Pramana unni-sr

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PRAMANA SHAREERA WITH SPECIAL REFERENCE TO ANGULI PRAMANA OF BAHYA KARNA-SHAREERA, VIVEK UNNI.K.K, RACHANA SHAREERA, ALVA’S AYURVEDA MEDICAL COLLEGE MOODBIDRI

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Pramana unni-sr

  1. 1. A COMPREHENSIVE STUDY OF PRAMANA SHAREERA WITH SPECIAL REFERENCE TO ANGULI PRAMANA OF BAHYA KARNA-SHAREERA DISSERTATION SUBMITTED TO THE  RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE  IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF     AYURVEDA VACHASPATI (M.D)   IN  RACHANA SHAREERA                          By  Dr. VIVEK UNNI.K.K        Under the Guidance of    Dr. B. N Mishra M.D (Ayu) Professor  DEPARTMENT OF POST GRADUATE STUDIES  IN RACHANA SHAREERA  ALVA’S AYURVEDA MEDICAL COLLEGE MOODBIDRI ‐ 574227  2010 
  2. 2. ALVA’S AYURVEDA MEDICAL COLLEGE DEPARTMENT OF POST GRADUATE STUDIES IN RACHANA SHAREERA MOODBIDRI, KARNATAKA DECLARATION I  hereby  declare  that  this  dissertation  entitled  “A  Comprehensive  Study of Pramana Shareera With Special Reference to Anguli Pramana  of  Bahya  Karna­Shareera”  is  a  bona‐fide  and  genuine  research  work  carried out by me under the guidance of Dr. B. N Mishra  M.D (Ayu)  Dept. of  P.G  Studies  in  Rachana  Shareera,  Alva’s  Ayurveda  Medical  College  Moodbidri.                                                                                    Dr.VivekUnni. K.K                                                                                   III Year P.G.Scholar                                                                                   Dept. of RACHANA SHAREERA                                                                                   Alva’s Ayurveda Medical College                                                                                   Moodbidri 574227   Date:  Place: Moodbidri     
  3. 3. ALVA’S AYURVEDA MEDICAL COLLEGE DEPARTMENT OF POST GRADUATE STUDIES IN RACHANA SHAREERA MOODBIDRI, KARNATAKA. CERTIFICATE This is to certify that the dissertation entitled “A Comprehensive Study  Of  Pramana  Shareera  With  Special  Reference  To  Anguli  Pramana  Of   Bahya  Karna­Shareera”  submitted  by  Dr.VivekUnni.  K.K  in  partial  fulfilment  for  the  degree  of  Ayurveda  Vachaspathi  (M.D)  in  Rachana  Shareera,  of  Rajiv  Gandhi  University  of  Health  Sciences,  Bangalore,  is  a  record of research work done by him during the period of his study in this  institute,  under  my  guidance  and  supervision  and  the  dissertation  has  not  previously formed the basis to the award of any degree, diploma, fellowship  or other similar titles.    I recommend this dissertation for the above degree to the University for  the approval.                  Guide                                                                       Dr. B. N Mishra M.D (Ayu)                                                                                              Professor                                                                           Dept. of P.G Studies in Rachana Shareera                                                                                        Alva’s Ayurveda Medical College                                                Date:                                             Moodbidri ‐ 574227 Place: Moodbidri                                               
  4. 4. ALVA’S AYURVEDA MEDICAL COLLEGE DEPARTMENT OF POST GRADUATE STUDIES IN RACHANA SHAREERA MOODBIDRI, KARNATAKA. CERTIFICATEThis is to certify that the dissertation entitled  “A Comprehensive Study Of Pramana Shareera With Special Reference To Anguli Pramana Of  Bahya Karna­Shareera” is a bona‐fide research work done by Dr. VivekUnni. K.K under  the  guidance  of  Dr.  B.  N  Mishra  M.D  (Ayu),  Dept.  of  P.G  Studies  in Rachana Shareera, for partial fulfilment of the requirement for the award of the degree in Ayurveda Vachaspathi(M.D) in Rachana Shareera, of Rajiv Gandhi University of Health Sciences, Karnataka Bangalore.  DR. RAMA BHAT. K. M. M.D (Ayu)  Professor and H.O.D.,  Dept. of P.G Studies in Rachana Shareera,  Alva’s Ayurveda Medical College  Moodbidri 574227Date: Place: Moodbidri  
  5. 5. ALVA’S AYURVEDA MEDICAL COLLEGE DEPARTMENT OF POST GRADUATE STUDIES IN RACHANA SHAREERA MOODBIDRI, KARNATAKA. ENDORSEMENT This is to certify that the dissertation entitled  “A Comprehensive Study Of  Pramana Shareera With Special Reference To Anguli Pramana Of  Bahya  Karna­Shareera” is a bona‐fide research work done by Dr. VivekUnni. K.K  under  the  guidance  of  Dr.  B.  N  Mishra  M.D  (Ayu),Dept.  of  P.G  Studies  in  Rachana Shareera, for partial fulfilment of the requirement for the award  of the degree in Ayurveda Vachaspathi(M.D) in Rachana Shareera, of Rajiv  Gandhi University of Health Sciences, Karnataka Bangalore.                    PRINCIPAL   Alva’s Ayurveda Medical College         Moodbidri 574227    Date: Place: Moodbidri 
  6. 6.   COPYRIGHT     I  hereby  declare  that  the  Rajiv  Gandhi  University  of  Health  Sciences,  Karnataka  shall  have  the  rights  to  preserve,  use  and  disseminate  this  dissertation in print or electronic format for academic/research purpose.       Dr. VivekUnni.K.K   III Year P.G.Scholar  Dept. of P.G. Studies in Rachana shareera   Alva’s Ayurveda Medical College   Moodbidri 574227  Date: Place: Moodbidri      © Rajiv Gandhi University of Health Sciences, Karnataka 
  7. 7. ACKNOWLEDGEMENTFirst of all I would like to dedicate this work to my parents. My mother, Dr. T.V. Aysha,  who  knows  me  better  than  myself,  inspired  to  be  a  better  person.  My father, K.R.Kalesan, who is my role model, guided me well to stay focused and achieve my goals.  I express my deepest feeling of veneration towards my beloved teacher & guide, Dr.B N Mishra, Professor, Dept. of Shareera Rachana whose heartening inspiration,relentless guidance heightened me to contrive this obscure task. Besides this, hispiquant affluence always provided me enough courage to cop up with each & everytask.I express my heartfelt respect and gratitude to my honorable teacher, Dr. G. M. Kantiwhose masterly suggestions & ablest guidance at every step which has molded,shaped, and enlightened my petite work into accomplishment.I am highly grateful to Dr. Rama Bhat. M.D (AYU). Professor and Head of dept. P.G. Studies in Shareera Rachana, Alva’s Ayurveda Medical College, Moodbidri, for his kind support, suggestions and valuable guidance which helped me in completing this work .  It  is  my  duty  to  thank  Dr.  Mohan  Alva,  Chairman,  Alva’s    Educational  Foundation, for providing me an opportunity in his institution for Post Graduate Studies.   I am indebted to express my thanks to Dr. K L Upadhya, Former Principal Alva’sAyurveda Medical College and Dr. Suresh Negalguli, Former Dean for PostGraduate faculty and Dr. Vinaya Chandra Shetty, of Alva’s Ayuveda MedicalCollege for their encouragement and support.
  8. 8. It is my privilege to articulate my heartfelt thanks to Dr.Mohan Kumar, former Prof.Dept of ShalyaTantra, whose optimistic views, magnanimous nature, always putvehemence in me to overcome the obstacles.   I  solely  thank  my  senior  Dr.Arun.S.Kumar,  for  his  valuable  suggestions  and support.  I express my thanks to my classmates Dr.Bini, Dr.Gisha and Dr.Sreekumar for their timely help and immense support during my study. I am really thankful to Dr.Deepak.D,  Dr.  ArunBhaskaran,  Dr.  Anuprabha,  Dr.  Benoy  and  Dr.MadanKumar.M.K for their support.  I  express  my  thanks  to  my  juniors  Dr.  Binu  Balachandran  and Dr.Krishnanad.C for his timely help and immense support during my study.  I  wish  to  express  my  deep  sense  of  gratitude  to  my  wife  Dr.Deepthi  and  my daughter Devika, for her love and affections. Nothing can ever absolve me of my indebtedness to her sacrifices.  I would like to express my thanks to the Librarian & Staff for providing me with necessary books during the study.   In addition there are numerous people who have helped me during the course of this study, either directly or indirectly. My profound gratitude goes to all those wonderful people too.  Above all I thank the Almighty for the blessings, he had showered on me.               Dr. VivekUnni.K.K   Date: Place: Moodbidri       
  9. 9. List of AbbreviationsA.H. : Ashtanga HrudayaA.H.Sa. : Ashtanga Hrudaya Shareera SthanaA.H.U : Ashtanga Hrudaya Uthara SthanaA.H.Chi : Ashtanga Hrudaya Chikitsa SthanaA.S. : Ashtanga SangrahaA.S.Sa : Ashtanga Sangraha Shareera SthanaA.S.U : Ashtanga Sangraha Uthara SthanaB. L. : Bhela SamhitaC.S. : Charaka SamhitaC. Chi. : Charaka Samhita Chikitsa SthanaC. I. : Charaka Samhita Indriya SthanaC. Sa : Charaka Samhita Shareera SthanaKa.S.Sa. : Kasyapa Samhita Shareera SthanaKa.S.Su : Kasyapa Samhita Sutra SthanasS.K.D. : Shabda Kalpa DrumaSha.S : Sharangadhara SamhitaSu.Su : Susruta Samhita Sutra SthanaSu. Sa : Susruta Samhita Shareera SthanaSu. Chi. : Susruta Chikitsa Sthana
  10. 10. ABSTRACTAnguli Pramana demeanor of anatomical connotation is one of the imperative concepts inAyurveda. It elaborates ample references from the samhitas narrating that pramanashareera has a foremost position in the fortitude of life span of an individual. It is attiredthat a person having appropriate measurements will attain long life.In the concept of Ayurveda, Karna(s) is an important organ among thepanchagyanendriyas. Its shape and size are variable depending on the ages, sex, height,and geographical phase too. The external ear’s shape and size are also an importantparameter for one person’s aesthetic build. The outer ear is the most external portion ofthe ear. The external ear includes the pinna (also called auricle), the ear canal, and thevery most superficial layer of the ear drum (also called the tympanic membrane). Inhumans, and almost all vertebrates, the only visible portion of the ear is the outer ear.Although literary the word "ear" may properly refer to the pinna (the flesh coveredcartilage appendage on either side of the head), this portion of the ear is not vital forhearing but helps direct sound through the ear canal to the tympanic membrane(eardrum).The framework of the auricle consists of a single piece of yellow fibro-cartilage with acomplicated relief on the anterior, concave side and a fairly smooth configuration on theposterior, convex side.Though Acharya Susruta noted anguli pramana of karna as 4 angula and that of karnamula as 2-angula, but In Ayurveda detailed description of the anguli pramana of karna isnot adequately described.Hence the present study is undertaken to add some input and to have ready description ofthe anthropometric (so called anguli pramana) measurement of the external anatomicalstructure of the karna by following the anguli pramana concept.
  11. 11. LIST OF CONTENTS Sl. No. Contents Page No. 1. Introduction 1–5 2. Objective 6 3. Review of literatures 7 – 56 4. Materials and Methods 57 – 61 5. Observations and Result 62 – 97 6. Discussion 98 – 107 7. Conclusion 108 – 111 8. Summary 112 – 114 9. Referred Shlokas 115 – 119 10. Bibliography 120 – 136 11. Annexure a. Proforma 137 – 138 b. Master Chart 139 – 140 c. Measurement Chart 141 - 149 
  12. 12. LIST OF GRAPHTable Description Page no. no. 1. Breadth of proximal interphalangeal joint of right middle finger 62 2. Breadth of metacarpophalangeal joint of right hand 63 3. Length of right middle finger 64 4. Length of right ear measured with the help of 65 Proximal interphalangeal joint of right middle finger in anguli 5. Length of right ear measured with the help of 66 Breadth of right metacarpaophalangeal joint in anguli 6. Length of right ear measured with the help of 67 Length of right middle finger in anguli 7. Width of right ear measured with the help of 68 Proximal interphalangeal joint of right middle finger in anguli 8. Width of right ear measured with the help of 69 Proximal interphalangeal joint of right middle finger in anguli 9. Width of right ear measured with the help of 70 Length of right middle finger in anguli 10. Circumference of right ear measured with the help of 71 Proximal interphalangeal joint of right middle finger in anguli 11. Circumference of right ear measured with the help of 72 Breadth of right metacarpophalangeal joint in anguli 12. Circumference of right ear measured with the help of 73 Length of right middle finger in anguli
  13. 13. 13. Root anterior of right ear measured with the help of Breadth of right 74 interphalangeal joint of right middle finger in anguli14. Root anterior of right ear measured with the help of 75 Breadth of right metacarpophalangeal joint in anguli15. Root anterior of right ear measured with the help of 76 Length of right middle finger in anguli16. Root posterior of right ear measured with the help of 77 Proximal interphalangeal joint of right middle finger in anguli17. Root posterior of right ear measured with the help of 78 Breadth of right metacarpophalangeal joint in anguli18. Root posterior of right ear measured with the help of 79 Length of right middle finger in anguli19. Breadth of proximal interphalangeal joint of left middle finger 80 in cm.20. Breadth of metacarpophalangeal joint of left hand in cm. 8121. Length of left middle finger in cm. 8222. Length of right ear measured with the help of 83 Proximal interphalangeal joint of left middle finger in anguli23. Length of right ear measured with the help of 84 Breadth of left metacarpophalangeal joint in anguli24.  Length of right ear measured with the help of 85  Length of left middle finger in anguli25.   Width of right ear measured with the help of 86  Proximal interphalangeal joint of left middle finger in anguli
  14. 14. 26.   Width of right ear measured with the help of 87  Breadth of left metacarpophalangeal joint in anguli 27.   Width of right ear measured with the help of 88  Length of left middle finger in anguli  28.   Circumference of right ear measured with the help of 89  Proximal interphalangeal joint of left middle finger in anguli 29.   Circumference of right ear measured with the help of 90  Breadth of left metacarpophalangeal joint in anguli 30.   Circumference of right ear measured with the help of 91  Length left middle finger in anguli 31.   Root anterior of right ear measured with the help of 92  Proximal interphalangeal joint of left middle finger in anguli 32.   Root anterior of right ear measured with the help of 93  Breadth of left metacarpophalangeal joint in anguli 33.  Root anterior of right ear measured with the help of 94  Length of left middle finger in anguli 34.   Root posterior of right ear measured with the help of 95  Proximal interphalangeal joint of left middle finger in anguli 35.  Root posterior of right ear measured with the help of 96  Breadth of left metacarpophalangeal joint in anguli   36.   Root posterior of right ear measured with the help of 97  Length of left middle finger in anguli 
  15. 15. LIST OF TABLESTable Description Page no. no. 1. Breadth of proximal interphalangeal joint of right middle finger 62 2. Breadth of metacarpophalangeal joint of right hand 63 3. Length of right middle finger 64 4. Length of right ear measured with the help of 65 Proximal interphalangeal joint of right middle finger in anguli 5. Length of right ear measured with the help of 66 Breadth of right metacarpaophalangeal joint in anguli 6. Length of right ear measured with the help of 67 Length of right middle finger in anguli 7. Width of right ear measured with the help of 68 Proximal interphalangeal joint of right middle finger in anguli 8. Width of right ear measured with the help of 69 Proximal interphalangeal joint of right middle finger in anguli 9. Width of right ear measured with the help of 70 Length of right middle finger in anguli 10. Circumference of right ear measured with the help of 71 Proximal interphalangeal joint of right middle finger in anguli 11. Circumference of right ear measured with the help of 72 Breadth of right metacarpophalangeal joint in anguli
  16. 16. 12. Circumference of right ear measured with the help of 73 Length of right middle finger in anguli13. Root anterior of right ear measured with the help of Breadth of right 74 interphalangeal joint of right middle finger in anguli14. Root anterior of right ear measured with the help of 75 Breadth of right metacarpophalangeal joint in anguli15. Root anterior of right ear measured with the help of 76 Length of right middle finger in anguli16. Root posterior of right ear measured with the help of 77 Proximal interphalangeal joint of right middle finger in anguli17. Root posterior of right ear measured with the help of 78 Breadth of right metacarpophalangeal joint in anguli18. Root posterior of right ear measured with the help of 79 Legth of right middle finger in anguli19. Breadth of proximal interphalangeal joint of left middle finger 80 in cm.20. Breadth of metacarpophalangeal joint of left hand in cm. 8121. Length of left middle finger in cm. 8222. Length of right ear measured with the help of 83 Proximal interphalangeal joint of left middle finger in anguli23. Length of right ear measured with the help of 84 Breadth of left metacarpophalangeal joint in anguli24.  Length of right ear measured with the help of 85  Length of left middle finger in anguli
  17. 17. 25.   Width of right ear measured with the help of 86  Proximal interphalangeal joint of left middle finger in anguli 26.   Width of right ear measured with the help of 87  Breadth of left metacarpophalangeal joint in anguli 27.   Width of right ear measured with the help of 88  Legnth of left middle finger in anguli  28.   Circumference of right ear measured with the help of 89  Proximal interphalangeal joint of left middle finger in anguli 29.   Circumference of right ear measured with the help of 90  Breadth of left metacarpophalangeal joint in anguli 30.   Circumference of right ear measured with the help of 91  Length left middle finger in anguli 31.   Root anterior of right ear measured with the help of 92  Proximal interphalangeal joint of left middle finger in anguli 32.   Root anterior of right ear measured with the help of 93  Breadth of left metacarpophalangeal joint in anguli 33.  Root anterior of right ear measured with the help of 94  Length of left middle finger in anguli 34.   Root posterior of right ear measured with the help of 95  Proximal interphalangeal joint of left middle finger in anguli 35.  Root posterior of right ear measured with the help of 96  Breadth of left metacarpophalangeal joint in anguli   36.   Root posterior of right ear measured with the help of 97  Length of left middle finger in anguli 
  18. 18. LIST OF PICTURES Picture No Description Page No Picture No I Embryology of Ear 53 Picture No II External Ear 54 Picture No III External Acoustic Meatus 55 Picture No IV Middle & Inner Ear 56 Picture V Screw Gauge 61 Picture VI VernierCalipers 61 
  19. 19. Introduction  1.0 INTRODUCTIONConcept of Pramana is included in Shareera for understanding the physical built andmental constitution. Pramana shareera, requires immense perceptive of measurement ofvarious body part, and in many instances explains the quality of life. Ample referencesfrom classics explain that Pramana shareera can play a major role in determination oflife span of a person1. It described that the person having appropriate measurement mayattain a long span of life. Out of the Pramanas described in the classics, Anguli pramanabears the prime important. Anguli pramana is a salutary anthropometric concept asdescribed in Ayurveda, where Anguli is the unit of measurement of a body part andstructure2.Pramana shareera can be correlated with physical anthropology, popularly known asanthropometry that describes measurement of ideal height and age. Whereas in Ayurveda,Pramana shareera in addition to above concept, also correlates the measurements ofvarious body parts with life span, and health status of an individual3.Acharya Charaka had included Pramana among tenfold of examine that guides to assessthe physical and mental built of an individual4.The concept of Pramana shareera refers the ways of meaning to attain knowledge5. Itexplains the processes of measurement of various human body parts6 and marks the signfor longevity of an individual and mimics the qualities of Dirghayou, for longer healthylife span.A Comprehensive Study of PramanaShareera with Special Reference to AnguliPramanof BahyaKarna-Shareera  1  
  20. 20. Introduction Acharya Charaka and Sushruta explained about Swaanguli pramana for evaluating theextremities and other physical constitution by using own finger as the measuring utility7,2.Various conceptual terms like Ayama, Vistara and Parinama are described under thesphere of Swaanguli pramana8. For examination of Ayu, Anguli pramana is one of theprime criteria of the measurement, from which we can measure and understand thequality and span of the life1. It is noted that Ayu will be more or less based on the variousmeasurement of the body parts. The Swaanguli pramana is considered by accepting thefinger breadth of an individual as the unit of measurement.The visible part of the human ear is a rather modest concern. During the course ofevolution, it has lost its long pointed tip and its mobility like the ear as visible in animals.In today’s era, the ear is fine; the sensitive edges have been evaluated, with ‘rolled rim’9.The main function of the external ear remains that of a sound gatherer- flesh- and bloodear trumpet. We may not be able to prick our ears like other animals, or twist and turnthem when seeking the direction of a sudden noise, but we are still capable of detectingthe source of a sound. During the evolution of ear in human, what we have lost in earmobility, have made up for with head mobility. When a deer or an antelope hears analarming sound, it raises its head and twists its ears in various directions, but when wehear such a sound, we turn our heads and it works almost as well10.The shape of our external ear is important in delivering undistorted sound to oureardrums. A minor function of our ear is temperature control. Elephants flap their hugeA Comprehensive Study of PramanaShareera with Special Reference to AnguliPramanof BahyaKarna-Shareera  2  
  21. 21. Introduction ears when they are overheated and this helps to cool the animal down. There is aprofusion of blood vessels near the surface of the skin and heat loss through this route canbe important to many of the species. For us it may only play a trivial role in thermoregulation, but it has become a social signal. When someone overheats in a moment ofemotional conflict, their ears may go bright red. This ear blushing has been the subject ofcomment since ancient times11.Finally, our ear appears to have acquired a new erotic function with the development ofsoft fleshy lobes. These are absent in our nearest relatives and appear to be a uniquelyhuman feature, evolved as part of our increased sexuality. Early anatomists dismissedthem as functionless: ‘a new feature which apparently serves no useful purpose, unless itis pierced for the carrying of ornaments’; but recent observations of sexual behavior haverevealed that during intense arousal, the earlobes become swollen and engorged withblood. This makes them unusually sensitive to touch. In rare instances, according toKinsey and his colleagues at the institute for sex research in Indiana, ‘a female or malereach orgasm as a result of stimulation of the ear’12.At the centre of the external ear is the ‘ear hole’ which leads to a narrow canal about aninch long. The canal twists slightly, giving it a design that helps to keep the air inside itwarm. This warmth is important for the proper functioning of the eardrum at its innerend. The eardrum itself is an extremely delicate organ, and the canal not only keeps itsnugly warm but also protects it from physical damage. Evolution has provided theA Comprehensive Study of PramanaShareera with Special Reference to AnguliPramanof BahyaKarna-Shareera  3  
  22. 22. Introduction answer in the shape of hair to keep out larger insects, and ear-wax to defeat smallercreatures13.Briefly, the sound vibrations which strike the eardrum are converted into nervousimpulses for transmission of the brain. The eardrum is incredibly sensitive, capable ofdetecting a vibration so faint that it only displaces the surface of the drum a thousand-millionth of a centimetre. This displacement is then transmitted through three ear ossiclesin the middle ear, which amplify the pressure twenty-two times. The enhanced signal isthen passed on to the inner ear. Vibration is enhanced that impinges on hair-like nervecells. There are thousands of these nerve cells – each one tuned to a particular vibration –and they send their messages to the brain via the auditory nerve14.The inner ear also contains vital organs of balance, three semicircular canals. Theimportance of these organs grew dramatically when our ancestors first stood up on theirhind legs and adopted bipedal locomotion. An animal standing on four legs is reasonablystable, but vertical living creates an almost non-stop demand for subtle balancingadjustments15.One of the sad aspects of our sense of hearing is that it starts to go into decline as soon aswe are born. The human infant can detect sound wave frequencies from 16 cycles asecond up to 30,000. At adolescence, the upper limit has already dropped to 20,000cycles a second. By the age of sixty this has declined to about 12,000 and the upper pitchthat we can detect continues to fall further and further as we become more elderly16.A Comprehensive Study of PramanaShareera with Special Reference to AnguliPramanof BahyaKarna-Shareera  4  
  23. 23. Introduction It has long been argued that it is possible to identify every individual by his or her earshape. In the last century it was suggested that this feature could be used to detectcriminals, but another method, finger-printing won the day and ear- typing was forgotten.It remains true, however, that it is impossible to find two people with precisely the sameear details17.A Comprehensive Study of PramanaShareera with Special Reference to AnguliPramanof BahyaKarna-Shareera  5  
  24. 24. Objectives 2.0 OBJECTIVE OF THE STUDY 1. To measure the variable measurement of anatomical descriptions of Bahya- karna by using of the fundamentals of Anguli pramana in healthy volunteers. 2. To correlate of the justification narrated by different Acharyas. 3. To evaluate the relevance of Pramana shareera from ancient literature in context with modern anthropometry.2.1 Previous Work Done – Mishra P C- A study of Dehika Prakrutis w.s.r. to Anguli Pramana. Lucknow State Ayurvedic College, University of Lucknow-1983. Manakar Atul S- A study of Suthra given by Acharaya Sushrutha about Anguli pramana. B .V Ayurveda College Pune, Pune University-2002. Viswanath.K.Channappanavar-Concept of Pramana Shareera w.s.r. to determination of the stature from Prabahu (brachium) under taken at S D M College of Ayurveda, Udupi, R G U H S, Bangalore 2006. Shyny Thankachan- Comparative study of Anguli pramana & Prakruti w.s.r. to Bahu, S D M College of Ayurveda, Udupi, R G U H S, Bangalore 2009 A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Praman of Bahya Karna-Shareera 6
  25. 25. Literature Evaluation  3.0 LITERATURE EVALUATIONLiterature evaluation also known as literature review includes the extensive study ofcurrent and relevant references with consistent and appropriate explanation.Proper use of terminology and comprehensive study of various researches and analysis ofthe easement are noted criteria for literature review. The measuring of literature review isto present and explain up to date knowledge with current literature and justification forfeature result in the particular area.Pramana refers to the various means of gaining knowledge. Pramana is that whichprovides us with knowledge5. It specifically destined to the measurements of human bodythat express quantitatively its dimensions6. Pramana is one among the ten folds ofexamination of a patient explained by Charaka4. It marks its significance in the fact that ithelps to unearth the Ayu, viz. longevity of an individual. A person having appropriatePramana of Anga-prathyanga’s is considered to have Dirghayou.In the era of Susrutacharya and Charakacharya Swaanguli Pramana is used for estimatingthe Anga-pratyanga and other body constituents7, 3. Ayama, Vistara and Parinama etc aremeasured by the exploit of Swaanguli Pramana where as other body constituentsincluding the fluid are considered by applying the knowledge of Swa-anjali Pramana8.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  7  
  26. 26. Literature Evaluation According to Susrutacharya before starting a treatment for an Atura, physician has toexamine many things including Ritu, Agni, Vaya, Deha, Bala, Satva, Satmya, Prakruti,Bheshaja and Desha18. For the examination of Ayu, Anguli Pramana is one of thecriteria1. Here Pramana of Anga-pratyanga has to be taken, the individuals withappropriate Anguli-Pramana have Dirghayou, and Ayu will be more or less if there isdifference of Pramana3.Pramana is one among the ten folds of examinations of a patient explained byCharakacharya. That is the patient has to be examined with reference to the measurementof his Anga-Pratyanga. This is resolute by measuring the height, length & breadth of theAnga-Pratyanga by taking the finger breadth of the individual as the unit measurement7.Technical terms used in the contextAnguliIt is the distal and movable part of the upper limb & lower limb; they are of twenty innumber & of five types19. a) Angushta b) Tarjani/ Pradeshini c) Madhyamanguli d) Anamika e) KanishtaA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  8  
  27. 27. Literature Evaluation PramanaIt is the parameter or tool used through which valid knowledge is obtained4.Anguli pramana: is a relative unit to denote length, breadth and circumference.Angula can be taken as;1) Width of the madhyama parva of the madhyama angula20.2) Measurement obtained by taking the length of the madhyama angula and dividing it byfive21.3) Measurement obtained by taking the width of the palm and then dividing by Four22.4) Nakhatalabhaga of angushtha23.3.1 SynonymsThe Karna is also known by other names as Sabdhagraha, Sruth, and Sravana.24“Sravana- Sruyathe anena ithi sravana” that means the organ which is engaged inperception of the sound is sravana, or known as Karna25.3.2 Chronological reviewSince time immemorial, a general inquiry regarding Pramanas was in prevalence whichcan be traced even up to pre historic era. This is evident from its notion in the earliestliterature i.e. Vedas and the oldest medical texts.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  9  
  28. 28. Literature Evaluation The chronological review may be noted as below –Karna is considered as Gyanendriya that is helpful us to listen to the sound of variousintensities. Even for the diagnosis of diseases a physician has to depend onPanchendriyas and Prasna26.3.2.1 Description in Samhita period:3.2.1.1 Sushruta SamhitaIn Susrutha samhita, Karna is described as one among the Pratyangas27. Sukra andSronita present in the Garbhasaya combined with Atma, Prakrti and Vikara is known asGarbha. Vayu mahabhuta divides this mass possessing Chetana; Tejas mahabhuta cooksit; Aap mahabhuta moistens it; Prithvi mahabhuta hardens it, and Akasa mahabhutaenlarges it. Developed in this manner, when it becomes endowed with hands, feet,tongue, nose ear, buttocks etc, we call the same as Sarira28.Acharya Sushruta, described that: 1. Karna is one among the Srotas29 2. Karna is made of one Asthi30 and two Sandhi31. 3. Asthi in Karna is of taruna type and type of Sandhi in Karna is Sankhavartha32, 33. 4. Two Mamsa pehsi are present in Karna34.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  10  
  29. 29. Literature Evaluation  5. Sabda vahini sira, one of the ten Siras as described, should not be incised as these any incision may lead to hearing loss35.Acharya Sushruta advises to practice Karna sandhi bandhana in Mrudu mamsa,fabricating the ear, joining the severed ear and bandaging by using soft skin, muscles andhollow stalk of lily plant36.Acahrya Sushruta also described that “Svastika” is the type of Bandhana mentioned forKarna37.Acahrya Sushruta described that “Aharya” is the method used for removing Karnamala38.He also described the methodology of ear-piercing, known classically as ‘Karnavyadhana vidhi’. This methodology is aimed to protect the child for protection and bearsthe cosmetic approach. The usual time for Karna vyadhana is sixth or seventh month onfull moon day (Shukla pakhsa) on any auspicious day. In male child, the right side ear hasto be pierced, in Daivakrita chhidra39.Improper ear-piercing can lead harm to kalika siraresulting fever, burning, swelling, pain; harm to Marmarika sira resulting pain, fever,swelling in the vessels; and harm to Lohitika sira resulting in Manyastambha, Apatanaka,Sirograha, Karnasoola40.Repair of Karna is bears the moral significance in all the surgical process. Fifteen typesof procedures are explained for repairing the injured earlobe41. The ear lobule injury isrepaired by taking skin from the surrounding neck region42. Mismanage in repair orA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  11  
  30. 30. Literature Evaluation bandaging can result in complications like Paripatika, Karnapati upadrava (Utpataka,Utputaka, Avamantha, Granthika, Jambala, Kanduka, Sravi, and Syava)43.Twenty-eight types of karna vyadhis are described by Acharya Sushruta Susrutha such asKarnasula, Karnapranada, Badhirya, Karnaksweda, Karnasrava, Karnakandu,Karnagutha, Karnapratinaha, Krimikarna, Karnavidradhi (Kshataabhighataga andDoshja), Karnapaka, Putikarna, Karnaarsa (Vataja, Pittaja, Kaphaja and Sannipadaja),Karnaarbutha (Vataja, Pittaja, Kaphaja, Sannipadaja, Raktaja, Mamsaja and Medhaja)and Karnasopha (Vataja, Pittaja, Kaphaja and Sannipadaja) 44.3.2.1.2 Charaka Samhita:Acharya Charaka noted about five attributes for Panchamahabhuta are Sabha, Sparsha,Rupa, Rasa and Gandha45.Acharya Charaka said that Sabdha, Srothra, Laghava, Soushmya are derived fromAkasha mahabutha46.Acharya Charaka said that Karna is one of the Panchendriyaadishatana and Sabda is thePanchendriabudhi47, 48. He describes the number of Karna and Karnaputraka are of twoin number49. The Sabda, and Sabendriya are of Akasha predomient50.3.2.1.3 Kashyapa SamhitaAcahrya Kashyapa described about the diagnostic process for various disorders of Karnaeven in the children that signifies the importance of the Karna. As per him one shouldA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  12  
  31. 31. Literature Evaluation doubt for the pain in the ear when child touches ear with both hands, roll head too much,has dullness, anorexia and insomnia51.Acharya Kashyapa also described about the measures to increase ear lobe, whichsignifies the cosmetic importance of Karna52. He emphasized the importance of expertfor ear-piercing. He described the quality of the physician for earlobe piercing andcautioned to keep away from the unskilled person for ear lobe piercing as wrongfulprocess can create permanent deformity or can harm to the ear. He explained that quackshould not pierce the ear of children of royal families or other great person53, 54. Thephysician should know where, how and when to pierce, and what is beneficial, non-beneficial & its complication the ear lobe. This signifies the importance of anatomicalknowledge of Karna in those days55, 56.3.2.1.4 Vagabhatta SamhitaEven piercing of ear is prescribed as one of the importance Samskara57. Protection fromdemons is one of the major indications for this Sanskara. It is also believed that piercingof Karna increase the immunity.He described the development of all Angas in fourth month of the gestational period59,and Karna may be counted as one of the major Anga. Fleshly and adherent ear indicate oflong span of life60.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  13  
  32. 32. Literature Evaluation Karnapurana, a process is mentioned where ear is to be filled with medicated oilysimultaneously massaging the root of ear and is to be retained till the pain subsides, in ahealthy person61.Acharya Vagabhatta described three Marmas related to Karna, and those are: 1. Vidhuramarma: It is situated below the Karna and injury to this causes loss of hearing62. 2. Shankamarma: It is situated between ear and end of the eye brow and injury to this marma cause immediate death63. 3. Srinkadakamarma: It is situated at the congregation of orifices of mouth, ear, nose and eyes64.Karna is site in which Abhyanga should be performed particularly65. Snana [bath] iscontra indicated for person affected by ear diseases66.He described that swelling in the Karna-mula occurs in Sannipathajwara67.Acharya described about Karnavedha (puncturing the ear lobe). It should be preferablycompleted done in Daivakritachidra to avoid injury to Sira in either sixth, seventh andeighth month of the baby68.Acharya described about the diseases, and their etiology of the ear69.Acahrya describedthe various types of diseases of Karna like Vatajakarnasula, Pittajakarnasula,KaphajakarnaSula, Raktajakarnasula, Sannipatajakarnasula, Karnanada, Krichrachuthi,A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  14  
  33. 33. Literature Evaluation Pratinaha, Kandushopha, Poothikarna, Krimikarna, Kuchikarna, Karnapippali,Karnavidarika, Palishosha, Tantrika, Paripod, Ulpata, Umanunmantho/gallira,Dhukhavardhana and Lihyapidaka. He also described about the treatment from variousKarnavyadhis.3.3 Concept of AnthropometryAnthropometry is a Greek word literally means "measurement of humans". In physicalanthropology it refers to the measurement of living human individuals for the purposes ofunderstanding human physical variations70.It is a series of systematized measuring techniques that express quantitatively thedimensions of the human body and skeleton. Anthropometry is often viewed as atraditional and perhaps the basic tool of biological anthropology, but it has a longtradition of use in forensic sciences and it is finding increased use in medical sciencesespecially in the discipline of forensic medicine71.By this, we can obtain measurement of the human body in terms of the dimensions ofbone, muscle, and adipose (fat) tissue. Measures of subcutaneous adipose tissue areimportant because individuals with large values are reported to be at increased risks forhypertension, adult-onset diabetes mellitus, cardiovascular disease, gallstones, arthritis,and other disease, and forms of cancer72.In the 19th and early 20th centuries, anthropometry was a pseudoscience used mainly toclassify potential criminals by facial characteristics. It is also called Bertillan system. ForA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  15  
  34. 34. Literature Evaluation example, Cesare Lombrosos criminal anthropology (1895) claimed that murderers haveprominent jaws and pickpockets have long hands and scanty beards. The work of EugeneVidocq, which identifies criminals by facial characteristics, is still used nearly a centuryafter its introduction in France. The most infamous use of Anthropometry was by theNazis, who’s Bureau for Enlightenment on Population Policy and Racial Welfarerecommended the classification of Aryans and non-Aryans on the basis of measurementsof the skull and other physical features. Craniometric certification was required by law.The Nazis set up certification institutes to further their racial policies. Not measuring upmeant denial of permission to marry or work, and for many it meant the death camps. Itwas applicable only to the adult since it was based on the principal that after 21 years ofage, no changes occurs in the dimensions of the skeleton & that the ratio in the size of thedifferent parts to one another varies considerable in different individuals73.Today, Anthropometry plays an important role in industrial design, clothing design,ergonomics, and architecture, where statistical data about the distribution of bodydimensions in the population are used to optimize products. Changes in life styles,nutrition and ethnic composition of populations lead to changes in the distribution ofbody dimensions (e.g., the obesity epidemic) 70.Anthropometry can be subdivided into somatometry including cephalometry andosteometry including craniometry74.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  16  
  35. 35. Literature Evaluation Somatometry75: It is the measurement of the living body and cadaver including head andface. Somatometry is useful in the study of the estimation of stature from different bodysegments age, sex, ethnic group, geographic location, etc.Osteometry76: It includes the measurements of the skeleton and its parts i.e. themeasurements of the bones including skull.3.4Utility of anthropometry Forensic anthropometry incorporates most of the techniques originating with the analysis of human skeletal material from Archaeological sites; Applicable to evolutionary interpretation. Applicable to clinical evaluation. Useful in industrial design. Studies of morphological variation, by their very nature have a comparative focus in which variation within and among populations is the central theme. Somatometry is useful in the study of age estimation from different body segments in a given set of individuals. Somatometry is extensively used in the estimation of stature from different body segments. Can study variation in bony skeleton of different populations of the world. Used in the estimation of sex and race in forensic and legal sciences. Helps in understanding of comparative anatomy of primates.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  17  
  36. 36. Literature Evaluation  Helps in orthopedic surgery in fractures, dislocation, and amputation, and in construction of artificial limbs i.e. prosthesis. It also helps in construction of artificial teeth in dentistry. Helps in forensic science to identify the individual. To identify the monozygotic & dizygotic twins. Today, anthropometry has many practical uses, most of them benign. For example, it is used to assess nutritional status, to monitor the growth of children, and to assist in the design of office furniture.3.5 EmbryologyThe three morphological subdivisions of the ear [namely the external, middle and internalear] each have a separate origin77.3.5.1 External ear78The external acoustic meatus is derived from the dorsal part of the first ectodermal cleft.However, its deeper part is formed by proliferation of its lining epithelium, which growstowards the middle ear. This proliferation is at fist solid [meatal plug], but is latercanalized.The auricle, or pinna, is formed from about six mesodermal thickenings [called tuberclesor hillocks] that appear on the mandibular and hyoid arches, around the opening of thedorsal of the first ectodermal cleft [i.e. around the opening of the external acousticmeatus].A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  18  
  37. 37. Literature Evaluation The mandibular arch forms only the tragus and a small area around it, the rest of theauricle being formed from the hyoid arch. This is consistent with the fact that theauricular muscles are supplied by the facial nerve.3.5.2 Tympanic membrane79This is formed by apposition of the tubo-tympanic recess and the first ectodermal cleft,these two formations the inner [endodermal] and outer [ectodermal] epithelial linings ofthe membrane. The intervening mesoderm forms the connective tissue basis.Two points worth noting are as follows: 1. The handle of the malleus grows into the connective tissue from above. 2. The chorda tympani nerve is at first outside the membrane but later comes to lie within its layers, because of upward extension of the membranes. 3.5.3 Middle ear80The epithelial lining of the middle ear and of the pharyngo-tympanic tube is derived fromthe tubo-tympanic recess. This recess develops from the dorsal part of the firstpharyngeal pouch, and also receives a contribution from the second pouch. The tympanicantrum and mastoid air cells are formed by extensions from the middle ear.The malleus and incus are derived from the dorsal end of Meckel’s cartilage, while thestapes is formed from the dorsal end of the cartilage of the second pharyngeal arch. TheA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  19  
  38. 38. Literature Evaluation ossicles are at first outside the mucous membrane of the developing middle ear. Theyinvaginate the mucous membranes, which covers them throughout life. The ossicles ofthe ear fully ossify in the fourth month of intrauterine life. They are the first bone in thebody to do so.The tensor tympani is derived from the mesoderm of the first pharyngeal arch and thestapedius from that of the second arch.3.5.4 Internal ear81The membranous labyrinth is derived from a specialized area of surface ectodermoverlying the developing hind brain. This area is first apparent as a thickening called theoticplacode. The oticplacode soon becomes depressed to form the otic pit.The otic vesicle is at first an oval structure. By differential growth of various parts of itswall, it gives rise to the structures comprising the membranous labyrinth.Localized areas of the epithelium of the membranous labyrinth undergo differentiation toform specialized sensory end organs of hearing, and of equilibrium [cristae ofsemicircular ducts; maculae of utricle and saccule; organ of corti of cochlea]. These areinnervated by peripheral processes of the cells of the vestibulocochlear ganglion. Thisganglion is derived from the neural crest. Its cells are peculiar in that they remain bipolarthroughout life.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  20  
  39. 39. Literature Evaluation The bony labyrinth is formed from the mesenchyme surrounding the membranouslabyrinth. This mesenchyme becomes condensed to form the otic capsule. Themesenchymal condensation is soon converted into cartilage. Between this cartilage andthe membranous labyrinth there is a layer of loose periotic tissue. The space of the bonylabyrinth is created by the disappearance of this periotic tissue. The membranouslabyrinth is filled with a fluid called endolymph, while the periotic spaces surrounding itare filled with perilymph.The periotic tissue, around the utricle and saccule, disappears to form a space called thevestibule. The periotic tissue, around the semicircular ducts also disappears to form thesemicircular canals. Two distinct spaces are formed, one on either side of the cochlearduct. These are the scala tympani and the scalavestibuli. The scalavestibuli communicateswith the vestibule while the scala tympani grows towards the tympanic cavity, fromwhich it remains separated by a membrane. The cartilaginous labyrinth is subsequentlyossified to form the bony labyrinth.3.5.5 Cronology of ear development82 22nd day – oticplacode is seen. 5th week – auricle starts forming 6th week – the cochlea and semicircular canals starts forming.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  21  
  40. 40. Literature Evaluation  8th week – the cochlea and semicircular canals assume their definitive external form. 10th week – scalavestibuli and scala tympani appear. 7th month – external acoustic meatus gets canalized. The ear is most sensitive to teratogens during the 4th to 9th week, and can be affected up to the 12th week.3.6 Anomalies of the ear3.6.1 Anomalies of the auricle83 1. The development of the auricle may get arrested at any stage. As a result of this, it may be totally, or partially, absent; it may be represented by isolated nodules; or it may be very small. Alternatively it may be very large. 2. The migration of the auricle from its primitive caudo-ventral position may remain incomplete. We have seen that this migration occurs as a result of the growth of the maxillary and mandibular processes. This explains the association of caudo- ventral displacement of the auricle with mandibulofacial dysostosis.3.6.2 Anomalies of the External Auditory Meatus84A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  22  
  41. 41. Literature Evaluation  1. There may stenosis, or atresia, of the meatus over its whole length or over part of it. The lumen may be closed by fibrous tissue, by cartilage, or by bone. 2. The normal curvature of the meatus may be accentuated as a resullt of which the tympanic membranes cannot be fully seen from the outside.3.6.3 Anomalies of the middle ear85 1. The ossicles may be malformed. They may show abnormal fusion to one another or to the wall of the middle ear. The stapes may be fused to the margins of the fenestra vestibuli. 2. The facial nerve may bulge into the middle ear and may follow an abnormal course. 3. The stapedial artery, which normally disappears, may persist.3.7 Anatomy of earThe ear is an organ of hearing. It is also concerned in managing the equilibrium of thebody. It consists of three parts like the external ear, the middle ear, and the internal ear89.3.7.1 The External earThe external ear consists of the auricle or pinna and the external acoustic meatus.3.7.1.1 The Auricle or pinna90A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  23  
  42. 42. Literature Evaluation This is the part seen on the surface. The greater part of it is made up a single crumpledplate of cartilage which is lined on both sides by skin. The lowest part of the auricle issoft and consists only of connective tissue covered by skin. This part is called the lobule.The lateral surface of the auricle is irregularly concave, faces slightly forwards anddisplays numerous eminences and depressions. It has a prominent curved rim, helix. Thisusually bears a small tubercle postero-superiorly, Darwan`s tubercle. The anti-helix is acurved prominent paraller and anterior to the posterior part of the helix. It divided aboveinto two cura which flank a depressed triangular fossa. The curved depression betweenhelix and antihelix is the scaphoid fossa. The antihelix encircles the deep, capaciousconcha of the auricle, which is incompletely divided by the cura or anterior end of thehelix. The conchal area above this, the cymba conchae, overlies the super meatal triangleof the temporal bone which can be felt through it, and which overlies the mastoid antrum.The tragus is a small curved flap below the cura of helix and in front of the concha, itproject posteriorly, partly over lapping the meatal orifice. The anti-tragus is a smalltubercle opposite the tragus and separated from it by the inter-tragic incisures or notch.3.7.1.2 The Skin91The skin of the auricle continues into external auditory meatus to cover the outer surfaceof the tympanic membranes. It is thin, has no dermal papillae, and is closely adherent tothe cerumen. The secretary cell are columnar which active but cuboidal when quiescent,there are covered externally by myoepithelial cells. Ducts open either on to the epithelialA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  24  
  43. 43. Literature Evaluation surface or into the nearby sebaceous gland of a hair follicle .Cerumen prevents themaceration of meatal skin by trapped water. 3.7.1.3 The Cartilaginous frame work92The auricle is a single thin plate of elastic fibro cartilage covered by skin, It surfacemoulded by eminences and depressions .It is connected to the surrounding part byligament and muscles and is continous with the cartilage of the external auditory meatus.There is no cartilage in the louble or between the tragus anti crux of the helix, where thegap is filled by dense fibrous tissue. Anteriorly, where the helix curves upwards, there isa small cartilaginous projection, the spin of the helix. Its other extremity is prolongedinferiorly as the tail of the helix and it is separated from the anti-helix by the fissura antitragahelixina. The cranial aspect of the cartilage bears the eminentia conchae andeminentiascaphae, which correspond to the depression on the lateral surface. The twoeminences are separated crus of the antihelix on the lateral surface. The eminentiaconchae are crossed by an oblique ridge, the ponticulus, for the attachment of auricularisposterior. There are two fissures in the auricular cartilage, one behind the crux of thehelix and another in the tragus.3.7.1.4 Ligaments93Anterior and posterior extrinsic ligament connect the auricle with the temporal bone .Theanterior ligament extends from the tragus and the spin of the helix to the root of thezygomatic process of the temporal bone. The posterior ligament passes from the posteriorA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  25  
  44. 44. Literature Evaluation surface of the concha to the lateral surface of the mastoid process to main intresticligament connect individual auricular cartilage: a strong fibrous band passes from thetragus to the helix, there by completing the meatus anteriorly and forming part of theboundary of the concha and another band passes between the antihelix and the tail of thehelix. Less prominent bands are seen on the cranial aspect of the auricle.3.7.1.5 Auricular muscles94Extrinsic auricular muscles connect the auricle to the skull and scalp and move the auricleas a whole. Intrinsic auricular muscles connect the different parts of the auricle.3.7.1.5.1 Extrinsic musclesThe extrinsic auricular muscles are the auricularis anterior, superior and posterior. Thesmallest of the three is auricularis anterior, a thin fan of pale fibres which arise from thealateral edge of the epicranialaponeurosis and converge to attach to the spine of the helix.The largest of the three, auricularis superior, is also thin and fan-shaped and convergesfrom the epicranialaponeurosis via a thin, flat tendon to attach to the upper part of thecranial surface of the auricle. The auricularis posterior consists of two or three fleshyfasciculi which arise by short aponeurotic fibres from the mastoid part of the temporalbone and insert into the ponticulus on the eminentia conchae.Vascular supplyA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  26  
  45. 45. Literature Evaluation The arterial supply of the extrinsic auricular muscles is derived mainly from the posteriorInnervation. Auricularis posterior is supplied by the posterior auricular branch of thefacial nerve.ActionIn man these muscles have very little obvious effect. However, despite the paucity ofauricular movement, auditory stimuli may evoke patterned responses from these smallmuscles and electromyography can detect the crossed acoustic response, used todetermine auditory threshold levels and brainstem latencies, which is elicited by thismeans in investigative clinical neurology.3.7.1.5.2 Intrinsic musclesThe intrinsic auricular muscles are helicis major and minor, tragicus, antitragicus,transversusauriculae and obliqusauriculae. Helicis major is a narrow vertical band on theanterior margin of the helix, passing from its spine to its anterior border, where the helixis about to curve back. Helicis minor is an oblique fasciculus covering the crus of thehelix. Tragicus is a short, flattened, vertical band on the lateral aspect of the tragus.Antitragicus passes from the outer part of the antitragus to the tail of the helix and theantihelix. Transversusauriculae, located on the cranial aspect of the auricle, consists ofscattered fibres, partly tendinous, partly muscular, which extend between the eminentiaconchae and the eminentia fibres which extend from the upper and posterior parts of theaminentia conchae to eminentiascaphae.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  27  
  46. 46. Literature Evaluation Vascular supplyThe intrinsic auricular muscles are supplied by branches of the posterior auricular andsuperficial temporal arteries.The intrinsic auricular muscles on the lateral aspect of the auricle are innervated by thetemporal branches of the facial nerve, and those on the cranial aspect of the auricle areinnervated by the posterior auricular branch of the facial nerve.ActionsThe intrinsic muscles modify auricular shape minimally, if at all, in most human ears:helicis major can draw the auricle forwards and upwards. Rare individuals can modify theshape and position of their external ear.3.7.1.6 Vascular supply & lymphatic drainage95ArteriesThe posterior auricular branch of the external carotid artery is the dominant blood supply.It supplies three or four branches to the cranial surface of the auricle: twigs from thesearteries reach the lateral surface, some through fissures in the cartilage, other round themargin of the helix. The posterior auricular artery ascends between the parotid gland andthe styloid process to the groove between the auricular cartilage and mastoid process. Thesuperior auricular artery has a constant course and connects the superior temporal arteryand the posterior auricular arterial network: this branch can provide a reliable vascularA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  28  
  47. 47. Literature Evaluation pedicle for retro-auricular flaps .The auricle is also supplied by anterior auricularbranches of the occipitalVeinsAuricular veins correspond to the arteries of the auricle. Arterio-venous anastomoses arenumerous in the skin of the auricles and are thought to be important in the regulation ofcore temperature. Lymphatic drainageThe posterior aspect of the pinna drains to nodes at the mastoid tip. The tragus and upperpart of the pinna drain into pre-auricular nodes, while the remainder of the pinna drains toupper deep cervical lymph nodes.3.7.1.7 Innervation96The sensory innervation of the auricle is complex and not fully determined. This isperhaps because the external ear represents an area where skin originally derived from abrachial region meets skin originally derived from a post brachial region. The sensorynerve involved are the great auricular nerve, which supplies most of the cranial surfaceand the posterior part of the lateral surface [helix, anti-helix, louble] the lesser occipitalnerve , which supplies the upper part of the cranial surface; the auricular branch of thevagus, which supplies the concavity of the cocha and posterior part of the eminentia; theauriculotemporal nerve, which supplies the tragus, crux of the helix and the adjacent partA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  29  
  48. 48. Literature Evaluation of the helix and the facial nerve, which together with the auricular branch of the vagusprobably supplies small areas on both aspects of the auricles, in the depression of theconcha and over its eminence. The details of the cutaneous innervation derived from thefacial nerve require further clarification. It is possible that as the auricular branch of thevagus probably supplies small area on both aspects of the auricle, in the depression of theconcha, and over its eminence. The details of the cutaneous innervation derived from thefacial nerve require farther clarification. It is possible that as the auricular branch of thevagus traverses the temporal bone and crosses the facial canal, approximately 4 mmabove the stylomastoid foramen, it contributes an ascending branch to the facial nerveand that in this way fibers of the vagus are carried via the facial nerve to pinna.3.8 External Acoustic Meatus97The external acoustic meatus extends from the concha to the tympanic membrane: it isapproximately 2.5 cm from the floor of the concha and approximately 4 cm from thetragus. It has two structurally different parts: its lateral third is cartilaginous and itsmedial two third is osseous .It forms an S-shape curve, directed at first medially,anteriorly, and slightly up [pars externa], then posteromedially and up [pars media] andlastly anteromedially and slightly down [pars interna]. It is oval in section, its greatestdiameter is obliquely inclined posteroinferiorly at the external orifice, but is nearlyhorizontal at its medial and. There are two constrictions, one near the medial end of thecartilaginous part, the other, the isthmus, in the osseous part about 2 cm from the bottomof the concha. The tympanic membranes, which closes its medial end, is obliquely set,A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  30  
  49. 49. Literature Evaluation which means that the floor and the anterior wall of the meatus are longer than its roof andposterior wall.The lateral, cartilaginous part is approximately 8 mm long. It is continuous with theauricular cartilage and attached by fibrous tissue to the circumference of the osseous part.The meatel cartilage is deficient posterosuperiorly, and the gap is occupied by a sheet ofcollagen. Two or three deep fissure [of santorini] exists in its anterior part: tumours of theexternal acoustic meatus escape the confines of the canal through these fissures andspread into the adjacent soft tissue.The osseous part is approximately 16 mm long, and is narrower than the cartilaginouspart. In sagittal section it is oval or elliptical and it is directed anteromedially and slightlydownwards, with a slight posterosuperior convexity. Its medial end is smaller than thelateral end and it terminates obliquely. The anterior wall projects medially approximately4 mm. beyond the posterior and is marked, except above, by a narrow tympanic sulcus oranulus, to which the perimeter of the tympanic membrane is attached. Its lateral end isdilated and mostly rough for the attachment of the meatal cartilage. The anterior, inferiorand most plate of the temporal bone, which in the foetus is only a tympanic plate of thetemporal bone, which in the foetus is only a tympanic ring. The posterosuperior region isformed by the squamous part of the temporal bone. The outer wall of the meatus isbounded above by the posterior zygomatic root, below which there may be a suprameatalspine.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  31  
  50. 50. Literature Evaluation 3.8.1 Relations of the meatusThe condylar process of the mandible lies anterior to the meatus and is partially separatedfrom the cartilaginous part by a small portion of the parotid gland. A blow on the chinmay cause the condyle to break into the meatus. The middle cranial fossa lies above theosseous meatus and the mastoid air cell are posterior to it, separated from the meatus onlyby a thin layer of bone. Its deepest part is situated below the epitympanic recess, and isanteroinferior to the mastoid antrum: the lamina of bone which separates it from theantrum is only 1-2 mm thick and provides the transmeatal approach of aural surgery.3.8.2 Vasculature and lymphatic drainageThe arterial supply of the external acoustic meatus is derived from the posterior auricularartery, the deep auricular branch of the maxillary artery and the auricular branches of thesuperficial temporal artery. Associated veins drain into the external jugular and maxillaryveins and the pterygoid plexus. The lymphatics drain into those associated with the pinna.3.8.3 InnervationThe sensory innervation of the external acoustic meatus is derived from theauriculotemporal branch of the mandibular nerve, which supplies the anterior andsuperior wall, and the auricular branch of the vagus, which supplies the posterior andinferior wall. The facial nerve may also contribute via its communication with the vagusnerve.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  32  
  51. 51. Literature Evaluation 3.9 Middle ear98The middle ear is an air-filled, mucous membrane-lined space in the temporal bonebetween the tympanic membrane laterally and the lateral wall of the internal ear medially.It is described as consisting of two parts. • Tympanic cavity immediately adjacent to the tympanic membrane. • Epitympanic recess superiorly.The middle ear communicates with the mastoid area posteriorly and the nasopharynx [viathe pharyngotympanic tube] anteriorly. Its basic function is to transmit vibrations of thetympanic membrane across the cavity of the middle ear to the internal ear. Itaccomplishes this through three interconnected but movable bones that bridge the spacebetween the tympanic membrane and the internal ear. These bones are the malleus[connected to the tympanic membranes], the incus [connected to the malleus], and thestapes [connected to the incus and the lateral wall of the internal ear at the oval window]3.9.1 BoundariesThe middle ear has a roof and a floor, and anterior, posterior, medial and lateral walls.Tegmental wall [Roof]The tegmentalwall of the middle ear consists of a thin layer of bone, which separates themiddle ear from the middle cranial fossa. This layer of bone is the tegmen tympani on theanterior surface of the petrous part of the temporal bone.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  33  
  52. 52. Literature Evaluation Jugular wall [Floor]The jugular wall of the middle ear consists of a thin layer of bone that separates it fromthe internal jugular vein. Occasionally, the floor is thickened by the presence of mastoidair cells.Near the medial border of the floor is a small aperture, through which the tympanicbranch from the glossopharyngeal nerve [9] enters the middle ear.Anterior wallThe anterior wall of the middle ear is only partially complete. The lower part consists of athin layer of bone that separates the tympanic cavity from the internal carotid artery.Superiorly, the wall is deficient due to the presence of: A large opening for the entrance of the pharyngotympanic tube into the middle ear: A smaller opening for the canal containing the tensor tympani muscle.The foramen for exit of the chorda tympani nerve from the middle ear is also associatedwith this wall.Mastoid wall [Posterior]A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  34  
  53. 53. Literature Evaluation The mastoid wall of the middle ear is only partially complete. The lower part of this wallconsists of a bony partition between the tympanic cavity and mastoid air cells.Superiorly, the epitympanic recess is continuous with the aditus to the mastoid antrumAssociated with the mastoid wall are: The pyramidal eminence, a small elevation through which the tendon of the stapedius muscle enters the middle ear. The opening through which the chorda tympani nerve, a branch of the facial nerve [7], enters the middle ear.Labyrinthine wall [Medial]The labyrinthine wall of the middle ear is also the lateral wall of the internal ear. Aprominent structure on this wall is a rounded bulge [the promontory] produced by thebasal coil of the cochlea, which is an internal ear structure involved with hearing.Associated with the mucous membrane covering the promontory is a plexus of nerves[the tympanic plexus], which consists primarily of contributions from the tympanicbranch of the glossopharyngeal nerve [9] and branches from the internal carotid plexus. Itsupplies the mucous membrane of the middle ear, the mastoid area, and thepharyngotympanic tube.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  35  
  54. 54. Literature Evaluation Additionally, a branch of the tympanic plexus [the lesser petrosal nerve] leaves thepromontory and the middle ear, travels across the anterior surface of the petrous part ofthe temporal bone, and leaves the middle cranial fossa through the foramen ovale to enterthe middle cranial fossa through the foramen ovale to enter the otic ganglion. Otherstructures associated with the labyrinthine wall are two openings, the oval and roundwindows, and two prominent elevations. The oval window is posterosuperior to the promontory, is the point of attachment for the base of stapes [footplate], and end the chain of bones that transfer vibrations initiated by the tympanic membrane to the cochlea of the internal ear. The round window is posteroinferior to the promontory. Posterior and superior to the oval window on the medial wall is the prominence of facial canal, which is a ridge of bone produced by the facial nerve [7] in its canal as it passes through the temporal bone. Just above and posterior to the prominence of facial canal is a broader ridge of bone [prominence of lateral semicircular canal] produced by the lateral semicircular canal, which is a structure involved in detecting motion.Membranous wall [Lateral]The membranous wall of the middle ear consists almost entirely of the tympanicmembrane, but because the tympanic membrane does not extend superiorly into theA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  36  
  55. 55. Literature Evaluation epitympanic recess, the upper part of the membranous wall of the middle ear is the bonylateral wall of the epitympanic recess.3.9.2 Mastoid area99 Posterior to the epitympanic recess of the middle ear is the aditus to mastoid antrum, which is the opening to the mastoid antrum. The mastoid antrum is a cavity continuous with collections of air-filled spaces [the mastoid cells], throughout the mastoid part of the temporal bone, including the mastoid process. The mastoid antrum is separated from the middle cranial fossa above by only the thin tegmen tympani. The mucous membrane lining the mastoid air cells is continuous with the mucous membrane throughout the middle ear. 3.9.3 Pharyngotympanic tube100 The Pharyngotympanic tube connects the middle ear with the nasopharynx and equalizes pressure on both sides of the tympanic membrane. Its opening in the middle ear is on the anterior wall, and from here it extends forward, medially, and downward to enter the nasopharynx just posterior to the inferior meatus to the nasal cavity. It consists of: A bony part [the one-third nearest the middle ear]. A cartilaginous part [the remaining two-thirds].A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  37  
  56. 56. Literature Evaluation  The opening of the bony part is clearly visible on the inferior surface of the skull at the junction of the squamous and petrous parts of the temporal bone immediately posterior to the foramen ovale and foramen spinosum. Vessels The arterial supply to the pharyngotympanic tube is from several sources. Branches arise from the ascending pharyngeal artery [a branch of the external carotid artery] and from two branches of the maxillary artery [the middle meningeal artery and the artery of the pterygoid canal]. Venous drainage of the pharyngotympanic tube is to the pterygoid plexus of veins in the infratemporal fossa. Innervations Innervation of the mucous membrane lining the pharyngotympanic tube is primarily from the tympanic plexus because it is continuous with the mucous membrane lining the tympanic cavity, the internal surface of the tympanic membrane, and the mastoid antrum and mastoid cells. This plexus receives its major contribution from the tympanic nerve, a branch of the glossopharyngeal [9]. 3.9.4 Auditory ossicles101A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  38  
  57. 57. Literature Evaluation  The bones of the middle ear consist of the malleus, incus, and stapes. They form an osseous chain across the middle ear from the tympanic membrane to the oval window of the internal ear. Muscles associated with the auditory ossicles modulate movement during the transmission of vibrations.MalleusThe malleus is the largest of the auditory ossicles and is attached to the tympanicmembrane. Identifiable parts include the head of malleus, neck of malleus, anterior andlateral processes and handle of malleus. The head of malleus is the rounded upper part ofthe malleus in the epitympanic recess. Its posterior surface articulates with the incus. Inferior to the head of malleus is the constricted neck of malleus, and below this are the anterior and lateral processes: The anterior process is attached to the anterior wall of the middle ear by a ligament. The lateral process is attached to the anterior and posterior malleolar folds of the tympanic membrane.The downward extension of the malleus, below the anterior and lateral processes, is thehandle of malleus, which is attached to the tympanic membrane.IncusA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  39  
  58. 58. Literature Evaluation The second bone in the series of auditory ossicles is the incus. It consists of the body ofincus and long and short limbs: The enlarged body of incus articulates with the head of malleus and is in the epitympanic recess; The long limb extends downward from the body, paralleling the handle of the malleus, and by bending medially to articulate with the stapes; The short limb extends posteriorly and is attached by a ligament to the upper posterior wall of the middle ear.StapesThe stapes is the most medial bone in the osseous chain and is attached to the ovalwindow. It consists of the head of stapes, anterior and posterior limbs, and the base ofstapes: The head of stapes is directed laterally and articulates with the long process of the incus. The two limbs separate from each other and attach to the oval base. The base of stapes fits into the oval window on the labyrinthine wall of the middle ear.3.9.5 Muscles associated with the ossiclesA Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  40  
  59. 59. Literature Evaluation Two muscles are associated with the bony ossicles of the middle ear: • Tensor tympani • StapediusTensor tympaniThe tensor tympani muscle lies in a bony canal above the pharyngotympanic tube. Itoriginates from the cartilaginous part of the pharyngotympanic tube, the greater wing ofthe sphenoid, and its own bony canal, and passes through its canal in a posteriordirection, ending in a rounded tendon that inserts into the upper part of the handle of themalleus.Innervation of the tensor tympani is by a branch from the mandibular nerve.Contraction of the tensor tympani pulls the handle of the malleus medially. This tensesthe tympanic membrane, reducing the force of vibrations in response to loud noises.StapediusThe stapedius muscle is a very small muscle that originates from inside the pyramidaleminence, which is a small projection on the mastoid wall of the middle ear. Its tendonemerges from the apex of the pyramidal eminence and passes in a forward direction toattach to the posterior surface of the neck of stapes.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  41  
  60. 60. Literature Evaluation Stapedius is innervated by a branch from the facial nerve. Contraction of the stapediusmuscle, usually in response to loud noise, pulls the stapes posteriorly and preventsexcessive oscillation.3.9.6 Vessels102Numerous arteries supply the structures in the middle ear: The two largest branches are the tympanic branch of the maxillary artery and the mastoid branch of the occipital or posterior auricular arteries; Smaller branches come from the middle meningeal artery, the ascending pharyngeal artery, the artery of the pterygoid canal, and tympanic branches from the internal carotid artery.Venous drainage of the middle ear returns to the pterygoid plexus of veins and thesuperior petrosal sinus.3.9.7 Innervations102The tympanic plexus innervates the mucous membrane lining the walls and contents ofthe middle ear, which includes the mastoid area and the pharyngotympanic tube. It isformed by the tympanic nerve, a branch of the glossopharyngeal nerve [9] and frombranches of the internal carotid plexus in the mucous membrane covering thepromontory, which is the rounded bulge on the labyrinthine wall of the middle ear.A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  42  
  61. 61. Literature Evaluation As the glossopharyngeal nerve [9] exits the skull through the jugular foramen, it gives offthe tympanic nerve. This branch re-enters the skull through a small foramen and passesthrough the bone to the middle ear.Once in the middle ear, the tympanic nerve forms the tympanic plexus, along withbranches from the plexus of nerves surrounding the internal carotid artery, in the mucousmembrane covering the promontory. Branches from the tympanic plexus supply themucous membranes of the middle ear, including the pharyngotympanic tube and themastoid area.The tympanic plexus also gives off a major branch [the lesser petrosal nerve], whichsupplies preganglionic parasympathetic fibers to the otic ganglion.The lesser petrosal nerve leaves the area of the promontory, exits the middle ear, travelsthrough the petrous part of the temporal bone, and exits onto the anterior surface of thepetrous part of the temporal bone through a hiatus just below the hiatus for the greaterpetrosal nerve. It continues diagonally across the anterior surface of the temporal bonebefore exiting the middle cranial fossa through the foramen ovale. Once outside the skullit enters the otic ganglion.3.10 Internal ear103A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  43  
  62. 62. Literature Evaluation The internal ear consists of a series of bony cavity [the bony labyrinth] and membranousduct and [the membranous labyrinth] within these cavities. All these structures are in thepetrous part of the temporal bone between the middle ear laterally and the internalacoustic meatus medially.The bony labyrinth consists of the vestibule, three semicircular canal and the cochlea.These bony cavities are lined with periosteum and contain a clear fluid [the perilymph].Suspended within the perilymph but not filling all spaces of the bony labyrinth is themembranous labyrinth, which consists of the semicircular ducts, the cochlear duct, andtwo sacs [the utricle and the saccule]. These membranous spaces are filled withendolymph.The structures in the internal ear convey information to the brain about balance andhearing: The cochlear duct is the organ of hearing. The semicircular duct, utricle, and saccule are the organs of balance.The nerve responsible for this function is the vestibulocochlear nerve [8], which dividesinto vestibular [balance] and cochlear [hearing] parts after entering the internal acousticmeatus.3.10.1 Bony labyrinth104A Comprehensive Study of Pramana Shareera with Special Reference to Anguli Pramana of Bahya Karna-Shareera  44  

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