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Arishta laxanas are certain ominous signs and symptoms observed in and around the patient that indicate patient's imminent death. Knowledge of Arishta laxanas is considered to be the important tool for a Vaidya to predict lifespan and approximate duration of remaining life of a patient. Knowledge of Arishta laxanas is thus believed to be the part of clinical prognosis exclusively described in Ayurveda and is certainly the example of superior intelligence, keen observation and deep study of Sharira (normal anatomy and physiology) of patient by our ancient Ayurveda scholars. It is a unique contribution of Ayurveda towards clinical diagnosis which is disappearing faster from the technology led medical science of today's world.

Arishta lakshanas are certain ominous signs and symptoms observed in and around the patient that indicate patient's imminent death. Knowledge of Arishta lakshanas is considered to be the important tool for a Vaidya to predict lifespan and approximate duration of remaining life of a patient. Knowledge of Arishta lakshanas is thus believed to be the part of clinical prognosis exclusively described in Ayurveda and is certainly the example of superior intelligence, keen observation and deep study of Sharira (normal anatomy and physiology) of patient by our ancient Ayurveda scholars. It is a unique contribution of Ayurveda towards clinical diagnosis which is disappearing faster from the technology led medical science of today's world.

== Introduction ==

== Introduction ==

Ayurveda is a systematic knowledge of medicine which defines Ayu (life) as a combination of sharira, indriyas, satva and atman with an objective of maintaining dhatus in their equilibrium state. Each section of classical Ayurveda treatises focuses on the betterment of this Ayu. The beginning of Ayu and the end of this Ayu is therefore should be known precisely. It is believed that, Ayu starts with union of male and female bijas (gametes) and Atman in the womb of the mother. In this way the physical body development and growth starts. After a certain period the growth stops and degeneration of the mortal components of life named 'Sharira' starts. Life ends when the union of Sharira, Atman, Indriya and Manas dissociates. Thus, one has to keenly observe the various stages of Ayu and use Ayurveda knowledge accordingly to achieve maximum benefits. In this context few sections in Classical Ayurveda Samhitas were designed to tell the Ayu (life span) of the diseased person with the help of arishta. Arishtas are believed to be the fatal signs of death which definitely occur in diseased person before death just like flowers indicates upcoming fruit and smoke indicates agni (fire) and cloud indicate rain. Various Ayurveda acharyas have described these ominous signs which indicate bad prognosis and imminent end of one's Ayu so as to help Vaidya to plan or stop treatment. Few thousand years ago, when advanced technology was not used in the practice of medicine and diagnosis was used to be merely clinical, this knowledge of Arishta laxanas enabled practitioners to foresee the imminent death and act accordingly.  

Ayurveda is a systematic knowledge of medicine which defines Ayu (life) as a combination of sharira, indriyas, satva and atman with an objective of maintaining dhatus in their equilibrium state. Each section of classical Ayurveda treatises focuses on the betterment of this Ayu. The beginning of Ayu and the end of this Ayu is therefore should be known precisely. It is believed that, Ayu starts with union of male and female bijas (gametes) and Atman in the womb of the mother. In this way the physical body development and growth starts. After a certain period the growth stops and degeneration of the mortal components of life named 'Sharira' starts. Life ends when the union of Sharira, Atman, Indriya and Manas dissociates. Thus, one has to keenly observe the various stages of Ayu and use Ayurveda knowledge accordingly to achieve maximum benefits. In this context few sections in Classical Ayurveda Samhitas were designed to tell the Ayu (life span) of the diseased person with the help of arishta. Arishtas are believed to be the fatal signs of death which definitely occur in diseased person before death just like flowers indicates upcoming fruit and smoke indicates agni (fire) and cloud indicate rain. Various Ayurveda acharyas have described these ominous signs which indicate bad prognosis and imminent end of one's Ayu so as to help Vaidya to plan or stop treatment. Few thousand years ago, when advanced technology was not used in the practice of medicine and diagnosis was used to be merely clinical, this knowledge of Arishta lakshanas enabled practitioners to foresee the imminent death and act accordingly.  

== Definition of Arishtas ==

== Definition of Arishtas ==

Acharya Vagbhata has defined Arishtas as the signs and symptoms which are definite indicator of death. He has mentioned the synonym Rishta for Arishta laxanas.<blockquote>रूपेन्द्रियस्वरच्छायाप्रतिच्छायाक्रियादिषु।।4।।</blockquote><blockquote>अन्येष्वपि च भावेषु प्राकृतेष्व्निमित्ततः। विकृतिर्वा समासेन रिष्टं तदिति लक्षयेत् ।।5।। (Asht. Hrda. 5.4-5) <ref>Ashtanga Hrdayam ([https://archive.org/details/Ashtanga.Hridaya.of.Vagbhata/page/n603 Sharirasthanam Adhyaya 5 Sutra 4-5])</ref></blockquote><blockquote>rūpendriyasvaracchāyāpraticchāyākriyādiṣu।।4।।</blockquote><blockquote>anyeṣvapi ca bhāveṣu prākr̥teṣvnimittataḥ। vikr̥tirvā samāsena riṣṭaṁ taditi lakṣayet ।।5।।<br>

Acharya Vagbhata has defined Arishtas as the signs and symptoms which are definite indicator of death. He has mentioned the synonym Rishta for Arishta lakshanas.<blockquote>रूपेन्द्रियस्वरच्छायाप्रतिच्छायाक्रियादिषु।।4।।</blockquote><blockquote>अन्येष्वपि च भावेषु प्राकृतेष्व्निमित्ततः। विकृतिर्वा समासेन रिष्टं तदिति लक्षयेत् ।।5।। (Asht. Hrda. 5.4-5) <ref>Ashtanga Hrdayam ([https://archive.org/details/Ashtanga.Hridaya.of.Vagbhata/page/n603 Sharirasthanam Adhyaya 5 Sutra 4-5])</ref></blockquote><blockquote>rūpendriyasvaracchāyāpraticchāyākriyādiṣu।।4।।</blockquote><blockquote>anyeṣvapi ca bhāveṣu prākr̥teṣvnimittataḥ। vikr̥tirvā samāsena riṣṭaṁ taditi lakṣayet ।।5।।<br>

</blockquote>Meaning:

</blockquote>Meaning:

== Place in Ayurveda samhitas ==

== Place in Ayurveda samhitas ==

Ayurveda treatises have stressed that, before going to start treatment of any disease physician should assess for Arishṭa lakshanas. Thus, even before expounding the treatment for various rogas, most of the Samhitas have dedicated either an entire Sthanam (section) or a part of it for offering the knowledge of Arishta laxanas. Different acharyas of ayurveda described them in different sthana of their text. Acharya Charaka contributed a separate sthana for assessment of Arishṭa lakshanas as Indriyasthanam.   

Ayurveda treatises have stressed that, before going to start treatment of any disease physician should assess for Arishṭa lakshanas. Thus, even before expounding the treatment for various rogas, most of the Samhitas have dedicated either an entire Sthanam (section) or a part of it for offering the knowledge of Arishta lakshanas. Different acharyas of ayurveda described them in different sthana of their text. Acharya Charaka contributed a separate sthana for assessment of Arishṭa lakshanas as Indriyasthanam.   

Acharya Sushruta in sutrasthanam of Sushruta Samhita & Acharya vagbhata in sharirsthanam of Ashtanga Hrdayam. All of them have emphasized that a physician must keep a keen observation on such fatal signs to achieve success in treatment, fame and prosperity.  

Acharya Sushruta in sutrasthanam of Sushruta Samhita & Acharya vagbhata in sharirsthanam of Ashtanga Hrdayam. All of them have emphasized that a physician must keep a keen observation on such fatal signs to achieve success in treatment, fame and prosperity.  

== 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|| (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" />:  

Acharya Sushruta has briefly mentioned the exceptions for every death followed by appearance of Arishta lakshanas. 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)

== Various Arishtas ==   

== Various Arishtas ==   

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,   

One can find various Arishta lakshanas 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

# Disease specific Arishtas

# Disease specific Arishtas

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

== Significance of Arishta lakshanas 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.<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>  

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.<ref name=":0" />

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.<ref name=":0" />

References

== References ==

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[[Category:Ayurveda]]

[[Category:Ayurveda]]