That means, Signs, Prognosis and Differential Prognosis, Therapy Rules and Trendy Views

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Klama is a time period which we encounter many occasions in Ayurveda literature. Its which means has been interpreted in numerous methods as per situational utilization of the time period. It’s used to explain states of fatigue, exhaustion or useful debility.

Klama is a state of exhaustion of many sorts – bodily, psychological, sensory or all collectively. Such exhaustion could have its origin from many causes, the primary ones being 0

–        Shrama – exertion,

–        Vyadhi – illness processes,

–        Dhatu kshaya – tissue depletion or

–        Dosha Vaishamya – doshic imbalance

Completely different vary of circumstances to contemplate underneath the umbrella time period ‘Klama’

Although generally understood as a state of exhaustion or fatigue, the time period KLAMA encompasses broader dimensions and states resembling

–        lassitude,

–        diminished enthusiasm,

–        decreased physiological effectivity and

–        impaired psychophysical functioning or

–        a mix of 1 or two circumstances talked about above (overlap)

Understanding Klama would give us invaluable insights into understanding power fatigue, exhaustion associated to ongoing illness pathologies, burnout syndromes and circumstances related to tissue depletion. 

Nirukti – Etymology of Klama

The phrase Klama originates from its root phrase Klam which implies to turn out to be weary, exhausted, languid or debilitated.

क्लमः श्रमो ग्लानिर्वा – Klama means Shrama or Glani. Right here, we see that the phrases Klama, Shrama and Glani are interchangeable. This offers totally different meanings for Klama –

–        Fatigue

–        Lassitude

–        Weariness

–        Exhaustion

–        Langour

Definition of Klama

1. Klama is outlined as ‘Anayasa Janya Shrama’.

–        Anayasa = with out bodily exertion

–        Janya = arising from / born out of (has its origin from)

–        Shrama = exhaustion or fatigue

Placing them collectively, Klama could be outlined as – ‘A state of Exhaustion or Fatigue arising with out vital exertion’.

Normally bodily exertion causes exhaustion or fatigue. Klama contains all such circumstances of exhaustion or fatigue that are brought about regardless of the particular person not being bodily exerted.

So Klama is a state which encompasses tiredness, psychological fog, heaviness, weariness or weak spot occurring on account of causes aside from bodily exertion.

It could be linked to varied elements that are contributory, resembling – depletion of ojas, impairment of agni, formation and accumulation of ama within the physique and involvement of Hridaya – coronary heart in a illness course of. It’s distinguished from the traditional post-exertional tiredness.

2. In response to Acharya Sushruta, Klama could be outlined as ‘A lower in bodily capability accompanied by subjective feeling of exhaustion’. Such Klama could be present in Vata problems, states of Kshaya (Dhatu Kshaya) and Abhighata (traumatic circumstances).

3. “कर्मासामर्थ्यम्” – Acharya Chakrapani defines Klama as ‘Lack of ability to carry out regular actions’. This definition explains Klama past a state of being drained and places it when it comes to ‘useful impairment’.

Varied states of exhaustion or weak spot in accordance with Ayurveda / Differential Prognosis of Klama

Under talked about phrases outline a state of tiredness or weak spot and must be contextually understood. Although every of those is probably not a precise state of weak spot or tiredness, weak spot or tiredness are half and parcel of those circumstances.

Amongst all these, Klama is a multidimensional state whereby the physique, thoughts and senses are concerned within the state of being weak or exhausted.

Nidanas for Klama

Klama could happen on account of a variety of causes. They’re as enlisted under –

Sharirika Nidana – Bodily causes –

–        Ati Vyayama – extreme train

–        Ati Gamana – extreme strolling

–        Ati Maithuna – extreme indulgence in sexual actions

–        Ratri Jagarana – extreme and recurring awakening at evening occasions

–        Upavasa – extreme hunger / fasting

Manasika Nidana – Psychological Causes

–        Chinta – extreme pondering / worries

–        Shoka – extreme grief

–        Bhaya – extreme concern

–        Krodha – extreme anger

Vyadhi Sambandhi Nidana – Illness Associated Causes – Klama is a symptom of sure ailments like –

–        Jwara – fever

–        Rajayakshma – power depletion of tissues, tuberculosis

–        Pandu – anaemia

–        Kshaya problems – depletion of tissues

–        Rasa Kshaya – poor formation and provide of dietary fluids within the abdomen

–        Jwara – numerous sorts of fevers

–        Kshata Kshina – emaciation and tissue loss on account of harm

–        Vata Vyadhi – particular vata problems 

Ahara / Poshana Janya – Dietary Causes

–        Alpa Ahara – consumption of much less meals / insufficient diet

–        Dhatu Kshaya – deterioration / destruction of tissues on account of dietary imbalances

–        Kuposhana / Mithya Ahara – malnutrition

Samprapti of Klama – (Hypothetical) Pathogenesis

The pathway of improvement and manifestation of Klama could be of some ways relying on the totally different causes from which it arises. However we will strive to attract a easy hypothetical pathogenesis which is perhaps the frequent pathway resulting in Klama.

As a consequence of totally different causes, there’s extreme expenditure of power from the physique.

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With the intention to compensate for this power, the agni over-works and therefore would get impaired within the course of. There may be hyperfunctioning of dhatu agnis additionally. There may be an imbalance between provide and demand.

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This results in tissue burnouts – dhatu kshaya.

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This ultimately results in diminution of ojas, which is a byproduct of dhatus – chargeable for power and energy.

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This might lead to Klama.

Various Pathway of Samprapti

Nidanas result in Vata Aggravation Dhatu Kshaya → Imbalance between provide and demand of diet → Additional discount of tissue nourishment → Manifestation of Klama

Completely different Dimensions of Manifestation of Klama

Klama is one thing which is past a sense of tiredness.

Dimension or Layer of Klama Manifestation	Manifestation / Signs
Bodily	Fatigue, Weak spot
Psychological	Lack of motivation
Sensory system	Decreased responsiveness Altered sensory notion Weak spot of sensory organs
Purposeful	Decreased work capability, lack of curiosity in doing any work or dedication in direction of it
Emotional	Feeling drained, Mind fog
Physiological	Decreased Effectivity

By this we perceive that Klama is a mix of subjective exhaustion and goal discount in useful functionality.

Understanding Dosha involvement in Klama

1. Vataja Klama – When Klama is attributable to Vata, there’s generalized weak spot, physique pains and tremors. The particular person would get exhausted shortly.

Vataja Klama could also be correlated with power fatigue or cachexia.

2. Pittaja Klama – When Klama is attributable to Pitta, the particular person would expertise fatigue with burning sensation within the physique together with extra thirst and psychological irritability and anger.

Pittaja Klama could also be correlated with fatigue brought about on account of irritation within the physique. Febrile exhaustion may also be included on this class.

3. Kaphaja Klama – When Klama is attributable to Kapha, the particular person would expertise fatigue related to heaviness of the physique, extreme drowsiness and decreased actions and laziness.

Kaphaja Klama could also be correlated with metabolic or obesity-related fatigue.

Understanding Klama from the attitude of Dhatu concerned (attributable to depletion of tissues)

Rasa Kshayaja Klama – When Klama happens on account of Rasa Kshaya, it’s related to thirst and dryness of the physique.

Rakta Kshayaja Klama – When Klama happens on account of Rakta Kshaya, it’s related to pallor.

Mamsa Kshayaja Klama – When Klama happens on account of Mamsa Kshaya, it’s related to muscle weak spot and losing.

Ojo Kshayaja Klama – When Klama happens on account of Ojo Kshaya, it’s related to extreme fatigue / weak spot, decreased vitality and lack of enthusiasm. Klama is an early expression of Ojas depletion, particularly if klama has endured for a protracted period. This will even predispose the particular person in direction of many ailments since immunity shall be compromised with Oja Kshaya.

Dhatu Kshaya will result in Ojas Kshaya which is able to result in Klama and Daurbalya and within the later interval when this progresses, the particular person would turn out to be sufferer of many ailments.

Trendy Biomedical Correlation of Klama

From the data obtainable in Ayurveda treatises and the contexts by which Klama has been talked about as a symptom, complication, premonitory symptom or signal of dangerous prognosis, Klama and its variants embody lots of the fashionable circumstances talked about under, underneath their umbrella.

They’re –

–        Fatigue

–        Persistent Fatigue Syndrome

–        Asthenia

–        Lack of energy

–        Bodily exhaustion / fatigue

–        Psychological exhaustion / fatigue

–        Persistent tiredness

–        Lassitude

–        Exhaustion syndrome

–        Decreased capability to carry out work

Fatigue associated to power circumstances like most cancers may also be included underneath Vyadhija Klama.

Different circumstances –

–        Neurophysiological circumstances like power deficit, decreased ATP era, imbalance of neurotransmitters, irritation of nerves, HPA Axis dysregulation and so forth. could also be thought-about.

–        Stress induced exhaustion

–        Psychological circumstances – like emotional exhaustion and burnouts, decreased motivation and so forth.

Medical Evaluation of Klama

Under talked about domains needs to be thought-about whereas clinically assessing Klama –

1. Bodily situation
2.   Power and endurance
3. Psychological state and stress
4.   Consideration and Motivation
5. Purposeful – each day actions
6. Severity and chronicity of ailments if any and related pathology
7. Immunity

Therapy rules of Klama

Nidana Parivarjana – Therapy of Klama, like all illness, is determined by the causative elements. Retaining away or addressing the causative elements won’t solely assist in treating Klama however will even forestall its recurrence.

Consideration to Agni and Ama, Deepana and Pachana Chikitsa – Agni and its sub-units (dhatvagni) needs to be correctly addressed. The presence of Ama and Sama Doshas / Sama Dhatus and Malas (affiliation of doshas, dhatus and malas with ama) too needs to be accessed and handled accordingly. Medicines which might improve the functioning of Agni (Deepana) and which digest Ama (Pachana) needs to be included.

Substitute and restoration of Dhatus – If dhatu Kshaya is current, Brimhana, Santarpana and Rasayana Chikitsa needs to be thought-about.

Shodhana Chikitsa – If there’s extra morbidity and extreme accumulation of morbid doshas within the physique, Shodhana needs to be thought-about as per dosha or doshas concerned within the pathogenesis of the illness in query which is inflicting Klama.

Brimhana and Rasayana – Persistent and cussed Klama related to any situation or Klama persisting for lengthy period following a illness course of or remedy schedule shall be addressed with Brimhana and Rasayana therapies. This can assist in tissue rejuvenation and would increase immunity. They won’t solely improve and restore the tissues however will even enhance the standing of Ojus within the physique. Kshira – milk and Ghrita – ghee needs to be used as each day Rasayanas (Nitya Rasayanas).

Sattvavajaya Chikitsa – For psychological causes of Klama, psychotherapies needs to be included within the remedy.

Others – Dhyana – meditation and Nidra – satisfactory sleep and Yoga needs to be adopted within the remedy schedule.

Medical point out of Klama in numerous ailments (Madhava Nidana)

Klama as Lakshana (symptom of ailments) is talked about in

–        Amlapitta

–        Udavarta – Adhovata Nirodhaja

–        Tandra

–        Pandu Roga – Sannipataja

–        Pittavruta Udana Vata

–        Pittavruta Vyana Vata

–        Masurika – Vataja

–        Visha – Jangama Visha

Klama as Upadrava (complication of ailments) is talked about in –

–        Vatarakta

–        Hrdroga

Klama as Asadhya Lakshan (symptom indicating dangerous prognosis of ailments) is talked about in –

–        Kumbha Kamala

Associated AIAPGET Questions

1. Anayasa Janya Shrama is –
2. Tandra
3.   Glani
4. Klama
5.   Alasya

Ans – c. Klama

2. In response to Chakrapani ‘Karma Asamartyam’ is –
3. Glani
4.   Shrama
5. Alasya
6.   Klama

Ans – Klama

3. Klama is a symptom of which sort of Udavarta?
4. Purisha Nirodhaja
5.   Kshut Nirodhaja
6. Adhovata Nirodhaja
7.   Trt Nirodhaja

Ans – c. Adhovata Nirodhaja

4. Klama is a symptom of –
5. Pittavruta Udana
6.   Pittavruta Vyana
7. Each a and b
8.   Pittavruta Samana

Ans – c. Each a and b

5. Klama is a symptom talked about in –
6. Gara Visha
7.   Sthavara Visha
8. Jangama Visha
9.   Luta Visha

Ans – c. Jangama Visha

6. Klama isn’t a symptom of
7. Amajirna
8.   Amlapitta
9. Masurika
10.   Tandra

Ans – a. Amajirna

7. Klama is talked about among the many Asadhya Lakshanas of –
8. Mrttikajanya Pandu
9.   Kumbha Kamala
10. Adhoga Raktapitta
11.   Krimi Roga

Ans – Kumbha Kamala

8. Klama is talked about among the many Upadravas of –
9. Amavata
10.   Kroshtushirshaka
11. Vatarakta
12.   Amlapitta

Ans – c. Vatarakta