Age Ayurveda Nighantu

Chikitsa Sutra (principles governing treatment choice)

How much weight this concept bears. Chikitsa sutra rests almost entirely on classical exegesis. The classical statements are real, locatable and verse-numbered, and they are internally coherent: like increases like and unlike decreases it (Ca.Su.1.44-45), disease as disequilibrium and treatment as whatever restores it (Ca.Su.9.4-5), four participants (Ca.Su.9.3), three modalities (Ca.Su.11.54), three routes (Ca.Su.11.55), six therapeutic measures (Ca.Su.22.4, 22.9-11), dose and application as the hinge between medicine and poison (Ca.Su.1.124-126), and an outcome-defined criterion for what counts as the right medicine at all (Ca.Su.1.134). The corpus also argues with itself about whether treatment changes outcomes (Ca.Su.10.3-5), and scopes its own efficacy claim to curable disease rather than asserting it universally. What the record did not find is an operationalised version of these rules. None of the indexed literature searched, which means the PubMed searches recorded in gatheringNotes and nothing wider, states the rule set as explicit decision criteria. That is a statement about what these searches returned, not about the field: Ayurvedic clinical-decision-support encodings and the AYUSH and CCRAS Standard Treatment Guidelines are not PubMed-indexed, were not searched, and could confirm or refute it. See notKnown and gatheringNotes. On the modern side there are now two trials of individualised selection and one reliability study. Kessler 2018 (PMID 29426006) randomised 151 knee osteoarthritis patients to individualised multimodal Ayurveda against conventional conservative care and found a significant WOMAC difference favouring Ayurveda, sustained at 12 months, but open-label and against conventional care rather than against a fixed Ayurvedic regimen. Furst 2011 (PMID 21617554) was double-blind and double-dummy but a 43-patient pilot with no placebo-only arm, and found no efficacy difference from methotrexate. Neither isolates the individualisation rule: both compare an individualised Ayurvedic arm against a non-Ayurvedic comparator, so a result in either direction is consistent with the selection rule contributing nothing. The secondary analyses of the 2018 trial (PMID 35683435) conclude that the therapeutic effects cannot be explained by the therapies themselves alone. Reliability has been measured once, for diagnosis rather than for treatment selection. Kessler 2019 (PMID 30653338) had 4 Ayurvedic experts diagnose the same 30 patients and found largely fair-to-poor kappa for central diagnostic entities including prakriti and agni, despite 95% agreement on the consented final diagnosis. That result matters more to this record than its size suggests: prakriti and agni are inputs to most dose and modality decisions, so unreliable inputs make a determinate output harder to claim. No study measuring agreement on the resulting treatment plan was found. The rest of the indexed literature retrieved on treatment principles consists of narrative and methodological essays which restate the classical scheme in modern vocabulary, argue that the RCT is the wrong instrument for it, and stop. No biomarker and no validated instrument for bala, or for any other step in the decision chain, was found in the searches recorded in gatheringNotes.

Chikitsa sutra is the classical Ayurvedic label for the set of rules a physician is supposed to apply when deciding what to do for a given patient, as distinct from the list of drugs used. The core claims are that disease is a disturbance of equilibrium among the bodily constituents, that treatment is whatever restores that equilibrium, that treatment succeeds only through the joint adequacy of four participants (physician, drug, attendant, patient), and that the same substance is medicine or poison depending on dose, timing, route, the patient's strength and the state of the doshas. Underneath these sits the samanya-vishesha rule (Ca.Su.1.44-45), that like increases like and unlike decreases it, which is what makes 'treat with the opposite' a rule rather than a slogan. Charaka sorts therapeutics into three modalities (invocatory/daiva, reasoned/yukti, mental restraint/sattvavajaya) at Ca.Su.11.54 and into three routes (internal, external, surgical) at Ca.Su.11.55, and at Ca.Su.22 sets out six therapeutic measures (langhana, brimhana, rukshana, snehana, svedana, stambhana) as the frame within which treatment is chosen. Charaka also argues, at Ca.Su.10, over whether treatment makes any difference at all. The tradition presents all of this as decision rules, but they are stated as maxims, and none of the classical passages retrieved for this record reduces them to an explicit, testable algorithm.

At a glance
Subject areaPrinciples of treatment
Domain, as recordedtreatment-principles
Contested questions3
Stated as not known13
Classical citations13, 12 quoting the text
Research papers assessed9
Citations checked2026-10-08

What is contested, and by whom

These are the questions on which the sources genuinely disagree. Each position is given as its source states it. No position is presented as the settled answer, because none of them is.

Is chikitsa sutra a genuine decision procedure or a post-hoc rationalisation of choices made on other grounds?

This is contested.

  1. Ayurvedic academic writing treats it as a determinate rule set that a trained physician applies to reach a defensible plan from nidana onward.
  2. Methodological critics inside the field (for example the 'Rishi principles' essay, PMID 24459385) concede the selection is not reducible to stated criteria and argue the appropriate response is to change the research method rather than to specify the rule.
  3. The one piece of agreement data found bears on the inputs rather than the output and favours the second position: Kessler 2019 (PMID 30653338) had 4 experts diagnose the same 30 knee osteoarthritis patients and found fair-to-poor kappa for prakriti and agni, with better agreement on disease-related than on constitutional entities. Its 95% figure is agreement on a consensus diagnosis reached by nominal group technique, not independent agreement, so it should not be read as supporting the first position.
  4. Neither position has been tested on the thing actually in dispute. No study was found measuring whether physicians who agree on a diagnosis then agree on a treatment plan, which is where a decision procedure would show itself.

What is the correct relation between hetu-viparita (opposite to cause) and vyadhi-viparita (opposite to disease) when the two point to different measures?

This is contested.

  1. TRANSLATOR'S VOICE, AND SECOND-HAND, BUT QUOTED. Bhishagratna, in his own Introduction to Sushruta Vol. I under the heading 'Principles of Ayurvedic Treatment' (printed page lx, running head page 110-111), writes that 'Ayurvedic physicians practically recognise two different sets of principles in the domain of practical therapeutics, which may be stated in the terms of their western colleagues as Laws of Similars and Contraries', and appends a footnote listing six categories: 'Similar in character to the exciting factors of a disease - Similar in character to the Esse of a disease - Similar in character both to the exciting factors and Esse of a disease. Contrary in character to the exciting factors of a disease. Contrary in character to the Esse of a disease. Contrary in character both to the exciting factors and Esse of a disease.', which he attributes to 'Madhava Nidanam Ch I. V, 8.' Verified verbatim on 2026-10-06 in archive.org englishtranslati01susruoft_djvu.txt. This is the six-fold scheme of which hetu-viparita, vyadhi-viparita and ubhaya-viparita are the three contrary members, and it is the first quotable attestation of it in this record. Three limits, stated because this project has absorbed a translator's voice as doctrine three times. It is Bhishagratna writing in 1907, not Sushruta. The locus he gives, Madhava Nidana I.8, was NOT retrieved, so that address is his attribution and not this record's. And he explicitly declines to resolve the conflict, saying the apparent contradiction 'has been fully accounted for and explained in the writings of the latter day commentators, but it does not fall within our province to enter into these disquisitions', so he is evidence that the scheme exists and the tie-break is commentarial, not evidence of what the tie-break is.
  2. The commentarial tradition is reported to hold that both, plus ubhaya-viparita (opposed to both), are legitimate and that the physician selects by which target is dominant. UNCITED in any primary or commentarial text retrieved for this record.
  3. Practical texts are reported to prioritise nidana parivarjana, removal of the cause, as always first. UNCITED, and the record carries no classical passage for nidana parivarjana at all.
  4. No passage retrieved for this record supplies a tie-breaking rule when cause-directed and disease-directed measures conflict, and no source consulted resolves it. Bhishagratna, the one source that states the scheme, says in terms that resolving it is outside his scope.

Does daivavyapashraya (invocatory therapy) belong inside the therapeutic system or is it a historical residue?

This is contested.

  1. Ca.Su.11.54, quoted in this record, lists daivavyapashraya as one of the three modalities on the same footing as reasoned therapy.
  2. TRANSLATOR'S VOICE, NOT DOCTRINE. Kaviratna, annotating this passage in the 1890s, writes in a footnote that the first kind of medicine 'is still extensively resorted to in this country by almost all classes of people. It should be noted, however, that no one relies on such medicine exclusively, the fact being that regular treatment is sought to be supplemented by it.' Verified verbatim in the BIUSante_47357 scan, Lesson XI. This is a Victorian translator's ethnographic observation about practice in his own time. It is recorded here because it is evidence about the reception of the doctrine, and it is labelled because this project has three times absorbed a translator's voice as doctrine.
  3. Modern Ayurvedic curricula and the modern literature retrieved for this record largely omit it, and no source found explicitly retires it from the classification.

What is not known

Stated rather than left out. Where a negative has actually been searched for rather than assumed, the entry says so.

  • Whether two independently trained Ayurvedic physicians presented with the same patient would select the same treatment plan. Reliability has been measured once for DIAGNOSIS, not for treatment selection: Kessler 2019 (PMID 30653338) found largely fair-to-poor inter-rater kappa for prakriti and agni across 4 experts and 30 knee osteoarthritis patients. No study measuring agreement on the resulting treatment plan was found in the searches recorded in gatheringNotes.
  • Whether individualised selection outperforms a FIXED Ayurvedic protocol for the same condition. This narrow gap survives the two trials the record now carries, because both compare an individualised Ayurvedic arm against a non-Ayurvedic comparator: Kessler 2018 (PMID 29426006) against conventional conservative care, Furst 2011 (PMID 21617554) against methotrexate. No trial found randomised patients between individualised and standardised Ayurvedic treatment, which is the comparison that would isolate the selection rule.
  • How 'bala' (strength of patient and of disease), on which most dose and modality decisions turn, is to be measured. No validated instrument was found. Kessler 2019's poor kappas for agni and prakriti suggest the same problem affects the other constitutional inputs.
  • Whether the three-modality classification (daiva / yukti / sattvavajaya) carries any predictive content, or is purely taxonomic.
  • What the actual decision weights are when dose, timing, season, constitution and disease stage give conflicting indications. The passages this record carries assert that the physician balances them but do not say how.
  • Whether the 'poison and medicine' maxim of Ca.Su.1.124-126 corresponds to any measured dose-response or therapeutic-index data for the classical formulations it is applied to.
  • NIDANA PARIVARJANA IS UNCITED IN THIS RECORD. The record lists removal or avoidance of the causative factor as a component of chikitsa sutra, because it is standard terminology in the secondary literature, but no classical passage for it was retrieved. Searches of the Kaviratna Charaka text for 'avoidance of the cause', 'removal of the cause', 'abstention from the cause' and similar phrasings returned nothing, which is a fact about those search strings and that translation, not about the corpus. The record also no longer asserts that nidana parivarjana is the first measure or prior to any drug, which was an unsourced claim about priority on top of an unsourced component.
  • THE VIPARITA TRIAD AND VIPARITARTHAKARI ARE UNCITED IN THIS RECORD. The general principle that like increases like and unlike decreases it is cited and quoted (Ca.Su.1.44-45). The commentarial triad hetu-viparita / vyadhi-viparita / ubhaya-viparita is not, nor is viparitarthakari, the separate notion that a measure nominally similar in quality may act oppositely in effect. Both appear in the secondary literature; neither is addressed to a text here, and the second contested item consequently cannot be checked from this record. UPDATED 2026-10-06: the six-fold similar/contrary scheme to which the triad belongs is now attested in one quotable source, Bhishagratna's own Introduction to Sushruta Vol. I (printed page lx), which lists the six categories and attributes them to Madhava Nidana Ch. I v. 8. That is a translator writing in 1907 citing a text this record has not retrieved, so the primary locus of the triad remains unverified and Madhava Nidana I.8 is not asserted here as an address. What is now known is that the scheme is real and pre-modern; what is still not known is where it is stated in a text this record can quote, and what the tie-breaking rule is.
  • ASHTANGA HRIDAYA SUTRASTHANA 14 IS UNREAD. The record carries a chapter-level address for Vagbhata's two-fold therapeutic scheme and nothing more. No text of the chapter was retrieved and no translation of it was found that this project can quote, so the record asserts nothing about what the chapter says or how it numbers its verses. Vagbhata's compression of treatment into nourishing and reducing classes is therefore absent from this record except as it is independently attested in Charaka at Ca.Su.22.
  • CHARAKA SUTRASTHANA 23 IS ADDRESSED ONLY AT ITS OPENING AND ITS CLOSING SUMMARY. The record quotes Ca.Su.23.3-23.5a on the causes of santarpana-induced disease, and the chapter's closing summary verse, Ca.Su.23.40, is quoted inside that entry's establishes. The apatarpana half of the chapter, the disease lists and the remedies prescribed for each class were read in the scan but are not recorded here, and no verse numbers are asserted for them.
  • SEARCH GAP, NOT AN EVIDENCE GAP: the non-indexed regulatory and institutional literature was not searched. AYUSH and CCRAS Standard Treatment Guidelines, the Ayurvedic Pharmacopoeia of India, state board curricula and any Ayurvedic clinical-decision-support encodings are outside PubMed and were not retrieved for this record. This is the material that would confirm or refute the claim that no published work states the rule set as explicit decision criteria. Until it is searched, this record's negative finding about explicit decision criteria is bounded to the indexed literature and must not be read as a statement about the field.
  • Whether the individualisation in the one large trial was doing any work. The trial's own secondary analyses (PMID 35683435) conclude that the therapeutic effects cannot be explained by the therapies themselves alone, and identify the treatment arm and baseline severity, not the tailoring, as the variables that mattered most in their models. No study was found that decomposes an individualised Ayurvedic intervention into the selection rule and the rest of the package.
  • Whether the stambhana definition at Ca.Su.22.12a and the five definitions before it were ever meant as an exhaustive classification of therapeutic action. The chapter's own closing summary, Ca.Su.22.44, calls the six 'the six therapies by which treatment proceeds', and Kaviratna's footnote on the chapter adds that however combined, other methods 'cannot transcend the six original methods mentioned in this Lesson'. That footnote is the translator's, not the text's, and no passage retrieved for this record says in its own voice that the list is closed.

The terms this concept is built from

Each is a technical term in its own right. Where this site holds a lexicon entry for one, it is linked.

TermWhat it names
Dhatu-samya (restoration of equilibrium) The stated goal of all treatment: disease is disequilibrium of the bodily constituents, health is their equilibrium.
Samanya-vishesha (similarity and dissimilarity) Like increases like; unlike decreases it. The general rule from which treatment by contraries is derived.
Nidana parivarjana Removal or avoidance of the causative factor.
Chikitsa chatushpada The four limbs whose combined quality determines outcome: physician, drug, attendant/nurse, patient.
Trividha chikitsa Three modalities of therapy: daivavyapashraya (invocatory, ritual), yuktivyapashraya (reasoned, diet and drug), sattvavajaya (restraint of the mind).
Trividha karma Three routes of application: antahparimarjana (internal), bahihparimarjana (external), shastrapranidhana (surgical).
Shad-upakrama and the shodhana / shamana decision Ca.Su.22 sets out six measures (langhana, brimhana, rukshana, snehana, svedana, stambhana) as the frame for all treatment. Sushruta Sutrasthana 1 states cleansing and pacification, with diet and conduct, as the four factors of treatment. The record does not claim that an eliminate-or-pacify binary is the first decision in every case: the passages it carries give six measures in Charaka and four factors in Sushruta, not a single fork.
Matra, kala, desha, bala Dose, timing, place/constitution and strength of patient and disease, as the modifiers that make the same measure right or wrong.
Viparita (treatment by contraries) That measures opposite in quality to the cause and to the disease are curative. The general principle is addressed; the commentarial triad hetu-viparita / vyadhi-viparita / ubhaya-viparita, and the separate notion viparitarthakari (a measure nominally similar that acts oppositely), are NOT addressed by any citation in this record. See notKnown.

The classical passages

Each citation gives its address so a reader can check it in a printed edition, our account of what it establishes, and the result of reading it against its source.

Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 1 (Deerghanjiviteeya):1.24 (standard Trikamji numbering); printed as verse 23 by Kaviratna · checked against the source

Fraught with the knowledge of causes, symptoms, and drugs, the refuge both of the hale and the sick, consisting of three aphorisms, eternal and auspicious, which the Grandsire had (first) discovered,

tr. Avinash Chandra Kaviratna

The trisutra: knowledge of cause, sign and remedy as the standing tripartite frame for both the healthy and the sick. Retrieved and read in the scan named in sourceUrl; the quoted string occurs exactly once there. Kaviratna prints his number after the aphorism and numbers this one 23; the standard Trikamji number is 24, confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com/index.php?title=Deerghanjiviteeya_Adhyaya, where hetulingaushadhajnanam svasthaturaparayanam is numbered ||24||. Kaviratna's one-behind offset in this chapter is therefore confirmed directly, not assumed. Sanskrit used only to fix numbering; that site's English is in copyright and is not quoted anywhere in this record. Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected, each flagged in this note. No wording supplied from any other source.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 1 (Deerghanjiviteeya):1.44-1.45 (standard Trikamji numbering); printed as verses 43-44 by Kaviratna · checked against the source

Of all things, at all times, similarity is the cause of increase; and dissimilarity is the cause of decrease. A tendency exists towards both. Similarity is that which produces oneness; and dissimilarity is that which produces diversity. Therefore, similarity is identity of substance, and dissimilarity is the reverse of this.

tr. Avinash Chandra Kaviratna

The samanya-vishesha siddhanta: the general rule that like increases like and unlike decreases it, which is the logical engine behind treatment by contraries. Without it, 'treat with the opposite' is an instruction with no stated warrant; with it, the whole viparita family of rules follows. Retrieved and read in the scan named in sourceUrl. On identifying the locus: the three-sentence passage as quoted occurs once in the volume, in Lesson I, immediately after Kaviratna's printed 42 and closing on his printed 44, with his printed 43 falling inside the passage after 'A tendency exists towards both.' String uniqueness is not what identifies the main text here, because the sentence 'similarity is the cause of increase; and dissimilarity is the cause of decrease' occurs once more in the volume with identical punctuation, in a cross-reference footnote in the lesson on the vitiation of the ducts ('vide aphorism 43, in page 4, of Lesson I of Sutrasthanam'); counted in the scan, that full sentence appears twice in all. Two further footnotes cite only the opening phrase and stop at 'increase', Kaviratna's own gloss on this verse, which gives the water-and-heat analogy, and a footnote in the ghee passage of Chikitsita. The surrounding printed aphorism numbers and the context are therefore what identify the locus. Kaviratna numbers these 43 and 44; the standard numbers are 44 and 45, confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com (sarvada sarvabhavanam samanyam vriddhikaranam ||44||, samanyam ekatvakaram ||45||). Kaviratna's footnote on 1.44 is his own 1890s commentary and is not part of the text; nothing in this entry is taken from it. Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected. No wording supplied from any other source.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 1 (Deerghanjiviteeya):1.124-1.126 (standard Trikamji numbering); printed as verses 123-125 by Kaviratna · corrected against the source

An unknown drug is like poison or weapon or fire or thunder, while a known drug is like nectar (amrita). Drugs unknown by name, appearance, and properties, or misapplied even if known, produce mischief. Well-applied, a virulent poison even may become an excellent medicine, while a medicine misapplied becomes a virulent poison.

tr. Avinash Chandra Kaviratna

The central chikitsa-sutra maxim that therapeutic identity is not a property of the substance but of its correct application. Quoted from Kaviratna's main text, Lesson I, pp. 11-12, where he prints these as his verses 123-125; the standard numbers 124-126 are confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 1 (Deerghanjiviteeya):1.134 (standard Trikamji numbering); printed as verse 133 by Kaviratna · checked against the source

That is the right medicine which can cure, and he is the best of physicians who brings about recovery.

tr. Avinash Chandra Kaviratna

An explicitly outcome-defined criterion for both drug and physician: the right medicine is the one that cures. This matters for a treatment-principles record because it is the classical corpus defining correctness by result rather than by conformity to a rule, which cuts against reading chikitsa sutra as an algorithm. Retrieved and read in the scan named in sourceUrl; the string occurs exactly once there, immediately before Kaviratna's 'Success in producing the intended results proves the right application (of a medicine)'. Standard number 134 confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com (tadeva yuktam bhaishajyam yadarogyaya kalpate ||134||). Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected, each flagged in this note. No wording supplied from any other source.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 9 (Khuddaka Chatushpada):9.3 (standard Trikamji numbering); printed as verse 1 by Kaviratna · checked against the source

The Physician, Drugs, Nurse, and Patient, constitute an aggregate of four. Of what virtues each of these should be possessed so as to become causes for the cure of disease, should be known.

tr. Avinash Chandra Kaviratna

Outcome is attributed to four participants jointly, not to the drug alone. Retrieved and read in the scan named in sourceUrl, in Lesson IX. Standard number 9.3 confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com (bhishagdravyanyupasthata rogi padachatushtayam ||3||), where the chapter's two opening sentences are numbered 1 and 2; Kaviratna does not number those, which is why his 1 is the standard 3. The offset between Kaviratna and standard numbering is therefore not constant across chapters (one in Sutrasthana 1, two here), and this record states Kaviratna's own printed number alongside the standard one in every entry rather than relying on a single rule. Note also that Kaviratna glosses 'Nurse' for 'Upasthatri'/'Paricharaka' in a translator's footnote; the footnote is his, and no doctrine in this record is drawn from it. Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected, each flagged in this note. No wording supplied from any other source.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 9 (Khuddaka Chatushpada):9.4-9.5 (standard Trikamji numbering); printed as verses 2-3 by Kaviratna · checked against the source

The absence of harmony in respect of the ingredient humours (of the body) is Disease ; while their harmony constitutes our normal condition. Health, again, is otherwise called Happiness ; while Disease is Sorrow or misery. In Disease, the well-known tale of four commencing with Physician has active agency. The course that is adopted for restoring the harmony of the ingredient humours is called Treatment.

tr. Avinash Chandra Kaviratna

The definition of chikitsa itself: any measure directed at restoring constituent equilibrium. This is the root statement from which the rest of chikitsa sutra is derived. Retrieved and read in the scan named in sourceUrl; the string occurs exactly once there. Standard numbers 9.4 and 9.5 confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com (vikaro dhatuvaishamyam ||4||, caturnam bhishagadinam ||5||). Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected, each flagged in this note. No wording supplied from any other source.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 10 (Maha Chatushpada):Charaka Samhita, Sutrasthana, chapter 10 (Mahachatushpada). Standard/Trikamji numbering: 10.4-10.5 (segments 1 and 2 both inside 10.4, segment 3 inside 10.5; nothing from 10.3 is quoted). Kaviratna's own printed aphorism numbers, which he prints after the aphorism and which I read off the scan rather than deriving from an offset: 2-5, not 1-4. Both numbering systems are named because Kaviratna splits what the vulgate carries as the single verse 10.4 across his 2, 3 and 4. · checked against the source

Maitreya said, - This is not so. For what reason are some patients seen to be restored that are furnished with drugs, equipt with nurses, possessed of intelligence, and treated by skilful physicians, while others possessed of the same advantages meet with death ? Hence, Treatment is futile. ... Hence, when by applying remedies success is achieved and by applying them death also results, and by foregoing them success is won and by foregoing them death also takes place, the thought strikes one that Treatment and no Treatment are the same. ... Verily, in diseases capable of being cured by treatment, treatment does not become futile. As regards those patients, again, that are restored without the application of treatment in its entirety, in their case treatment in its entirety may not be necessary.

tr. Avinash Chandra Kaviratna

The chapter the tradition devotes to the prior question a treatment-principles record has to answer first: whether treatment is indicated at all. Maitreya's objection is that outcomes are observed both with and without treatment, so 'Treatment and no Treatment are the same'. Atreya rejects the objection outright rather than conceding it, 'Thou thinkest erroneously... Thy doubts, however, are groundless', and then narrows the efficacy claim: treatment is not futile in diseases capable of being cured, patients who recover without treatment in its entirety may not have needed it, and the incurable will not respond, because 'all diseases are not capable of cure'. The classical corpus therefore scopes its own efficacy claim rather than asserting it universally. Retrieved and read in the scan named in sourceUrl, Lesson X, pages 107-108. The ellipses mark omitted material, not joined fragments: the three segments are consecutive passages of Kaviratna's main text.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 11 (Tistraishaniya):11.54 (standard Trikamji numbering) · checked against the source

Medicines are of three kinds; those that depend for their action upon the deities and invisible influences ; those that depend for their application and action upon knowledge and reason ; and those that appertain to the subjugation of the mind.

tr. Avinash Chandra Kaviratna

The threefold modality classification: daivavyapashraya, yuktivyapashraya, sattvavajaya. Retrieved and read in the scan named in sourceUrl, Lesson XI; the string occurs exactly once there. Standard number 54 confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com (trividhamaushadhamiti- daivavyapashrayam, yuktivyapashrayam, sattvavajayashca ||54||). Kaviratna's own printed number for this block is not asserted here, and CORRECTED 2026-10-06 as to why. The earlier revision said the digits are illegible at this point. They are not illegible; they are mutually inconsistent, which is a different and more useful thing for an auditor to know. The OCR prints '64' after the aphorism preceding this block ('restorers of life and strength.64') and '*56' after this one ('constitutes medicine of the third kind.*56'). Two consecutive aphorisms cannot be 64 and 56, so at least one digit pair is an OCR corruption and the record will not guess which. Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected, each flagged in this note. No wording supplied from any other source. SECOND-PASS VERIFICATION 2026-10-06. An independent pass re-downloaded this scan (archive.org BIUSante_47357_djvu.txt, 4,989,688 bytes) and re-read the passage in context. The standard number was re-confirmed independently in the verse-numbered Sanskrit, where 11.54 reads daivavyapashrayam, yuktivyapashrayam, sattvavajayashca| tatra daivavyapashrayam-mantraushadhimanimangala... and closes sattvavajayah- punarahitebhyo arthebhyo manonigrahah||54||, confirming both that the modality triad is 54 and that Kaviratna's single block legitimately covers the triad plus its enumeration.

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Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 11 (Tistraishaniya):11.55 (standard Trikamji numbering) · checked against the source

When the sources of the faults of the body (viz., wind, bile, and phlegm) become disordered, it is very generally seen that three kinds of medicines, all of which must be brought in contact with the body, become necessary. These three kinds are (1) those for internal application, (2) those for external application, and (3) the application of surgery.

tr. Avinash Chandra Kaviratna

The threefold route classification: antahparimarjana, bahihparimarjana, shastrapranidhana. Retrieved and read in the scan named in sourceUrl, Lesson XI, immediately following the modality verse; the string occurs exactly once there. Standard number 55 confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com (sharirodoshaprakope khalu shariramevashritya prayashastrividhamaushadhamicchanti- antahparimarjanam, bahihparimarjanam, shastrapranidhanam ceti ||55||). Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected, each flagged in this note. No wording supplied from any other source. Specifically: the scan prints the first list marker as '(i)', which is OCR for '(1)', the following two reading '(2)' and '(3)'. SECOND-PASS VERIFICATION 2026-10-06. An independent pass re-downloaded this scan (archive.org BIUSante_47357_djvu.txt, 4,989,688 bytes) and re-read the passage in context. Kaviratna's printed number for this block is likewise not asserted: the OCR after the surgery enumeration reads 'applying leeches.6*', which is not a usable digit pair. The standard number was re-confirmed in the verse-numbered Sanskrit, which gives antahparimarjanam, bahihparimarjanam, shastrapranidhanam ceti and closes shastrapranidhanam punashchedanabhedanavyadhanadaranalekhanotpatana...ksharajalaukasashceti||55||, a verse distinct from 54.

source

Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 22 (Langhana-Brimhaniya):22.4, 22.9-22.12a and 22.44 (standard Trikamji numbering); the definitions printed as verses 7-9 by Kaviratna. CORRECTED 2026-10-06 from '22.4 and 22.9-22.11'; see establishes. · checked against the source

He is a true physician who knows the time when the administration should be resorted to of the courses of treatment called Langhana, Vrimhana, Rukshana, Snehana, Swedana, and Stambhana. ... Anything that lightens or attenuates (the aggravated humours and altered constituents) in the body has been said to be a Langhana. That which promotes nutrition and bulk of the body is known as Vrimhana. That which brings about dryness, and roughness and paleness is said to be Rukshana. That which leads to secretions of oily matter, softness of the body, and increase of impurities, is said to be Snehana. Anything that produces perspiration and destroys stiffness and heaviness and sensation of cold is said to be Swedana. That which constipates or stops the motion of such constituents of the body as are liquid, restless, and endued with motion, is said to be Stambhana. ... Thus have the six methods, in pursuance to which all treatment has been introduced, been expounded in this Lesson on Langhana (and the rest).

tr. Avinash Chandra Kaviratna

The shad-upakrama: six therapeutic measures, defined by what each does to the body, presented by the chapter's own closing summary as the frame in which all treatment is organised. This is the reducing/nourishing axis that the secondary literature calls apatarpana/santarpana, and it is the most schematic treatment-choice statement the record carries from a source it has actually read. It also constrains a claim this record used to make: the classical frame here is six measures, not a binary eliminate-or-pacify fork. Retrieved and read in the scan named in sourceUrl, Lesson XXII, whose closing colophon reads 'Thus ends the twenty-second Lesson called Langhana-Vrimhaniya'. Standard numbering confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com (index.php?title=Langhanabrimhaniya_Adhyaya): langhanam brimhanam kale rukshanam snehanam tatha / svedanam stambhanam caiva janite yah sa vai bhishak ||4||, and the six definitions at ||9||-||11||. Kaviratna numbers the definitions 7-9, two behind standard, consistent with his not numbering the chapter's two opening sentences. The ellipses mark omitted material; the segments are consecutive passages of Kaviratna's main text. Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected, each flagged in this note. No wording supplied from any other source. Specifically: the scan prints the term variously as 'Vring-hana', 'Vrin-ghaoa' and 'Vrim-haniya', all OCR of Vrimhana, normalised here to 'Vrimhana'; 'Stamhhana' corrected to 'Stambhana'. SECOND-PASS VERIFICATION 2026-10-06. An independent pass re-downloaded this scan (archive.org BIUSante_47357_djvu.txt, 4,989,688 bytes) and re-read the passage in context. Two address corrections, both from reading the verse-numbered Sanskrit rather than trusting the earlier revision's span. First, the six definitions do not end at 22.11. Standard 22.9 covers langhana, 22.10 brimhana and rukshana, 22.11 snehana and svedana, and the stambhana definition is the FIRST HALF of 22.12: stambhanam stambhayati yadgatimantam calam dhruvam| , after which 22.12 continues laghushnatikshnavishadam ruksham sukshmam kharam saram||12||. The span is therefore 22.9-22.12a, and the entry's verse field has been corrected. Second, the closing summary sentence quoted here as the third segment had no address at all in the earlier revision, which gave only 22.4 and the definitions. It is standard 22.44: tatra shlokah- ityasmin langhanadhyaye vyakhyatah shadupakramah| yathaprashnam bhagavata chikitsa yaih pravartate||44||. 22.4 itself was re-confirmed as langhanam brimhanam kale rukshanam snehanam tatha| svedanam stambhanam caiva janite yah sa vai bhishak||4||. TRAP RECORDED, because it is the same shape as the press-notice failure that this record was repaired for. The definition sentence exists twice in the Kaviratna volume in near-identical wording. The main text in Lesson XXII reads "Any' thing that lightens or attenuates (the aggravated humours and altered constituents) in the body has been said to be a Langhana", which is what is quoted here; a translator's footnote in a later lesson reads 'Anything that lightens or attenuates (the aggravated humours) of the body is called Langhana. The word does not mean fast only. - T.' A matcher normalising punctuation would treat the footnote as a hit. This quote was taken from the main text, identified by Kaviratna's printed 7-9 and by the surrounding dialogue with Agnivesha.

source

Charaka Samhita (Kaviratna translation, 1896-1913)Sutrasthana 23 (Santarpaniya):Charaka Samhita, Sutrasthana, chapter 23 (Santarpaniya). The quote is standard/Trikamji 23.3-23.5a only; 'and 23.40' must come out of the verse field, because no part of 23.40 appears in the quote. Kaviratna's printed markers 3 and 4 do bracket the quoted sentence, as the field says, but he is one aphorism BEHIND the standard numbering in this lesson rather than zero-offset: his printed 3 closes what the vulgate numbers ||4|| ('cēṣṭādvēṣī divāsvapnaśayyāsanasukhē rataḥ||4||' = '...good beds and seats and other comforts'), and his printed 4 closes ||5|| ('pramēhapiᶪkanaukandu... pramehapidakakothakandupandvamayajvarah||5||' = '...urticaria evanida, anaemia and jaundice, fever'), with the same offset at the end of the lesson where his 38 is standard ||39||. · checked against the source

One who gratifies oneself with such things as are oily, or sweet, or heavy, or slimy, or with new rice, or new spirits and wines, or meat of aquatic animals or of those living in marshy regions, or with the juice of the cow (milk), or with cakes made with raw sugar or other ingredients, taken to excess, one that is averse to all exertion, or that indulges in sleep at day-time, and that habitually uses good beds and seats and other comforts, gets numerous diseases in consequence of such indulgence, at once sedative and nutritive, in food and acts, called Tarpana.

tr. Avinash Chandra Kaviratna

Santarpana stated as a source of disease rather than only as a therapeutic lever: over-nourishment in food (unctuous, sweet, heavy and slimy fare, new rice, new spirits and wines, flesh of aquatic and marsh animals, milk, raw-sugar and other cakes, all taken to excess) together with sedentary conduct (aversion to exertion, day sleep, habitual ease of beds and seats) is itself the stated cause of a named disease class, 'numerous diseases in consequence of such indulgence... called Tarpana' (standard 23.5a, rōgāstasyōpajāyantē santarpaṇanimittajāḥ). For a treatment-choice record this is the classical statement that a nourishing measure carries its own disease class when carried too far. The passage speaks of santarpana only; neither apatarpana nor under-nourishment appears in it, so this citation does not establish the two-directional axis or the claim that the choice can do harm in either direction. Retrieved and read in the scan named in sourceUrl, Lesson XXIII, whose running heading is OCR-mangled as "lesson xx'irr" but whose colophon and chapter title are legible. Standard span 23.3-23.5a confirmed against the verse-numbered Sanskrit at carakasamhitaonline.com; Kaviratna's own printed markers are 3 and 4, and he runs one aphorism behind the standard numbering throughout this lesson because he merges the vulgate's opening two aphorisms into his 1. Quote transcribed from the OCR of the scan named in sourceUrl; line-break hyphens closed and obvious OCR letter-errors corrected. No wording supplied from any other source.

source

Sushruta Samhita (Bhishagratna translation, 1907-1916), Vol. ISutrasthana 1 (Vedotpatti):NONE ASSERTED. See establishes. · checked against the source

Samshodhanam (Cleansing), and Samshamanam (Pacification of the deranged or agitated bodily humours giving rise to the disease) and the regimen of diet and conduct are the four factors which should be duly employed in order to successfully cope with a disease.

tr. Kaviraj Kunja Lal Bhishagratna

Sushruta's four-factor statement of what treatment consists of, which puts diet and conduct alongside the two drug/procedure classes rather than below them. Quote re-verified verbatim on 2026-10-06 in the full text at archive.org/stream/englishtranslati01susruoft/englishtranslati01susruoft_djvu.txt, Sutrasthanam Chapter I, printed page 11, where it occurs exactly once. No verse number is recorded because Bhishagratna prints no Sanskrit verse numbers at all, only his own chapter and section divisions; asserting one would mean mixing two numbering systems, which this project has established to be almost always wrong. A page number in his edition is the only address available and is given. CAUTION, and the reason this entry names a page: the same volume's Introduction, at about p. 111 under the heading 'Samshodhanam and Samshamanam', has Bhishagratna writing in his own voice that 'All kinds of treatment may be grouped under two heads such as Samshodhanam and Samshamanam'. That is the translator reducing four factors to two, not Sushruta, and it is the kind of sentence that has been absorbed as doctrine in this project before. Nothing in this record is drawn from it, and the two-fold reduction is not attributed to Sushruta anywhere here.

source

Ashtanga Hridaya (Vagbhata)Sutrasthana 14 (Dvividhopakramaniya):NONE ASSERTED. See establishes.

Chapter-level address only. The chapter title Dvividhopakramaniya means 'on the two-fold therapeutic approach', and the secondary literature treats this chapter as Vagbhata's compression of all treatment into a nourishing and a reducing class. This record asserts nothing about its contents. No text of it was retrieved and no translation of it is quoted here, so under this project's rule, no quote means no claim, and nothing in this entry may be promoted to a published claim.

What the research actually shows

Every paper located for this concept, with what it measured and what it does and does not establish. The assessment is ours.

Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. · J Clin Rheumatol · 2011 · PMID 21617554

A trial that tested individualised classical Ayurvedic treatment, that is chikitsa sutra applied by Ayurvedic physicians rather than a fixed formula, under double-blind, double-dummy, randomised conditions, in 43 seropositive rheumatoid arthritis patients against methotrexate and against the combination. All three arms improved and no statistically significant efficacy difference was found.

How much it shows. Empirical, and the most tightly blinded study of individualised Ayurvedic treatment found in the searches recorded in gatheringNotes, but explicitly a pilot: n=43 across three arms, no placebo-only arm, and therefore no power to distinguish equivalence from mutual non-effect. Critically, the design does not isolate the individualisation rule itself: it cannot show that chikitsa-sutra-guided selection performed better than a fixed Ayurvedic regimen would have.

Effectiveness of an Ayurveda treatment approach in knee osteoarthritis - a randomized controlled trial. · Osteoarthritis Cartilage · 2018 · PMID 29426006

Multicentre randomised controlled open-label trial of a multi-modal individualised Ayurvedic treatment approach against multi-modal conventional conservative care in 151 knee osteoarthritis patients (Ayurveda n=77, conventional n=74), 15 treatments over 12 weeks, in two hospital clinics and two private outpatient clinics in Germany. Primary outcome WOMAC change at 12 weeks favoured the Ayurveda arm (mean difference 61.0, 95% CI 52.4 to 69.6, versus 32.0, 95% CI 21.4 to 42.6; between-group p<0.001; Cohen's d 0.68, 95% CI 0.35 to 1.01), with similar trends in all secondary outcomes and effects sustained at 6 and 12 months. Registered NCT01225133.

How much it shows. The largest trial of individualised whole-system Ayurvedic treatment found in the searches recorded in gatheringNotes, and the most directly relevant modern study to a record about treatment selection. But it is open-label, so expectation effects are uncontrolled, and the comparator is conventional care rather than a fixed Ayurvedic regimen. It therefore does not isolate the contribution of individualisation either: a positive result here is consistent with the Ayurvedic package working and with the individualisation rule adding nothing. The authors say so themselves, calling for further study to clarify the role of different treatment components and non-specific effects.

Reliability of Ayurvedic Diagnosis for Knee Osteoarthritis Patients: A Nested Diagnostic Study Within a Randomized Controlled Trial. · J Altern Complement Med · 2019 · PMID 30653338

Inter-rater reliability study of Ayurvedic diagnosis, nested in the knee osteoarthritis randomised trial above: 30 patients each diagnosed in sequence by all 4 Ayurvedic experts using a semi-structured history form, 120 individual ratings plus 30 consensus ratings, agreement measured by Fleiss' and Cohen's kappa. High raw percentage agreement on main diagnostic entities and on the consented final Ayurvedic diagnosis (95% consensus agreement on main diagnosis) was NOT reflected in the kappas, which were largely fair to poor for central diagnostic aspects including prakriti and agni (kappa between 0 and 0.4). Agreement on disease-related entities was better than on constitutional entities.

How much it shows. Empirical and the only study of inter-rater agreement in Ayurvedic practice found in the searches recorded in gatheringNotes. Small (30 patients, 4 raters), single condition, and the raters reached a consensus diagnosis by nominal group technique, so the high consensus figure is a product of the procedure rather than independent agreement. It measures agreement on DIAGNOSIS, not on the treatment plan that chikitsa sutra is supposed to generate from a diagnosis, so it does not close the reliability question for treatment selection. What it does do is bear directly on it: if trained physicians agree only fairly to poorly on prakriti and agni, the inputs to most dose and modality decisions are themselves unreliable.

Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee--study protocol for a randomized controlled trial. · Trials · 2013 · PMID 23701973

Published protocol for the knee osteoarthritis trial above, stating the design before results. Relevant to this record for one specific reason: it documents what the Ayurvedic arm was permitted to individualise (tailored combinations of manual treatments, massages, dietary and lifestyle advice, selected foods, nutritional supplements, yoga posture advice, knee massage) and records that the investigators placed the trial, on an adapted PRECIS scale, in the middle of the efficacy-effectiveness continuum, describing the design as 'a compromise between rigor and pragmatism'.

How much it shows. A protocol, not evidence of effect. Its value here is that the individualisation was specified in advance and in public, which is what makes the trial a test of a selection procedure rather than of an unspecified package, and that the authors themselves name the design trade-off rather than leaving it to be inferred.

Ayurveda in Knee Osteoarthritis-Secondary Analyses of a Randomized Controlled Trial. · J Clin Med · 2022 · PMID 35683435

Secondary analyses of the same 151 patients, applying generalised linear models, a radial basis function network, exhausted CHAID, CART, and C5.0 with adaptive boosting to identify what predicted response. The treatment arm and the baseline WOMAC subscale values came out as the most important variables; intake of nutritional supplements in the Ayurveda arm did not appear to be a significant factor. The authors' own conclusion is that 'therapeutic effects cannot be explained by the therapies themselves alone, although they were the most important factors in the applied models'.

How much it shows. Post hoc and exploratory, on data from a single open-label trial, with many modelling approaches applied to one dataset; the reported 89.4% and 98% predictive accuracies are in-sample model-fitting figures and are not evidence of effect. Recorded here because it is the closest thing found to an attempt to decompose which part of an individualised Ayurvedic intervention did the work, and because its finding cuts against, not for, the specificity of the selection rule.

Randomized trial of a whole-system ayurvedic protocol for type 2 diabetes. · Altern Ther Health Med · 2006 · PMID 17017752

Randomised trial of a whole-system Ayurvedic protocol (diet, exercise, meditation, herb) versus standard diabetes education in 60 newly diagnosed type 2 diabetes patients. No significant between-group differences in clinical outcomes at 6 months on the prespecified analysis.

How much it shows. Empirical and randomised, but small, unblinded, and the positive findings emerge only from a post hoc analysis stratified on baseline HbA1c, which the authors themselves frame as hypothesis-generating. Reported as a feasibility study. Note also that the protocol was fixed rather than individualised, so it tests an Ayurvedic package, not a selection rule.

Ayurvedic treatments for diabetes mellitus. · Cochrane Database Syst Rev · 2011 · PMID 22161426

Cochrane review of Ayurvedic treatments for diabetes mellitus. Seven trials, 354 participants, six of proprietary herbal mixtures and only one of whole-system Ayurvedic treatment; the whole-system study did not report HbA1c or fasting glucose. Methodological deficiencies and small samples prevented any definite conclusion.

How much it shows. A high-quality systematic review, and its conclusion is negative on the evidence base rather than on the treatments. It is NOT a study of treatment-selection principles and is not offered as one: it is about herbal products in one disease. It is retained for the single narrow thing it does support, that within the one disease area it systematically searched, whole-system Ayurvedic treatment accounted for one trial in seven and that trial did not report the primary glycaemic outcomes. It is not evidence about how much of the classical decision framework has been tested overall, and the evidenceState field no longer uses it that way.

Foundational principles of classical Ayurveda research. · J Ayurveda Integr Med · 2013 · PMID 24459385

Argues that RCT methodology is structurally mismatched to individually optimised Ayurvedic therapy and proposes three 'Rishi principles' (inductive learning, whole-systems thinking, individually optimised therapy) as an alternative research frame.

How much it shows. Narrative and methodological essay by a single independent author, with no data. Not evidence that the principles work, and not evidence about the field as a whole. It supports one thing only: that this author, writing in an indexed Ayurvedic journal, treats individualised selection as not reducible to stated criteria.

Evidence-based approaches for the Ayurvedic traditional herbal formulations: toward an Ayurvedic CONSORT model. · J Altern Complement Med · 2008 · PMID 18684081

Proposes an 'Ayurvedic CONSORT' reporting framework for multimodal integrative interventions, using lymphoedema treatment as the worked example.

How much it shows. Methodological position paper, not an empirical study and not a validated reporting guideline. Retained as documentation that its authors saw a reporting gap for individualised Ayurvedic treatment selection and proposed to fill it. The record no longer uses it to assert that no accepted standard existed as of publication, which is an exhaustive negative this record cannot support.

Open questions on this record

Recorded rather than resolved: what this entry cannot currently settle.

  • For the next auditor: every classical citation in this record now points to one of two scans, BIUSante_47357 for Charaka and englishtranslati01susruoft for Sushruta, and every quoted string was checked to occur exactly once in its file. The check that caught the 2026-09-20 failure was reading the surrounding context, not matching the string, because the string matched in the press notices too. An auditor repeating this work should re-read context, not re-match quotes.
  • The Kaviratna-to-standard numbering offset is one in Sutrasthana 1 and two in Sutrasthana 9, 10, 22 and 23. Anyone applying a single uniform offset to this corpus will introduce errors. Each entry carries both numbers for this reason.
  • The largest open item is a search, not a citation: the non-indexed AYUSH and CCRAS material has not been looked at, and until it is, this record's negative claim about explicit decision criteria stays bounded to PubMed.
  • STRING UNIQUENESS IS NOT A SUFFICIENT TEST IN THIS VOLUME, and the second pass found three more near-duplicates to prove it: the samanya sentence of 1.44 appears in the main text, in Kaviratna's footnote gloss on the same verse, and in a cross-reference footnote in a later lesson; the middle sentence of 1.124-126 appears in the main text and in the bound-in press notice, differing by a single comma; and the langhana definition of 22.9 appears in the main text and in a translator's footnote in a later lesson with 'the aggravated humours' for 'the aggravated humours and altered constituents'. An auditor must read the surrounding printed aphorism numbers, not count matches.

How to cite this entry

Age Ayurveda Nighantu, Chikitsa Sutra (principles governing treatment choice), https://nighantu.ageayurveda.com/concept/chikitsa-sutra/, CC BY 4.0. The whole set is downloadable from the concept index. Machine-readable source: Markdown. Data exported 2026-10-08.

Educational reference only. This page describes what a body of theory claims and how well it is evidenced. Nothing here is advice, and nothing here describes how any condition should be treated.