Sadhya-asadhya (prognosis and the decision to treat)
How much weight this concept bears. Sadhya-asadhya rests on classical exegesis, and this revision made the classical side substantially stronger while narrowing what can be said about the modern side. On the texts, the concept is now sourced in three samhitas and nineteen citations, of which eighteen carry a quote. Charaka states the fourfold scheme at Ca.Su.10/9, grades the curable again by magnitude of means at 10/10, and then gives a separate criteria list for each of the four tiers at 10/11-20, built from a recurring set of variables whose values shift across the tiers: force of causes and signs, correspondence of dosha with dushya, prakriti, season and place, number of doshas, number of pathways, depth of seat, marma and sandhi involvement, duration, complications, tolerance of medicines, and completeness of the four padas. That block is the most detailed prognostic rule in either samhita and the record did not have it at gathering, which is why it previously credited Sushruta with the nearest thing to an operational rule. Charaka restates the scheme independently at Ca.Su.18/39-41, where yapya is named in the verse. Sushruta's three tiers and his criteria are at Su.Su.35, and Su.Su.23 shows the three tiers applied to one disease class with a named yapya block. Vagbhata compresses the whole thing into A.H.Su.1/29+(1) to 1/35. The arishta material is Charaka's twelve Indriya Sthana chapters, Sushruta Su.Su.28 to 33, and A.H.Sharirasthana 5. The two bodies are joined inside the text: Charaka's refusal criteria at Ca.Su.10/20 include sarishtam, Vagbhata's at A.H.Su.1/33 include drishta-rishta, and Sushruta closes his arishta block at Su.Su.32 by saying that the physician who can read the fatal signs is honoured by the king for determining whether a disease is curable or incurable. Three separate loci therefore state the purpose of the arishta chapters to be the sadhya-asadhya judgement, which the record previously asserted as its own reading. The doctrine has an internal feature that resists testing, and it is in the Sanskrit rather than in anyone's English: Ca.In.2/5 says no arishta once arisen vanishes other than by death and no death is unpreceded by one, and 2/6 assigns both false positives and false negatives to prajnaparadha. But Vagbhata reports a qualification the record did not have. At A.H.Sha.5/3-4 he says that some hold rishta to be twofold, sthayin and asthayin, and that a mere abundance of doshas can produce a rishtabhasa, an appearance of a rishta, which subsides when the doshas are pacified, while the persistent one goes inevitably to death. That is a prospectively applicable criterion, and it narrows the self-sealing reading without dissolving it. On the modern side, nothing was found in the indexes searched that tests any part of the concept, and the searches are named in full in searchRecord rather than summarised. PubMed E-utilities was run on 2026-10-06 with seventeen strings, DHARA with ten, and the AYUSH Research Portal, which holds 30,920 Ayurveda records and is the largest relevant index, failed server-side on every attempt with its own tempdb error and has therefore not been searched at all. Scopus, Web of Science, Embase, CENTRAL, Google Scholar, any Hindi or Devanagari search, and any hand-search of non-indexed Indian Ayurveda journals were not attempted. Within those bounds: changing the search string recovered three on-topic indexed records the record had missed, so the record's previous claim that there is no modern evidence base was not merely unbounded but wrong in part. One of the three, a 1997 paper in Ancient Science of Life, states the classical ruling that kaphaja prameha is sadhya and pittaja and vataja are yapya and asadhya, and sets out to test it against insulin level; its retrievable abstract reports an aim and no results, so it establishes that the attempt exists and nothing more. Another is a commentarial study of arishta-vijnana in Dalhana and Chakrapani, which shows that the scholarly literature on the arishta material is substantial and that this record has consulted none of it in the original. The strongest material actually in hand remains indirect: the knee-osteoarthritis reliability study, which shows that Ayurvedic experts agree poorly on the diagnostic inputs a prognostic judgement would be built from, and the three oil-drop papers, of which the 2012 one is a standardisation protocol whose own premise is that the technique is crude and variable. Zero of the ten modern references report a sadhya, yapya or asadhya assignment tested against an outcome, an agreement statistic for any prognostic category, or sensitivity, specificity or a c-statistic for any arishta sign. That is the honest summary of the modern position, and it is a statement about these searches rather than about the world. This revision also added three comparators from conventional medicine, because the defensible claim is not that no evidence exists but that the test has not been done and this is what it would look like. Christakis and Lamont (2000) measured clinician prognostic accuracy directly: 20 per cent of 468 predictions accurate, 63 per cent overoptimistic, survival overestimated by a factor of 5.3. The Surprise Question meta-analysis (2017) reports pooled accuracy of 74.8 per cent over 25,718 predictions with c-statistics from 0.512 to 0.822, which is the form a single clinician-rated death sign has to be reported in to be assessable at all. The Palliative Prognostic Index meta-analysis (2025) does the same for a composite score built from weighted features, which is the form Charaka's and Sushruta's criteria lists take. Together they show that the quantity the arishta chapters claim to deliver is one conventional medicine also attempts and is measurably poor at, so the comparison is not between a tested method and an untested one; it is between a method whose error has been quantified and one whose error has not. What remains most in need of explicit treatment in any modern reference is the ethical content, and this revision sharpened it rather than softening it. Charaka's disclosure rule at Ca.In.12/62-64 directs the physician to withhold a terminal prognosis and decline the case without saying why, and at 12/65 it directs him to declare recovery with certainty when the contrary signs appear, so it is a one-way restriction and not a general reticence. Vagbhata's refusal list at A.H.Su.1/34-35 is wider still and eleven of its twelve grounds are not prognostic: political disfavour, lack of means, distraction, non-compliance, violence, grief, timidity, ingratitude, and thinking oneself a physician. Every reason the three texts give for getting the prognosis right is a reason of the physician's standing: loss of wealth and fame at Ca.Su.10/8, infamy and loss of one's own interest at A.H.Sha.5/1+(2), professional success at Su.Su.33, and the king's honour at Su.Su.32. This is the part that is incompatible with contemporary informed-consent and palliative-care practice, and no source consulted reconciles them.
Sadhya-asadhya is the classical requirement that the physician determine, before beginning treatment, whether a disease is curable, manageable but not curable, or beyond treatment. Charaka divides diseases into sadhya (curable) and asadhya (incurable), each into two: curable easily or with difficulty, and incurable but suppressible (yapya) or without treatment at all (anupakramya, pratyakhyeya). He states this at Ca.Su.10/9 and then, at Ca.Su.10/11-20, gives a graded list of criteria for each of the four. That criteria block is the most detailed prognostic rule either samhita contains, and this record did not carry it at gathering. Charaka restates the scheme at Ca.Su.18/39-41, where yapya is named in the verse and curability is crossed with mildness and violence to give four kinds. Sushruta gives three working categories, curable, yapya and incurable, at Su.Su.35, and specifies the features that make a disease yield to medicine: recent onset, absence of distressing complications, mismatch with the patient's country, season, temperament and habituation, intact digestion, and the presence of strength and fortitude. He applies the same three tiers to one disease class at Su.Su.23, where a named block of yapya ulcers admits palliation only. Vagbhata compresses the whole scheme into Ashtanga Hridaya Sutrasthana 1/29+(1) to 1/35. The classification carries a strong professional injunction. Charaka warns at Ca.Su.10/8 that a physician who treats an incurable case loses wealth, knowledge and fame and incurs the censure of the world; Sushruta at Su.Su.33 tells the physician to abandon patients with named fatal complications; and Vagbhata at A.H.Su.1/34-35 lists the patients to be given up, most of them named for reasons that are not medical at all. A parallel body of material, the arishta lakshanas of Charaka's Indriya Sthana, twelve chapters whose titles are enumerated in components, and Sushruta Sutrasthana 28 to 33, catalogues signs of impending death; Vagbhata's counterpart is Sharirasthana 5. The two bodies are joined inside the text itself, because Charaka's criteria for refusal at Ca.Su.10/20 include sarishta, the disease accompanied by arishtas, and Vagbhata's at A.H.Su.1/33 include drishta-rishta. Charaka also lays down a disclosure rule at Ca.In.12/62-64: the physician should never say unasked that death is near, should not say so even when asked if the declaration would cause harm, and should instead decline the case without saying why. The rule is asymmetric; at Ca.In.12/65-66 the physician is told to declare recovery when the contrary signs appear.
| Subject area | Examination and assessment |
|---|---|
| Domain, as recorded | diagnosis |
| Contested questions | 5 |
| Stated as not known | 14 |
| Classical citations | 19, 16 quoting the text |
| Research papers assessed | 10 |
| Citations checked | 2026-10-08 |
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 the classification three-fold or four-fold?
This is contested.
- Three: sadhya, yapya, asadhya. This is Sushruta's formulation at Su.Su.35 (classical[11]) and the one used in most teaching.
- Four: sukhasadhya, kricchrasadhya, yapya, anupakramya/pratyakhyeya. This is Charaka's at Ca.Su.10/9 (classical[1]) and Vagbhata's at A.H.Su.1/29+(1) (classical[17]), in the same terms in both.
- Charaka elsewhere crosses curability with severity to produce a different four, mild-curable, violent-curable, mild-incurable and violent-incurable, at Ca.Su.18/41 (classical[6]). The three schemes are routinely presented as one, which they are not.
- Arguably more than four, since Ca.Su.10/10 divides the curable again by whether the means required are alpa, madhyama or utkrishta (classical[2]). Charaka therefore has at least five grades of sadhya-ness within the curable alone, and the record's own earlier count of four was itself a simplification.
Is refusing an incurable case an ethical duty or professional self-protection?
This is contested.
- The texts give the reason in self-interested terms, and this revision found that all four places they do so agree. Ca.Su.10/8 lists artha, vidya, yasha, upakrosha and asangraha, all costs to the physician. A.H.Sha.5/1+(2) says treatment in one whose life-span is exhausted yields ayashas and svartha-hani, infamy and loss of one's own interest. Su.Su.33 says the physician 'with any regard to professional success' should abandon such a patient. Su.Su.32 says the physician who can read the fatal signs is honoured by the king for determining curability. Four loci, four reasons, none of them about the patient.
- Modern Ayurvedic commentary reframes pratyakhyana as honesty about limits and avoidance of futile burdensome treatment, closer to a palliative-care rationale. Both readings are defensible from the text, but they are different rationales and the texts state the first.
- Vagbhata's refusal list at A.H.Su.1/34-35 (classical[17]) makes the self-protection reading harder to avoid, because most of it is not about prognosis at all. The physician is to give up the patient who is hated by physicians and kings, who hates them, who is hinopakaranam (lacking means), vyagram (distracted), avidheyam (non-compliant), chandam (violent), shokaturam (grief-stricken), bhirum (timid), kritaghnam (ungrateful) or vaidyamaninam (thinks himself a physician). Only gatayusham, one whose life-span is gone, is a prognostic ground. Whatever pratyakhyana is in Charaka, in Vagbhata it is partly a rule about which patients are worth taking on.
- A third reading is possible and is not the same as either: that the texts are describing a reputational economy rather than prescribing one, i.e. recording what a physician who wished to keep a practice in that setting had to do. No source consulted here argues this, and this record does not assert it; it is listed because the first two positions are usually presented as exhausting the options and they do not.
Should a terminal prognosis be disclosed?
This is contested.
- Charaka Ca.In.12/62-64 (classical[9]): never unasked, not even when asked if harm would follow, and decline without explaining.
- The rule is one-directional, which the record did not previously state. Ca.In.12/65 (classical[10]) tells the physician to declare recovery dhruvam, with certainty, when the signs contrary to the death-signs appear. So the text is not reticent about prognosis as such; it withholds bad news and gives good news positively. This makes the conflict with informed consent sharper, not softer, because the asymmetry is itself the thing modern consent doctrine objects to.
- Contemporary medical ethics and the informed-consent framework under which registered Ayurvedic practitioners operate in India require disclosure to a competent patient who asks. The classical rule and current professional obligation conflict, and no source consulted resolves this.
- The classical rule's own stated ground is harm, 'tatra yatropaghatakam', where it would be injurious, which is recognisably a therapeutic-privilege argument and is not simply evasion. That does not reconcile the two, because modern consent doctrine has largely rejected therapeutic privilege as a default, but it does mean the disagreement is about whether the privilege holds rather than about whether patients matter.
Do arishta signs have prognostic content?
This is contested.
- The tradition treats them as reliable, on the strength of long clinical observation; Kaviratna's own preface remarks that experience seems to confirm many of Punarvasu's observations. That remark is the translator's and is recorded as such.
- No sign has been evaluated prospectively in anything found in the searches named in searchRecord, and several arishta chapters concern dreams, omens, the conduct of the messenger sent to fetch the physician, and incidents on the road, which are not observations about the patient at all. Ca.In.12/66 confirms this directly: the signs the physician may read recovery off include the messenger, omens on the road, the patient's household and the patient's property.
- The doctrine's definition is self-sealing, and this is in the Sanskrit rather than in the English. Ca.In.2/5 says no arishta once arisen vanishes other than by death and no death is unpreceded by one; Ca.In.2/6 assigns both false positives and false negatives to prajnaparadha. A.H.Sha.5/2 says the same. On that definition clinical experience cannot discriminate between true and false arishtas.
- But Vagbhata reports a qualification that is not post-hoc. At A.H.Sha.5/3-4 (classical[18]) he says 'ke-cit tu tad dvi-dhety ahuh', some say it is twofold, by the division into sthayin and asthayin: an abundance of doshas can produce a rishtabhasa, an appearance of a rishta, which subsides when the doshas are pacified, whereas the persistent one goes inevitably to death. Persistence through dosha-pacification is a criterion that can be applied before the outcome is known. It does not remove the circularity, since the persistent sign is still fatal by definition, but it means the tradition is not uniformly committed to the unfalsifiable version, and the record's flat statement that it is was too strong.
- What would settle it is not in dispute and has simply not been done: a prospective cohort reporting, for each named sign, sensitivity, specificity and a time horizon, in the form the Surprise Question literature uses (modern[8]). Until then the question is open rather than answered in either direction.
Is yapya a useful category today?
This is contested.
- It maps naturally onto chronic disease management and is cited as evidence that Ayurveda distinguished control from cure long before modern medicine did.
- The mapping is loose: Sushruta's eight 'hard to cure' conditions at Su.Su.33 include several (ashmari, bhagandara, some udara) that are now routinely curable surgically, so the category's membership is not stable across time.
- The claim that yapya is defined only negatively, by the failure of cure, is no longer tenable in the form the record previously stated it. Ca.Su.10/17-18 gives positive criteria: remaining life-span, a small ease gained from wholesome regimen, a slight cause restarting the condition, depth of seat, many dhatus, marma and sandhi involvement, continuous presence, long duration, two doshas. Ca.Su.18/39 adds a positive functional definition, that treatment well done becomes yatrakara, enabling the patient to go on. Whether those criteria can be scored reproducibly is a separate and open question; that they exist is now sourced.
- A sharper difficulty than the negative-definition one is that the criteria are time-indexed to therapeutics. 'Beyond the path of treatment' at Ca.Su.10/19 and 'needing surgery, alkali or fire' at Ca.Su.10/15 are both statements about what the available means can reach, so the boundary between kricchrasadhya, yapya and pratyakhyeya moves whenever the means change, and the texts give no updating rule. See notKnown.
- Su.Su.35's second sentence adds a different instability: each of the three tiers is to be examined for whether the disease is primary, aupasargika (accessory or sympathetic to something else), or the premonitory sign of something incipient. A yapya condition that is actually aupasargika is not a stable member of the class, because its course is governed by the primary disease.
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 a sadhya/yapya/asadhya assignment predicts survival or recovery. NARROWED. The record previously said 'No prospective cohort has ever tested this'. One attempt was found, modern[3], a 1997 paper in Ancient Science of Life that states the classical ruling on prameha (kaphaja sadhya, pittaja yapya, vataja asadhya) and sets out to test it against insulin level; its retrievable abstract reports an aim and no design, sample size or results, and the full text was not obtained. What can be said is that no adequate test was found in the searches named in searchRecord, not that none has ever been attempted.
- Whether two physicians assign the same patient to the same prognostic category. No inter-rater reliability study of prognostic classification was found in the searches run. The nearest datum, modern[6], shows poor agreement on the diagnostic inputs rather than on the prognostic output, which bounds the answer without giving it.
- The sensitivity, specificity, positive predictive value, c-statistic or lead time of any individual arishta sign. None was found. The form such a report would have to take is now specified by comparison with modern[8], which reports exactly these quantities for a structurally similar single clinician-rated judgement.
- Whether Charaka's criteria at Ca.Su.10/11-20 can be operationalised and scored reproducibly. This replaces the record's earlier item, which asked the question only of Sushruta's Su.Su.35 list because it did not have the Charaka block. The Charaka block is the harder case: it uses about a dozen variables with ordinal values and gives no weights, no thresholds and no combination rule. No instrument was found for either list. Modern[9] shows what a validated composite of this shape looks like in practice.
- Whether the sthayin and asthayin distinction Vagbhata reports at A.H.Sha.5/3-4 was ever worked out into a usable rule, how long a rishta must persist through dosha-pacification to count as sthayin, and who the 'ke-cit', the some who say so, were. The verse reports the view and does not develop it, and no commentary on it was consulted here.
- How the classification is meant to be revised as treatment changes. Several conditions listed as intrinsically hard to cure at Su.Su.33 are now surgically curable, and 'beyond the path of treatment' at Ca.Su.10/19 is explicitly indexed to available means. The texts give no updating rule and no source consulted supplies one.
- Whether pratyakhyana as practised today leads to referral, to abandonment, or to delayed presentation to conventional care. No observational data on what actually happens to refused patients was found.
- How the non-disclosure rule is handled in current practice under Indian consent law, and whether practitioners follow the classical rule, the modern rule, or something in between. No survey was found. The asymmetry now documented at Ca.In.12/65 makes this a sharper question than the record previously posed, because a practitioner could be following the classical rule precisely while appearing to disclose freely.
- Whether Vagbhata's refusal list at A.H.Su.1/34-35 is read today as live guidance, as historical context, or as something to be explained away. Eleven of its twelve grounds are non-medical and one of them, hinopakaranam, is poverty. No source consulted addresses how it is taught.
- Whether the oil-drop urine test measures anything. Its inter-observer reliability has still not been reported in anything found. NARROWED: the record previously said the reliability 'has never been reported', without noting that modern[2], a 2012 standardisation paper, states the problem in its own words ('the technique is very crude and there are chances of variations in the observations') and proposes a protocol intended to make observations reproducible. A protocol is not a reliability estimate, so the gap stands, but it is not an unexamined gap.
- What Chakrapani's Ayurvedadipika on the Indriya Sthana, Dalhana's Nibandha Samgraha and Chakrapani's Bhanumati say about this material. Modern[4] reports that all three treat arishta-vijnana at length and that Chakrapani held Charaka's Indriya Sthana superior for it. None was read in the original here and none is cited. This is the largest classical gap left in the record, and it is the same gap recorded on the roga-marga record of this project.
- Sushruta's threefold classification of ayu into dirghayu, madhyamayu and alpayu, which modern[5] reports with characteristics for each. The locus was not identified and the passage was not retrieved, so it is not cited. It is plainly adjacent to this concept, since the life-span judgement is what Ca.Su.10/17 makes yapya depend on, and it is recorded as a gap rather than paraphrased from the review.
- Whether the prognostic material in Charaka's Vimana and Chikitsa Sthanas, which modern[5] names alongside Indriya and Sharira, adds anything to the four tiers. Those two sthanas were not searched.
- Whether the AYUSH Research Portal holds work that would change any of the above. It holds 30,920 Ayurveda records, its search failed server-side on every attempt on 2026-10-06, and it has therefore not been searched. This is the single largest boundary on every negative statement in this record.
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.
| Term | What it names |
|---|---|
| Sadhya (curable) | Diseases that respond to treatment. Charaka subdivides into sukhasadhya (easily curable) and kricchrasadhya (curable with difficulty) at Ca.Su.10/9, and at Ca.Su.10/10 divides the curable again by whether the means required are alpa, madhyama or utkrishta, slight, intermediate or great. Each subdivision has its own criteria list: sukhasadhya at Ca.Su.10/11-13, kricchrasadhya at Ca.Su.10/14-16. |
| Yapya (suppressible / manageable) | Not curable, but controllable so that well-applied treatment prolongs life. The text's own criteria are at Ca.Su.10/17-18: the life-span being what remains, the patient has had a little ease from wholesome regimen and a slight cause sets the condition off again; the disease is deep-seated (gambhira), lodged in many dhatus, settled in marma and sandhi, continuously present, long-standing, and arising from two doshas. Ca.Su.18/39 names the category in the verse: incurable diseases called yapya, in which treatment well done is yatrakara, enabling the patient to go on. Sushruta's Su.Su.23 applies it to ulcers, where the yapya group admits palliation only. This is the closest classical analogue to chronic disease management. |
| Asadhya / anupakramya / pratyakhyeya (incurable, to be refused) | No treatment produces benefit; the physician is told to decline. Charaka states at Ca.Su.10/10 that incurable diseases that are niyata, settled, do not admit of the threefold division by means. The criteria are at Ca.Su.10/19-20: arising from three doshas, having passed beyond the path of treatment (kriyapatham atikrantam), following all the pathways, producing anxiety, stupefaction and restlessness, destroying the senses, fully grown in a weak patient, and accompanied by arishta (sarishtam). Ca.Su.18/40 adds that only the foolish strive at these and the learned physician does not. |
| Fourfold cross-classification | Ca.Su.18/41 crosses curability with severity: 'sadhyash chaivapy asadhyash cha vyadhayo dvividhah smritah | mridu-daruna-bhedena te bhavanti chaturvidhah'. Diseases are of two kinds, curable and incurable, and by the division into mild and violent they become four. The verse stops there. It does not say which of the four is equivalent to yapya. |
| Charaka's graded curability criteria | Ca.Su.10/11-20 gives a criteria list for each of the four categories, built from a recurring set of variables: the force of the causes, premonitory signs and present signs; whether the dushya, the season, the patient's prakriti and the place are favourable to the disease or not; how many doshas are involved; how many pathways; depth of seat; involvement of marma and sandhi; duration; the presence of complications; whether the body tolerates all medicines; and whether the four padas of treatment are complete. The same variables run through all four categories with their values shifted, which makes it a graded scale rather than four separate lists. |
| Sushruta's curability criteria | Recent onset; no distressing complications; the disease unsuited to the patient's country, season, temperament and habituation; samagni (regular and unimpaired digestion); strength, fortitude and signs of longevity; and the four commendable factors of treatment (physician, drugs, attendant, patient) present. A disease marked by the opposite features is incurable; one with traits common to both is extremely hard to cure. Su.Su.35 states the three tiers and this rule in the same chapter. |
| Arishta lakshana | Signs of impending death. Charaka devotes the whole of his Indriya Sthana to them, twelve chapters whose titles, verified against the critical edition's chapter index, are: 1 Varnasvariyam (colour and voice), 2 Pushpitakam (odour and taste), 3 Parimarshaneeyam (touch), 4 Indriyaneekam, 5 Purvarupeeyam, 6 Katamanisharireeyam, 7 Pannarupiyam, 8 Avakshiraseeyam, 9 Yasyashyavanimittiyam, 10 Sadyomaraneeyam, 11 Anujyotiyam, 12 Gomayachurniyam. Sushruta's block is Su.Su.28 to 33, six chapters whose Bhishagratna chapter openings were read and are listed at classical[16]. Vagbhata's counterpart is A.H.Sharirasthana 5, Vikritivijnaniya. Charaka's Pushpitakam chapter likens an arishta to a flower and death to the fruit (Ca.In.2/3). |
| Pratyakhyana (refusal) and disclosure | The physician's duty to decline hopeless cases, coupled with a restriction on announcing death: never unasked, not even when asked if it would injure, and declining without stating the reason (Ca.In.12/62-64). The restriction runs one way only: at Ca.In.12/65-66 the physician is told to declare recovery with certainty when the signs contrary to the death-signs appear. Vagbhata's refusal list at A.H.Su.1/34-35 is wider than Charaka's and mostly non-medical. |
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 SamhitaSutra Sthana 10 (Mahachatushpada):8 · checked against the source
अर्थविद्यायशोहानिमुपक्रोशमसङ्ग्रहम्| प्राप्नुयान्नियतं वैद्यो योऽसाध्यं समुपाचरेत्||८||
That physician who takes up the treatment of a disease that is incurable incurs loss of wealth, loss of knowledge, loss of fame, censure of the world, and incapacity for practice.
The professional sanction behind the classification. Note what the verse gives as the loss: artha (wealth), vidya (knowledge), yasha (fame), upakrosha (censure) and asangraha (not being retained in practice). All five are costs to the physician. The verse names no cost to the patient and no duty to the patient, and this is the textual basis of position 1 in contested[1].
Charaka SamhitaSutra Sthana 10 (Mahachatushpada):9 · checked against the source
सुखसाध्यं मतं साध्यं कृच्छ्रसाध्यमथापि च| द्विविधं चाप्यसाध्यं स्याद्याप्यं यच्चानुपक्रमम्||९||
As regards curable diseases, they are of two kinds, viz., those that are easily curable and those that are curable with difficulty. Incurable diseases, also, are of two kinds, viz., those that are capable of being suppressed, and those that have no treatment.
The four-way classification in the Sanskrit and in a lawfully quotable English: sukhasadhya, kricchrasadhya, yapya, anupakrama. The verse names the four and does nothing else; the criteria that distinguish them are at 10/11-20 and are cited separately at classical[3], classical[4] and classical[5].
Charaka SamhitaSutra Sthana 10 (Mahachatushpada):10 · checked against the source
साध्यानां त्रिविधश्चाल्पमध्यमोत्कृष्टतां प्रति| विकल्पो, न त्वसाध्यानां नियतानां विकल्पना||१०||
As regards diseases that are curable, they may again be regarded from three points of view, viz., those that are capable of being cured by the application of means that are easy, those that are curable by means neither easy nor difficult, and lastly those that are curable by means that are difficult. Incurable diseases, which have no treatment, do not admit of being looked upon from different points of view. This much on the points of view from which diseases may be looked upon.
That the curable are graded a second time by the magnitude of means required (alpa, madhyama, utkrishta), and that the settled incurable are treated as internally undifferentiated. Also, as an exhibit, two of Kaviratna's footnotes that this record previously drew doctrine from.
Charaka SamhitaSutra Sthana 10 (Mahachatushpada):11-13 · checked against the source
हेतवः पूर्वरूपाणि रूपाण्यल्पानि यस्य च| न च तुल्यगुणो दूष्यो न दोषःप्रकृतिर्भवेत्||११|| न च कालगुणस्तुल्यो न देशो दुरुपक्रमः| गतिरेका नवत्वं च रोगस्योपद्रवो न च||१२|| दोषश्चैकः समुत्पत्तौ देहः सर्वौषधक्षमः| चतुष्पादोपपत्तिश्च सुखसाध्यस्य लक्षणम्||१३||
The characteristics of diseases that are easily curable are as follows. When the causes, premonitory indications, and present symptoms are slight ; when the derangement has no sympathy with the inducing causes of the disease, when the derangement that has brought about the disease is not capable of being aggravated by the constitution of the patient; when the inducing derangement is not sympathetic with the virtues of the season in which the disease has appeared ; when the treatment does not become difficult in consequence of the place where the disease occurs ; when the part affected by the disease is one ; when it is new ; when the disease is free from violent symptoms ; when the derangement that has caused the disease is concerned with only one (of the three, viz., wind, bile, and phlegm) ; when the body is such that it is capable of bearing all kinds of medicines ; and lastly, when all the four requisites are present ; diseases are said to be easily curable.
New. Charaka's criteria for sukhasadhya, the first tier of the gradation. Eleven conditions, and they are the same variables that reappear with shifted values in the other three tiers: force of the causes, premonitory signs and present signs; non-correspondence between dosha and dushya; non-correspondence with the patient's prakriti; non-correspondence with the season; a place that does not obstruct treatment; one gati or pathway; recent onset; absence of upadrava; one dosha; a body that tolerates all medicines; and the four padas complete. This entry, with classical[4] and classical[5], is the Charaka material the record was missing, and it is what makes the scheme a graded scale rather than four labels.
Charaka SamhitaSutra Sthana 10 (Mahachatushpada):14-17 · checked against the source
निमित्तपूर्वरूपाणां रूपाणां मध्यमे बले| कालप्रकृतिदूष्याणां सामान्येऽन्यतमस्य च||१४|| गर्भिणीवृद्धबालानां नात्युपद्रवपीडितम्| शस्त्रक्षाराग्निकृत्यानामनवं कृच्छ्रदेशजम्||१५|| विद्यादेकपथं रोगं नातिपूर्णचतुष्पदम्| द्विपथं नातिकालं वा कृच्छ्रसाध्यं द्विदोषजम्||१६|| शेषत्वादायुषो याप्यमसाध्यं पथ्यसेवया| लब्धाल्पसुखमल्पेन हेतुनाऽऽशुप्रवर्तकम्||१७||
The characteristics of diseases that are curable with difficulty are as follows : when the causes, premonitory indications, and present symptoms, are of force neither slight nor very grave ; when any of these, viz., the season of the disease, its nature, and the character of those ingredients of the body which are known by the name of Dushya, is sympathetic with the derangement that induces the disease ; when the disease appertains to an elderly woman, an old man, and an infant ; when the disease is not characterised by excessively violent symptoms ; when the disease is such that it should be treated with the aid of operations by (surgical) instruments, by caustic alkali, and by fire ; when the disease is chronic ; when the disease, affecting some vital limb or some joint of the body, affects only one part; when the four principal requisites of treatment are wanting in some particular and the disease affects two parts; when the disease is not very old; and lastly when the disease has been induced by a double derangement ; such diseases should be known as curable with difficulty. Even diseases that are incurable in consequence of the exhaustion of one's allotted period of life may be kept in a suppressed state by means of regulated diet and (proper) nursing.
New. Charaka's kricchrasadhya criteria (10/14-16) and the first of his two yapya criteria verses (10/17). The kricchrasadhya list is the sukhasadhya list with its values moved: middling force of the causes, the premonitory signs and the present signs; correspondence with any one of kala, prakriti and dushya; a vulnerable patient (pregnant or elderly woman, old man, child, on which see variantReadings); moderate complications; dependence on surgery, alkali or fire; chronicity (anavam); origin in a difficult desha (kricchradeshajam, 10/15, the moved counterpart of the sukhasadhya variable na desho durupakramah at 10/12); one pathway with the four padas incomplete; two pathways but not long standing; two doshas. Marma and sandhi involvement is not one of them. Neither marma nor sandhi occurs anywhere in 10/14-16; marmasandhisamashritam stands at 10/18, a yapya verse, which this record quotes and places correctly at classical[5]. Kaviratna's English for this block does read 'when the disease, affecting some vital limb or some joint of the body, affects only one part', but that is his gloss on kricchradeshajam and ekapatham, resting on his own commentator's footnote that desha covers 'both the division of the country and the particular part of the body'. It is the translator's voice, not the verse, and belongs with the four other translator's-voice absorptions this record already documents. 10/17 defines yapya by the remainder of the life-span, by a small ease gained from wholesome regimen, and by a slight cause setting the condition off again.
Charaka SamhitaSutra Sthana 10 (Mahachatushpada):18-20 · checked against the source
गम्भीरं बहुधातुस्थं मर्मसन्धिसमाश्रितम्| नित्यानुशायिनं रोगं दीर्घकालमवस्थितम्||१८|| विद्याद्द्विदोषजं,...तद्वत्प्रत्याख्येयं त्रिदोषजम्| क्रियापथमतिक्रान्तं सर्वमार्गानुसारिणम्||१९|| औत्सुक्यारतिसम्मोहकरमिन्द्रियनाशनम्| दुर्बलस्य सुसंवृद्धं व्याधिं सारिष्टमेव च||२०||
When the disease is deeply ingrained (into the marrow and such other constituents of the body), when it affects many of the constituent parts, when it is attached to the vital limbs and joints of the body, when it manifests itself continuously, when it is chronic and very old, when it is born of the derangement of two of the three ingredients (of wind, bile, and phlegm) or of all the three, when it is beyond the operation of treatment, when it affects all the organs, when the patient is thoroughly cheerless and despairing, when the disease is characterised by a stupefaction of the mind, when the disease weakens the strength of all the organs (of knowledge and action), when the disease has reached the highest limit of aggravation and the patient has become entirely strengthless, and lastly when the disease exhibits indications of the patient's dissolution, it should be regarded as one that should not be taken up for treatment.
New. Charaka's pratyakhyeya criteria at 10/19-20, as distinct from the yapya criteria at 10/17-18: tridosha origin, having passed beyond kriyapatha (the path of treatment), following all the margas, producing autsukya, arati and sammoha (anxiety, restlessness, stupefaction), destroying the indriyas, fully grown in a weak patient, and sarishta, accompanied by arishtas. The last of these is the joint between this concept and the arishta literature, and it is in the verse rather than in anyone's commentary: the refusal rule explicitly takes the arishta signs as one of its inputs. Vagbhata makes the same join at A.H.Su.1/33 with drishta-rishta (classical[17]).
Charaka SamhitaSutra Sthana 18 (Trishothiya, on the three swellings):39-41 · checked against the source
असाध्याश्चापरे सन्ति व्याधयो याप्यसञ्ज्ञिताः| सुसाध्वपि कृतं येषु कर्म यात्राकरं भवेत्||३९|| सन्ति चाप्यपरे रोगा येषु कर्म न सिध्यति| अपि यत्नकृतं बालैर्न तान् विद्वानुपाचरेत्||४०|| साध्याश्चैवाप्यसाध्याश्च व्याधयो द्विविधाः स्मृताः| मृदुदारुणभेदेन ते भवन्ति चतुर्विधाः||४१||
There are others (of this class) which are regarded incurable. Some, again, ( though incurable ) are capable of being suppressed. In diseases of this latter kind, well-applied treatment assists the patient to live on. There are others that are truly incurable. In them no treatment produces success. Only fools strive to treat them. The learned physician never sets his hand upon them. Diseases are of two kinds, viz., Curable and Incurable. Distributing them according to the considerations of mildness and violence, they become of four kinds.
Charaka's second, independent statement of the scheme, in a chapter about swellings rather than about method. Three things it adds to Ca.Su.10. (1) Yapya is named in the verse itself, 'yapya-sanjnitah', and defined by its effect: treatment well done becomes yatrakara, enabling the patient to go on. (2) The refusal is put as a contrast between the foolish and the learned (balaih / vidvan), which is a different register from the loss of wealth and fame at 10/8. (3) 18/41 crosses curability with mridu and daruna, mild and violent, to give four kinds, and stops there without saying which of the four corresponds to yapya. That identification comes from Kaviratna's footnote and is quoted as an exhibit at classical[7].
Charaka SamhitaSutra Sthana 18:Kaviratna's footnote to his verse 46, i.e. to Ca.Su.18/41. Not a verse of the samhita. · checked against the source
Four kinds, such as (1) Mild and Curable, (2) Violent and Curable, (3) Mild and Incurable, and (4) Violent and Incurable. Among these, Mild and Incurable would mean Yapya or suppressible. - T.
Added as the source of a claim the record had mis-attributed. It establishes who said that mild-incurable means yapya, and that it is not in the verse.
Charaka SamhitaIndriya Sthana 2 (Pushpitakam Indriyam):3-6 · checked against the source
पुष्पं यथा पूर्वरूपं फलस्येह भविष्यतः| तथा लिङ्गमरिष्टाख्यं पूर्वरूपं मरिष्यतः||३|| अप्येवं तु भवेत् पुष्पं फलेनाननुबन्धि यत्| फलं चापि भवेत् किञ्चिद्यस्य पुष्पं न पूर्वजम्||४|| न त्वरिष्टस्य जातस्य नाशोऽस्ति मरणादृते| मरणं चापि तन्नास्ति यन्नारिष्टपुरःसरम्||५|| मिथ्यादृष्टमरिष्टाभमनरिष्टमजानता| अरिष्टं वाऽप्यसम्बुद्धमेतत् प्रज्ञापराधजम्||६||
As a flower is seen here to be the premonitory indication of a fruit to be, so a symptom called 'Arishta' is a premonitory indication of a person about to die. There may, indeed, be a flower that is not followed by a fruit. So also there may be a fruit that has not been preceded by a flower. For all that, there cannot be a disappearance of an 'Arishta' that has manifested itself, without death occurring (as a consequence). There cannot, again, be a death that has not been preceded by an 'Arishta.' An ignorant physician regards a symptom as an 'Arishta' which without being a real 'Arishta' only puts forth the appearance of an 'Arishta.' Similarly, such a person fails to detect an 'Arishta' in a symptom that is really so. Both these are due to a deficiency of the understanding.
The arishta doctrine, including its unfalsifiable structure, which is now shown to be in the Sanskrit and not an artefact of the English. 2/5 says there is no vanishing of an arishta once arisen other than by death, and no death that is not preceded by an arishta. 2/6 then assigns both false positives and false negatives to prajnaparadha, the physician's error of judgement. Taken together, a true arishta is always followed by death by definition and every apparent counter-example is reclassified as misperception, so no observation can count against the rule. Vagbhata reports a variant that partly answers this; see classical[18] and contested[3].
Charaka SamhitaIndriya Sthana 12 (Gomayachurniyam Indriyam):62-64 · checked against the source
मरणायेह रूपाणि पश्यताऽपि भिषग्विदा| अपृष्टेन न वक्तव्यं मरणं प्रत्युपस्थितम्||६२|| पृष्टेनापि न वक्तव्यं तत्र यत्रोपघातकम्| आतुरस्य भवेद्दुःखमथवाऽन्यस्य कस्यचित्||६३|| अब्रुवन्मरणं तस्य नैनमिच्छेच्चिकित्सितुम्| यस्य पश्येद्विनाशाय लिङ्गानि कुशलो भिषक्||६४||
The physician, even if he marks these symptoms of death which have been laid down (in the above verses) agreeably to medical scriptures and in accordance with the purpose in view, should never, unasked, say that death is near. Even when asked, he should not say so when his declaration is capable of producing injury, that is, when the patient himself or anybody else is likely to suffer pain or torture in consequence. Without telling him that his death is near, the intelligent physician should simply decline to take up the treatment of that patient in whom signs of death may become noticeable.
The classical disclosure rule, which is non-disclosure by default and refusal without explanation, now anchored to the Sanskrit: aprishtena na vaktavyam (62), prishtenapi na vaktavyam tatra yatropaghatakam (63), abruvan maranam tasya nainam icchech chikitsitum (64). This is in direct tension with modern informed-consent norms and is the most consequential ethical content of the concept. The rule is one-directional; see classical[10].
Charaka SamhitaIndriya Sthana 12 (Gomayachurniyam Indriyam):65-66 · checked against the source
लिङ्गेभ्यो मरणाख्येभ्यो विपरीतानि पश्यता| लिङ्गान्यारोग्यमागन्तु वक्तव्यं भिषजा ध्रुवम्||६५|| दूतैरौत्पातिकैर्भावैः पथ्यातुरकुलाश्रयैः| आतुराचारशीलेष्टद्रव्यसम्पत्तिलक्षणैः||६६||
When the physician, guided by (his observation of) messengers, inauspicious incidents occurring on his way (to the patient's house), similar incidents connected with the patient's family, the conduct and disposition of the patient, and the signs connected with the possessions of the patient, sees symptoms which are the reverse of those that are called death-indicating, he should declare the certain recovery of the patient to be at hand.
New. The disclosure rule is asymmetric, and the asymmetry is in the verse. 12/62-64 forbid announcing imminent death; 12/65 directs the physician to declare recovery dhruvam, with certainty, when the contrary signs appear. Bad news is withheld and good news is given positively. This bears directly on contested[2]: the classical rule is not a general reticence about prognosis, it is a one-way restriction, which makes the conflict with informed consent sharper rather than softer. 12/66 also shows what the physician is allowed to read the good news off: messengers, omens on the road, the patient's household, and the patient's property. The last of these, dravya-sampatti, is the patient's means, and Kaviratna's footnote on the page glosses it as implying that 'According to Charaka, the treatment of those that are poor should not be taken up'. That gloss is his and is not quoted as doctrine here, but Vagbhata's own refusal list at A.H.Su.1/34 does include hinopakaranam, one lacking the means; see classical[17].
Sushruta SamhitaSutra Sthana 35 (Aturopakramaniya) · checked against the source
All the diseases, whose names have been specifically enumerated before, may be grouped under any of the three different heads as the curable, the suppressible (Yapya) and the incurable (lit : fit to be pronounced as hopeless). Each of these different types, in its turn, should be carefully observed so as to determine whether it is a primary or an independent disease, or merely an accessory or sympathetic one, or the premonitory indication of an incipient distemper in its incubative stage.
Sushruta's three working prognostic categories, named in his own chapter on clinical observation. The second sentence, which the record did not previously carry, adds a cross-cutting distinction that is not a prognostic tier at all: each of the three is to be examined for whether it is a primary disease, an accessory or sympathetic one (aupasargika), or the premonitory sign of something incipient. That is a second axis, and it is relevant to contested[4], because a yapya condition that is actually aupasargika to something else is not stable as a category member.
Sushruta SamhitaSutra Sthana 35 (Aturopakramaniya) · checked against the source
A disease of recent growth or origin unattended with any distressing or unfavourable complications, and unsuited to the nature of the country, the season of the year, the temperament, and the adopted or congenial or naturalised traits of the physique of a patient with a regular and unimpaired state of digestion (Samagni), and who exhibits traits of strength, fortitude and longevity and commands the co-operation of the four commendable factors of a course of medical treatment, readily yields to medicine. A disease, which is marked by features other than those described above, should be regarded as incurable, while the one exhibiting traits common to both the abovesaid types, should be looked upon as extremely hard to cure.
Sushruta's explicit criteria for assigning a case to curable, hard-to-cure or incurable, stated as one positive list plus two residual rules: the opposite features mean incurable, mixed features mean extremely hard to cure. The structure is worth noting because only the top tier is defined positively; the other two are defined by departure from it, which is the point made in contested[4] about yapya lacking a positive criterion.
Sushruta SamhitaSutra Sthana 33 (Avaraniya, on incurable diseases) · checked against the source
Hear me describe, Oh child, the diseases which being attended with many a distressing and supervenient symptom, and being treated without rejuvenating and restorative medicines, speedily assume incurable character. ... A physician with any regard to professional success should abandon a patient laid up with any of the preceding diseases, marked by complications such as, emaciation of the body, loss of strength, dyspnoea, palpitation, wasting, vomiting, dysentery and hie-cough, fever and swoon.
A named list of eight conditions treated as intrinsically hard to cure, and the complication set that converts a case to abandonment. The eight, read on the page and not quoted because the OCR garbles several of them, are Maha-vata-vyadhi, Prameha, Kushtha, Arsha, Bhagandara (printed 'Vagandara' in the scan), Ashmari, Mudha-garbha and the eight kinds of Udara. Two things in the sentence matter for contested[1]. The reason given for abandonment is the physician's professional success. And the trigger is not the disease but its complications, which means a case moves into the abandonment class by acquiring an upadrava rather than by being that disease.
Sushruta SamhitaSutra Sthana 23 (Krityakritya-vidhi, prognosis of an ulcer) · checked against the source
Ya'pya ulcers :--An ulcer incidental to, and affecting the seat of any of the following diseases, viz. ... and characterised by the germination of parasites in its interior, as well as the one appearing in the cavity of the abdomen, or affecting the mucous linings of the intestines, or brought about by the corrosive secretions of a nasal catarrh (Pratishyaya), and infested with parasites, should be considered as only admitting of a palliative treatment. Similarly palliation is the only remedy in the case of an ulcer which appears in a patient suffering from any morbid secretion from the urethra (Prameha) or from any form of cutaneous affections, marked by worms in its inside.
New. This entry was previously part of a bundled, unquoted 'located' entry. It matters because it is the one place found in either samhita where the three tiers are worked through for a single disease class with a named yapya block. Bhishagratna's own table of contents for the chapter lists 'Easy curability of an ulcer', 'Symptoms of difficult or incurable types, as well as of those which admit only of palliation'. The chapter grades ulcers by the patient (young, muscular, strong, resolute heal readily; old, emaciated, timid, weak heal slowly), then by anatomical site, then by comorbidity, and only then names the yapya group. The five conditions in the elided clause appear on the page as Avapathika (which the OCR corrupts, and which Bhishagratna glosses as paraphimosis), Niruddha-prakasha, Sanniruddha-guda, Jathara and Granthi; they are reported here and not quoted. The operational interest is that yapya status is assigned by the host condition and by the presence of parasites, not by the ulcer itself.
Sushruta SamhitaSutra Sthana 32 (Svabhava-vipratipatti) · checked against the source
The physician, who can detect and fully interpret these fatal indications, is honoured by the king for determining the curable or incurable nature of a disease.
New. One sentence, and it does two things the record needed. It states the purpose of the whole Sushruta arishta block explicitly: the fatal signs are read in order to determine whether a disease is curable or incurable, which is the sadhya-asadhya judgement. So the two bodies of material are joined on the Sushruta side as well as the Charaka side, in the text rather than by this record's inference. And it states the incentive in the same breath: the physician who can do it is honoured by the king. That is a third datum for contested[1], alongside Charaka's loss of wealth and fame at Ca.Su.10/8 and Sushruta's 'regard to professional success' at Su.Su.33. All three reasons the texts give for getting the prognosis right are reasons of the physician's standing.
Sushruta SamhitaSutra Sthana 28 to 33 (the arishta block), read as a body
Enumerated, having previously been cited as a vague range. The six chapters and their own stated subjects, taken verbatim from Bhishagratna's chapter openings, are: XXVIII, favourable or unfavourable prognosis of an ulcer (Viparita-aviparita-Vrana-Vijnaniya); XXIX, favourable or unfavourable prognosis in diseases as known from messengers, omens and dreams (Viparita-aviparita-Duta-vijnaniya); XXX, prognosis from the perverted functions of the five sense organs (Panchendriyartha-Vipratipatti); XXXI, prognosis from the altered condition of features (Chhaya-Vipratipatti); XXXII, prognosis from the perversion of the external appearances of the body (Svabhava-vipratipatti); XXXIII, incurable diseases (Avaraniya). Two corrections to the record follow. The record previously gave the block as 'Sushruta Sutrasthana 28-33' in the summary but as 'Chapters XXVIII-XXXII' in this citation; the range is 28 to 33, with 33 being the refusal chapter rather than an arishta chapter proper, and both places now say so. And chapter XXIII, which the record bundled into this entry, is not part of the block: it is the ulcer-prognosis chapter and is now cited separately and quoted at classical[14]. The content of XXIX in particular is summarised and deliberately not quoted here, because it concerns the conduct of the messenger sent to fetch the physician and incidents on the road, and quoting it as clinical doctrine would misrepresent it.
Ashtanga HridayaSutra Sthana 1 (Ayushkamiya):29+(1), 30-35
Quotation withheld: nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at this address.
New, replacing an unquoted placeholder. Vagbhata's whole treatment of the concept in seven verses, and it adds three things the record did not have. (1) 1/29+(1) gives the fourfold scheme in Charaka's own terms: 'sadhyo 'sadhya iti vyadhir dvidha tau tu punar dvidha | susadhyah krichchhrasadhyash cha yapyo yash chanupakramah'. (2) 1/30-33 compress the criteria: 1/30-31 for sukha (a body tolerating all medicines, a young self-controlled patient, not marma-going, slight causes and signs, no upadrava, dushya and desha and ritu and prakriti not alike, the padas complete, favourable grahas, one dosha, one marga, recent), 1/32 for krichchhra (needing surgery and the rest, or mixed) and for yapya ('sheshatvad ayusho yapyah pathyabhyasad viparyaye', yapya by what remains of the life-span and by regimen, in the contrary case), 1/33 for anupakrama (in the utterly contrary case), which includes 'drishta-rishtah', one in whom a rishta has been seen. That is Vagbhata making the same join between this concept and the arishta literature that Charaka makes at Ca.Su.10/20 with sarishtam. (3) 1/34-35 are a refusal list, and this is the part with the most weight for contested[1]. The physician should abandon the patient who is hated by physicians and kings, who hates them, who is hostile, who is hinopakaranam (lacking the means), vyagram (distracted), avidheyam (not to be directed, non-compliant), gatayusham (whose life-span is gone), chandam (violent), shokaturam (stricken with grief), bhirum (timid), kritaghnam (ungrateful), and vaidyamaninam (one who thinks himself a physician). Eleven of those twelve grounds are not prognostic at all. They are about politics, means, temperament and the patient's deference to the physician. On the evidence of this verse, refusal in the classical texts is not reducible to a judgement that treatment would be futile.
Ashtanga HridayaSharira Sthana 5 (Vikritivijnaniya):1, 1+(1) to 1+(3), 2-5
Quotation withheld: nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at this address.
New, and the locus the audit asked for by name. Four things. (1) 5/1 is Vagbhata's version of Charaka's flower-and-fruit figure, with two more analogies added: 'pushpam phalasya dhumo 'gner varshasya jala-dodayah', the flower of the fruit, the smoke of the fire, the rising of the cloud of the rain, so is rishta of death, dhruvam, certainly. (2) 5/1+(1) and 1+(2) restate the professional sanction on the same pattern as Ca.Su.10/7-8: in one who has life-span, all therapies properly applied bear fruit, bhishajam bhutyai, for the prosperity of physicians; in one whose life-span is exhausted, what is done is futile and yields ayashas (infamy), deha-samdeham and svartha-hanim, loss of one's own interest. The costs named are again the physician's. (3) 5/2 restates the unfalsifiable structure in almost Charaka's words: there is no death without arishta, no life where a rishta has been seen, and the misperception of rishta where there is none and the failure to perceive it where there is run 'a-naipunat', from lack of skill. (4) 5/3-4 is the part this record did not have and could not have inferred. Vagbhata reports an opinion, marked as an opinion, 'ke-cit tu tad dvi-dhety ahuh', but some say it is twofold: by the division into sthayin and a-sthayin, persistent and non-persistent. From a mere abundance of doshas a rishtabhasa, an APPEARANCE of a rishta, may arise; that one subsides when the doshas are pacified, whereas the persistent one goes inevitably to death. That is a criterion, prospectively applicable, for separating a true sign from a false one, and it is not post-hoc reclassification. It does not dissolve the circularity, because the persistent one is still fatal by definition, but it is a real qualification of the self-sealing reading this record states on Charaka's authority, and it is now a position in contested[3] rather than being left out.
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.
Assessment of prognostic aspects of cancer by Taila Bindu Pariksha. · Ayu · 2015 · PMID 26730133
Pilot study of Taila Bindu Pariksha (the spread of an oil drop on a urine sample) as a prognostic indicator in 20 cancer patients about to receive radiotherapy or chemotherapy, compared with the ECOG performance scale; reports that in the majority of patients the correlation was statistically highly significant. The paper states plainly that there is no direct description of a method to ascertain cancer prognosis in the Ayurvedic classics.
How much it shows. Weak. Single group of 20, no blinding of the oil-drop reader to the patient's clinical state, no inter-observer agreement reported for the drop-shape reading, ECOG itself is a coarse clinician-rated scale, and the analysis is a correlation with no prespecified hypothesis or correction. The finding should be treated as hypothesis-generating at most. Its most useful content is its own admission that the classics contain no prognostic method for this.
A study on Tailabindu pariksha - An ancient Ayurvedic method of urine examination as a diagnostic and prognostic tool. · Ayu · 2011 · PMID 22131762
Earlier study of Taila Bindu Pariksha as a diagnostic and prognostic tool.
How much it shows. Small single-centre study; same methodological limitations as the 2015 pilot. Included for completeness, not as support.
A study on the method of Taila Bindu Pariksha (oil drop test). · Ayu · 2012 · PMID 23723648
A methods paper that standardised the Taila Bindu Pariksha procedure in apparently healthy volunteers: shape and size of the testing container, volume of urine, size of the oil drop, height of the drop above the urine surface, and variety of sesame oil, each varied one at a time, with the whole procedure recorded on video. Its own stated premise is the reason it is cited here: 'Technique of this test is very crude and there are chances of variations in the observations', and the standardisation was undertaken 'so that the observations could be reproducible'.
How much it shows. A standardisation exercise, not a diagnostic accuracy or reliability study. No patients, no outcome, and no agreement statistic is reported, so it does not establish that the test is reproducible; it establishes that the problem was recognised in the literature and that a protocol was proposed. Added because the record's notKnown previously said the test's inter-observer reliability 'has never been reported' without noting that the reproducibility problem had been addressed at the protocol level.
Prognosis of prameha on the basis of insulin level. · Anc Sci Life · 1997 · PMID 22556802
The only study found in any of the searches run here that takes a classical sadhya/yapya/asadhya assignment and tries to test it against a measurement. Its stated premise, quoted from the abstract, is 'It has been mentioned in the text Kaphaj Prameha is sadhya, pittaj & vataj prameha is yapya & asadhya respectively', and its stated aim is 'to establish the prognostical aspect of prameha scientifically in relation to the insulin level of the body'.
How much it shows. Cannot be assessed from what is retrievable. The PubMed record carries only a three-sentence abstract that states the aim and reports no design, no sample size, no results and no statistics; the full text was not retrieved. It is cited for the existence and the shape of the attempt, not for any finding. It is enough, however, to require a correction: the record's notKnown previously said that whether a sadhya/yapya/asadhya assignment predicts anything had never been tested, and that is too strong. What can be said is that no study found here reports an adequate test.
Comparative studies of Bhanumati and Nibandha Samgraha with special reference to Arista Vijnana (prognostic science). · Ayu · 2011 · PMID 22408294
A comparative study of Dalhana's Nibandha Samgraha and Chakrapani's Bhanumati on arishta-vijnana as described in the Sutrasthana of the Sushruta Samhita. It states that the system 'has advised the physicians to strictly avoid treating the incurable diseases' and that the signs of incurability 'have been described in Brhattrayi of Ayurveda'; that Charaka placed them in a separate section while Chakrapani and Dalhana treated them at length in commentary; that Dalhana was greatly influenced by the Charaka Samhita on prognostic science; and that Chakrapani repeatedly recognised the superiority of Charaka's Indriya Sthana for the analysis of prognostic science.
How much it shows. A textual and commentarial study, not an empirical one. No patients, no data, no outcome. It is cited for two things only: that indexed scholarly work on arishta-vijnana exists, which this record previously denied by implication, and that the commentarial tradition on it is substantial and has not been consulted in the original here. Added as the direct counter-example to the record's unbounded negative.
Importance of Ayu Pareeksha for the Management of Diseases. · J Clin Diagn Res · 2017 · PMID 28273996
A short review of ayu-pariksha, the examination of life-span, whose stated purpose is 'to obtain knowledge regarding longevity, residual span of life in diseased person and rate of the mortality'. It locates the material across Charaka's Vimana, Chikitsa, Indriya and Sharira Sthanas, distinguishes ayu from vaya (age), and reports that Sushruta classifies ayu into dirghayu, madhyamayu and alpayu with characteristics given for each.
How much it shows. Narrative review in an indexed but general clinical journal. No data of any kind. Cited for scope rather than for evidence: it shows that the prognostic material is distributed across four of Charaka's sthanas rather than confined to Indriya Sthana, and it names the Sushruta three-fold life-span classification, which this record does not cite and has not retrieved. See notKnown.
Reliability of Ayurvedic Diagnosis for Knee Osteoarthritis Patients: A Nested Diagnostic Study Within a Randomized Controlled Trial. · J Altern Complement Med · 2019 · PMID 30653338
Establishes only indirectly: it shows that Ayurvedic experts assessing the same patients agree poorly on the diagnostic components that would feed a prognostic judgement. No prognostic category was itself assessed for agreement.
How much it shows. Good methodology but not a prognosis study. Cited here because it bounds how reproducible a sadhya-asadhya assignment could be, given that its inputs are unreliable.
Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. · BMJ · 2000 · PMID 10678857
Prospective cohort in five outpatient hospice programmes in Chicago; 343 doctors gave survival estimates for 468 terminally ill patients at the time of hospice referral. Median survival was 24 days. Only 20 per cent (92/468) of predictions were accurate within 33 per cent of actual survival; 63 per cent were overoptimistic and 17 per cent overpessimistic, and overall the doctors overestimated survival by a factor of 5.3. Few patient or doctor characteristics predicted accuracy; doctors in the top quartile of practice experience were the most accurate, and accuracy fell as the duration of the doctor-patient relationship increased.
How much it shows. Strong for its question and the standard reference for it, which is why the audit named it. Limits: one city, hospice referrals only, year 2000, so the base rates are specific to that population and era. Its relevance here is as a benchmark and as a check on a framing error. It shows that the quantity Charaka's arishta chapters claim to deliver, a declaration that death is near, is one that conventional clinicians also attempt and are measurably bad at, and that the error is systematically in one direction. The honest comparison is therefore not between a tested method and an untested one but between a method whose error has been measured and one whose error has not.
How accurate is the 'Surprise Question' at identifying patients at the end of life? A systematic review and meta-analysis. · BMC Med · 2017 · PMID 28764757
Systematic review and meta-analysis of the Surprise Question ('would I be surprised if this patient died in the next year?'), 26 papers included, 22 with complete data, 25,718 survival predictions. The c-statistic across studies ranged from 0.512 to 0.822 and the pooled accuracy was 74.8 per cent (95% CI 68.6 to 80.5). Doctors were more accurate than nurses at recognising people in the last year of life (c-statistic 0.735 against 0.688) and the tool was more accurate in oncology settings. The authors' own conclusion is that accuracy ranged 'from poor to reasonable'.
How much it shows. A well-conducted meta-analysis of a heterogeneous literature; the heterogeneity is the main limit and the authors say so. Its value here is methodological rather than substantive. It is the closest modern analogue to what the arishta material is: a single clinician-rated judgement intended to flag impending death. It shows what such a judgement has to be reported as in order to be assessable, namely a c-statistic or a sensitivity and specificity against a defined time horizon, and that is the exact form in which no arishta sign has ever been reported. It is cited to make the record's gap in notKnown specific rather than rhetorical.
Prognostic utility of Palliative Prognostic Index in advanced cancer: A systematic review and meta-analysis. · Palliat Support Care · 2025 · PMID 40123501
Systematic review and meta-analysis of the Palliative Prognostic Index in adults with advanced cancer; 23 studies, 11,235 patients. Higher PPI scores were associated with death in every meta-analysis performed: PPI greater than 6 against PPI 4 or less gave a pooled adjusted hazard ratio of 5.42 (95% CI 2.01 to 14.59), and PPI as a continuous variable gave a pooled unadjusted hazard ratio of 1.30 (95% CI 1.22 to 1.38). The authors caution that only 2 to 4 studies entered each analysis and that the original risk groups still need validation.
How much it shows. Reasonable evidence with the authors' own stated caution about the small number of studies per analysis. Cited as the comparator for a composite prognostic score rather than a single sign, because that is the form Sushruta's Su.Su.35 criteria and Charaka's Ca.Su.10/11-20 criteria take: a set of weighted features combined into a category. The PPI is built from performance status, oral intake, oedema, dyspnoea at rest and delirium, which is a shorter list than Charaka's. It is cited to show that a classical-style composite is the kind of instrument that can be validated, and to specify what validating one would require.
How to cite this entry
Age Ayurveda Nighantu, Sadhya-asadhya (prognosis and the decision to treat)
, https://nighantu.ageayurveda.com/concept/sadhya-asadhya/,
CC BY 4.0. The whole set is downloadable from the concept index.
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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.