Charak Samhita

Pitta dosha

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Pitta dosha is responsible for maintaining body temperature, digestion and metabolism. Pitta dosha is agni mahabhuta predominant. [Code:SAT-B.401][1] This chapter describes the physiological functions and pathological importance of pitta dosha.

Contributors
Section/Chapter/topic Concepts/Dosha/Pitta Dosha
Authors Bhojani M. K. 1,
Tanwar Ankur Kumar 1
Reviewer Basisht G.2
Editor Deole Y.S.3
Affiliations 1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India
2 Rheumatologist, Orlando, Florida, U.S.A.
3Department of Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails meera.samhita@aiia.gov.in,
carakasamhita@gmail.com
Publisher Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication: December 16, 2022
DOI 10.47468/CSNE.2022.e01.s09.122

Etymology and derivation

The word ‘Pitta’ is derived from Sanskrit root “tap”.[Su. Sa. Sutra Sthana 21/5][2] The root word ‘tap’ has three meaning: 1) tap dahe means to burn, 2) tap santape means heat generator and 3) tap aishwarye means able to procure eight types of attainments of a yogi (animadi aishwarye).[3] Dahana denotes transformation or conversion (paka) in the living body. This explains the function of pitta is the transformation or modification of one substance to other.

Synonyms

Mayu, teja, ushma, agni, anala, bile, to inflame, to nourish, a type of kala in the body.[3][4]

Bhautika composition

Pitta dosha has dominance of teja mahabhuta. [A.S. Sutra Sthana 20/1][5] Pitta dosha is originated from agni or teja mahabhuta.[Chakrapani on Su.Sa. Sutra Sthana 15/8][2][Figure 01]

Pitta dosha and triguna

All the living & nonliving things originate from panchamahabhuta which originate from trigunatmaka prakriti as described in evolution process (utpatti krama). Dosha are evolved from panchamahbhuta, so these dosha bear triguna property. Pitta is evolved from agni that has sattva and raja predominance.[2][Su. Sa.Sharira Sthana 1/20] Sharangadhara and Bhavaprakasha opines that pitta has sattva predominance. [Sha.Sa.Pratham Khanda 5][6] [Bh. P. Purva Khand 3/103][7]
[Figure 01]

 
Figure 01: Relation between triguna, mahabhuta and pitta dosha.

Sites of pitta

Dosha are present in every part of the body. [Cha.Sa. Sutra Sthana 20/9] General location of pitta dosha is the middle part of the body, marked between the heart(hridaya) and umbilicus(nabhi).[A.S. Sutra Sthana 1/4][5] Pitta is predominately present in body parts between the large intestine(pakvashaya) and stomach(amashaya). [Su. Sa.Sutra Sthana 21/6][2]
The specific seats of pitta are (Figure 02):

Among all these sites, duodenum (amashaya) and umbilicus (nabhi) are the prime sites of pitta.[Cha.Sa. Sutra Sthana 20/8][K.S. Sutra Sthana 27/11][9] Amashaya (stomach) is located in between the breast (stana) and umbilicus(nabhi). In amashaya, the digestion of all types of food takes place. [Cha.Sa. Vimana Sthana 2/17] Duodenum is the area of the digestive tract where maximum digestive process occurs. Acharya Chakrapani clears that the location of pitta is lower part of amashaya( i.e. duodenum). [Chakrapani on Cha.Sa. Sutra Sthana 20/8]

 
Figure 02. General (A)and specific sites(B) of Pitta dosha.

Attributes

The characteristics of pitta are:

Pitta is pungent (katu) in completely formed or mature stage. It is sour (amla) when in raw or incompletely formed stage. [Su. Sa. Sutra Sthana 21/11][2] Pitta is yellow in color in the mature stage and blue in color in raw stage. [ Dalhana on Su. Sa. Sutra Sthana 21/11][2]
Acharya Chakrapani described the two types of pitta: 1) sadrava and 2) nirdrava. Sadrava is the natural pitta with liquidity and unctuousness. Nirdrava causes fever(jwara) and other diseases and is dry(rukshta). [Chakrapani on Cha.Sa. Chikitsa Sthana 3/217]
These attributes should be considered while taking diet and lifestyle management of health. If the food and lifestyle habits having similar characteristics are followed in excess, a person may experience pitta dosha vitiation leading to pitta disorders. Kashypa stated that pitta have all colors (varna) except white (shweta) and crimson red (aruna). [K.S. Sutra Sthana 27/38-39][9]

Functions of Pitta

Pitta has the independent function to perform within the body. The principal function of pitta dosha is to maintain the normal physiology by supplying energy to the body for all processes. The special functions of pitta are: [Cha.Sa. Sutra Sthana 18/50] [Cha.Sa. Sutra Sthana 12/11] [Su. Sa.Sutra Sthana 15/4][2] [A.Hr. Sutra Sthana 11/2-3][8]
  • Vision (darshan)
  • Digestion (pakti)
  • Feeling of hunger (kshuta)
  • Thirst (trishna)
  • Softness within the body (dehamardava)
  • Luster of the body (prabha)
  • Cheerfulness (prasad)
  • Intelligence (medha or buddhi)
  • Maintenance of normal body temperature (matratvam ushma)
  • Normal complexion of skin (prakrit varna)
  • Courage (shauryam)
  • Anger (krodha)
  • Desire of food (ruchi)
  • Discriminative power and understanding (dhi)
 
Figure 03: Categorization of the functions of pitta.

Acharya Sushruta first described five types of pitta and defined their particular functions as below:[Su.Sa. Sutra Sthana 15/4][2] [Dalhana on Su.Sa. Sutra Sthana 15/4][2]

  1. Imparting normal color (ragakriit): Ranjaka pitta
  2. Process of digestion (paktikrt): Pachaka pitta
  3. Production of oja and maintenance of intelligence (ojakrit and medhakrit): Sadhaka pitta
  4. Process of vision (tejakrit): Alochaka pitta
  5. Production of heat within the body (ushmakrit): Bhrajaka pitta

Classification

The classification of pitta is based on different functions and locations in human body. [Su.Sa. Sutra Sthana 21/10][2] [A.S. Sutra Sthana 20/5][5] [A.Hr. Sutra Sthana 12/12-14][8]

Five types of pitta dosha, sites and functions:

Pachaka, ranjaka, sadhaka, alochaka, and bhrajaka are the five types of pitta dosha. Five sets of functions by which pitta dosha is divided into five types are described. [Su.Sa. Sutra Sthana 15/4][2] The location and function of five types of pitta dosha are based on different Ayurvedic texts, as given in table 01.
Table 01: Description of five types of pitta dosha
S.No. Type of Pitta Location Function
01. Pachaka In between the stomach and large intestine (pakva amashaya madhya)
  • Digestion of four types of food stuff (chaturvidha annapanam pachti)
  • Differentiation of nutrient and waste products from food (vivechyati cha dosha rasa mutra purishani)
  • Provides support and energy to other pitta (sheshanam pitta sthananam anugraham karoti)
02. Ranjaka Liver (yakrit)
Spleen (pliha)
Amashaya (lower part of stomach and duodenum) 		Impart color to blood (rasasya ragkrit)
03. Sadhaka Heart (hridaya)
Brain (mastishka)
  • Implementation of desires (abhiparthita manoratha)
  • Decisive power (buddhi)
  • Intellect (medha)
  • Self esteem (abhimana)
  • Enthusiasm (utsaha)
  • Perception of word (shabda), touch (sparsha) and odor (gandha)[Bhe.Sa.4/8][10]
04. Alochaka Eyes (drishti) Perception of vision (rupa grahana)
05. Bhrajaka Skin (twacha)
  • Absorption of various formulation applied through massage (abhyanga), showering (parisheka), tub bath (avgahana) and local application (avlepana)
  • Radiates the glow of skin (chayanam cha prakashaka)
  • Gives lustre to skin (kantikaritvam) [Bha. P. Purva Khand 3/125][7]
  • Maintenance of normal body temperature [Chakrapani on Cha.Sa. Sutra Sthana 12/11]
 
Figure 04: Physiology of different types of pitta dosha

Pitta dominant constitution (prakriti)

The characteristic features of pitta dominant constitution individuals based on properties of pitta dosha are described as below. [Cha.Sa. Vimana Sthana 8/97]
  • The predominance of moles, pimples, wrinkles
  • Premature graying of hair and scanty hair or baldness
  • Presence of brownish-reddish hair
  • Strong digestive power
  • Excessive sweating and body odor
  • Intolerance to summer and hot things
  • Intake of food and water in an excessive amount
  • Short-tempered
  • Full of courage
  • Intelligent person

Loka Purusha Samya

Pitta is responsible for all destruction or catabolism in the cosmos. The agni mahabhuta is represented by the pitta dosha in human body. Nourishing (visarga), depleting (adana) and distributing (vikshepa) in the universe are carried by the moon, sun and wind. Similarly, the human body has kapha, pitta, and vata performing the same functions, respectively. [Su.Sa. Sutra Sthana 29/6][2]

Factors responsible for abnormal states of pitta

Certain factors cause excess or decline of pitta in the human body. These factors are natural or unavoidable and artificial or avoidable.

Natural factors

These factors are the essential component of biological rhythm occurring in the external as well as internal environment of the body. This natural increase is physiological. These factors are as follows:[Su.Sa. Sutra Sthana 21/20][2], [A.Hr. Sutra Sthana 1/8][8], [A.Hr. Sutra Sthana 12/20-21][8] [A.Hr. Nidana Sthana1/16][8](Figure 05)
  • Season (ritu): Pitta undergoes natural accumulation in rainy season(varsha), gets vitiated during autumn(sharada) and subsides to normal during winter(hemant).
  • Various stages of digestion of food: Pitta gets vitiated during the meal digestion (jiryteanne).
  • Biological rhythm of day and night: Pitta gets vitiated in the middle of the day(madhyanhe) and night (ardharatre).
  • Age (vaya): In middle age, pitta is in excess as compared to other doshas.
 
Figure 05: Natural factors responsible for increase in pitta.

Acquired factors

Acquired factors cause vitiation of pitta dosha other than natural factors. These are avoidable and used in clinical practice through the concept of samanya vishesha siddhanta. These factors are as follows: [Su.Sa. Sutra Sthana 21/22][2] [A.Hr. Nidana Sthana 1 /16][8]
  • Diet(dravya) and a particular property of diet: Food with the dominance of pungent (katu), sour (amla), and salty (lavana) taste, hot potency cause aggravation of pitta dosha. Intake of insufficient quantity at the improper time leads to vitiation of pitta dosha.
  • Lifestyle and other activities: Fasting (upavasa), overstrain (ayasa) and excessive sexual indulgence (maithuna upagamana)
  • Emotional and behavior factors: Anger(krodha), sorrow(shoka), and fear(bhaya).

Clinical aspects

Preventive aspect: A person with pitta dominant body constitution should avoid the diet and lifestyle mentioned above to maintain equilibrium and healthy status.

Stages of dosha:

Dosha continues to exist in three states: hypofunction (kshaya), hyperfunction (vriddhi), and normal physiological state (sama). [Cha.Sa. Sutra Sthana17/110] Increase and reduction in dosha functioning (karma) can be used to understand dosha increase and decline in the body. Dosha, when increased, produce their respective features in excess; when decreased, cut off their functions and when in normal state, they perform their normal functions.

Hyperfunctioning of pitta (vriddhi lakshana):

When pitta levels increase, the body exhibits various signs and symptoms as stated below: [Su.Sa. Sutra Sthana 15/13][2], [A.Hr. Sutra Sthana 11/7][8], [A.S. Sutra Sthana 19/5][5]:
  • Yellowish coloration of stool(purisha), urine(mutra), eyes(netra) and skin(twacha).
  • Increased hunger (kshudha)
  • Increased thirst (trishna)
  • Burning sensation(daha)
  • Less sleep(alpanidrata)
  • Fainting (glani)
  • Weakness of senses or inability to work properly(indriya daurbalya)
  • Vitiation of essence(ojovisramsa)
  • Desire for cold (shita abhilasha)
  • Bitter feeling in mouth(tiktasyata)
  • Giddiness(murchha)
  • Excessive anger(krodhi)
  • Less strength(bala hani)

Hypo functioning of pitta (kshaya lakshana):

When pitta levels decline, the body exhibits various signs and symptoms as below: [Su.Sa. Sutra Sthana 15/7][3], [A.Hr. Sutra Sthana 11/16][8], [A.S. Sutra Sthana 19/8][5]
  • Poor digestive capacity and decreased digestive functions (manda anala)
  • Coldness(shita)
  • Loss of skin luster (prabha hani)
  • Stiffness(stambha)
  • Pricking pain(toda)
  • Less desire of food(arochaka)
  • Excessive coarseness on the body(angaparushya)
  • Tremors(kampa)
  • Heaviness in body(gaurav)
  • Whitish coloration of eyes, nails etc.(nakha-nayana shaukalayadi)

Diagnosis:

The state of pitta dosha can be diagnosed and assessed based on clinical features. The most common clinical features of pitta dosha are burning sensation(daha), feeling of hotness (ushnata), suppuration(paka), strava(discharge), redness(raga) rigidity(stambhana), wasting (shosha)and harshness(parusha). [Cha.Sa. Sutra Sthana 20/15] [K.S. Sutra Sthana 27/39][9]
Forty types of diseases are caused due to an imbalance of pitta dosha (pitta nanatmaja vyadhi).[Cha.Sa. Sutra Sthana 20/14][Table 02]:
Table 2: Disorders due to pitta dosha (pitta nanatmaja vikara)[10]
Heating (osha) Scorching (plosha) Burning (daha) Intense heat (davathu)
Fuming (dhoomaka) Hyperacidity (amlika) Burning sensation (vidaha) Internal burning (antardaha)
Burning sensation in arm (amsadaha) Hyperthermia (ushmadhikya) Excessive sweating (atisveda) Foul smell from body (angagandha)
Tearing of body parts (angavadarana) Retention of metabolites in blood (shonita kleda) Retention of metabolites in muscles (mamsa kleda) Burning sensation in skin (tvag daha)
Cracking of skin (tvagavadarana) Thickness of skin (charmadalana) Urticarial patches (rakta kotha) Pustules (rakta visphota)
Bleeding disorders (raktapitta) Hemorrhagic rounded patches/ echymosis (raktamandala) Greenish discolouration (haritatva) Yellowish discoloration (haridratva)
Blue moles (neelika) Furunculosis (kaksha) Jaundice (kamala) Bitter taste in mouth (tiktasyata)
Blood-like smell from the oral cavity (lohita gandhasyata) Fetid smell from oral cavity, or halitosis (pootimookhata) Polydypsia (trishnadhikya) Loss of contentment (atripti)
Stomatitis (asyavipaka) Inflammation in throat (galapaka) Inflammation in eyes (akshipaka) Inflammation in anus (Gudapaka)
Inflammation in penis (medhrapaka) Discharge of pure blood (jivadana) Darkness in front of the eye (tamapravesha) Green-yellow discoloration of eyes, urine, stool (harita haridra netra mutra varchastva)

Diagnostic and assessment tools

Pitta dosha can be assessed by its normal or abnormal functionality through subjective methods like questionnaires and objective methods. Currently, there are no validated and standardized tools for dosha assessment within the body. Pitta vriddhi and kshaya features can be assessed through a subjective questionnaire. Ayurvedic physicians assess the normalcy and abnormality through the ayurvedic principles of examination (pariksha).
Subjective and objective methods which may be used to assess the normal functioning of pitta dosha are:
  • Test for assessment for digestive enzymes and hormones like serum lipase[11], serum amylase[11], serum pepsinogen[12] and serum gastrin[13] etc.
  • Hemoglobin level, Red blood cell count, Mean Corpuscular Hemoglobin, Mean corpuscular hemoglobin concentration.[14]
  • Subjective assessment of Intelligence quotient like Wechsler Intelligence Scale for Children (WISC)[15].
  • Subjective assessment of emotional intelligence like Mayer-Salovey-Caruso emotional intelligence test[16].
  • Cognitive assessment-Montreal Cognitive Assessment (MoCA)[17], Mini-Cog[18] & ICMR-PNT(Picture naming test)[19] etc.
  • Memory test through memory drum[20].
  • Visual acuity-Snellen’s chart[21].
  • Perception of vision- tachistoscope[22].
  • Skin test like sebum content, trans-epidermal water loss and melanin content through various instruments[23].
  • Assessment of body Temperature.
  • Subjective assessment of Agni-Self-Assessment Tool to Estimate Agnibala[24] & CCRAS Agni assessment tool(http://www.ccras.res.in/ccras_sas/).
Application of all such tests will serve as a powerful analytical tool for assessing pitta dosha.

Treatment

To manage and prevent disease, the clinician shall follow the theory of similarity and dissimilarity (samanya vishesha siddhanta). Avoiding diet and lifestyle factors similar to properties of pitta dosha is required to pacify it. Contrarily, the decline of pitta dosha is treated by consuming foods and lifestyles that stimulate it. Therapeutic purgation (virechana) is the best intervention indicated for vitiated pitta.[Cha.Sa. Sutra Sthana 20/16] [Cha. Sa. Sutra Sthana 25/40]
Ingestion of milk and ghee (ghrita) is best for the treatment of pitta. [Cha. Sa. Sutra Sthana 25/40] [A.Hr. Sutra Sthana 13/4-9][8]
The herbs having sweet, bitter, astringent, and cold qualities used in single or combination along with therapies like oleation, purgation, massage and shower etc. are helpful in the treatment of pitta disorders. [Cha.Sa. Sutra Sthana 20/16] [K.S. Sutra Sthana 27/39][9]


Dietary modification: Three tastes (rasa) that help in controlling the vitiated pitta are – sweet (madhura), bitter (tikta) and astringent (kashaya). [Cha.Sa. Sutra Sthana 1/66] [A.Hr. Sutra Sthana 13/4-9][8]
Lifestyle modification: Following modifications in lifestyles and measures help to maintain equilibrium of pitta dosha and manage its disorders.

  • Frequent application of paste of cool substances like kapur (camphor), Chandana (sandalwood), and ushira (Khashkhash grass) over body
  • Sitting in the moonlight in the evening
  • Listening to lovely and soothing music
  • Exposing to soft cool air
  • Companionship of individuals who talk honestly and innocuously
  • Living near ponds, parks, and fountains with fresh water
  • Wearing garlands/necklaces with appealing and cooling nature.[A.Hr. Sutra Sthana 13/4-9][8]

Current researches

Analysis of physiology of vision:

Ayurveda describes the entire visual process in terms of vata and pitta dosha. Vata is responsible for excellence of vision (aksha patavam) and pitta dosha is responsible for vision (darshana); particularly, alochaka pitta.[25]

Functions of pitta dosha as per gender and prakriti:

This study determines the variance in the functional condition of various pitta forms using objective metrics in 201 young, healthy volunteers. For pachaka pitta, serum lipids, cholesterol, total protein, and glucose levels were assessed. For ranjaka pitta, haemoglobin concentration;for alochaka pitta, visual acuity; for sadhaka pitta, memory, and response time, and for bhrajaka pitta, Red-Green-Blue(RGB) value were evaluated. Except for bhrajaka pitta, each type of pitta had a separate functional status in each prakriti for both genders. Study suggested that while organizing and assessing research based on prakriti, gender inequalities be taken into account.[26]

Pitta detection using finger photoplethysmography:

According to the study, an increase in pitta level causes changes in the finger pulse profile features. Some of the selected features, such as A2/A1 of the middle finger and TP2/TPT of the ring finger in both the left and right hands of all three participants, demonstrated a monotonic decrease in variance. According to the study, this change is noticeable primarily in the TP2/TPT feature of the right hand's ring finger due to elevated pitta levels.[27]

Analysis of pitta imbalance using machine learning algorithm:

This work focused on evaluating pitta imbalance using a machine learning method and gives fresh insights into pitta dosha analysis utilising real-time pitta datasets and machine learning technologies. Pitta dosha was assessed using the Support Vector Machine (SVM). The work used real-time pitta datasets and machine learning approaches to analyse pitta dosha in 152 healthy subjects. The study revealed that lifestyle modifications had an effect on the vata-pitta dosha.[28]

Theses done

  1. Thamman R.K.(1996): Ranjaka pitta ka vaigyanika vivechnatmak adhyayana( yakrit ke paripreshya me), Dept. of Kriya Sharir, NIA Jaipur.
  2. Chhimpa R.(2019): Physiological study of drava and ushna guna of pitta and their applied aspect with clinical evaluation of khanda-kushmanda avaleha and patoladi kwatha in amlapitta,Dept. of Kriya Sharir, NIA Jaipur. This study concluded that guna-based research is useful for determining the appropriate medication to administer in a particular state.
  3. Gautam V.J. (2020): A study on effects of transcendental meditation on healthy volunteers with special reference to sadhaka pitta in ayurveda, Department of Rachana Sharir, B.H.U. This study concluded that by increasing the mental fortitude (sattva) among the healthy volunteers, Transcendental Meditation may be used to regulate and maintain mental health (sadhaka pitta functions) as well as minimize the reactivity to stressful situations.

Future area of research

The critical area of research is the preparation of a validated and standardization of questionnaires for assessment of states like pitta kshaya, vriddhi, and normal functioning of pitta. Guna based assessment of pitta is needed. Evaluation of digestive functions in various disorders like hypothyroidism and hyperthyroidism will help understand the pitta's normal and abnormal functioning. Assessment of pitta state in various physiological and emotional states like anger, sorrow, pleasure, pain through subjective and objective methods. Pitta assessment in criminals may be helpful in counseling and understanding their nature. This may be useful in planning diet and behavioral therapy too. Profession wise pitta assessment may be helpful to choose the best and most suitable profession for the individual.

Send us your suggestions and feedback on this page.

References

  1. ↑ National AYUSH Morbidity and Standardized Terminologies Electronic Portal by Ministry of AYUSH Available on http://namstp.ayush.gov.in/#/Ayurveda
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.
  3. ↑ 3.0 3.1 3.2 Amarkosha. Amarsimha, Edited by Pt. Haragovinda sastri. Reprint Ed. Varanasi:Chaukhambha Sanskrit Sansthan, 2020.
  4. ↑ Monier-Williams. Monier William's Sanskrit-English Dictionary, 2nd Ed., Oxford University Press;1899.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Vagbhata. Ashtanga Samgraha. Edited by Shivprasadsharma. 3rd Ed., Varanasi: Chowkhamba Sanskrit Series Office; 2012.
  6. ↑ Sharangdhara. Sharangadhara Samhita. Edited by Parashuram Shastri Vidyasagar. Varanasi: Chaukhambha Surbharati Prakashan ;2013.
  7. ↑ 7.0 7.1 Bhava mishra. Bhavaprakasha, Edited by Brahmasankara Mishra, Rupalalaji Vaisya. 5th ed. Hindi Commentary Vidyotini; Varanasi: Chaukhambha Sanskrit Sansthan, 1969.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 Vagbhata. Ashtanga Hridayam. Edited by HarishastriParadkar Vaidya. 1st ed. Varanasi: Krishnadas Academy; 2000.
  9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 9.12 Kashyapa. Kashyapa Samhita. Edited by P. V. Tewari. Reprint. Varanasi: Chaukhambha vishvabharati;2008.
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  11. ↑ 11.0 11.1 Byadgi P.S., Saini N.. Maharoga Adhyaya. In: Kar A.C., Rai S., Deole Y.S., Basisht G., eds. Charak Samhita New Edition. 1st ed. Jamnagar, Ind: CSRTSDC; 2020. https://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Maharoga_Adhyaya&oldid=41150. Accessed November 6, 2022.
  12. ↑ Ismail OZ, Bhayana V. Lipase or amylase for the diagnosis of acute pancreatitis?. Clin Biochem. 2017;50(18):1275-1280.
  13. ↑ Mukoubayashi C, Yanaoka K, Ohata H, et al. Serum pepsinogen and gastric cancer screening. Intern Med. 2007;46(6):261-266.
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  15. ↑ George-Gay B, Parker K. Understanding the complete blood count with differential. J Perianesth Nurs. 2003;18(2):96-117.
  16. ↑ Woolger C. Wechsler intelligence scale for children-(WISC-III). InUnderstanding psychological assessment 2001 (pp. 219-233). Springer, Boston, MA.
  17. ↑ Maul A. The validity of the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) as a measure of emotional intelligence. Emotion Review. 2012 Oct;4(4):394-402.
  18. ↑ Kang JM, Cho YS, Park S, et al. Montreal cognitive assessment reflects cognitive reserve. BMC Geriatr. 2018;18(1):261.
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  20. ↑ Paplikar A, Varghese F, Alladi S, et al. Picture-naming test for a linguistically diverse population with cognitive impairment and dementia. Int J Lang Commun Disord. 2022;57(4):881-894.
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  22. ↑ Chen TA, Li J, Schallhorn JM, Sun CQ. Comparing a Home Vision Self-Assessment Test to Office-Based Snellen Visual Acuity. Clin Ophthalmol. 2021;15:3205-3211.
  23. ↑ Benschop R. What is a tachistoscope? Historical explorations of an instrument. Sci Context. 1998;11(1):23-50.
  24. ↑ Hua W, Fan LM, Dai R, et al. Comparison of two series of non-invasive instruments used for the skin physiological properties measurements: the DermaLab® from Cortex Technology vs. the series of detectors from Courage & Khazaka. Skin Res Technol. 2017;23(1):70-78.
  25. ↑ Singh A, Singh G, Patwardhan K, Gehlot S. Development, Validation, and Verification of a Self-Assessment Tool to Estimate Agnibala (Digestive Strength). Journal of Evidence-Based Complementary & Alternative Medicine. 2017;22(1):134-140.
  26. ↑ Balakrishnan P, Ashwini MJ. Conceptual analysis of Physiology of vision in Ayurveda. J Ayurveda Integr Med. 2014;5(3):190-196.
  27. ↑ Agrawal S, Gehlot S. Variations in the functions of Pitta Dosha as per gender and Prakriti. TANG [HUMANITAS MEDICINE] [Internet]. 2017 Nov 30;7(4):18.1-18.8.
  28. ↑ Singh M, Chauhan B. High pitta detection using finger photo plethysmograph based features: a feasibility study. International Journal of Computer Science and Communication. 2012;3:73-5.
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