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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 8
| Issue : 4 | Page : 249-265 |
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Ayurlakshaneeyam of Bhela Samhita- Indriya Sthana: An explorative study
Kshama Gupta, Prasad Mamidi
Department of Kaya Chikitsa, SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh, India
| Date of Submission | 19-Jul-2020 |
| Date of Decision | 20-Nov-2020 |
| Date of Acceptance | 21-Nov-2020 |
| Date of Web Publication | 11-Feb-2021 |
Correspondence Address:
Dr. Kshama Gupta
Department of Kaya Chikitsa, SKS Ayurvedic Medical College & Hospital, Mathura, Uttar Pradesh.
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JISM.JISM_72_20
Bhela Samhita is one of the prominent treatises of Ayurveda. Indriya Sthana is one among the eight sections of Bhela Samhita and it comprises 12 chapters. Ayurlakshanam Indriyam (ALI) is the first chapter of B Indriya Sthana. Though it consists of various unique concepts, it is modestly explored or unexplored till date. Previous works have explored various clinical conditions present in “Charaka Indriya Sthana”; these have prognostic significance and clinical applicability in the present era also but such types of studies are lacking in “Bhela Samhita-Indriya Sthana.” The current work is aimed at exploring the contents of ALI of “Indriya Sthana.” ALI deals with the estimation of life expectancy and age-specific mortality based on some anthropometric or phenotypic characteristics. Most of the content is unique and not explained in any other Ayurveda classical texts. Various conditions such as craniofacial anomalies/ disorders, multi-malformed infants, infant/ neonatal mortality, synophrys, mental retardation (MR), congenital, chromosomal, genetic syndromes/ conditions, neonatal intensive care unit (NICU) conditions, newborn cry-based diagnostic systems (NCDs), spina bifida (SB), hydrocephalus, congenital talipes equinovarus (CTEV), hypertrichosis, malnutrition, calculation of life expectancy based on various anthropometric indices (e.g., length and breadth of fingers, palms, ears, nose, forehead, and thighs), and phenotypic biomarkers and personality traits that are positively associated with centenarians have been documented in this chapter. Maharshi Bhela has provided techniques that are inexpensive, simple, noninvasive, highly accurate, and suitable for low- or middle-income countries for estimating life expectancy as well as for diagnosing hidden diseases. Though further research is still required to substantiate the claims made in this chapter, the current study paves the path for future research directions. Keywords: Anthropometric indices, Indriya Sthana, Bhela Samhita, Charaka Indriya Sthana
How to cite this article:
Gupta K, Mamidi P. Ayurlakshaneeyam of Bhela Samhita- Indriya Sthana: An explorative study. J Indian Sys Medicine 2020;8:249-65 |
| Introduction | |  |
Bhela Samhita is one of the prominent treatises of Ayurveda (post-Vedic period, 100 BC to 400 BC). Maharshi Bhela was one of the six disciples of “Punarvasu Atreya” and contemporary of “Agnivesha” (author of Charaka Samhita). Maharshi Bhela is the author of “Bhela Samhita.”[1] Bhela Samhita is not available in its entirety, and the available version contains many errors.[2] It has eight sections and 120 chapters (some chapters are missing completely, and some others are incomplete).[3] “Indriya Sthana” is one among the eight sections of Bhela Samhita, and it comprises 12 chapters. Ayurlakshanam Indriyam (ALI) is the first chapter of “Bhela Samhita-Indriya Sthana.” Conditions that lead to death at different time points, such as death on day 1, day 15, day 30, day 60, day 90, and day 120, death at the age of 16, 28, 40, 50, 60, 70, 80, and 100 years, are explained in this chapter.[3],[4] Estimating life expectancy based on some anthropometric features or anatomical features is also explained in this chapter [Table 1].[3]
Previous works have explored various clinical conditions present in “Charaka Indriya Sthana” that have prognostic significance and clinical applicability in the current era also[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] but such types of studies are lacking in “Bhela Indriya Sthana.”
| Materials and Methods | | |
Ayurveda literature regarding “Bhela Samhita-Indriya Sthana” has been collected from Bhela Samhita and also relevant references from other classical texts of Ayurveda such as “Charaka Samhita,” “Sushruta Samhita” etc. Electronic databases “Google search” and “Google scholar search” have been searched to find out the relevant studies and reviews published till June 2020, irrespective of their appearance/publication year. Relevant key words have been used (both Ayurveda and terms related to contemporary medicine) for conducting the search. Abstracts and full text, open access articles in the English language were only considered.
| Contents ofAyurlakshanam Indriyam | | |
‘Dve vaa jaata eva vinashyati’[17]
The verse cited denotes conditions that lead to death immediately after birth. The delivery of a dead fetus after completion of 28 weeks of pregnancy is known as a stillbirth or late fetal death. Fresh stillbirth is a condition where intrapartum death usually results in the delivery of a fresh fetus, whereas fetuses that die antepartum show varying degrees of maceration and are termed as “macerated stillbirth.” The death of an infant within a week of birth is called as “early neonatal death,” and both stillbirth and early neonatal death together are called as “perinatal death.”[18] Prematurity and low birth weight, neonatal infections, and birth asphyxia and birth trauma are the most common causes of early neonatal deaths in India.[19] Early neonatal deaths occur on day of life “0” (on the same day the child was born). Birth asphyxia is the most common cause for early neonatal deaths.[20] Congenital anomalies or birth defects were found to be the second largest cause of neonatal deaths.[21] The verse cited earlier is broken and incompletely available. The verse “Dve Eva Jaata Eva Vinashyati” denotes that there are two conditions that lead to death shortly after birth. The current verse denotes various conditions such as fresh still birth or early neonatal death that occur due to prematurity, low birth weight, infections, birth asphyxia, birth trauma, and congenital anomalies.
‘Hrasvekapaksho—upapadyate’[17]
The current verse denotes two different conditions that lead to death within 15 days or one month since birth. The word “Hraswa” denotes “short stature” or “small-for-gestational age” or “prematurity” or “low birth weight” or “dwarfism.” The word “Suswara” denotes “cry characteristics of healthy infants.” The life expectancy of a neonate who is “Hraswa” with “Suswara” is 30 days whereas it is only 15 days for a “Hraswa” neonate who does not have “Suswara.”[17] The current verse denotes various pathological conditions such as birth asphyxia, neonatal infections, congenital malformations, prematurity etc., which are characterized by short stature or low birth weight or prematurity with pathological cry.
Hraswa
It denotes various clinical conditions such as prematurity, low birth weight, small-for-gestational age, dwarfism, and shorter “crown-heel length” (CHL). Anthropometric measurements of neonates are an important clinical tool for the diagnosis of abnormally small or large neonates.[22] Body length has prognostic significance. A small infant with small body length has impaired growth potential due to genetic factors or infectious or other teratogenic insults in early fetal life.[23] Prematurity is a major determinant of neonatal survival. Neonatal survival rate increases with increasing gestational age.[24] In addition to prematurity, babies that are small-for-gestational age are at a higher risk of death.[25] Systemic diseases such as hypothyroidism, celiac disease, and other chronic disorders can impair growth and, ultimately, may lead to short stature. Children can be categorized clinically as having a skeletal dysplasia, syndromic short stature, or isolated short stature and they can also be categorized as having polygenic or monogenic short stature.[26] Primordial dwarfism (PD) is a disease in which severely impaired fetal growth persists throughout postnatal development and results in stunted size. The condition is highly heterogeneous clinically.[27] Separate causes of death estimates are required for the early (0–6 days of age) and late (7–27 days of age) neonatal periods because the cause of death distribution differs substantially between these periods.[25]Maharshi Bhela has classified and documented his observations according to “perinatal mortality,” “early neonatal mortality,” “late neonatal mortality,” “infant mortality,” and “age specific mortality” in the ALI chapter.
Suswara
“Suswara” denotes “normal or healthy infant cry.” In the current verse, “cry analysis” has been done by Maharshi Bhela to estimate the prognosis or to calculate the life expectancy in infants.[17] “Cry analysis” is a new field and previous works have defined several cry characteristics and presented their common values, such as the fundamental frequency, formants, cry modes, cry latency, phonation, hyperphonation, and dysphonation. Gradually, detailed acoustic analysis, which measures and compares the acoustic characteristics of newborn infant cry signals, shows the hidden diagnostic potential of cry signals for the basic cry types and the cries of infants in pathological conditions such as brain damage, central nervous system (CNS) diseases, and Down syndrome (DS).[28] The cries of newborns having neurological disturbances exhibit auditory abnormalities. Hyperphonic cries and very high pitched cries are associated with neurological problems, sick newborns, neonatal risk, asphyxia, microcephaly, meningitis, intrauterine growth retardation (IUGR), congenital malformations, and respiratory distress syndrome (RDS).[29] Acoustic analysis of infant cry has proven to be effective in identifying Autism Spectrum Disorder (ASD), Sudden Infant Death Syndrome (SIDS), and a variety of auditory-related problems during the early stages of development.[30] The most common cause of death in neonates was birth asphyxia followed by neonatal infections (sepsis, meningitis, and pneumonia) and prematurity.[31] The current verse denotes a condition of early (Hraswa without Suswara) and late neonatal death (Hraswa with Suswara) due to various underlying pathological conditions discussed earlier. “Suswara” indicates “vigor,” hence it is a good quality in neonates and it also signifies better prognosis.
“Pindee Shira Deergha Hanu—Grabhmeedrusha”[17]
The death of an infant with features such as “Pindee Shira” (ball or lump like skull), “Deergha Hanu” (elongated or protruded lower jaw), and “Analpa Samhate Bhruva” (thick and conjoined eyebrows) after attaining two months of age. This verse denotes “Craniofacial anomalies with synophrys.”
Pindee shira
“Pindee Shira” denotes a soft, lump-like or ball-like, moldable skull. Soft, lax, moldable skull is seen in conditions such as anencephaly, osteogenesis impercecta, hydrocephalous, hypophosphatasia, and acalvaria.[32] The shape of a newborn’s skull is highly variable due to plasticity, and variations from the typical oval shape may denote cranial deformations or malformations. Craniosynostosis is an abnormal cranial development due to premature fusion of one or more cranial sutures. It is classified as simple versus compound, and isolated (no other major malformations) versus syndromic (one of multiple associated anomalies). Various conditions such as abnormal bone or suture development, monogenic defects, teratogens, chromosomal defects, and metabolic diseases (rickets, hyperthyroidism, mucopolysaccharidosis, hematological diseases, osteoporosis, and fibrous dysplasia are the causes for primary craniosynostosis. Conditions like microcephaly, encephalocele, shunted hydrocephalus and holoprosencephaly are the causes for secondary craniosynostosis.[33] Congenital malformations of the CNS (anencephaly, microcephalus, and hydrocephalus) and other birth defects are the one among important causes of infant death.[34] “Pindee shira” may also represent conditions such as microcephaly, brachycephaly, hydrocephaly, dolichocephaly, plagiocephaly etc.
Deergha Hanu
“Deergha Hanu” represents an elongated or a protruded or large lower jaw. Genetic factors and environmental factors contribute to the development of mandibular prognathism (MP) (protruded lower jaw), including congenital anatomica, defects (cleft lip and cleft palate), endocrine disturbance (acromegaly, gigantism, and pituitary adenomas), naso-airway obstruction (enlarged tonsils), habitual posture, and trauma.[35] Macrognathia (an enlargement of lower jaw) is a developmental deformity of the mandible.[36]
Analpa Bhruva
“Analpa Bhruva” indicates thick, bushy eyebrows in infants. Hypertrichosis is a clinical condition that is characterized by excessive hair growth without androgenic stimulation. Primary hypertrichosis is further classified as congenital or acquired.[37] Hypertrichosis with extremely bushy eyebrows meeting in the midline can be seen in “Werewolf syndrome.”[38]
Samhata Bhruva
“Samhata Bhruva” (unibrow /monobrow /jacco) denotes bushy eyebrows meeting in the middle above the bridge of the nose. Fusion of eyebrows above the bridge of the nose is known as “synophrys,” which may be a normal variation. It is seen in several genetic disorders, with “Cornelia de Lange syndrome” (CdLS) being the most common.[39]
The clinical features such as “Pindee Shira,” “Deergha Hanu,” and “Analpa and Samhata Bhruva” mentioned in the earlier verse denote various conditions such as craniofacial anomalies, congenital malformations, CdLS, Werewolf syndrome, Acromegaloid syndrome, and several other genetic disorders associated with poor prognosis. CdLS is also known as Brachmann–de Lange syndrome and it is a multisystem malformation syndrome. Characteristic eyebrows (well-defined, penciled and arched with synophrys), long thick curved eyelashes, depressed nasal bridge, maxillary prognathism or mandibular retrognathism or micrognathia, “carp” mouth, highly arched or cleft palate, microbrachycephaly, low anterior and posterior hairline, short neck etc. are the characteristic facial features of CdLS.[40] The “Over growth syndrome” comprises generalized overgrowth, mental handicap, thickening and coarsening of the face, and abundant head hair with bushy eyebrows and synophrys. Bony overgrowth leads primarily to a heavy body frame with a large head circumference and a square jaw.[41] Hypertrichosis and enlargement of jaw can be found in “Acromegaloid facial appearance (AFA) syndrome.”[42] Large dolichocephalic skull with an increased head circumference, acromegaloid features, and prominent mandible can be seen in ‘cerebral gigantism’ or ‘SOTOS syndrome’.[43] The present verse denotes craniofacial anomalies or congenital malformations due to various genetic disorders.
“Jaatamatrasya—Grabhmeedrusha”[17]
Secondary sexual characteristics such as manifestation of moustache or axillary or pubic hair in infants leads to death within the third month of life (on or before 90th day after birth). Patients with “congenital hypertrichosis universalis” show a clinical presentation with hairs distributed over the face, back, trunk, and limbs. The affected individuals present with terminal hairs from birth.[44] Peculiar facial appearance and hypertrichosis in children are the characteristic features seen in a wide variety of conditions such as dysmorphic syndromes, CdLS, Coffin-Siris syndrome, Rubinstein Taybi syndrome, Seckel’s syndrome, cerebro-oculo-facio-skeletal syndrome, Gorlin’s syndrome, Schinzel Giedion midface retraction syndrome or Barber Say syndrome, Hajdu Cheney syndrome, leprechaunism, Patterson’s syndrome, and Seip’s syndrome. Generalized hypertrichosis is present at birth in Ambras’ syndrome.[45] Virilization in a female newborn is commonly seen in congenital adrenal hyperplasia (CAH) and maternal androgen excess secretion.[46] Hypertrichosis in a newborn girl infant of a diabetic mother with congenital hypothyroidism is reported.[47] The appearance of hair in the pubic area in a male infant suggests a true excess of circulating androgens, for example in CAH.[48] CAH, precocious puberty, virilizing tumors, and exogenous exposure are the pathological causes for the manifestation of premature pubarche (PP). The etiology of PP in infants remains unknown.[49] Early puberty seen in children is termed as premature adrenarche (PA). The characteristic presentation in a PA child is development of pubic and axillary hair, accompanied by axillary odor. Elevation in dehydroepiandrosterone sulfate (DHEA-S) and testosterone levels can be seen in infants with mini puberty.[50] The current verse indicates various conditions such as genetic, chromosomal, and endocrinal disorders.
“Trikekaro Ghatashira—Upagachhanti”[17]
The death of an infant within the fourth month of life (on or before the 120th day after birth) having features such as “Trikekaro” (some pathology at the level of Trika Sandhi, sacroiliac region or lower back), “Ghata Shira” (hydrocephalus), and “Suswara” (normal or healthy infant cry characteristics). The term “spinal open neural tube defect” (SONTD) denotes failure of fusion of the neural tube and herniation of meninges, and it lacks skin covering or is covered by a thin transparent membrane. Hydrocephalus affects the majority of patients with SONTD who have myelomeningocele (MMC) and Chiari malformation type II (CM II). Hydrocephalus may be absent at birth but later it may appear in the first few weeks or months of life.[51] SB is the most common CNS malformation and it is most common among neural tube defects (NTDs). The etiology of SB is heterogeneous and multifactorial, and it is associated with poor prognosis.[52] The word “Trikekaro” refers to an abnormal tuft or clump of hair or small dimple or fluid-filled sac or protrusion or birthmark on the skin at the site of spinal malformation in SB, whereas “Ghata Shira” refers to hydrocephalus. The current verse represents the condition of NTDs, with poor prognosis during the Samhita period.
“Yasya Shodasa Varshasya—Naatra Samshaya”[17]
Manifestation of secondary sexual characteristics on or before 16 years of age denotes a short life span whereas their manifestation around the age of 20 years indicates long life. Manifestation of secondary sexual characteristics (breast, genitals and pubic hair), reproductive capability, weight, height, and accompanying behavioral and psychological changes are considered as pubertal changes.[53] The median age of attaining gonadarche and pubarche for boys is 10.41 years (10.2 to 10.6 years) and 13.60 years (13.3 to 14.0 years), respectively.[54] The mean age at menarche among Indian women was 13.76 years (13.75 to 13.77 years). Early age at menarche is strongly associated with early marriage and premature parenthood, breast cancer, obesity, ovarian cancer, psychological disorders (stress, anxiety, and depression), metabolic syndrome (diabetes, coronary heart disease, stroke, and respiratory problems), substance abuse, and delinquent behavior.[55] Previous studies have established that for each year that age of menarche was delayed, the risk of premenopausal breast cancer was reduced by 9%, and the risk of postmenopausal breast cancer was reduced by 4%.[56] Age at menarche is strongly associated with adverse health outcomes in later life. Women with an earlier menarche are more likely to have menstrual problems and subfertility.[57] Several studies have noted that contemporary girls are undergoing pubertal maturation at younger ages.[58] Early maturation is associated with negative outcomes for both boys and girls. Early puberty in girls has been linked to depressive symptoms, other internalizing symptoms, eating disorders, and delinquency.[53] Early puberty is associated with greater fat accumulation, cardiometabolic risk, increased risk of cardiovascular events and mortality, diabetes, hypertension, cancer in later life, increased oxidative stress, hyperinsulinemia, and behavioral risk factors.[59] According to the current verse, the mean age of onset of puberty during the Samhita period was around 16 to 20 years. Delayed onset of puberty (around 20 years) determined a longer life span, and early onset of puberty (around 16 years) was associated with various detrimental consequences later and a shorter life span. The observations made by Maharashi Bhela stand true regarding earlier onset of puberty and its association with negative outcomes.
“Shareera Apachayo—Gataayushamaadishet”[17]
A child who has been suffering with weakness, emaciation or malnourishment or stunted growth, and having MR will die. The word “Apachaya” denotes wasting or low body mass index (BMI) or emaciation or malnourishment; “Abuddhi” denotes MR or intellectual disability; and “Abalam” denotes physical disability or weakness or functional disability or developmental disability. Apachaya, Abuddhi, and Abalatvam lead to imminent death in children and denote developmental disabilities with MR and malnutrition found in various syndromes or conditions. MR is a manifestation of a heterogeneous set of impairments and conditions that result in cognitive limitation. MR is found in various conditions such as DS, Fragile X syndrome, Williams syndrome (WS), Prader-Willi syndrome (PWS), Angelman syndrome (AS), NTDs, Phenylketonuria (PKU) deficiency, hypothyroidism (cretinism), Cerebral palsy (CP), Alstrom syndrome, Autism spectrum disorders, Bannayan-Riley-Ruvalcaba syndrome, Bardet-Biedl syndrome, Beckwith-Wiedemann syndrome, Cohen syndrome, Lesch-Nyhan syndrome, Neurofibromatosis, Rubinstein-Taybi syndrome, Smith-Lemli-Optiz syndrome, Smith-Magenis syndrome, Sotos syndrome, storage diseases, Velocardiofacial syndrome (VCFS), Shprintzen syndrome, 22q deletion syndrome, DiGeorge syndrome, X-linked adrenoleukodystrophy, and Zellweger syndrome. Poverty, prematurity, low birth weight, and intrauterine infection are the risk factors associated with MR.[60],[61]
The functional disabilities are most predictive of poor prognosis in a large population of severely disabled and nonambulatory children with mental retardation.[62] Birth defects are responsible for 20% of all infant deaths.[63] Sustained malnutrition among children causes diminished cognitive functioning. Due to malnutrition, half of the children younger than five years of age are stunted and underweight. Malnutrition may be one of the causes of MR. A positive association existed between nutritional status and MR. Children who were both wasted and stunted had the highest MR as compared with normal children.[64] It seems that the association of MR, malnutrition, wasting, and developmental disabilities indicates poor prognosis in children, as quoted in the current verse.
“Yasya Jaatasya—Hanta Maanavam”[17]
The presence of “Gulmaka / Gulphaka Stanuka” leads to death at the age of 28 years. The word “Gulmaka / Gulphaka Stanuka” is conspicuous and it is a spelling error. It is very difficult to translate or understand this word and also the whole verse. It can be assumed that the word “Gulpha” is related to ankle joint; the current verse denotes pathology of the ankle joint that can be seen in newborns, and it also may cause death at later stages if it is associated with some other anomalies. The condition seems to represent CTEV, which is associated with NTDs, or especially SB, which can lead to death during adulthood. SB and CTEV are common congenital malformations that occur together. CTEV is the most common congenital disorder affecting the musculoskeletal system and it occurs with other congenital anomalies such as NTDs, especially SB.[65] SB cystica is frequently associated with skeletal muscle paralysis, paralytic congenital dislocation of the hip, and talipes calcaneovarus.[66] Various health factors such as urological problems, hypertension, metabolic syndrome, cancer, obesity, sleep apnea, pain, and orthopedic complications affect the adults with SB.[67]
“Prushte Cha Urasi Cha—Maranaaya Upakalpate” (Verse 9)[17]
The presence of abnormal hair whorls on chest and the lumbosacral region in the anticlockwise direction indicates death at or before 40 years of age. Abnormal scalp hair patterns with absent or aberrant whorls may be seen on the heads of children with abnormal brain development (microcephaly). Displacement of the scalp line occurs in a number of syndromes.[68] In generalized hypertrichosis, on the back of the trunk the hair converges on the midline, forming whorls over the spine. It may occur as part of a syndrome or metabolic disorder (symptomatic hypertrichoses).[45] Localized hypertrichosis is defined as the presence of a tuft of terminal hair in a patchy distribution. The most common location is in the midline over the lumbosacral region, suggesting an underlying developmental defect. Congenital localized hypertrichosis can be seen in conditions such as Becker’s nevus, nevoid hypertrichosis, congenital melanocytic nevi, and sacral midline developmental defect. The presence of hypertrichosis in the midline suggests developmental malformations such as SB occulta and diastematomyelia.[69] Children with SB may show double hair whorls and opposite hair whorl orientation.[70] The brain and scalp hair whorls have shown pathological correlation with hair whorl irregularities and gross cerebral malformation. Direction and placement of the whorl indicates several medical syndromes that involve cerebral malformations.[71]
In “Charaka Indriya Sthana” also, similar conditions have been mentioned. Manifestation of new part lines or hair whorls on the scalp without having any visible cause / reason denotes imminent death within three to six days (Verse 6–7). In DS, microcephaly, and mental subnormality conditions, the number (usually one or two), rotation (clockwise or counterclockwise), and location of the occipital hair whorls may vary and they may also have a great practical value.[11] Currently, most of the research works available on hair whorls and their pathological significance are focused only on “scalp hair whorls.” The current verse indicates the abnormal hair whorls of chest hair and in the lower back region. It seems that the abnormal location and rotation of hair whorls as mentioned in the current verse denotes various NTDs, SB, and other congenital malformations or genetic syndromes that may cause later onset of death.
“Aavarto Yashcha Prushte—Na Prasuyate”[17]
A female newborn having three hair whorls at the lumbosacral region may not conceive or becomes sterile in future. The current verse denotes the diagnosis of reproductive tract anomalies that may get detected in future or later stages based on the presence of abnormal hair whorls present at the lumbosacral region in a female newborn. “Localized hypertrichosis” is defined as the presence of a tuft of terminal hair in a patchy distribution. The most common location in the midline over the lumbosacral region suggests an underlying developmental defect.[69] Childhood hypertrichosis may be associated with various dysmorphic syndromes, metabolic and chromosomal disorders. In symptomatic generalized hypertrichosis, hair converges on the midline on the back of the trunk and often forms whorls over the spine.[45] Congenital hypertrichosis is a component feature of various syndromes. Clinical forms of congenital generalized hypertrichosis (CGH) are characterized by generalized hypertrichosis of the face, trunk, and limbs. In congenital hypertrichosis universalis, patients present with hair distribution at face, trunk, back, and limbs.[44]
A few studies have documented specific gynecological problems or reproductive endocrine dysfunction that are unique to women with SB. Women with SB may have congenital anomalies of the female reproductive tract, such as bicornate uterus, and they may develop a prolapsed uterus at a much younger age. Kyphoscoliosis, hip dislocation or subluxation, lower extremity contractures, and pelvic obliquity are secondary conditions found in women with SB. These orthopedic conditions may physically alter the reproductive anatomy of women with SB. Women with SB may suffer pregnancy complications due to various secondary conditions such as ventricular shunts, kyphoscoliosis, and neurogenic bowel and bladder. According to a study, a woman had three pregnancies that resulted in spontaneous abortion, preterm delivery of a nonviable fetus, and preterm delivery of a healthy infant, respectively. Women with SB are often born with renal and genitourinary abnormalities. There is a high risk for the offspring of women with SB to develop congenital or developmental abnormalities.[72]
“Sthulaasthula Anguli—Panchaashad Varsha Eva Cha”[17]
The word “Sthula Anguli” denotes broad fingers, and “Sthula Paani” denotes broad hand or increased palmar width; “Nakha Lohita” denotes properly vascularized nail bed or nails that are red in color representing optimum vascularization; and “Kalyana Desha Pratyanga” denotes good-looking body parts having desired anthropometric measurements. The person possessing all these features will survive up to 50 years of age. Ayurveda explains certain signs and symptoms to decide the life span (Ayu) of a patient. According to “Acharya Sushruta,” assessment of life span of an individual has been broadly classified into three broad headings, Dhirghayu (long life span), Madhyamayu (mediocre life span), and Alpayu (short life span). Charaka Indriya Sthana has been dedicated to measuring the residual life span of a diseased person whereas “Jaatisutriya Adhyaya” of “Charaka Shareera Sthana” contains the description of characteristic properties of the child who is going to survive for a longer period. Various anthropometric measurements and signs and symptoms are mentioned in “Jaatisutriya Adhyaya” of “Charaka Samhita” based on which the life span of an individual can be assessed. Hands and feet that are well developed (well nourished or big) and round, long, and well-nourished fingers and toes denote a long life span according to “Charaka Samhita.”[73] The physical features or anthropometric characteristics as mentioned by Maharshi Bhela in this chapter are unique and totally different from other Ayurveda texts.
Sthula Anguli
Macrodactyly is the condition of increased girth and length of fingers. “Broad fingertips” is the term that denotes an increased width limited to the distal phalanges only.[74] Congenital macrodactyly is characterized by progressive enlargement of all mesenchymal elements of a digit. Macrodactyly of the foot occurs due to an excessive proliferation and accumulation of adipose tissue, whereas involvement of the nerve might be the fundamental lesion in gigantism of the hand.[75] Pachydermodactyly (PDD) denotes pachy (thick), dermo (skin), and dactylos (finger). PDD is benign, asymptomatic soft tissue swelling that affects the proximal interphalangeal (PIP) joints of fingers (second, third, and fourth). Various other conditions such as knuckle pads, foreign body granuloma, collagenous plaques of the hands, progressive nodular fibrosis of the skin, chewing pads, juvenile digital fibromatosis, thyroid disease, pachydermoperiostosis (Touraine-Solente-Gole syndrome), acromegaly, fibrosing inflammatory conditions, Garrod’s pads in violinists, connective tissue nevi, acropachydermodactyly in psoriasis, paraneoplastic acropachydermodactyly, Thiemann’s disease, and sarcomas mimic PDD.[76] Broad thumbs and toes along with unusual facial appearances can be found in Rubinstein-Taybi syndrome (RTS). Broad terminal phalanges of great toes, thumbs, and other fingers are the most common symptoms of RTS.[77] Broad big toes along with congenital heart malformations can also be seen in “Hirschsprung’s disease.”[78] “Acrodysostosis” refers to a heterogeneous group of skeletal dysplasia characterized by severe brachydactyly, facial dysostosis, and nasal hypoplasia.[79]
Sthula Paani
Anthropometry deals with the measurements of the human body, such as shape, strength, work capacity, and body size. “Hand anthropometry” can be defined as the study of comparative measurements of the human hand, such as hand length, palm length, thumb length, thumb breadth, index finger length, and hand breadth. Several illnesses in the elderly people may have an impact on their hand anthropometry.[80] Athletes with longer fingers and greater hand surface have shown greater handgrip strength. The handgrip measurement can be used in research, as follow-up of patients with neuromuscular disease, as a predictor of mortality, as the functional index of nutritional status, and also for predicting the extent of complications following surgical procedures. According to research, handgrip strength has a positive relationship with body height, body weight, BMI, hand length, body surface area, arm and calf circumferences, skin folds, fat-free mass, physical activity, and hip-waist ratio.[81] Anthropometric data are required for developing 3D hand models, and for studying the kinematics of the human hand.[82] “Sthula Paani” mentioned in the current verse denotes increased palmar width of the hand, which may be due to various underlying conditions as explained under the section of “Sthula Anguli.”
Lohita Nakha
The word “Lohita nakha” (red-colored nails) is a physiological condition that denotes optimum dermal vascularization. Discoloration with changes in color from white-pink to yellowish-gray, changes in contour, and changes in the thickness and roughness of the nail surface can be seen in older people and is associated with age-related nail changes. Changes in aging fingernails may be symptoms of underlying disease or metabolic disorders. The translucent nature of the nail plate enables the coloration of the underlying nail bed, predominantly provided by the dermal vascularization, which provides an indication of problems such as anemia.[83] However, “Lohita Nakha” mentioned in the current verse denotes a physiological condition and signifies optimum nail bed vascularity.
Kalyana Desha Pratyanga
Represents various terms such as optimum /healthy /proper /desired regional tissue distribution, anthropometric indices /variables, regional body composition (BC) and body shape and composition etc. Maharshi Bhela has put forward a concept of estimating life span by using various anthropometric indices. Ayurveda has postulated that a proportionate body is associated with good health and longevity. A disproportionate body is predisposed to the disease. The reference unit of measurement mentioned in Ayurveda texts is one’s own finger measurement (Madhyama Anguli Parva), which is known as one Anguli or Swanguli. This concept is described in Ayurveda, which uses Anguli Parimana (the breadth of one’s own finger as 1 unit) to measure body proportions. The association of disproportionate body size measurements with various noncommunicable diseases has been proved. A proportionate body is an indicator of good health and vice versa. Proportionate individuals enjoy longevity, vitality, strength, happiness, and financial stability. Anthropometric standards mentioned in Ayurveda texts regarding a proportionate body are based on a number of keen observations made by ancient Ayurveda sages.[84] “Kalyana Desha Pratyanga” represents “an ideal human figure” with specific proportions between its constituent parts.
Anthropometry and its role in assessing life span
Morphometry is a quantitative approach that deals with the variations and changes in the forms of organisms and their relationship between the human body and disease. Anthropometric data are used in various contexts to screen for or monitor disease. Anthropometry (branch of morphometry) is the study of the size and shape of the components of biological forms and their variations among diverse populations. Morphometrics can also be defined as the quantitative analysis of biological forms.[85] Body shape and composition are heterogeneous among humans, with an impact for health. Health risk is associated with human body dimensions in a more complex way, and it depends on the relationship between muscles and fat and their distributions along the body.[86] To obtain proper knowledge of individual tissue compartments, accurate methods are required to assess regional BC.[87]
Computed tomography (CT), Magnetic resonance imaging (MRI), Dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis, and three-dimensional (3D) whole body laser scanning methods are useful to collect anthropometric data. Body scanning is utilized in medical application to assess their possible relevance for health risk prediction.[86] Regional BC changes with age and those changes are associated with chronic diseases and increased mortality. The BC indices are subject to intra- and interobserver variability. Anthropometry is simple, inexpensive, portable, and safe. Quantitative MRI is also a useful practical tool for regional BC assessment.[87] Calipers, weight balances or scales, tape measures, and calibrated rulers are some of the tools that have been in use since a long time.[88]
It is difficult to conclude which of the measures of BC and anthropometry best predict mortality.[89] The association of five anthropometric measures (BMI, waist circumference [WC], hip circumference, waist-to-hip ratio [WHR], and waist-to-height ratio [WHtR]) with mortality in general and specific to cardiovascular disease (CVD) mortality has been established. The WHR and WHtR were found to be strongly associated with mortality.[90] Upper body and lower body fat depots show opposite associations, with risk for diabetes and CVD. Body weight, height, and BMI in earlier stages of life seem to affect diseases later in life, such as obesity, diabetes, hypertension, and stroke. Anthropometric measures, such as BMI, WHR, WHtR, and “a body shape index” (ABSI), have been developed to assess the health status in terms of obesity, mortality, and biological age.[86]
It has been proved that breast cancer is strongly associated with body size.[91] Anthropometric parameters provide unique prognostic information regarding subcutaneous fat, muscle mass, and fat accumulation such as arm circumference (AC), WC, thigh circumference (TC), and calf circumference (CC). It has been proved that WC had negative associations with cardiovascular mortality. Anthropometric indices such as CC and CC/ WC had an inverse association with cancer-related mortality, skeletal muscle wasting, and cachexia. CC is a valuable tool that is used as a clinical prognostic indicator for the risk of mortality.[92] It can be postulated that prognosis, life span, and health status can be assessed based on various anthropometric parameters as mentioned by Maharshi Bhela.
“Vyudha Urasko—Shashtim Varshaani Jeevati”[17]
The words denote broad chest, broader shoulders, large knee joints, and long fingers and nails, respectively. The person or child who possesses these physical characteristics can survive up to the age of 60 years. These are various anthropometric parameters that indicate a life span of 60 years according to Maharshi Bhela.
Vyudha Uras
A strong correlation has been found between chest circumference (CC) and birth weight.[93] The CC is used to identify low birth weight (LBW) preterm neonates. Previous studies have reported good correlation between CC and birth weight.[94] After attaining one year of age, the chest becomes progressively larger in diameter than the head.[95] Upper and lower chest expansion (CE) is useful to evaluate chest mobility and lung function. The normal range of CE decreases with age. There is a significant decrease in chest wall mobility with aging and chronic chest diseases. Thoracic chest measurement is a commonly measured metric in subjects with cardiorespiratory problems.[96] CC, mid upper arm circumference (MUAC), and foot length are all good predictors of small newborns (LBW and premature infants).[97]
A strong relationship is established between trunk development and lung function. A high correlation between lung volumes and height increment in children is also established. A significant positive association of all chest dimensions with anthropometric features has been found in both sexes. A significant and positive relationship between some torso parameters and vital capacity has been established.[98] The CC has been in a decreasing trend for the past 80 years.[99] A larger total lung capacity (TLC) is responsible for the larger forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The TLC reflects the size of the thoracic cage, the strength of the inspiratory muscles, and the compliance of the lungs and chest wall.[100] Chest dimensions (width, depth, and circumference) have been found to be associated with FEV1 and FVC.[101] Latest research supports Maharshi Bhela’s view that a broader chest denotes healthiness, a long life span, and optimum lung functions.
Deergha Bhuja
Biacromial breadth (shoulder width) increases more in boys than in girls. Individuals who have wider shoulders are efficient in throwing tasks.[102] Males with relatively wide shoulders are heavier. It is well known that in all populations males have relatively broader shoulders.[103] Broad shoulders are found to be attractive in male physiques. Greater chest muscularity resulted in slightly higher attractiveness ratings.[104] The mesomorphy somatotype is characterized by broad shoulders, a muscular body, strong forearms and thighs, and very little body fat.[105] It is evident that the current verse denotes “mesomorphy somatotype” with broad shoulders and a muscular body. Broad shoulders denote fitness, healthy status, high muscularity, and a long life.
Sthula Janu
The knee is an important load-bearing joint having three compartments (two tibiofemoral and one patellofemoral) and menisci, which contribute significantly to the transfer of contact stresses from one articular surface to another.[106] The knee circumference is an anthropometric measure that has been in use, particularly with regard to arthritis of the knee.[107] Knee swelling can be measured by using a tape measure.[108] Though further research works are required to establish the association between knee circumference and life span, it can be assumed that larger knee joints denote greater articular surface, greater stability, healthy menisci, strong ligaments, tendons, and associated structures, which ultimately improves the weight-bearing capacity of knee joints.
Deergha Anguli
It has been found that digit anthropometry can be used as a prognostic indicator of different diseases. An adverse relationship between the 2D:4D (2D-second digit and 4D-fourth digit) ratio (especially of the left hand) and prostate cancer has been established. The prevalence of prostate cancer was higher in patients with a lower 2D:4D ratio. The 2D:4D ratios of both hands are lower in patients with cervical cancer compared with controls. Another study has revealed a higher 2D:4D ratio in patients with oral cancer compared with the control group. The 2D:4D ratio was lower in the left hand of men with gastric cancer compared with controls. Different anthropometric characteristics, such as digit length, fingerprints, and palm print, could be used as prognostic indicators in some cancers (especially breast and gastric cancers).[109] It was confirmed that the length of the finger and phalange had a significant correlation with stature.[110] There is a strong positive correlation between height and hand dimensions. The stature of an individual can be calculated from either of the dimensions of the hand, that is length or breadth and vice versa.[111] The third finger (middle finger) length provides a better prediction of stature.[112] It has been suggested that athletes with longer fingers and larger hand surfaces enjoy stronger grip power. When the fingers are longer, grasping an object will become more efficient and less fatiguing.[81] “Deergha Nakha” or longer nails may also denote longer fingers. Broader chest, shoulders, large knee joints, and longer fingers as mentioned by Maharshi Bhela denote a life span of 60 years, and further research works are required to substantiate this.
“Utpidita Swaram—Vidyaat Saptatikam Nara”[17]
The words denote deep or strong or good quality of voice, long or prominent nose, coarse or erect or healthy hair, and larger or muscular thighs or optimum thigh circumference respectively. The person or child who possesses these physical characteristics can survive up to the age of 70 years according to the verse just cited.
Utpidita Swaram
The human voice changes from childhood and throughout an individual’s life span due to biochemical and physiological changes affecting the speech mechanism. Listeners can make fairly accurate assessments of the speaker’s age. Based on several voice parameters such as jitter, shimmer, noise, and tremor, listeners can estimate the age of a speaker.[113] Voice aging is caused by normal anatomical and physiological changes such as calcification and ossification of cartilages, muscles and vocal fold atrophy, reduced mucosal wave, vocal fold bowing, reduced pulmonary lung pressures, elasticity, volumes, and recoil. The aged voice has been associated with increased hoarseness and breathiness, vocal fatigue, instability, and crackling.[114]Maharshi Bhela has introduced acoustic analyses as a voice evaluation protocol to estimate the life span of an individual. Estimation of the life span based on the quality of voice is a unique contribution of Maharshi Bhela that needs to be standardized by further research works.
Tunga nasa
Nasal index ratio (ratio of nasal width to nasal height multiplied by 100) has aided in the classification of nasal index into three different nose types: “Leptorrhine” or “long-nosed,” “Mesorrhine” or “medium-nosed,” and “Platyrrhine” or “broad-nosed.” It has been found that narrower noses are better favored in cold and dry climates whereas broad noses are favored in moist and warm environments.[115] Aging is generally associated with deeper nasolabial folds and a longer nose. The lengthening of the nose results from an enlargement of the piriform aperture as the bony edges recede. A drooping tip of the nose is one of the characteristic features of advanced age.[116] The nasal index is correlated with average temperature and humidity in different regions, and nasal size is correlated with oxygen utilization. Nasal height, width, and index in males are higher compared with females. The sexual dimorphism of the nose may be due to various etiological factors such as genetics and hormones.[117] Though there are no studies available to support the theory of a long nose and its association with life expectancy of 70 years, it has been established that various anthropometric parameters of the nose such as nasal height or index etc. can denote aging, race, climatic conditions, and gender.
Kachonmukham
The word denotes erect or standing scalp hair. This represents a particular hair style or hair type that is characterized by thick and strong hair. The thicker the hair, the more erect it should stand.[118] As per Ayurveda texts, hair that is discrete, soft, unctuous, firmly rooted, and black denotes longevity.[73] Hair density, diameter, resistance to breakage, length, smooth fiber interaction, no tangles, integrity of the cuticle layers, integrity of the cortex, integrity of the cuticle surface lipids, and healthy hair follicle all together make the hair strong and healthy. Strong hair appears as long, full, shiny, and manageable.[119] There is a link between the decrease in hair density and hair diameter; it has been found that hair density is significantly associated with the decrease in hair diameter.[120] According to a study, people living in a village called “Yuzurihara” in Japan, also known as “the village of long life,” were ten times more likely to live beyond the age of 85. These people had exhibited thick hair.[121] It can be assumed that scalp hair that is erect (indirectly denotes thickness of hair) may denote long life, as quoted by Maharshi Bhela.
Urukam Bhadra Sampannam
Denotes good-looking or gracious thighs that are large or strong. This can be measured by using the anthropometric parameter, TC. Decreased TC may denote various pathological conditions. TC might be a useful diabetes marker in lean populations.[122] The unique parameters of the volumes of the thigh in relation to the torso and abdomen–hip, by stereovision body imaging (SBI) are effective in predicting visceral adipose tissue deposition. The SBI has been found to be an efficient method for determining body size and shape via total and regional body volumes and ratios in both sexes.[123] Waist-thigh ratio (WTR) is the best predictor of diabetes. TC has been recognized as a relevant anthropometric measure that identifies individuals with an increased risk of premature morbidity and mortality from CVD early in the disease.[124] It has been found that lean tissue mass (LTM) or skeletal muscle (SM) is best evaluated from the thigh region compared with the whole body due to its greater responsiveness to aging.[125] A small TC is associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both sexes. The measure of TC might be a relevant anthropometric measure to predict an increased risk of premature morbidity and mortality. The cross-sectional area of the mid-thigh muscle was a far better predictor of mortality than BMI.[126]
“Bhadram Purashcha—Krishna Atreya Vacho Yatha”[17]
The word denotes an attractive and beautiful-looking body from both sides (anterior and posterior): “Rujukam” denotes proper alignment of the body or a straight body without abnormal curvatures, and “Priya Vaadinam” denotes a person who speaks softly and kindly. A person who possesses all these characteristics can survive up to the age of 80 years according to the verse just cited. These features denote longevity as per Maharshi Bhela.
Bhadram Purashcha Pashchashcha
The most attractive people are expected to be the healthiest and the most fertile. A face or body cue is a valid cue to health and it is related to attractiveness, and also to real physiological health. Attractiveness is a mechanism for detecting healthy and fertile mates; healthy levels of body fat are perceived as healthiest and the most attractive. High muscle mass in men is associated with increased physical fitness, longevity, and a decreased risk of developing diseases; it indicates mating success, positive body image, and multiple sexual partners. Lean muscularity (increased muscle mass and reduced fat mass) among males is considered as the most desired feature.[127] Facial attractiveness provides signals of biological quality and healthy status in humans. Sexual dimorphism, symmetry, adiposity, averageness, and skin color are considered attractive traits, which have been implicated as signals of biological quality. Numerous aspects of health such as immune function, oxidative stress, and semen quality have been found to be associated with sexual signaling.[128]
Rujukam
Body posture is a fundamental index for estimating health and quality of life (QoL). As an aspect of body posture, maintaining proper sagittal alignment is an important determinant for proper spinal function and alterations in spinal alignment denote diminished body biomechanics. Analysis of sagittal balance is a key point to optimize the management of spinal degenerative diseases. The sagittal alignment can be affected by aging-related degeneration. Significant changes have been observed with age in most parameters of body posture, such as increased cervical lordosis, thoracic kyphosis, knee flexion etc. as early as around 50years. There is a significant relationship between sagittal plane deterioration and QoL measures.[129] It seems that “Rujukam” mentioned by Maharshi Bhela denotes proper sagittal alignment or spinal alignment that is associated with spinal health and ultimately with longevity.
Priya Vaadinam
Some researchers believe in the existence of a “longevity personality”; individuals who are optimistic and easygoing are more likely to live longer. Personality is associated with longevity and there are certain potential personality traits that contribute to the centenarian phenotype.[130] Happy people live longer. Mortality risk is lower for happy individuals compared with unhappy individuals.[131] Specific traits related to the positive emotion component of “Extraversion” (e.g., optimism and cheerfulness) have shown associations with longevity.[132] Higher levels of conscientiousness were significantly and positively related to longevity.[133] Femininity trait is related to longevity and also “type B behavior” is associated with longevity.[134] Laughter is good medicine and it increases positive emotion and improves immune system functioning. Positive emotions mediate the effects of coping with humor and immune system functioning. Positive emotions are associated with immediate and long-term beneficial outcomes. Positive emotions facilitate adaptive coping and adjustment to acute and chronic stress. Humor, creative exploration, relaxation, and optimistic thinking are considered as effective ways of coping.[135]
Higher level of conscientiousness and lower levels of hostility and type D personality are associated with greater longevity. Personality-health relations are intertwined with social forces that influence longevity. Elements of “extraversion” such as sociability and positive mood are associated with reduced mortality risk. Higher levels of “extraversion” are associated with greater longevity. Optimism is associated with a lower risk of mortality. Agreeableness is related to maintaining interpersonal harmony such as trust, honesty, compliance, interpersonal deference, altruism, and compassion for others.[136] The word “Priya Vaadinam” denotes various personality traits such as “agreeableness,” “humor,” “extraversion,” “conscientiousness,” “low levels of hostility,” “sociability,” “positive mood,” “optimism,” and an adaptive coping strategy, which have been associated with longevity. Thousands of years ago, Maharshi Bhela had conceptualized the role of personality traits in longevity and this has stood the test of time.
“Lalaatam Nasika—Sa Jeevati Shatam Sama”[17]
As the person who has six angula (angula is an average value of right and left hand, mediolateral proximal interphalangeal joint of the middle finger) measurement of forehead, nose, and ear can survive up to of 100 years. Before generalizing the facial anthropometric indices mentioned in the current context, one should consider variables among populations, such as body size, age, sex, ethnicity, nutritional status, and socioeconomic and environmental conditions. Maharshi Bhela has documented various phenotypic characteristics or facial anthropometric indices of centenarians in the current verse. A proportionate reference individual according to “Charaka Samhita” should have a height and arm span of 84 Angulis and forehead, nose, and neck of 4 Angulis each. It has been found that individuals who had a proportionately larger forehead and face had higher beta cell function, indicating a lower risk for diabetes.[84] Forehead is the part of the face above the eyebrows, below the hairline, and between the temples.[137] The height of the forehead (measured from trichion to glabella), eyes, nose (measured from nasion to subnasale), and mouth exhibited the greatest interethnic variability.[138] Individuals with higher handgrip strength (HGS) have shown wider faces with a lower and broader forehead, a wider distance between the medial canthi of the eyes, a wider nose, fuller lips, and a larger, squarer lower facial outline compared with weaker individuals of the same age and sex group.[139]
The facial measurements can be used to determine the aging pattern of an individual at a particular age.[140] Aging is generally associated with a flatter face, sagged soft tissue (broken jaw line), deeper nasolabial folds, smaller visible areas of the eyes, thinner lips, and longer nose and ears. Drooping tip of the nose and lengthened ears are also the characteristic features of aging.[116] The size of various facial features of infants such as larger eye height and width and larger forehead height are positively associated with cuteness. It was also predicted that more attractive women would have larger foreheads.[141] In has been found that total ear length, ear width, and total ear area are positively correlated with the BMI.[142] Chinese art of physiognomy believes that long ears predict longevity. A positive correlation between age and ear size has been established. According to a hypothesis, as we get older our ears get bigger. As per another interpretation, big ears predict survival; men with smaller ears may die at younger ages. Ear size and pattern may act as a marker of some biological process related to health. Several studies have related the diagonal earlobe crease to coronary heart disease and mortality. A person’s facial features reveal a vast amount of information regarding that person’s personality and yield forecasts of prosperity, longevity, and mishaps according to Chinese literature. It is important to study the features of the forehead, eyebrows, eyes, nose, ears, lips, and teeth together to give an accurate forecast of the person’s destiny.[143]
“Yasya Aakunchitameva—Pautram Pashyatyayam Nara”[17]
Some phenotypic characteristics /anthropometric indices of centenarian people. As per the current verse, when a person bends forward and his head touches the knee joints or his head comes to the level of his knee joints and ears are placed above the level of knee joints, that person survives up to 100 years. This verse represents a condition of longer legs and shorter trunk that is positively associated with longevity. Various indices pertaining to leg length have been in use, such as iliac height (IH), the distance between the summit of the iliac crest and the floor; subischial leg length (SLL), the difference between stature and sitting height; thigh length (TL), the distance between the proximal end of the greater trochanter and the distal lateral femoral condyle and it is measured from the midpoint of the inguinal ligament to the proximal edge of the patella; knee height (KH), the distance between the anterior surface of the thigh above the condyles of the femur and about 4cm above the patella and the floor; sitting height ratio (SHR), which defines the percentage of total stature that is comprised by head and trunk; relative subischial leg length (RSLL), which defines the percentage of total stature that is comprised by the legs; knee height ratio (KHR), which defines the percentage of total stature that is comprised by the lower segment of the leg, that is tibia + foot height. Human leg length (femur + tibia), sitting height (trunk length + head length) and their proportions such as SHR are associated with epidemiological risk for overweight, diabetes, coronary heart disease, liver dysfunction, and various malignancies. Leg length and proportion are important in the perception of human beauty and are considered a sign of health and fertility.[144]
Relatively short legs (defined by the ratio to total height) are associated with negative health outcomes such as poor insulin resistance, coronary heart disease, hypertension, high cholesterol, high BMI, diabetes, and dementia. Slightly above average legs have been linked to developmental stability, good nutrition, and high socioeconomic status. Leg-to-body ratio (LBR) indicates stable development and general welfare. Relatively long legs indicate “reserve capacity” that can buffer against nutritional or mechanical stress.[145] Shorter legs are associated with the risk of developing diabetes.[146] The current verse indicates longer legs or above-average leg length, lower SHR, higher RSLL, higher KHR, greater TL, and shorter trunk length, all of which are positively associated with longevity.
“Mahaantau vipulau—Sa Cheha Shatamruchhati”[17]
Long, fleshy, and hairy ears as well as unctuous, dense, and thick scalp hair denote longevity. Maharshi Bhela has documented the phenotypic characteristics of ears and scalp hair of centenarians in the current verse. The association between big ears and longevity has already been explored in the previous sections (verse 15). The length of the earlobe denotes long life, and thickness means greater wealth. It is also said in Chinese literature that the longer the ears, the more noble the person will be.[143] “Hypertrichosis pinnae auris” (hairy ears) is defined as the presence of excessive hair growth on the outer helix of the pinna, commonly observed in older men. The age of appearance of hairs on the ear varies from one ethnic group to the other. Hairy pinna is considered an individualizing characteristic.[147] Hairy ears are seen in people from some parts of India, Sri Lanka, and also in other ethnic groups. It was originally described as a Y chromosome-linked trait but it is believed now that it is not linked to it.[148] Quantitative trichoscopic analysis is an image analysis system that has the ability to provide hair diameter and hair density. Skin biopsies have revealed a decrease in hair counts and number of follicular units in subjects of older age. Hair density and hair diameter are reduced with chronological aging.[149] Hair loss and graying are characteristics of intrinsic or chronological aging.[150] Smaller diameters of hair are associated with old age. Hair follicle miniaturization, inflammation, and fibrosis are the hallmarks of male pattern baldness. Senescent alopecia is characterized by a reduction in the size of follicles.[151] The phenotypic characteristics proposed by Maharshi Bhela pertaining to ears and scalp hair seem to be true and valid based on the earlier evidence.
“Dharmena Satyavakyena—Sa Deerghamanujeevati”[17]
Maharshi Bhela has explained some personality traits that are associated with longevity. Personality traits such as “Dharma” (conscientiousness), “Satya Vakya” (righteousness /honesty), “Guru Susrusha” (serving the mentor /teacher), and “Rasayana Prayoga” (antiaging medication) are positively associated with longevity.
Dharma and Satyavakya
It has been found that longevity is associated with conscientiousness, emotional stability, and activeness. Personality traits can influence health and longevity. The finding related to conscientiousness is consistent with the literature on personality predictors of mortality. Conscientious people avoid health risk behaviors, avoid hazardous situations, and engage in a wide range of health-promoting activities; they tend to be more informed, more resourceful, disciplined, organized, and more resilient during adversity; they are less likely to smoke or abuse drugs, more likely to exercise, which has a large impact on mortality risk.[132] Conscientious individuals perform healthier behaviors, and they have decreased risks for physical disorders. Conscientiousness predicts greater longevity.[152] Agreeableness is a composite of several traits such as trust, honesty, compliance, interpersonal deference, altruism, compassion for others etc. related to maintaining interpersonal harmony.[136] Higher extraversion is characterized by higher optimism, higher self-efficacy, and an external attribution style. These factors work to decrease the impact of stress and this leads to longevity.[130] Religiosity / Spirituality (R/S) involvement is associated with greater social support, greater marital stability, less crime or delinquency, and greater social capital. R/S beliefs and doctrines support human virtues such as honesty, courage, dependability, altruism, generosity, forgiveness, self-discipline, humility, patience, and social relationships. R/S activities provide supportive social connections, opportunities for altruism and they promote health. Social factors are known to influence both mental and physical health and predict greater longevity.[153]
Guru Susrusha
Service provided by the student to his teacher or preceptor can also provide longevity to the serving student. Students can achieve greater success, social support, ability to cope with stress, employment opportunities, social recognition, problem-solving skills, emotional stability, self-control, and engagement in other healthy behaviors by serving and adapting their teacher’s positive personality traits. Children’s personality traits begin to influence their emerging relationships with teachers at a young age.[154]
Rasayana Prayoga
Rasayana is a specialized branch of Ayurveda that comprises use of herbal, herbo-mineral formulations, diet, and lifestyle along with self-discipline to achieve the optimum state of health. Rasayana is a way to achieve homeostasis, delay the aging process and for prevention of diseases.[155] Most of the diseases seen today are due to “oxidative stress”. Free radicals are highly reactive and can damage cellular components. A delicate balance exists between free radicals and antioxidants in healthy individuals.[156] Aging can be controlled in a systematic manner with the help of Rasayana therapies. Rasayana drugs may achieve this purpose through various pharmacological activities such as antiaging, antioxidant, cognitive-enhancing, nootropic, adaptogenic, and immunomodulatory effects.[157] The centenarian personality traits proposed by Maharshi Bhela seem to be true and valid based on the earlier evidence.
| Conclusion | | |
Of the content of Ayurlakshanam Indriyam is unique and not explained in any other Ayurveda classical texts. Various conditions such as craniofacial anomalies /disorders, multi-malformed infants, infant /neonatal mortality, synophrys, congenital, chromosomal, genetic syndromes /conditions, NICU conditions, NCDs, SB, CTEV, hypertrichosis, malnutrition, calculating life expectancy based on various anthropometric indices (e.g., length and breadth of fingers, palms, ears, nose, forehead, and thighs), and phenotypic biomarkers and personality traits that are positively associated with centenarians have been documented in this chapter. Maharshi Bhela has provided techniques that are inexpensive, simple, noninvasive, highly accurate, and suitable for low- or middle-income countries for estimating life expectancy as well as for diagnosing hidden diseases. Though further research is still required to substantiate the claims, the descriptive results of the current study provide fundamental understanding on potential ideas and pave the path for future research directions.
Acknowledgment
The authors are thankful to “Vd. Hrishikesh B. Mhetre” for his help in understanding the Sanskrit verses of the present work.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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