We will now expound the chapter known as Dosopakramaniya (remedial measures for the doshas); thus said Atreya and other great sages.
अथातो दोषोपक्रमणीयमध्यायं व्याख्यास्यामः । इति हस्माद्दुरात्रेयादयो महर्षयः ॥
Vata Chikitsa Upakrama – treatments for Vata Dosha
वातस्योपक्रमः स्नेहः स्वेदो मृदूनि स्निग्धोष्णमधुराम्ललवणानि संशोधनान्यभ्यवहार्याणि चाभ्यङ्गपूर्वमुपनाहनोपवेष्टनोन्मर्दन परिषेकावगाहसंवाहन पीडनानि वित्रासनविध्मापनवि स्मरणानि सुरासवविधानं स्नेहाश्चानेकयोनयो दीपनीयपाचनीयवातहर विरेचनीयद्रव्योपयोगि तास्तथा शतपाकसहस्त्रपाकाः सर्वशः प्रयोगार्था बस्तयो बस्तिनियमो विशेषतस्तैलं मांसरसोऽनुवासनानि सुखशीलता स्त्रीसम्पर्कवर्ज्यश्च हैमन्तो विधिः ॥१॥
The treatment for Vata (which has undergone increase) are; oleation (external and internal use of fatty materials) sudation (fomentation and other methods of causing perspiration), mild purgations with drugs which are unctuos, hot in potency, sweet, sour and salt (Madhura,Amla,Lavana) in taste and also the use of foods of these qualities, poultices, wrapping/binding, massaging, bath, immersion in liquids, brisk massage and squeezing of the body parts – each done only after application of oil over the part or the whole body; sudden threatening, voilent shaking, causing forgetfulness, use of wines observing the prescribed regimen, use of fatty substances of different origin (vegetable and animal) for preparing recipes to cause hunger, digestion of food, mitigation of vata and purgations; and also to prepare recipes (especially oils) cooked hundred times or thousand times for use in all methods; administration of enemas, adopting the regimen prescribed for the post-enema therapy; especially use of oil, meat soup and oil enema; remaining happy and comfortable, avoidance of contact of women (sexual acts) and resorting to the regimen prescribed for hemanta (cold season). (1)
Pitta Chikitsa upakrama – treatment for pitta dosha
पित्तस्य सर्पिष्यानं सर्पिषा स्त्रेहनमधोदोषहरणं मधुरतिक्तकषायाणामौषधाभ्यवहार्याणामुप योगो मृदुसुरभिशीतहृद्यानां गन्धानामुपसेवा परमशिशिरसुरभिसलिलमज्जनम् । मनोऽनुकूलं संस्पर्शसुखानां मुक्तामणिवैडूर्याश्मगर्भशङ्खशिलापद्मरागचन्द्रकान्ततरतरलावलीनां भ्रमरत्रा सितसहस्रपत्रासितोत्पल कदलीदलनवमालिका कुन्दमल्लिकादि विविधपूर्ण प्रसूनविरजितानां स्त्रजां च धारणमुरसा। क्षणे क्षणे चाग्र्यचन्दप्रियङ्गकालेयक मृणालकर्पूरसुगन्धिकशीतस्वच्छगन्धवारिभिः सकमलकुमुद कुवलयैर्भूमितलकवाटवातायन हर्म्यभित्तीनामाभिप्रोक्षणम् । श्रुतिसुखमृदुमधुरमनोऽनुगानां गीतवादित्राणामभ्युदयानां च श्रवणम् । अयन्त्रणैः समानविष यवेषचरितैरुत्सवोत्सवतरान्योन्यदर्शनैः सुहृदिः सहासनम् । अनृतवचनविरहस्वभाव सुरभि तरवदनकुड्मलानां नातिस्पष्टाभिधायिनामनुपचारमधुरकोमलोल्लापानां प्रियाणामपत्यकानां सदयमाश्लेषः । निर्दयं च तनुतरमृदुसुरभि निवसनाभिर्माल्लिकामुकुलानुकारिमुक्ताफल प्रायालङ्काराभिः सहचरीनिनादसञ्जल्पोपजनितौत्सु-क्यकलहंसानुनादितनूपुररशनाकलाप शिञ्जि तानुगमनसम्मुग्धमुग्ध स्त्रिग्धमृदुवचनाभि र्निजजघननिबिडकुचयुगलालङ्कारभारोद्वहनश्रमश्वसन कम्पितमध्यमुकुलित लोचनोत्पलाभिः किञ्चिद्विगलितनवयौवनाभिः प्रियाङ्गसङ्ग मात्रा तिमात्रसुखास्वादवित्रं स्यमानांशुकैक कालोपजातव्रीडा वैलक्ष्यप्रगल्भतावैक्ल व्यहर्षविषा दविस्मयस्मितकोपप्रसादसाध्वसस्त्रस्तस्विन्नसर्वाङ्गद्रवीकृतहिमाङ्गरागाभिः समस्तदेहहृदयप्र ह्लादकारिणीभि र्विलासवतीभिश्चतुरङ्गमिवानङ्गबलमङ्गै स्तनुभिरपिसमुद्वहन्तीभिरङ्गनाभिराश्लेषः । सकलरजनीकरकरनिकरावकीर्णशिशिरतराणि भवनतलसलिलपुलिनानि । अतिसितसिकतोपास्तृततलमनेककाययन्त्रप्रवृत्तविमलसलिलधार धारागृहम् । सागरानुकारितोयाशयोपतीरसुनिविष्टकुसुमितबहुविटपपृथुतुङ्गविविधतरतटरुहतरुनिवहबहलच्छायोपसञ्छन्नं धवलरक्तनीलनी रजरजोव्याप्तमस्त जलविपुलसिकतिलतलोपकल्पितं दोलायमान गणतिथपृथुदृतिकलश-सरणकरकस्रवदुद्द्कप्रवाहाहितमृत्सौरभभूतलैकदेशं प्रलम्बनमानाम्रज म्बूकदम्बविदुलनिचुलादिकिसलयम जरीस्तबकप्रत्युप्तपटालिकं मुहुर्मुहुः पुरुषप्रयत्नप्रेरितघटमु खोद्गीर्णोशीरचन्दनानुविद्धावलग्नपतितशेष मुक्ताफलायमान जललवमुछ्रायविस्तारवदनिषि द्धदूर विस्तृतशीतवातप्रवेशमत्यर्थसन्तताम्बुशीतशीकराभिषेक प्रतिहतसन्तापदाहमोह श्रमक्ल मपिपासमतिशयप्राप्त रामणीयकं हिमाचलस्पर्द्धिशैत्यमम्बुधरकाललीलाविडम्बि कायमानम्। प्रफुल्लपद्मोत्पलपुण्डरी- कसौगन्धिक कोकनदशतपत्रपरागरागानुरञ्जितजलचरविहगगण कलनिनदरम्या दीर्घिकाः मधुपानलोभनिलीयमानालिकुलचलितलताप्रताननिपतितविविधकु सुमनिचयशयनरचनासव्यापारमृदुपवनान्युपवनानि । विशेषतस्तु घृतं पयो विरेचनानि सौम्याः सर्वे भावाः दिवास्वप्नवर्ज्य श्च विधिः ॥ २ ॥
The treatment for Pitta (which has undergone increase) are : drinking of ghee, application of ghee over the body, mild purgations with drugs which are sweet, bitter and astringent (Madhura,Tikta,Kashaya) in taste; use of foods also with these qualities, use of scents (perfumes), which are mild, pleasant, cold and agreeable; remaining inside water which is clean, cold and sweet smelling; comfortable touch by women who are liked, wearing garlands of pearls, gems, diamonds, stones, conch, quartz, ruby, marble and such other materials; wearing garlands of flowers such as red lotus, white lotus, tender petals of plantain flowers, fresh jasmine, round jasmine and other flowers attracting bees by their sweet smell; remaining inside a room the floor, door, windows and walls of which are being frequently sprayed with water made fragrant with addition of aguru, candana, priyangu, kaleyaka (pita candana) mrnala karpura, lotus, lily and such others; hearing of vocal or instrumental music which is aggreable (liked), mild, sweet and pleasant to the mind; company of friends who are unrestrained (free, intimate) having common liking in subjects, dress and manners, who are joyful and playful with each other; company of women who do not speak untruth, who do not like solitude, who have a blossoming face, who speak slightly incoherantely, who do not require too much of cajoling to speak sweetly, who love their spouces and children; tight embrace by women who have slender, soft, sweet smelling body, who have put on pleasant dress, and garlands of pearls resembling buds of jasmine and other flowers; whose voice resembles that of a parrot or playful swan, vibrate with the sound of anklets which produces mild, melodious notes while walking; whose words are soft and pleasant; who have round and well shaped buttocks and breasts, by whose weight their slender waist shakes and body gets tired; breathing heavily, whose lotus like eyes are half closed; who are just passing through youth, who desire very much to enjoy the pleasure of sex, exhibiting emotions such as playfulness, mirth, audacity, disappointment, worry, sorrow, astonishment, laughter, anger and satisfaction; with garments falling off, body perspiring, vermillion and other cosmetics getting wet by sweat, whose body and mind are exhilarated, supported by the armoury of the cupid, raging with profound emotions.
The dwelling house, water and walking lanes have plenty of moonlight and cool breeze. Spending time in houses whose floor is covered with shining white sand, automatic fountains of various shapes sprinkling pure water all over; or on lakes which resemble an ocean, while having plenty of blooming flowers, their banks with plenty of different kinds of creepers entwining them, giving fine and thick shade beneath; water studded with the pollen of flowers like white, red or blue lotus and others; water moving slowly, boats and other vessels gliding beautifully, their oars bringing up the scent of mud.
Or in forests with trees such as amra, jambu, kadamba, vidula, nicula and the like with wide spread branches, entwined with flowering creepers; water scented with usira and sandalwood in drops from the mud pots, resembling pearls, frequently manipulated (stirred) by hand; cool pleasant and unpolluted breeze coming from all directions in steady stream, mitigating the heat, burning sensation, delusion, fatigue, exhaustion and thirst.
Or spend time on hills which are high, covered with snow, clouds and tall trees.
Or in artificial (man made) gardens having flowers such as lotus, lily, chrysanthemum, jasmine, rose etc., the pollen of these floating on the lake, waterbirds and animals playing there joyfully producing pleasant sound, bees greedy of nectar swarming to the flowers and causing the flowers to fall on the ground; fern house being constructed there, with flowers arranged in different shapes on its floor; mild and cool breeze coming in from all directions. Ghee, milk, purgations, all kinds of cold comforts and the regimen prescribed for grisma (summer) except the afternoon nap – these are to be made use of specially. (2)
Kapha Chikitsa upakrama – treatment for kapha dosha
श्लेष्मण: पुनिर्विधिविहितानि तीक्ष्णानि संशोधनानि रुक्षप्रायाण्यभ्यवहार्याणि कटुतिक्तकषायोपहितानि तीक्ष्णानि दीर्घकालस्थितानि हृद्यानि मद्यानि धावनलङ्घनप्लवनजागरणानियुद्धयुद्धव्यवायव्यायामरूक्षोन्मर्दनस्त्रानोच्छादनानि । विशेषतः क्षौद्रं यूषो वमनानि सर्वशश्चोपवासः सधूमगण्डूषः सुखप्रतिषेधः सुखार्थमेव वासन्तिको विधिरिति । भवन्ति चात्र ॥ ३ ॥
उपक्रमः पृथग्दोषान् योऽयमुद्दिश्य कीर्तितः । संसर्गसन्निपातेषु तं यथास्वं विकल्पयेत् ॥४॥
The treatments for Kapha (which has undergone increase) are strong purificatory therapies (emesis and purgation) with drugs possessing dryness, pungent, bitter and astringent tastes,(Katu, Tikta, Kashaya) use of foods possessing the same properties; use of wines which are strong, old and pleasant; activities such as running, jumping, swimming, keeping awake without sleep, fighting with arm, fighting with weapons, sexual intercourse, physical exercises, dry massage, bath and application of dry powders to the body.
Honey, soups of grains or pulses, emesis, fasting, inhalation of smoke, mouth gargles, avoidance of comfort and regimen prescribed for vasanta (spring) are all to be observed especially for benefit. (3)
In conditions of a combination of two doshas or of all the three doshas, the remedial measures suggested for each dosha separately may be combined judiciously as found suitable. (4)
ग्रैष्मः प्रायो मरुत्पित्ते वासन्तः कफमारुते । मरुतो योगवाहित्वात् कफपित्ते तु शारदः ॥५॥
If vata and pitta have combined together the regimen is like that grisma ( summer);
if kapha and vata it is like that of vasanta (spring ) because vata is yogavahi (ambivalent);
in case of kapha and pitta combination, the regimen is that of sarat (autumn) (5)
योज्याः पट्वम्लमधुरा वायौ कुद्धे रसाःक्रमात् । पित्ते तिक्तस्ततः स्वादुः कषायश्चरसोहितः ॥६॥
कटुकः प्राक् ततस्तिक्तः कषायोऽन्ते कफामये ॥७॥
In case of increase of vata, substances possessing salt, sour and sweet (Lavana, Amla, Madhura) tastes are to be used, in that order;
in the increase of pitta it is bitter first, next sweet and astringent,(Tikta, Madhura, Kashaya)
and in increase of kapha it is pungent first, next bitter and astringent last. (Katu, Tikta, Kashaya)(6-7a)
Dosha-rutu sambandha – relationship between doshas and seasons
चयप्रकोप्रशमा वायोर्गीष्मादिषु त्रिषु । वर्षादिषु तु पित्तस्य श्लेष्मणः शिशिरादिषु ॥ ८ ॥
Vata undergoes caya ( mild increase ), prakopa (profound increase) and prasama (decrease to normal) respectively in three succeeding rutu (seasons) commencing with grisma;
Pitta undergoes these stages in three seasons commencing with varsa and
kapha in three seasons commencing with sisira. (8)
Notes: The above can be made clear with this table.
Vata Pitta Kapha Sisira Caya Vasanta Prakopa Grisma Varsa Caya Prasama Prakopa Caya. Srat Prasama Prakopa Prasama Hemanta
चीयते लघुरूक्षाभिरोषधीभिः समीरणः । तद्धिधस्तद्विधे देहे कालस्यौष्ण्यान्न कुप्यति ॥९॥ अभ्दिरम्लविपाकाभिरोषधीभिश्च तादृशम् । पित्तं याति चयं कोपं न तु कालस्य शैत्यतः ॥१०॥ चीयते स्निग्धशीताभिरुदकौषधिभिकफः । तुल्येऽपि काले देहे च स्कन्नत्वान्न प्रकुप्यति ॥११॥ इति कालस्वभावोऽयम्
In Grisma, vata undergoes only caya (mild increase) because the food materials that are used then, possess lightness (easily digestible) and dryness and the same condition exists inside the body also. It does not undergo Prakopa (profound increase) because of the heat of the season.
In Varsa, pitta undergoes only caya (mild increase) because the food substances that are used then, possess more moisture and become sour at the end of digestion and similar condition exists inside the body also. It does not undergo prakopa (profound increase) because of the cold of the season.
In Sisira, kapha undergoes caya by the use of food substances which are unctuos, cold potency and full of water, similar will be the condition inside the body. It will only become solidified by the effect of the season but does not undergo prakopa. Thus are the nature of the seasons. (9-11)
आहारदिवशात् पुनः । चयादीन् यन्ति सद्योऽपिदोषाः कालेऽपि वा न तु ॥१२॥
व्याप्नोति सहसा देहमापादतलमस्तकम् । निवर्तते तु कुपितो मलोऽल्पाल्पं जलौघवत् ॥१३॥
The doshas undergo caya and other states either suddenly or slowly (after some time) by the effect of foods and activities, irrespective of the season, and not merely by the effect of the season.
Doshas which have increased profoundly invade the entire body from the feet to the head, very quickly but recede very slowly, little by little, just like the clouds in the sky. (12-13)
Notes: Accumulation of rain bearing clouds in the sky is very quick and causes rain over a wide area. If it does not rain due to some reason, the clouds do not vanish quickly but move away slowly after a long time. Similarly the doshas, do not return to normal quickly.
Dosha upakrama yukti – procedure in the treatment
चय एव जयेद्दोषं कुपितं त्वविरोधयन् । सर्वकोपे बलीयांसं शेषदोषाविरोधतः ॥१४॥
क्रमान्मरुत्पित्तकफान् सर्वत्र सदृशे बले । वातादीनां यथापूर्वं यतः स्वाभाविकं बलम् ॥१६॥
ऊचे पराशरोऽप्यर्थममुमेव प्रमाणमयन् । यथोपन्यासतः प्राप्तमादौ दोषभिषग्जितम् ॥१६॥
नेतृभङ्गेन दृष्टो हि समं सैन्यपराजयः ॥१७॥
Doshas are to be controlled (brought back to normal) during the stage of caya (mild increase) itself. If it has reached the prakopa stage (profound increase) the treatment for the increased dosha should not interfere with the other doshas (which are normal). If there is prakopa of all the three doshas, which ever is more powerful should be treated first without interfering with the others. If all are of equal strength, treatment should be for vata first, next to pitta and last to kapha, because that is the order of strength of the doshas in the body naturally.
Even Parasara also has substantiated this statement with an illustration stating, that by the fall of the commander, the army gets defeated quickly and easily. (14-17)
Notes: Among the doshas, vata is very powerful, quick in action, causing many ailments to the body by its own inherent capacity. Pitta is next inferior in strength, quickness of action and causation of ailments. Kapha is still inferior in strength, very slow in action and in causation of ailments, pitta and kapha often require the help of Vata to act. So Vata is considered as the leader or commander of doshas. In conditions wherein all the three have undergone an increase, if vata is brought to normal by treatment, the other two doshas may become normal even without treatment or with very simple treatments.
स्थानतः केचिदिच्छन्ति प्राक् तावच्छ्लेष्मणो वधम् । शिरस्युरसि कण्ठे च प्रलिप्तेऽन्नरुचिः कुतः ॥१८॥
तदभावे कथं भोज्यपानद्रव्यावचारणम् । असत्यभ्यवहारे च कुतो दोषविनिग्रहः ॥१९॥
तस्मादादौ कफो घात्यः कायद्वारार्गलो हि सः । मध्यस्थायि यतः पित्तमाशुकारिच चिन्त्यते ॥ २०॥
अतो वातसखस्यास्य कुर्यात्तदनु निग्रहम् । अत एव च पित्तादिः कफान्तोऽन्यैः क्रमः स्मृतः ॥२१॥
Some authorities give importance to the site (of accumulation of increased dosha) and say that kapha is to be controlled first. If kapha accumulates in the head, chest and throat where is the possibility of taste of food?, in such an absence, how is it possible to use foods, drinks or drugs? If there is no ingestion of food where is the possibility of controlling the doshas? So, kapha is to be controlled first, because it remains as a bolt at the door of the body. Pitta is to be treated next, for it resides in the centre (of the body), is considered as acting swiftly being a freind of Vata; vata is to be treated in the last.
Yet others say that treatment should start first with pitta and end with kapha. (17-21)
सुश्रुतश्च न सर्वत्र मतमेतत् ब्रवीति तु । जयेज्वरे ऽतिसारेच क्रमात् पित्तकफानिलान् ॥२२॥
प्रायेण तापात्मतया ज्वरे तेजो विशिष्यते । विशश्च सरणं पित्तात्तथा च मृदुकोष्ठता ॥ २३ ॥
तस्यचाऽनुबलः श्लेष्मागौरवाऽपक्तिजाड्यकृत् । वायुश्च वर्द्धते ऽवश्यं यात्स्वहस्सु तयोः क्षये ॥२४॥
ज्वरातिसारयोस्तस्मादेष दोषजये क्रमः ॥२५॥
Susruta opines that the above method is not appropriate uniformly (in all diseases).
In cases of jvara (fever) and atisara ( diarrhoea) the order of treatment should be first for pitta, next kapha and last for vata;
in fever, the heat and consequent discomfort, point to predominance of tejas (pitta); likewise in diarrhoea, the elimination of faeces is due to pitta predominance, so also the loose bowel movements. In both the diseases kapha is next inferior in strength and causes feeling of heaviness, indigestion and lassitude. Vata also undergoes an increase during day time, inevitably because of the decrease of these two (doshas). Hence in fever and diarrhoea, this is the method of treatment for the doshas. (22-25)
कफपित्तानिलानन्ये क्रमादाहुस्तयोरपि । यस्मादामाशयोत्क्लेशात् भूयिष्ठं तत्समुद्भवः ॥२६॥
कम्रेणाद्येन तत्रापि प्रवृद्धान् स्वाश्रये स्थितान् । स्वाश्रयेषु प्रदुष्टानां स्थितैव ह्याशुकारिता ॥ २७ ॥
Some others say, that the treatment should be for kapha, pitta and vata in succession; beacuse the increase of doshas are produced chiefly in the stomach by its excitation. That dosha which has undergone increase in its own seat is quick to act (to produce diseases), hence it should be controlled first by treatment. (26-27)
विज्ञाय कर्मभि: स्वैः स्वैर्दोषोद्रेकं यथाबलम् । भेषजं योजयेत्तत्तत् तन्त्रीकुर्यान्न तु क्रमम् ॥ २८ ॥
Taking into consideration the strength of the increased doshas by their actions, appropriate treatment is to be done and not by sticking on rigidly to the advise of the texts. (28)
प्रयोगः शमयेद् व्याधिं योन्यमन्यमुदीरयेत् । नासौ विशुद्धः शुद्धस्तुशमयेद्यो न कोपयेत् ॥ २९ ॥
A treatment is not ideal, if it cures one disease and causes the increase of another disease at one and the same time; an ideal treatment is that which cures a disease but not excites another. (29)
क्रुद्धं मलमलं जेतुं नाल्पभावादुभावपि । दोषा दोषात्मकत्वाच्च न समेऽपि परस्परम् ॥३०॥
शीतद्रवाम्ललवणकट्वादिगुणतुल्यता । दृष्टा मिथश्च दोषेषु नातोन्योन्यं जयन्ति ते ॥३१॥
आरम्भकं विरोधेऽपि मिथो यद्यत् गुणत्रयम् । विश्वस्य दृष्टं युगपद्व्याधेर्दोषत्रयं तथा ॥ ३२ ॥
Two doshas which are weak are not enough to overcome (cause decrease) one dosha which has undergone increase. In condition of combination of equal strength of all the three doshas, one does not subjugate the other because of inherent properties of doshas. Coldness, liquidity, sourness, saltiness, pungency and other qualities are common to more then one dosha, even then one dosha does not destroy the other.
In the combination of doshas which are of opposite qualities, the same condition seen in the things of the universe having the three (great) qualities (coexisting together peacefully is also seen) so also in diseases produced by the three doshas. (30-32)
Notes: Two kinds of combinations of doshas can be possible; first one, that of dosha possessing similar qualities eg. Vata and Kapha; the second one, that of dosha does possessing opposite qualities eg, Kapha and Pitta. In both the cases, one dosha does not cause either increase or decrease of the other dosha. This is due to sahaja satmya (a natural inherent immunity) present in the body which protects the body both during normal and abnormal conditions. The simile of the three qualities – Satwa, Rajas and Tamas – makes the point clear. Each of these three is opposite of the other they are present in every substance of this universe, they function without hindering one another.
Sama dosha lakshana – signs of doshas mixed with ama
वायुरामान्वयः सार्तिराध्मानकृदसञ्चरः । दुर्गन्धमसितं पित्तं कटुकं बहलं गुरु ॥३३॥
Vata mixed with Ama (undigested materials) causes pain and flatuence (distention of the abdomen with gas) and absence of elimination (of flatus, feces and urine). (33)
Pitta mixed with ama, has foul smell, black, colour, pungent taste, is thick and heavy.
आविलस्तन्तुमांस्त्यानः प्रलेपी पिच्छिलः कफः । विपर्यये तु पक्कत्वं तथा ताम्रं समेचकम् ॥३४॥
पीतश्च पित्तमच्छञ्च श्लेष्माऽच्छः पिण्डितोऽथवा विशदश्च सफेनश्च धवलो मधुरो रसे ॥३५॥
Kapha mixed with Ama will be turbid, thread-like, solidified, sticky (gummy) and slimy. They are opposite (i. e. pakwa) when they posses opposite qualities;
Pitta is to be considered pakva (properly formed, well processed) when it exhibits the opposite qualities and also has colour like copper, eye of peacock’s tail (darkblue in colour) or yellow and a clear fluid. (34-35)
Kapha is considered pakva (properly processed, well formed) when it is seen as clear fluid or as small pellets, non-slimy, mixed with bubbles (forth), white in colour and sweet in taste (tasteless to be more correct.
Ama utpattti – production of ama
ऊष्मणोऽल्पबलत्वेन धातुमाद्यमपाचितम् । दुष्टमामाशयगतं रसमामं प्रचक्षते ॥३६॥
अन्ये दोषेभ्य एवातिदुष्टेभ्योऽन्योन्यमूर्च्छनात् । कोद्रवेभ्यो विषस्येव वदन्त्यामस्य सम्भवम् ॥३७॥
The first dhatu – the Rasa – which has been inadequately digested (improperly processed) due to the weakness of the digestive fire and accumulating in the stomach (and intestines) (in the abnormal state) is known as Ama.
Others say that Ama is also produced by the combination of doshas among themselves, which have undergone abnormal increase, just as poison is produced from kodrava grain. (36-37)
आमेन तेन सम्पृक्ता दोषा दूष्याश्च दूषिताः । सामा इत्युपदिश्यन्ते ये च रोगास्तदुद्भवाः ॥३८॥
Tho doshas and dushyas which are polluted by admisture with ama are called as Sama; (mixed with ama); so also the diseases produced by them (doshas and dusyas). (38)
Notes: The ingested food udergoes transformation (digestion) inside the alimentary tract by the agency of kosthagni (digestive fire) vis a vis Pacaka Pitta (digestive juices having firelike activity). At the end of digestion, Ahara Rasa (the essence of the food) gets separated. It undergoes further processing and gets transformed as Rasa dhatu – the first liquid tissue of the body. When the kosthagni (digestive functions vis a vis the juices) are normal (in their quantity and qualities) the Rasa dhatu will be properly formed and adequately processed. This is what happens during health.
If on the other hand the kosthagni is poor (in quantity, and quality) all the food materials are not digested adequately and properly. As such, undigested (ama) materials accumulate and the Rasa dhatu that gets formed will be having less or more of these undigested materials. These materials act as poison (amavisa – endotoxins) to the body. When the Rasa dhatu circulates all over the body in its normal routine, these poisonous materials are purveyed to all the parts of the body. They stagnate in some places and give rise to the onset of diseases there. The doshas which are also circulating along with Rasa dhatu gets mixed with these undigested materials, thereby becoming sama dosha (mixed with ama materials).
Ama nirharana – Elimination of ama
सर्वदेहप्रविसृतान् सामान् दोषान् न निर्हरेत् । लीनान् धातुष्वनुत्क्लिष्टान् फलादामाद्रसानिव ॥३९॥
आश्रयस्य हि नाशाय ते स्युर्दर्निहर्रत्वतः । पाचनैर्दीपनैःस्त्रेहैस्तान् स्वेदैश्चपरिष्कृतान् ॥४०॥
शोधयेच्छोधनैः काले यथासन्नं यथाबलम् । हन्त्याशुयुक्तं वक्त्रेण द्रव्यमामाशयान्मलान् ॥४१॥
घ्राणेन चोर्ध्वजत्रूत्थान् पक्वाधानात् गुदेन तु । उत्क्लिष्टानध ऊर्ध्वं वा न चाऽऽमान् वहतः स्वयम् ॥४२॥
धारयेदौषधैर्दोषान् विधृतास्ते हि कुर्वते । रोगानुत्पादनिर्दिष्टानतिस्थौल्यादिकान् गदान् ॥ ४३ ॥
प्रवृत्तान् प्रागतो दोषानुपेक्षेत हिताशिनः । विबद्धान् पाचनैस्तैस्तैः पाचयन् निर्हरेत वा ॥४४॥
Attempt should not be made to eliminate (suddenly by force) the Sama doshas which are circulating all over the body, which are accumulating in the tissues and which have not become excited to move out the body. Such an attempt will be like taking out the juice from an unripe fruit, it will cause destruction of the body itself, as these materials are removable with great difficulty. So they should be expelled out of the body after administration of therapies such as digestives, appetisers, oleation (lubrication) and sudation and finally by purificatory measures (emesis and purgation), in accordance with the location and strength of such materials (doshas).
Those (doshas) which have accumulated in the amasaya (stomach and small intestine) should be expelled through the mouth, that accumulating in the head through the nose and that accumulating in the pakvasaya (large intestine) through the rectum.
Attempt should not also be made to stop the movement of Ama out of the body which has started of its own accord, by administration of drugs and therapies. By such with holding, they create conditions suitable for origin of diseases such as obesity etc. enumerated in Roganutpadaniya (Chapter 5).
So (the physician) desirous of health (of the patient), should be negligent of the doshas which have started moving out of the body of their own accord, at their commencement, digest them which have stagnated deep inside by administration of drugs and expel them out later on. (39-44)
॥ इति एकविंशोध्यायः ॥
Thus ends the twentyfirst chapter