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Ayulakhshan were also stated and if physician see those (ayulakshana) signs and symptoms then without wasting any time a physician should start his treatment. Hence a physician must have a keen observation in identifying the arishtalakshana as well as ayulakshana.

Ayulakhshan were also stated and if physician see those (ayulakshana) signs and symptoms then without wasting any time a physician should start his treatment. Hence a physician must have a keen observation in identifying the arishtalakshana as well as ayulakshana.

Acharya Vagbhata in Ashtanga Hrdayam says that, <blockquote>अरिष्टं नास्ति मरणम् दृष्टरिष्टं च जीवितम् । (Asht. Hrda. 5.२)</blockquote><blockquote>ariṣṭaṁ nāsti maraṇam dr̥ṣṭariṣṭaṁ ca jīvitam ।</blockquote>Similarly Achrya Charaka mentions that, <blockquote>अप्येवं तु भवेत् पुष्पं फलेनाननुबन्धि यत् । फलं चापि भवेत् किञ्चिद्यस्य पुष्पं न पूर्वजम् ।।</blockquote><blockquote>न त्वरिष्टस्य जातस्य नाशोऽस्ति मरणादृते । मरणं चापि तन्नास्ति यन्नारिष्टपुरःसरम्।।</blockquote><blockquote>apyevaṁ tu bhavet puṣpaṁ phalenānanubandhi yat । phalaṁ cāpi bhavet kiñcidyasya puṣpaṁ na pūrvajam ।।</blockquote><blockquote>na tvariṣṭasya jātasya nāśo'sti maraṇādr̥te । maraṇaṁ cāpi tannāsti yannāriṣṭapuraḥsaram।।</blockquote>Charak sutra from Charaka Indriya 2/4-5

Acharya Vagbhata in Ashtanga Hrdayam says that, <blockquote>अरिष्टं नास्ति मरणम् दृष्टरिष्टं च जीवितम् । (Asht. Hrda. 5.2)<ref>Ashtanga Hrdayam ([https://archive.org/details/Ashtanga.Hridaya.of.Vagbhata/page/n603 Sharirasthanam Adhyaya 5 Sutra 2])</ref></blockquote><blockquote>ariṣṭaṁ nāsti maraṇam dr̥ṣṭariṣṭaṁ ca jīvitam ।</blockquote>Similarly Achrya Charaka mentions that, <blockquote>अप्येवं तु भवेत् पुष्पं फलेनाननुबन्धि यत् । फलं चापि भवेत् किञ्चिद्यस्य पुष्पं न पूर्वजम् ।।</blockquote><blockquote>न त्वरिष्टस्य जातस्य नाशोऽस्ति मरणादृते । मरणं चापि तन्नास्ति यन्नारिष्टपुरःसरम्।। (Char. Samh. 2.4-5)<ref>Charaka Samhita ([http://niimh.nic.in/ebooks/ecaraka/?mod=read Indriyasthanam Adhyaya 2 Sutra 4-5])</ref></blockquote><blockquote>apyevaṁ tu bhavet puṣpaṁ phalenānanubandhi yat । phalaṁ cāpi bhavet kiñcidyasya puṣpaṁ na pūrvajam ।।</blockquote><blockquote>na tvariṣṭasya jātasya nāśo'sti maraṇādr̥te । maraṇaṁ cāpi tannāsti yannāriṣṭapuraḥsaram।।</blockquote>Meaning: The flower may sometimes be devoid of fruits and sometimes even the fruits may be produced without being preceded by flowers. But once an arishta manifests, it doesn’t depart without ensuing in death. Conversely, death can not occur without earlier manifestation of arishta.

 

Meaning: The flower may sometimes be devoid of fruits and sometimes even the fruits may be produced without being preceded by flowers. But once an arishta manifests, it doesn’t depart without ensuing in death. Conversely, death can not occur without earlier manifestation of arishta.

== Failure to understand Arishtas ==

== Failure to understand Arishtas ==

Illusion about Arishtas

Illusion about Arishtas

Acharya Vagbhata has clearly mentioned that one may fail to recognize the Arishtas or differentiate them from clinical features of diseases. Arishta like clinical features might be seen even when the Doshas are present in even more than their excess levels. <blockquote>दोषाणामपि बाहुल्याद्रिष्टाभासः समुद्भवेत् । (Asht. Hrda. 5.३)</blockquote><blockquote>doṣāṇāmapi bāhulyādriṣṭābhāsaḥ samudbhavet ।</blockquote>This inability to identify and differentiate between Arishtas and clinical features of excessive levels of Doshas might cause physician to land in difficult situation. This happens because of Prajnaparadha of the physician making the Vaidya and Rugna suffer. Arishtas are wrongly interpreted due to subtle nature of these symptoms, ignorance or stupidity of the physician or because such symptoms are very closely followed by the death of the patient.[4].<blockquote>मिथ्यादृष्टमरिष्टाभमनरिष्टमजानता| अरिष्टं वाऽप्यसम्बुद्धमेतत् प्रज्ञापराधजम्||६||</blockquote><blockquote>mithyādr̥ṣṭamariṣṭābhamanariṣṭamajānatā| ariṣṭaṁ vā'pyasambuddhametat prajñāparādhajam||6||</blockquote>Meaning: An ignorant person may sometimes wrongly perceive symptoms presenting in an individual as arishta lakshana and sometimes he may even not recognize the arishta lakshana presenting in an individual, all this is the result of intellectual errors

Acharya Vagbhata has clearly mentioned that one may fail to recognize the Arishtas or differentiate them from clinical features of diseases. Arishta like clinical features might be seen even when the Doshas are present in even more than their excess levels. <blockquote>दोषाणामपि बाहुल्याद्रिष्टाभासः समुद्भवेत् । (Asht. Hrda. 5.3)<ref>Ashtanga Hrdayam ([https://archive.org/details/Ashtanga.Hridaya.of.Vagbhata/page/n603 Sharirasthanam Adhyaya 5 Sutra 3])</ref></blockquote><blockquote>doṣāṇāmapi bāhulyādriṣṭābhāsaḥ samudbhavet ।</blockquote>This inability to identify and differentiate between Arishtas and clinical features of excessive levels of Doshas might cause physician to land in difficult situation. This happens because of Prajnaparadha of the physician making the Vaidya and Rugna suffer. Arishtas are wrongly interpreted due to subtle nature of these symptoms, ignorance or stupidity of the physician or because such symptoms are very closely followed by the death of the patient.<ref name=":0">Nipane Mayur S et al / Int. J. Res. Ayurveda Pharm. 9 (1), 2018</ref><blockquote>मिथ्यादृष्टमरिष्टाभमनरिष्टमजानता| अरिष्टं वाऽप्यसम्बुद्धमेतत् प्रज्ञापराधजम्||६|| (Char. Samh. 2.6)<ref>Charaka Samhita ([http://niimh.nic.in/ebooks/ecaraka/?mod=read Indriyasthanam Adhyaya 2 Sutra 6])</ref></blockquote><blockquote>mithyādr̥ṣṭamariṣṭābhamanariṣṭamajānatā| ariṣṭaṁ vā'pyasambuddhametat prajñāparādhajam||6||</blockquote>Meaning: An ignorant person may sometimes wrongly perceive symptoms presenting in an individual as arishta lakshana and sometimes he may even not recognize the arishta lakshana presenting in an individual, all this is the result of intellectual errors

== Ways to overcome Arishta laxnas ==

== Ways to overcome Arishta laxnas ==

Acharya Sushruta has briefly mentioned the exceptions for every death followed by appearance of Arishta laxanas. He says that even though the death is certain once Arishtas appear, there are certain exceptions or ways which have capacity to ward off this impending death.  <blockquote>ब्राह्मणैस्तत् किलामलैः | रसायनतपोजप्यतत्परैर्वा निवार्यते ||५|| <ref>Sushruta Samhita ([http://niimh.nic.in/ebooks/esushruta/?mod=read Sutrasthanam Adhyaya 28 Sutram 5])</ref> </blockquote><blockquote>brāhmaṇaistat kilāmalaiḥ | rasāyanatapojapyatatparairvā nivāryate ||5||</blockquote><blockquote>रिष्टेऽपि मरणनिवृत्तिमुपायविशेषैराह- ब्राह्मणैरित्यादि| किलशब्दोऽत्रागमार्थं सूचयति; एवं किल आगमे प्रतिपादितमित्यर्थः| अमलैरिति रागादिदोषरहितैः| ब्राह्मणेभ्योऽपरानपि दर्शयन्नाह- रसायनतपोजप्येत्यादि|- रसायनपरा इति स्वभावव्याधिनिवारणविशिष्टौषधचिन्तकाः, ते रसवीर्यौषधप्रभावेण मरणं निवारयन्ति| तथा तपःपराः तपस्विनः, तेऽपि विशिष्टतपःप्रभावेण मरणं निवारयन्ति | जप्यपराः सिद्धमन्त्रचिन्तकाः, तेऽपि मन्त्रशक्तियुक्ताः पञ्चत्वं निषेधयन्ति | एतच्च नियतानियतरिष्टविषयं ज्ञेयम्||५||</blockquote><blockquote>riṣṭe'pi maraṇanivr̥ttimupāyaviśeṣairāha- brāhmaṇairityādi| kilaśabdo'trāgamārthaṁ sūcayati; evaṁ kila āgame pratipāditamityarthaḥ| amalairiti rāgādidoṣarahitaiḥ| brāhmaṇebhyo'parānapi darśayannāha- rasāyanatapojapyetyādi|- rasāyanaparā iti svabhāvavyādhinivāraṇaviśiṣṭauṣadhacintakāḥ, te rasavīryauṣadhaprabhāveṇa maraṇaṁ nivārayanti| tathā tapaḥparāḥ tapasvinaḥ, te'pi viśiṣṭatapaḥprabhāveṇa maraṇaṁ nivārayanti | japyaparāḥ siddhamantracintakāḥ, te'pi mantraśaktiyuktāḥ pañcatvaṁ niṣedhayanti | etacca niyatāniyatariṣṭaviṣayaṁ jñeyam||5||</blockquote>This means Arishta are always resulted by death unless warded off by following factors:  

Acharya Sushruta has briefly mentioned the exceptions for every death followed by appearance of Arishta laxanas. He says that even though the death is certain once Arishtas appear, there are certain exceptions or ways which have capacity to ward off this impending death.  <blockquote>ब्राह्मणैस्तत् किलामलैः | रसायनतपोजप्यतत्परैर्वा निवार्यते ||५|| (Sush. Samh. 28.5) <ref name=":1">Sushruta Samhita ([http://niimh.nic.in/ebooks/esushruta/?mod=read Sutrasthanam Adhyaya 28 Sutram 5])</ref> </blockquote><blockquote>brāhmaṇaistat kilāmalaiḥ | rasāyanatapojapyatatparairvā nivāryate ||5||</blockquote><blockquote>रिष्टेऽपि मरणनिवृत्तिमुपायविशेषैराह- ब्राह्मणैरित्यादि| किलशब्दोऽत्रागमार्थं सूचयति; एवं किल आगमे प्रतिपादितमित्यर्थः| अमलैरिति रागादिदोषरहितैः| ब्राह्मणेभ्योऽपरानपि दर्शयन्नाह- रसायनतपोजप्येत्यादि|- रसायनपरा इति स्वभावव्याधिनिवारणविशिष्टौषधचिन्तकाः, ते रसवीर्यौषधप्रभावेण मरणं निवारयन्ति| तथा तपःपराः तपस्विनः, तेऽपि विशिष्टतपःप्रभावेण मरणं निवारयन्ति | जप्यपराः सिद्धमन्त्रचिन्तकाः, तेऽपि मन्त्रशक्तियुक्ताः पञ्चत्वं निषेधयन्ति | एतच्च नियतानियतरिष्टविषयं ज्ञेयम्||५|| (Dalhana's Commentary on Sush. Samh. 28.5) <ref name=":1" /></blockquote><blockquote>riṣṭe'pi maraṇanivr̥ttimupāyaviśeṣairāha- brāhmaṇairityādi| kilaśabdo'trāgamārthaṁ sūcayati; evaṁ kila āgame pratipāditamityarthaḥ| amalairiti rāgādidoṣarahitaiḥ| brāhmaṇebhyo'parānapi darśayannāha- rasāyanatapojapyetyādi|- rasāyanaparā iti svabhāvavyādhinivāraṇaviśiṣṭauṣadhacintakāḥ, te rasavīryauṣadhaprabhāveṇa maraṇaṁ nivārayanti| tathā tapaḥparāḥ tapasvinaḥ, te'pi viśiṣṭatapaḥprabhāveṇa maraṇaṁ nivārayanti | japyaparāḥ siddhamantracintakāḥ, te'pi mantraśaktiyuktāḥ pañcatvaṁ niṣedhayanti | etacca niyatāniyatariṣṭaviṣayaṁ jñeyam||5||</blockquote>This means Arishta are always resulted by death unless warded off by following factors <ref name=":0" />:  

* Blessings of the holy pure hearted Brahman.

* Blessings of the holy pure hearted Brahman.

* With the help of divyara sayanaaushdhi (drug)

* With the help of divyara sayanaaushdhi (drug)

* With the grace of siddha yogi [5]

* With the grace of siddha yogi

== Types of Arishtas ==

== Types of Arishtas ==

Arishtas are classified in 2 types on the basis of certainty of death.<ref>Ashtanga Hrdayam (Sharirasthanam Adhyaya 5 Sutra 2)</ref>  (Nipane Mayur S et al / Int. J. Res. Ayurveda Pharm. 9 (1), 2018)

Arishtas are classified in 2 types on the basis of certainty of death.<ref>Ashtanga Hrdayam (Sharirasthanam Adhyaya 5 Sutra 2)</ref>   

=== Sthayi arishta ===

=== Sthayi arishta ===

== Various Arishtas ==   

== Various Arishtas ==   

Mahesh Hirulal: Review on Indriya sthāna of Charaka Samhitha AAMJ 2016; 3:779 – 783

One can find various Arishta laxanas described in Ayurveda classics under multiple categories <ref>Mahesh Hirulal: Review on Indriya sthāna of Charaka Samhitha AAMJ 2016; 3:779 – 783</ref> as listed below, 

# Varna Arishta

# Varna Arishta

# Swara Arishta

# Swara Arishta

== Significance of Arishta laxanas in today's era ==

== Significance of Arishta laxanas in today's era ==

Even though all of the determinants (i.e., signs and symptoms) cannot be explained by rational scientific parameters (as evident by the references above to paranormal and occult sciences), some of these signs and symptoms have been documented and reported as having been experienced by people in various parts of the world. Within the treatise Charaka Samhita, physicians are instructed to thoroughly examine the patient for certain signs that indicate terminal illness and investigate using biomarkers. The treatise then advises physicians to stop any therapeutic treatment being given to such terminal patients and provide them palliative care instead. In the present era, with advancements in medical sciences, many arishta lakshanas are well treatable and cannot be considered as "predictors" of death as they used to even a few centuries back. However, these signs and symptoms could serve as important indicators of prognosis of disease and therefore, would be helpful in prompt management to save life of patients. http://www.carakasamhitaonline.com/mediawiki-1.28.2/index.php?title=Indriya_Sthana

Even though all of the determinants (i.e., signs and symptoms) cannot be explained by rational scientific parameters (as evident by the references above to paranormal and occult sciences), some of these signs and symptoms have been documented and reported as having been experienced by people in various parts of the world. Within the treatise Charaka Samhita, physicians are instructed to thoroughly examine the patient for certain signs that indicate terminal illness and investigate using biomarkers. The treatise then advises physicians to stop any therapeutic treatment being given to such terminal patients and provide them palliative care instead. In the present era, with advancements in medical sciences, many arishta lakshanas are well treatable and cannot be considered as "predictors" of death as they used to even a few centuries back. However, these signs and symptoms could serve as important indicators of prognosis of disease and therefore, would be helpful in prompt management to save life of patients.<ref>Preamble of Indriya Sthana (Section on assessment of lifespan of patients) available from [http://www.carakasamhitaonline.com/mediawiki-1.28.2/index.php?title=Indriya_Sthana Charakasamhitaonline.com]</ref>

 

In today’s clinical practices estimating prognosis typically receives less attention than diagnosing and treating disease. Yet, many clinical decisions are not fully informed unless the patient’s prognosis is considered. Critical prognostic information, physicians will be better equipped to make clinical decisions that are aligned with their patients’ values, preferences and goals of care.[7]