Chapter 13: Doshopakramaniyam

Treatment of Dosha Imbalance and AAma In this chapter we are learning the treatment options for Dosha imbalance, how Tridosha reach with Ama and produce symptoms, what is the line of treatment for this condition. We also learn about time of administration of medicines based on disease. It is the 13th chapter of Sutrasthana of Ashtanga Hrudaya, called as Doshopakramaneeya Adhyaya.

Treatment for Vata imbalance (increase) – Vriddha Vata chikitsa— वात तोप मः

नेहः वेदः संशोधनं म ृद ु

वाद ललवणो णा न भो या न अ य ग मदनम ् १

वे टनं

ासनं सेको म यं षैि टकगौ डकम ्

ि न धो णब तयो बि त नयमः सुखशी लता २

द पनैः पाचनैः स ाः

नेहा चः अनेकयोनयः

वशेषा मे य प शतरस तैलानुवासनम ् ३ Treatment options for increased Vata Dosha areSneha – oleation-oral administration of oil / ghee / fat and external oil massage Sveda – Sudation – diaphoresis, sweating therapy Mrudu Samshodhana – Mild purification procedure, Mild Panchakarma (Vamana and Virechana). Excess of Panchakarma might lead to Vata increase. Svadu Amla Lavana Ushna Bhojya – foods which are of sweet, sour and salt taste; Abhyanga – Oil massage Mardana – simple massage Veshtana – wrapping / covering the body/ organ with cloth Trasana – Threatening, frightening Seka – pouring of herbal decoctions / oils on the affected part Paishtika Goudika Madya – wine prepared from corn flour and jaggery- molasses Snigdha Ushna Basti – enema therapy with fat-oil, enema with drugs of hot potency Sukhasheelata – comforting the patient Deepana Pachana Siddha Sneha – medicated fats of different kinds- sources prepared with drugs causing increase of hunger and improving digestion; Medya Pishita Taila Anuvasana – oleation enema prepared from juice of fatty meat and oil- 1-3

Treatment for Pitta imbalance (increase) – Vriddha Pitta Chikitsa प त य स पषः पानं

वाद ुशीतैः वरे चनम ्

वाद ु त तकशाया ण भोजना न औषदा न च ४

सुगि धशीत

यानां ग धानामुपसेवनम ् ५

कपूरच दनौशीरैःअनुलेपः दोष च

अय

णे

णे

माः सौधं हा र गीतं हमो अ नलः ६

णसुखं म ं पु ः सि द धमु धवाक्

छ दानुव तनो दाराः

याः शील वभू षताः ७

शीता बुध ारागभा ण ग ृहा ण उ यान द घकाः सुतीथ वपुल

व छस ललाशय सैक ते ८

सा भोजजल तीरा ते कायमाने

म ु ाकुले

सो या भावाः पयः स प वरे क च वशेषतः ९ Treatment options for increased Pitta Dosha are – Sarpi paana – drinking of Ghrita (clarified Butter). It can be plain or medicated, based on physician’s advice. Svadu, sheeta Virechana – purgation therapy with drugs of sweet taste and cold potency, Intake of foods and drugs having sweet, bitter and astringent tastes. Inhaling of fumes from herbs that are coolant, pleasant and cordial Anointing the body with camphor, sandalwood paste, Vetiver paste, very frequently. Residing on terraces lit by moonlight in the evenings, enjoying pleasant music and soft cold breeze, company of friends who do not restrain him, of sons who speak cordially and with innocence. Spending time with wife, who is obedient, pleasing and virtuous; Residing in houses equipped with fountains emitting cooled water, parks and ponds, Spending time in houses near water reservoirs having clean water, sand, lotus, flowers, and trees, with a calm mind; Consuming milk, ghee and Purgation therapy (Virechana)

Treatment for Kapha imbalance (increase) – Vriddha Kapha Chikitsa ले मणा व धना यु त ती णं वमनरे चनम ्

अ नं

ा पती णो णं कटु त तकषायकम ् १०

द घकालि थतं म यं र त ी तः अनेक पो यायामः च ता वशेषात ् वमनं यूषः

जागरः

ं वमदनम ् ११

ौ ं मेदो नमौषधम ्

धूमोपवासग डूषा नःसुख वं सुखाय च १२ Treatment options for increased Kapha Dosha areVidhiyukta Teekshna Vamana Virechana – Strong emesis and purgation in accordance with prescribed procedure, Consuming food which are dry, Consuming food in limited quantity Consuming food that have Teekshna (strong, piercive), Ushna (hot), pungent, bitter and astringent taste, Old wine Sexual activity

keeping awake at night, Exercises of different kinds, Worry, Dry massage of the body; Vamana – emesis therapy, drinking of soups- of grains Use of honey, Therapies and medicines that reduce fat, Inhalation of medicinal smoke, Fasting, Gargling Facing difficulties 10-12 उप मः प ृथ दोषान ् यो अयमु

य क ततः

संसगसि नपातेषु त यथा वं वक पये त ् The different treatment prescribed for each Dosha individually, may be combined appropriately in conditions of combinations of two or three Doshas. 13 ै मः

ायो म ि प ते वास त कफमा ते ।

म तो योगवा ह वात, कफ प ते तु शारदः ॥१४॥ Generally the treatment for the combination of Vata and Pitta is similar to the regimen of summer- described in Chapter 3. For Kapha and Vata combination treatment, it is similar to the regimen of Vasanta- spring because Maruta- Vata is Yogavahi; Yogavahi means, Vata, when associated with Pitta, boosts Pitta Dosha, when it is associated with Kapha, it boosts Kapha Dosha. For the combination of Kapha and Pitta the treatment shall be similar to the regimen of SaradAutum .14 चय एव जये ोषं कु पतं त ु अ वरोधयन ् ।

सवकोपे बल यांसं शेषदोष अ वरोधतः ॥१५॥ The Doshas should be treated properly when there are in Chaya stage (mild increase) only. In their stage of Kopa (Dosha enhanced imbalance), they should be vanquished without opposing / interfering with one another Dosha. When there is simultaneous enhanced increase (Kopa) of all the three Doshas, the most powerful / most aggravated Dosha should controlled first, without opposing the remaining Doshas. 15 योगः शमये या धमेकं यो अ यमद ु रये त ्

ना असौ वशु ः शु

तु शमये यो न कोपयेत ्

That treatment which cures one disease and gives rise to another disease- sooner or later, is not Shuddha- pure/ good/appropriate; A pure treatment is that which cures one – diseases and does not give rise to another. 16

Movement of Dosha from Digestive Tract to Body Tissues and vice versa – यायामात ् ऊ मणः तै

को ठा छाखाि थममा ण

यात ् अ हताचरणाद प त ु वा मा त य च

Movement from Koshta to Shakha - By the effect of exercise, increase of heat, unsuitable/unhealthy activities and due to quick movement of Vata, the increased Doshas move out of the Kostha (gastrointestinal tract) to the Shakhas- tissues, Asthi – bones and Marmas- vital organs and vulnerable points. दोषा याि त तथा ते यः वृ

त

ोतोमुख वशोधनात ्

यात ् अ भ य दना पाका को ठं वायो च न हात ् था च वल बे रन ् भूयो हे तु ती णः

ते काला दबलं ल

वा कु यि त अ या ये व प

Movement from Shakha to Koshta - Doshas move from body channels and tissues to the gastro intestinal tract, by the effect of purification, clearing and widening of the minute body channels. By further increase of Doshas, By liquefaction, By maturity, By Balancing and controlling Vata. When Doshas move from one place to other, they remain there for some time, waiting for an exciting factor. After deriving strength by season, time etc, they get further aggravated and move to other places as well. 17-19

Native and foreign Doshas:- Sthayi- and Agantu Doshas:त ा य

थानसं थेषु तद यामबलेषु तु

कुयाि च क साम ्

वामेव बलेना या ममा वद ु

Treatment should be done- especially on priority to that Dosha which has travelled into the seats of other Doshas and which is weak, Priority should also be given to that Dosha which, by its own strength overcomes other Doshas.

Agantu Dosha – आग तुं शमये ोषं

था ननं

तकृ य वा

Foreign Dosha, should be treated either after treating the Sthanika (native Dosha) or even otherwise. The choice of Dosha, to be treated first depends on the level of aggravation and strength of Doshas. 20

Triyak gata Dosha ायि तय गता दोषाः कुया न तेषु

लेशय

यातुरांि चरम ्

वरया दे हाि नबल वत ्

याम ्

शमये तान ् योगेण सुखं वा को ठमानये त ्

ा वा को ठ प नां च यथास नं व नहरे त ्

Usually, the Triyaggata Doshas – which are not localized in the gastrointestinal tract but localized in the tissues, cause troubles to the patient for a long time; they should not be treated in haste. They should be carefully treated only afterdetermining the strength of the body and digestive activity. They should be mitigated with stipulated palliative treatment or they should be brought into the alimentary tract and then they should be expelled out by the nearby route (either by mouth – by emeisis – Vamana or by anal route, by purgation – Virechana). 21-22 Effects of Doshas associated with Ama - SamaDosha Lakshana ोतोरोध बल ंश गौरव अ नल मढ ू ताः

आल यापि त न ठ वमलस गा च लमाः ल गं मलानां सामानां , नरामाणां वपययः When imbalanced Doshas get associated with Ama (a factor of indigestion / false metabolism), it is called as Saama Dosha. (Sa aama Dosha, Sa means ‘with’). The features that are seen due to Sama Dosha are Srotorodha - Obstruction of the channels, pores Balabhramsha – loss of strength, Gaurava – feeling of heaviness of the body, Anila Moodata – inactivity of Anila-vata, Alasya – laziness, lassitude, Apakti – loss of digestive power, Nishteeva – Person spits saliva frequently, more of expectoration, Malasanga – constipation or low frequency of urination leading to accumulation of wastes Aruchi – anorexia, Klama – exhaustion The opposites of the above symptoms are of the Nirama Doshas –Doshas not mixed up with the Ama. (undigested materials) 23-24

Origin of Ama – Amotpattiऊ मणो अ पबल वेन धातुमा यं अपा चतम ्

द ु टं आमाशयगतं रसमामं

च ते

Soon after digestion process, the useful part gets separated from the waste. The useful, nutrition rich part is called as Rasa dhatu.

Due to lack of digestion strength, The Rasa Dhatu does not form well, it remains in raw, weak form. It gets vitiated, it stays in the Amashaya (stomach and intestines) itself, and becomes ‘Ama’. 25 अ ये दोषे य एव तद ु टे यो अ यो य मू छनात ् को वे यो वष येव वद याम य स भवम ्

Other authors opine that Ama gets formed from intimate mixing with one another of greatly increased Doshas. 26 साम न ि त आमेन तेन स प ृ ता दोषा द ू या च द ू षताः सामा इ युप द य ते ये च रोगा तद ु वाः

The Doshas and Dusyas (the Dhatus and Malas) which get mixed with this Ama are designated as Sama – mixed with Ama; The diseases originating from this Saama dosha are called as Saama Vyadhi. 27

Saama Dosha chikitsa—treatment of Sama Doshas :सवदे ह

वसत ृ ान ् सामान ् दोषान ् न नहरे त ्

ल नान ् धातुषु अनुि

ल टान ् फलादामा सा नव

आ य य ह नाशाय ते

यःु द ु नहर वतः

The Sama Doshas which are spread all over the body, which are lurking in the Dhatus and which are not moving out of their places of accumulation, should not be forced out by purification Panchakarma therapies like emesis, purgations etc. Just as attempts of extracting juice from an unripe fruit leads to destruction, the dwelling place itself will get destroyed if Doshas are tried to expel out along with Ama. 28

Right approach in Sama Dosha treatment - Sama Doshas should be treated पाचनैद पनैः

ने है तान ्

वेदै च प र कृतान ्

शोधयेत ् शोधनैः काले यथास नं यथाबलम ्

- first with drugs which are digestive and which increase hunger; - next with oleation and sudation therapies (Snehana, Svedana) and - finally they should be expelled out with Shodhana therapies- emesis, purgation at the proper time, and in accordance with the strength of the patient. 29 ह याशु यु तं व

ेण

यमामाशया मलान ्

ाणेन चो वज ू थान ् प वाधाना गुदेन च

Drugs administered through the mouth, bring out the Malas- Doshas from the Amasaya- stomach and small intestines; Drugs administered through the nose bring out the Doshas from the parts above the shoulders and Drugs administered through the rectum bring out the Doshas from the Pakvasaya – large intestine. 30 उि

ल टानध ऊ व वा न चामा वहतः

धारयेदौषधैद षान ् वध ृता

ते ह रोगदाः

वयम ्

Saama Doshas which are greatly increased and going out of the body on their own accord, either in the upward or downward routes- vomiting and purging respectively should not be stopped by medicines, for they produce diseases, if they are stopped. 31 व ृ तान ् ागतो दोषानुपे े त हता शनः

वब ान ् पाचनै तै तैः पाचयेि नहरे त वा Such Doshas which are going out should be ignored in the early stage and the patient should be given suitable foods- light food; Next in the second stage they should be cooked with digestive drugs or removed out by purification (Panchakarma) therapies. 32

Time for eliminating Dosha out of the body ावणे का तके चै े मा स साधारणे

मात ् ३३

ी मवषा हमा चतान ् वा वाद न ् आशु नहरे त ् Vata which undergoes mild increase (Chaya) in Greeshma (summer) should be removed from the body (by basti- enema) in Shravana masa (August) Pitta which undergoes mild increase in Varsha (rainy season), should be expelled out of the body in kartika Month (by Virechana – purgation) Kapha which undergoes mild increase in Shishira (winter) should be expelled out in Chaitra month (April) by Vamana. 33 अ यु णवषशीता ह

ी मवषा हमागमाः

स धौ साधारणे तेषां द ु टान ् दोषान ् वशोधये त ्

Greeshma, Varsa and Hemanta [summer, rainy season and winter]- have too much of heat, rain and cold respectively; in the period in between these, known as Sadharana Kala; the Doshas should be cleared out. 34 कृ वा शीतो णव ृ ट नां योजयेि

यां

ा तं

तीकारं यथायथम ्

याकालं न हापयेत ्

After having overcome the effects of cold, hot and rainy seasons suitably- by adopting appropriate protective methods necessary treatment – therapies should be administered;

The Kriyakala- period of abnormal activity, stages of disease evolution should not be allowed to progress- further. 36 Aushadha Sevana Kala – time of administration of medicines:यु

यादन नम नादौ म ये अ ते कवला तरे ासे

ासे मुहुः सा नं सामु ं न श चौषधम ् ३७

Medicines should be administered, 1. ananna – on empty / when there is no food- in the stomach ; 2. annadau – just before food or at the beginning of food intake, 3. anna madhye – during / in between food intake 4. anna ante – at the end of food intake. 5. kavalantare – in between morsels 6. grase grase – with each morsel 7. muhu: – repeatedly, many a times a day 8. sa annam – mixed with food 9. samudgam – before and after food 10 nishi – at night, bed time कफो े के गदे अन नं ब लनो रोगरो गणोः अ नादौ वगुणे अपाने , समाने म य ई यते याने अ ते

ातराश य, सायमाश य तू तरे

ास ासा तयोः

ाणे

द ु टे मात र व न

मुहुमुहु वष छ

ह मात ृ

वासका सषु

यो यं संभो यं भेष यं भो यैि व ैररोचके क पा े प ह मासु सामु गं लघुभोिजनाम ऊ वज ु वकारे षु

व नकाले

श यते

Medicines should be administered, 1. Ananna – on empty stomach – For diseases arising from increase of Kapha, which are severe and for persons who are strong, the time of administration of medicine shall be when there is no food- in the stomach ; 2. Annadau – just before food or at the beginning of food intake – in disorders of Apanavata, 3. Anna Madhye – During / in between food intake – in disorders of Samana vata 4. Anna ante – at the end of food intake – in disorders of Vyana vata at the end of the morning meal, in disorders of Udana vata at the end of evening meal. 5. Kavalantare – in between morsels – in disorders of Prana- vata 6. Grase Grase – With each morsel – in anorexia, loss of taste it shall be mixed with different kinds of tasty foods 7. Muhu: – Repeatedly, many a times a day – in diseases produced by poison, vomiting, hiccup, thirst, dysponea and cough 8. Sa annam – Mixed with food – in anorexia 9. Samudgam – before and after food – in tremors, Akshepaka (convulsions), Hiccup, 10 Nishi – at night, bed time – for diseases affecting head and neck. 37 Thus ends 13th chapter.