Arishta Lakshanas – Ominous Signs And Symptoms Indicating Bad Prognosis

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
A physician should know his limits in treating a particular disease. For this he should have a thorough knowledge of prognosis and pathogenesis of a disease.

Disease classification

Based on the curability and incurability of diseases, the diseases can be classified as –
Sukha sadhya vyadhis – easily curable diseases
Krichra Sadhya vyadhis – diseases curable with difficulty
Yapya vyadhis – maintainable diseases
Asadhya / pratyakhyeya / anupakrama vyadhis – incurable diseases
Read: Reasons Why Curable Diseases Become Incurable

Knowing this classification would help a physician to make a sensible choice of the patients and diseases which he could treat within the boundaries of his capacity and knowledge.
This will also help the physician to avoid treating diseases which are out of his capacity.
In fact it enables them to refer to the concerned specialty.

Without the knowledge of prognosis if the physician attempts to treat diseases, he would not only be harming the life of a patient but also would be an enemy of his own reputation and fame.
A physician should not try to treat incurable diseases because they are incurable.

To make matters worse, if the incurable diseases are associated with arishta lakshanas, the physician should not even think of attempting to treat the disease.

In this article, we shall discuss about arishta lakshanas which indicate bad prognosis of a disease or that the patient would die in short span of time.
Read – 42 Different Criteria For Ayurvedic Prognosis – Charaka Sutrasthana 10

Ominous signs

Arishta Lakshan –
Signs of approaching death of patient or incurability and bad prognosis of a disease.
While explaining the qualities of incurable diseases, Charaka mentions ‘sa arishtam’.
This means that the physician should not treat diseases which are associated with arishta lakshanas.

So what are these arishta lakshanas which makes a physician to reject a patient?
Arishta lakshans are the symptoms which point towards the approaching death in a patient.
They also indicate that a particular disease cannot be treated in spite of best efforts being made.
Even if the physician tries to treat that patient out of sympathy, the death would be inevitable and sure. The doctor would be damaging his name and reputation by doing this.

Arista lakshanams are the boundaries of limitations for the physician to select or reject a case.
Presence of ominous symptoms impending death of a patient or bad prognosis of a disease are clues to the physician to avoid treating such conditions.
Read – How To Make Prognosis Of Disease According To Ayurveda?

Ominous sign analysis

Meanings of Arishta Lakshana –
– Signs of approaching death
– Signs and symptoms of bad prognosis of a disease
– Fatal signs
– Disastrous signs
– Boding misfortune
– Signs of misfortune
– Signs of ill luck
– Apprehensive of death

Classical reference

Definitions of Arishta Lakshanas
In certain diseased conditions, there will be some symptoms in the patient which indicate approaching death in that patient. Such symptoms are called as rishta lakshanas.

Certain symptoms produced in the diseases suggest definitive death of a patient in future. Such dangerous or ominous signs and symptoms which indicate an impending death are called as rishta lakshanas.

If sudden, drastic and abnormal changes occur in the physical and mental constitution of the patient without any appropriate reason, the physical or mental symptoms produced by such changes are considered as rishta.

In arishta lakshanas, the normal features i.e. prakrita bhavas suddenly transform into abnormal features i.e. vikruta bhavas without any obvious reason. These changes are seen at physical, mental or at both planes.
The changes occur in terms of –
– Rupa – appearance
– Indriya – sense organs and their perception
– Swara – voice
– Chaya – shadow
– Pratichaya – reflection
– Kriya – normal physiological activities of the body etc.

A sudden change in the normal Dosha constitution of the body i.e. deha prakriti is an unnatural thing. Therefore the dosha constitution of the body is something which is unchangeable till the death of the patient.

The drastic symptoms of arishta are produced due to disintegration of the dosha constitution leading to the disintegration of all the body constituents. Therefore the symptoms such as sudden change in body complexion, change in appearance of sense organs and in the luster of the body and change in other features are suddenly manifested without any reason in arishta lakshanas.

The arishta lakshanas occurs when
– a disease spreads into the  visceral spaces, tissues of the body and vital organs and structures of the body
– when doshas cross the barriers of their normal functioning routes and tend to spread in all directions i.e. upwards, downwards and sidewards
– when the vitiated doshas spread over the entire body
– when the disease doesn’t respond to any treatment even to the slightest extent
Read – Dosha Gati: Normal And Abnormal Movements Of Doshas

The arishta lakshanas might occur even in an otherwise healthy person.
In such conditions, the death occurs definitely.

If the proper medicines given at proper stage, in proper doses become ineffective, it is also a case of arishta. This means to tell that in the presence of arishta lakshanas the best medicines too fail to deliver good results or even to make an impact.

Other important things to know about Arishta Lakshanas
Charaka has contributed immensely towards the understanding and learning of this extraordinary science of short-listing the diseases on the basis of their ominous signs and symptoms acting as indicators of approaching death in a patient or worst prognosis of a disease.
He has written an entire section towards understanding this concept in Indriya sthana wherein 12 chapters are dedicated towards the discussion of arishta lakshanas related to various aspects and entities.

Indriya sthana deals with studying, analyzing and examining different entities including voice, color, smell, taste, touch, sense organs, mind, likes, character, behavior, memory, nature, deformity, intelligence, strength, built, dryness, lubrication, sleep, heaviness, lightness, qualities, food, life activities, digestion, diseases, pain, complications, luster, color, complexion, shadow, reflection, messenger, and many other factors thoroughly in order to know about the residual life span of an individual.

Acharya Charaka advices the physicians to examine these factors in the patients with the help of –
– pratyaksha – direct observation,
– anumana – inference and
– aptopadesha – theoretical references, teaching of teachers
Read – 11 Tips To A Junior Ayurvedic Doctor

Clinical significance

Importance of having the knowledge of Arishta Lakshanas
– The knowledge of arishta lakshanas would help the physician to know and understand about the signs and symptoms of approaching death.
–  Help in understanding the prognosis of the diseases, especially the diseases with worst prognosis.

– Help a physician to understand his limitations in treating a person. It will help him to be choosy, to scrutinize and short-list the conditions which he can treat and which conditions he should reject.
–  Understanding the nature, quality and quantity of life span and residual lifespan of an individual.
– Safeguard physicians reputation and fame.
– Help a physician to refer the patient to related specialists in right time without wasting time.

Examination of arishta

Methods of examination Arista Laksanas
Like other diseases and morbid doshas, arishtas too can be known by examining the normal and pathological features and also by differentiating them.

Arishta lakshanas could be understood by thoroughly examining some aspects and factors in the body.
Among these aspects some may be existing in the body i.e. aashrita bhavas and some may be not be existing i.e. anashrita bhavas.

Those factors which do not exist in the body shall be examined through the help of references and scriptures and those which do exist in the body should be examined with the help of prakriti i.e. normal and constitutional factors and vikriti i.e. pathological factors.
Read – Personalities of Ayurveda Body Types

Examination of non-existing aspects –
The factors which do not exist in the body are called anashrita bhavas. They should be examined with the help of scriptures and thinking skills and inferential knowledge because there will be no other source of understanding these aspects.
Read Shat Kriya Kala – ‘Stage-Wise Disease Management’

Examples of the non-existing factors are –
– The knowledge of arishta based on the messenger i.e. the way the messenger comes, the time at which he comes, the way he conveys the message, the way he looks etc
– Inauspicious views seen on the way while going to the patient or patient’s home
– Seeing that the cot has been placed in an erect way in the patient’s home
– The fire being brought out of the patient’s home etc

These are the arishta signs which indicate that the patient is approaching death or that the disease cannot be cured at any cost or by any measures.
Read Aham Brahmasmi – The Most Premiere State Of Mind

Normalcy (prakruti), abnormalcy (vikruti)

Examination of existing aspects –
The aspects which exist are called aashrita bhavas. To understand the existing aspects in terms of arishta symptoms in the body shall be examined with the help of normal and abnormal features of one’s constitution

Examples of the existing factors are –
– Color
– Complexion
– Appearance
– Voice
– Touch etc

Prakriti – Dosha body types
Individual variations of voice, color, complexion etc aspects of different individuals depend on the above said type of prakritis. The manifestation of arishtas also depends on sudden changes occurring in the above said aspects of prakriti.
Read – Dosha Body Type Features As Per Master Sushruta

Vikriti
Vikriti is of three types.
They are the types of arishta lakshanas.
This means to tell that the three types of Vikriti are the sources of understanding arishta lakshanas.

They are –
1. Lakshana Nimitta
Lakshana nimitta vikruti is that in which the arishta lakshanas are manifested in the body depending on the deeds done in previous birth.
Some symptoms are related and localized in the body. When time of manifestation occurs, they get located in different places of the body and produce diseases accordingly.

The diseases in this type of manifestation will be decided only on the basis of the manifested symptoms (lakshanas). Therefore they are called lakshana nimitta vikruti.
Thus, the symptoms which get manifested are the sources for understanding this vikriti.

The appearance of lines and images resembling lotus flowers on the nails is an indication that one would lose the kingdom, wealth, etc and would suffer from disorders of locomotion, would face arrest or death sentence etc. these symptoms occur due to the fate.
Read Tri Malas – The Three Major Waste Matters Of Body

Similarly the arishtas are also known by the symptoms they exhibit.
Even in the manifestation of these symptoms, the fate plays a major role. Once these symptoms are manifested in the body we would know the arishta related to them.

Example – appearance of innumerable dividing lines or circular whirls on the eyebrows or scalp, which were never seen before that are indicative of impending death. The patient presenting these symptoms will die within 3 days time. Similarly if these symptoms appear in a healthy person, he will die in 6 days time.
Read – Ayurveda Vata Diet – What To Take And What To Avoid For Vata

2. Lakshya Nimitta
Lakshya nimitta vikritis are those diseases for which causes are available, similar to those explained in section of treatises which discusses about the etiological factors for the diseases.
Example, dryness, roughness, coldness, instability, lightness are the qualities of vata.
If the food and life activities which have similar qualities are consumed in the form of etiological factors or causes, the vata will get aggravated.

3. Nimitta Anurupa
Some things in spite of not being nimittas (causes), act like causative factor towards the causation of an effect. Such causes are called nimitta anurupa vikritis.

Example – actually those things having dryness etc qualities should cause vitiation of vata.
On the contrary in some instances if the same dryness, coldness etc qualities instead of vitiating vata, if they pacify vata, these qualities (nimittas) are called nimitta anurupa vikriti.

In some person if vata is vitiated and do not get pacified with vata pacifying medicines but get pacified by things which vitiate vata, those causes (which pacify vata instead of vitiating it) are called nimitta anurupa vikritis.

Here we should note that the ruksha etc qualities are not the causes for vata pacification but they are working as ‘causes for vata pacification’.
Hence the deformity occurs in the form of vata pacification. Though vata pacification contributes to health, in this case since it is pacified by its vitiating agents, it would be considered as deformity of vata.

This type of Vikriti will help in knowing about the residue life span and are indicators of development of arishtas.
Research: Critical analysis of arista vijnana
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