Dhatusamya Lakshana Mentioned by Acharya Charaka To Understand Health Status

Introduction
INTRODUCTION
Health is a status which is in continuous exposure to change of internal

equilibrium. It is not a constant entity, but varying in nature. A healthy human life
needs to adjust with its external environment in order to maintain the dynamicity of
life. In Ayurveda healthy life is a pre-requisite for the attainment of purushartha1
(goals of life).
According to WHO, “health is a state of complete physical, mental and social

well-being and not merely the absence of disease or infirmity” 2. The amplitude of this
definition carries a powerful indication towards the need of well acknowledged
definition of health, which could cover all aspects of life. Thus this definition has
been the target of criticism since its formation in 1948. There was a massive change
that occurred within the perception of disease as a set of pathological process than a
state. Hence in 1984, WHO revised the definition of health as ‘the extent to which an
individual or group is able to realize aspirations and satisfy needs and to change or
cope with the environment’.
With regard to a common man, health is an essential resource for

maintaining their act of living. Social and personal relationships essentially depend
upon this resource. A comprehensive approach in defining health pertaining to
mental, intellectual, emotional and social aspects of a person was found more
beneficial in a practical sense. Moreover the ability of a person to handle stress, to
acquire skills and to maintain relationships will definitely depend on these parameters
of health. But for an Ayurvedic scholar, it was easy to skip this shift by application of
Dhatusamya lakshana mentioned by Acharya Charaka to understand health status.
Health is a relative state in which one is able to perform well physically,

mentally, socially and spiritually to express the full range of one’s unique
potentialities within the environment. Both health and illness are considered as
dynamic processes and each person is said to be located on a graduated scale or
continuous spectrum ranging from wellness and optimal functioning in every aspect
of one’s life at one end to illness culminating in death at the other end.3
Health is a common topic for all cultures and all communities. They have
their own concepts regarding the facts of health. In Greek philosophy health and
A Study to design prospective algorithms of diagnosis by screening variations in dhatusamya lakshanas 1

Introduction
harmony are considered equivalent. Harmony being defined as ‘being at peace with
the self, the community, God and cosmos’4. Thus health has evolved in multiple ways
in different streams of medicine.
Ayurveda has described health with a multidisciplinary approach. The

definition of swastha by Acharya Susrutha is popular, but not much practical,
whereas Acharya Charaka and Kasyapa had given more suited definitions for health.
Among them, dhatusamya lakshana of Charakacharya serves as a perfect definition
of health. This explanation of health includes components like physical, mental along
with spiritual and social aspects. It consists of eighteen factors which include Ruk
upashamana (absence of any discomfort), swara varna yoga (appearance of normal
voice and complexion), sareeropachaya (nourishment of body), balavridhi (proper
strength), abhyavahaaryabhilasha (desire for taking food), ruchiraaharakale (relish
the food), abhyavahritasya cha aharasya kale samyak jaranam (proper digestion of
the food taken at proper time), nidralaabho yadha kaalam (getting sleep at the
appropriate time), vaikaarinaam cha swapnaanam adarshana (absence of dreams
indicating morbidity), sukhena cha pratibodhanam (pleasant awakening), vata
mootra pureesha retasam mukthi (proper elimination of flatus, urine, stool and
semen) and sarvaakaarai mano budheendriyaanam cha avyaapatti (unimpairment of
mind, intellect and sensory faculties and association of all healthy symptoms) that are
relevant in the assessment of health status.5
Vikrithi according to classical thought is an alteration in equilibrium6 which is

often less noticed or ignored. Dhatusamya lakshanas indicate normalcy of health and
any deviation (expressed as signs and symptoms) is considered as an indicator of a
future disease or underlying pathology depending on the degree of variation. This
itself acts as a navigation point for the physician to reach a diagnosis. Diagnostic
wisdom of an Ayurvedic physician greatly depends on the signs and symptoms shown
by the patient. In other words, proper diagnosis of an ailment demands a practical
awareness of its signs and symptoms.
The technique adopted for analysing and in interpreting the principles of

diagnosis is always unique and distinctive in Ayurvedic science. Each and every
disease is described using the Nidanapanchaka that details the illness from its origin
to its manifestation. Among these five ways of understanding the disease, linga/roopa

Introduction
refers to the signs and symptoms of a disease that stands as the important tool for
understanding disease in its actual sense. Roopa gives knowledge about the involved
doshas and dushyas as well as the severity. According to the manifestation of
different roopa, one can assess the degree of vitiation of different dosha, its sites,
characteristics (like eka-doshaja, samsargaja or sannipataja vyadhis) and thereby
helps in planning the apt treatment modalities.
The Ayurvedic approach for correct diagnosis of a disease give importance to

the skill of the physician to differentiate and interpret the manifested symptoms. This
itself is the first step towards the principles of Ayurvedic treatment. Hence roopa
plays an important role in interpreting the nature of the disease for differential
diagnosis, prognosis and ultimately for proper treatment.
The five means of achieving knowledge about disease are nidana,

purvaroopa, roopa, samprapthi and upashaya7. This five means of diagnosis is
essential for understanding disease and its nature.
Classification of Roopa
Roopa can be classified into two types.
1. Samanya roopa
2. Vishesha roopa
Samanya Roopa
It represents the general features of a disease and helps to understand that disease.
Example: Samanya lakshana of Jwara are absence of sweating, rise in body

temperature and ache all over the body.8 Samanya lakshana of Gulma are stable or
mobile tumour developed between heart and umbilicus, sometimes it increases and
sometimes it decreases in its size.9 Samanya lakshana of Amavata are body ache, loss
of appetite, thirst, tiredness, heaviness, fever, indigestion and pain in all joints10.
Vishesha roopa
It represents the specificity that can happen within the same disease in
different persons and with difference in aetiology. For example vataja, pittaja,

Introduction
kaphaja, vatapittaja, vatakaphaja, pittakaphaja, sannipataja and aganthu jwara

lakshana.
Relation of roopa with vyadhi
One symptom may be common to many disease. For example fever is the
common symptom of many diseases having irregular onset and complicated origin.
One symptom may be related to only one disease (Prathyaathma niyatha lakshanas).
For example santapa (hyperpyrexia) is the symptom of fever only. Many symptoms
may be related to only one disease. For example many symptoms related to irregular
onset and complicated origin are found in fever. Many symptoms may be related to
many disease. For example many symptoms like irregular onset are found in different
diseases like fever, dyspnoea, hiccups etc11.
The symptoms can occur both as physiological as well as pathological. That is

the symptoms may be svabhavika (natural) or occurs as dosavaisamya (abnormality
of dosa), dhatuvaisamya (abnormality of dhatu), malavaisamya (abnormality of
mala), srotovaisamya (abnormality of channels), agnivaisamya (abnormality of
digestive enzyme), aharavaisamya (defective food), viharavaisamya (defective
activities), chikitsavaisamya (defective treatment), abhigata (trauma) and
visa(toxicity) etc.
Each and every disease will have its own Prathyathma lakshanas. But the
same lakshana can also be found in other diseases too. Through Prathyaathma
lakshana we get a complete picture about that disease which leads to proper diagnosis
and help to plan a better treatment.
Need of the Study
This is an era where people with mild disease are being exploited
economically in the name of complete health check-ups. Such a need has paved the
way for this study so that any affordable Ayurvedic substitute can be explored.
Development of a diagnostic algorithm is a humble attempt that can help to prevent
progression of pathology of many manageable diseases which if not interfered at the
right moment may progress into incurable diseases.
Algorithm is a systematic mathematical procedure that produces the answer

to a question or the solution of a problem in a finite number of steps 12. Here

Introduction
algorithms are based on variations in signs and symptoms and can serve as
prospective diagnostic tools. This will help as indicators of a future disease and act as
markers of undergoing pathogenesis (samprapthi). As chikitsa is defined as the
process of breaking of pathology (samprapthi vighatanam), this step by step approach
is essential pre-requisite for the proper diagnosis and management of disease.
Health is not just an issue of doctors, social services and hospitals. It is an

issue of social justice. Thus one should have adequate knowledge regarding the
dimensions and criteria which determine the status of health. The first arm of the
study was the review of literature. It gives a better understanding of the concept of
health. The different definitions of health were described. Among them dhatusamya
lakshana of Acharya Charaka was chosen as the guiding lamp because of its
practicability. The eighteen factors as described by Acharya Charaka denote the
proper functioning of various systems of human body. Detailed descriptions of each
lakshana were done.
The second arm of the study was divided into three parts. The first part was
the construction of algorithms. Algorithms of diagnosis connote the concept of
construction of algorithms of various symptoms, its possible progressions to different
diseases and thus an effective means of diagnosis. These symptoms for which
algorithms were developed may be signs of manifested diseases or prodromal signs of
future illnesses. In both cases, the constructed algorithms assist in the early and
prompt diagnosis of medical conditions. For this the variations of each dhatusamya
lakshana were noted. Out of these variations, some symptoms which have clinical
importance were selected and algorithms of diseases from these symptoms were
prepared. The textual references of symptoms in various diseases associated with
these variations were collected from Brihattrayee and Madhava nidana. These along
with variations in dhatusamya lakshana could function as an efficient aid for the
clinician in prompt diagnosis of the disease. The second part was the designing of an
Ayurvedic health check-up format based on dhatusamya lakshana.
The third part consists of a survey. In order to find out the practicality of
health check-up format a primary health survey was conducted among the students of
our college. Those who shows variation in dhatusamya lakshana were taken as
unhealthy candidates and others who show no variation were considered as healthy

Introduction
candidates. Then secondary survey was conducted among selected unhealthy

candidates and their variations were mapped through Algorithmic method to reach the
hints of diagnosis.
The aims and objectives of this study was,
1. To study Dhatusamya lakshanas in detail.

2. To construct a format for complete Ayurvedic health check-up.
3. To conduct a survey with a list of questionnaire based on Dhatusamya
lakshana.
4. To study the variations of dhatusamya lakshanas and design a Prospective
diagnostic algorithm.
The whole work was designed under five chapters.
 The first four chapters encloses descriptive literary part while the fifth chapter
deals with the survey.
 The first chapter includes health and its various dimensions, various
examinations in Ayurveda, definitions of health by different Acharya and the
supremacy of Dhatusamya lakshana.
 The second chapter is an overview of Dhatusamya lakshanas and how each
factor in Dhatusamya lakshana influence the health was detailed.
 The third chapter deals with the variations of Dhatusamya lakshana and
prospective diagnostic algorithms were constructed for the selected variations.
 The fourth chapter deals with the designing of Ayurvedic health check-up
format based on dhatusamya lakshana.
 The fifth chapter constitutes of survey – In primary survey, the health status of
students were checked using a questionnaire based on dhatusamya lakshana.
In the secondary survey, in-depth interview method was used and the
variations were mapped through algorithmic method to reach probable
diagnosis.

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Introduction

Health is a status which is in continuous exposure to change of internal

According to WHO, “health is a state of complete physical, mental and social

With regard to a common man, health is an essential resource for

Health is a relative state in which one is able to perform well physically,

A Study to design prospective algorithms of diagnosis by screening variations in dhatusamya lakshanas 1

Ayurveda has described health with a multidisciplinary approach. The

Vikrithi according to classical thought is an alteration in equilibrium6 which is

The technique adopted for analysing and in interpreting the principles of

A Study to design prospective algorithms of diagnosis by screening variations in dhatusamya lakshanas 2

The Ayurvedic approach for correct diagnosis of a disease give importance to

The five means of achieving knowledge about disease are nidana,

Roopa can be classified into two types.

Example: Samanya lakshana of Jwara are absence of sweating, rise in body

A Study to design prospective algorithms of diagnosis by screening variations in dhatusamya lakshanas 3

kaphaja, vatapittaja, vatakaphaja, pittakaphaja, sannipataja and aganthu jwara

Relation of roopa with vyadhi

The symptoms can occur both as physiological as well as pathological. That is

Need of the Study

Algorithm is a systematic mathematical procedure that produces the answer

A Study to design prospective algorithms of diagnosis by screening variations in dhatusamya lakshanas 4

Health is not just an issue of doctors, social services and hospitals. It is an

A Study to design prospective algorithms of diagnosis by screening variations in dhatusamya lakshanas 5

candidates. Then secondary survey was conducted among selected unhealthy

The aims and objectives of this study was,

1. To study Dhatusamya lakshanas in detail.

The whole work was designed under five chapters.

A Study to design prospective algorithms of diagnosis by screening variations in dhatusamya lakshanas 6

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