Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Acharya Sushruta says that ‘Aprasanna Indriyatvam’ is a tool for diagnosing the abnormalities and imbalances of doshas using anumana i.e. inference or inferential knowledge as a tool.
Word meaning
– Aprasanna – unpleasant
– Indriya – sense organs
– Aprasanna Indriyatvam – a feeling of unpleasantness in the sense organs
Reference – Sushruta Samhita Sutra Sthana, ‘Dosha dhatu mala kshaya vriddhi vijnaniya adhyaya’, Chapter 15, verse 39 (Su.Su.15/39)
In this article we will try to know more about Aprasanna Indriyatvam.
Aprasanna Indriyatvam
दोषादीनां त्वसमतामनुमानेन लक्षयेत् ।
अप्रसन्नेन्द्रियं वीक्ष्य पुरूषं कुशलो भिषक् ॥३९॥
Acharya Sushruta says, ‘A wise physician should understand the subtle abnormalities and imbalances occurring in dosha etc (dhatus, mala etc) through Anumana i.e. inference or inferential knowledge. To gain this knowledge, he should use ‘aprasanna indriyatvam’ explained by the patient as a tool’.
The intelligent physician
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Keenly observes ‘Aprasanna Indriyatvam’ – unpleasantness of the senses and mind in the patient and
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Uses his inferential knowledge i.e. Anumana Pramana / Anumiti Jnana
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To understand the subtle abnormalities occurring in dosha etc (dhatu, mala etc) in the patient
Why is understanding ‘Aprasanna Indriyatvam’ important for a physician?
Some patients do not know what is happening with them. Many do not know how to explain their health condition and what abnormalities they are experiencing in their body and mind.
On the other hand, the presentation of minor or moderate disturbances and imbalances of the doshas in the body are so minute and subtle that it is difficult to understand or diagnose the disease and its nature.
Many people just say that ‘I am not feeling well’. Some may say, ‘I am feeling very low today’. Others may say, ‘I am not sure what is happening with me, I just know I want help’.
Many physicians would have come across people presenting their problem in this way. This state of ‘not feeling well’ is aprasanna indriyatvam. Here, the physician would not get a lot of information to diagnose the disease or write medicines for the same. At the same time, this cannot be ignored. Here is where the tool of ‘anumana’ comes into play.
The physician should have a patient hearing and while the patient is narrating something he or she is unsure of, in relation to their health imbalances, should make calculations in their mind so as to how to deal with it. Though the patient himself is not clear of what is happening, he or she may need medical advice at the end or a thorough evaluation, especially when this happens very often.
Why does aprasanna indriyatvam happen?
Prasanna indriyatvam is one of the signs of good health, which means pleasantness of the senses. Acharya Sushruta explains the same while describing the features of a healthy person later in the same chapter. (Su.Su.15/42).
Pleasantness of mind alone will not be a surety or marker of comprehensiveness of health. It needs to be a part of ‘many balances’. It should be accompanied with equilibrium of doshas, dhatus, malas, agni and also pleasantness of mind and soul.
Body and mind are interdependent phenomena. If one is afflicted, the other too is afflicted. So, ‘aprasanna indriyatvam’ is not just an indicator of imbalances or disturbances at the level of indriyas, it would reflect abnormalities and imbalances of the doshas, dhatus, mala, agni, manas etc entities also.
But we can tell that there are markers for everything. Ayurveda treatises have already explained the symptoms of increase, decrease and aggravation of all doshas, dhatus and malas, the signs of agni disturbances, the symptoms of mind imbalances, the symptoms of affliction of srotas and everything. This would anyway make our job easy in diagnosing the disturbances of these entities and also promptly address them. We also have the description of signs and symptoms of diseases.
Why does a physician need to observe aprasanna indriyatvam and use anumana to diagnose or understand the abnormalities and imbalances of doshas etc?
This is because of the subtleties of pathogenesis.
Aprasanna indriyatvam may be manifested and expressed by the patient in the below mentioned conditions –
– The patient is un-expressive or less expressive
– The samprapti i.e. pathogenesis of the disease is not well established
– The samprapti is weak enough to create a strong disease or strong symptoms
– The disturbances in the body and mind are very subtle and gross which makes it difficult for the patient to understand
– The patient is not in a condition of telling what exactly is happening or cannot understand what is happening with him
– The patient explains the condition in half processed or unprocessed way wherein there is clouding of the condition
– The disturbances may be in sanchaya – accumulation, prakopa – aggravation or prasara – spreading nature which are difficult to express on the part of the patient
– The disease may be in premonitory – purvarupa stage wherein it is difficult to explain by patient or to understand by the physician
– The patient is strong enough, physically and mentally and is finding a disturbing symptom to be a simple one
– These people are predominantly disturbed by mind
How to make anumana on the basis of aprasanna indriyatvam?
The physician needs a good knowledge of fundamentals of Ayurveda and health to do this. This is because, the only evidence to investigate a given case and come to a possible conclusion is ‘aprasanna indriyatvam’. That may be due to subtle disturbances at the level of body, mind, senses or all.
Example, an anxious patient is predominantly vata. He will be cranky in front of the physician in terms of physical and mental behaviour. He will be confused and fidgeting with something around. It may not necessarily be a mental condition, the person may be sane and yet cranky. He is aware but confused. He says ‘I am not sure doctor, please figure it out yourself’. The game starts here.
Likewise, a depressed person may be predominantly afflicted by kapha disturbances or tamasic predominance. He will not speak and is a silent patient. Anumana takes the physician deep into the kapha and tamasic fields wherein he can play his game.
Aprasanna idriyatvam is a clue which the ‘Sherlock Holmes’ physician should use to crack an unexplained mystery.
All rules of examination of the patient through Anumana are applicable here and almost every aspect which can be examined through inference shall be brought into play to analyse, understand and address aprasanna indriyatvam, because we do not have sufficient evidence to crack the mystery and anumana is the key tool. But before that, it is very important to observe and understand the ‘aprasanna indriyatvam’ and its nature and the person presenting himself or herself in this state.