Klama: Meaning, Symptoms, Diagnosis and Differential Diagnosis, Treatment Principles and Modern Perspectives

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

Klama is a term which we encounter many times in Ayurveda literature. Its meaning has been interpreted in different ways as per situational usage of the term. It is used to describe states of fatigue, exhaustion or functional debility.

Klama is a state of exhaustion of many kinds – physical, mental, sensory or all together. Such exhaustion may have its origin from many causes, the main ones being 0

–        Shrama – exertion,

–        Vyadhi – disease processes,

–        Dhatu kshaya – tissue depletion or

–        Dosha Vaishamya – doshic imbalance

Different range of conditions to consider under the umbrella term ‘Klama’

Though commonly understood as a state of exhaustion or fatigue, the term KLAMA encompasses broader dimensions and states such as

–        lassitude,

–        diminished enthusiasm,

–        reduced physiological efficiency and

–        impaired psychophysical functioning or

–        a combination of one or two conditions mentioned above (overlap)

Understanding Klama would give us valuable insights into understanding chronic fatigue, exhaustion related to ongoing disease pathologies, burnout syndromes and conditions associated with tissue depletion. 

Nirukti – Etymology of Klama

The word Klama originates from its root word Klam which means to become weary, exhausted, languid or debilitated.

क्लमः श्रमो ग्लानिर्वा – Klama means Shrama or Glani. Here, we see that the words Klama, Shrama and Glani are interchangeable. This gives different meanings for Klama –

–        Fatigue

–        Lassitude

–        Weariness

–        Exhaustion

–        Langour

Definition of Klama

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

–        Anayasa = without physical exertion

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

–        Shrama = exhaustion or fatigue

Putting them together, Klama can be defined as – ‘A state of Exhaustion or Fatigue arising without significant exertion’.

Usually physical exertion causes exhaustion or fatigue. Klama includes all such conditions of exhaustion or fatigue which are caused in spite of the person not being physically exerted.

So Klama is a state which encompasses tiredness, mental fog, heaviness, weariness or weakness occurring due to reasons other than physical exertion.

It may be linked to various factors which are contributory, such as – depletion of ojas, impairment of agni, formation and accumulation of ama in the body and involvement of Hridaya – heart in a disease process. It is distinguished from the normal post-exertional tiredness.

2. According to Acharya Sushruta, Klama can be defined as ‘A decrease in physical capacity accompanied by subjective feeling of exhaustion’. Such Klama can be found in Vata disorders, states of Kshaya (Dhatu Kshaya) and Abhighata (traumatic conditions).

3. “कर्मासामर्थ्यम्” – Acharya Chakrapani defines Klama as ‘Inability to perform normal activities’. This definition explains Klama beyond a state of being tired and puts it in terms of ‘functional impairment’.

Various states of exhaustion or weakness according to Ayurveda / Differential Diagnosis of Klama

Below mentioned terms define a state of tiredness or weakness and needs to be contextually understood. Though each of these may not be an exact state of weakness or tiredness, weakness or tiredness are part and parcel of these conditions.

Condition	Features (Modern Equivalent)
Klama	Persistent Exhaustion
Shrama	Exertional Fatigue
Glani	Mental and Physical Exhaustion / Depression
Alasya	Laziness, Disinterest or unwillingness in doing any kind of work
Tandra	Drowziness
Daurbalya	Weakness, Fatigue
Karshya	Emaciation

Among all these, Klama is a multidimensional state wherein the body, mind and senses are involved in the state of being weak or exhausted.

Nidanas for Klama

Klama may occur due to a wide range of causes. They are as enlisted below –

Sharirika Nidana – Physical causes –

–        Ati Vyayama – excessive exercise

–        Ati Gamana – excessive walking

–        Ati Maithuna – excessive indulgence in sexual activities

–        Ratri Jagarana – excessive and habitual awakening at night times

–        Upavasa – excessive starvation / fasting

Manasika Nidana – Psychological Causes

–        Chinta – excessive thinking / worries

–        Shoka – excessive grief

–        Bhaya – excessive fear

–        Krodha – excessive anger

Vyadhi Sambandhi Nidana – Disease Related Causes – Klama is a symptom of certain diseases like –

–        Jwara – fever

–        Rajayakshma – chronic depletion of tissues, tuberculosis

–        Pandu – anaemia

–        Kshaya disorders – depletion of tissues

–        Rasa Kshaya – deficient formation and supply of nutritional fluids in the stomach

–        Jwara – various kinds of fevers

–        Kshata Kshina – emaciation and tissue loss due to injury

–        Vata Vyadhi – special vata disorders 

Ahara / Poshana Janya – Nutritional Causes

–        Alpa Ahara – consumption of less food / inadequate nutrition

–        Dhatu Kshaya – deterioration / destruction of tissues due to nutritional imbalances

–        Kuposhana / Mithya Ahara – malnutrition

Samprapti of Klama – (Hypothetical) Pathogenesis

The pathway of development and manifestation of Klama can be of many ways depending on the different causes from which it arises. But we shall try to draw a simple hypothetical pathogenesis which might be the common pathway leading to Klama.

Due to different causes, there is excessive expenditure of energy from the body.

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In order to compensate for this energy, the agni over-works and hence would get impaired in the process. There is hyperfunctioning of dhatu agnis also. There is an imbalance between supply and demand.

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This leads to tissue burnouts – dhatu kshaya.

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This eventually leads to diminution of ojas, which is a byproduct of dhatus – responsible for energy and strength.

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This would result in Klama.

Alternative Pathway of Samprapti

Nidanas lead to Vata Aggravation Dhatu Kshaya → Imbalance between supply and demand of nutrition → Further reduction of tissue nourishment → Manifestation of Klama

Different Dimensions of Manifestation of Klama

Klama is something which is beyond a feeling of tiredness.

Dimension or Layer of Klama Manifestation	Manifestation / Symptoms
Physical	Fatigue, Weakness
Mental	Lack of motivation
Sensory system	Reduced responsiveness Altered sensory perception Weakness of sensory organs
Functional	Reduced work capacity, lack of interest in doing any work or commitment towards it
Emotional	Feeling drained, Brain fog
Physiological	Decreased Efficiency

By this we understand that Klama is a combination of subjective exhaustion and objective reduction in functional capability.

Understanding Dosha involvement in Klama

1. Vataja Klama – When Klama is caused by Vata, there is generalized weakness, body pains and tremors. The person would get exhausted quickly.

Vataja Klama may be correlated with chronic fatigue or cachexia.

2. Pittaja Klama – When Klama is caused by Pitta, the person would experience fatigue with burning sensation in the body along with excess thirst and mental irritability and anger.

Pittaja Klama may be correlated with fatigue caused due to inflammation in the body. Febrile exhaustion can also be included in this category.

3. Kaphaja Klama – When Klama is caused by Kapha, the person would experience fatigue associated with heaviness of the body, excessive drowsiness and reduced activities and laziness.

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

Understanding Klama from the perspective of Dhatu involved (caused by depletion of tissues)

Rasa Kshayaja Klama – When Klama occurs due to Rasa Kshaya, it is associated with thirst and dryness of the body.

Rakta Kshayaja Klama – When Klama occurs due to Rakta Kshaya, it is associated with pallor.

Mamsa Kshayaja Klama – When Klama occurs due to Mamsa Kshaya, it is associated with muscle weakness and wasting.

Ojo Kshayaja Klama – When Klama occurs due to Ojo Kshaya, it is associated with severe fatigue / weakness, reduced vitality and loss of enthusiasm. Klama is an early expression of Ojas depletion, especially if klama has persisted for a long duration. This will also predispose the person towards many diseases since immunity will be compromised with Oja Kshaya.

Dhatu Kshaya will lead to Ojas Kshaya which will lead to Klama and Daurbalya and in the later period when this progresses, the person would become victim of many diseases.

Modern Biomedical Correlation of Klama

From the information available in Ayurveda treatises and the contexts in which Klama has been mentioned as a symptom, complication, premonitory symptom or sign of bad prognosis, Klama and its variants include many of the modern conditions mentioned below, under their umbrella.

They are –

–        Fatigue

–        Chronic Fatigue Syndrome

–        Asthenia

–        Loss of strength

–        Physical exhaustion / fatigue

–        Mental exhaustion / fatigue

–        Persistent tiredness

–        Lassitude

–        Exhaustion syndrome

–        Reduced capacity to perform work

Fatigue related to chronic conditions like cancer can also be included under Vyadhija Klama.

Other conditions –

–        Neurophysiological conditions like energy deficit, reduced ATP generation, imbalance of neurotransmitters, inflammation of nerves, HPA Axis dysregulation etc. may be considered.

–        Stress induced exhaustion

–        Psychological conditions – like emotional exhaustion and burnouts, reduced motivation etc.

Clinical Assessment of Klama

Below mentioned domains should be considered while clinically assessing Klama –

1. Physical condition
2.   Strength and endurance
3. Mental state and stress
4.   Attention and Motivation
5. Functional – daily activities
6. Severity and chronicity of diseases if any and associated pathology
7. Immunity

Treatment principles of Klama

Nidana Parivarjana – Treatment of Klama, like any disease, depends on the causative factors. Keeping away or addressing the causative factors will not only help in treating Klama but will also prevent its recurrence.

Attention to Agni and Ama, Deepana and Pachana Chikitsa – Agni and its sub-units (dhatvagni) should be properly addressed. The presence of Ama and Sama Doshas / Sama Dhatus and Malas (association of doshas, dhatus and malas with ama) too should be accessed and treated accordingly. Medicines which would enhance the functioning of Agni (Deepana) and which digest Ama (Pachana) should be included.

Replacement and restoration of Dhatus – If dhatu Kshaya is present, Brimhana, Santarpana and Rasayana Chikitsa should be considered.

Shodhana Chikitsa – If there is more morbidity and excessive accumulation of morbid doshas in the body, Shodhana should be considered as per dosha or doshas involved in the pathogenesis of the disease in question which is causing Klama.

Brimhana and Rasayana – Chronic and stubborn Klama associated with any condition or Klama persisting for long duration following a disease process or treatment schedule shall be addressed with Brimhana and Rasayana therapies. This will help in tissue rejuvenation and would boost immunity. They will not only enhance and restore the tissues but will also improve the status of Ojus in the body. Kshira – milk and Ghrita – ghee should be used as daily Rasayanas (Nitya Rasayanas).

Sattvavajaya Chikitsa – For mental causes of Klama, psychotherapies should be included in the treatment.

Others – Dhyana – meditation and Nidra – adequate sleep and Yoga should be adopted in the treatment schedule.

Clinical mention of Klama in various diseases (Madhava Nidana)

Klama as Lakshana (symptom of diseases) is mentioned 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 diseases) is mentioned in –

–        Vatarakta

–        Hrdroga

Klama as Asadhya Lakshan (symptom indicating bad prognosis of diseases) is mentioned in –

–        Kumbha Kamala

Related AIAPGET Questions

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

Ans – c. Klama

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

Ans – Klama

3. Klama is a symptom of which type 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. Both a and b
8.   Pittavruta Samana

Ans – c. Both a and b

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

Ans – c. Jangama Visha

6. Klama is not a symptom of
7. Amajirna
8.   Amlapitta
9. Masurika
10.   Tandra

Ans – a. Amajirna

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

Ans – Kumbha Kamala

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

Ans – c. Vatarakta