# Vikriti assessment (assessing the present deranged state) > Canonical version of this page: https://nighantu.ageayurveda.com/concept/vikriti-assessment/ ## How much weight this concept bears Vikriti assessment is where the gap between doctrine and measurement is widest, and this revision has had to narrow what it says about both sides. THE CLASSICAL SIDE. What is quotable from a public-domain translation is small and definite: Charaka defines vikriti as deviation from normal, makes it the second item of the ten-fold examination whose stated purpose is 'ascertainment of the measure of strength (of the patient)', lists the factors by which the derangement's strength is graded, and gives the three grades. That is all. No procedure is attached to any of it, and the Sushruta parallel is a list of things to observe that does not use the prakriti/vikriti axis. The record previously called this basis 'clear and quotable', which was true of the definition and false of the method, and the phrase is withdrawn: the quotable part is not the operational part. The operational part, the eight-fold examination with pulse and tongue at its centre, is not in Charaka or Sushruta. Both public-domain translators say so in their own voice (Kaviratna's note at Indriya Sthana, p. 871; Bhishagratna's Introduction, p. lxvii), the project's own search of both scans finds no pulse procedure, and the earliest text in which this record has located pulse examination is Sharngadhara Samhita Purva Khanda 3, now quoted in Sanskrit from an archive.org scan. The attribution of the eight-fold list as a named set to Yogaratnakara rests on secondary literature; neither it nor Bhavaprakasha was retrieved. Two adjacent doctrines supply what Charaka's definition lacks and are now cited: khavaigunya, which explains why a disturbed dosha produces disease at one site (Su.Su. XXIV; Ca.Ci. XV; Ca.Ni. IV on the conjunction of cause, dosha and dushya), and the sama / nirama judgement, for which Vagbhata gives ten signs and a treatment rule, that sama doshas are not to be expelled until ripened (A.H.Su. 13/23-24, 27, 28-29, Sanskrit only). THE MEASUREMENT SIDE. When pulse and tongue examination have been measured for inter-rater reliability, the one study located gives average weighted kappa 0.07 for pulse and 0.17 for tongue, with the null hypothesis of random rating not rejected for any of 105 doctor pairs on tongue (PMID 24191170); the companion pulse analysis ranges from poor to moderate (28664059); a single expert's self-consistency on pulse was 0.42 (27257530). These are among the lowest chance-corrected figures this record has encountered for a clinical assessment; the earlier version said 'some of the lowest ... recorded for any clinical assessment', which is a comparison across fields that no search behind this record supports, and it is withdrawn. In real patients, agreement on constitutional and functional entities such as agni sat between 0 and 0.4 while raw agreement on the final label reached 95% (30653338), which means the consensus label is not being produced by the component assessments in any traceable way. A 2024 vignette study (39183608) shows the disagreement persists when every clinician receives identical written case information, so it is not solely an artefact of hands-on technique. INSTRUMENTATION. Pulse-acquisition hardware exists (Nadi Tarangini, 18002428, 2007) and a 2024 review counts 67 sensor papers (38815517). In the papers retrieved here the reference standard is the practitioner: the 2007 paper states the system 'is being evaluated by Ayurvedic practitioners', and the 2017 pilot (29103852) compares sensor positions, not diagnoses, and has no reference diagnosis at all. An instrument validated against practitioner judgement cannot be shown to exceed that judgement's reliability, which is the circularity a critic finding named; the record states it for the papers it has read and does not generalise it to the 67 it has not. The one Ayurveda-framed tongue-image classifier located (37702608) reports 99.17% accuracy with no statement of label provenance in its abstract. CODING. ICD-11 Chapter 26 Module 2 (release 2026-01, held in a sibling repository snapshot) codes constitution patterns (SS50-SS56, prakriti by dosha) and per-dosha derangement stages (SR10-SR1E: prakopa, sanchaya, vriddhi, prasara, kshaya) and an ama state (SS15), but contains no entity for vikriti by name, no examination method and no grading of strength. The output of a vikriti assessment is thus internationally codeable; its method and warrant are not. The WHO's own Bulletin perspective (41180267) states that the chapter's inter-rater reliability requires dedicated study. BOUNDED NEGATIVES. Within the searches named in modernCoverage: no operational definition of a vikriti state validated against an external criterion was located; no prospectively tested biomarker for dosha derangement, agni or ama was located; no study was located that tests whether a vikriti assessment predicts outcome or treatment response. These are statements about what was searched, not about the literature as a whole; DHARA, the AYUSH Research Portal, IEEE Xplore and Scopus were not searched. Beyond the reliability studies, the indexed literature retrieved on vikriti and its sub-concepts consists of narrative reviews that restate the classical categories in modern physiological vocabulary and propose candidate biomarkers as future work. Vikriti is the assessment of a patient's current deranged state. Charaka defines it in one sentence, as deviation from what is normal, and sets it against prakriti as its reference point: where prakriti is what the person is by birth, vikriti is what has gone wrong now. In Charaka it is the second of the ten items of patient examination (dashavidha pariksha), and the text attaches to it a list of factors to be weighed, cause, dhatu, dosha, prakriti, place and time, together with the symptoms, by which the derangement is graded strong, middling or weak. That is the whole of what Charaka says about vikriti as such, and this record now says so plainly: the definition, the position in the list and the grading factors are quotable from a public-domain translation, but no examination procedure is attached to any of them. The procedure clinicians actually use for vikriti assessment, the eight-fold ashtavidha pariksha with pulse (nadi) and tongue (jihva) at its centre, is not in Charaka or Sushruta. The two public-domain translators of those texts both say so in their own voice, and the earliest text in which this record has located pulse examination is the Sharngadhara Samhita, Purva Khanda 3, quoted here in Sanskrit. So the quotable part of vikriti doctrine is not the operational part, and the operational part is not classical. Two adjacent doctrines give vikriti its content once a disturbed dosha is found: khavaigunya, the site defect that explains why disease lands where it does, and the sama / nirama distinction, the judgement that undigested matter (ama) is or is not bound up with the disturbed dosha, which Vagbhata makes the condition for whether the doshas may be expelled at all. Both are now cited from located verses and cross-referenced to their own records. Modern reliability measurement of pulse and tongue examination has produced chance-corrected agreement in the slight range (mean weighted kappa 0.07 and 0.17 in the one inter-rater study retrieved), which is among the lowest figures this record has encountered; no systematic comparison with other clinical assessments was made and none is claimed. Instrumented pulse acquisition and tongue-image classification exist and are cited; in the papers retrieved here the reference standard they are evaluated against is the practitioner's own judgement, which is the quantity whose reliability is in question. ## At a glance | Field | Value | | --- | --- | | Subject area | Examination and assessment | | Domain, as recorded | diagnosis | | Contested questions | 6 | | Stated as not known | 19 | | Classical citations | 16, 9 quoting the text | | Research papers assessed | 12 | | 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 nadi pariksha a legitimate part of classical Ayurvedic diagnosis? This is contested. - Traditional practice treats it as central and defends it by long historical use, and some Ayurvedic sources read scattered references to dhamani or sira in the samhitas as implicit pulse examination. Bhishagratna, himself a Kaviraj, concedes the absence from Sushruta and explains it as a division of labour with a separate pulse treatise (Introduction, p. lxvii). - Textual scholarship, and much Ayurvedic writing itself, accepts that Charaka and Sushruta contain no description of pulse examination and that the method appears later. Kaviratna states the absence flatly in his note at Indriya Sthana ('Suçruta also is silent, like Charaka, on the pulse'), and this record has located the method no earlier than Sharngadhara Purva Khanda 3. If so, the emblematic vikriti method has no samhita-period authority. Whether Sharngadhara is the EARLIEST text to carry it is a priority claim this record does not make; see notKnown. ### What is the relation between vikriti and the disease diagnosis? This is contested. - Vikriti is a separate axis: two patients with the same named disease can have different vikriti and therefore different treatment, which is the standard justification for individualisation. The classical ground for the separateness is khavaigunya and the conjunction requirement (Ca.Ni. IV): the same dosha produces different diseases by site and dushya. - The 2019 reliability data show agreement is better on disease entities than on constitutional and functional ones, which suggests the named disease is doing most of the work and the vikriti layer adds variance rather than information. ### Is high raw agreement on a final diagnosis evidence of a working method? This is contested. - Practitioners point to 95% agreement on the consensus final diagnosis as showing the method works in practice. - Methodologists point out that raw agreement is inflated by unequal prevalence of categories and that chance-corrected kappa for the same study's components was 0 to 0.4; the two figures cannot both describe a reproducible process. ### Can vikriti be assessed without first establishing prakriti, and is the pair circular? This is contested. - Charaka's definition makes vikriti deviation from the individual's own norm, so prakriti must be established first. - In practice many assessments grade current dosha states against a population norm rather than the individual's constitution, which is a different quantity. The literature retrieved here does not consistently distinguish the two, and no study comparing them was located. - The circularity, added on revision: in a sick patient prakriti is usually inferred from the same examination that produces the vikriti finding, so the reference and the deviation are read off one observation. The prakriti record carries the measurement side of this (prakriti inter-rater kappa 0.28 in PMID 24191170); if the reference is that unreliable, the deviation from it inherits the unreliability before any vikriti-specific error is added. ### Is ama a measurable state? This is contested. - It is treated clinically as assessable through tongue coating, appetite and other signs, and a validated ama instrument exists within the Ayurvedic literature. The classical sign list is now quoted (A.H.Su. 13/23-24), and ICD-11 TM2 carries an ama-state category (SS15). - No external biochemical or imaging correlate has been established in the literature retrieved here; the 2026 rheumatoid arthritis pilot is exploratory and the ama instrument's validation is internal to the same tradition, so the construct has no independent anchor. ### Does instrumenting the pulse escape the reliability problem? This is contested. - Device proponents hold that a sensor removes the subjectivity of finger palpation and that classifiers trained on recorded waveforms will be reproducible by construction. - Reproducibility of the signal is not validity of the label. In the papers retrieved here the labels come from practitioners (18002428) or there is no reference diagnosis at all (29103852), so a classifier can at best reproduce the practitioner's kappa-0.07 judgement more consistently. The field's own 2024 review concedes that 'procedure standardization is also required' (38815517). Added on revision after a critic finding; the circularity is stated for the retrieved papers, not asserted of the whole literature. ## 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 an operational definition of a vikriti state would be. No published definition specifying the observations, thresholds and combining rule required to assign a vikriti was located in the searches named in modernCoverage, so the assessment cannot be independently reproduced from any source this record has. - Whether any vikriti finding predicts treatment response or outcome. No prospective study testing this was located in the searches named in modernCoverage. - Whether the three-grade strength scale (strong / middling / weak) can be applied reproducibly. No reliability study of it was located, and none was specifically searched for. - Whether a vaidya's pulse finding carries information beyond rate and rhythm. The kappa of 0.07 is consistent with none. The instrumented work retrieved here (Nadi Tarangini, PMIDs 18002428 and 29103852) records the artery but either uses the practitioner as the reference or compares sensor positions without any diagnosis, so no study located here tests a practitioner's dosha reading against an instrumented measurement of the same artery as an independent criterion. Restated on revision; the earlier version said no study had tested pulse findings against instrumented measurement, which was too broad once the device literature was retrieved. - Whether tongue coating indexes anything beyond oral hygiene, smoking, hydration and medication; no study located here controlled for these while testing the ama association. - Whether agni has any measurable correlate. Candidate markers have been proposed in narrative reviews retrieved here but none was found to have been prospectively tested against an agni assessment. - Whether structured forms, training or image standardisation can raise agreement to usable levels. The one experience effect reported (p=0.04, small sample, unadjusted) is too weak to answer this. - How vikriti assessment should be documented for research. No agreed case record form was located, which is why the reliability studies retrieved here have each had to build their own item list. - What reference standard the sensor-based nadi pariksha literature uses. The 2024 review (38815517) counts 67 papers but its abstract does not say how their classification labels were obtained, and this record did not retrieve them individually. The circularity a critic finding asserted of the whole literature (that it validates against vaidya opinion) is confirmed here only for PMID 18002428 and cannot be asserted of the rest. - Where the disease labels in the tongue-image classification literature come from. The one Ayurveda-framed classifier located (37702608) reports 99.17% accuracy without stating label provenance, image-set size or evaluation protocol in its abstract; the full text was not read. - Whether Sharngadhara Samhita is the EARLIEST text to describe pulse examination, and what its date is. This record has located the method there and nowhere earlier among the texts it has retrieved, which is a statement about the retrieval; the 'c. 13th-14th century' date is from secondary literature and was not verified. Settling priority would need the Sanskrit of the other candidates named by the 2024 review (Ravana Samhita, Nadi Vijnana of Kanada) and a dating argument this record does not have. - What Yogaratnakara and Bhavaprakasha say in their own words about the eight-fold examination, and when they were composed. Neither was retrieved in any language; the attribution of the eight-fold list to Yogaratnakara is carried from secondary sources only. A critic's 'c. 17th c.' for Yogaratnakara was not adopted. - Which edition the archive.org Sharngadhara scan reproduces. The item carries no publisher, place or date metadata, and the verse text is quoted from a Tesseract OCR layer with regular conjunct errors. The normalised reading given in the record is this record's own and should be checked against the page images before publication. - Whether the classical texts stage ama in three steps (sama, pachyamana, nirama) or two. A critic finding named a three-stage sequence. What this record located is a two-state contrast, sama and nirama, in A.H.Su. 13/24 and a treatment rule keyed to it in 13/28-29. No verse naming pachyamana as a middle state was located in the Ashtanga Hridaya Sutrasthana text searched, and the Charaka and Sushruta scans were not searched for it; the term may belong to the later fever literature. Scoped in rather than asserted. - Whether the sama / nirama judgement 'changes treatment immediately' in the general way a critic finding stated. A.H.Su. 13/28-29 supports one specific consequence (no expulsion of sama doshas until ripened); a survey of treatment rules keyed to the judgement across the texts was not made. - Whether khavaigunya and the sama / nirama judgement are in practice part of what clinicians record as vikriti, or are recorded separately. No case record form or practice survey retrieved here addresses this. - How clinicians select among the ICD-11 TM2 per-dosha stage codes (SR10-SR1E) and whether that selection is reproducible. The WHO's own Bulletin perspective (41180267) says the chapter's inter-rater reliability requires dedicated study; none was located. - Which standard-edition (Trikamji) verse numbers correspond to the Kaviratna aphorism numbers used throughout this record's Charaka citations (Vimana VIII 110 and the unnumbered vikriti passage; Nidana I 11; Nidana IV 3; Chikitsa XV 35-36 and 44-48). Kaviratna's offset is not constant across chapters and was not measured here except where the khavaigunya and dosha-dushya records had already done so by content. The earlier 'Vi. 8.94' mapping was never established by this project and has been withdrawn. - Whether the trividha pariksha (aptopadesha, pratyaksha, anumana) is correctly placed as the epistemic frame of vikriti assessment. The component is carried from general knowledge of Charaka Vimana IV and VIII and no passage was retrieved for it. ## The terms this concept is built from | Term | What it names | | --- | --- | | Definition | Charaka: 'an abnormal condition has been said to be a deviation from what is normal', assessed by explicit contrast with the patient's own prakriti. Kaviratna's footnote to aphorism 110 glosses the Sanskrit term: 'vikrititah has reference to the reverse of the above, i. e., to the abnormal condition that has set in', the 'above' being prakriti, 'the normal constitution in health'. The footnote is the translator's, but it fixes which Sanskrit word his English phrase renders. | | Dosha vikriti | Which of vata, pitta and kapha are disturbed, singly or in combination, and by how much (vriddhi, kshaya, or normal). Charaka's grading passage names 'faults (i. e., wind, bile, and phlegm)' among the things to be weighed; the vriddhi / kshaya vocabulary of degree is carried from the project's dosha records and is not quoted here. | | Dhatu and srotas involvement | Which of the seven tissues and which channels are affected. The dhatus are in Charaka's list of what must be weighed to grade the derangement ('constituent elements (of the body, such as juice, blood, flesh, fat, bones, marrow, and vital seed)'). The srotas item is NOT in that list; it enters through khavaigunya, the channel-site defect, which is now cited separately. | | Adhishthana (site) and kala (time) | Seat or habitat of the disease, and time understood as both season of the year and the patient's age. Both are in Charaka's grading list, with Kaviratna's parenthetical glosses '(meaning seat or habitat of the disease)' and '(i. e., season of the year as also age of the patient)', which are the translator's and are marked as such. | | Bala (strength grading) | The derangement is graded strong, middling or weak according to how far dhatu, dosha, prakriti, site and time agree with one another and how strong the cause and symptoms are. All three grades are now quoted: strong when the listed factors 'draw an agreement with one another' and cause and symptoms 'are possessed of strength'; of little strength 'when the reverse of this happens'; of middle strength when 'there is agreement between some only' and cause and symptoms are 'of middle strength'. Charaka also states the dependency outright: without weighing these particulars 'there can be no knowledge of the degree of strength of the disease'. | | Position in dashavidha pariksha | Vikriti is the second of Charaka's ten items for examining the patient: prakriti, vikriti, sara, samhanana, pramana, satmya, sattva, ahara-shakti, vyayama-shakti, vaya. Charaka frames the whole list as serving 'ascertainment of the measure of strength (of the patient)', which is the stated purpose of the examination, not diagnosis of a disease entity. | | Ashtavidha pariksha (eight-fold examination) | Nadi (pulse), mutra (urine), mala (stool), jihva (tongue), shabda (voice), sparsha (touch), drik (eyes), akriti (general appearance). This is the working method taught for vikriti assessment today, and it is post-classical. Pulse examination is absent from Charaka and Sushruta: both public-domain translators say so in their own notes, now quoted, and the earliest text in which this record has located it is the Sharngadhara Samhita, Purva Khanda chapter 3, whose colophon names the chapter after nadi pariksha, now quoted in Sanskrit. The eight-fold set as a named list is attributed by secondary literature to Yogaratnakara and is elaborated in Bhavaprakasha; neither has been retrieved for this record in any language, so that attribution is carried as located-and-paraphrased, not quoted. Dating: the 'c. 13th-14th century' commonly given for Sharngadhara is from secondary literature and is not verified here; no date is asserted for Yogaratnakara. | | [Trividha pariksha](https://nighantu.ageayurveda.com/lexicon/trividha-pariksha/) | Charaka's three means of knowing: authoritative instruction (aptopadesha), direct perception (pratyaksha) and inference (anumana). The epistemic warrant under which vikriti findings are taken as knowledge. NOT sourced in this record: no passage stating the three pramanas was retrieved, so the component is carried from the project's general knowledge of Vimana IV and VIII and is flagged rather than left to look cited. | | Khavaigunya as the locus of vikriti | The site defect that explains why a provoked dosha, circulating everywhere, produces disease in one place. Sushruta states it in one verse (Sutra XXIV, Bhishagratna pp. 235-236): the deranged humours 'give rise to a disease at the place in which they are incarcerated'. Charaka states it of circulating rasa (Chikitsa XV, Kaviratna's aphorism 36): 'in consequence of the fault of ether (i. e., the hollows of the ducts)' rasa becomes adherent and 'causes diverse diseases'. Charaka's Nidana IV adds the conjunction requirement, that manifestation of disease depends on the particular characteristics of cause, dosha and dushya together. This is the mechanism vikriti assessment is supposed to localise, which is why dosha vikriti alone does not determine the disease. The compound dosha-dushya-sammurchana used in modern teaching for this meeting is a modern term; see the project's record on it. | | Sama / nirama (ama) staging | The judgement whether the disturbed dosha is bound up with undigested matter (sama) or free of it (nirama). Vagbhata gives the ten signs of sama doshas, 'srotorodha, balabhramsha, gaurava, anilamudhata, alasya, apakti, nishthiva, malasanga, aruchi, klama', with nirama as 'the reverse' (Ashtanga Hridaya Sutra 13/23-24), defines sama as doshas and dushyas 'conjoined with that ama' (13/27), and attaches the treatment consequence: sama doshas spread through the body are NOT to be expelled, 'like juice from an unripe fruit', but are first to be ripened with pachana, dipana, oleation and sudation and only then purified (13/28-29). Charaka's Chikitsa XV has the antecedent doctrine, that undigested food 'is a terrible poison' which, combining with excited bile, phlegm or wind, produces the diseases of each (Kaviratna's aphorisms 44-48). This is the vikriti judgement with the most direct treatment consequence in the located texts. A three-stage sama / pachyamana / nirama sequence was NOT located in any text retrieved here; see notKnown. | ## The classical passages Each citation gives its address so a reader can check it in a printed edition, our account of what it establishes, and the result of reading it against its source. ### Charaka Samhita Vimana Sthana Lesson VIII:aphorism 110 in Kaviratna's numbering, printed after the aphorism, checked against the source > 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. Avinash Chandra Kaviratna, public domain The ten-fold examination of the patient, with vikriti ('the abnormal condition that has set in') as the second item and prakriti as the first. The sentence before it in the same run states the purpose: 'For ascertainment of the measure of strength (of the patient), these (ten) incidents beginning with (prakriti) the normal constitution in health, we shall explain here.' Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Vimana Sthana Lesson VIII, the vikriti passage:the prose immediately following Kaviratna's aphorism 115, which closes the prakriti section; no number is printed against this passage itself, checked against the source > Next, as to abnormal conditions: an abnormal condition has been said to be a deviation from what is normal. In this connection, the physician should examine the abnormal condition, by observing the particulars, as regards strength, of cause, constituent elements (of the body, such as juice, blood, flesh, fat, bones, marrow, and vital seed) faults (i. e., wind, bile, and phlegm), nature or normal condition, and place (meaning seat or habitat of the disease), time (i. e., season of the year as also age of the patient). He should examine it by observing the symptoms of the patient as well. Without observing the particulars, as regards strength, of cause and the rest, there can be no knowledge of the degree of strength of the disease. tr. Avinash Chandra Kaviratna, public domain The definition of vikriti as deviation from normal, the list of factors to be weighed, and the explicit statement that grading disease strength depends on them. This is the whole of Charaka's statement about vikriti as such; no examination procedure is attached. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Vimana Sthana Lesson VIII, continuation of the vikriti passage:the three grading sentences that follow the definition; the number printed after the last of them is OCR'd '*115' and is not asserted, checked against the source > That disease is strong (or violent) in which the constituent elements (of the body, the faults, nature or normal condition), place (or seat of disease), and time (that is, season or age), draw an agreement with one another, but whose cause or causes and symptoms are possessed of strength. When the reverse of this happens, the disease is regarded as of little strength. That disease is regarded as of middle strength in which among the constituent elements, faults, &c., there is agreement between some only, and whose cause or causes, and symptoms, are possessed of middle strength. tr. Avinash Chandra Kaviratna, public domain The three-grade strength scale (strong / middling / weak) is arrived at by whether the listed factors agree and by the strength of cause and symptoms. This is the nearest thing the classical text offers to an operational rule, and it is a rule about disease strength, not about which dosha is disturbed or how to find out. Extended on revision from the middle grade alone to all three grades. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Nidana Sthana Lesson I:opening sentence of the block Kaviratna numbers 11; the number is printed two sentences later, after 'agreeably to truth', checked against the source > Hence the physician, with unafflicted mind and intelligence, should duly examine diseases by the considerations of Cause and the rest. tr. Avinash Chandra Kaviratna, public domain Links vikriti assessment back to the nidana-panchaka frame: the disease state is assessed through the five-limbed considerations. The sentences immediately before it in the same block define 'Solution of doubt (Vikalpa)' as 'the ascertainment of the measure in which the faults, existing in a state of union, have been excited', and state that 'the distinctions of Strength and Time (in respect of disease) are dependant on the season ... day, night, the hours of eating', which parallels the Vimana VIII grading factors. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Sushruta Samhita Sutrasthana Chapter XXXV (Aturopakramaniya, on clinical observations):the opening passage of the chapter. Bhishagratna prints NO number against it; the locator is the page., checked against the source > A physician should first observe the vital condition (Ayu) of the patient before commencing the medical treatment. After that, the nature of the disease, the country and season of the year in which it has made its appearance, as well as the state of digestion, age, body, strength, disposition, habit, previous medicine, natural temperament and the power of endurance of the patient, etc. should be observed and carefully examined. tr. Kaviraj Kunja Lal Bhishagratna, public domain Sushruta's parallel examination list, which includes previous medication and endurance but does not use the prakriti/vikriti contrast as its organising axis. 'The nature of the disease' is the nearest item to vikriti. Source: https://archive.org/stream/b24758619_0001/b24758619_0001_djvu.txt ### Sharngadhara Samhita Purva Khanda 3 (nadi-pariksha-adi-vidhi, per the chapter colophon):1-4, with the chapter colophon **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at https://archive.org/download/sharngadhara_samhita_madhya_202001/sharngadhara_samhita_purva_djvu.txt Pulse examination as a diagnostic method, located in a text and quoted. The chapter opens with the site of examination (the artery at the root of the thumb), correlates pulse gait with provoked vata, pitta and kapha, and continues (verses 5-11, retrieved but not quoted) with sannipata, two-dosha, fatal, febrile, emotional, mandagni and sama pulses. Its colophon names the chapter after nadi pariksha. This is the earliest text in which this record has located pulse examination; whether it is the earliest text in which it occurs is a priority claim this record cannot make from one retrieved text and does not. The record previously carried this as located-and-paraphrased with no quote; upgraded on revision. ### Charaka Samhita (translator's note, not text) Indriya Sthana Lesson I, Kaviratna's footnote to the opening of the Division:footnote; no aphorism **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt A public-domain, attributed statement that Charaka and Sushruta contain no pulse examination, from someone who had translated the former in full. The record previously asserted this absence on the strength of the project's own search of the two texts; it now has an addressable witness as well. The same passage appears, almost word for word, in Kaviratna's prefatory synopsis of the Indriya Sthana in the unpaginated front matter of the same fascicule, which is not separately cited because its page cannot be given. ### Sushruta Samhita (translator's introduction, not text) none; Bhishagratna's Introduction to volume 1 Introduction, the paragraph on the Nidana Sthana:none **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at https://archive.org/stream/b24758619_0001/b24758619_0001_djvu.txt A second public-domain translator, of the other samhita, stating that his text has no pulse instructions. Together with Kaviratna's note this gives the record two attributed witnesses for the absence it asserts, from opposite sides of the question (Kaviratna hostile to pulse diagnosis, Bhishagratna a defender of it). ### Yogaratnakara, Purva Khanda (ashtasthana pariksha); Bhavaprakasha Secondary literature attributes the eight-fold examination (nadi, mutra, mala, jihva, shabda, sparsha, drik, akriti) as a named set to Yogaratnakara and its elaboration to Bhavaprakasha. NEITHER TEXT WAS RETRIEVED FOR THIS RECORD IN ANY LANGUAGE. No public-domain English translation is known to this record and no Sanskrit edition was located, so the attribution is carried as located-and-paraphrased from secondary sources, with no quote and no verse. No date is asserted for either text; a critic finding gave 'c. 17th c.' for Yogaratnakara and that figure is not adopted here because nothing retrieved supports it. ### Sushruta Samhita Sutrasthana Chapter XXIV (Vyadhi-samuddeshiya):Bhishagratna's 'Authoritative verse on the Subject' at the close of the disease enumeration; the Sanskrit is Su.Su.24/10 per the project's khavaigunya record, which carries the verse, checked against the source > The deranged and aggravated humours, freely coursing through the body, give rise to a disease at the place in which they are incarcerated owing to an obstruction in their natural passage. tr. Kaviraj Kunja Lal Bhishagratna, public domain The site-selection doctrine in one sentence: provoked doshas run everywhere, disease appears where they lodge. This is the mechanism a vikriti assessment is supposed to localise, and the reason a dosha finding alone does not identify a disease. Added on revision after a critic finding; cross-reference data/concepts/khavaigunya.json. Source: https://archive.org/stream/b24758619_0001/b24758619_0001_djvu.txt ### Charaka Samhita Chikitsa Sthana Lesson XV (Grahani-dosha Chikitsita):Chikitsa Sthana, Lesson XV (Grahani-dosha Chikitsita), Kaviratna's aphorisms 35-37, pp. 1415-1416. Numbering quoted is Kaviratna's own printed numbering, not the Trikamji vulgate, and Kaviratna prints the number after the aphorism; the quote's final sentence falls inside his 37, whose marker stands after the following sentence ('...as also the food that is eaten.* 37'). Verified in the archive.org OCR of Kaviratna, item BIUSante_47357., checked against the source > The 'dhatu' called 'Rasa' (that is, the juicy matter into which food is first converted) is continuously diffused through every part of the body simultaneously, by the life-breath called 'Vyana' whose function it is to diffuse. 35 If in consequence of the fault of ether (i. e., the hollows of the ducts), 'Rasa,' while it is being diffused (by the life-breath called 'Vyana'), becomes immovable (i. e., adherent), it causes diverse diseases, like clouds (when they mass together in the welkin owing to some obstruction) causing downpours below. 36 Even this is what happens in respect of faults when they become immovable (or adherent) in a particular place; that is, they become excited and cause diverse diseases. tr. Avinash Chandra Kaviratna, public domain Charaka's statement of the same site doctrine, with rasa rather than dosha as what lodges, followed by the sentence extending it to the doshas: where they 'become immovable (or adherent) in a particular place ... they become excited and cause diverse diseases'. Added on revision after a critic finding; cross-reference data/concepts/khavaigunya.json. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Nidana Sthana Lesson IV (Prameha Nidana):Kaviratna's aphorism 3, printed after the aphorism, checked against the source > Here (in the world), verily, from the particular characteristics of 'Nidana' or causes, 'doshas' or faults, and 'dushyas' or the ingredients or 'dhatus' composing the body, arise the manifestation, the non-manifestation, and the partial manifestation of diseases in general. tr. Avinash Chandra Kaviratna, public domain The conjunction requirement: whether a disease manifests, and how fully, depends on cause, dosha and dushya together. This is Charaka's own statement of the ground the modern compound dosha-dushya-sammurchana names, and it is the reason a vikriti assessment that stops at the dosha is incomplete by the text's own standard. Added on revision after a critic finding; cross-reference data/concepts/dosha-dushya-sammurchana.json, which establishes that the compound itself is modern. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Chikitsa Sthana Lesson XV (Grahani-dosha Chikitsita):Kaviratna's aphorisms 44-45 (last sentence only) to 48, printed after the aphorisms, checked against the source > The food in the stomach that is not digested is a terrible poison. 44-45 Combining with excited bile, this undigested food, which becomes poison, produces burning of the skin, thirst, diseases of the mouth, sour bile, and other ailments born of (excited bile). 46 Combining with (excited) phlegm, it produces phthisis, inflammation of the Schneiderian membrane, gonorrhoea, and other diseases born of (excited phlegm). Combining with the (excited) wind, it produces diverse diseases that are born of the (excited) wind. 47 When it goes into the urine, that poison causes diseases of the urine. When it goes into the stools, it causes diseases of the abdomen. When combined with 'Rasa' and the rest, it produces diverse diseases born of 'Rasa' and the rest. 48 tr. Avinash Chandra Kaviratna, public domain The antecedent in Charaka of the sama-dosha doctrine: undigested matter combining with each excited dosha produces that dosha's diseases. This is what the later sama / nirama judgement sorts for. Added on revision after a critic finding; cross-reference data/concepts/ama-formation.json. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Ashtanga Hridaya (Vagbhata) Sutrasthana 13 (Doshopakramaniya):23cd-24 **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at https://gretil.sub.uni-goettingen.de/gretil/corpustei/transformations/plaintext/sa_vAgbhaTa-aSTAGgahRdayasUtra.txt The ten signs by which a disturbed dosha is judged sama (bound with ama) and the definition of nirama as their reverse. This is the located classical content of the sama / nirama judgement. The ama-formation record carried this locus as 'located' without text; the Sanskrit is now quoted. Added on revision after a critic finding. ### Ashtanga Hridaya (Vagbhata) Sutrasthana 13 (Doshopakramaniya):27 **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at https://gretil.sub.uni-goettingen.de/gretil/corpustei/transformations/plaintext/sa_vAgbhaTa-aSTAGgahRdayasUtra.txt The definition of sama as a state of both doshas and dushyas, which makes the sama / nirama judgement a statement about the whole deranged state and not only about the dosha. Immediately preceding it, verses 25 and 26 give two rival accounts of ama's origin (weak agni leaving the first dhatu uncooked; or greatly vitiated doshas mixing with one another), which the ama-formation record treats. Added on revision. ### Ashtanga Hridaya (Vagbhata) Sutrasthana 13 (Doshopakramaniya):28-30ab **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at https://gretil.sub.uni-goettingen.de/gretil/corpustei/transformations/plaintext/sa_vAgbhaTa-aSTAGgahRdayasUtra.txt The treatment consequence that makes the sama / nirama judgement the vikriti decision with the most immediate practical effect in the located texts: sama doshas are not to be expelled until ripened. The record states this consequence only as far as this passage carries it; it does not generalise to 'the one judgement that changes treatment immediately', which is a critic's phrase and would need a survey of treatment rules this record has not made. Added on revision. ## 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. ### 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/) Direct measurement of the reliability of the two methods most used for vikriti assessment. Fifteen Ayurvedic doctors, 20 healthy subjects, 105 doctor pairs: average pairwise weighted kappa 0.07 for pulse and 0.17 for tongue (and 0.28 for prakriti). Random rating could not be rejected for any pair on tongue assessment and for only one pair on pulse. **How much it shows.** Empirical, blinded, randomised order, correct chance-corrected statistics. Small and in healthy volunteers, but these are the most direct figures located for this record and no larger study retrieved here contradicts them. A kappa of 0.07 is indistinguishable from chance agreement. ### Intrarater and interrater reliability of pulse examination in traditional Indian Ayurvedic medicine. Integr Med Res · 2013 · PMID 28664059 (https://pubmed.ncbi.nlm.nih.gov/28664059/) Companion analysis of 600 pulse examinations (15 doctors, 20 volunteers, twice each, blinded and randomised): intra-rater and inter-rater reliability ranged from poor to moderate; doctors more often diagnosed a two-dosha combination than a single dosha; kappa values were significantly larger for more experienced doctors (p=0.04). **How much it shows.** Empirical with adequate examination count. The experience effect is the one encouraging finding but rests on an observational comparison within a small sample with no adjustment; it should not be read as showing that training fixes the problem. ### Repeatability of Pulse Diagnosis and Body Constitution Diagnosis in Traditional Indian Ayurveda Medicine. Glob Adv Health Med · 2012 · PMID 27257530 (https://pubmed.ncbi.nlm.nih.gov/27257530/) Test-retest (intra-rater) repeatability of pulse and constitution diagnosis: one expert examined 17 healthy participants twice, blinded and in random order; weighted kappa 0.42 for pulse diagnosis and 0.65 for body constitution, 'moderate' and 'substantial' on the Landis-Koch scale; the hypothesis that the doctor's diagnosis did not depend on the subject was rejected (p=.02 for pulse). **How much it shows.** Empirical and blinded, but it measures one physician's self-consistency with n=17, not agreement between physicians. Read with PMID 24191170 it gives the pattern of a single assessor being fairly self-consistent while assessors disagree with each other, which is what idiosyncratic rather than shared criteria would produce. Added on revision: it is the third Kurande-group paper and the only one of the group's reliability studies the record lacked. ### 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/) In 30 knee osteoarthritis patients assessed by 4 experts, agreement on disease-related diagnostic entities was better than on constitutional entities, but kappa for central items including agni remained between 0 and 0.4; 95% raw agreement on the consensus final diagnosis coexisted with poor agreement on its components. **How much it shows.** The most clinically realistic reliability study retrieved for this record (real patients, structured history form, pre-agreed item list, correct statistics). Single condition, single centre, n=30. ### Myth and reality of "theory-driven individualised practice" in Ayurveda: Mapping physicians' approaches using case-based scenarios. Indian J Med Ethics · 2024 · PMID 39183608 (https://pubmed.ncbi.nlm.nih.gov/39183608/) 141 practitioners given identical case vignettes disagreed substantially on the clinical diagnosis and on the pathophysiological account (samprapti) of the same case, and constructs such as agnibala did not uniformly determine prescriptions. **How much it shows.** Cross-sectional vignette survey with convenience sampling; not a reliability study and no chance-corrected statistic. Its contribution is that disagreement persists even when every clinician is given identical written information, which rules out examination technique alone as the explanation. ### Tongue coating, severity of Ama, and disease activity in patients with Rheumatoid Arthritis: A pilot study. J Ayurveda Integr Med · 2026 · PMID 42142499 (https://pubmed.ncbi.nlm.nih.gov/42142499/) Pilot study of tongue coating, scored by five clinicians from standardised smartphone images using the Winkel tongue coating index, against a validated ama-severity instrument and CDAI disease activity in 22 rheumatoid arthritis patients (11 active, 11 in remission). **How much it shows.** Explicitly a pilot. n=22, only 11 images per group analysable by all assessors, groups differed at baseline in age, education and BMI, and the ama instrument's own validation is internal to the Ayurvedic literature. It is methodologically better than most work in this area because it standardises the image and uses an external index, but it cannot support any inference about tongue examination in practice. ### Reliability studies of diagnostic methods in Indian traditional Ayurveda medicine: An overview. J Ayurveda Integr Med · 2013 · PMID 23930037 (https://pubmed.ncbi.nlm.nih.gov/23930037/) Overview of reliability methodology for Ayurvedic diagnosis, stating that while reliability studies in Chinese, Japanese and Sasang medicine are in a formative stage, reliability studies in Ayurveda are in a preliminary stage, and setting out the study designs and statistics that would be needed. **How much it shows.** A methodological overview, not primary evidence. Included because it is the field's own assessment of its position, written by the group that then produced the reliability data. ### Nadi Tarangini: a pulse based diagnostic system. Annu Int Conf IEEE Eng Med Biol Soc · 2007 · PMID 18002428 (https://pubmed.ncbi.nlm.nih.gov/18002428/) The Nadi Tarangini pulse-acquisition system: a strain-gauge diaphragm, amplifier and 16-bit digitiser that records the radial pulse as a time series. The abstract states that the waveform 'is also shown to have the desirable variations with respect to age of patients, and the pressure applied at the sensing element', and that 'the system is being evaluated by Ayurvedic practitioners as a computer-aided diagnostic tool'. **How much it shows.** Engineering conference paper describing an instrument, not a diagnostic accuracy study. Its importance for this record is what it states about validation: the evaluators are Ayurvedic practitioners, so the reference standard for the instrument is the practitioner's judgement, whose reliability PMIDs 24191170 and 28664059 measure at kappa 0.07 to moderate. An instrument validated against that standard cannot be shown to exceed it. Added on revision after a critic finding; note the located paper is 2007, not '2011 onward' as the finding had it. ### Significance of arterial stiffness in Tridosha analysis: A pilot study. J Ayurveda Integr Med · 2017 · PMID 29103852 (https://pubmed.ncbi.nlm.nih.gov/29103852/) Pilot study using Nadi Tarangini to compute arterial stiffness index (SI) and reflection index (RI) from 42 pulse samples 'of vata, pitta and kapha pulses', finding SI and RI significantly lower at the vata position than at the pitta and kapha positions. The authors frame this as a framework for 'interventional studies in Ayurveda'. **How much it shows.** The quantity compared is the sensor POSITION on the radial artery (the three finger locations named for the doshas), not the patients' dosha state, and the abstract reports no reference diagnosis at all. A difference in pulse-wave indices between three sensor placements under different applied pressures is expected on haemodynamic grounds and says nothing about whether any position carries information about a dosha. It is included because it is what the instrumented pulse literature retrieved here actually measures, and because a reader could mistake its title for a validation of tridosha analysis. Added on revision. ### A comprehensive review on technological advancements for sensor-based Nadi Pariksha: An ancient Indian science for human health diagnosis. J Ayurveda Integr Med · 2024 · PMID 38815517 (https://pubmed.ncbi.nlm.nih.gov/38815517/) Review of sensor-based nadi pariksha covering 2 books and 67 research papers, organised by sensors, pre-processing, feature extraction, feature selection, classification and diseases diagnosed. It names the textual sources of pulse diagnosis as 'Ravansamhita, Bhavprakash, Nadivigyan by Kanad, Sharangdhar, and Yogratnakar', and concludes that 'significant work remains to be done ... and the procedure standardization is also required'. **How much it shows.** Narrative engineering review from a computer-engineering school, with no quality appraisal of the included studies reported in the abstract and a frankly advocatory framing ('making the Nadi Pariksha more reliable and faster'). Useful here for two facts only: the size of the sensor literature (67 papers), and the field's own admission that the procedure is not standardised. The abstract does not state what reference standard the 67 studies used for their classification labels; this record did not retrieve them individually and records that gap in notKnown rather than asserting the critic's general claim that all validate against vaidya opinion. Added on revision. ### ODQN-Net: Optimized Deep Q Neural Networks for Disease Prediction Through Tongue Image Analysis Using Remora Optimization Algorithm. Big Data · 2023 · PMID 37702608 (https://pubmed.ncbi.nlm.nih.gov/37702608/) A deep-learning tongue-image classifier framed on Ayurvedic tongue diagnosis ('Tongue analysis plays the major role in disease type prediction and classification according to Indian ayurvedic medicine'), reporting 99.17% accuracy and F1 0.9975 for multiclass disease prediction from tongue images. **How much it shows.** Machine-learning paper in a data-science journal. The abstract does not state where the disease labels for the training images came from, the size or provenance of the image set, or whether evaluation was on held-out data; accuracies above 99% on a multiclass medical image task from a small group are the pattern that typically reflects leakage or label circularity rather than a working diagnostic. It is the only Ayurveda-framed tongue-image classification paper the PubMed searches named in modernCoverage returned, and is included as an exhibit of the genre, not as evidence that tongue imaging carries diagnostic information. Added on revision. ### International Statistical Classification of Diseases and data gaps in traditional medicine. Bull World Health Organ · 2025 · PMID 41180267 (https://pubmed.ncbi.nlm.nih.gov/41180267/) Bulletin of the WHO perspective on ICD-11 Chapter 26, the traditional medicine chapter. Per the project's disease-classification record, which read the full text at PMC12578526 on 2026-10-06, it states that Chapter 26 is 'a supplementary, morbidity-only chapter, enabling dual coding of traditional medicine concepts alongside conventional diagnoses', that Module II (Ayurveda, Siddha, Unani) was added in 2025, and that 'the validity and reliability of Chapter 26 require dedicated study', with within-system reliability to be 'tested through interrater and test-retest assessments among traditional medicine clinicians'. **How much it shows.** Policy perspective, no abstract, no data, authors inside the institution. Cited here for one point only: that the body which now provides codes for dosha-state and constitution patterns says itself that their inter-rater reliability has not been studied, which is exactly the gap the Kurande and Kessler papers measure for the examination methods behind those patterns. PMID, title, journal, authors and DOI re-resolved; the quoted sentences are taken from the sibling record's full-text reading and were not re-read here. ## Citation Age Ayurveda Nighantu, "Vikriti assessment (assessing the present deranged state)", https://nighantu.ageayurveda.com/concept/vikriti-assessment/, 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.