6. Clinical examination in Ayurveda

The clinical examination in Ayurveda is conducted with the knowledge given by I. Pratyaksa. II. Anumana. III. Aptvacana. I. pratyaksa (pamcabhihsrotradibhihprasnena ca ). II. anumana . III. aptavacana . I. Pratyaksa-Pareeksa (includes examination by the five senses and by asking direct questions to the patient or to his relatives. The following are the five senses used for Pratyaksa-Pareeksa. (a) srotremdriya grahya By hearing sounds, noises etc. and by marking the voice. (b) sparsanemdriya grahya (c) caksurimdriya grahya (d) rasanemdriya grahya By touching, feeling and manipulating with hand. By seeing the various parts and noting the changes therein. (1) By judging the taste of the discharges, secretions and excretions as felt by insects such as ants, flies, etc., and (2) by inquiry into the nature of the tongue and taste in the mouth.

111 (e) ghranemdriya grahya By smelling the discharges, excretions and breath. Modern books contain detailed information on this most important subject and the students do well by referring to such books. The methods given in Ayurveda are exactly analogus to inspection, percussion, auscultation and mensuration as understood in modern literature. Since the advent of the thermometer, the stethoscope, the microscope and various other instruments for examining the eyes, ears, nose, throat, the stomach, the bladder, the rectum, etc. much knowledge has been added to what could only be gained by old methods. Electricity especially has been of great use for the purposes of diagnosis and treatment. X-ray analysis, radiology, the electro-cardiogram, ultraviolet rays, ultramicroscopy, infra-red rays, photography, diathermy, etc., have been all very important additions to the plain physical instruments, till now in use. Great advance in diagnostic radiology has been recently made. The radiologist visualises the biliary tract and the gall-bladder by means of certain chemical substances; by injection of air he can outline organs in the abdominal cavity and the sinuses in the brain. By the use of organic compounds of iodine, he can make visible the lungs, the air-passages, the interior of the uterus, etc. Modern fluorescent screen enables digestive movements, heart beats or lung movements to be watched. It cannot yet be said how far physics can be of use to the development of the science of medicine in future. The Ayurvedists must move with the times and make use of the knowledge gained by these instruments for the elucidation of many unexplainable statements found in old literature. Anumana : anumanam nama tarko yuktyapeksah, vyayamasaktya, srotradini sadbadigrahanenetyevamadih || Anumana means examination by yathoktam, agnim jaranasaktya, balam carakasamhita - vi . 8.6-32. inference. This involves descrimination between things noticed and association of ideas. All

112 advance in knowledge must consist of both these operations; for, objects first appearing separately, are brought together in the course of our observation. Analysis and synthesis are thus incessantly alternating mental activities without which no ordinary progress in the currency of thought is possible. Reasoning again is an important application of thought to arrive at conclusions, and to know essential and non-essential characters of occurences. Caraka has made reference to all these mental processes as they are necessary for the proper understanding of the case. The first chapter in Shareera-Sthana is very important in this respect to study a case and to arrive at a proper diagnosis. For the systematic method of case-taking, this examination is absolutely necessary. Even in the methods of examination by pratyaksa and aptavacana, anumana is necessary for discriminating the determinative purposes. For, in Rasa-Pareeksha, we have to depend upon what the patient says regarding the taste in his mouth, or we have to infer the condition of discharges from the way in which insects are attracted to them. Anumana again has some scope when one has to judge the condition of the patient from his cravings, mental attitudes, facial expressions, and so on. Apta - Vacana tatraptopadesonamaptavacanam, apta hyavitarkasmrtivibhagavido nispripyupata- padarsinasca || carakasamhita - vi . 4.4 -... Upadesa means the rules laid down by experienced clinicians without any restrictions such as formality, faddism or pre-possession. Caraka defines 3 HH as the advice of disinterested persons whose judgement is well-founded, admitted by scholars and scrutinised by authoritative persons and whose word is only meant for the welfare of humanity pariksakaih pranitah sistanumato lokanugrahapravrttah sastravadah sa captagamah || -caraka samhita - sutrasthana - 11.27 It must be noted here that the ancient Ayurvedists who wrote works on medicine, were well-versed in other sciences also such as logic,

113 philosophy, grammar, etc., and so their observations were based on truth and impartial judgement. Though they appreciated the principles laid down in other sciences, they accepted only such of them as would agree with the purposes of medical science. The adjustment of the Pancabhautika theory and formulation of show this. They have, similarly, not blindly followed samkhya, vaisesika or nyayadarsana but have made such alterations as would suit their purpose. They were aware of the wide range of the ways of medical relief, and having kept their mind open to good sense, truth and justice, welcomed all suggestions and deliberations for the sake of human welfare. It was with this object that were arranged in olden times. Caraka's words in this connection deserve to be remembered 56: So, in other words, Apta-vakya does not only mean blind following but it also means authority proved by facts and tested by experience. In recent times, much is made of such therapeutics which is named "inductive science' based on observation. Ayurveda does not only accept this, but goes further and makes use of deductive conclusions also, whenever necessary. Therefore, treatment ought to be such that the application of the remedy should be faultless and not one sided. Vagbhata says, prayogah samayedvyadhimekam yo'nyamudirayet | asai faye: yet qªUi a hicud || a.hr .su .a. 13.16 That medicine which temporarily alleviates symptoms, but may give rise to appearance of disease in some other situation, is not rational, i.e., based on correct principles. But such treatment is appropriate where the medicine modifies but does not, at the same time, provoke new complications. 56. na caiva hyasti sutaramayurvedasya param, tasmadapramattah sasvadabhiyogamasmin gacchet, etadbha karyamevambhuyasca vrttasaustavamanasuyata parebhyo'pyagamayitavyam || - carakasamhita - vi . 8.6