Interactive Workshop on Ayurveda (Prognosis Through Arishta Lakshanas and Their Scientific Basis)

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For years it has been the constant efforts of RAV to enhance the capabilities of Ayurvedic professionals for a successful practice of Ayurveda in every walk of profession, may be clinical, teaching, research or study. Accordingly RAV took up programmes to achieve these goals. One of the programs is a series of interactive workshop, which initially started with WHO-offered two-part program; one meant for UG students and the other for PG students. But the huge success and appreciation led RAV to evolve these workshops in series, which has now become one of the hall marks of RAV's activities. This year RAV decided to bring to light the forgotten branches of ancient science, like nadi vigyan, arishta vigyan etc. for their optimum utilization.

Extensive documentation is available indicating the poor prognosis of various disease conditions in arishta vigyan, albeit in a very concise form. This discipline, an equivalent of prognostics in modern medical science, appears to have been developed keeping in mind the chances of survival of the patient with certain conditions. Several physicians' extensive experiences spanning thousands of years have led to conclude these poor prognostic features and predict the survival time for each condition. However, there are some huge differences between these two specialties. The statistical data and prognostic score or indicators (developed for some of the diseases) are not found in arishta vigyan. Why have these two aspects become so important? Studies indicate that the physicians tend to be overly optimistic when dealing with the prognosis. There is a tendency for over-estimating the likelihood of the positive results and underestimating the likelihood of negative events. This is called optimism bias. The negative aspects of this are loss of fame for the physician, financial loss and poor quality of life for the patient, suffering for the patient's family members etc (Charak). There may be positive aspects. It could be protective against depression.

Did the optimism bias occur in ancient times also? Probably, yes. The names of certain medicines and their indication indicate this, e.g. Mahamrityunjay rasa and Mrityunjay sura. We all know that none of these medicines work in all the conditions and all the times as is claimed in the texts. Why does optimism bias occur? To understand this, take the example of prognosis of stroke. Twenty five percentage of the patients die within one year of the first stroke. Now, it is difficult to translate this into a prognosis for an individual case; in other words it would be difficult to forecast whether the particular patient falls in the category of 75% lucky patients who are going to survive or 25% unfortunate victims who are going to succumb. The ultimate prognosis depends on many factors such as age at the time of development of disease, time lapsed for seeking treatment after the development of the disease, complications etc. Above all these factors, is the unexplained the phenomenon called destiny (or daiva in Ayurveda) where despite all the odds the patient survives or vice versa.

Understanding of the prognostics/ arishta prevents the physician from the dangers of the overestimation of self competence and optimism bias. Revealing the futility of further treatment in cases with poor prognosis (arishta) also helps the patient and family members from the consequent financial implication, suffering and poor quality of the remaining life of the patient, if the treatment is continued. Quality of life applies not only to the patient but also to the close family members or caretaker.

Charak has advised to leave such a patient who is like a dead (probably in the vegetative form). Here Charak appears to give more consideration to the patient's quality of life and his family members' sufferings.

Unfortunately, only features carrying poor prognosis are.described. Hardly anything about the pathological conditions is found in arishta vigyan. Additionally, the subject related to messenger (duta) of the patient and dreams are also given equal importance in these chapters dealing with prognosis. These latter topics are still very much inexplicable.

In the present time if the Ayurvedic fraternity wants to escape the trap of overestimation/overconfidence, the faculty need to develop its own prognostic scores or indicators for various ailments taking into consideration this arishta vigyan and features of sadhya-asadhyata explained for various diseases. For example the features mentioned in asadhya udarroga resemble very much the same that have been mentioned in Child-Pugh Score mentioned for the indication -of liver transplantation. Without the liver transplantation such patients would not survive for a long. It is quite paradoxical that such wonderful records are available in ancient Ayurvedic texts but so far we have not done anything and/or developed a single prognostic score or indicator for any disease. Also we need to have some statistical data to support these poor prognostic features and prognostic scores.

Somewhere the beginning has to be made to develop these chapters of arishta into a full-fledged faculty of prognostics, which has practicability in accordance to the modern times and where the issues of request for do-not-resuscitate (DNR) and quality of life (QoL) etc are also included. This workshop is a humble effort in that direction.

I hope this workshop would throw light on the forgotten aspects of this branch of knowledge and encourage starting experiencing the prognostic features also while managing the patients.

In this connection, I express my gratitude to the members of the Governing Body and the officials of the department of AYUSH for their continued backing for all the initiatives of the Vidyapeeth. I also appreciate the enthusiasm and hard work of all resource persons, who have contributed to the book and simultaneously enriching their own knowledge through satisfying the queries of young professionals. I thank my colleagues in the RAV for all support in the activities. Dr. Sandhya Patel deserves appreciation in the preparation of this book.

**Contents and Sample Pages**