# Swasthya: the Ayurvedic definition of health > Canonical version of this page: https://nighantu.ageayurveda.com/concept/swasthya-definition/ ## How much weight this concept bears The swastha definition rests on classical exegesis. It is a normative definition, and the chapters that state it give no measurement procedure, threshold or instrument for any of its seven clauses. The nearest classical material to an assessment procedure, Charaka's tenfold examination of the patient (Vi. 8.94) and his fourfold agni classification (Vi. 6.12), is now cited; both name heads of examination and behavioural types without a scoring rule, and the tenfold examination's own stated purpose is to gauge strength for dosing, not to classify a person as healthy. On the modern side, this record now separates three things that an earlier draft ran together. First, instruments: questionnaire operationalisations exist for the agni clause (PMIDs 26283805, 27381899, 41774580) and for dosha constitution (33750638, 34548242), and one composite Ayurveda-principle-based health scale was located (Swasthya Assessment Scale, 37347084, whose authors state that nothing validated preceded it). Each reports internal consistency or observer agreement; one agni tool reports an association with serum lipids (27381899); none located here reports criterion validation against a health outcome, test-retest stability of the composite, or replication. In the newest agni scale the samagni subscale was the one that failed the reliability threshold (41774580). Second, reliability of clinical judgement: three independent studies measure it. Among four experts rating 30 knee-osteoarthritis patients, chance-corrected agreement on prakriti and agni was fair to poor (kappa 0 to 0.4) despite 95 percent consensus on the final diagnosis (30653338); among fifteen doctors examining twenty healthy volunteers, average pairwise kappa was 0.07 for pulse, 0.17 for tongue and 0.28 for prakriti (24191170); software-versus-clinician agreement on prakriti was ICC 0.72 for vata, 0.58 for pitta and 0.44 for kapha (33750638). These studies rate prakriti, which is constitution, not the current dosha state (vikriti) that the samadosha clause concerns, and only one of them (30653338) rates agni; none rates dhatu or mala state. So the honest statement is narrower than 'the first three clauses are not reproducibly ascertainable': the one clause for which a chance-corrected inter-rater figure was located, agni, measured poorly in that one small study, and the examination methods used to reach constitutional judgements measure poorly in two others. Third, validity: no study located in the searches recorded in gatheringNotes tests whether people classified swastha differ from the merely asymptomatic, whether baseline swastha status predicts anything, or whether the Ayurvedic and WHO 1948 classifications agree on the same individuals; AYU and several Indian journals are incompletely indexed, so absence from these searches is not absence from the literature. The frequently repeated claim that Sushruta's definition anticipated WHO 1948 is a modern interpretive comparison, not a finding. The position, then, is that the definition is philosophically clear and clinically unoperationalised in the classical texts; that modern instruments operationalise two of its clauses as questionnaire categories with internal consistency but, in what was located here, without criterion validation; and that the experts who apply the definition in practice agree on the final label while disagreeing on the constitutional components that are supposed to generate it. Ayurveda defines health (swasthya; the healthy person is swastha) not as absence of disease but as a stated list of simultaneous equilibria. The locus classicus is the verse of Sushruta Samhita Sutrasthana 15 beginning samadoshah samagnishcha (numbered 15.41 in the Sanskrit presentations retrieved for this record and 15.48 in at least one Chaukhambha edition; see the citation entry), which requires balanced doshas, balanced agni (digestive and metabolic fire), balanced formation and function of the dhatus (tissues) and malas (excreta), together with a pleasant or clear state of atman, indriyas and manas (self, senses and mind). The verse immediately preceding it (15.40) states the physician's two-armed duty, preservation in the well and correction in the sick. Charaka states the same aim differently: the purpose of the science is dhatusamya, the restoration and maintenance of equilibrium of the body's constituents (Sutrasthana 1.53), and its twofold objective is preserving the health of the healthy and relieving the disorder of the diseased (Sutrasthana 30.26). Vagbhata compresses it further to dosha equilibrium alone (Ashtanga Hridaya Sutrasthana 1.20). The definition is constitutive rather than diagnostic: it names the conditions that must hold, and the chapters that carry it supply no thresholds or instruments for deciding whether they hold in a given person. The nearest classical material to an assessment procedure sits elsewhere, in Charaka's tenfold examination of the patient (Vimanasthana 8.94) and his fourfold classification of agni (Vimanasthana 6.12), neither of which gives a measurement rule either. Modern writing frequently contrasts the clause about mind, senses and self with the WHO 1948 definition of health as complete physical, mental and social well-being; that comparison is an interpretive move by modern authors, not something the classical text makes. ## At a glance | Field | Value | | --- | --- | | Subject area | How the body is held to work | | Domain, as recorded | health-and-physiology | | Contested questions | 5 | | Stated as not known | 14 | | Classical citations | 9, 8 quoting the text | | Research papers assessed | 9 | | 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. ### What exactly does the mental clause, prasanna atmendriya manah, require? This is contested. - A subjective state of contentment or pleasantness, making swasthya a wellbeing construct comparable to modern subjective wellbeing measures - A functional statement that the self, senses and mind are performing their operations without obstruction, closer to unimpaired sensory and cognitive function than to reported happiness - A soteriological clause about the self being settled in itself (the folk etymology swa-stha, 'established in one's own self'), which cannot be measured at all and belongs to Ayurveda's Samkhya frame rather than to its clinical frame ### Which classical definition is authoritative? This is contested. - Sushruta 15.41 as the full definition, requiring seven simultaneous conditions including the mental one - Charaka's dhatusamya (Su. 1.53) as the operative definition, which is narrower and purely physiological - Vagbhata's formula rogastu doshavaishamyam doshasamyam arogata, which reduces health to dosha equilibrium alone and drops agni, dhatu, mala and mind ### Is swasthya a binary state or a continuum? This is contested. - Binary: the definition lists conditions that either hold or do not, and a person is swastha or atura - Continuous: classical commentary on dosha vriddhi and kshaya describes degrees, and modern Ayurveda scale developers score health on ordinal bands, implying a gradient the source text does not authorise ### Does the definition anticipate the WHO 1948 definition? This is contested. - Yes, commonly asserted in Ayurvedic literature because both go beyond absence of disease and both include a mental component - No: WHO adds a social dimension that Sushruta's list does not contain, and Sushruta adds physiological equilibria (agni, dhatu, mala) that WHO does not; the resemblance is partial and has never been tested empirically ### Can the clauses of the definition be ascertained reliably by trained clinicians, as opposed to by questionnaire? This is contested. - No, or not yet: chance-corrected agreement among four experts on prakriti and agni was kappa 0 to 0.4 (PMID 30653338), and among fifteen doctors on pulse, tongue and prakriti it averaged 0.07, 0.17 and 0.28 (PMID 24191170); the examination methods that feed constitutional judgement are poorly reproducible between examiners. - Partly yes, by instrument rather than by examiner: structured questionnaires and software give consistent prakriti classifications (significant evidence against random rating in 24191170; ICC 0.44 to 0.72 against clinicians in 33750638) and agni questionnaires reach Cronbach's alpha above 0.87 on three of four states (26283805), so the construct is reproducible when the clinician is removed from the loop, at the cost of not knowing whether the questionnaire measures what the clinician was meant to judge. - The question is mis-posed for the composite: every reliability figure located concerns one clause or one examination technique; no study located here rates the seven-clause swastha judgement as a whole, so the composite's reliability is simply unmeasured (see notKnown). ## What is not known Stated rather than left out. Where a negative has actually been searched for rather than assumed, the entry says so. - What measured value of any biomarker corresponds to samagni, samadosha or sama dhatu-mala kriya. No biomarker threshold was located for any clause. This is narrower than the earlier draft's statement that no threshold had been proposed for any clause: questionnaire operationalisations of agni exist (PMIDs 26283805, 27381899, 41774580) and one relates agni category to serum lipids, but a questionnaire category is not a validated physiological threshold, and none located here is validated against a health outcome. - Whether people classified as swastha by the definition differ in any measurable way from people who are merely asymptomatic. - Whether the definition has predictive value: no cohort study located in the searches recorded in gatheringNotes has tested whether baseline swastha status predicts incident disease, mortality or function. - How the seven clauses are weighted, or whether failing one clause is sufficient to make a person not swastha. The text gives a conjunction without saying whether it is strict. - Whether the definition is stable within a person over time. No test-retest data for the composite were located; the agni and dosha instruments report internal consistency or single-occasion agreement, not stability. - Whether Ayurvedic and biomedical or WHO classifications of the same individuals agree, and by how much. - How swastha relates to the classical category of the person who is neither clearly healthy nor clearly diseased; the texts do not define an intermediate state and modern writers who assert one are extrapolating. - Whether the mental clause adds anything beyond existing subjective wellbeing instruments, since it has never been measured separately alongside one. - Whether the classical conduct chapters, Charaka Sutrasthana 5 (Matrashitiya, measure of food), 6 (Tasyashitiya, seasonal regimen) and 7 (Na vegan dharaniya, non-suppression of natural urges), supply any criterion for swasthya beyond prescribing the conduct that maintains it. Kaviratna's Lessons V, VI and VII are present in the retrieved OCR and were located by heading on 2026-10-06, but they were not read for this record; they are the subject of the ahara-vidhi, ritucharya-rationale and vega-dharana records, and this record does not claim to know what they say about assessment. - Whether Charaka's tenfold examination (Vi. 8.94) was ever used, classically or in modern practice, to classify a person as swastha rather than to gauge strength for dosing. The verse states the dosing purpose; no commentary or modern protocol that repurposes it for health classification was consulted here. - How many agni assessment instruments exist and how they compare. Two PubMed searches on 2026-10-06 (gatheringNotes) returned four instrument papers and one systematic-review protocol (42314162) whose authors say 'several' tools exist; the AYUSH research portal and DHARA, which that protocol will search, were not searched for this record, so the agni-instrument list here is a floor, not a count. - Whether any inter-rater reliability figure exists for the dhatu or mala clauses, or for current dosha state (vikriti) as distinct from constitution (prakriti). The three reliability studies cited rate prakriti, pulse, tongue and (in one) agni; none rates the other clauses, and no search specifically for vikriti reliability was run. - Whether the 15.41 / 15.48 numbering of the Sushruta definition reflects a difference in the division of the chapter's prose sutras or a difference in recension. This record documents that both numbers are in use and which editions carry them; it did not compare the editions themselves, and no philological reference (such as Meulenbeld's History of Indian Medical Literature) was consulted on the point. - Whether institutional operationalisations of swasthya exist in practice, for instance CCRAS Swasthya Rakshan programme proformas or AYUSH prakriti-assessment forms, and what criteria they apply. Not investigated for this record; the modern list is limited to PubMed-indexed instrument and reliability papers. ## The terms this concept is built from | Term | What it names | | --- | --- | | [Samadosha](https://nighantu.ageayurveda.com/lexicon/sama-dosha/) | Equilibrium of the three doshas (vata, pitta, kapha) in quantity and function | | Samagni | Balanced agni, the digestive and metabolic fire; neither weak, irregular nor excessive | | Samadhatu kriya | Normal formation and functioning of the seven dhatus (bodily tissues) | | Sama mala kriya | Normal formation and timely elimination of the malas (faeces, urine, sweat and other excreta) | | Prasanna atma | Pleasant, clear or contented state of the self | | Prasanna indriya | Senses functioning clearly and agreeably | | Prasanna manas | Mind in a pleasant, undisturbed state | | Dhatusamya | Charaka's parallel formulation: equilibrium of the body's constituents, named as the purpose of the whole treatise | ## 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. ### Sushruta Samhita Sutrasthana 15 (Dosha-dhatu-mala-kshaya-vriddhi-vijnaniya):41 (siva.sh and sa.wikisource numbering); printed as 48 in Ambikadatta Shastri's Chaukhambha edition, checked against the source > समदोषः समाग्निश्च समधातुमलक्रियः । प्रसन्नात्मेन्द्रियमनाः स्वस्थ इत्यभिधीयते ॥४१॥ Sanskrit mūla > A person with an uniformly healthy digestion, and whose bodily humours are in a state of equilibrium, and in whom the fundamental vital fluids course in their normal state and quantity, accompanied by the normal processes of secretion, organic function, and intellection, is said to be a healthy person. tr. Kaviraj Kunja Lal Bhishagratna (1907) The canonical definition of swastha as a conjunction of balanced agni, balanced doshas, normal dhatu state and quantity, and normal excretory, functional and mental processes. Bhishagratna prints no verse number here; his English is the second-to-last paragraph of Chapter XV, read in the archive.org OCR on 2026-10-06 immediately before 'Thus ends the fifteenth Chapter of the Sutrasthanam'. The verse number is an edition-dependent fact and is recorded as such: siva.sh gives 15.41 and has no page for 15.42; the 2026-09-20 verifier read it as 15.41 and as the chapter's closing verse on sa.wikisource; Desai et al. (World Journal of Pharmaceutical Research 10(8), 2021, reference 1) cite the same verse as Sutrasthana 15.48 in Kaviraj Ambikadatta Shastri's edition, Chowkambha Sanskrit Sansthan 1996, p. 64. The two numbers are two editions' counts of the same chapter, not a disagreement about which verse this is. This record cites 15.41 because that is the number on the Sanskrit it retrieved, and flags 15.48 so that a reader holding a Chaukhambha edition is not misled. Source: https://archive.org/stream/englishtranslati01susruoft/englishtranslati01susruoft_djvu.txt ### Sushruta Samhita Sutrasthana 15:40, corrected against the source > स्वस्थस्य रक्षणं कुर्यादस्वस्थस्य तु बुद्धिमान् । क्षपयेद्बृंहयेच्चापि दोषधातुमलान् भिषक् ॥४०॥ Sanskrit mūla > An intelligent physician should preserve the state of health in a healthy individual, while he should increase or decrease the quantity of the bodily humours, vital fluids, or excrements in a sick patient according to the exigencies of the case until his health is perfectly restored. tr. Kaviraj Kunja Lal Bhishagratna (1907) That the chapter pairs the definition of health with a two-armed clinical duty, preservation in the well and correction of dosha, dhatu and mala in the sick. In the Sanskrit this verse PRECEDES the swastha definition (15.40 then 15.41); Bhishagratna prints the two in the opposite order, definition first, duty second, which is how the earlier draft came to infer a non-existent verse 42. The earlier framing that the definition is 'immediately operationalised' by this verse inverted the textual order and has been dropped. Source: https://archive.org/stream/englishtranslati01susruoft/englishtranslati01susruoft_djvu.txt ### Sushruta Samhita Sutrasthana 1 (Vedotpatti):14 (Sanskrit numbering; Bhishagratna prints no number in Sutrasthana 1), checked against the source > वत्स सुश्रुत! इह खल्वायुर्वेदप्रयोजनं- व्याध्युपसृष्टानां व्याधिपरिमोक्षः, स्वस्थस्य रक्षणं च ॥१४॥ Sanskrit mūla > The object or utility of the science which forms the subject of our present discussion, may be grouped under two distinct sub-heads such as (1) the cure of diseased persons, and (2) the preservation of health in those who are not afflicted with any sort of bodily distempers. tr. Kaviraj Kunja Lal Bhishagratna (1907) Sushruta's twofold statement of the aim of the science, parallel to Charaka's. The English is Dhanvantari's reply to Sushruta in Chapter I (Vedotpatti); the OCR has two damaged letters in 'may be grouped', normalised here. Source: https://archive.org/stream/englishtranslati01susruoft/englishtranslati01susruoft_djvu.txt ### Charaka Samhita Sutrasthana 30 (Arthedashamahamuliya):26, checked against the source > The purpose of the Science of Life is protection of the health of the hale and alleviation of disease of one that is ailing. tr. Kaviraj Avinash Chandra Kaviratna (1890-1913) The most-quoted statement of Ayurveda's purpose, swasthasya swasthya rakshanam aturasya vikara prashamanam cha. The quote was re-read on 2026-10-06 in the full /download/ OCR of BIUSante_47357 inside Lesson XXX, closing 'Thus ends the Thirtieth Lesson called Arthe Dapa Maha-muliya'. The verse number 26 is from a Sanskrit-numbered edition (carakasamhitaonline, read by the 2026-09-20 verifier: प्रयोजनं चास्य स्वस्थस्य स्वास्थ्यरक्षणमातुरस्य विकारप्रशमनं च ॥२६॥). Kaviratna's own number is not legible, so his numbering does not confirm 26 and 26 does not confirm his. Source: https://archive.org/download/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Sutrasthana 1 (Dirghanjivitiya):53, checked against the source > The modes of restoring the ingredient humours to their normal state have been said to be the object of this Science. tr. Kaviraj Avinash Chandra Kaviratna (1890-1913) Charaka's dhatusamya formulation: equilibrium of the body's constituents, not absence of symptoms, is the declared object of the treatise. Verse 53 was confirmed by the 2026-09-20 verifier against carakasamhitaonline's Sanskrit (धातुसाम्यक्रिया चोक्ता तन्त्रस्यास्य प्रयोजनम् ॥५३॥). Kaviratna prints 52 for this aphorism; in this stretch of Sutrasthana 1 he runs one behind the Sanskrit count. The offset is measured here and is not carried to any other chapter. Source: https://archive.org/download/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Sutrasthana 1:55, checked against the source > Body and mind are regarded as the subjects in which health and disease co-inhere; parity of correlation being the cause of health. tr. Kaviraj Avinash Chandra Kaviratna (1890-1913) That health and disease are predicated of body and mind jointly, which is the textual basis for treating the mental clause of the swastha definition as constitutive rather than decorative. Verse 55 confirmed by the 2026-09-20 verifier against carakasamhitaonline's Sanskrit (शरीरं सत्त्वसंज्ञं च व्याधीनामाश्रयो मतः। तथा सुखानां, योगस्तु सुखानां कारणं समः ॥५५॥). Kaviratna prints 54, one behind, consistent with the previous entry in this same chapter. Source: https://archive.org/download/BIUSante_47357/BIUSante_47357_djvu.txt ### Ashtanga Hridaya Sutrasthana 1 (Ayushkamiya):20 **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. Vagbhata compresses the definition to the formula rogastu doshavaishamyam, doshasamyam arogata: disease is dosha disequilibrium, health is dosha equilibrium. This drops the agni, dhatu, mala and mental clauses that Sushruta requires, and is the narrowest of the three classical definitions. The half-verse is numbered 20 on sa.wikisource, between 19 (kalartha-karmanam yogo hina-mithyati-matrakah) and 21 (nijagantu-vibhagena...). The earlier draft's 'near 20, located after verse 22 on one presentation' is superseded by this reading. No public-domain English translation of Ashtanga Hridaya is known to this project, so the Sanskrit is quoted and the English is a gloss, not a quotation. ### Charaka Samhita Vimanasthana 8 (Rogabhishagjitiya):94, checked against the source > तस्मादातुरं परीक्षेत प्रकृतितश्च, विकृतितश्च, सारतश्च, संहननतश्च, प्रमाणतश्च, सात्म्यतश्च, सत्त्वतश्च, आहारशक्तितश्च, व्यायामशक्तितश्च, वयस्तश्चेति, बलप्रमाणविशेषग्रहणहेतोः ॥९४॥ Sanskrit mūla > Hence, the patient should be examined in respect of his normal constitution in health, of the abnormal condition that has set in, of the predominance of some particular element in his constitution (such as blood, or flesh, &c.), of his compactness or otherwise, the make of his proportions such as stature, &c., of what things are suitable to his constitution, of his mental disposition, of his power of eating, of his power of exercise, and of his age. tr. Kaviraj Avinash Chandra Kaviratna (1896-1913) The dashavidha pariksha, Charaka's tenfold examination of the patient: prakriti, vikriti, sara, samhanana, pramana, satmya, sattva, aharashakti, vyayamashakti and vayas. This is the closest thing the Brihat Trayi has to an assessment protocol and it is relevant to swasthya because several of its heads (prakriti, vikriti, aharashakti, sattva) are the elements a clinician would use to judge the dosha, agni and mind clauses. But its own stated purpose is balapramana-vishesha-grahana, to gauge the patient's strength for dosing, not to classify a person as swastha or atura, and it names heads of examination without giving a scoring rule for any of them. It therefore shows WHERE the classical operational content sits and confirms that even there no threshold is given. Source: https://archive.org/download/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Vimanasthana 6 (Roganika):12, checked against the source > अग्निषु तु शारीरेषु चतुर्विधो विशेषो बलभेदेन भवति। तद्यथा- तीक्ष्णो, मन्दः, समो, विषमश्चेति। तत्र तीक्ष्णोऽग्निः सर्वापचारसहः, तद्विपरीतलक्षणस्तु मन्दः, समस्तु खल्वपचारतो विकृतिमापद्यतेऽनपचारतस्तु प्रकृताववतिष्ठते, समलक्षणविपरीतलक्षणस्तु विषम इति। एते चतुर्विधा भवन्त्यग्नयश्चतुर्विधानामेव पुरुषाणाम्। तत्र समवातपित्तश्लेष्मणां प्रकृतिस्थानां समा भवन्त्यग्नयः ... ॥१२॥ Sanskrit mūla > In the fires dwelling in the physical system, a fourfold distinction may be made agreeably to difference of strength. It is as follows: Keen, mild, even, and uneven. Amongst these that fire is said to be keen which can bear all kinds of dietary riotousness. That fire which is endued with characteristic of an opposite kind is called mild. That fire is said to be even which becomes vitiated by dietary riotousness, but which exists without being deranged when no dietary riotousness is indulged in. That fire which possesses characteristics that are the reverse of the above, is called uneven. These are the four different kinds of fire of four different kinds of persons. Amongst these, of those persons that are of equable wind, bile, and phlegm, and that are in their normal state, the (digestive) fires are even. tr. Kaviraj Avinash Chandra Kaviratna (1896-1913) Charaka's fourfold classification of agni (tikshna, manda, sama, vishama) and the statement that sama agni belongs to persons whose three doshas are in their natural state. This is the classical content behind the samagni clause of the swastha definition: it defines sama agni behaviourally (not deranged by ordinary diet, deranged only by dietary abuse) rather than by any measurable quantity. Every modern agni questionnaire in this record's modern list builds its four-way classification on this aphorism. Quoted from Kaviratna's main text; his footnote on the same passage ('I have rendered Sama even...') is translator's commentary and is not cited as doctrine. Source: https://archive.org/download/BIUSante_47357/BIUSante_47357_djvu.txt ## 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. ### Swasthya Assessment Scale (SAS)-Ayurveda based health assessment tool-insights on its development and validation. Ayu · 2021 · PMID 37347084 (https://pubmed.ncbi.nlm.nih.gov/37347084/) Reports the development and validation of the Swasthya Assessment Scale, and states explicitly that before it no validated Ayurveda-principle-based health assessment scale existed. Content validity index was high and inter-observer agreement was tested in 183 individuals. **How much it shows.** Single-centre instrument-development study. It establishes content validity and observer agreement only; there is no criterion validation against health outcomes, no external replication, and no demonstration that scale scores track anything clinically consequential. Its main value here is the authors' own admission that the field had no validated health measure until 2021, roughly two millennia after the definition was written. ### Reliability of Ayurvedic Diagnosis for Knee Osteoarthritis Patients: A Nested Diagnostic Study Within a Randomized Controlled Trial. J Altern Complement Med · 2019 · PMID 30653338 (https://pubmed.ncbi.nlm.nih.gov/30653338/) Measured inter-rater reliability of Ayurvedic diagnosis among four experts assessing 30 knee osteoarthritis patients. Percentage agreement on the final consensus diagnosis was high (95%), but chance-corrected kappa for the central constitutional components, prakriti and agni, was fair to poor, in the range 0 to 0.4. Agreement on disease entities was better than on constitutional entities. **How much it shows.** Small (30 patients, 4 raters) but genuinely empirical and nested in a randomised trial, which makes it one of the few chance-corrected reliability measurements in the field. It bears directly on the swastha definition because agni and dosha state are two of its required clauses, and it shows that trained experts do not reliably agree on them. ### Correlation of prakriti diagnosis using AyuSoft prakriti diagnostic tool with clinician rating in patients with psychiatric disorders. J Ayurveda Integr Med · 2021 · PMID 33750638 (https://pubmed.ncbi.nlm.nih.gov/33750638/) Compared prakriti determined by the AyuSoft software tool with two Ayurveda physicians' independent clinical assessments in 112 psychiatric inpatients. Intraclass correlation was 0.72 for vata, 0.58 for pitta and 0.44 for kapha. **How much it shows.** Empirical reliability study with an adequate sample, but it measures tool-versus-clinician consistency in one specialised population, not test-retest stability or validity against any outcome. The kapha figure in particular is weak agreement. The authors frame the result positively; the numbers are more equivocal than the framing. ### Development of a reliable Dosha self-assessment questionnaire. Explore (NY) · 2022 · PMID 34548242 (https://pubmed.ncbi.nlm.nih.gov/34548242/) Developed an open-source dosha self-assessment questionnaire, stating as its rationale that no existing open-source questionnaire had been shown to be reliable for self-assessment. **How much it shows.** Instrument development with item analysis and repeat administration. Useful as documentation that, as of 2021, the field had no reliable open self-report measure of the dosha state that the swastha definition presupposes. It does not validate the construct, only the internal behaviour of items. ### Interrater reliability of diagnostic methods in traditional Indian ayurvedic medicine. Evid Based Complement Alternat Med · 2013 · PMID 24191170 (https://pubmed.ncbi.nlm.nih.gov/24191170/) Measured inter-rater reliability of Ayurvedic pulse (nadi), tongue (jivha) and constitution (prakriti) assessment: fifteen registered Ayurvedic doctors with 3 to 15 years' experience independently examined twenty healthy subjects. Average pairwise weighted kappa was 0.07 for pulse, 0.17 for tongue and 0.28 for prakriti; the null hypothesis of random rating was rejected for twelve of 105 doctor pairs on prakriti, one pair on pulse and none on tongue. Questionnaire and software prakriti assessment showed significant evidence against random rating. **How much it shows.** Small (n=20, one centre, healthy volunteers only) but it is the largest rater panel in the field and the only study located here that measures pulse and tongue agreement. What it did NOT measure must be stated because an earlier draft of this cluster overreached from it: it rated prakriti, which is constitution, not current dosha state (vikriti), and it did not rate agni, dhatu or mala at all. It therefore bears on the swastha definition only indirectly, by showing that the clinical examination techniques Ayurvedic doctors use to reach constitutional judgements are poorly reproducible between examiners. It cannot support any statement about the reproducibility of the dosha, agni or dhatu-mala clauses themselves. Cross-record note: this paper is also cited in tridosha-theory and vyadhikshamatva; here it is one of three independent reliability studies (with PMIDs 30653338 and 33750638), not the sole empirical support. ### Formation and validation of questionnaire to assess Jāṭharāgni. Anc Sci Life · 2015 · PMID 26283805 (https://pubmed.ncbi.nlm.nih.gov/26283805/) Formation and validation of a 64-item questionnaire classifying jatharagni into the four classical states (manda, vishama, tikshna, sama) in 500 volunteers; Cronbach's alpha 0.916 overall, with subscale alphas of 0.909 (vishama), 0.873 (tikshna), 0.894 (manda) and 0.876 (sama). **How much it shows.** Instrument development with internal-consistency statistics only. It operationalises the samagni clause as a questionnaire category and shows the items hang together; it does not validate the category against any physiological or clinical criterion, so it cannot say whether a person classified samagni differs in any measurable way from one classified otherwise. Its existence is what refutes the earlier draft's statement that no threshold had been proposed for any clause: a questionnaire cut-off is a proposed operationalisation, even though no biomarker threshold has been proposed or validated. ### Development, Validation, and Verification of a Self-Assessment Tool to Estimate Agnibala (Digestive Strength). J Evid Based Complementary Altern Med · 2017 · PMID 27381899 (https://pubmed.ncbi.nlm.nih.gov/27381899/) Development, validation and verification of a self-assessment tool for agnibala (four functional states: regular, irregular, intense, weak) in 300 healthy volunteers aged 18 to 40; the authors report statistical reliability and validity and that serum lipid parameters varied significantly with agni status. **How much it shows.** The one agni instrument located here that is checked against a laboratory measure, which makes it the nearest thing to criterion validation for any clause of the swastha definition. The abstract gives no coefficients, the lipid association is cross-sectional in healthy volunteers, and the authors frame it as a screening use rather than a validation of the construct. It supports 'an agni questionnaire has been related to a biomarker' and not 'samagni has a validated biomarker threshold'. ### Development and Preliminary Psychometric Evaluation of Agni Assessment Scale: A Measure of Functional Digestive Capacity Based on Ayurveda. Complement Med Res · 2026 · PMID 41774580 (https://pubmed.ncbi.nlm.nih.gov/41774580/) Development and preliminary psychometric evaluation of a 26-item Agni Assessment Scale in 467 Indian participants (field study n=100, exploratory factor analysis n=367). Four subscales emerged (samagni, vishamagni, mandagni, tikshnagni) with alphas from 0.57 to 0.83; all subscales except samagni met conventional reliability thresholds. **How much it shows.** The most recent agni instrument located and the one with the most explicit psychometrics. Its most relevant result for this record is a negative one: the samagni subscale, which is the clause the swastha definition actually requires, was the one subscale that did not reach acceptable internal consistency. The authors themselves call for further validation in clinical and cross-cultural settings. ### Evaluation of the Psychometric Properties and Applicability of Agni Assessment Tools in Ayurveda: Protocol for a Systematic Review. JMIR Res Protoc · 2026 · PMID 42314162 (https://pubmed.ncbi.nlm.nih.gov/42314162/) Protocol for a systematic review of agni assessment tools (self-report and clinician-administered), appraising content, construct and criterion validity, internal consistency and test-retest reliability with COSMIN and QUADAS-2, across PubMed, EBSCO, Cochrane, Google Scholar, the AYUSH research portal and DHARA; review initiated October 2025 with completion expected November 2026. **How much it shows.** Protocol only; no results. It is cited for two facts it establishes by existing: that 'several' agni tools exist in the authors' view, which bounds this record's own agni-instrument list as incomplete, and that no synthesis of their psychometric quality had been published when the protocol was registered. When the review appears it should replace this record's own partial listing. ## Open questions on this record Recorded rather than resolved. - Citation 2 (Bhishagratna, 'An intelligent physician should preserve the state of health...') was refuted on location by the 2026-09-20 verifier: the verse is Sutrasthana 15.40, preceding the definition at 15.41, and no verse 42 exists in the Sanskrit presentations retrieved. The correction is applied in the entry. ## Citation Age Ayurveda Nighantu, "Swasthya: the Ayurvedic definition of health", https://nighantu.ageayurveda.com/concept/swasthya-definition/, CC BY 4.0. Whole concept set: https://nighantu.ageayurveda.com/concepts.json and https://nighantu.ageayurveda.com/concepts.csv. 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.