|Year : 2012 | Volume
| Issue : 2 | Page : 188-192
Applicability and importance of Caraka's concept of Aaturaparijnana Hetawah in understanding a patient
Rupesh Wadher1, Rambabu R Dwivedi2
1 Lecturer, Department of Basic Principles, Government Ayurveda College, Vadodara, Gujarat, India
2 Professor and Head, Department of Basic Principles, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
|Date of Web Publication||29-Dec-2012|
13, Dahya Bhai Park, Behind C. P. College, Near Bhagat Singh Statue, Bhaleja Road, Anand - 390019, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Many concepts in Ayurveda are untouched or unexplored till date. One of such concepts to understand the healthy and unhealthy persons is that of the Aaturaparijnana Hetawah (APH), which is only mentioned in Caraka Samhita. The descriptions about Dushya, Desha, Bala, Kala, Prakriti, etc. are mentioned very briefly in all the classics. But no standard figure or pattern is maintained while considering them. It is only in the description of Aaturaparijnana Hetawah mentioned in Vimana Sthana that all the factors are pre-arranged in a chronological order to understand an individual according to one's Desha as from birth till grown up stage, and also to understand about the illness and most common disorders. In this article, it is aimed at presenting an in-depth evaluation about description of Aaturaparijnana Hetawah in Ayurveda. For this study, the references of Aturaparijnana Hetu have been collected through the Ayurvedic texts along with their commentaries. By making use of 14 factors described in Aaturaparijnana Hetawah, it is possible to have an in depth understanding about the patient's nature and factors that may be contributing to his health and illness. Aaturaparijnana Hetawah helps in an in-depth understanding of a patient's disease and heath status. More in-depth evaluation studies and application in the modern medical science should be done in order to avail the benefits of this approach.
Keywords: Aaturaparijnana Hetu, Bala, Dehabala, Desha, Dushya, Kala, Prakriti
|How to cite this article:|
Wadher R, Dwivedi RR. Applicability and importance of Caraka's concept of Aaturaparijnana Hetawah in understanding a patient. AYU 2012;33:188-92
| Introduction|| |
'Aaturaparijnana Hetawah'  (APH) provides an accurate status of an individual, giving a systemic and holistic approach to understand an individual in the outline of what one should be and in what condition or status a person is. With the help of fourteen parameters given by Carakacarya in Vimana Sthana, one can get a standard, on which the person could be assessed about his health and ill status. The legend concept behind the person understanding, is to remind that, "Before going to Aatura Pariksha in context of Roga and Rogi, there is first a need to study and understand a person from exact history of a person, in whom the physician wants to examine the state of Roga or Dosha Bala."
History taking is also essential in every field of life, including patient understanding. Modern medical science has a wide scope to understand a person by various means of technology, suited to their principles. Similarly, in all the three compendia Ayurveda, several types of Hetu or Jnanopaya are mentioned, regarding the study and understanding of a person. However, out of them, APH is an accurate method to obtain the true knowledge to study and understand a person.
Without perceiving an Aatura (Healthy or Unhealthy Person), it will not be easy to examine, in context of his status of health or illness. APH are such factors, which make a standard on which the state of health and illness as well as values of health and illness can be examined, understood and managed accordingly.
Pariksha is an important within each and every field of knowledge. An additional word Pari Jnana is necessary for achieving and assessing as well as verification of the reality and truthiness with the help of Pariksha. There is no any additional tool or method designed for the validation of knowledge. Hence in Ayurveda it is mandatory to practice and apply the Pariksha in all the aspects.
Following this, a study of the knowledge of APH with one's respective Desha has been applied before Dashavidha Pariksha of the person (i.e. state of health and illness).
Aims and Objectives
An in-depth evaluation about description of Aaturaparijnana Hetawah in Ayurveda.
| Materials and Methods|| |
For this study the literary materials which include the reference of 'Aaturaparijnana Hetu' have been collected through the Ayurvedic text mainly the Caraka Samhita,  Susruta Samhita and Vagbhata and its available commentary.
Conceptual Review (Literary Review)
The word Aaturaparijnana Hetwah is made up of four words i.e. Aatura, Pari, Jnana, and Hetu. So it is essential to have an idea regarding from its root.
The word 'Aatura' has been derived from the Sanskrit root 'tur tvarane varna' by applying 'Lhadi' in Karma as per the category of the 'Sutra', and has a meaning related to the Sanskrit root of 'a ata uraca',which suggests a person who has suffered from particular things.
Aatura or Patient means injured, sufferening from, influenced, affected, afflicted by, sick (in body or mind), disabled, diseased, eager, over anxious, feeble, incapable of doing any heavy physical work etc.
In the context of APH, Cakrapani explains that, from the word Aatura, both the states (healthy and unhealthy) are to be understood as it is tricky to maintain the Sama-Dhatu and obey the rules of Swasthavritta in healthy state.
- Glana, Amayavi, Vikruto, Vyadhita and Apatu are synonyms of Aatura.
- Ullagha is a word used immediately after closing stages of disease state of an individual.
- Anaamaya is a state of disease free condition.
No direct definition of an Aatura is available in any of three compendia of Ayurveda. However, the definition of Atura may be considered as opposite of Swastha state, i.e. one who stands in the balanced status of one's own self, and its absence can be named as 'Aatura Avastha'. Acarya Sushruta has clearly defined Swasthya as a state of equilibrium of entire Dhatus.
The word 'Pari' denotes the various meanings in Ayurveda and in present context it is used as a prefix. However, briefly, it can also be understood as: Round, roundabout, towards, successively, from, out of, in consequence of, more than, in accordance with, etc. 
But in reference to the context, the word 'Pari' used here as Upasarga which is confined to 'special' meaning, which while added to Jnana, it becomes the factors which assist to obtain the differential knowledge in regarding to patient understanding, as it become synergetic.
The word Jnana is very broad in context of Ayurveda and has given due importance. One synonym of Ayurveda is also Jnana. There is a huge difference between knowledge and Jnana, and tremendous difference between Jnana and Vijnana, which is to be kept in mind while examining the object. 
Jnana means knowing, becoming acquainted with, knowledge, (esp.) the higher knowledge (derived from meditation on the one Universal Spirit) "knowledge about anything cognizance" or name of a Shakti.
Here in the present context, Hetu is the means for obtaining the knowledge. The term Nidana relates both to etiology as well as diagnosis of diseases. The 'etiology' helps in ascertaining the causative factors of a disease whereas 'diagnosis' helps in the determination of the nature of the disease. But in present context it is taken as factor which helps in direct attainment of the knowledge. 
In the present context, 'Hetu, Nimitta, Aayatana, Karta, Karana, Pratyaya and Samutthana' are the synonyms of Hetu. But according to Cakrapani commentary, Hetu includes the immediate (Sannikrushta) and distant (Viprakrushta) method, process, way, manner or mode of Vyadhi. Acarya Caraka has described various types of Hetu for each and every Vyadhi. Thus, Hetu is the foremost part of the Nidanapancaka.
Here also the Hetu means the parameter (also instrument, device, means, utensils, tool, mechanism, method, technique, mode, system, scheme, plan, format, way, manner etc.) by which a factor is to be understood.
d) Linga or Symptomatology
Linga acquires the second position in the Tri Sutra. It includes entire signs and symptoms of the diseases and health also. Only the knowledge of Hetu is not sufficient for the diagnosis of Aaturavastha. Hence Linga or the symptomatology is very useful tool in the diagnosis of a disease.
Probability of Aaturaparijnana Hetu
Cakrapani has specifically mentioned that Aaturaparijnana Hetu is imperative in understanding an individual; however, it is entirely on a probable manner. APH can differentiate a person from 'one group' to another. And these assumptions are very perfect in nature. Sometimes, a wise physician easily understands the person from his name and birth place only, out of 14 parameters of Aaturparijnana Hetu. Sometimes half of the diagnosis can be understood easily by the name, place of living and diet. 
But the ultimate aim of a physician is to understand a person from all the angles, criteria, to understand Karya. As rightly quoted in Darshana Shastra as well as in Ayurveda
- Karya is to be imagined from Karana and
- Karana is to be understood from Karya
Caraka quoted that,  unless the physician with his knowledge, intelligence and experiences examines the patient thoroughly with deep insight, i.e. 'Antaraatma' [Sharira (physical body), Indriya (sense organs), Satva (psyche) and Atma (soul) = Ayu]; and understands the patient completely, he will not be capable of treating patient securely, for example;
- The people with feeble mind, who lack bodily strength and who suffer even with minor illness project it to be major illness (Laghu Vyadhi).
- People with strong mind and the body though suffer from greater illness project it to be minor illness (Guru Vyadhi).
Hence, in both the instances exact nature of the disease is not judged or known effortlessly. The physician who is inexperienced becomes fumble and gives contradictory treatment such as
- Administering highly potent drugs and regimen for minor illness or
- Drugs and regimen of low potency for major illness causing death of the patient.
Place can be considered as land as well as patient. Land is to be examined for the knowledge about the patient or the drug. For the knowledge about the patient; the fourteen factors of APH examined are:
- In what type of land the patient is born (Janma)
- Jangala, Anupa or Sadharana,
- Grown or Samvriddha,
- Diseased (Vyadhita),
- In that type of land, people probably having such diet (Aaharajatam),
- Such physical and mental behavior (Viharajatam),
- Such code of conduct (Acharajatam),
- Such having strength (physical, mental, social and spiritual) (Bala)
- Such mind (mental status) (Satva),
- Such suitability to substances (Satmya),
- Such having definite pathology (Dosha),
- Such likings (Bhakti),
- Such having disorders (vyadhi),
- Such probable wholesome and unwholesomeness" (Hita and Ahita)
APH as Vikalpa Samprapti
Acharya Vagbhata  in Adhyaya of Bheashajavacharniya in context of APH, further mentioned about
and suggests the physician to understand each and every point of patient understanding.
- 'Vikalpa Samprapti' or
- 'Anshansha Kalpana'
Vagbhata mentioned these according to Ahara, Vihara, etc. for the future thinking of Dosha and Dhatu and their Samurchhana in a proper way.
The first thing is to learn, then understand and lastly the knowledge has to be applied. However, without understanding, proper application of text will not be done.
So, the first need is to study and understand an individual and then to administer the medicine. Without this, no medicine is to be administered.
Prior to starting of treatment, all the following factors about a patient should be considered: Pradesika Ahara (food habits),
(activities and ascertain) the Bala (strength),Satva (psychological capacity),Satmya (to what he is accustomed),Bhakti (his likings, hobbies in food, activities etc.),Which are the usual disorders occurring in the region of this stay?,What are suitable or unsuitable elements of that region?This information helps in understanding about the dosa by which he has been vitiated.
| Discussion|| |
There is a tremendous requisite to understand the belongings, which are in their appropriate form; one has to perceive the entirely related factors, like for 'what purpose author has written the text' and 'at present how to manage the text'.
The ultimate question to be asked is: 'what is the optimum level of health in a particular type of person'. And this can be very rightly demonstrated with the help of APH.
APH provides an accurate status of an individual, giving a 'Systematic and Holistic approach' to understand an individual in the outline of 'what one should be' and 'in what condition or status a person is'. With the help of fourteen parameters given by Carakacarya, one can get a standard, on which the person could be assessed about his health and illness status.
Several types of Hetu or Jnanopaya are mentioned in all the three compendia of Ayurveda, regarding the study and understanding of person. However, out of them, APH is one of the most accurate methods to obtain the true knowledge. APH has been placed in Vimana Sthana, because all type of Jnanopaya are collected in Vimana Sthana only. Also as, in the Vimana Sthana, all the accurate parameters are mentioned, after full description in the Sutra Sthana, the former acts as a joining bridge between Nidana Sthana and Cikitsa Sthana. It gives all the accurate parameters to understand the Sutra (Head / Controlling Center), Nidana (Causative Factor-Observational Unit) and applying it in Cikitsa (Special Task Force).
The various states of a person differ from time to time, and from place to place as mentioned as various synonyms of Aatura Desha mentioned by Amara Kosha, in Manushya Varga [Figure 1]. APH helps to differentiate these stages according to Deha, Bala and Dosha Bala.
In the process of APH along with proper Dashavidha Pariksha a physician studies three states of an individual which are as follows:
- As per his birth or from the very beginning of one's life; 'what is one supposed to be'?
- As a normal person or healthy person 'What has one became in the present stage'?
- After the changes in health, 'what he is', and when one became ill?
If physician gets the knowledge through applying the 14 factors of APH, then certainly he can become confident about the complete knowledge of the person. These persons may be healthy or ill and their values obtained through APH become standard, because it says that 'what is a person to be', in state of health and illness, particularly in aspect of Dehabala, Agnibala, Satvabala etc.
APH is systematize and calculative clinical approach to Aatura Pariksha covering a broad area from the very beginning of life. A perfect sequence is mentioned to understand an individual in their proper way and very systematic approach is described in the classics in Caraka Samhita and accepted by Susruta Samhita and Vagbhata in Ashtanga Samgraha, etc. classics as it is. APH give more and more minute and perfect information about the patient, and drives physician more and more nearer to the point of success.
After the knowledge of APH, when a physician applies the Dashavidha Pariksha in a healthy or ill person, the obtained value could be compared with the standard value obtain through APH, then physician gets the knowledge that 'what changes comes in person at present time' on these basis a physician can decide the three category of bala of each factor of dehabala, Agni bala, Saώva Bala of each factor of Dehabala, Agnibala, Satvabala, etc. in three categories Pravara, Madhyama and Avara Bala.
| Conclusion|| |
Nothing can be accepted as it looks and in-depth knowledge is required. Even the common person knows the importance of 'understanding a person' properly, hence we need to know about the level of Dehabala.
As Acharya Vagbhata has mentioned, APH is to be considered as Vikalpa Samprapti or Anshansha Kalpana in the diagnosis of healthy state and ill state, in regarding the Bala of the person. Here it is to be pointed out that, through this Vikalpa Samprapti or Anshansha Kalpana, physician gets the mean score of each and every individual factor responsible for total Bala or mean score value on which Pravara, Madhyama and Avara Bala is decided.
- APH helps to understand and differentiate an individuals, from a group of individuals in very accurate and easier way. As it gives the actual grade, regarding 'what the person should be' according to its original Desha, recommended as standard.
- Pariksha is important within each and every field of knowledge. An additional word 'Pari Jnana' is necessary for achieving and assessing as well as verification of the reality and truthfulness with the help of Pariksha. There is no any additional tool or method designed for the validation of knowledge. Hence in Ayurveda, it is mandatory to practice and apply the Pariksha in the entire aspects.
- Without having the standards of Aaturaparijnana, Dashavidha Pariksha cannot give perfect state of Bala. Hence comparison between these two types of Pariksha i.e. Pariksha by Aaturaparijnana then Dashvidha Pariksha, together becomes essential, to know the perfect state of healthy person in regards to Bala.
- So along with Dashvidha Pariksha, APH indicates the angle of deviation in the health and illness on the basis of Deha Bala and Dosha Bala, that are pin pointed and effectively utilized in Cikitsa Karma and Swasthavritta.
- A real procedure to obtain a proper history, was mentioned in Ayurveda in the form of Aaturaparijnana Hetu, which was hidden or absent (as per few physicians) in last few decades of Diagnostic Research.
- Aaturaparijnana Hetu is a time-over riding procedure, to exploit-out the true understanding about person's Dehabala.
- APH contributes Vikalpa Samprapti.
| References|| |
|1.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Vimana Sthana, Roga Bhishagajitiyam, 8/93, edited by Vaidya Jadavaji Trikamji Acharya, 2 nd edition, Choukhamba Krishnadas Academy, Varanasi, 2006; 276. |
|2.||Ibidem. Charaka Samhita, Viamana Sthana, Rogabhishagajitiyam, 8/95; 276. |
|3.||Ibidem. Charaka Samhita, Sutra Sthana, 10/5. |
|4.||Ibidem. Charaka Samhita, Viamana Sthana, Rogabhishagajitiyam, 8/90. |
|5.||Ibidem. Charaka Samhita, Viamana Sthana, Rogabhishagajitiyam, 8/92. |
|6.||Susruta, Susruta Samhita, Sutra Sthana, 35/3, edited by Vaidya Jadavaji Trikamji Acharya, 8 th edition, Choukhamba Orientalia, Varanasi, 2005. |
|7.||Vagabhata, Ashtanga Samgraha, Sutra Sthana, 23/3, Hindi Commentary by Kaviraj Atridev Gupta, reprint, Krishnadas Academy, Varanasi, 2002. |
|8.||Raja Radhakanta Devam, Shabdakalpadruma, Choukhamba Sanskrit Series Office, Varanasi, 2001; 112. |
|9.||Amar Sinha, Amar Kosha Vol-2 nd , Manushya Varga, 2.6.58 57 50, 6 th edition, Nirnaya Sagar Press, Bombay; 1976. |
|10.||Vamana Ganesh Apte, Ayurvediya Shabda Kosha, Choukhamba Sanskrit Series Office, Varanasi, 1961; 225. |
|11.||Agnivesha, Charaka, Dridhabala, Charaka Samhita, Vimana Sthana, Triividharoga Vishesh Vijnaniya, 4/12, edited by Vaidya Jadavaji Trikamji Acharya, 2 nd edition, Choukhamba Krishnadas Academy, Varanasi, 2006. |