Vriddhi and Kshaya: What the Body Has Too Much and Too Little Of

How much weight this concept bears. This concept rests on classical exegesis, and the record's searches found no biological or psychometric study of any vriddhi or kshaya sign-set as such. What the searches were: PubMed via the NCBI eutils API on 2026-10-06, with these counts: raktakshaya 1 (the Panchakola trial, PMID 24250128); 'rakta kshaya' 0; 'dhatu kshaya' 6, none of them a study of the construct (a Shatavari eye-drop trial, an ojas biomarker essay, two case reports, a diabetic retinopathy concept paper and a geriatric anaemia trial); dhatukshaya 1 (an osteoarthritis trial); 'dhatu vriddhi' 0; 'kshaya ayurveda' 12; 'samanya vishesha' 5 (PMID 30401500 among them); 'ayurveda AND dhatu AND (reliability OR validation OR validity)' 3, of which the nearest is the dhatu sarata weighted-mean proposal (PMID 26834429); 'ayurveda AND (interrater OR inter-rater)' 15, none with a dhatu kshaya or vriddhi judgement in its title. Google Scholar, AYUSH Research Portal, DHARA and non-English literature were not searched, so these are counts for one database on one date and not claims about the world. Within that scope: no interrater reliability figure, no sensitivity or specificity against a reference standard, and no validated instrument for any dhatu kshaya or vriddhi judgement was located. On agreement in Ayurvedic assessment generally, the two measurements retrieved here point in different directions: Kurande et al. found average pairwise kappas of 0.07 (pulse), 0.17 (tongue) and 0.28 (prakriti) among fifteen doctors (PMID 24191170), while Rotti et al. found a kappa of 0.77 between physicians and a structured tool for prakriti in 3,416 subjects (PMID 25336848). Neither concerns kshaya or vriddhi, and they give no basis for predicting agreement on these sign-lists in either direction. On quantity, the record previously described the absence of a stated normal measure as a gap; Sushruta states it as doctrine (Su.Su.15.37: parimANaM na vidyate) and prescribes inference from health and from the signs in its place (15.38-40), so the model is non-quantitative by design, and the open question is whether any modern operationalisation has been attempted, not whether the texts omitted one. ICD-11 TM2 now assigns a code to every one of these patterns; in the project's enrichment data those codes carry names and index terms but no definitions, so they standardise the vocabulary without supplying criteria. The one trial that uses a dhatu kshaya as an enrolment category (PMID 24250128) reached its outcome measure by assuming rakta kshaya equals anaemia, which is the operationalisation that needed testing. The framework's standing on this record's evidence is as a structured clinical vocabulary with internal coherence, an explicit theory of why it cannot be quantified, and long use, not as a validated diagnostic system.

Ayurveda holds that health is a state in which the doshas, the seven dhatus and the malas are each present in their proper measure, and that disease arises when any of them increases (vriddhi) or decreases (kshaya) from that measure. The governing rule is the principle of samanya and vishesha: like increases like, unlike decreases it, so a deficient constituent is replenished by substances resembling it and an excessive one is reduced by substances unlike it (Charaka Sutrasthana 1.44-45 in standard numbering; Kaviratna prints 43-44). Sushruta Sutrasthana 15 is the primary locus: it lists the signs of decrease and of increase for each dosha, each tissue and each excretion, prescribes replenishing or reducing treatment accordingly, and closes with the obesity and emaciation (sthaulya and karshya) that follow from rasa going wrong in either direction. On the question of measurement the chapter takes an explicit doctrinal position rather than leaving a gap: because bodies differ and change from moment to moment, the quantity of the doshas, dhatus and malas cannot be laid down (15.37); their equilibrium can be known only through the presence of health (15.38); their disparity is inferred from the state of the senses and the signs (15.39); and the physician reduces or builds until the patient is free of disease, which is itself the mark of balance (15.40). The system is therefore a sign-based and inference-based clinical method by its own account, and it defines the balanced state positively as well as negatively (15.41). Charaka's Ashtauninditiya chapter (Sutrasthana 21) supplies the companion material on the over-nourished and under-nourished body, and Sutrasthana 22 defines the two therapeutic directions, langhana and brimhana, that the diagnosis leads to.

At a glance
Subject area	How the body is held to work
Domain, as recorded	Ayurvedic physiology and clinical assessment
Contested questions	7
Stated as not known	13
Classical citations	22, 19 quoting the text
Research papers assessed	8
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.

Does rakta kshaya denote anaemia?

This is contested.

The equation is standard in modern Ayurvedic clinical research and is assumed outright in the one trial on the subject (PMID 24250128), which uses haemoglobin, serum iron, ferritin and TIBC as outcomes.
Sushruta's own sign-list for rakta kshaya is rough skin, craving for acid food and drink, longing for cool places and flabby veins - pallor is not among them, and the chapter's separate signs for pitta kshaya include dullness of complexion. The mapping is therefore an interpretive choice, not a reading of the text.
A third position holds that rakta in Ayurveda is not blood as a measurable fluid compartment at all but a functional principle, in which case no haematological index could confirm or refute its deficiency.

Does an increase in one dhatu necessarily increase the next?

This is contested.

Sushruta Sutrasthana 15.18 states the cascade explicitly in its metrical text and uses it to justify treating any excess.
Charaka's samanya-vishesha principle (Sutrasthana 1.44-45 in standard numbering; Kaviratna prints 43-44) is about like substances increasing like, and does not by itself entail a forward cascade down the dhatu sequence; the two are often conflated in secondary writing.
Secondary literature also describes the opposite pattern, kshaya of a later dhatu following kshaya of an earlier one, without reconciling the two directions.

Is the object of vriddhi and kshaya quantity or quality?

This is contested.

A quantitative reading: the texts speak of a normal measure (Su.Su.15.40, 'until free of disease'), Bhishagratna's rendering of 15.17 warns against reducing a constituent below it, and ICD-11 TM2 codes each increase and decrease as a countable pattern, all of which imply a real amount.
A functional reading: Su.Su.15.37 says outright that no quantity exists to be stated, 15.38-39 make balance knowable only through health and imbalance only by inference, and the diagnosis is made entirely from function-related signs (cravings, sensations, capacity), so what varies is the tissue's functional adequacy, not its mass. Modern clinical writing slides between these without marking the shift.

Are kshaya of a dhatu and vriddhi of a dosha the same event described twice?

This is contested.

Treated as distinct in the texts, which list them in separate sections with separate signs.
But the sign-lists overlap heavily - dryness, emaciation and joint looseness appear under vata vriddhi, kapha kshaya, and several dhatu kshayas - and the tradition offers no decision rule for attributing an overlapping sign to one rather than another.

Is sthaulya (obesity) medo-vriddhi?

This is contested.

Charaka Sutrasthana 21.4: in the very obese 'fat alone accumulates, not so the other dhatus' (meda evopacIyate na tathetare dhAtavaH), a medas-centred account in which obesity is the increase of one tissue.
Sushruta Sutrasthana 15.32: 'obesity and emaciation are both caused by rasa' (rasanimittam eva sthaulyaM kArshyaM ca); immature, over-sweet rasa generates medas, so the primary disorder is of rasa and the fat is downstream. On this reading medo-vriddhi is a consequence of sthaulya's cause rather than its definition.
ICD-11 TM2 indexes the same Sanskrit term, medovRuddhi, under two codes: SR47 'Increase of adipose tissues pattern' and SP62 'High fat disorder'. The classification therefore encodes the ambiguity rather than resolving it.

Does Sushruta Sutrasthana 15 state the causes of kshaya?

This is contested.

Bhishagratna's translation carries a footnote to the kshaya section listing them (excessive cleansing and pacifying treatment, suppression of urges, violent exercise, sexual excess, unsuitable food, grief), and a reader of the English, including this record's critic, takes it as the text.
The root text of 15.7-12 in the Trikamji/NIIMH edition has no such sentence. Dalhana reports it as a reading that 'some read here' and that 'the teachers' reject as purposeless, because those causes mostly increase vata and deplete pitta and kapha, so the cause must be judged case by case. Bhishagratna rendered the disputed variant into a footnote.
Sushruta's in-text aetiology of depletion is elsewhere in the chapter: the causes of karshya at 15.33 and of ojas kshaya at 15.23. Charaka gives general kshaya causes at Sutrasthana 17.76-77 and karshya causes at 21.11-12. All four are quoted in this record.

Does Su.Su.15.17 warn against reducing a constituent below normal?

This is contested.

Bhishagratna's rendering: excesses 'should be checked or remedied ... so as not to reduce them to a smaller quantity than that in which they are found in the normal and healthy state of a body', an explicit overshoot warning.
The Sanskrit is three words, kShayAdaviruddhaiH kriyAvisheShaiH, and Dalhana records an alternative reading that omits kShayAt; the overshoot clause is therefore a translator's expansion of a phrase whose reading is disputed. The treat-to-target doctrine is better grounded in 15.40 (reduce or build 'until free of disease, that is the mark of balance').

What is not known

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

No normal quantity for any dhatu is stated in the classical passages this record retrieved, and Sushruta Sutrasthana 15.37 says one cannot be laid down; what is not known is whether any modern author has proposed and tested an operational quantity or threshold for any dhatu kshaya or vriddhi, since none was located by the searches logged in evidenceState.
No interrater reliability, sensitivity or specificity figure for any vriddhi or kshaya sign-set was located by the PubMed searches logged in evidenceState (2026-10-06); other databases and non-English literature were not searched.
No validated questionnaire, scale or examination protocol for dhatu kshaya or vriddhi was located in PubMed by the searches logged in evidenceState; the nearest retrieved item is a methods note on dhatu sarata, a different construct.
It is not known whether the classical sign-lists discriminate between tissues at all, given how much they overlap with each other and with dosha imbalance signs; no study testing this was located.
Whether brimhana (replenishing) therapy chosen by the samanya rule outperforms generic nutritional support for any defined deficiency state has not, in any study located here, been tested head to head.
No modern referent is established in the retrieved literature for medas, majja or shukra kshaya; the correspondences to adipose tissue, marrow and reproductive function are assumed by the papers that use them.
Whether the cascade rule holds (whether increase in one tissue is followed by increase in the next) has not, in any study located here, been observed or measured.
Ashtanga Hridaya Sutrasthana 11 and the Madhava Nidana are real loci for this material that the record does not cover: no public-domain English translation of either was located by this project and their Sanskrit was not retrieved, so their 'located' entries are not to be counted as quoted sources.
Charaka Sutrasthana 23 (Santarpaniya), on the diseases of over- and under-nourishment, was not retrieved and is not cited; it is the natural companion to the Sutrasthana 21 and 22 material added here.
Whether the ICD-11 TM2 entities for these patterns carry definitions or criteria on the WHO browser beyond the title and index terms held in the project's enrichment file is not known here; in that file every such entity has a null definition.
Whether the kshaya-cause sentence Dalhana reports as a disputed variant at Su.Su.15.7 appears as root text in any other edition of the Sushruta Samhita was not checked; only the Trikamji/NIIMH text and Bhishagratna's footnote were compared.
Kaviratna's printed verse number for the Sutrasthana 21.20 sentence (heavy-but-depleting regimen for the obese) could not be read from the OCR and is not asserted.
Whether physician-versus-instrument agreement of the kind Rotti et al. reported for prakriti has been attempted for any kshaya or vriddhi judgement is not known; none was located by the searches logged here.

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
Samanya	Similarity. The principle that substances resembling a bodily constituent increase it. The operative rule for replenishment therapy.
Vishesha	Dissimilarity. The principle that substances unlike a bodily constituent decrease it. The operative rule for reduction therapy.
Vriddhi	Pathological increase of a dosha, dhatu or mala above its proper measure, recognised by a set of signs specific to each.
Kshaya	Pathological decrease or wasting of a dosha, dhatu or mala below its proper measure, likewise recognised by specific signs.
Sama-avastha	The balanced state, the reference point. Sushruta defines it both negatively, as the absence of the signs of vriddhi and kshaya and as whatever state is present when the patient is free of disease (Su.Su.15.38, 15.40), and positively, as balanced doshas, balanced agni, balanced dhatus and malas in their functions, and a serene self, senses and mind (Su.Su.15.41). No quantity attaches to it, and the text says none can (15.37).
The enumerated constituents	Three doshas (vata, pitta, kapha), seven dhatus (rasa, rakta, mamsa, medas, asthi, majja, shukra), the malas (faeces, urine, sweat), and in Sushruta's list also artava (menstrual blood), stanya (breast milk) and garbha (the foetus).
Dhatu-specific kshaya signs	Examples from Sushruta (Su.Su.15.9): rasa kshaya gives cardiac pain, palpitation and thirst; rakta kshaya gives rough skin and craving for sour and cold; mamsa kshaya gives wasting of buttocks, cheeks, thighs; medas kshaya gives splenic enlargement and empty joints; asthi kshaya gives aching bones and wasting teeth; majja kshaya gives reduced semen and breaking joint pain; shukra kshaya gives genital pain and impotence.
Dhatu-specific vriddhi signs	Examples from Sushruta (Su.Su.15.14): rasa vriddhi gives nausea and salivation; rakta vriddhi gives reddened complexion and full veins; mamsa vriddhi gives fullness of buttocks, lips, arms and heaviness; medas vriddhi gives oily skin, bulk at the flanks, fetid odour, cough and dyspnoea; asthi vriddhi gives extra teeth and bony overgrowth; shukra vriddhi gives excessive emission and bladder concretions.
Brimhana and langhana (santarpana and apatarpana)	The two therapeutic directions that follow from the diagnosis: nourishing or building treatment for kshaya, lightening or reducing treatment for vriddhi. Charaka defines them in Sutrasthana 22.9-10 (whatever produces lightness in the body is langhana; whatever produces bulk is brimhana) and applies them to the obese and the emaciated in Sutrasthana 21.16 and 21.20.
The cascade rule	Sushruta's metrical statement (Su.Su.15.18) that an over-increased constituent increases the one next in the sequence, which is why excess is to be reduced rather than left alone.
Sthaulya and karshya	Obesity and emaciation, the whole-body expressions of over- and under-nourishment. Sushruta roots both in rasa (Su.Su.15.32-33); Charaka treats them as the two worst of the eight condemned body types (Su.21.3-4, 21.11-12) and holds that both are always diseased and always to be treated (21.16).
Parimana-abhava (the unstatable quantity)	Sushruta's doctrine that no quantity (parimana) of the doshas, dhatus and malas can be laid down, because bodies differ and are not stable (Su.Su.15.37). This is a positive position in the text, not an omission, and it is the reason the model works through signs and inference rather than measurement.

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 SamhitaSutrasthana 1 (Dirghanjiviteeya):Kaviratna prints 43 and 44 after the two sentences; standard (Trikamji) Sutrasthana 1.44-1.45 · checked against the source

sarvadA sarvabhAvAnAM sAmAnyaM vRuddhikAraNam| hrAsaheturvisheShashca, pravRuttirubhayasya tu||44|| sAmAnyamekatvakaraM, visheShastu pRuthaktvakRut| tulyArthatA hi sAmAnyaM, visheShastu viparyayaH||45||
Sanskrit mūla

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

tr. Avinash Chandra Kaviratna (1896-1913)

The samanya-vishesha axiom from which the vriddhi/kshaya management scheme is derived, in a lawfully quotable public-domain translation, with the Sanskrit for both verses. Kaviratna's own footnote calls it 'almost the basis of the Science of Life'; that assessment is his, not the text's.

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Sushruta SamhitaSutrasthana 15 (Dosha-Dhatu-Mala-Kshaya-Vriddhi-Vijnaniya):Bhishagratna prints no verse numbers; the content corresponds to standard (Trikamji) Su.Su.15.1-15.3 · checked against the source

athAto doShadhAtumalakShayavRuddhivij~jAnIyamadhyAyaM vyAkhyAsyAmaH ||1|| yathovAca bhagavAn dhanvantariH ||2|| doShadhAtumalamUlaM hi sharIraM, tasmAdeteShAM lakShaNamucyamAnamupadhAraya ||3||
Sanskrit mūla

Now we shall describe the Chapter which treats of development and non-development of the humoral constituents of the body and excrements (Dosha-Dhatu-Mala-Kshaya-Vriddhi-Vijnaniya-madhyayam). Since the human body is constituted of humours, (Doshas), excretions (Mala), and the fundamental principles (Dhatus) of blood, marrow, etc., hear me discourse on the features which are peculiar to each of them.

tr. Kunja Lal Bhishagratna (1907-1916)

That an entire dedicated chapter of Sushruta is given to the recognition of decrease and increase across doshas, dhatus and malas - this is the primary locus of the concept.

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Sushruta SamhitaSutrasthana 15:Bhishagratna prints no verse numbers; the content corresponds to standard (Trikamji) Su.Su.15.9 (first part) · checked against the source

rasakShaye hRutpIDAkampashUnyatAstRuShNA ca, shoNitakShaye tvakpAruShyamamlashItaprArthanA sirAshaithilyaM ca, mAMsakShaye sphiggaNDauShThopasthoruvakShaHkakShApiNDikodaragrIvAshuShkatA raukShyatodau gAtrANAM sadanaM dhamanIshaithilyaM ca,
Sanskrit mūla

Similarly the loss of lymph chyle is marked by pain about the region of the heart, Angina Pectoris, with palpitation of the heart, a sensation of emptiness or gone-feeling in the viscus, and thirst. The loss of blood is attended with such symptoms as roughness of the skin, and a craving for acid food or drink. The patient longs to be in a cool place and asks for cool things, and the veins become loose and flabby. The loss of flesh is marked by emaciation of the buttocks, cheeks, lips, thighs, breasts, armpits, neck, and the calves of the legs.

tr. Kunja Lal Bhishagratna (1907-1916)

The actual clinical sign-lists for rasa, rakta and mamsa kshaya. Note that rakta kshaya is characterised by rough skin and a craving for sour and cold, not by pallor - which matters for the modern equation of rakta kshaya with anaemia.

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Sushruta SamhitaSutrasthana 15:Bhishagratna prints no verse numbers; the content corresponds to standard (Trikamji) Su.Su.15.9 (continued) · checked against the source

medaHkShaye plIhAbhivRuddhiH sandhishUnyatA raukShyaM meduramAMsaprArthanA ca, asthikShaye~asthishUlaM dantanakhabha~ggo raukShyaM ca, majjakShaye~alpashukratA parvabhedo~asthinistodo~asthishUnyatA ca,
Sanskrit mūla

The loss of fat is followed by such symptoms as the enlargement of the spleen, a sense of emptiness in the joints, and a peculiar dryness of the skin and a craving for cold and emollient meat. The degeneration of the bones is marked by an aching pain in the bones and bone-joints, a wasting of teeth and gums, and a general dryness of the body. Similarly, the loss or waste of marrow is characterised by the formation of a lesser quantity of semen, aching pain in the bones and breaking pain in the bone-joints which have become marrowless.

tr. Kunja Lal Bhishagratna (1907-1916)

The sign-lists for medas, asthi and majja kshaya, showing the pattern: each is diagnosed by subjective sensation, craving and gross appearance rather than by any measurement.

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Sushruta SamhitaSutrasthana 15:Bhishagratna prints no verse numbers; the content corresponds to standard (Trikamji) Su.Su.15.13 (opening sentence) · checked against the source

ata UrdhvamativRuddhAnAM doShadhAtumalAnAM lakShaNaM vakShyAmaH | vRuddhiH punareShAM svayonivardhanAtyupasevanAdbhavati |
Sanskrit mūla

The quantities of these humours, principles and secretion, are abnormally increased through the use of substances that primarily contribute to their formation in the organism.

tr. Kunja Lal Bhishagratna (1907-1916)

The aetiological half of the samanya rule as applied to pathology: excess arises from over-use (atyupasevana) of what increases a constituent's own source (svayonivardhana). Together with the treatment rule 'svayonivardhanAnyeva pratIkAraH' for kshaya (15.8), this makes diet the primary lever.

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Sushruta SamhitaSutrasthana 15:Bhishagratna prints no verse numbers; the content corresponds to standard (Trikamji) Su.Su.15.18 · checked against the source

pUrvaH pUrvo~ativRuddhatvAdvardhayeddhi paraM param | tasmAdatipravRuddhAnAM dhAtUnAM hrAsanaM hitam ||18||
Sanskrit mūla

An increased quantity of a bodily principle gives rise to a similar increase in the quantity of one immediately succeeding it in the order of enumeration as stated above ; aud hence an increase in any of the fundamental principles of the body should be checked and reduced to its normal quantity.

tr. Kunja Lal Bhishagratna (1907-1916)

The cascade rule linking vriddhi of one dhatu to vriddhi of the next, and the therapeutic imperative to correct excess. This is the clearest classical statement that the tissues are causally coupled in sequence.

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Sushruta SamhitaSutrasthana 15:Bhishagratna prints no verse numbers; the content corresponds to standard (Trikamji) Su.Su.15.17 · checked against the source

teShAM yathAsvaM saMshodhanaM kShapaNaM ca kShayAdaviruddhaiH kriyAvisheShaiH prakurvIta ||17||
Sanskrit mūla

These abnormal excesses of the aforesaid humours and principles, etc. of the body should be checked or remedied with corrective (cleansing) or pacifying measures as would be indicated by their respective natures, so as not to reduce them to a smaller quantity than that in which they are found in the normal and healthy state of a body.

tr. Kunja Lal Bhishagratna (1907-1916)

That excess is to be reduced by cleansing (saMshodhana) and depleting (kShapaNa) measures appropriate to each constituent. The 'explicit warning against overshoot' that an earlier version of this record read into the sentence is Bhishagratna's rendering; the firmer classical locus for treating to a target is Su.Su.15.40, cited below.

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Charaka SamhitaSutrasthana 17 (Kiyantah Shirasiya):Kaviratna prints 74-75 after the passage; standard (Trikamji) Sutrasthana 17.76-17.77 · checked against the source

vyAyAmo~anashanaM cintA rUkShAlpapramitAshanam| vAtAtapau bhayaM shoko rUkShapAnaM prajAgaraH||76|| kaphashoNitashukrANAM malAnAM cAtivartanam| kAlo bhUtopaghAtashca j~jAtavyAH kShayahetavaH||77||
Sanskrit mūla

The following are the causes of the attenuation, or loss of the constituent elements of the body, viz., excessive physical exercise, fasting, anxiety, taking food that is dry and insufficient, or food in excess, exposure to wind or the sun, circumstances creating fear, grief, drinking liquids whose properties are dry, night-keeping, the excessive emission of phlegm, blood, and semen (through disease), or expectorations and emissions of the same through other causes, phthisis, and afflictions caused by evil spirits or forces of nature.

tr. Avinash Chandra Kaviratna (1896-1913)

Charaka's own list of the causes of kshaya (kShayahetavaH): exertion, fasting, worry, dry, scanty or measured food, wind and sun, fear, grief, dry drinks, sleeplessness, excessive loss of kapha, blood, semen and excreta, time, and bhUtopaghAta. The aetiology is predominantly behavioural and dietary. This is the record's primary classical source for why a dhatu is depleted; it was present in the version the critic reviewed.

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Ashtanga Hridaya (Vagbhata)Sutrasthana 11 (Doshadi Vijnaniya Adhyaya):not asserted

Vagbhata's condensed restatement of the increase and decrease of doshas, dhatus and malas, including the signs of ojas depletion. Located but not quoted: this project has not located a public-domain English translation of the Ashtanga Hridaya, and the Sanskrit was not retrieved. Not to be counted or published as a quoted classical reference; the gap is stated in notKnown.

Madhava Nidanan/a not asserted

The nidana tradition inherits the vriddhi/kshaya sign-lists as diagnostic criteria for individual diseases. Cited for location only; no public-domain English translation was located and no chapter is asserted. Not to be counted or published as a quoted classical reference; the gap is stated in notKnown.

vailakShaNyAccharIrANAmasthAyitvAttathaiva ca | doShadhAtumalAnAM tu parimANaM na vidyate ||37|| eShAM samatvaM yaccApi bhiShagbhiravadhAryate | na tat svAsthyAdRute shakyaM vaktumanyena hetunA ||38|| doShAdInAM tvasamatAmanumAnena lakShayet | aprasannendriyaM vIkShya puruShaM kushalo bhiShak ||39||
Sanskrit mūla

Since the temperament, constitution, size and the fundamental principles of) the body vary in different individuals ; and since the body, in its turn, undergoes such gradual transformations as infancy, youth and old age\ and changes its state each moment, it is absolutely impossible to lay down the exact quantity of the deranged humours, excrements and fundamental principles (of lymph chyle, blood, semen, albumen, etc.^ that may be found in the human organism. Hence it is necessary for a physician to ascertain their state of equilibrium (their continuance in normal state and quantity) at any particular time ; and which should be pronounced only in cases where signs of perfect health would be visible. An experienced physician would naturally draw a contrary inference from the improper functions of the organs in an individual.

tr. Kunja Lal Bhishagratna (1907-1916)

Sushruta's doctrinal position on measurement, which an earlier version of this record misreported as a mere absence: the quantity (parimANa) of doshas, dhatus and malas does not exist to be stated (na vidyate), because bodies differ (vailakShaNya) and are not stable (asthAyitva); their balance can be asserted only from health (svAsthya) and from no other ground; and their imbalance is to be inferred (anumAnena) from a person whose senses are not serene. The model is inferential by design.

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(svasthasya rakShaNaM kuryAdasvasthasya tu buddhimAn) | kShapayedbRuMhayeccApi doShadhAtumalAn bhiShak | tAvadyAvadarogaH syAdetatsAmyasya lakShaNam ||40|| samadoShaH samAgnishca samadhAtumalakriyaH | prasannAtmendriyamanAH svastha ityabhidhIyate ||41||
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. ... 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. Kunja Lal Bhishagratna (1907-1916)

The treat-to-target rule and the positive definition of balance. The physician depletes or builds (kShapayed bRuMhayec cApi) the doshas, dhatus and malas until the person is free of disease, and that state is the mark of sAmya; the healthy person is one of balanced doshas, balanced agni, balanced dhatu and mala function, and serene self, senses and mind. This is the textual footing for a target of therapy, and it is stated without any quantity. Note that Bhishagratna prints the definition before the treatment rule; the Sanskrit order is 40 then 41, and the two sentences are quoted here in the Sanskrit order with the omission marked.

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doShadhAtumalakShINo balakShINo~api vA naraH | svayonivardhanaM yattadannapAnaM prakA~gkShati ||29|| yadyadAhArajAtaM tu kShINaH prArthayate naraH | tasya tasya sa lAbhe tu taM taM kShayamapohati ||30||
Sanskrit mūla

A person suffering from a wasting of any of the constituent humours or fundamental principles or excrements of the body, as well as one suffering from loss of Ojah (albumen) naturally craves for drink and food that tend to contribute directly to the formation of the matter (or bodily principle) so lost or wasted. Conversely, the particular food or drink longed for by a person suffering from a loss or waste of any of the abovesaid fluids or principles, should be looked upon as possessed of a curative virtue in that particular case.

tr. Kunja Lal Bhishagratna (1907-1916)

That craving is treated as both a diagnostic sign of kshaya and a guide to its remedy: the depleted person desires what builds the depleted constituent (svayonivardhana), and obtaining it removes the kshaya. This is the classical basis for the cravings that appear throughout the sign-lists.

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rasanimittameva sthaulyaM kArshyaM ca | tatra shleShmalAhArasevino~adhyashanashIlasyAvyAyAmino divAsvapnaratasya cAma evAnnaraso madhuratarashca sharIramanukrAmannatisnehAnmedo janayati, tadatisthaulyamApAdayati ; tamatisthUlaM kShudrashvAsapipAsAkShutsvapnasvedagAtradaurgandhyakrathanagAtrasAdagadgadatvAni kShipramevAvishanti,
Sanskrit mūla

Obesity or loss of flesh (Karsha) should be ascribed to changes in the condition of the lymph chyle. The lymph chyle derived from the assimilated food of a person, who is habituated to a course of diet which tends to promote the quantity of the bodily Kapham or is in the habit of pampering his belly even when a previous meal has not been thoroughly digested, or who is addicted to a habit of sleeping in the day, or leading a sedentary life, or is averse to taking any sort of physical exercise, continues in an immature state and is transformed into a serum of sweet taste which moves about within the body, engendering the formation of fat which produces excessive stoutness. A person afflicted with obesity develops such symptoms as shortness of breath, thirst, ravenous appetite, excessive sleepiness, perspiration, fetid odours in the body, wheezing sound in the throat during sleep or sudden suspension of breath, inert feeling in the limbs, dulness or heaviness of the body, and indistinctness of speech.

tr. Kunja Lal Bhishagratna (1907-1916)

Sushruta's own statement that obesity and emaciation are both rooted in rasa (rasanimittam eva sthaulyaM kArshyaM ca): immature (Ama), over-sweet rasa generates fat and so excessive stoutness. The symptom list for the obese follows. This is the primary text on whether sthaulya is a disorder of medas or of rasa, and it was unquoted in the version the critic reviewed.

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tatra punarvAtalAhArasevino~ativyAyAmavyavAyAdhyayanabhayashokadhyAnarAtrijAgaraNapipAsAkShu tkaShAyAlpAshanaprabhRutibhirupashoShito rasadhAtuH sharIramananukrAmannalpatvAnna prINAti, tasmAdatikArshyaM bhavati;
Sanskrit mūla

Loss of flesh or a gradual emaciation of the body should be ascribed to the partaking of food in the composition of which, matter which aggravates the bodily Vayu largely or excessively enters, to over-fatiguing physical exercise, sexual excesses, over study, fright, grief or anxiety, to the keeping up of late hours, to unsatisfied hunger, insufficient food, and to astringent food which tends to dry up the lymph chyle.

tr. Kunja Lal Bhishagratna (1907-1916)

Sushruta's in-text aetiology of depletion: the causes of karshya, which the text roots in a dried-up (upashoShita) rasa-dhatu that fails to nourish the body. This is the chapter's own answer to why a dhatu is depleted, and it is in the root text (unlike the kshaya-cause sentence Bhishagratna prints as a footnote to 15.7; see the Dalhana entry).

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bhavanti cAtra- atyantagarhitAvetau sadA sthUlakRushau narau | shreShTho madhyasharIrastu kRushaH sthUlAttu pUjitaH ||35||
Sanskrit mūla

Excessively corpulent and excessively lean persons are alike condemnable. A body which is neither too stout nor too lean, but strikes the mean as regards plumpness, is the best. A lean frame should have the preference to a stout one.

tr. Kunja Lal Bhishagratna (1907-1916)

The verse that pairs excess and deficiency as equally condemned states and ranks emaciation as the lesser evil, matching Charaka Sutrasthana 21.17. It is the clearest statement that vriddhi and kshaya at the level of the whole body are both pathology, not one of them a norm.

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Dalhana, Nibandhasangraha (commentary on Sushruta Samhita)Sutrasthana 15, commentary on sutra 7:Su.Su.15.7 (commentary) · checked against the source

Quotation withheld: no English translation of this passage has been cleared for reproduction, and the text held here is not the Sanskrit itself. The passage is at this address.

That the kshaya-cause sentence (excessive saMshodhana and saMshamana, suppression of urges, unsuitable food, mental distress, exertion, fasting, sexual excess) is NOT in the root text of Su.Su.15 as transmitted in the Trikamji/NIIMH edition. Dalhana reports it as a reading that 'some read here' (kecid atra ... paThanti) and adds that 'the teachers say' these causes mostly increase vata and deplete pitta and kapha, so the cause must be judged case by case and 'there is no purpose in this reading' (nAsmin pAThe prayojanam). Bhishagratna translated the variant into a footnote. It is recorded here as a disputed variant, not as Sushruta's doctrine.

Charaka SamhitaSutrasthana 21 (Ashtauninditiya):Kaviratna prints 2 and 3 after these sentences; standard (Trikamji) Sutrasthana 21.3-21.4 (first part) · checked against the source

iha khalu sharIramadhikRutyAShTau puruShA ninditA bhavanti; tadyathA- atidIrghashca, atihrasvashca, atilomA ca, alomA ca , atikRuShNashca, atigaurashca, atisthUlashca, atikRushashceti||3|| tatrAtisthUlakRushayorbhUya evApare ninditavisheShA bhavanti| atisthUlasya tAvadAyuSho hrAso javoparodhaH kRucchravyavAyatA daurbalyaM daurgandhyaM svedAbAdhaH kShudatimAtraM pipAsAtiyogashceti bhavantyaShTau doShAH|
Sanskrit mūla

Referring to the body, there are eight persons that are regarded as worthy of condemnation. They are as follow: 1. one that is very tall in stature ; 2. one that is very short in stature ; 3. one that is very hairy ; 4. one that is not at all hairy ; 5. one that is very dark (or black) of complexion ; 6. one that is very white of complexion ; 7. one that is very corpulent or obese ; and 8. one that is very emaciated or lean. Amongst these, of him that is very corpulent and him that is very lean, there are certain incidents, wanting in the others, that are especially worthy of condemnation. Of him that is very corpulent are these eight faults, viz., 1. diminution of the period of life, 2. (untimely) attack of decrepitude, 3. excessive difficulty of sexual congress, 4. weakness, 5. foetid smell in every part of the body, 6. excessive perspiration, 7. abnormal appetite for food, and 8. abnormal thirst.

tr. Avinash Chandra Kaviratna (1896-1913)

Charaka's locus classicus for sthaulya and karshya: the eight condemned body types, with the over-nourished and the under-nourished singled out, and the eight faults of the obese. Charaka's mechanism in the same sutra is that in the obese 'fat alone accumulates, not so the other dhatus' (meda evopacIyate na tathetare dhAtavaH), which is a medas-centred account against Sushruta's rasa-centred one (Su.Su.15.32); see contested.

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Charaka SamhitaSutrasthana 21 (Ashtauninditiya):Kaviratna prints 7-8 after the sentence; standard (Trikamji) Sutrasthana 21.11-21.12 · checked against the source

sevA rUkShAnnapAnAnAM la~gghanaM pramitAshanam| kriyAtiyogaH shokashca veganidrAvinigrahaH||11|| rUkShasyodvartanaM snAnasyAbhyAsaH prakRutirjarA| vikArAnushayaH krodhaH kurvantyatikRushaM naram||12||
Sanskrit mūla

The habitual use of dry food and drink, fasts, insufficiency of food, excessive administration of purgatives and emetics, grief, suppression of the urgings of nature and sleep, habitual use of dry unguents and indulgence in baths without rubbing oil on the body, natural waste, or the waste that follows disease and excessive wrath, these make a man lean or emaciated.

tr. Avinash Chandra Kaviratna (1896-1913)

Charaka's in-text causes of karshya, the whole-body form of depletion: dry food, fasting (la~gghana), measured eating, over-treatment (kriyAtiyoga), grief, suppression of urges and of sleep, dry rubbing, habitual bathing, constitution, old age, the after-state of disease, and anger. With Su.17.76-77 and Su.Su.15.33 this gives the record three in-text aetiologies of depletion, which is the material the kshaya-nidana finding asked for, sourced from root text rather than from a translator's footnote.

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Charaka SamhitaSutrasthana 21 (Ashtauninditiya):Kaviratna prints 12 and 13 after these sentences; standard (Trikamji) Sutrasthana 21.16-21.17 · checked against the source

satataM vyAdhitAvetAvatisthUlakRushau narau| satataM copacaryau hi karshanairbRuMhaNairapi||16|| sthaulyakArshye varaM kArshyaM samopakaraNau hi tau| yadyubhau vyAdhirAgacchet sthUlamevAtipIDayet||17||
Sanskrit mūla

He that is very corpulent, and he that is very emaciated, both these are to be regarded as always diseased. They should, therefore, be always subjected to treatment (by administration of medicines and diet) that is calculated to reduce bulk and promote nutrition and growth. Among the two, viz., excessive corpulency and excessive emaciation, the latter is rather tolerable ; for though the corpulent and the emaciated are equally situated, yet if disease assails both of them, it is sure to afflict the corpulent man more than the emaciated one.

tr. Avinash Chandra Kaviratna (1896-1913)

That both extremes are permanently diseased (satataM vyAdhitau) and permanently under treatment, by karshana for the one and bRuMhaNa for the other, with emaciation the lesser evil. This is the therapeutic pairing that the record's brimhana/langhana component describes, stated in Charaka's root text, and it matches Su.Su.15.35.

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Charaka SamhitaSutrasthana 21 (Ashtauninditiya):Kaviratna's printed number after this sentence is OCR-damaged ('J1', most likely a footnote dagger plus 16); standard (Trikamji) Sutrasthana 21.20 · checked against the source

guru cAtarpaNaM ceShTaM sthUlAnAM karshanaM prati| kRushAnAM bRuMhaNArthaM ca laghu santarpaNaM ca yat||20||
Sanskrit mūla

In reducing the bulk of persons that are very corpulent, food that is heavy and such dietary regulations and other practices as fall within Atarpana, are beneficial. For the nourishment, however, of persons that are very lean, food that is light and such dietary regulations and other practices as fall within Santarpana, are beneficial.

tr. Avinash Chandra Kaviratna (1896-1913)

Charaka's paradoxical prescription: heavy but non-nourishing (guru, atarpaNa) regimen to reduce the obese, light but nourishing (laghu, santarpaNa) regimen to build the emaciated. It shows that brimhana and langhana are not simply 'more food' and 'less food' but qualities of regimen, which matters for how the samanya rule is applied in practice.

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Charaka SamhitaSutrasthana 22 (Langhana-Brimhaniya):Kaviratna prints 7-9 after the block of six definitions; the two sentences quoted correspond to standard (Trikamji) Sutrasthana 22.9-22.10 · checked against the source

yat ki~jcillAghavakaraM dehe talla~gghanaM smRutam||9|| bRuhattvaM yaccharIrasya janayettacca bRuMhaNam|
Sanskrit mūla

Any thing that lightens or attenuates (the aggravated humours and altered constituents) in the body has been said to be a Langhana. That which promotes nutrition and bulk of the body is known as Vring-hana.

tr. Avinash Chandra Kaviratna (1896-1913)

Charaka's definitions of the two therapeutic directions the vriddhi/kshaya diagnosis leads to: whatever produces lightness (lAghava) in the body is langhana; whatever generates bulk (bRuhattva) of the body is bRuMhaNa. Added because the record's component on brimhana and langhana previously carried no citation. The parenthesis '(the aggravated humours and altered constituents)' is Kaviratna's gloss; the Sanskrit says only 'in the body'.

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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.

Clinical efficacy of panchakola on raktakshaya. · Ayu · 2013 · PMID 24250128

The one indexed clinical trial located by this record's searches that takes a named dhatu kshaya as its enrolment category. 46 patients with rakta kshaya, randomised to Panchakola tablet or rice-powder placebo for six weeks; the treatment arm showed a significant rise in haemoglobin and in classical symptom scores.

How much it shows. Small single-centre trial, and its central move is an assumption rather than a finding: the authors state at the outset that 'Raktakshaya can be correlated with anemia' and then use haemoglobin and iron studies as the outcome. That equivalence is never tested. So the trial is weak evidence that one formulation raises haemoglobin, and no evidence at all that the classical construct rakta kshaya picks out anaemia. Sushruta's own sign-list for rakta kshaya (rough skin, craving for sour and cold, flabby veins) does not mention pallor.

Universal significance of the principle of Samanya and Vishesha beyond Ayurveda. · J Ayurveda Integr Med · 2018 · PMID 30401500

A recent articulation of the samanya-vishesha principle, arguing for its applicability beyond medicine to ecology, economics and social policy.

How much it shows. Conceptual essay, explicitly argumentative rather than empirical, with worked illustrations drawn from family structure, climate governance and poverty reduction. It contains no clinical data and does not test the principle in its original therapeutic setting. Its presence in the indexed literature is a fair indicator of what that literature consists of for this concept.

Explication on tissue nutrition in prenatal and postnatal life: An Ayurveda perspective. · J Ayurveda Integr Med · 2021 · PMID 32855015

Supplies the mechanistic backdrop against which vriddhi and kshaya are supposed to occur, namely that tissues are nourished continuously at different rates governed by agni and are mutually dependent.

How much it shows. Narrative review, no data, no systematic method. Included here because the vriddhi/kshaya model presupposes the tissue-nutrition model, and this is the clearest indexed statement of the latter that this record located - not because it provides evidence for either.

Interrater reliability of diagnostic methods in traditional Indian ayurvedic medicine. · Evid Based Complement Alternat Med · 2013 · PMID 24191170

The interrater reliability study most often cited for Ayurvedic clinical assessment: fifteen registered Ayurvedic doctors examined twenty healthy subjects; average pairwise weighted kappa was 0.07 for pulse, 0.17 for tongue and 0.28 for prakriti, which the authors call a low level of reliability for all three.

How much it shows. Small (20 subjects, all healthy), single setting, three modalities only. It does not examine any dhatu kshaya or vriddhi judgement, so it is indirect evidence about the kind of sign-based assessment this record describes, not evidence about this construct. Cited so that the record's statement about poor agreement on other modalities has a source and a number.

Reliability studies of diagnostic methods in Indian traditional Ayurveda medicine: An overview. · J Ayurveda Integr Med · 2013 · PMID 23930037

The same group's overview of reliability studies in Ayurvedic diagnosis. Its abstract states that reliability studies in Ayurveda are 'in the preliminary stage' and offers study designs and statistics for future work.

How much it shows. Methodological overview, no new data. Only the abstract was retrieved for this record, so whether its body lists any study of a dhatu kshaya or vriddhi judgement is not known here; the abstract names prakriti classification and pulse diagnosis as its examples.

Determinants of prakriti, the human constitution types of Indian traditional medicine and its correlation with contemporary science. · J Ayurveda Integr Med · 2014 · PMID 25336848

A large multicentre prakriti study (3,416 healthy men aged 20-30) reporting 80 percent concordance and a kappa of 0.77 between Ayurvedic physician assessment and a computer-aided tool, with a significant association between dominant prakriti and BMI.

How much it shows. Cross-sectional; the agreement measured is physician versus software, not physician versus physician, and the construct is prakriti, not vriddhi or kshaya. It is included because it cuts against a blanket claim that agreement in Ayurvedic assessment is uniformly poor: with a structured instrument, agreement for one classical construct was substantial. No comparable instrument for any kshaya or vriddhi judgement was located by this record's searches.

Weighted mean: A possible method to express overall Dhatu Sarata. · J Ayurveda Integr Med · 2015 · PMID 26834429

The nearest thing to a dhatu-assessment methods paper that the record's PubMed search for 'ayurveda AND dhatu AND (reliability OR validation OR validity)' returned: a proposal to express overall dhatu sarata (tissue excellence grading) as a weighted mean rather than a single category.

How much it shows. A short methods communication with no data. Its abstract concedes that in dhatu sarata 'no substantial work has been carried out' on inter-rater variability, reliability or validation. Dhatu sarata grades the quality of a tissue in a healthy person and is a different construct from kshaya and vriddhi, so this is evidence about the state of the adjacent literature, not about this concept.

Untitled · 2026

That every vriddhi and kshaya pattern this record describes has an official ICD-11 TM2 code. From the project's own enrichment file (ayurveda-atlas/data/enrichment/icd-tm2.json, release 2026-01, fetched 2026-09-17), with the Sanskrit index terms the file carries: dosha patterns SR12 vAtavRuddhi, SR14 vAtakShaya, SR17 pittavRuddhi, SR19 pittakShaya, SR1C kaphavRuddhi, SR1E kaphakShaya; dhatu patterns SR41 rasavRuddhi, SR42 rasakShaya, SR43 raktavRuddhi, SR44 raktakShaya, SR45 mAMsavRuddhi, SR46 mAMsakShaya, SR47 medovRuddhi, SR48 medaHkShaya, SR49 asthivRuddhi, SR4A asthikShaya, SR4B majjAvRuddhi, SR4C majjAkShaya, SR4D shukravRuddhi, SR4E shukrakShaya; ojas SR4F ojaHkShaya, SR4G ojovyApat, SR4H ojovisraMsa; artava and stanya SR4J-SR4M; mala patterns SR80 purIShavRuddhi, SR81 purIShakShaya, SR82 mUtravRuddhi, SR83 reduced urine, SR84 svedavRuddhi, SR85 svedakShaya. The set mirrors Sushruta Sutrasthana 15 almost entity for entity, including the three ojas derangements of 15.24.

How much it shows. This is a nomenclature, not a measurement. In the enrichment file every one of these entities has a null definition and carries only a title and index terms, so what TM2 supplies is a standardised name and a code for each pattern, not diagnostic criteria, thresholds or a reference quantity. Whether coding counts as operationalisation is therefore answered narrowly here: it operationalises the vocabulary (each pattern can now be recorded and counted in health statistics) and leaves the record's central point untouched, that no criteria, instrument or reliability figure for assigning the code to a patient was located. Two further things the file shows and the record flags rather than resolves: the same Sanskrit term is indexed under a pattern code and a disorder code in several cases (medovRuddhi under SR47 and SP62 'High fat disorder'; shukrakShaya under SR4E and SN03 'Oligospermia disorder'; stanyakShaya under SR4M and SN10; svedavRuddhi under SR84 and SN45), and SR1T 'Blood deficiency pattern' is a Unani entity indexed by Arabic and Persian terms, not raktakShaya. The WHO browser's full entity pages were not read for this record, so any definitions published there and not carried in the enrichment file are not known here.

How to cite this entry

Age Ayurveda Nighantu, Vriddhi and Kshaya: What the Body Has Too Much and Too Little Of, https://nighantu.ageayurveda.com/concept/tissue-need-and-lack/, CC BY 4.0. The whole set is downloadable from the concept index. Machine-readable source: Markdown. Data exported 2026-10-08.

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