Possible Measures to Assess Functional States of Tridosha: a Critical Review

International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Review Article

Possible Measures to Assess Functional States of Tridosha: A Critical Review

Vandana Verma1, Sonam Agrawal2, Sangeeta Gehlot3

1Assistant Professor, 3Professor and Head, Department of KriyaSharir, Faculty of Ayurveda, Institute of Medical Science, Banaras Hindu University 2BAMS, MD (KriyaSharir)

Corresponding Author: VandanaVerma

ABSTRACT

Healthy and unhealthy state of a human being depends on normal and abnormal functional state of Tridosha, considering the physiological importance of Dosha in maintenance of homeostasis of the body Tridosha have been called as root (Dosha Dhatu Mala Moolam hi Shariram) of the body. All the functions of the body could be explained in terms of Dosha, Dhatu and Mala. Tridosha are the biological entities derived from Panchamahabhuta, responsible for regulation of all bodily functions and its regulation. Variation in functional state of Tridosha with respect to age, day-night, and season occurs to accommodate body with the environmental influences like sunrise, sunset and seasonal variations. Ayurveda has described three dynamic states of Tridosha, namely Sama (balanced state), Kshaya (hypo functional state) and Vriddhi (hyper functional) state/ state of excess accumulation. These states of Dosha could be assessed by observing the sign and symptoms produced in body by altered state of Dosha. This paper is aimed to summarize and analyze the descriptions regarding the hypo and hyper functional states of Tridosha (Dosha Kshya-Vriddhi) made by Ayurvedic scholars and suggest some objective parameters to assess the functional state of Tridosha. Keywords: Dosha, Dosha kshaya, Dosha vriddhi, Dhatu.

INTRODUCTION Panchamahabhuta, responsible for Ayurveda has considered that the regulation of all bodily functions. Both balanced state of Dosha, Dhatu and Mala quantitative and qualitative criteria have leads to state of health and their imbalanced been mentioned for describing the state produces disease. [1] This state of functional status of Dosha, Dhatu and Mala. equilibrium is maintained through not only Quantitative assessment is done by Anjali the definite quantity but also quality Pramana and qualitative assessment (functional state) of these factors i.e. Dosha through the observing their functions. Dhatu and Mala. [2] The state of health has Quantitative assessment: No quantitative been defined as the presence of equilibrium measurement has been described for in activities of Dosha, Agni, Dhatu, Mala assessment of Kshaya and Vriddhi of and calm and pleasant state of soul, sense Dosha. Acharya Sushruta in Dosha Dhatu organ and mind. [3] The state of health is Mala Kshaya Vriddhi Vigyaniyaya maintained until and unless these factors are Adhyayaa has mentioned that quantity of in equilibrium but results in diseases when Dosha, Dhatu and Mala couldn’t be given there is any discordance in them due to two reasons i.e. Vailakshayata (Vaishmaya). [1] (Ch.su.9/4) Tridosha are (individual variations due to different the biological entities derived from Prakriti, Sara and Sahanana) and

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Asthiravata (due to variation as per day, category produces disease. The Dosha night, age and season). [4] Although the dominant in psychosomatic constitution is Charaka has mentioned quantity (Anjali of mild category, do not produce any Pramana) of Pitta and Kapha Dosha as five disorders but only make the individual and six Anjali respectively but no Anjali susceptible for the disease of Dosha which Pramana has been mentioned for Vata is dominant in Prakriti. The assessment of Dosha. [5] Practically quantitative proportions of inherent Dosha assessment of Dosha is not possible, and (Doshaansha) in Prakriti is done by thus more emphasis has been given on observing the morphological, physiological qualitative assessment. and psychological traits described for each Qualitative Assessment: To assess the Doshaja Prakriti. functional state of Dosha the qualitative Now various research studies have assessment is advised, that is to observe the been attempted to specify biochemical, given characteristics in different functional hematological and genetic basis of state of Dosha. Qualitative assessment is constitutional types described in Ayurveda. done for both balanced and imbalanced state Difference in various biochemical parameter of Dosha. Balanced state is assessed by and hematological parameters have been observing distinct properties and functions found in different psychosomatic which have been ascribed to each Dosha constitutions and thus are responsible for and inherent proportion of Dosha which is different disease predisposition and can help present since birth i.e. Prakriti. The to uncover genes that may contribute to imbalanced state of Dosha is assessed for system level differences in individuals. [9, 10] making proper diagnosis, pathogenesis and extensive metabolizer genotype is found to treatment plan through observing the be associated with Pitta Prakriti while poor different proportion of Dosha in diseases. In metabolizer genotype in Kapha Prakriti state of Doshakshya the normal functions which is concurrent with the description of are found diminished while in state of Ayurveda that Pitta Prakriti individuals are Dosha Vriddhi augmented functions are having Teekshagni and Kapha Prakriti are observed. [6] having Mandagni. [11] For instance, Vata contributes to Variation in functional status of Dosha: manifestation of shape, cell division, Even in the physiological condition, signaling, movement, excretion of wastes, there is some discordance or Kshaya cognition and also regulates the activities of Vriddhi occurs naturally in these biological Kapha and Pitta. Kapha is responsible for factors i.e. Dosha, Dhatu, Mala, which is anabolism, growth and maintenance of not harmful because they do not produce structure, storage and stability. Pitta is any disease. [2] When this Kshaya Vridhhi primarily responsible for metabolism, will exceed beyond the physiological limit, thermo-regulation, energy homeostasis, disease will be produced. While describing pigmentation, vision, and host surveillance. the Anjali Pramana (measurements) of the [7, 8] body elements, Acharya Charaka has Qualitative measurement of Tridosha mentioned that these quantities can undergo through assessment of Prakriti: variation in the form of increase (Vriddhhi) Prakriti or Psychosomatic or decrease (Kshaya) in healthy individuals constitution of an individual is determined too. [5] through the different proportion of Tridosha Dosha accumulation beyond which is inherent from birth itself. Acharya physiological limit always lead to disorders. Charaka has described that Dosha Vriddhi is Degree of their accumulation can be of three categories mild (Heena), moderate measured with the expressions shown on (Madhyam) and severe (Pravara). [6] (The body functions. Dosha when aggravated Dosha Vriddhi of moderate and severe manifest their sign and symptoms in

International Journal of Health Sciences & Research (www.ijhsr.org) 220 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review accordance with degree of aggravation, opposite qualities. [17] Dalhan has named it Dosha in state of Kshaya give up their as Sahantirupa Vriddhi Chaya [18] normal execution and those in a state of Prakopa: The aggravated Dosha spreads to equilibrium carry out their normal functions. different parts of the body, causes [2] appearance of their own features, feeling of ill health, and occurrence of premonitory MATERIALS & METHODS symptoms and manifestation of diseases. [16] A comprehensive study was done on Dalhna has described it as Vilayanarupa descriptions related to different functional Vriddhhi. [18] Thus for treatment of disease, state of Tridosha, its characteristics of state of Dosha, causes of vitiation, sites etc. Kshaya and Vriddhi and measures to assess should be determined. [19] the different functional state of Tridosha. Physiological rhythmic variation in Descriptions were collected from various functional state of Dosha: A physiological Ayurvedic Samhita and recent research variation in activities of Dosha occurs in papers related to it were searched online relation with age, day and night, during from scientific sites viz. Pubmed, Google digestion [20] and season [21] but when this scholar, web of science by using keywords Kshaya Vriddhi will exceed beyond the like Dosha biorhythm, Dosha Kshaya and physiological limit, disease will be Vriddhi. The findings were analyzed in view produced. Description related to of modern physiology and research to physiological variations in bodily functions understand changes in functional state of and cellular mechanisms have been also Dosha and measures to assess it. mentioned in circadian and quotidian rhythm. All biophysical and biochemical REVIEW AND DISCUSSION parameters like heart rate, blood pressure, Various functional States of Dosha: WBCs, hormones show the physiological Whole body is abode of three state of the body which also varies as per Dosha, which brings about good and bad age, level of physical activity, climatic results according to their normal and changes, after meal intake. The similar abnormal state. [12] There are two aspects of description has been mentioned in Ayurveda Dosha i.e. Prakriti (natural) and Vaikrit in relation to Vata, Pitta and Kapha i.e. (morbid). [13] In normal state they are Tridosha which are responsible for all [22] Visham responsible for the growth, strength, and physiological and biochemical changes. a good complexion but on abnormalcy, results Mechanism of action of Tridosha Guna in in various type of diseases. [12] Again three state of altered physiological state-- types of Dosha Gati or Doshavastha have Types of hypo and hyper functional states been mentioned i.e. Kshaya, Sthana and of Dosha: 62 permutation of combination of Vriddhi. [14] In other words, Dosha have two Dosha manifest due to combination of three states, Samya and Vaishamaya. Vaishamaya Dosha in different proportion to each other. is of two types Kshaya and Vriddhhi, and For example one Dosha excessively Vriddhhi is again of two types Chaya and aggravated while other two aggravated or Prakopa. And thus there are four states vice versa, or these three Dosha are (Avastha) of Dosha i.e. Samya, Kshya, increased progressively, two Dosha may be Chaya and Prakopa. [15] increased while one is diminished, one Sama: Normalcy of Dosha in their Dosha may increase, one diminished while respective sites and non-manifestation of another is normal, or the three Dosha are diseases. [16] increased separately. [23] As the properties of Chaya: Increase of Dosha in their own sites Dosha are mutually contradictory to each which produces dislikes for the causative other, on combination may cause factors and liking for the factors having destruction to each other but due to their natural power of coexistence they do not

International Journal of Health Sciences & Research (www.ijhsr.org) 221 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review destroy each other in spite of mutually Agni Mahabhuta do resides in same contradictory qualities, just like the Dravaya without nullyfying each other and dangerous poison in body of snake does not producing Amla Rasa. Indian Gooseberry kill it. [24] Hormones, enzymes or (Embelica ribes) possess five Rasa, and neurotransmitters acting in body do not have pacifies Dosha through different Guna i.e. similar functions, somewhat are having Amla Rasa alleviates Vata Dosha, Madhura opposite functions to each other for example and Sheeta alleviates Pitta Dosha, Katu - insulin decreases the blood glucose level Tikta Rasa alleviates Kapha Dosha but while glucagon decreases blood glucose Amla Rasa does not destroy Vata Dosha level by stimulating or inhibiting different with Kashaya and Sheeta Guna , Madhura sets of enzymes, on deficiency of insulin the and Sheeta doesn’t destroy Pitta having secretion of glucagon is relatively decreased Amla Rasa. (Chakrapani on Ch.Su.17/62) due to sustained increased level of blood Modern physiology also describes the glucose. The hypersecretion of growth similar phenomenon as in case of hormonal hormones or glucocorticoids causes secretions, which are independently increased insulin resistant in spite of controlled through their releasing and increased insulin production. [25] inhibitory factors. Although it is also In state of Vata Kshaya (hypo mediated through certain circulatory factors functioning of Vata Dosha), characteristics for example secretion of Growth hormone is of Kapha Vriddhi (hyper functioning of controlled through releasing and inhibitory Kapha dosha) are produced. This relative factors from hypothalamus. The level of increase in features of Kapha Dosha are growth hormone is also controlled through found due to decrease in functioning of Vata circulatory factors like blood level of Dosha. The hypo or hyper functioning of glucose, amino acid, fatty acid, ghrelin, Dosha may be independent to each other or testosterone and conditions like trauma, relative to each other. This relationship of stress, excitement, starvation and fasting functioning of Dosha can be explained enhances the release of growth hormone. through the various feedback mechanism of But the increased level of glucose, free fatty hormonal and neurotransmitter interaction acid, somatomedin, and conditions like taking place in body for example in obesity and aging, decreases the secretion of Parkinsonism, due to degeneration of growth hormones. The factor influencing nigrostriatal neurons in the basal ganglion the secretion of one hormone will not have results in dopamine deficiency leads to necessarily same effect on production of imbalance between the activity of inhibitory other hormones. [25] Dopaminergic neuron and excitatory Causes of hypo and hyper functioning of cholinergic neuron, and produces enhanced Dosha: function of cholinergic neurons. [26] 1. Trividha Karana: Doshas are increased Independent feedback mechanism: Dosha due to improper association of sensory also show the independent feedback object with respective sense organ, Kala mechanism in their functioning. As the (time, season) and Karma (action). Each properties of Dosha are mutually of this is of three types, Hina contradictory to each other, on combination (inadequate), Mithya (improper) and Ati may cause destruction to each other but due (excess). [27] to their natural power of coexistence they do 2. Factors causing Aggravation of Dosha: not destroy each other in spite of mutually Each Dosha get aggravated by contradictory qualities, just like the overindulgence in diet and activities dangerous poison in body of snake does not which are having similar properties to kill it. [24] Mutually contradictory properties them. Indulgence in attributes having exists in Panchbhautika Dravya without similar or dissimilar properties to nullifying each other for example Jala and Dosha: Properties similar to Dosha

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results in increase while dissimilar Pichhila results in Prashama properties results in decrease. [28,29] Like (pacification) of Kapha [30] same should indulgence in substances having be understand for Pitta and Vata also. properties opposite of Guru, Sheeta, (Table 1) [31-34] Mridu, Snigdha, Madhura, Sthira,

Rasa (Taste) and qualities of food Eating behaviors Behaviors Physical activities Psychological attributes Vata Katu(pungent), Tikta(bitter), Kashaya Fasting, taking food Suppressing the Indulgence in over Excessive Dosha (Astringent) Rasa, dry , light , cold in at improper time urges of flatus, physical activity anxiety, fear, potency for example dry leafy urine, feces, like fighting with grief vegetables and meat, pulses semen, vomiting, stronger person or sneezing, belching animal. and tears Pitta Katu(Pungent),Amla(sour),Lavana(salt). Fasting, ingestion Over copulation Anger, grief, Dosha Ushna, Teekshna and food which are of food which fear light in digestion causes burning sensation inside abdomen during digestion. Kapha Madhura (sweet),Amla (sour), Lavana Overeating Day sleep, absence Dosha (salt), Cold unctuous and guru (heavy), of physical Pichhila (slimy), Abhisyandi (food activity, lassitude. producing blockage in channels). Eg. Cereals, curd, milk, Krishara, Payasa, product of sugarcane juice, meat and fat of animals of marshy region

3. Effect of therapeutic procedures: Prakopa of Dosha (Sham Prakopo Therapeutic procedures specifically, Doshaanam Sarveshaam Agnisansrito) Vamana (Emesis), Virechana [41] or aggravation and alleviation of (Purgation) and Basti (Enema) alleviates diseases, that’s why in some disease Kapha, Pitta and Vata respectively. [35] conditions like Arsha, Atisara and Snehana or oileation therapy alleviates Grahani the subject is advised to give Vata Dosha. [36] Raktamokshana special care for the maintenances of (bloodletting) through Shring, Jaloka Agni. [42] and Alaabu alleviates Vata, Pitta and 5. Role of Srotas: Kshya vriddhi of all Kapha Raktaja Vikara respectively. [37] body substances are carried out through Above mentioned conditions are Srotas, thus the functional state of therapeutic and maintains the normalcy Dosha is also depends on status of but when used improperly (i.e. improper srotas, All sorts of phenomenon taking drug, time), instead of pacifying the place in body are because of Srotas aggravated Dosha results in aggravation only. [43] of Dosha, for example excess (Atiyoga) Features of hypo functioning of Dosha: of Vamana and Virechana causes The diminution in Vata, Pitta and Kapha is aggravation of Vata Dosha. [38] indicated by decrease in their respective Excessive bloodletting too leads to normal functions or increase of their aggravation of Vata Dosha. [39] opposite functions. For example in hypo 4. State of Agni: Agni is one of the functioning of Vata, there will be deficient important factor maintaining the normal enthusiasm, hypo functioning of Pitta will status of Dosha, Dhatu and Mala. Agni result in indigestion, lack of appetite etc. [44] and Dosha are interdependent to each The diminished Dosha will not vitiate the other i.e. status of Dosha effects Agni Dhatu to produce illness, they just cease to and Agni also effects the functional manifest their normal functions. [6] This status of Dosha. Vata, Pitta and Kapha hypo functional state of Dosha could be brings about Vishamagni, Teekshagni understood as the manifestations resulting and Mandagni respectively. [40] Status of from decreased secretion of endocrine Agni is responsible for Shaman and hormones shows diminished action of that International Journal of Health Sciences & Research (www.ijhsr.org) 223 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review hormone. Deficiency in normal action of Uchhasvas & Nihashvas- RR, Spirometry Dosha will not necessarily lead to for assessing different pulmonary function aggravation of opposite action for example test. if enthusiasm goes down, it doesn’t meant Chesta- Reflexes, Muscle power, Muscle that grief would necessarily in excess. The tone, Body parts movements/minute aggravation or diminution of one action will Vegapravartana- Excretion of urine and not always lead to diminution or stool in normal quantity and in appropriate aggravation of other Dosha. time (Urge for defecation and micturition Features of hyper functioning of Dosha: and their voluntarily excretion) Dosha when gets aggravated Measures to assess functional state of produces sign and symptoms in accordance Vata Dosha [50] with their degree of aggravation. [6] It is a 1. Higher functions, Consciousness (state well-known fact that degree of of awareness of one's self and manifestations of sign and symptoms of any environment), emotional state, disease is directly related to its severity. For orientation in place and time, delusion example sign and symptoms of anemia and hallucination. depends upon its severity. Aggravation of 2. Motor system- muscle tone, Power Dosha is invariably indicated by something (lower range of normal power), reflexes, in excess of respective normal action. [45] gait, coordination of muscular activity Mechanism of Dhatu Kshaya vriddhi by (finger-to-nose test, heel –to- shin test, Dosha: The aggravated Dosha brings about rapid alternating movement) decrease or diminution of the Dhatu by their 3. Sensory system: clinical testing of own strength i.e. Pitta Dosha causes general sensation like touch (light touch, Kshapana due to its Katu und Ushna touch localization, two point property, Vata through Shoshana Karma discrimination), proprioception, pain, and Kapha through obstruction of channels temperature. (Margaavoradha) in the similar way as fire 4. ANS test: cold pressure test, hand grip when augmented evaporates the water in the test, Valsalva maneuver. pot by its own power. [46] This mechanism Characteristics of Hypo functioning of could be explained through the hormonal Vata Dosha [51-53] action like thyroid hormone, glucocorticoids Praseka ~excessive salivation etc., when secreted in excess causes Aruchi ~ anorexia increased catabolic activities and thus Hrillasa ~ nausea Sangyamoha/mudhsangyata ~ loss of consciousness decreasing the strength of the body. The Alpavakachesta ~ loss of speech and physical Dosha when gets vitiated (undergoes activity Apraharsha ~lack of happiness abnormal increase or decrease) causes Angsada ~debility vitiation of Rassadi Dhatu together and Agnivaishamaya ~disorders of digestive activity Shleshmavriddhalakshana ~ features of Kapha Vridhhi vitiates mala and in turn it vitiates the Bhasiteihitam ~loss of speech and physical [47] Malayana. activity. Assessment of functions of Vata Dosha by different parameters: Vata in normal state 1. Manda Cheshta (diminished carries out functions like enthusiasm, movements)- Upper(lesion in cranial nerve) inspiration expiration, movements, and and lower motor neuron normal metabolic transformation of tissue lesions(poliomyelitis, trauma in peripheral and proper elimination of excreta. [48] It is nerve), Parkinson disease, paraplegia, also responsible for proper functioning and hemiplegia etc. coordination of sensory and motor organs 2. Alpha vakatvam: (diminished speech): [49] These functions can be assessed through Motor Aphasia, dysarthria, temporal lobe certain parameters like syndrome, brain injury.

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3. Apraharsa: (lack of contentment/ pain produced in body is due to Vata Dosha. emotional instability) - frontal lobe Different type of pain sensation has been syndrome described in hyper functional state of Vata 4. Mudha sangyata: (sensory perception Dosha, which is very similar to the disorders) -Parietal cortical lesions. [54] description of modern science regarding the Hyper functioning of Vata Dosha: various characters of pain depending upon Ayurveda has conceived that any kind of pathology. [55-59]

Sransa ~to fall, droop , fall down , get loose from Vyaasa ~severing, separation, division Vyadha ~to pierce Swapa ~loss of sensation Saada ~weakness Ruka ~pain Toda ~pricking pain Bheda ~splitting pain Angabhanga ~crushing pain Sankocha ~contraction Varta ~twisting pain Asthishula ~pain in bones Harshana ~tingling sensation Tarshana ~thirst Kampa ~tremors Parushya ~roughness Soshirya ~cavitation Shosha ~dryness Spandana ~pulsation Veshthanam ~convulsion Stambha ~stiffness, rigidity, obstruction Kashayarasta ~astringent taste Vyatha ~sorrowful or unhappy Shyaava arunavarna ~blue or crimson discoloration Karshya ~emaciation Karshnya ~blackish discoloration Ushnakamatva ~desire of hot things Kampa ~trembling/ tremor/ shaking Balanidraindriyabhransha Diminished Bala, sleep and functions of sensory and motor organs. Aanaha/ Gadhavarchastva/ Malasanga ~constipation Alpabala ~lack of strength Pralapa ~delirium Bhrama ~fainting Deenata ~distress , weakness Gatrasphuran `~ throbbing sensation in limbs Sangyanaasha ~loss of consciousness Majjashosha ~decrease in bone marrow Aadhmaan ~flatulence Aatopa ~gurgling noise Moha ~delusion Dainya ~depression Bhaya ~fear Shoka ~grief

Disorders associated with features of 4. Ushna kamita (desire for warmth) - hyper function (Vriddhi) of Vata Dosha [60- Hypothermia, Hypoglycaemia, 62] Hypothyroidism. 1. Vaka Parushyam (hoarseness of voice)- 5. Gatra sphuran, Kampa Irritation or injury to vocal cord due to (twitching/convulsion, tremors) – Tics (non- Laryngitis, trauma. rhythmic stereotyped motor movements), 2. Karsya (Emaciation)- Anorexia nervosa, Anxiety, nervousness, cerebellar diseases, Starvation. Wilson diseases. 3. Karshnya (hyper pigmentation of the 6. Nidra nasha (Insomnia) – in Old age body) – ACTH dependent Cushing (physiological) – Anxiety, Irritable bowel syndrome, primary hypoadranalism. syndrome, Stress, Arthritis 8. Gadha Varchasvam (constipation) - Old age, Bad dietary habits, Drug induced-

International Journal of Health Sciences & Research (www.ijhsr.org) 225 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review opium, cannabis, iron, IBS, intestinal 7. Assessing certain psychological obstruction attributes like valor, courage, anger, Assessment parameters for different enthusiasms etc. through certain functions of Pitta Dosha: Pitta being in questionnaires related to personality. normal state is responsible for good vision, Characteristics of hypo functioning of good digestion, normal temperature, normal [52,53,67] hunger, normal thirst, bodily softness, Pitta Dosha [63, 64] Stambha ~ stiffness luster, happiness and intelligence. Shaitya ~ coldness Measures to assess the functional state of Aniyatatoda ~ irregular pain Arochaka ~ anorexia Pitta Dosha- Avipaka ~ indigestion 1. Visual acuity for distant and near vision, Angaparushya ~ roughness of the body color vision, field of vision. Kampa ~ tremor Gaurava ~ feeling of heaviness 2. BMR, core body temperature Nakhanayanshaukla ~ whitish coloration of nails and eyes 3. Hemoglobin , total iron binding capacity Prabhahaani ~ loss of luster Mandoanala ~ weakness of digestive fire 4. Skin color by derma spectrophotometer Mandoushmata ~decreased body temperature and RGB, Dryness of skin by Trans- Pathological conditions associated with epidermal water loss (TEWL). [61,68] 5. Biochemical analysis: - Analysis of hypo functioning of Pitta Dosha different kinds of digestive enzymes, 1. Arochaka (Anorexia): Acute viral hormone and other secretion like bile, hepatitis, tuberculosis, chronic smoking Gastrin, CCK, Secretin, Pancreatic or alcoholism, cirrhosis of liver, CRF. enzymes etc. to assess Pachakagni. All 2. Dyspepsia : peptic ulcer diseases, enzymes involved in Krebs cycle may esophageal spasm, acute gastritis, gall be analyzed to assess the Dhatvagni stone, pancreatic diseases, hepatic responsible for metabolism at tissue diseases, NSAIDS, Corticosteroids, iron level, LFT for the assessment of and potassium supplements Bhutagni. Assessing Agni Bala and 3. Mandoushmata(Hypothermia): Jaran Shakti (ability to bear hunger, hypothyroidism, hypopituitarism, frequency and quantity of meal intake exposure to cold temperature, and digestive capacity) by using Agni immersion in cold water. Assessment questionnaire. [65] 4. Pallor: Anemia Pittavrinanetratwaka/ ~yellow discoloration of urine, eye skin. 6. Hormonal analysis – can be done to Pittaavabhasta assess the functional status of Kshuta ~hunger Trita ~thirst Dhatvaagni and Bhutagni. Increased or Daha ~burning sensation decreased in concentration of hormones Alpanidrta ~lack of sleep Santapa ~ increased body temperature can be considered hyper and hypo Sheetakamitya ~desire for cold functioning of that Dhatvagni. Murchha ~fainting Hormones can be categorized to Balahani ~diminished strength Indriyadoubralya ~weakness of sensory organs different Dhatvagni group depending Glaani ~lassitude , exhaustion upon their action on different organs of Ojavisransa ~decreased Oja Daaha ~burning sensation the body. For example thyroxine, Raaga ~reddish discoloration growth hormone and insulin can be Ushma ~heat Paakita ~ inflammation or suppuration included under Mamsadhatvagni, Sweda ~perspiration glucocorticoids , insulin and glucagone Kleda ~moistness under Medodhatvagni, Vitamin D, Struti ~exudation Kotha ~putrefaction calcitonin and parathyroidhormone Sadan ~debility under Asthidhatvagni, testestesteron, Mada ~insanity Katuamala ~bitter sour taste in mouth estrogen and progesterone under Panduarunavarjita ~appearance of color other than [66] Shukradhatvagni etc. yellowish white and crimson Tiktasyata ~bitter taste in mouth Krodhaadi ~ psychological symptoms like anger etc.

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Features of hyper functioning of Pitta 1. Pittavabhasta (Hyperbilirubinemia): Dosha [56-59,69,70] Jaundice, Hemolytic Anemia, Characteristics of burning sensation Hyperpyrexia. produced due to aggravated Pitta 2. Bhrama(Vertigo): vestibular neuritis, depends upon sites (Dushya/Dhatu) and trauma, meningitis, brain stem ischemia associated Dosha: [71] terminologies like or infarction, migraine, multiple Dava, Daha etc. in different disorders sclerosis. associated with vitiation of Pitta. Following 3. Alpanidra (Lack of sleep) : are the words used in Ayurveda to express Hyperthyroidism, excessive caffeine the various types of burning sensation. intake Daha: severe burning sensation all over the 4. Santapa (Hyperthermia): pyogenic body infection, brain lesion, hyperthyroidism, Osha: burning sensation accompanied with diabetes insipidus. sweating and restlessness. Kapha Dosha Plosha: localized burning sensation without Functions of Prakrita Kapha- Kapha being sweating as through touched by flame. in normalcy is responsible for the functions Dava: burning sensation in mouth, lips, like unctuousness, cohesion, steadiness, palate. heaviness, virility, strength, forbearance, Davathu: burning sensation in eye and other patience and greedlessness. [72,73] sense organs. Assessment parameters for different Vidaha: various types of burning sensation functions of Kapha Dosha. in palm, sole and shoulders. 1. Bala – Fatigue Index (Generalized, Antardaha: burning sensation inside the Localized)/ internal and external. alimentary tract Assessment of Bala both physical and Dhumaka: feeling of movement of hot psychological through Sara assessment fumes inside the head, neck, throat and questionnaire [74] or by observing palate. Vyayama Shakti or stress response, Amlaka: burning sensation in alimentary Fatigue Index. Biochemical analysis of tract accompanied with pain in heart and Immunoglobulin, CD4, CD8 and TLC, sour belching. DLC. Shonitakleda: blackish discoloration, bad 2. Bandha: skin fold thickness, smell and thinness of blood. Anthropometry measurement. Mamsakleda: blackish discoloration with 3. Sneha-Lipid Profile, Skin Moisture, foul smell Skin Sebum Pathological conditions associated with 4. Dhruti- Short term and long term Pitta Dosha Vriddhi are [62, 68] Memory, cognition and conation, learning capacity. 5. Gaurava- BMI

Characteristics of hypo functioning of Kapha [52, 53, 67] Bhrama ~giddiness Udveshtana ~convulsion, contraction Anidra ~loss of sleep Angamarda ~pain in whole body Pariplosha ~mild burning sensation Toda ~pricking pain Dava ~burning sensation in mouth, lips and palate. Daaha ~severe burning sensation all over the body Sphotana ~splitting, cracking, tearing Vepana ~tremor/trembling Dhumayana ~movement of hot fumes from inside Sandhisaithiliya ~looseness of joints Hridayadrava ~palpitation Shleshmashayshunyata ~emptiness in seat of Kapha

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Pathological conditions associated with hypo functioning of Kapha Dosha: [61] Hypo salivation: dehydration, sialolithiasis Palpitation (Hridayadrava): Hypoglycemia, Hypovolumia, Atrial fibrillation, brady aarhythemias Features of hyper functioning of Kapha Dosha: [56,57,59,69,75] Agnisadana ~diminished digestive activity Praseka ~excess salivation Gouravam ~feeling of heaviness Shaitya ~coldness Swetaya ~white discoloration Slathangatva ~looseness of body parts Swasha ~dyspnea Kasa ~cough Atinidrata ~excess sleep Tandra ~inability to perception as through engrossed in sleep Sthoulya ~plumpness Angasada/ ~Fatigue,(Sada: exhaustion weariness) Srotopidhana ~obstruction in channels Murchha ~fainting Harllasa ~nausea Sandhivishlesha/ Sandhasthivishlesha ~looseness of joints Sthairya ~immobility Sneha ~unctuousness Kathinya ~hardness Kandu ~itching Sheeta ~coldness Gauravam ~heaviness Bandha ~obstruction Upalepa ~coating inside the channels Staimitya ~rigidity, immobility , numbness Shopha ~swelling Atinidrata ~excess sleep Swetavarna ~whitish discoloration Chirakarita ~delay in all activities Svaadulavana ~sweet and sour taste

Cough (Kasa): laryngitis, tumor, tracheitis, Vata resides in Asthi, Pitta in sweat and bronchitis, asthma, tuberculosis, pneumonia, Rakta, Kapha in remaining sites i.e. pulmonary edema, bronchiectasis etc. Rasa, Mamsa, Meda, Majja and Shukra, Dysponea (swasa): Pneumonitis, and due to this increase or decrease in hydrothorax, pulmonary embolism. one will result in same for the other Vomiting (Chhardi): raised intracranial except Asthi and Vayu. [76] pressure, meningitis, gastro paresis, diabetic 2. The person who has decrease of Dosha, ketoacidosis and Addison’s diseases. Dhatu, Mala or even Bala develops Hypersomnolence (Atinidra): obesity, desire for food and drinks which makes Narcolepsy, idiopathic them to increase, the person debilitated Hyper salivation (Praseka): disease of because of lack of food desires food and esophagus, intestine, stomach, nausea and after getting it , he gets over that vomiting. debility. [29] Avoiding the disliked food Overlapping Features of Vitiated Dosha- and indulgence of desired one helps in  Insomnia-Kapha Kshaya, Vata controlling the Kshaya and Vriddhi of Vriddhi Dosha. [77]  Dhumayana-Pitta Vriddhi, Kapha Increased Dosha produces desire of Kshaya substances having dissimilar property to Dosha while the decrease Dosha Principles of management of discordance produces desire of food substances Dosha: having similar properties. It is inbuilt 1. Dosha and Dhatu has intimate property of body elements to demand of relationship as Ashraya and Ashraiyi i.e. what is deficient, for example pica

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desire in iron deficiency anemia. Desire physician should have knowledge of for cold and sour things in case of Rakta features of normalcy or abnormalcy of Kshaya, [78] craving for fatty meat in Dosha. He should try to balance the Dosha case of Meda Kshaya, [78] flesh attached by increasing the decreased one and with bone (Asthibadhamamasta) in case decreasing the increased one. [83] of Asthi Kshaya, [79] desire for hot substances in case of Vata Vriddhi, CONCLUSION desire for cold things in case of Pitta When all the biological entities i.e. Vriddhi. [59] Dosha, Dhatu, Mala are within their 3. The decreased Dosha should be physiological limits qualitatively and increased, the Kupita Dosha should be quantitatively then it leads to state of health suppressed, the increased should be and any deviation(Kshaya and Vriddhi) removed and Sama Dosha should be beyond physiological limits produces maintained. [80] discomfort or diseased state of body. The 4. Generic concomitance (Samanya) Dosha according to their different augments the factors but variant factors functional state produces different type of (Vishesha) are responsible for the diseases and symptoms. Diseases produced diminution. [28] In case of DoshaVriddhi, by them might be either Samanayaja or Vishesha factors should be given in case Nanatamaja depending upon the type of of Dosha Vriddhi while Samanya factors etiological factor and aggravated Dosha. As should be given in case of Dosha diseased produced are innumerable in Kshaya. These principle may act numbers due to huge diversity in etiological through the receptor mechanism, the factor, degree of aggravation, site for Samanya factors augments the functions diseases production etc. it is a difficult task through agonist action while Vishesha to provide assessment criteria for the factors antagonizing their action. different functional state of Dosha (normal, 5. To follow diet and regimen described hypo and hyper functioning). However the for each seasons. For each season diet suggested criteria can serve a path for and regimen has been described which enlightening the scholars of Ayurveda to should be followed to maintain the have a broad prospective regarding the health. Shodhana Karma described in Kshaya Vriddhi of Dosha and thus better accordance to season should also be diagnosis and treatment. Again the objective applied for the maintenance of health. parameters provided for the assessment of The Dosha which are increased slightly normal functioning of Dosha, need some in Varsha, Hemanta, and Greeshma Ritu sort of associative study to proof its should be eliminated when they are consistency and if not then development of greatly increased i.e. in Sharad, Vasanta a better tool or parameters for the same. and Hemanta Ritu respectively. [81] Circadian rhythm is result of interaction REFERENCES between endogenous and exogenous 1. Sharma R.K., Das B, editor, (reprint factors. Following these guidelines may edition). Charaka Samhita of help in regulation of this interaction, by Agnivesha, Sutrasthana; Khudakchatushpadam Adhyaya: balancing the endogenous factor in Chapter 9, verse 4. Varanasi: accordance with exogenous factor. Choukhmbha Sanskrita Series office 6. The regimens which are of opposite 2014; p.184. qualities of that of habitat and disease 2. Sharma R.K., Das B, editor, (reprint [82] should be followed. edition). Charaka Samhita of Importance of Knowledge of Agnivesha, Sharirasthana; KshayaVriddhi of Dosha: Acharya Sharirvichayashariram: Chapter 6, verse Sushruta has advised that an intelligent

International Journal of Health Sciences & Research (www.ijhsr.org) 229 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review

4. Varanasi: Choukhmbha Sanskrita Metabolic Variability. Evid. Based Series office 2014; p.426. Complementary and Alternative 3. Murthy Shrikantha K.R. editor, (reprint Medicine. 2011 edition). Susruta Samhita of Sushruta, 12. Sharma R.K., Das B, editor, (reprint Sutra Sthana; Dosha dhatu mala kshaya edition). Charaka Samhita of vriddhi Adhyaya: chapter 15, verse 41. Agnivesha, Sutrasthana; Maharoga Varanasi: Choukhambha Orientalia Adhyaya: Chapter 20, verse 9. Varanasi: 2014; p. 110. Choukhmbha Sanskrita Series office 4. Murthy Shrikantha K.R. editor, (reprint 2014; p.362. edition). Sushruta Samhita of Sushruta, 13. Sharma R.K., Das B, editor, (reprint Sutra Sthana; Dosha dhatu mala kshaya edition). Charaka Samhita of vriddhi Adhyaya: chapter 15, verse 36. Agnivesha, Sutrasthana; Varanasi: Choukhambha Orientalia Kriayantahashirshiya Adhyaya: Chapter 2014; p.109. 17, verse 115. Varanasi: Choukhmbha 5. Sharma R.K., Das B, editor (reprint Sanskrita Series office 2014; p.334. edition). Charaka Samhita of 14. Sharma R.K., Das B, editor, (reprint Agnivesha, Sharirasthana; edition). Charaka Samhita of Sharirvichayashariram: Chapter 7, verse Agnivesha, Sutrasthana; 15. Varanasi: Choukhmbha Sanskrita Kriayantahashirshiya Adhyaya: Chapter Series office 2014; p.458. 17, verse 112. Varanasi: Choukhmbha 6. Sharma R.K., Das B, editor (reprint Sanskrita Series office 2014; p.333. edition). Charaka Samhita of 15. Murthy Shrikantha K.R., editor, (reprint Agnivesha, Sutrasthana; edition). Ashtanga Sangraha of Kriayantahashirshiya Adhyaya: Chapter Vagbhata, Sutra Sthana; Doshbhediya 17, verse 62. Varanasi: Choukhmbha Adhyaya: chapter20, verse5. Varanasi: Sanskrita Series office 2014; p.322. Choukhambha Orientalia 2012; p.371. 7. Namita P. Mahalle, Mohan V. Kulkarni, 16. Murthy Shrikantha K.R. editor, Narendra M. Pendse, Sadanand S. Naik. (10thedition). Ashtanga Hridaya of Association of constitutional type of Vagbhatta, Sutra Sthana; Doshbhediya Ayurveda with cardiovascular risk Adhyaya: chapter12, verse23. Varanasi: factors, inflammatory markers and Choukhambha Krishandas Academy insulin resistance. J Ayurveda Integr 2014; p.171. Med. 2012; 3(3): 150–157. doi: 17. Murthy Shrikantha K.R., editor, 10.4103/0975-9476.100186.PMCID: (10thedition). Ashtanga Hridaya of PMC3487241. Vagbhatta, Sutra Sthana; Doshbhediya 8. Svoboda Robert E. Prakriti: Your Adhyaya: chapter12, verse22. Varanasi: Ayurvedic Constitution. Motilal Choukhambha Krishandas Academy Banarsidass Publishers. 2005 2014; p.170. 9. Prasher B, Negi S, Aggarwal S, Mandal 18. Murthy Shrikantha K.R., editor, (reprint AK, Sethi TP, Deshmukh SR, et al. edition). Sushruta Samhita of Sushruta, Whole genome expression and Sutra Sthana; Vranaprashana Adhyaya: biochemical correlates of extreme chapter21, verse 8. Varanasi: constitutional types defined in Choukhambha Orientalia 2014; p.157. Ayurveda. J Trans Med. 2008; 6:48. 19. Murthy Shrikantha K.R., editor, 10. Patwardhan B, Joshi K, Chopra A , (10thedition). Ashtanga Hridaya of Classification of human population Vagbhatta, Sutra Sthana; Doshabhediya based on HLA gene polymorphism and Adhyaya: chapter12, verse 66. the concept of Prakriti in Ayurveda. J Varanasi: Choukhambha Krishandas Altern Complement Med 2005; 11: Academy 2014; p.179. 349–53. 20. Murthy Shrikantha K.R. editor, 11. Ghodke Y, Joshi K, Patwardhan (10thedition). Ashtanga Hridaya of B.Taditional medicine to modern Vagbhata, Sutra Sthana; Ayushkamiya Pharmacogenomics: Ayurveda Prakriti Adhyaya: chapter1, verse 7. Varanasi: Type and CYP2C19 Gene Choukhambha Krishandas Academy Polymorphism Associated with the 2014; p.6.

International Journal of Health Sciences & Research (www.ijhsr.org) 230 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review

21. Murthy Shrikantha K.R., editor, verse 61. Varanasi: Choukhmbha (10thedition). Ashtanga Hridaya of Sanskrita Series office 2014; p.43. Vagbhatta, Sutra Sthana; Doshabhediya 31. Murthy Shrikantha K.R., editor, Adhyaya: chapter12, verse24. Varanasi: (10thedition). Ashtanga Hridaya of Choukhambha Krishandas Academy Vagbhatta, Sutra Sthana; Ayushkamiya 2014; p.171. Adhyaya: chapter 1, verse15. Varanasi: 22. Verma V, Agrawal S, Gehlot S. Choukhambha Krishandas Academy Ayurveda perspective in Chrono 2014; p.6. biological concerns in human biology. J 32. Murthy Shrikantha K.R. editor, (reprint Res Edu Indian Medicine. Online first edition) Sushruta Samhita of Sushruta, October 2017. Doi: 10.5455/JREIM.82- Sutra Sthana; Vranaprashniya Adhyaya: 1506402458. chapter 21, verse 19-24. Varanasi: 23. Sharma R.K., Das B, editor, (reprint Choukhambha Orientalia 2014; p. 158- edition). Charaka Samhita of 159. Agnivesha, Sutrasthana; 33. Murthy Shrikantha K.R., editor, Kriayantahashirshiya Adhyaya: Chapter (10thedition). Ashtanga Hridaya of 17, verse 41-42. Varanasi: Choukhmbha Vagbhatta, Nidanasthana; Sanskrita Series office 2014; p.317. Sarvaroganidana Adhyaya: chapter 1, 24. Sharma R.K., Das B, editor,(reprint verse14-17. Varanasi: Choukhambha edition). Charaka Samhita of Krishandas Academy 2014; p.7-8. Agnivesha, Chikitsasthana; 34. Kumari A, Tiwari PV, editor, (1st Trimarmiyachitisam: Chapter26, verse edition). Yogratanakar , Basic concept 293. Varanasi: Choukhmbha Sanskrita of Ayurveda: chapter 1, verse Series office 2014; p.548. 153.Varanasi: Chaukhambha 25. John E.Hall. Guyton and Hall textbook Visvabharti 2010;p..23. of medical physiology. Reprint edition. 35. Murthy Shrikantha K.R. editor, A south Asian publication, Elsevier (10thedition). Ashtanga Hridaya of 2014. Vagbhatta, Sutra Sthana; Ayushkamiya 26. Padmja Udaykumar. Medical Adhyaya: chapter 1, verse25. Varanasi: pharmacology. 4th edition. New Delhi: Choukhambha Krishandas Academy CBS publishers and distributors. 2013, 2014; p. 14. p. 259 36. Sharma R.K., Das B, editor,(reprint 27. Murthy Shrikantha K.R., editor, edition). Charaka Samhita of (10thedition). Ashtanga Hridaya of Agnivesha, Siddhisthana; Kalpanasiddhi Vagbhatta, Sutra Sthana; Doshabhediya Adhyaya: Chapter 1, verse 7. Varanasi: Adhyaya: chapter12, verse35. Varanasi: Choukhmbha Sanskrita Series office Choukhambha Krishandas Academy 2014; p.143. 2014; p.172-73. 37. Murthy Shrikantha K.R., editor, (reprint 28. Sharma R.K., Das B, editor, (reprint edition). Sushruta Samhita of Sushruta, edition). Charaka Samhita of Sutra Sthana; Jalokaavcharniya Agnivesha. Sutrasthana; Adhyaya: chapter13, verse 4. Varanasi: Deerghajivatiyo Adhyaya: Chapter 1, Choukhambha Orientalia 2014; p.78. verse 44. Varanasi: Choukhmbha 38. Murthy Shrikantha K.R., editor,(reprint Sanskrita Series office 2014; p. 26. edition). Sushruta Samhita of Sushruta, 29. Murthy Shrikantha K.R., editor, (reprint Chikitsasthana; Vamana virechana edition). Sushruta Samhita of Sushruta, vyapadachilitasam: chapter 34, verse Sutra Sthana; Dosha dhatu mala kshaya 11. Varanasi: Choukhambha Orientalia vriddhi Adhyaya: chapter15, verse29. 2014; p.323. Varanasi: Choukhambha Orientalia 39. Murthy Shrikantha K.R., editor, (reprint 2014; p.106. edition). Sushruta Samhita of Sushruta, 30. Sharma R.K., Das B, editor, (reprint Sutra Sthana; Shonitavarniya Adhyaya: edition). Charaka Samhita of chapter14, verse 37. Varanasi: Agnivesha, Sutrasthana; Choukhambha Orientalia 2014; p.95. Deerghajivatiyo Adhyaya: Chapter 1, 40. Murthy Shrikantha K.R., editor, (reprint edition). Sushruta Samhita of Sushruta,

International Journal of Health Sciences & Research (www.ijhsr.org) 231 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review

Sutra Sthana; Aturopakramaniya Agnivesha, Sutrasthana; Adhyaya: chapter 35, verse 25. Vatakalaakaliya Adhyaya: Chapter 12, Varanasi: Choukhambha Orientalia verse 7. Varanasi: Choukhmbha 2014; p. 248. Sanskrita Series office 2014; p.239. 41. Sharma R.K., Das B, editor, (reprint 50. Ghai CL editor (8th edition). A text book edition). Charaka Samhita of of Practical physiology, Clinical Agnivesha, Chikitsasthana: examination of nervous system. New Gulmachikitsm Chapter 5, verse 136. Delhi: Jaypee brothers medical Varanasi: Choukhmbha Sanskrita Series publishers (P) Ltd, 2013, page no 276- office 2014; p.287. 309. 42. Sharma R.K., Das B, editor, (reprint 51. Murthy Shrikantha K.R., editor, edition). Charaka Samhita of (10thedition). Ashtanga Hridaya of Agnivesha, Chikitsasthana; Vagbhatta, Sutrasthana; Dosha Arshachikitasma: Chapter 14, verse adivigyaniya Adhyaya: chapter 11, 244-45. Varanasi: Choukhmbha verse 15. Varanasi: Choukhambha Sanskrita Series office 2014; p. 630. Krishandas Academy 2014; p.158. 43. Sharma R.K., Das B, editor, (reprint 52. Murthy Shrikantha K.R., editor, (reprint edition). Charaka Samhita of edition). Ashtanga Sangraha of Agnivesha, Vimanasthana; Vagbhatta, Sutrasthana; Dosha Srotovimaniya Adhayaya: Chapter 5, adivigyaniya Adhyaya: chapter 19, verse 3. Varanasi: Choukhmbha verse 5. Varanasi: Choukhambha Sanskrita Series office 2014; p. 171. Oreintalia 2012; p.353. 44. Sharma R.K., Das B, editor, (reprint 53. Murthy Shrikantha K.R., editor, (reprint edition). Charaka Samhita of edition). Sushruta Samhita of Sushruta, Agnivesha, Sutrasthana; Sutra Sthana; Dosha dhatu mala kshaya Athatatrishothiyaadhyaya: Chapter 18, vriddhi Adhyaya: chapter 15, verse 7. verse 52. Varanasi: Choukhmbha Varanasi: Choukhambha Orientalia Sanskrita Series office 2014; p.346. 2014; p.100. 45. Sharma R.K., Das B, editor, (reprint 54. K Sembulingam, Prema Sembulingam. edition). Charaka Samhita of Essentials of medical physiology.6th Agnivesha, Sutrasthana; edition.New Delhi: Jaypee Brothers Athatatrishothiyaadhyaya: Chapter 18, Medical Publishers (P) Ltd.2012. verse 53. Varanasi: Choukhmbha 55. Murthy Shrikantha K.R., editor, Sanskrita Series office 2014; p.347. (10thedition). Ashtanga Hridaya of 46. Murthy Shrikantha K.R., editor, (reprint Vagbhata, Sutrasthana; Doshabhediya edition). Sushruta Samhita of Sushruta, Adhyaya: chapter 12, verse 49-50 Sutra Sthana; Dosha dhatu mala kshaya Varanasi: Choukhambha Krishandas vriddhi Adhyaya: chapter 15, verse 36. Academy 2014; p.176. Varanasi: Choukhambha Orientalia 56. Murthy Shrikantha K.R., editor, (reprint 2014; page no 109. edition). Ashtanga Sangraha of 47. Murthy Shrikantha K.R., editor, Vagbhata, Sutrasthana; Doshabhediya (10thedition). Ashtanga Hridaya of Adhyaya: chapter 20, verse 16. Vagbhatta, Sutrasthana; Varanasi: Choukhambha Oreintalia Doshaadivigyaniya Adhyaya: chapter 2012; p. 376. 11, verse 35-36. Varanasi: 57. Murthy Shrikantha K.R., editor, (reprint Choukhambha Krishandas Academy edition). Ashtanga Sangraha of 2014; p.163. Vagbhatta, Sutrasthana; 48. Sharma R.K., Das B, editor, (reprint Doshaadivigyaniya Adhyaya: chapter edition). Charaka Samhita of 19, verse 3. Varanasi: Choukhambha Agnivesha, Sutrasthana; Oreintalia 2012; p.350. Athatatrishothiyaadhyaya: Chapter 18, 58. Murthy Shrikantha K.R., editor, verse 49. Varanasi: Choukhmbha (10thedition). Ashtanga Hridaya of Sanskrita Series office 2014; p. 346. Vagbhatta. Sutrasthana; Dosha 49. Sharma R.K., Das B, editor, (reprint adivigyaniya Adhyaya: chapter 11, edition). Charaka Samhita of

International Journal of Health Sciences & Research (www.ijhsr.org) 232 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review

verse 5-6 .Varanasi: Choukhambha verse 16.Varanasi: Choukhambha Krishandas Academy 2014; p.156. Krishandas Academy 2014; p.156. 59. Murthy Shrikantha K.R., editor, (reprint 70. Murthy Shrikantha K.R., editor, edition.) Sushruta Samhita of Sushruta, (10thedition). Ashtanga Hridaya of Sutra Sthana; Dosha dhatu mala kshaya Vagbhatta, Sutrasthana; Doshabhediya vriddhi Adhyaya: chapter 15, verse 13. Adhyaya: chapter 12, verse52. Varanasi: Choukhambha Orientalia Varanasi: Choukhambha Krishandas 2014; p. 102. Academy 2014; p.176. 60. Michael Swash, Michael Glynn. 71. Murthy Shrikantha K.R., editor, (reprint Hutchison’s Clinical methods.22nd edition). Ashtanga Sangraha of edition. Elsevier, 2007. Vagbhatta, Sutrasthana; Doshabhediya 61. Kundu A K. Bedsides clinics in Adhyaya: chapter 20, verse 12. medicines.5th edition. Kolkata: Varanasi: Choukhambha Oreintalia Academic publishers.2006. 2012; p. 375. 62. Graham Douglas, Fiona Nicol, Colin 72. Sharma R.K., Das B, editor, (reprint Robertson. Macleod’s clinical edition). Charaka Samhita of examination.13th edition. Elsevier 2013. Agnivesha, Sutrasthana; 63. Sharma R.K., Das B, editor, (reprint Athatatrishothiyaadhyaya: Chapter 18, edition). Charaka Samhita of verse 51. Varanasi: Choukhmbha Agnivesha, Sutrasthana; Sanskrita Series office 2014; p. 346. Athatatrishothiyaadhyaya: Chapter 18, 73. Sharma R.K., Das B, editor,(reprint verse 50. Varanasi: Choukhmbha edition). Charaka Samhita of Sanskrita Series office 2014; p. 346. Agnivesha, Sutrasthana; 64. Sharma R.K., Das B, editor, (reprint Vatakalaakaliya Adhyaya: Chapter 12, edition). Charaka Samhita of verse 12. Varanasi: Choukhmbha Agnivesha, Sutrasthana; Sanskrita Series office 2014; p.241. Vatakalaakaliya Adhyaya: Chapter 12, 74. Gunawat CP, Singh G, Patwardhan K, verse 11. Varanasi: Choukhmbha Gehlot S. Weighted mean : A possible Sanskrita Series office 2014; p.240. way to express overall Dhatu Sarata.J 65. Singh A, Singh G, Patwardhan K, Ayurveda Integr Medicine. Gehlot S. Develapment, validation, and 2015;6(4):286-289.Doi 10.4103/0975- verification of self-assessment tool to 9476.172386 estimate Agnibala (digestive strength). 75. Murthy Shrikantha K.R., editor, Journal of Evidence based (10thedition). Ashtanga Hridaya of complementary and alternative Vagbhatta. Sutrasthana; Doshabhediya medicine. 2017 Jan;22(1):134-140. Adhyaya: chapter 12, verse 52. 66. Patwardhan K. Human Physiology in Varanasi: Choukhambha Krishandas Ayurveda. Reprint edition. Varanasi: Academy 2014; p.176. Chaukhmbha Orientalia; 2013,48. 76. Murthy Shrikantha K.R., editor, 67. Murthy Shrikantha K.R., editor, (10thedition). Ashtanga Hridaya of (10thedition) Ashtanga Hridaya of Vagbhatta. Sutrasthana; Vagbhatta. Sutrasthana; Dosha Doshaadivigyaniya Adhyaya: chapter adivigyaniya Adhyaya: chapter 11, 11, verse 26-27 .Varanasi: verse 16. Varanasi: Choukhambha Choukhambha Krishandas Academy Krishandas Academy 2014; page no 2014; p.160. 158. 77. Murthy Shrikantha K.R., editor, 68. Brian R. Walker, Nicki R. Colledge, (10thedition). Ashtanga Hridaya of Stuart H. Ralston, Ian D. Penman. Vagbhatta. Sutrasthana; Dosha Davidson’s principles and practices of adivigyaniya Adhyaya: chapter 11, medicine. 22nd edition. Elsevier verse 42. Varanasi: Choukhambha 69. Murthy Shrikantha K.R., editor, Krishandas Academy 2014; p.164. (10thedition). Ashtanga Hridaya of 78. Murthy Shrikantha K.R., editor, (reprint Vagbhatta, Sutrasthana; Dosha edition.). Sushruta Samhita of Sushruta, adivigyaniya Adhyaya: chapter 11, Sutra Sthana; Dosha dhatu mala kshaya vriddhi Adhyaya: chapter 15, verse 9.

International Journal of Health Sciences & Research (www.ijhsr.org) 233 Vol.8; Issue: 1; January 2018 Vandana Verma et al. Possible Measures to Assess Functional States of Tridosha: A Critical Review

Varanasi: Choukhambha Orientalia Sutra Sthana; Ritucharya Adhyaya: 2014; p. 100. chapter 6, verse 12. Varanasi: 79. Murthy Shrikantha K.R., editor, (reprint Choukhambha Orientalia 2014; p. 41. edition). Ashtanga Sangraha of 82. Sharma R.K., Das B, editor, (reprint Vagbhatta, Sutrasthana; edition). Charaka Samhita of Doshaadivigyaniya Adhyaya: chapter Agnivesha, Sutrasthana; Tashyaasitiya 19, verse 10. Varanasi: Choukhambha Adhyaya: Chapter 6, verse 50. Varanasi: Oreintalia 2012; p.358. Choukhmbha Sanskrita Series office 80. Murthy Shrikantha K.R , editor, (reprint 2014; p.144. edition.). Sushruta Samhita of Sushruta, 83. Murthy Shrikantha K.R.,editor, (reprint Chikitsa Sthana; Vamana edition.) Sushruta Samhita of Sushruta, virechanasadyoupdravachikitsam: Sutra Sthana; Dosha dhatu mala kshaya chapter33, verse3. Varanasi: vriddhi Adhyaya: chapter 15, verse 40. Choukhambha Orientalia 2014; p. 307. Varanasi: Choukhambha Orientalia 81. Murthy Shrikantha K.R.,editor, (reprint 2014; p. 110. edition.) Sushruta Samhita of Sushruta,

How to cite this article: Verma V, Agrawal S, Gehlot S. Possible measures to assess functional states of tridosha: A critical review. Int J Health Sci Res. 2018; 8(1):219-234.

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