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Definition
The Source or means by which a valid knowledge can be obtained is
known as Pramana.
General Application
-1-
Number of Pramanas:-
Generally the means of obtaining knowledge are mainly three i.e.
Pratyakasha, Anumana and Aptopdesha. But Charaka Samhita adds one
more, the Yukti as fourth. Again both Charaka and Sushruta add Upamana
as the fifth pramana to obtain knowledge.
Infect, if we critically examine the Yukti and Upamana, these two can
be included in Anumana and Pratyaksha respectively. But in the context of
clinical application both Yukti and Upamana have been given an
independent status. So finally the Pramanas are totally five in number, which
can be applied clinically to obtain the knowledge about the disease.
Order of Sequence
Generally starts with Pratyakshya then Anumana next Aptopdesh and
later on other pramanas like Yukti & Upamana. But in the context of clinical
application, Aptopdesha is given the first preference to be followed
successively by pratyaksha, Anumana & yukti etc. Why? The answer is
what Charak Says
Kku leqnk;su iwoZ ijh{; jksxa loZnk loZeFkksÙkjdkye/;olkua enks"k
Hkofr u fg Kkuko;osu d`RLus Ks;s KkueqRi|rs f=fo/ksRofLeu~ Kkuleqnk;s
iwoZekIrksns'kkr~ Kkua rr% izR;{kkuqekukH;ke ijh{kksii|rsA fda áuqifn"Va iwoZ
;Ùkr~ izR;{kkuqekukH;ke~ ijh{kek.kks fo|kr~A¼p% fo 4@5½
First of all one should examine the various aspects of disease by
employing all the Pramanas (sources of knowledge) so that the observations
made thereafter are infallible. One can not acquire the complete knowledge
of a thing in all its aspect simply by examining it through a part of these
"Source of knowledge" Among all the sources of knowledge one should
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acquire knowledge in the beginning through "Aptopdesha" and there after
proceeds to examine that through pratyakhsha. Anumana and others. What is
to be examined by Pratyakhsha and Anuman unless something is prima facie
stated?
That means one should obtain knowledge about a disease from the
textual description and thereafter ascertain its various characteristics by
examining the sign & symptoms of the disease already in memory through
pratyaksha & Anumana. Specific characteristics of the diseases are difficult
to understand. They cannot be ascertained without authoritative testimony.
Therefore, a disease can be correctly diagnosed by examining its specific
characteristics like etiology and other factors as mentioned in the texts
through pratyaksha & Anuman.
-3-
That's why Charaka says
rLekf}fo/kk ijh{kk Kkuorka izR;{ke~ vuqekua p% f=fo/kk ok lgksins'ksu
¼p-fo% 4@5½
Definition of APTA
jtLreksH;ka fueqZDrk Lriks Kkuoysu ;s
;s"kka f=dkyeeya KkueO;kgra lnk
vkIrk% f'k"Vk fooq)kLrs rs"kka okD;ela'k;e~
lR;a o{;fUr rs dLeknlR;a uhjtLrek%
¼p-lw-% 11@18&19½
Those enlightened and refined persons who are absolutely free from the
predominance of rajas and Tamas by virtue of the power of penance and
knowledge and who are always in possession of an uninterrupted knowledge
pertaining to past, present and future are known as authorities (Apta). They
are also known as Sista(Gentleman) and Vivuddha (enlightened persons).
Their words are true beyond any doubt. How could such persons, relatively
free from Rajas & Tamas may tell a lie?
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considered to be an accessory of the source of knowledge, still in the matter
of scientific statement relating to things present, memory may not always
serve to be an infallible source of knowledge. There are certain branches of
knowledge like scriptures, Mathematics where memory plays an important
role but in a branch of knowledge like science of medicine where direct and
easy access to the various aspect of medicine is required, memory would not
serve the purpose in as much as it often gives rise to wrong perception or
often represents impossible images devoid of scientific aptness. Persons can
further be considered to be authoritative only when they are free of
prejudices of all kinds & who can see things objectively & in an infallible
manner. This absolute authoritativeness can no doubt be found only in the
Gods like Brahma & the ancient Rishis and Acharyas like Charak, Sushruta
&other authors of Ayurvedic texts.
Even an ordinary man who possess the above qualification and gained
infallible knowledge on certain things by constant experience and intimate
contact over a long period of time can also be considered as authorities with
reference to the particular subject in which they are specialized. They can be
any one irrespective of caste, creed, community and country (_";k;Z
adoptable. Because the entire world is the teacher to the intellects (d`RLu fg
yksdks% oqf)erkekpk;kZ& p%fo% 8@14) So in this group Teachers,
Technicians working in the laboratories, nurses, pharmacists etc can be
included as Apta.
-5-
According to Chakrapani, the patient and his well wishers can be
regarded as Apta, because at the time of distress & suffering, he speaks only
the truth as he will be genuily interested to get rid off the trouble.
Information concerning his food and habits, the nature of his sufferings etc.
are precisely only known to him not to others and the physician has to rely
upon his words more than of others. So the patient also becomes an Apta to
a fairly considerable extent.
The patient, close relatives and other persons who are genuinly
interested in the welfare of the patient can also be considered as Apta in
many instances. The information they provide may be many times more
correct and valuable than the sayings of the patient, especially when the
patients are children, mentally deranged and incapable of talking due to
diseases. Even if a father is cruel, his statements regarding his ailing child
will undoubtedly be authoritative, if he possesses a sound mind, is not a fool
nor attached otherwise.
-6-
Availability of Aptopdesh
It is available in three forms.
(i) Scriptures – All Samhitas & text books
(ii) Oral evidence & writer Communication – Teachers, Experts,
Radiologists, Pathologists etc
(iii) The patient & his well wishers – To be recorded as History of the
patient
Clinical Application.
The following factors of every disease are to be learnt from textbooks.
(p%fo% 4@6)
1. izdksi.ka – Provoking factors of the disease
7. laLFkkue – Signs
-7-
13. ;ksx – Concomitants / Prescribed medicines
Pratyaksha
This is the second method but most important method of examination
Definition
vkResfUnz; euksFkkZuka lfUud"kZkr~ izorZrs
O;Drk rnkRos ;k oqf) izR;{ka lk fu:P;rs ¼p%lw 11@20½-
Perception / Observation, definite and immediate arising from the
correlation (coming together) of Atma, Indriya (sense organs) Manas (mind)
and the Indriyarthas (objects) is known as Pratyakksha.
-8-
Percussion)
Ghrana (nasa) Gandha (Smell) Ghrana (Olfaction)
Jihwa (Tongue) Rasa (Taste) Rasana (gustation)
Eye (Inspection)
Skin (Palpation)
Ear (Auscultation)
Nose (Olfaction)
Jihwa
(Gustation)
-9-
losZfjfUnz;S% lokZfufUnz;kFkkZukrqj'kjhjxrku~ ijh{ksr] vU;= jlKkukr~ ---- jla
rq [kYokrqj'kjhjxrfefUnz; oS"kf;deqI;quqekunoxPNsr~ uáL; izR;{ks.k
xzg.keqii|rs ¼p-fo- 4@7½
Clinical Application
1. Darshan Pratyaksha (Inspection)
a. o.kZ laLFkku izek.k Nk;k& Colour / Shape / Quality /External
appearance, Measurement, number, proportion, complexion or
lusters
b. 'kjhj izd`fr fodkjkS& Normal and abnormal appearance of
body and organs.
c. vuqDrkfu &What ever else not described here but comes within
the preview of eyes.
- Sankhya (Number/ counting) Chesta, Gati (spandana/ movement)
pulsation, Throbbing etc.
d. X-ray findings, USG finding, CT scan findings, Microscopic
vision & magnifying lenses can be included.
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Touch the entire body of the patient with the palm neither too hot nor too
cold.
The following factors are to be examined.
(i) lrra LiUnekukuka 'kjhjns'kukeLiUnue~ - Absence of Pulsation in
such of the organs of the body which pulsate constantly like pulse
examination
(ii) fuR;ks"e.kka 'khfrHkko – Coldness in organs which normally remain
constantly hot – Temperature of the body to be examined by
touching.
(iii) e`nquka nk:.kRoa- Hardness in soft organs
(iv) 'y{.kkauk [kjRoa – Roughness in smooth organs
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being used and the modern stethoscope is nothing but an improvement
on it.
Percussion: - Another method of Shravana Pariksha is based upon the
principle of transmission of sound s through a medium. An artificial sound is
created over some part of the body & by nature and intensity of this sound
being reflected back; the condition of the organ underlying is understood. So
here, ear is indirectly used for this purpose.
Clinical Application
4. Gandha Pariksha
The physician should cultivate the practice of smelling various
substances of the body and must train himself to detect their normal or
abnormal smell and it is by training that the nose can be made efficient in
detecting the smell. Compared to animals, man is poor in his capacity of
smell detection; the only thing required is a little bit of training & tolerance.
He should not feel reluctant to smell if circumstances warrant. A pleasant
smell or an unpleasant smell should be taken with equal regard and decision
whether either one is normal or abnormal should be taken after careful
consideration.
- 12 -
Information -
xU/kkLrq [kyq loZ'kjhxrkukrqjL; izd`froSdkfjdku~ ?kzk.ksu ijh{ksrA
The Ganda (Smell), normal or abnormal of the patient's body & its
individual components deserves examination.
ijh{kk½
(ii) Impairment of taste of body – By noting the behaviour of lice etc.
Sweet – attraction of flies
Bad taste – Going away of lice from the body
Lice remain in body only when the taste of the body is normal and
conducive to their existence. When there is any abnormalcy in the
taste of the body, they leave it.
(iii) Bleeding from the body - Whether vitiated by Pitta? Intake by dog &
crow indicates not vitiated by Pitta.
Now –a –days various laboratory tests are being adopted to determine the
taste of many materials of the body.
Urine Sugar (e?kqj ) - By Benedict’s test / Uristix.
- 13 -
The information available through these methods are no doubt based on
Anumana but can be substituted for Pratyaksha.
ANUMANA
Though this is the third method of obtaining knowledge but it has
more importance than pratyaksha because
izR;{ka fg vYie~] vuYieizR;{kefLr] ;nkxekuqeku;qfDrfHk:iyH;rs
¼p-lw% 11@7½
Scope of perception is limited and there exists a vast multitude of
unperceivable things, which has to be understood by Agama (texts),
Anumana (inference) & yukti (reasoning).
- 14 -
(ii) Inferring the cause from effect (Past knowledge) – By seeing
pregnancy one can have the past knowledge of sexual intercourse.
(iii) General inference (Present Knowledge) – Based on routine observation
– By seeing smoke one can have knowledge of fire.
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12.Energy – by initiative in such actions as are normally difficult to
perform.
YUKTI
Mentioned as fourth Pramana by Charak and strictly speaking
included in Anumana itself.
Definition: cqf) i';fr ;k Hkkoku~ cgqdkj.k ;ksxtku~
;qfDrfL=dkyk lk Ks;k =hoxZ% lk/;rs ;;kß
¼p%lw% 11@25½
The intellect, which perceives things as outcomes of combination of multiple
causative factors, valid for the past, present, & future is known as Yukti or
can be defined as the knowledge arising out of many things when operating
together.
Example – Sweet music from instrument – due to combination of strings,
fingernails & body of instrument.
Harvest – due to combination of water, tilling operation, seeds & season.
Treatment – Combination of Chatuspada.
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Clinical Application
Use of thermometer- in mercury column in temperature of body
Urine containing sugar – detected by benedict's solution, which turn it
into brick red.
All Chemical test in laboratory
Graph obtained from ECG machine
X-rays, USG, Scanning, Animal experiments – All are nothing but the
implication of Yukti pramana.
UPAMANA
(Comparative knowledge / Analogy)
Both charak & Sushruta describe this
Definition
vkSiE;a uke ;nU;sukU;L; lkn`';ef/kd`R; izdk'kua
¼p% fo% 8@42½
Exposition based on the similarity of the one with the other is Aupamya/
Analogy or Gaining knowledge of a little known object or rare objects by
comparing with the better-known objects
Method – Among the two objects which are mutually similar One, Which is
better known is taken as a effect of comparison - as a means of explaining
the less known object of comparison
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Clinical Application
1. To give knowledge about the rare disease in clinical teaching by
comparing with the better-known objects (due to non-availability of
such diseases or patients in more numbers).
Dandaka – with staff
Tetany - with bow etc.
2. To name the drugs & to identify by remembering the analogy with the
known objects.
Sankhapuspi – flower like conch
Danta vija (Dadima) – Seed just like teeth etc.
3. To name some diseases by comparing with known objects
Saravika
Kachhapika etc.
References
1. Charak: Charak Samhita, Chowkhambha Publications
Varanasi- English Commentary by Vd. Bhagwan Dash.
2. K.R. Srikantha Murthy: Doctrines of Pathology in Ayurveda
Chowkhambha Publications Varanasi,
3. K.R. Srikantha Murthy : Clinical Methods in Ayurveda
Chowkhambha Publications, Varanasi.
4. Singh R.H. – Kayachikitsa vol-1, Chowkhambha Publications,
Varanasi
5. Sushruta – Sushruta Samhita, Chowkhambha Publications,
Varanasi Commentary by Ambika Datta Sastri.
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