Introduction

The aim of Ayurveda is to maintain Dhatusamya which is responsible for health.[1] Disease-free condition is the best source of Dharma ,Artha , Kama and Moksha while the disease destroyer of this sources , life and welfare[ 2] Now this has become great challenge for human being and As the Solution of this Challenge Lord Indra delivered the knowledge of Ayurveda to Bharadwaja in Few words in the form of Trisutra.The whole Ayurveda is included in these Trisutra .The concept of Trisutra i.e. Hetu, Linga and Aushadha has been described in Ayurveda for the fulfillment of aim of maintaining the health of a healthy person and to Cure disease of a patient. the concept of Trisutra Ayurveda is for both the swastha and Atura   it has been described in all samhita in Scattered form. Hetu is the causative factor responsible for manifestation of disease as well as health . Linga means symptoms of Swastha as well as Atura. Linga in swastha purush includes symptoms of physical, mental and spiritual well being and Atura includes samanya( common) , Vishesha( Cardinal) and Arishta lakshana of disease  and Aushadha are the means used to maintain and promote the Health of Healthy and treatment of I’ll patients.[3]

Aim and Objective

• To collect, compile the information of Trisutra from various samhita

• To Analyse the applied aspect of Trisutra for healthy and ill patient .

Material and Methodology

Material

• Charak samhita and their commentaries

• Sushruta samhita And their commentaries

• Madhav nidana

• Other Ayurvedic Literature will be reffered whenever Required

• Journal and internet

Methodology

This is the detailed literary study . The information and references were collected from charak samhita and other Ayurvedic literature

Concept of Trisutra

Hetu Sutra

Hetu means factors responsible health as well as responsible for Diseases[4] Hetu, Nimitta ,Ayatana ,Karta , karan , pratyaya , Samutthana are the synonyms of Hetu [5] .Acharya Gangadhar Rai has called hetu as beeja . Thus Hetu means the factors responsible for health And etiological factors of the disease. The causative factors has been divided into two types i.e Upayogi Hetu and Utpadak Hetu . Upayogi  Hetu which deals with the maintenance of health I e. Main aim of Ayurveda i.e. Dhatusamya, and it furthur divides into Adharabhuta(objective)- the body and mind; and sahakari- the Co-operative factors Thus, the Hetu for maintenance of good health( swasthya) Responsible for equilibrium between Dosha Dhatu , mala and Agni

 Utpadak hetu is the etiological factor of disease. These Factors affecting the objects of healthy person and could be Samvayi Hetu (internal factors) or the Nimittarupa (external factors). The internal and external factors are different For each and every disease and have been explained separately in text of each disease. The internal etiological factors i.e. Samvayi hetu are Ayoga, Atiyoga & Mithyayoga of Indryartha, Pragya and Parinam. factors which are Mobile i.e. Cheshtavana  (Dravyarupa Vata-pitta-Kapha) are the active participants in the pathogenesis of disease. These factors are extrinsic and get vitiated by Asatmyendriyartha sanyoga and Pragyapradha. This means improper perception of sense objects by their respective sense organs and impairment of Dhi, Dhriti Smriti leads to vitiation of all the doshas of body and mind. The other hetu which are Steady i.e. Nishcheshta, by their quality play important role in the pathogenesis of the disease. These intrinsic factors are Dosha-Dushya Sammurchna and Dosha-Sthana Sanshraya While, the external factors (Nimittarupa) of Utpadaka hetu are trauma etc. [6]

Importance of Hetu sutra

Diagnostic aspect

For diagnosis of disease one should know the Exact cause responsible for the manifestation of disease. For e.g. The Hetu of Prameha are continuously sitting, oversleep, excessive Consumption of curd, soup of the domestic, aquatic Animals and milk, new cereals and drinks, products of Jaggery and all other Kapha aggravating Ahara Vihara [7] .Vatarakta[8] and Kustha[9] are having same Poorvaroopa like Swedasya ati pravutti or Abhava, Vaivarnya and Supti etc. so here by knowledge of Hetu help in proper diagnosis . one can prevent diseases by avoiding such things

For differential diagnosis

When the signs and symptoms of two or more Diseases are similar a precise diagnosis proper diagnosis of disease becomes very Stressful . In such conditions if we have knowledge of Hetu Exact becomes possible because the etiological Factors are different for different disease . For example, there are eight Types of Udaravyadhis . When the patient reaches at later stage, a Diagnosis of the specific type of disease becomes difficult . But if the Patient gives history of addiction of drinking alcohol The disease can be diagnosed as Yakrutodara. [10]

Treatment aspect

Knowledge of Hetu has given prime importance in The prevention as well as the cure of diseases. As Acharya Sushruta told ' sankshepatah kriyayoge nidan parivarjana[ 11] . Which means avoiding etiological factor is first line of treatment Eg. In treatment of Hikka and Swasa it is advised to  patient that avoid aggregating factors.

Apathya are the things which should be Avoided after treatment of disease. Upashaya is nothing but Satmya[12] i.e. Opposite to hetu .

Prognostic aspect

Acharya charak has mentioned that severity of disease depends on the Bala of hetu . Disease is Sadhya if Hetu is having Alpa Bala and Krichasadhya if with moderate Bala and Yapya if hetu is having uttam Bala[ 13]

The highest priority should be given to avoidance of Causative factors responsible for the vitiation of Dosha it will Be helpful in breaking the samprapti ( pathogenesis ) of the diseases. All These things will be helpful only if there is a accurate Knowledge about the Causative factors therefore ., knowledge of Causative factor is very helpful to the physician .

Linga Sutra

Linga means the Symptoms of both the swastha (healthy) And Atura (diseased ) Linga also called as Lakshana , Chinha, Akruti , vyanjana, etc [ 14] . Acharya Charaka Described the symptoms of healthy person As one who is well proportionate in mansa dhatu, well-knit in figure, Proper sanyoga of indriya, able to tolerate hunger and thirst, heat and cold, exercise and has normal digestive and absorptive Power is swastha purusha [ 15] .According to Acharya Sushruta,Equilibrium between Dosha ,Dhatu ,Mala & Agni with pleasant Atma, Mana & Indriya are the Symptoms of swastha purusha [ 16]  Kashyap also mentioned the definition of swastha i.e. Desire of having food, proper digestion of food, proper Evacuation of faeces, urine and flatus, lightness , sense organs in pleasant state, proper sleep, to gain strength &Complexion, pleasant mind and normal digestive fire [ 17].By observing these characteristics , one can examine the person is healthy or diseased person

In diseased person ,symptoms obtained by vitiation of Dosha and Dushya . The symptoms are of 3 types- Samanya lakshana( Common), Vishishta lakshana & the Arishta Lakshana(Symptoms which indicate the definite death)  .

 Example- In Jwar fatigue, restlessness, loss of taste , loss of appetite etc are samanya lakshana Burning sensation in body in pittaja jwar is Vishishta lakshana[18]

Importance of linga Sutra

Diagnostic aspect

In Vata Vyadhi [19] Ksatakseena [20] pooorvaroopavastha is Avyakta And their diagnosis can be done only on basis of their lakshana . In Some disease some symptoms may be similar then Diagnosis will be done according to collection of Symptoms. E.g. In Vatikagulma[21] pain will increase after Digestion of food and In Parinama shoola[22] also pain will Increase after digestion, In both condition, diagnosis of Disease has been confirmed by observing the collection of Symptoms

Treatment aspect

Knowledge of lakshana is essential for specific Treatment. For e.g. In Kustha chikitsa[23] If Dosha are Alpa and Anavagadha ; then Raktamokshana should be done with Shringa and Alabu. In Bahu Dosha condition Raktamokshana Should be done with Siravedha .In different stage of shotha i.e., Amavastha, Panchyamanavastha and Pakvavastha; specific chikitsa is given . For e.g. In Amavastha chhedan is not indicated [24]and in Pakvavastha incision is given to drain the pus . These stages can be differentiated with the knowledge of Lakshana only.  In Urdvaga Raktapitta; Tarpana should be given after Langhana & in Adhoga raktapitta Peya is recommended . Urdhvaga and Adhoga raktapitta can be differentiated by Lakshana only .[25]

Prognostic aspect

As stated by Acharya Charaka, these Lakshana also provide a platform for the assessment of the disease’s prognosis. That if the symptoms are minor, the disease has a good prognosis, and if they are moderate or major in number, the prognosis of the disease becomes moderate or bad, respectively[ 13

If vaidya is unaware of Lakshana of diseases, he is unable to accurately diagnose, predict the prognosis, and prescribe the appropriate course of treatment. Lakshana is therefore given top priority in Trisutra Ayurveda.

Aushadha Sutra

Aushadha is known as ‘karana’ in Ayurveda [26] . Aushadha are the means used for maintenance the health i.e. diet And lifestyle along with the medicine that is used to treat the Disease. Aushadha is one of the Chatushpada helpful for successful chikitsa . It is necessary that the drug should possess all the 4 qualities of good medicine [ 27]. Many principles have been explained in samhita for maintenance and promotion of health but this are in scattered form .

Principles for maintenance of health are explained are

• Dinacharya
• Rutucharya
• SwasthaVrutta
• Sadvrutta palan
• Achara Rasayana
• Dharniya and adharniya Vega
• Ashtauaharavidhi visheshayatana etc

And for promotion of health use Rasayan and vajikaran should be done[ 28] . And for treatment of disease

Therapeutic measure broadly classified into two types shodhana and shaman .Out of which, the p therapy is given higher priority since the aggrevated Dosha lowered by Langhana & Pachana may occasionally be stimulated again; but, in the case of those lowered by purificatory technique (shodhana), there is no potential of such recurrence [ 29]

Therapeutic measure are again classified into three types i.e. Daivavyapashraya , Yuktivyapashraya , and Satvavajaya. For sharirik dosha , Daivavyapashraya is useful and for Manas Dosha Satvavajaya Chikitsa is useful [ 30] .

Again, there are other 18 types of treatment method , such as Hetu-vipareeta or Vyadhi-vipareeta or both; and Hetu-viparitarthakari , Vyadhi-viparitarthakari or both, where vyadhi indicates Vyadhi lakshana[31]  

This proves that Aushadha sutra depends on Both the Hetu sutra and Linga Sutra. According to the severe, moderate, or mild stage of the disease, Teekshna, Madhya, or Mrudu aushadha is recommended, as has been stated in the Ayurvedic literature.

Importance of Aushadha Sutra

Diagnostic aspect

It is helpful in diagnosis of disease where diagnosis become difficult due to similar Lakshana, in such condition Upashaya or Unupashaya of Chikitsa helps to diagnose the disease accurately. For Example. If the treatment ( Snehan ) done with the idea that it is Sandhigatavata ,Aggrevates the pain then we can diagnose it as Amavata .

Treatment aspect

18typesof Upashaya used as a therapy described by Acharya Chakrapani For example Shunthi In Kapahaj Jwar Comes under Hetu Vipareeta Chikitsa, Kutaja in Atisar Is Vyadhi vipareeta chikitsa and Use of Vatahara and shothahara Dashmool kashaya in Vatik Shotha is Ubhaya Vipareeta Chikitsa. [ 31]. Acharya Charaka clearly mentioned, if this Hetu Vipareeta treatment is not useful for Vyadhi shamana then should go for Vyadhi vipareeta treatment.

Discussion

The concept of Trisutra ( Hetu, Linga, Aushadha) of Ayurveda which is Shashwat ( eternal) is the foundation of the entire ayurvedic Science .Trisutra is also called as Triskandha . It is beneficial in both swastha and Atura. It is Trisutra is useful in fulfilling the foremost aim of Ayurveda i.e. the vikar prashamanam(Treatment of disease)and the swastha Rakshanam( Maintenance of health), The concept of the trisutra should be understood in order to comprehend both health and illness. As a result, only one Trisutra principle serves as the foundation for everything in Ayurveda. Ayurveda strongly suggest that it is not necessary to name every Disease[32] The understanding of Hetu , Linga ( According to dominance of Dosha) aa well as its Stages of Progression is considered as important in success of treatment .It is possible to achieve Success of treatment by having knowledge of . As whatever mentioned in Ayurvedic Samhita’s are based on Trisutra. Hetu are the cause of the disease because they vitiate the Dosha . This vitiated Dosha get into six stages of pathogenesis ( Shatkriyakala) of not treated in early stage cause the disease. To avoid further pathogenesis knowledge of Hetu is must. Hetus are also equally to Responsible for both health And illness . Complete knowledge of Hetu will help in proper diagnosis , to know the prognosis and to plan the treatment Accordingly. Linga is the sign and symptoms of the both health and disease. It occurs according to the vitiation and Dominance of the doshas which help in proper diagnosis, Prognosis and treatment of disease. If vaidya is unaware of Lakshana of diseases, he is unable to accurately diagnose, predict the prognosis, and prescribe the appropriate course of treatment. Aushadha is a type of medicine that can be either curative that is, used to treat disease or preventive, maintaining health. Therefore, if Diet and lifestyle are followed in accordance with the Guidelines of ayurveda, one can avoid diseases. If the vaidya( physician) have a complete knowledge of the Trisutra of Ayurveda then they will be perfect to treat of all the disease.

Conclusion

In Ayurveda the Concept of maintenance and promotion of health and treatment of the Disease has explained in the form of Trisutra. Swastha means Dhatusamya, while Atura means Dhatu Vaishamyata and for the maintenance of health (samyavastha ) ,that is conversion of Vishmavastha into samyavastha knowledge of the Trisutra (Hetu, Linga & Aushadha) is essential All the principles of Ayurveda are included under Trisutra and it has been elaborated in detail in Ayurveda In our Samhita’s it is said that successful practice of Vaidya depends on the diagnosing the disease correctly and treatment should be given according to that. Naming of disease is not given that much importance, but knowing the exact causative factor ,pathogenesis and symptoms of disease it is easy to cure the disease . Hetu(Causative factor of disease) is to be avoid for proper treatment. Linga (Symptoms) is an important tool indicating the stage, severity, type of disease. Aushadha (treatment of disease)plays an important role for treatment as well as differential Diagnosis of disease.  Hence we conclude that Trisutra is useful to find Causative factor , do diagnosis and treatment of disease and a Vaidya should understand and evaluate the concept to gain success in Clinical practices.