Charaka Trividha Roga Vishesha Vijnaniya Vimana: 4th chapter

The 4th chapter of Charaka Samhitha Vimana Sthana is Trividha Roga Vishesha Vijaninya Vimana. It deals with usage of Aptopadesha (scriptural knowledge), Pratyaksha (patient examination) and inference in patient and disease examination. 

अथातस्त्रिविध रोग विशेष विज्ञानीयं विमानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātastrividha roga viśeṣa vijñānīyaṃ vimānaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
We shall now explore Trivodha Roga Vishesha Vijnaneeya adhyaya. This chapter deals with determination of three Factors for understanding the disease characteristics”. Thus said Lord Atreya [1-2]

Three sources of knowledge:
त्रिविधं खलु रोग विशेष विज्ञानं भवति; तद्यथा आप्तोपदेशः, प्रत्यक्षम्, अनुमानं चेति||३||
trividhaṃ khalu roga viśeṣa vijñānaṃ bhavati; tadyathā āptopadeśaḥ, pratyakṣam, anumānaṃ ceti||3||
There are three means to know about disease features:
Aaptopadesha – authoritative instruction, preachings of saints
Pratyakṣam – direct observation and
Anumana – inference. [3]

Aptopadesha:
तत्राप्तोपदेशो नामाप्तवचनम्|
tatrāptopadeśo nāmāptavacanam|
Aptopadesha – preaching of saints / authoritative instructions are the teachings of Aptas (persons who are reliable and truthful).

Apta Lakshana: features of truthful reliable person:
आप्ता ह्यवितर्कस्मृति विभागविदो निष्प्रीत्युपतापदर्शिनश्च|
āptā hyavitarkasmṛti vibhāgavido niṣprītyupatāpadarśinaśca|
Aptas are free from doubts and their memory is unimpaired (Avitarka Smruti), i.e. they know things in their entirety by determinate experience. They see things without any attachment or affliction.

तेषामेवङ्गुणयोगाद्यद्वचनं तत् प्रमाणम्| अप्रमाणं पुनर्मत्तोन्मत्तमूर्खरक्तदुष्टादुष्टवचनमिति;
teṣāmevaṅguṇayogādyadvacanaṃ tat pramāṇam| apramāṇaṃ punarmattonmattamūrkharaktaduṣṭāduṣṭavacanamiti;
Because of these qualities, their teaching is authentic. The statements made by intoxicated, mad, illiterate and attached persons are not to be considered as authoritative.

Pratyaksha and Anumana Pramana: 
प्रत्यक्षं तु खलु तद्यत् स्वयमिन्द्रियैर्मनसा चोपलभ्यते|
अनुमानं खलु तर्को युक्त्यपेक्षः||४||
pratyakṣaṃ tu khalu tadyat svayamindriyairmanasā copalabhyate|
anumānaṃ khalu tarko yuktyapekṣaḥ||4||

Pratyaksha or direct observation is that which is comprehensive by an individual through his own sense organs and mind.
Anumana or inference is the indirect knowledge acquired by reasoning. [4]

Patient examination with 3 Pramanas:
त्रिविधेन खल्वनेन ज्ञान समुदायेन पूर्वं परीक्ष्य रोगं सर्वथा सर्वमथोत्तरकालमध्यवसानमदोषं भवति, न हि ज्ञानावयवेन कृत्स्ने ज्ञेये ज्ञानमुत्पद्यते|
trividhena khalvanena jñāna samudāyena pūrvaṃ parīkṣya rogaṃ sarvathā sarvamathottarakālamadhyavasānamadoṣaṃ bhavati, na hi jñānāvayavena kṛtsne jñeye jñānamutpadyate|

At first, one should examine various aspects of diseases with the help of the above 3 Pramanas (sources of knowledge). This helps to get accurate disease knowledge.

त्रिविधे त्वस्मिन् ज्ञानसमुदये पूर्वमाप्तोपदेशाज्ज्ञानं, ततः प्रत्यक्षानुमानाभ्यां परीक्षोपपद्यते|
trividhe tvasmin jñānasamudaye pūrvamāptopadeśājjñānaṃ, tataḥ pratyakṣānumānābhyāṃ parīkṣopapadyate|

First knowledge is gained by Aptopadesha (by reading text books and getting to know theoretical aspects of disease). After that, disease knowledge is gained by Pratyaksha – direct observation and then by Anumana – inference.

किं ह्यनुपदिष्टं पूर्वं यत्तत् प्रत्यक्षानुमानाभ्यां परीक्षमाणो विद्यात्|
तस्माद्द्विविधा परीक्षा ज्ञानवतां प्रत्यक्षम्, अनुमानं च; त्रिविधा वा सहोपदेशेन||५||
kiṃ hyanupadiṣṭaṃ pūrvaṃ yattat pratyakṣānumānābhyāṃ parīkṣamāṇo vidyāt|
tasmāddvividhā parīkṣā jñānavatāṃ pratyakṣam, anumānaṃ ca; trividhā vā sahopadeśena||5||
What is to be examined by direct observation, and inference unless something is Prima Facie stated? Therefore, a thing can be examined in two ways, viz, “Direct observation” and inference or in three ways which include Aptopadesha in addition. [5]

Different aspects of the examination of diseases:
तत्रेदमुपदिशन्ति बुद्धिमन्तः- रोगमेकैकमेवम्प्रकोपणमेवंयोनिमेवमुत्थानमेवमात्मानमेवमधिष्ठानमेवंवेदनमेवं संस्थानमेवंशब्द स्पर्श रूप रस गन्धमेवमुपद्रवमेवं वृद्धि स्थान क्षय समन्वितमेवमुदर्क मेवन्नामानमेवंयोगं विद्यात्; तस्मिन्नियं प्रतीकारार्था प्रवृत्तिरथवा निवृत्तिरित्युपदेशाज्ज्ञायते||६||
tatredamupadiśanti buddhimantaḥ- rogamekaikamevam prakopaṇamevaṃyonimevamutthānamevamātmānamevamadhiṣṭhānamevaṃvedanamevaṃ saṃsthānamevaṃ śabda sparśa rūpa rasa gandhamevam upadravamevaṃ vṛddhi sthāna kṣaya samanvitamevamudarka mevannāmānamevaṃyogaṃ vidyāt; tasminniyaṃ pratīkārārthā pravṛttirathavā nivṛttirityupadeśājjñāyate||6||

Learned physicians described the following features) of each and every disease:
Prakopana – Provoking factors, viz, dry food intake etc.
Yoni – Source of Doshas involved
Utthana – Mode of manifestation.
Atma – nature and seriousness of disease
Adhishtana – site of disease manifestation
Vedana – Pain
Samsthana – Symptoms
Association with specific touch, colors, tastes and smell
Complications
Association with symptoms of aggravations, maintenance and abatement
Prognosis
Names
Concomitants and
Prescriptions and prohibitions in the treatment, e.g prescription of fasting and use of digestive drugs, and prohibition of day sleep and bath in fever.
One can understand the above mentioned characteristic features of diseases from authorities’ testimony. [6]

Factors to be examined by Pratyaksha – direct observation :
प्रत्यक्षतस्तु खलु रोगतत्त्वं बुभुत्सुः सर्वैरिन्द्रियैः सर्वानिन्द्रियार्थानातुरशरीरगतान् परीक्षेत, अन्यत्र रसज्ञानात्;
pratyakṣatastu khalu rogatattvaṃ bubhutsuḥ sarvairindriyaiḥ sarvānindriyārthānāturaśarīragatān parīkṣeta, anyatra rasajñānāt;

The doctor should examine the patient with all his sense organs except tongue.

तद्यथा- अन्त्रकूजनं, सन्धिस्फुटनमङ्गुलीपर्वणां च, स्वरविशेषांश्च, ये चान्येऽपि केचिच्छरीरोपगताः शब्दाः स्युस्ताञ्छ्रोत्रेण परीक्षेत;
tadyathā- antrakūjanaṃ, sandhisphuṭanamaṅgulīparvaṇāṃ ca, svaraviśeṣāṃśca, ye cānye’pi keciccharīropagatāḥ śabdāḥ syustāñchrotreṇa parīkṣeta;

The following is examined by auscultation / ears – 
antrakūjanaṃ – Gurgling sound in the intestine
sandhisphuṭanamaṅgulīparvaṇāṃ – Cracking sound in the joints including those in the fingers
svaraviśeṣāṃśca – Voice of the patient and
ye cānye’pi keciccharīropagatāḥ śabdāḥ syustāñchrotreṇa parīkṣeta – Such other sounds in the body of the patient like the sounds of coughing and hiccup
auscultation points for heart

Factors examined by eyes – Chakshu Indriya:
वर्णसंस्थानप्रमाणच्छायाः, शरीरप्रकृतिविकारौ, चक्षुर्वैषयिकाणि यानि चान्यान्यनुक्तानि तानि चक्षुषा परीक्षेत;
varṇa saṃsthāna pramāṇacchāyāḥ, śarīraprakṛtivikārau, cakṣurvaiṣayikāṇi yāni cānyānyanuktāni tāni cakṣuṣā parīkṣeta;

The following is examined visually:-
varṇa saṃsthāna pramāṇa cchāyāḥ – Color, shape, measurement and complexion
śarīraprakṛtivikārau – Natural and unnatural states of the body and
cakṣurvaiṣayikāṇi yāni cānyānyanuktāni tāni cakṣuṣā parīkṣeta – Others which can be examined visually like signs of the diseases and luster.

Examination of taste:
रसं तु खल्वातुरशरीरगतमिन्द्रियवैषयिकमप्यनुमानादवगच्छेत्, न ह्यस्य प्रत्यक्षेण ग्रहणमुपपद्यते, तस्मादातुरपरिप्रश्नेनैवातुरमुखरसं विद्यात्, यूकापसर्पणेन त्वस्य शरीरवैरस्यं,
rasaṃ tu khalvāturaśarīragatamindriyavaiṣayikamapyanumānādavagacchet, na hyasya pratyakṣeṇa grahaṇamupapadyate, tasmādāturaparipraśnenaivāturamukharasaṃ vidyāt, yūkāpasarpaṇena tvasya śarīravairasyaṃ,
Tastes of the various factors in the body of the patient are however be ascertained by Anumana and not by direct observation (Pratyaksha). Therefore, the taste in the mouth of the patient is ascertained by interrogation. Impairment of the taste of the body is inferred when lice etc., go away from the body.

Use of animals to examine body fluids:
मक्षिकोपसर्पणेन शरीरमाधुर्यं, लोहितपित्तसन्देहे तु किं धारिलोहितं लोहितपित्तं वेति श्वकाकभक्षणाद्धारिलोहितमभक्षणाल्लोहितपित्तमित्यनुमातव्यम्, एवमन्यानप्यातुरशरीरगतान् रसाननुमिमीत;
makṣikopasarpaṇena śarīramādhuryaṃ, lohitapittasandehe tu kiṃ dhārilohitaṃ lohitapittaṃ veti śvakākabhakṣaṇāddhārilohitamabhakṣaṇāllohitapittamityanumātavyam, evamanyānapyāturaśarīragatān rasānanumimīta;
Sweet taste of the body can be inferred when flies are attracted towards the body. In the case of bleeding from the body, if there is a doubt about the nature of the blood, it is resolved by giving the blood to dogs and crows to eat. Intake of the blood these animals indicates that patient’s blood is vitiated by Pitta Dosha (Raktapitta)

Patient examination by smell and touch:
गन्धांस्तु खलु सर्व शरीरगतानातुरस्य प्रकृतिवैकारिकान् घ्राणेन परीक्षेत; स्पर्शं च पाणिना प्रकृतिविकृतियुक्तम्|
इति प्रत्यक्षतोऽनुमानादुपदेशतश्च परीक्षणमुक्तम्||७||
gandhāṃstu khalu sarva śarīragatānāturasya prakṛtivaikārikān ghrāṇena parīkṣeta; sparśaṃ ca pāṇinā prakṛtivikṛtiyuktam|
iti pratyakṣato’numānādupadeśataśca parīkṣaṇamuktam||7||

Normal and abnormal smell of the entire body of the patient is examined by nose. Similarly the normal and abnormal touch of the patient is examined by hand. Thus the examination of a patient by direct observation, inference and Aptopadesh is described. [7]
patient examination by touch

Factors to be observed by Inference – Anumana:
इमे तु खल्वन्येऽप्येवमेव भूयोऽनुमानज्ञेया भवन्ति भावाः|
ime tu khalvanye’pyevameva bhūyo’numānajñeyā bhavanti bhāvāḥ|
The following among others are the factors to be observed by inference:-

तद्यथा- अग्निं जरणशक्त्या परीक्षेत, बलं व्यायामशक्त्या, श्रोत्रादीनि शब्दाद्यर्थग्रहणेन, मनोऽर्था व्यभिचरणेन, विज्ञानं व्यवसायेन, रजःसङ्गेन,
tadyathā- agniṃ jaraṇaśaktyā parīkṣeta, balaṃ vyāyāmaśaktyā, śrotrādīni śabdādyarthagrahaṇena, mano’rthāvyabhicaraṇena, vijñānaṃ vyavasāyena, rajaḥsaṅgena

Factors to be observed by Inference – Anumana:
Agniṃ jaraṇaśaktyā parīkṣeta – Agni (digestive fire) from the power of digestion
Balaṃ vyāyāmaśaktyā – Strength from the capacity for exercise
śrotrādīni śabdādyarthagrahaṇena – Condition of the senses, viz. auditory facility faculty etc. from their capacity to perceive the respective objects, viz sound etc.
Mano’rthāvyabhicaraṇena – The min perceptions are observed by its activities,
vijñānaṃ vyavasāyena – Knowledge of a thing from proper reaction to it,
Rajaḥsaṅgena – Rajoguna from attachment to woman etc;

मोहमविज्ञानेन, क्रोधमभिद्रोहेण, शोकं दैन्येन, हर्षमामोदेन, प्रीतिं तोषेण, भयं विषादेन, धैर्यमविषादेन, वीर्यमुत्थानेन, अवस्थानमविभ्रमेण,
mohamavijñānena, krodhamabhidroheṇa, śokaṃ dainyena, harṣamāmodena, prītiṃ toṣeṇa, bhayaṃ viṣādena, dhairyamaviṣādena, vīryamutthānena, avasthānamavibhrameṇa

Mohamavijñānena – Moha (unconsciousness) from lack of understanding
Krodhamabhidroheṇa – Anger from the revengeful intentions
śokaṃ dainyena – Grief from the sorrow feelings
Harṣamāmodena – Joy from happiness, viz, indulgence in dancing, singing, playing musical instruments and remaining in festive mood.
Prītiṃ toṣeṇa – Priti (Pleasure) form satisfaction which is reflected by happiness of face, eyes etc.
Bhayaṃ viṣādena – Fear from apprehension
Dhairyamaviṣādena – Courage from strength of mind even in dangerous situation.
Vīryamutthānena – Energy from his initiative in difficult situations
Avasthānamavibhrameṇa – stability of the mind from the avoidance of any mistake

श्रद्धामभिप्रायेण, मेधां ग्रहणेन, सञ्ज्ञां नामग्रहणेन, स्मृतिं स्मरणेन, ह्रियमपत्रपणेन, शीलमनुशीलनेन, द्वेषं प्रतिषेधेन, उपधिमनुबन्धेन ,
śraddhāmabhiprāyeṇa, medhāṃ grahaṇena, sañjñāṃ nāmagrahaṇena, smṛtiṃ smaraṇena, hriyamapatrapaṇena, śīlamanuśīlanena, dveṣaṃ pratiṣedhena, upadhimanubandhena ,
śraddhāmabhiprāyeṇa – desire from request
Medhāṃ grahaṇena – intelligence from the power of comprehension of scriptures etc
Sañjñāṃ nāmagrahaṇena – Recognition from the recollection of the name
Smṛtiṃ smaraṇena – Memory from the recollection of the name
Hriyamapatrapaṇena – Modesty from bashfulness
śīlamanuśīlanena – Liking from habitual intake of things
dveṣaṃ pratiṣedhena – Dislike from disinclination
Upadhimanubandhena – Deception from subsequent manifestations

धृतिमलौल्येन, वश्यतां विधेयतया, वयोभक्तिसात्म्यव्याधिसमुत्थानानि कालदेशोपशयवेदनाविशेषेण, गूढलिङ्गं व्याधिमुपशयानुपशयाभ्यां,
dhṛtimalaulyena, vaśyatāṃ vidheyatayā, vayobhaktisātmyavyādhisamutthānāni kāladeśopaśayavedanāviśeṣeṇa, gūḍhaliṅgaṃ vyādhimupaśayānupaśayābhyāṃ,
Dhṛtimalaulyena – Courage from firmness
Vaśyatāṃ vidheyatayā – Obedience from compliance with orders
vayobhaktisātmyavyādhisamutthānāni – Age, liking, homologation (Satmya) and cause of the disease from the stage of the life, habit, conductionciveess and characteristic features of pain respectively.

Age of the patient can be determined by the stage of his life.
Desha is determined by habits
kāladeśopaśayavedanāviśeṣeṇa – Disease curability is guesed by symptoms
Gūḍhaliṅgaṃ vyādhimupaśayānupaśayābhyāṃ – The curability of disease is inferred by hidden symptoms.

दोषप्रमाणविशेषमपचारविशेषेण, आयुषः क्षयमरिष्टैः, उपस्थितश्रेयस्त्वं कल्याणाभिनिवेशेन, अमलं सत्त्वमविकारेण, ग्रहण्यास्तु मृदुदारुणत्वं स्वप्नदर्शनमभिप्रायं द्विष्टेष्टसुखदुःखानि चातुरपरिप्रश्नेनैव विद्यादिति||८||
doṣapramāṇaviśeṣamapacāraviśeṣeṇa, āyuṣaḥ kṣayamariṣṭaiḥ, upasthitaśreyastvaṃ kalyāṇābhiniveśena, amalaṃ sattvamavikāreṇa, grahaṇyāstu mṛdudāruṇatvaṃ svapnadarśanamabhiprāyaṃ dviṣṭeṣṭasukhaduḥkhāni cāturaparipraśnenaiva vidyāditi||8||

Doṣapramāṇa viśeṣam apacāraviśeṣeṇa – Quantity of Dosha vitiation is inferred by amount of apathya – unsuitable diet and lifestyle
āyuṣaḥ kṣayamariṣṭaiḥ – Arishta lakshanas give a hint toward life expectancy
upasthitaśreyastvaṃ kalyāṇābhiniveśena – Promotion of Sattvika qualities of the mind from the absence of its impairments, viz, attachment, envy etc
Softness or chronic symptoms of Grahani, dreams, desires for food etc., likes and dislikes, happiness and unhappiness etc, are known by Prashna – interrogating the patient. [8]

भवन्ति चात्र-
आप्ततश्चोपदेशेन प्रत्यक्षकरणेन च|
अनुमानेन च व्याधीन् सम्यग्विद्याद्विचक्षणः||९||
bhavanti cātra-
āptataścopadeśena pratyakṣakaraṇena ca|
anumānena ca vyādhīn samyagvidyādvicakṣaṇaḥ||9||
Thus it is said: – The wise should properly understand a disease by the Aptopadesh, Pratyaksha and Anumana – inference.

सर्वथा सर्वमालोच्य यथासम्भवमर्थवित्|
अथाध्यवस्येत्तत्त्वे च कार्ये च तदनन्तरम्||१०||
sarvathā sarvamālocya yathāsambhavamarthavit|
athādhyavasyettattve ca kārye ca tadanantaram||10||
As far as possible all factors is discussed in their entirety. After examining the disease by Aptopadesha etc., the physician should obtain knowledge regarding the nature of disease and the therapies required thereafter.

कार्यतत्त्व विशेषज्ञः प्रतिपत्तौ न मुह्यति|
अमूढः फलमाप्नोति यदमोहनिमित्तजम्||११||
kāryatattva viśeṣajñaḥ pratipattau na muhyati|
amūḍhaḥ phalamāpnoti yadamohanimittajam||11||
One who is well versed in specific nature of disease and therapies, therefore, seldom fails to act properly. It is only he who acts properly reaps the results of proper action (success).

ज्ञानबुद्धिप्रदीपेन यो नाविशति तत्त्ववित्|
आतुरस्यान्तरात्मानं न स रोगांश्चिकित्सति||१२||
jñānabuddhipradīpena yo nāviśati tattvavit|
āturasyāntarātmānaṃ na sa rogāṃścikitsati||12||
When a physician who even if well versed in the knowledge of the disease and its treatment does not try to enter into the heart of the patient by virtue the light of his knowledge, he will not be able to treat the diseases. [9-12]

To sum up:-
तत्र श्लोकौ-
सर्वरोग विशेषाणां त्रिविधं ज्ञान सङ्ग्रहम्|
यथा चोपदिशन्त्याप्ताः प्रत्यक्षं गृह्यते यथा||१३||
ये यथा चानुमानेन ज्ञेयास्तांश्चाप्युदारधीः|
भावांस्त्रिरोगविज्ञाने विमाने मुनिरुक्तवान्||१४||
tatra ślokau-
sarvaroga viśeṣāṇāṃ trividhaṃ jñāna saṅgraham|
yathā copadiśantyāptāḥ pratyakṣaṃ gṛhyate yathā||13||
ye yathā cānumānena jñeyāstāṃścāpyudāradhīḥ|
bhāvāṃstrirogavijñāne vimāne muniruktavān||14||

There methods for the determination of disease, factors to be understood by the instruction of Aptas (sages), by Pratyaksha and Anumana are explained in detail in this chapter. [13-14]

इत्यग्निवेशकृते तन्त्रे चरक प्रतिसंस्कृते विमान स्थाने
त्रिविधरोग विशेष विज्ञानीयं विमानं नाम चतुर्थोऽध्यायः||४||
ityagniveśakṛte tantre caraka pratisaṃskṛte vimāna sthāne
trividharoga viśeṣa vijñānīyaṃ vimānaṃ nāma caturtho’dhyāyaḥ||4||
Thus ends the 4th chapter Trividha Roga Vishesha Vijnaniya of Vimana Section of Agnivesha’s work as redacted by Charaka. [4]


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