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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[[Sutra Sthana]] Chapter 28 has explained the causes responsible for the movement of ''[[dosha]]s'' 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 ''[[dosha]]s'' 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 ''[[dosha]]s'' from ''shakha'' to ''kostha'' are also mentioned, aggravation of ''[[dosha]]s'', 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 ''[[dosha]]s'' 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.

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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.

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[[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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[[Sutra Sthana]] Chapter 1 ([[Deerghanjiviteeya Adhyaya]]), verse 124 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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The physician with good memory, having adequate knowledge of ''hetu'' (causes of disease), proper reasoning, self control and having presence of mind by combination of various drugs can ~~practise~~ medicine. In [[Sutra Sthana]] Chapter 9, [[Khuddakachatushpada Adhyaya]], four aspects of therapeutics- physician, medicament, attendant and the patient are described. The physician occupies the most important place; the qualities of physician are excellence in medical knowledge, having extensive practical experience, expertise and purity. The physician engaged in acquiring the knowledge of medical science, understanding its practical interpretation, implementation in clinical ~~practise~~ and the appropriate knowledge of therapies is often termed as''Pranabhisara Vaidya'' or a life saviour physician. The physician who possesses six qualities – knowledge, critical approach, insight to other sciences, good memory, promptness and perseverance can never become unsuccessful in treatment. The one with knowledge, intellect, concentration, practical experience, constant ~~practise~~ of treatment modalities, success in treatment and has ~~practised~~ with experienced teachers deserves to be called as ‘good physician’. The physician should be friendly, sympathetic towards patients, show concern towards patients who can be cured and should have detachment towards those who are heading death.

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The physician with good memory, having adequate knowledge of ''hetu'' (causes of disease), proper reasoning, self control and having presence of mind by combination of various drugs can practice medicine. In [[Sutra Sthana]] Chapter 9, [[Khuddakachatushpada Adhyaya]], four aspects of therapeutics- physician, medicament, attendant and the patient are described. The physician occupies the most important place; the qualities of physician are excellence in medical knowledge, having extensive practical experience, expertise and purity. The physician engaged in acquiring the knowledge of medical science, understanding its practical interpretation, implementation in clinical practice and the appropriate knowledge of therapies is often termed as''Pranabhisara Vaidya'' or a life saviour physician. The physician who possesses six qualities – knowledge, critical approach, insight to other sciences, good memory, promptness and perseverance can never become unsuccessful in treatment. The one with knowledge, intellect, concentration, practical experience, constant practice of treatment modalities, success in treatment and has practiced with experienced teachers deserves to be called as ‘good physician’. The physician should be friendly, sympathetic towards patients, show concern towards patients who can be cured and should have detachment towards those who are heading death.

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''Dasha pranayatana'' or the ten important resorts of life are two temples, three vital organs (head, heart and bladder), throat, blood, semen, ''ojas'' and rectum. The physician who has knowledge of these resorts, senses, knowledge of science similar to

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''Dasha pranayatana'' or the ten important resorts of life are two temples, three vital organs (head, heart and bladder), throat, blood, semen, ''[[ojas]]'' and rectum. The physician who has knowledge of these resorts, senses, knowledge of science similar to

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[[Ayurveda]] (all medical fields), reason of consciousness- soul, causes of diseases and recovery from diseases is known as “Saviour of life”. Those who are born in noble families, who have deep knowledge of science, who are skillful in preparing medicines, who have vast practical experience of treating patients medically and surgically, who are hygienic, self controlled, well equipped, sense organs functioning normally, well acquainted with the symptoms of disease and the ''~~prakriti~~'' of patient and having the knowledge of the etiological factors of diseases are the ~~saviours~~ of life of patients. Two types of physicians are described by Charak in [[Sutra Sthana]] Chapter 29 - ''pranabhisara vaidya'' (~~saviour~~ of life) and ''rogabhisara vaidya'' (bad physician/votaries of diseases), the qualities of these may be referred to [[Sutra Sthana]] chapter 30, “pallavaghrahita vidya” the physicians with superficial knowledge and their qualities are described (verse 72- 77).

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[[Ayurveda]] (all medical fields), reason of consciousness- soul, causes of diseases and recovery from diseases is known as “Saviour of life”. Those who are born in noble families, who have deep knowledge of science, who are skillful in preparing medicines, who have vast practical experience of treating patients medically and surgically, who are hygienic, self controlled, well equipped, sense organs functioning normally, well acquainted with the symptoms of disease and the ''[[Prakriti]]'' of patient and having the knowledge of the etiological factors of diseases are the saviors of life of patients. Two types of physicians are described by Charak in [[Sutra Sthana]] Chapter 29 - ''pranabhisara vaidya'' (savior of life) and ''rogabhisara vaidya'' (bad physician/votaries of diseases), the qualities of these may be referred to [[Sutra Sthana]] chapter 30, “pallavaghrahita vidya” the physicians with superficial knowledge and their qualities are described (verse 72- 77).

In present context the utility of this is for selecting doctor for treatment, the qualification of the physician, validity of his medical degree and medical registration, clinical and surgical skills of the physician and the surgeon to whom approaching for treatment. If these things are not checked and the person who is doing treatment is not well qualified, then there is fear of losing money without getting cured and also of losing life.

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

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

=== Three aushadha (therapies) ===

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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>Shukla A V, Tripathi R, Charak. Sutra Sthana, Cha.11 Tistraishaniya Adhyaya ver.54. In: Acharya Vidyadhara Shukla, Prof. Ravidutt Tripathi, Editors. Vaidyamanorama Charak Samhita.2nd ed. Delhi: Chowkhambha Sanskrit Pratisthana;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>JayadevVidya Alankara, Charak. Sutra Sthana, Cha.11 Tistraishaniya Adhyaya ver.54. In: JayadevVidya Alankara, Editor. Charak Samhita.9th ed. Delhi: Motilal Banarasidas;1975.</ref> ====

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This is the therapy done by the planned use of drugs, foods and regimen for the treatment of diseases caused by vitiation of bodily ''[[dosha]]s''. 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 ''[[dosha]]s'' 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 ''[[dosha]]s'' 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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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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The various causes of the diseases are reasoned out and suitable means and methods are designed to cure, based on fundamental principles of [[Ayurveda]] viz. ''[[Pancha mahabhuta]], tri[[dosha]], samanya visesha'' etc. <ref name=ref23>A. R. V. Murthy and R. H. Singh, The concept of psychotherapy in ayurveda with special reference to satvavajaya, ancient science of life, vol no. Vi no. 4 april 1987, pages 255 - 261</ref>The path of pathogenesis is broken by the administration of appropriate medicines and by advising suitable diets and regimens. These methods include both internal and external application of medication.

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The various causes of the diseases are reasoned out and suitable means and methods are designed to cure, based on fundamental principles of [[Ayurveda]] viz. ''Pancha mahabhuta, ~~tridosha~~, samanya visesha'' etc. <ref name=ref23>A. R. V. Murthy and R. H. Singh, The concept of psychotherapy in ayurveda with special reference to satvavajaya, ancient science of life, vol no. Vi no. 4 april 1987, pages 255 - 261</ref>The path of pathogenesis is broken by the administration of appropriate medicines and by advising suitable diets and regimens. These methods include both internal and external application of medication.

In internal treatment category have two types of procedures viz., ''samsodhana'' and ''samsamana'':

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# ''Samsamana'': These procedures include internal medication to pacify the diseases.

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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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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).

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

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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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# '''''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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# '''''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.

# Psycho-supportive Techniques: Charak has described several psychological supportive techniques, under the category of ''sattvavajaya chikitsa''. He advocates ''aswasana'' (reassurance and explanation), ''suhritvakya'' (guidance and suggestion), ''dharmartha vakya'' (education of individual and family), ''ishta vinashana'' (verbal shock), ''adbhuta darshana'' (showing extra ordinary things), ''tadana'' (physical shock), ''trasana'' (mental shock), ''santwana'' (rehabilitation,reassurance, or consolation), which are also known as psychological intervention.

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# Promotion of ''jnayana'' (cognition): The methods for improving ''jnayana'' (cognition) and its components like ''dhi'' (intellect), ''dhrti'' (controlling power) and ''smrti'' (recollection/ memory) are part of ''sattavavajaya chikitsa''. Some important techniques / steps in promoting ''jnana'' are- recognizing and correcting negative automatic thoughts, teaching reattribution techniques, increasing objectivity in perspectives, keeping spiritual understanding of life, identifying and testing maladaptive assumption, and decentering and it may also include such behavioural techniques as activity scheduling, homework assignments, graded task assignment, behavioural rehearsal, role playing and diversion techniques and teaching problem solving skills

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# Promotion of ''jnayana'' (cognition): The methods for improving ''jnayana'' (cognition) and its components like ''dhi'' (intellect), ''dhrti'' (controlling power) and ''[[smrti]]'' (recollection/ memory) are part of ''sattavavajaya chikitsa''. Some important techniques / steps in promoting ''jnana'' are- recognizing and correcting negative automatic thoughts, teaching reattribution techniques, increasing objectivity in perspectives, keeping spiritual understanding of life, identifying and testing maladaptive assumption, and decentering and it may also include such behavioural techniques as activity scheduling, homework assignments, graded task assignment, behavioural rehearsal, role playing and diversion techniques and teaching problem solving skills

# Promotion of ''vijnayana''- It is mentioned in the scriptures and texts about the activities of the physical world, social and personal conducts, knowledge of the activities and interrelationship of body and mind, dietary rules, rules to be followed in disease state. The promotion of ''vijnana'' in context to ''sattvavajya'' includes the development and uses of behavioral techniques for treating psychosomatic and psychiatric disease. This relieves the patient's apprehensions and calms his disturbed mind.

# 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.

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# ''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.

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# ''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.

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# ''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).

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# ''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.

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.

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Thus the Chapter on “Three Desires” has been explained.

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