ISO/TR 4421:2023

Health informatics — Introduction to Ayurveda informatics

This document seeks to establish a baseline understanding of Ayurvedic medicine system. It introduces various elements and processes inherent and integral to Ayurvedic diagnosis and treatment. It establishes concept models for Ayurvedic analysis of a subject which can potentially form the basis of system models. The following topics are out of scope of this document: — concept models and categorial structures for the individual elements of the concept models proposed. — individual Ayurvedic dosage forms or medicines or therapies.

Informatique de santé — Introduction à l'informatique sur l'Ayurveda

General Information

• Status: Published
• Publication Date: 08-Jun-2023
• ICS: 35.240.80 - IT applications in health care technology
• Technical Committee: ISO/TC 215 - Health informatics
• Drafting Committee: ISO/TC 215/WG 10 - Traditional Medicine
• Current Stage: 6060 - International Standard published
• Start Date: 09-Jun-2023
• Due Date: 12-May-2023
• Completion Date: 09-Jun-2023

Standards Content (Sample)

ISO/DTR 4421:2023(E)
2022-02-02
ISO/TC 215
Secretariat: ANSI
Health informatics- — Introduction to Ayurveda informatics

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ISO/DTR 4421:2023(E)
© ISO 2023
All rights reserved. Unless otherwise specified, or required in the context of its implementation,
no part of this publication may be reproduced or utilized otherwise in any form or by any
means, electronic or mechanical, including photocopying, or posting on the internet or an
intranet, without prior written permission. Permission can be requested from either ISO at the
address below or ISO’s member body in the country of the requester.
ISO copyright office
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CH-1214 Vernier, Geneva
Phone: [phone]
Email: [e-mail]
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DTR stage




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ISO/DTR 4421:2023(E)
© ISO 20XX

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part
of this publication may be reproduced or utilized otherwise in any form or by any means, electronic or
mechanical, including photocopying, or posting on the internet or an intranet, without prior written
permission. Permission can be requested from either ISO at the address below or ISO’s member body in the
country of the requester.

ISO copyright office
CP 401 • Ch. de
Blandonnet 8 CH-1214
Vernier, Geneva Phone:
[phone]
Fax: [phone]



















iv © ISO 2023 – All rights reserved

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Published in Switzerland
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ISO/DTR 4421:2023(E)
Contents
Introduction . 5
1 Scope . 1
2 Normative references . 1
3 Terms and definitions . 1
.1 General terms . 2
3
3.2 Characterizing categories . 5
4 Semantic links . 5
4.1 isAppliedTo . 5
4.2 hasCharacteristicOf . 5
4.3 isA . 6
4.4 includes . 6
4.5 utilizes . 6
4.6 resultsIn . 6
5 Concept diagrams . 7
5.1 Subject of healthcare . 7
5.2 Ayurvedic analysis of a healthy subject of healthcare . 7
5.3 Ayurvedic analysis of an unhealthy subject of healthcare . 8
6 Road map for standardization in Ayurveda informatics . 9
Annex A (informative) Fundamental principles of Ayurveda . 11
Bibliography . 23

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ISO/DTR 4421:2023(E)
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national
standards bodies (ISO member bodies). The work of preparing International Standards is normally
carried out through ISO technical committees. Each member body interested in a subject for which a
technical committee has been established has the right to be represented on that committee.
International organizations, governmental and non-governmental, in liaison with ISO, also take part
in the work. ISO collaborates closely with the International Electrotechnical Commission (IEC) on all
matters of electrotechnical standardization.
The procedures used to develop this document and those intended for its further maintenance are
described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for
the different types of ISO documents should be noted. This document was drafted in accordance with
the editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).
Attention is drawn to the possibility that some of the elements of this document may be the subject
of patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details
of any patent rights identified during the development of the document will be in the Introduction
and/or on the ISO list of patent declarations received (see www.iso.org/patents).
Any trade name used in this document is information given for the convenience of users and does not
constitute an endorsement.
For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and
expressions related to conformity assessment, as well as information about ISO's adherence to the
World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see
www.iso.org/iso/foreword.html.
This document was prepared by Technical Committee ISO/TC 215, Health informatics.
Any feedback or questions on this document should be directed to the user’s national standards body.
A complete listing of these bodies can be found at www.iso.org/members.html.

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ISO/DTR 4421:2023(E)
Introduction
Ayurveda, the “science of life”, integrally incorporates the concepts of health and disease and aims
not only at treating a patient but also at maintaining wellbeing of a healthy person by achieving
homeostasis of the body, mind, and spirit; referred to as the holistic approach (see Annex A A).
With an increase in lifestyle-related disorders, there is a worldwide resurgence of interest in
Ayurveda and other holistic systems of healthcare, particularly with respect to the prevention and
management of chronic and non- communicable diseases. Today, more than 110 WHO member states
use herbal medicine and more than 90 WHO member states have reported use of Ayurveda. In most
of these countries Ayurveda treatment is covered inby insurance too.
The globalization of Ayurveda calls for standardization in terms of terminology; clinical examination;
diagnosis; maintenance of health records; interventions in form of herbs, herbal/ herbo-mineral
formulations, diet and lifestyle; pharmaceuticals as well as pharmacovigilance specific to Ayurveda.
Application of standardized informatics tools in Ayurveda is poised to bring robustness in clinical
decision support systems, electronic health records, telemedicine, processing and storage of data,
automation of time consuming, subjective and laborlabour-intensive clinical examination involving
multi-layered parameters, personalized medication, identification of herbs, processing of
formulations, pharmacovigilance and even drug re-positioning.
This document shares the concept diagram of Ayurvedic diagnosis. Since prevention of disease and
maintaining health is an important concept in Ayurveda, the reportthis document shares the concept
diagram for Ayurvedic analysis of a healthy subject in addition to an unhealthy subject.
The potential uses for this categorial structure are to:
— facilitate the representation of Ayurvedic analysis of a subject using a standard core model in a
manner suitable for computer processing.;
— support developers of new terminology systems concerning Ayurvedic medicine systems.;
— facilitate mapping and integration between Ayurvedic and other Traditional medicinal models.;
— facilitate meta-data association, automatic processing of medicinal literature and texts on
Ayurvedic medicine systems and integration of the same with Ayurveda based EHR systems.
The potential beneficiaries of this document include:

—— developers of Ayurveda and other traditional medicine based diagnosis and analysis systems.;
— developers of information systems for patient findings, Ayurvedic medicinal treatment and its
efficacy.;
— informaticians, analysts, researchers who would require common models of knowledge to
facilitate analysis of data available on traditional medicine. ;
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— developers of EHR systems, aiming on interoperability of biomedicine and traditional medicine
based systems.
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TECHNICAL REPORT ISO/DTR 4421:2023(E)

Health informatics- — Introduction to Ayurveda informatics
1 Scope
This document seeks to establish a baseline understanding of Ayurvedic medicine system. It
introduces various elements and processes inherent and integral to Ayurvedic diagnosis and
treatment. It establishes concept models for Ayurvedic analysis of a subject which can potentially
form the basis of system models.
The following topics are out of scope of this document:
— concept models and categorial structures for the individual elements of the concept models
proposed.
— individual Ayurvedic dosage forms or medicines or therapies.
2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
ISO and IEC maintain terminologicalterminology databases for use in standardization at the
following addresses:
— ISO Online browsing platform: available at https://www.iso.org/obphttps://
— IEC Electropedia: available at https://www.electropedia.org/
3.1 3.1 General terms
3.1.1
assessment of signs of the disease
assessment of an observable indication of a disease, injury, or abnormal physiological state that can
be detected during a physical examination, patient history taking, or a diagnostic procedure
3.1.2
assessment of symptoms of the disease
assessment of the something out of the ordinary that is experienced by an individual or reported by
a patient
3.1.3
Ayurveda
science of life where advantageous and disadvantageous, happy and unhappy states of life along with
what is good and bad for life, its measurement and life itself are described
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Note 1 to entry: Ayurveda deals with inter-individual variability for personalized and predictive medicine.
3.1.4
Ayurvedic medicinal treatment
ayurvedic pharmacological intervention involving administration of single herbs or compound
formulations which can be internal or external
3.1.5
Ayurvedic surgery
ayurvedic intervention involving para-surgical or surgical interventions
3.1.6
Ayurvedic therapy
treatment of diseases or disorders, as by remedial, rehabilitating, or curative process described in
Ayurveda
3.1.7
concept
unit of knowledge created by a unique combination of characteristics
[SOURCE: ISO 1087:2019, 3.2.7, modified – notes— Note to entry removed] .]
3.1.8
concept model
concept diagram formed by means of a formal language
[SOURCE: ISO 24156-1:2014, 3.2]
3.1.9
Daivavyapashraya chikitsa
divine therapy
non-pharmacological Ayurvedic intervention involving social and religious rituals based on faith
3.1.10
diagnosis
process of identifying a disease, condition, or injury from its signs and symptoms
Note 1 to entry: A health history, physical exam, and tests, such as blood tests, imaging tests, and biopsies, can
be used to help make a diagnosis.
3.1.11
disease
illness or medical condition, irrespective of origin or source, that presents or could present significant
harm to humans
[SOURCE: WHO-INTERNATIONAL HEALTH REGULATIONS (2005)]
3.1.12
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disease susceptibility
state of being predisposed to, or sensitive to, developing a certain disease
3.1.13
family predisposition
genetic predisposition
increased chance of developing a certain disease based on the genetic makeup
3.1.14
healthcare
care activities, services, management or supplies related to the health of an individual
Note 1 to entry: This includes more than performing procedures for subjects of care. It includes, for example,
the management of information about patients, health status and relations within the healthcare delivery
framework and can also include the management of clinical knowledge.
[SOURCE: ISO/TR 18307:2001, 3.70, modified – activities— "Activities" and "management" added] ,
note 1 to entry modified.]
3.1.15
healthy subject of healthcare
healthy person who uses, or is a potential user of, a health care service for the purpose of
maintenance of health
3.1.16
herbs
crude plant material, such as leaves, flowers, fruit, seeds, stems, wood, bark, roots, rhizomes or other
plant parts, which can be entire, fragmented or powdered
3.1.17
intervention
treatment, procedure, or other action taken to prevent or treat disease, or improve health in other
ways
3.1.18
logical information model
information model that specifies the structures and relationships between data elements but is
independent of any particular technology or implementation environment
[SOURCE: ISO 13972:2022, 3.1.8] , modified — Second preferred term removed.]
3.1.19
miscellaneous factors
miscellaneous risk factors
different kinds of factors that have a potential to affect one’s health
3.1.20
occupational factors
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occupational risk factors
health risk factors associated with one's work or profession
3.1.21.1.21
personalized diet
tailored nutritional recommendations that promote and maintain an individual's health and helps to
fight against existing diseases
3.1.22
personalized lifestyle
tailored lifestyle recommendations that promote and maintain an individual's health and helps to
fight against existing diseases
3.1.23
prakriti
phenotype
body constitution type as per Ayurveda
3.1.24
preventive intervention
activity undertaken with the objective of improving human health by preventing disease, by curing
or reducing the severity or duration of an existing disease, or by restoring function lost through
disease or injury
3.1.25
Satvavjaya chikitsa
psychotherapy
non-pharmacological Ayurvedic intervention primarily aimed at behaviorbehaviour correction by
virtue of counselling, Yoga and meditation
3.1.26
staging of disease
Shadvidha kriyakaala
classification system that uses diagnostic findings to produce clusters of patients who require similar
treatment and have similar expected outcomes
3.1.27
subject of healthcare
person who uses, or is a potential user of, a health care service
[SOURCE: ISO/TS 22220:2011, 3.2]
3.1.28
treatment
attempted remediation of a health problem, usually following a diagnosis
3.1.29
unhealthy subject of healthcare
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unhealthy person who uses, or is a potential user of, a health care service for diagnosis, treatment,
mitigation or cure of any specific disease, signs and/ or symptoms
3.1.30
use case diagram
a diagram that shows relations between actors and use cases.
[SOURCE: ISO 13374-2:2007, 0000_68]
3.1.31
vikriti
disturbed homeostasis leading to the condition of suffering from a disease
3.1.32
Yuktivyapashraya chikitsa
rational therapy
ayurvedic pharmacological intervention which can be internal or external
3.2 3.2 Characterizing categories
3.2.1
ayurvedic analysis of a healthy subject of healthcare
process of Ayurvedic analysis where the four factors, i.e. prakriti (3.1.23), family predisposition
(3.1.13), occupational factors (3.1.20) and miscellaneous factors (3.1.19) are taken into consideration
3.2.2
ayurvedic analysis of an unhealthy subject of healthcare
process of Ayurvedic analysis where the five factors, i.e. vikriti (3.1.31), prakriti (3.1.23), family
predisposition (3.1.13), occupational factors (3.1.20) and miscellaneous factors (3.1.19) are taken into
consideration.
Note 1 to entry: In case of an unhealthy subject of healthcare, the processes of disease diagnosis (3.1.10), staging
of disease (3.1.26) and assessment of signs of disease (3.1.1) and assessment of symptoms of disease (3.1.2) are
used to elaborate the attributes associated with vikriti (3.1.31) or disease (3.1.11).
4 Semantic links
4.1 isAppliedTo
Relationship between the process and subject of healthcare (see 3.1.27).
It is the representation of the semantic link between the (see 3.1.27) and the
process of (see 3.2.1, 3.2.2) resulting into personalized diagnosis and
(see 3.1.28).
EXAMPLE isAppliedTo .
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4.2 hasCharacteristicOf
Characteristics/ data associated with a subject of healthcare (see 3.1.27).
It is the representation of the semantic link between the (see 3.1.27) and the
primary findings/ characteristics of the subject.
EXAMPLE hasCharacteristicOf >.
4.3 isA
Property of the main element is being inherited by the child.
It is the representation of the semantic link between two elements where the child element inherits
all the properties of a parent element.
EXAMPLE isA >.
4.4 includes
Products or processes being implemented as an integral part of the analysis of a subject of healthcare
(see 3.1.27) in Ayurveda (see 3.1.3).
It is the representation of the semantic link between processes or products with another process or
product where one is essential for successful completion of the other.
EXAMPLE includes >.
4.5 utilizes
Facts or information essential to the analysis of a subject of healthcare (see 3.1.27) in Ayurveda (see
3.1.3).
It is the representation of the semantic link between facts or information with a process where the
fact or information is for successful completion of the other.
EXAMPLE utilizes >.
4.6 resultsIn
Conclusion of the process of analysis of a subject of healthcare (see 3.1.27) in Ayurveda (see 3.1.3).
It is the representation of the semantic link between (see 3.1.31) prescribed or
conclusion of the process of analysis of (see 3.1.27) in (see 3.1.3).
EXAMPLE resultsIn < satvavajaya chikitsa>>.
5 Concept models
5.1 Subject of healthcare
The concept model for subject of healthcare (see 3.1.27) bifurcates the subject into two categories
based on the attribute and characteristics. The formal concept model outlines the inheritance and
semantic links (see Clause 4) in Figure 1.
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Figure 1 –— Concept model for representation of subjects of healthcare in Ayurveda
5.2 Ayurvedic analysis of a healthy subject of healthcare
The formal concept representation system for Ayurvedic analysis of a healthy subject of healthcare
(see 3.2.1) and semantic links (see Clause 4) is illustrated through the concept model in Figure 2. It
would also act as a logical information model (see 3.1.18) for an Ayurveda (see 3.1.3) based analysis
application.

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Figure 2 –— Concept model for representation of the process of Ayurvedic analysis of a
healthy subject of healthcare
Use case representation based on the concept model above in Figure 2 is illustrated through Figure 3.
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Figure 3 –— Use case diagram for representation of the process of Ayurvedic analysis of a
healthy subject of healthcare.
5.3 Ayurvedic analysis of an unhealthy subject of healthcare
The formal concept representation system for the Ayurvedic analysis of an unhealthy subject of
healthcare (see 3.2.2) and semantic links (see Clause 4) is illustrated through the concept model in
Figure 4.
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Figure 4 –— Concept model for representation of the process of Ayurvedic analysis of an
unhealthy subject of healthcare
Use case representation based on the concept model above in Figure 4 is illustrated through Figure 5.

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Figure 5 –— Use case diagram for representation of the process of Ayurvedic analysis of an
unhealthy subject of healthcare
6 Road map for standardization in Ayurveda informatics
The use case scenarios of processes of Ayurvedic analysis of a healthy subject of healthcare and an
unhealthy subject of healthcare decipher the broad contours of the important attributes which define
the roadmap for standardization in the domain of Ayurveda informatics.
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Annex A
(informative)

Fundamental principles of Ayurveda
A.1 A.1 Concept of trisutra
Ayurveda describes the approach to network medicine by virtue of trisutra (see Figure A.1), meaning
the three interconnected aspects including causes (hetu), features (linga or lakshana) and
therapeutics (aushadha) both for healthy and diseased people (see Figure A.2).
Causes of diseases (hetu), are ascribed to lifestyle, dietary regimen, and thought processes that affect
the behavior of various metabolic pathways. These are described with signs and symptoms (linga or
lakshana), and the correction of the disturbed metabolic pathways is done through both natural and
therapeutic interventions (aushadha).


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Figure A.1 –—Trisutra Ayurveda
The disturbance, restoration, or suitability in a human system is assessed, modulated, or predicted,
respectively, through the management of tridosha by appropriate drug, dietary, and lifestyle
recommendations in a personalized manner. This includes detoxification with panchakarma
therapeutics both in health and disease states.

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Figure A.2 –—Trisutra Ayurveda in reference to healthy and diseased
The nature and state of disease, the strength of the diseased individual compared with his baseline
health state, and the geo-climatic environment all are considered for deciding the line of treatment.
A.2 A.2 Concept of Guna
Guna refers to a property of a medicine detected by sense organs other than the tongue. They are 20
in number and represent the characteristics of the elements. There are 10 pairs of contrasting
characteristics – guru (heavy)/ laghu (light), manda (dull)/ tikshna (sharp), shita (cold)/ ushna (hot),
snigdha (unctuous)/ ruksha (non-unctuous), shlakshna (smooth)/ khara (rough), sthira (immobile)/
sara (mobile), mridu (soft)/ kathina (hard), vishada (clear)/ picchila (slimy), sandra (solid)/ drava
(fluid), sthula (bulky)/ sukshma (fine).
A.3 A.3 Pathology in Ayurveda
According to Ayurveda, there are three main causes of disease, namely asatmyendriyartha samyoga
(indiscriminate use of senses and their objects), prajnaparadha (error of intellect resulting in a loss
of discrimination between wholesome and unwholesome with subsequent indulgence in
unwholesome diets and behaviour) and parinama (seasonal variation, cosmic effects and the effects
of time).
Disease examination is done using parameters likesuch as nidana (causative factors of the disease),
purvarupa (prodromal symptoms), rupa (clinical features – signs and symptoms), upashaya –
anupshaya (aggravating and pacifying dietary and lifestyle factors) and samprapti (pathogenesis of
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the disease from exposure to manifestation). These are collectively referred to as pancha lakshana
nidana (the five components of the pathology of a disease).
Patient examination is done using modalities likesuch as trividha pareeksha (threefold examination
of a patient) comprising of darshana (examination by inspection), sparshana (examination by touch)
and prashna (examination by interrogation); shadvidha pareeksha (sixfold examination of a patient)
comprising of examination by inspection, through smell, auscultation, through taste, through touch
and by asking questions; ashtavidha pareeksha (eightfold examination of a patient) including
examination of nadi (pulse), mala (stool), mootra (urine), jihwa (tongue), shabda (sounds), sparsha
(touch), drik (eyes) and aakriti (built/ gait/ decubitus); dashavidha pareeksha (tenfold examination)
comprising of assessment of prakriti (body constitution), vikriti (morbidity status), saara (essence of
body tissues), samhanana (compactness of the body), pramaana (anthropometry), saatmya
(suitability), satva (mental faculties), aahara shakti (appetite), vyaayama shakti (physical stamina)
and vaya (age).
The concept of shatkriyakala (six stages of pathogenesis) is vital for understanding of the
pathological samprapti (states) of the doshas that result in disease. These are sanchaya
(accumulation), prakopa (aggravation), prasara (overflowing), sthanasamshraya (localization),
vyakta (manifestation) and bheda (classification or dissolution) of doshas. The concept refers to the
recognition of the stage of a disease's progress, which helps to determine appropriate measure to
correct the imbalance in doshas. Here ‘kriya’ means the choice to treatment (medicine, food and
daily-routine) used to improve the disturbance in doshas, and ‘kala’ refers to the stage of progress of
a disease.
A.4 A.4 Pharmacology in Ayurveda
In Ayurveda, substances of natural origin are used as medicines which act on the principles of
samanya (homologous) and vishesha (antagonistic) action. Substances possessing homologous
properties and actions increase the relevant elemental properties or constituents of the body while
those having antagonistic properties or actions decrease those properties or constituents. In cases of
disease or imbalance, the rational use of naturally available substances aims to restore normalcy.
In Ayurvedic pharmacology a given drug action is attributed to certain principles/ d
...

FINAL
TECHNICAL ISO/DTR
DRAFT
REPORT 4421
ISO/TC 215
Health informatics — Introduction to
Secretariat: ANSI
Ayurveda informatics
Voting begins on:
2023-02-21
Informatique de santé — Introduction à l'informatique sur l'Ayurveda
Voting terminates on:
2023-04-18
RECIPIENTS OF THIS DRAFT ARE INVITED TO
SUBMIT, WITH THEIR COMMENTS, NOTIFICATION
OF ANY RELEVANT PATENT RIGHTS OF WHICH
THEY ARE AWARE AND TO PROVIDE SUPPOR TING
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BEING ACCEPTABLE FOR INDUSTRIAL, TECHNO-
ISO/DTR 4421:2023(E)
LOGICAL, COMMERCIAL AND USER PURPOSES,
DRAFT INTERNATIONAL STANDARDS MAY ON
OCCASION HAVE TO BE CONSIDERED IN THE
LIGHT OF THEIR POTENTIAL TO BECOME STAN-
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NATIONAL REGULATIONS. © ISO 2023

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ISO/DTR 4421:2023(E)
FINAL
TECHNICAL ISO/DTR
DRAFT
REPORT 4421
ISO/TC 215
Health informatics — Introduction to
Secretariat: ANSI
Ayurveda informatics
Voting begins on:
Informatique de santé — Introduction à l'informatique sur l'Ayurveda
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All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may
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the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address below
or ISO’s member body in the country of the requester.
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LOGICAL, COMMERCIAL AND USER PURPOSES,
DRAFT INTERNATIONAL STANDARDS MAY ON
Published in Switzerland
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DARDS TO WHICH REFERENCE MAY BE MADE IN
ii
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NATIONAL REGULATIONS. © ISO 2023

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ISO/DTR 4421:2023(E)
Contents Page
Foreword .iv
Introduction .v
1 Scope . 1
2 Normative references . 1
3 Terms and definitions . 1
3.1 General terms . 1
3.2 Characterizing categories . 4
4 Semantic links . 4
4.1 isAppliedTo . 4
4.2 hasCharacteristicOf . 5
4.3 isA . . 5
4.4 includes . 5
4.5 utilizes . 5
4.6 resultsIn. 5
5 Concept models . 5
5.1 Subject of healthcare . 5
5.2 Ayurvedic analysis of a healthy subject of healthcare . 6
5.3 Ayurvedic analysis of an unhealthy subject of healthcare . 8
6 Road map for standardization in Ayurveda informatics .10
Annex A (informative) Fundamental principles of Ayurveda .11
Bibliography .21
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ISO/DTR 4421:2023(E)
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out
through ISO technical committees. Each member body interested in a subject for which a technical
committee has been established has the right to be represented on that committee. International
organizations, governmental and non­governmental, in liaison with ISO, also take part in the work.
ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of
electrotechnical standardization.
The procedures used to develop this document and those intended for its further maintenance are
described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the
different types of ISO documents should be noted. This document was drafted in accordance with the
editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).
Attention is drawn to the possibility that some of the elements of this document may be the subject of
patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of
any patent rights identified during the development of the document will be in the Introduction and/or
on the ISO list of patent declarations received (see www.iso.org/patents).
Any trade name used in this document is information given for the convenience of users and does not
constitute an endorsement.
For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and
expressions related to conformity assessment, as well as information about ISO's adherence to
the World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see
www.iso.org/iso/foreword.html.
This document was prepared by Technical Committee ISO/TC 215, Health informatics.
Any feedback or questions on this document should be directed to the user’s national standards body. A
complete listing of these bodies can be found at www.iso.org/members.html.
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ISO/DTR 4421:2023(E)
Introduction
Ayurveda, the “science of life”, integrally incorporates the concepts of health and disease and aims not
only at treating a patient but also at maintaining wellbeing of a healthy person by achieving homeostasis
of the body, mind, and spirit; referred to as the holistic approach (see Annex A).
With an increase in lifestyle-related disorders, there is a worldwide resurgence of interest in Ayurveda
and other holistic systems of healthcare, particularly with respect to the prevention and management
of chronic and non- communicable diseases. Today, more than 110 WHO member states use herbal
medicine and more than 90 WHO member states have reported use of Ayurveda. In most of these
countries Ayurveda treatment is covered by insurance too.
The globalization of Ayurveda calls for standardization in terms of terminology; clinical examination;
diagnosis; maintenance of health records; interventions in form of herbs, herbal/ herbo-mineral
formulations, diet and lifestyle; pharmaceuticals as well as pharmacovigilance specific to Ayurveda.
Application of standardized informatics tools in Ayurveda is poised to bring robustness in clinical
decision support systems, electronic health records, telemedicine, processing and storage of data,
automation of time consuming, subjective and labour-intensive clinical examination involving multi-
layered parameters, personalized medication, identification of herbs, processing of formulations,
pharmacovigilance and even drug re­positioning.
This document shares the concept diagram of Ayurvedic diagnosis. Since prevention of disease and
maintaining health is an important concept in Ayurveda, this document shares the concept diagram for
Ayurvedic analysis of a healthy subject in addition to an unhealthy subject.
The potential uses for this categorial structure are to:
— facilitate the representation of Ayurvedic analysis of a subject using a standard core model in a
manner suitable for computer processing;
— support developers of new terminology systems concerning Ayurvedic medicine systems;
— facilitate mapping and integration between Ayurvedic and other Traditional medicinal models;
— facilitate meta-data association, automatic processing of medicinal literature and texts on Ayurvedic
medicine systems and integration of the same with Ayurveda based EHR systems.
The potential beneficiaries of this document include:
— developers of Ayurveda and other traditional medicine based diagnosis and analysis systems;
— developers of information systems for patient findings, Ayurvedic medicinal treatment and its
efficacy;
— informaticians, analysts, researchers who would require common models of knowledge to facilitate
analysis of data available on traditional medicine;
— developers of EHR systems, aiming on interoperability of biomedicine and traditional medicine
based systems.
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TECHNICAL REPORT ISO/DTR 4421:2023(E)
Health informatics — Introduction to Ayurveda informatics
1 Scope
This document seeks to establish a baseline understanding of Ayurvedic medicine system. It introduces
various elements and processes inherent and integral to Ayurvedic diagnosis and treatment. It
establishes concept models for Ayurvedic analysis of a subject which can potentially form the basis of
system models.
The following topics are out of scope of this document:
— concept models and categorial structures for the individual elements of the concept models
proposed.
— individual Ayurvedic dosage forms or medicines or therapies.
2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
ISO and IEC maintain terminology databases for use in standardization at the following addresses:
— ISO Online browsing platform: available at https:// www .iso .org/ obp
— IEC Electropedia: available at https:// www .electropedia .org/
3.1 General terms
3.1.1
assessment of signs of disease
assessment of an observable indication of a disease, injury, or abnormal physiological state that can be
detected during a physical examination, patient history taking, or a diagnostic procedure
3.1.2
assessment of symptoms of disease
assessment of the something out of the ordinary that is experienced by an individual or reported by a
patient
3.1.3
Ayurveda
science of life where advantageous and disadvantageous, happy and unhappy states of life along with
what is good and bad for life, its measurement and life itself are described
Note 1 to entry: Ayurveda deals with inter-individual variability for personalized and predictive medicine.
3.1.4
Ayurvedic medicinal treatment
ayurvedic pharmacological intervention involving administration of single herbs or compound
formulations which can be internal or external
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3.1.5
Ayurvedic surgery
ayurvedic intervention involving para-surgical or surgical interventions
3.1.6
Ayurvedic therapy
treatment of diseases or disorders, as by remedial, rehabilitating, or curative process described in
Ayurveda
3.1.7
concept
unit of knowledge created by a unique combination of characteristics
[SOURCE: ISO 1087:2019, 3.2.7, modified — Note to entry removed.]
3.1.8
concept model
concept diagram formed by means of a formal language
[SOURCE: ISO 24156-1:2014, 3.2]
3.1.9
Daivavyapashraya chikitsa
divine therapy
non-pharmacological Ayurvedic intervention involving social and religious rituals based on faith
3.1.10
diagnosis
process of identifying a disease, condition, or injury from its signs and symptoms
Note 1 to entry: A health history, physical exam, and tests, such as blood tests, imaging tests, and biopsies can be
used to help make a diagnosis.
3.1.11
disease
illness or medical condition, irrespective of origin or source, that presents or could present significant
harm to humans
[SOURCE: WHO (2005)]
3.1.12
disease susceptibility
state of being predisposed to, or sensitive to, developing a certain disease
3.1.13
family predisposition
genetic predisposition
increased chance of developing a certain disease based on the genetic makeup
3.1.14
healthcare
care activities, services, management or supplies related to the health of an individual
Note 1 to entry: This includes more than performing procedures for subjects of care. It includes, for example, the
management of information about patients, health status and relations within the healthcare delivery framework
and can also include the management of clinical knowledge.
[SOURCE: ISO/TR 18307:2001, 3.70, modified — "Activities" and "management" added, note 1 to entry
modified.]
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3.1.15
healthy subject of healthcare
healthy person who uses, or is a potential user of, a health care service for the purpose of maintenance
of health
3.1.16
herbs
crude plant material, such as leaves, flowers, fruit, seeds, stems, wood, bark, roots, rhizomes or other
plant parts, which can be entire, fragmented or powdered
3.1.17
intervention
treatment, procedure, or other action taken to prevent or treat disease, or improve health in other ways
3.1.18
logical information model
information model that specifies the structures and relationships between data elements but is
independent of any particular technology or implementation environment
[SOURCE: ISO 13972:2022, 3.1.8, modified — Second preferred term removed.]
3.1.19
miscellaneous factors
miscellaneous risk factors
different kinds of factors that have a potential to affect one’s health
3.1.20
occupational factors
occupational risk factors
health risk factors associated with one's work or profession
3.1.21
personalized diet
tailored nutritional recommendations that promote and maintain an individual's health and helps to
fight against existing diseases
3.1.22
personalized lifestyle
tailored lifestyle recommendations that promote and maintain an individual's health and helps to fight
against existing diseases
3.1.23
prakriti
phenotype
body constitution type as per Ayurveda
3.1.24
preventive intervention
activity undertaken with the objective of improving human health by preventing disease, by curing or
reducing the severity or duration of an existing disease, or by restoring function lost through disease
or injury
3.1.25
Satvavjaya chikitsa
psychotherapy
non-pharmacological Ayurvedic intervention primarily aimed at behaviour correction by virtue of
counselling, Yoga and meditation
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ISO/DTR 4421:2023(E)
3.1.26
staging of disease
Shadvidha kriyakaala
classification system that uses diagnostic findings to produce clusters of patients who require similar
treatment and have similar expected outcomes
3.1.27
subject of healthcare
person who uses, or is a potential user of, a health care service
[SOURCE: ISO/TS 22220:2011, 3.2]
3.1.28
treatment
attempted remediation of a health problem, usually following a diagnosis
3.1.29
unhealthy subject of healthcare
unhealthy person who uses, or is a potential user of, a health care service for diagnosis, treatment,
mitigation or cure of any specific disease, signs and/ or symptoms
3.1.30
use case diagram
diagram that shows relations between actors and use cases
3.1.31
vikriti
disturbed homeostasis leading to the condition of suffering from a disease
3.1.32
Yuktivyapashraya chikitsa
rational therapy
ayurvedic pharmacological intervention which can be internal or external
3.2 Characterizing categories
3.2.1
ayurvedic analysis of a healthy subject of healthcare
process of Ayurvedic analysis where the four factors, i.e. prakriti (3.1.23), family predisposition (3.1.13),
occupational factors (3.1.20) and miscellaneous factors (3.1.19) are taken into consideration
3.2.2
ayurvedic analysis of an unhealthy subject of healthcare
process of Ayurvedic analysis where the five factors, i.e. vikriti (3.1.31), prakriti (3.1.23), family
predisposition (3.1.13), occupational factors (3.1.20) and miscellaneous factors (3.1.19) are taken into
consideration.
Note 1 to entry: In case of an unhealthy subject of healthcare, the processes of disease diagnosis (3.1.10), staging
of disease (3.1.26) and assessment of signs of disease (3.1.1) and assessment of symptoms of disease (3.1.2) are used
to elaborate the attributes associated with vikriti (3.1.31) or disease (3.1.11).
4 Semantic links
4.1 isAppliedTo
Relationship between the process and subject of healthcare (see 3.1.27).
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It is the representation of the semantic link between the (see 3.1.27) and the
process of (see 3.2.1, 3.2.2) resulting into personalized diagnosis and
(see 3.1.28).
EXAMPLE isAppliedTo .
4.2 hasCharacteristicOf
Characteristics/ data associated with a subject of healthcare (see 3.1.27).
It is the representation of the semantic link between the (see 3.1.27) and the
primary findings/ characteristics of the subject.
EXAMPLE hasCharacteristicOf .
4.3 isA
Property of the main element is being inherited by the child.
It is the representation of the semantic link between two elements where the child element inherits all
the properties of a parent element.
EXAMPLE isA .
4.4 includes
Products or processes being implemented as an integral part of the analysis of a subject of healthcare
(see 3.1.27) in Ayurveda (see 3.1.3).
It is the representation of the semantic link between processes or products with another process or
product where one is essential for successful completion of the other.
EXAMPLE includes .
4.5 utilizes
Facts or information essential to the analysis of a subject of healthcare (see 3.1.27) in Ayurveda (see
3.1.3).
It is the representation of the semantic link between facts or information with a process where the fact
or information is for successful completion of the other.
EXAMPLE utilizes .
4.6 resultsIn
Conclusion of the process of analysis of a subject of healthcare (see 3.1.27) in Ayurveda (see 3.1.3).
It is the representation of the semantic link between (see 3.1.31) prescribed or conclusion
of the process of analysis of (see 3.1.27) in (see 3.1.3).
EXAMPLE resultsIn < satvavajaya chikitsa>.
5 Concept models
5.1 Subject of healthcare
The concept model for subject of healthcare (see 3.1.27) bifurcates the subject into two categories based
on the attribute and characteristics. The formal concept model outlines the inheritance and semantic
links (see Clause 4) in Figure 1.
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ISO/DTR 4421:2023(E)
Figure 1 — Concept model for representation of subjects of healthcare in Ayurveda
5.2 Ayurvedic analysis of a healthy subject of healthcare
The formal concept representation system for Ayurvedic analysis of a healthy subject of healthcare
(see 3.2.1) and semantic links (see Clause 4) is illustrated through the concept model in Figure 2. It
would also act as a logical information model (see 3.1.18) for an Ayurveda (see 3.1.3) based analysis
application.
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ISO/DTR 4421:2023(E)
Figure 2 — Concept model for representation of the process of Ayurvedic analysis of a healthy
subject of healthcare
Use case representation based on the concept model in Figure 2 is illustrated through Figure 3.
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Figure 3 — Use case diagram for representation of the process of Ayurvedic analysis of a
healthy subject of healthcare
5.3 Ayurvedic analysis of an unhealthy subject of healthcare
The formal concept representation system for the Ayurvedic analysis of an unhealthy subject of
healthcare (see 3.2.2) and semantic links (see Clause 4) is illustrated through the concept model in
Figure 4.
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Figure 4 — Concept model for representation of the process of Ayurvedic analysis of an
unhealthy subject of healthcare
Use case representation based on the concept model in Figure 4 is illustrated through Figure 5.
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Figure 5 — Use case diagram for representation of the process of Ayurvedic analysis of an
unhealthy subject of healthcare
6 Road map for standardization in Ayurveda informatics
The use case scenarios of processes of Ayurvedic analysis of a healthy subject of healthcare and an
unhealthy subject of healthcare decipher the broad contours of the important attributes which define
the roadmap for standardization in the domain of Ayurveda informatics.
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ISO/DTR 4421:2023(E)
Annex A
(informative)

Fundamental principles of Ayurveda
A.1 Concept of trisutra
Ayurveda describes the approach to network medicine by virtue of trisutra (see Figure A.1), meaning
the three interconnected aspects including causes (hetu), features (linga or lakshana) and therapeutics
(aushadha) both for healthy and diseased people (see Figure A.2).
Causes of diseases (hetu), are ascribed to lifestyle, dietary regimen, and thought processes that affect
the behavior of various metabolic pathways. These are described with signs and symptoms (linga or
lakshana), and the correction of the disturbed metabolic pathways is done through both natural and
therapeutic interventions (aushadha).
Figure A.1 — Trisutra Ayurveda
The disturbance, restoration, or suitability in a human system is assessed, modulated, or predicted,
respectively, through the management of tridosha by appropriate drug, dietary, and lifestyle
recommendations in a personalized manner. This includes detoxification with panchakarma
therapeutics both in health and disease states.
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Figure A.2 — Trisutra Ayurveda in reference to healthy and diseased
The nature and state of disease, the strength of the diseased individual compared with his baseline
health state, and the geo­climatic environment all are considered for deciding the line of treatment.
A.2 Concept of Guna
Guna refers to a property of a medicine detected by sense organs other than the tongue. They are
20 in number and represent the characteristics of the elements. There are 10 pairs of contrasting
characteristics – guru (heavy)/ laghu (light), manda (dull)/ tikshna (sharp), shita (cold)/ ushna (hot),
snigdha (unctuous)/ ruksha (non-unctuous), shlakshna (smooth)/ khara (rough), sthira (immobile)/
sara (mobile), mridu (soft)/ kathina (hard), vishada (clear)/ picchila (slimy), sandra (solid)/ drava
(fluid), sthula (bulky)/ sukshma (fine).
A.3 Pathology in Ayurveda
According to Ayurveda, there are three main causes of disease, namely asatmyendriyartha samyoga
(indiscriminate use of senses and their objects), prajnaparadha (error of intellect resulting in a loss
of discrimination between wholesome and unwholesome with subsequent indulgence in unwholesome
diets and behaviour) and parinama (seasonal variation, cosmic effects and the effects of time).
Disease examination is done using parameters such as nidana (causative factors of the disease),
purvarupa (prodromal symptoms), rupa (clinical features – signs and symptoms), upashaya –
anupshaya (aggravating and pacifying dietary and lifestyle factors) and samprapti (pathogenesis of the
disease from exposure to manifestation). These are collectively referred to as pancha lakshana nidana
(the five components of the pathology of a disease).
Patient examination is done using modalities such as trividha pareeksha (threefold examination of
a patient) comprising of darshana (examination by inspection), sparshana (examination by touch)
and prashna (examination by interrogation); shadvidha pareeksha (sixfold examination of a patient)
comprising of examination by inspection, through smell, auscultation, through taste, through touch and
by asking questions; ashtavidha pareeksha (eightfold examination of a patient) including examination
of nadi (pulse), mala (stool), mootra (urine), jihwa (tongue), shabda (sounds), sparsha (touch), drik
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(eyes) and aakriti (built/ gait/ decubitus); dashavidha pareeksha (tenfold examination) comprising of
assessment of prakriti (body constitution), vikriti (morbidity status), saara (essence of body tissues),
samhanana (compactness of the body), pramaana (anthropometry), saatmya (suitability), satva (mental
faculties), aahara shakti (appetite), vyaayama shakti (physical stamina) and vaya (age).
The concept of shatkriyakala (six stages of pathogenesis) is vital for understanding of the pathological
samprapti (states) of the doshas that result in disease. These are sanchaya (accumulation), prakopa
(aggravation), prasara (overflowing), sthanasamshraya (localization), vyakta (manifestation) and
bheda (classification or dissolution) of doshas. The concept refers to the recognition of the stage of a
disease's progress, which helps to determine appropriate measure to correct the imbalance in doshas.
Here ‘kriya’ means the choice to treatment (medicine, food and daily-routine) used to improve the
disturbance in doshas, and ‘kala’ refers to the stage of progress of a disease.
A.4 Pharmacology in Ayurveda
In Ayurveda, substances of natural origin are used as medicines which act on the principles of samanya
(homologous) and vishesha (antagonistic) action. Substances possessing homologous properties and
actions increase the relevant elemental properties or constituents of the body while those having
antagonistic properties or actions decrease those properties or constituents. In cases of disease or
imbalance, the rational use of naturally available substances aims to restore normalcy.
In Ayurvedic pharmacology a given drug action is attributed to certain principles/ doctrines namely
r
...