We will now expound the chapter called Dvividhopakrama – the two kinds of treatment; thus said atreya and other great sages. (1)
अथातो द्विविधोपक्रमणीयं नामाध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
Dvividha upakrama – two kinds of treatment
उपक्रम्यस्य हि द्वित्वाद द्विधैवोपक्रमो मतः । एकस्सन्तर्पणस्तत्र द्वितीयश्चापतर्पणः । बृहणो लङ्घनश्चेति तत्पर्यायांवुदोहृतौ ॥२॥
Treatment is of Santarpana and Apatarpana because, those to be treated two kinds : they are also known as Brimhana and Langhana respectively.
बृंहणं यत् बृहत्वाय लङ्घनं लाघावाय यत् । देहस्यं भवतः प्रायो भौमापमितरच्च ते ॥३॥
Brimhana is meant to make the body stout (plump) and Langhana for making it light (thin); the first is caused by the predominance of Prithvi and Ap (bhutas) and the second by the remaining (bhutas) (3)
स्नेहनं रूक्षणं कर्म स्वेदनं स्तम्भनञ्च यत् । भूतानां तदपि द्वैध्यात् द्वितयं नातिवर्तते ॥४॥
Treatments such as Snehana (lubrication, oleation) Ruksana (causing dryness), Svedana ( sudation) and Sthambhana ( stopping, witholding, binding ) are not separate from the above two, in view of the predominance of the two bhuta grouping. (4)
शोधनं शमनञ्चेति द्विधा तत्रापि लङ्घनम् । यदीरयेत् बहिर्दोषान् पञ्चाधा शोधनञ्च तत् ॥५॥
निरूहो वमनं कायशिरोरेकोऽस्त्रविस्त्रुतिः । न शोधयति यद्दोषान् समान्नोदीरयत्यपि ॥६॥
समीकरोति विषमान् शमनंतच्च सप्तधा। पाचनं दीपनं क्षुत्तृव्यायामातपमारुताः ॥
Langhana is of two kinds – Sodhana and Samana.
Sodhana is that which expels the doshas out of the body; it is of five kinds viz., niruha (decoction enema), vamana (emesis), Virechana (purgation to the body), Sirovirechana (purgation to the head i.e., nasal medication, inhalation of smoke etc.) and raktamokshana (blood letting).
Samana is that which neither expels the doshas out nor excites (causes increase, aggravate) the doshas which are normal but only mitigate (decrease to normal) the increased doshas; it is of seven kinds, viz., causing good digestion, increasing the appetite, creating hunger, thirst, doing exercise, exposure to sun and breeze. (Deepana, Pachana,Kshut,Trut,Vyayama,Atapasevana) (5-6b)
Brimhanayogyah – persons fit for stoutening therapy
बृंहणं शमनन्त्वेव वायोः पित्तानिलस्य च ॥७॥
बृंहयेद् व्याधिभैषज्यमद्यस्त्रीशोककर्शितान् । भाराध्वोरः क्षतक्षीणरूक्षदुर्बलवातलान् ॥ ८ ॥
गर्भिणीसूतिकाबालवृद्धान् ग्रीष्मेऽपरानपि । मांसक्षीरसितासर्पिर्मधुरस्निग्धबस्तिभिः । स्वप्नशय्यासुखाभ्यङ्गस्नाननिर्वृतिहर्षणैः ॥९॥
Brimhana is also samana for vata and vata pitta combination. Brimhana (therapy) is indicated for persons who have become emaciated due to diseases, treatments, intoxicating drinks, sexual intercourse, and grief; who indulge in lifting heavy weights, walk long distances, who are having injury inside their chest, who are thin (weak) dry, debilitated, suffering from diseases of vata origin; the pregnant woman, woman in parturtion, children, the aged and even others also during grisma (summer). Daily use of meat, milk, sugar, ghee, sweets, fatty substances, oil enema, good sleep, comfortable bed etc., oil-massage, bath and inducing happiness – all these make persons stout. (7-10a)
Langhana yogyah – persons fit for thinning therapy
मेहामदोषातिस्त्रिग्धज्वरोरुस्तम्भकुष्ठिनः। विसर्पविद्रधिप्लीहशिरः कण्ठाक्षिरोगिणः ॥१०॥ स्थूलांश्च लङ्घयेन्नित्यं शिशिरे त्वपरानपि ।
Langhana (therapy) should be done daily for persons suffering from diabetes, ama (endogenous toxins), too much of moisture in the body, fever, stiffness of the thighs, leprosy (and other skin diseases), visarpa (herpes), abscess, splenic diseases, diseases of the head, throat and eyes; those who are obese (fatty) and even for others during sisira (winter). (10)
तत्र संशोधनैः स्थौल्यबलपित्तकफाधिकान्। आमदोषज्वरच्छर्दिरतीसारहृदामयैः ॥११॥
विबन्धगौरवोद्गारल्लासादिभिरातुरान् । मध्यस्थौल्यादिकान् प्रायः पूर्व पाचनदीपनैः ॥ १२ ॥
एभिरेवामयैरार्तान् हीनस्थौल्यबलादिकान्। क्षुत्तृष्णानिग्रहैर्दोषैस्त्वार्तान्मध्यबलैर्दृढान् ॥१३॥ समीरणातपायासैः किमुताऽल्पबलैर्नरान् ।
Those who are very obese, strong and having increase of pitta and kapha should be given purificatory therapies (emesis, purgation etc.), daily;
those who are suffering from amadosha (endogenous toxins), fever, vomiting, diarrhoea, diseases of the heart, constipation, feeling of heaviness, excessive belching, nausea etc., and who are moderately obese should be treated first with digestives and hunger-increasing drugs (or methods) (Deepna, Pachana) so also, patients of the above diseases but who are slightly obese and poor in strength.
Control of (Kshut,Trut) hunger and thirst (avoiding food and water), should be done by those who are moderately strong and stout;
for those who are of poor strength what else can be better than exposure to wind, sunlight and exertion (Atapa/Vayu Sevana, Vyayama). (11-14a)
न बृंहयेल्लङ्घनीयान् बृंह्यांस्तु मृदु लङ्घयेत् । युक्तया वा देशकालादिबलतस्तानुपाचरेत् ॥१४॥
Those who are to be made thin should not be given any therapy (food or drugs) which makes them stout but those who are to be made stout should be given therapies (food or drugs) which make them slightly thin, or both can be given such treatment which is appropriate and suitable to the region, season, strength etc., intelligently. (14)
Notes: Indu, the commentator opines that the purpose of prescribing treatment for thinning the body for persons who are to be made stout, is to increase their capacity of digestion and thereby to obtain favourable condition for stoutening therapy.
Brimhana phalam – benefits of stoutening therapy
बृंहिते स्यात् बलं पुष्टिस्तत्साध्यामयसंक्षयः । विमलेन्द्रियता सर्गो मलानां लाघवं रुचिः ॥१५॥
The benefits of brimhana therapy are: increase of strength, development of the body, diminution of diseases which require such treatment, clarity of sensory perceptions, proper elimination of waste products, and feeling of lightness of the body and of taste (or desire). (15)
Langhana phalam – benefits of thinning therapy
क्षुत्तृट्सहोदयश्शुद्धहृदयोद्गारकण्ठता। व्याधिमार्दवमुत्साहस्तन्द्रानाशश्च लङ्गिते ॥ १६ ॥
Feeling of the hunger and thirst together, purity of heart (mind), belchings and throat (voice); diminution in the severity (virulence) of the disease, improvement of enthusiasm and disappearance of stupor (lassitude) are the benefits of langhana (thinning) therapy. (16)
अनपेक्षितमात्रादिसेविते कुरुतस्तु ते । अतिस्थौल्यातिकार्यादीन्वक्ष्यन्ते ते च सौषधाः । रूपं तैरेव च ज्ञेयमतिबृंहितलङ्घिते ॥१७॥
Both these (therapies) used injudiciously will produce too much of stoutness or too much of emaciation respectively; the treatment for which will be described later. The features ( symptoms) of these also will have to be understood, there itself (chapter 5)
Sthaulya karana – causes of obesity
तत्र शोधनमुद्दिश्य स्थौल्याद्याः प्रागुदाहृताः । गुर्वादिवृद्धसंलीनश्लेष्ममिश्रोऽन्नजो रसः ॥ १८ ॥
आम एव श्लथीकुर्वन् धातून् स्थौल्यमुपानयेत् । अतिस्थौल्यादतिक्षुत्तुट्प्रस्वेदश्वासनिद्रताः॥१९॥
आयासाक्षमता जाड्यमल्पायुर्बलवेगता । दौर्गन्ध्यं गद्गदत्वञ्च भवेन्मेदोतिपुष्टितः ॥२०॥
स्त्रोतस्तु मेदोरुद्वेषु वायुः कोष्ठे विशेषतः । चरन् प्रज्वलयत्यग्निं क्षुत्तुषौ स्तस्ततोऽधिकम् ॥ २१ ॥
स्थूलं कोटरवद्वृद्धौ दहतोऽग्न्यनिलौ च तम् । स्वेदवाहिसिरामूलभावाद्विष्यन्दनादपि । मेदस श्लेष्मयोगाच्च भवति स्वेदभूरिता ॥ २२ ॥
कोष्ठ एव विपक्वेऽस्य संरूद्धस्त्रोतसो रसे। सर्वत्रालब्धवृत्तित्वात् प्रायो मेदः प्रचीयते ॥२३॥
तच्छेषोऽल्परसोऽल्पत्वान्नालं रक्तादिपुष्टये । तुल्येपि वाय्वादिचये प्राक्वितं चीयतेतराम् । मेदस्तेनाऽसमस्तेन धातूनां विदधाति तत् ॥ २४ श्वासादीनचिराच्चान्यान् ज्वरोदरभगन्दरान् । मेहोरुस्तम्भपिटकाविद्रधिप्रभृतीन् गदान् ॥ २५ ॥
अयथोपचयोत्साहश्चलस्फिगुदरस्तनः । अतिस्थूलः स्मृतो योज्यं तत्रान्नं मारुतापहम् ॥२६॥
श्लेष्ममेदोहरं यच्च कुलत्था यवका यवाः । जूर्णश्यामाकमुद्गाद्याः पानेऽरिष्टं मधूदकम् ॥२७॥
मस्तु तक्रं च तीक्ष्णोष्णं रूक्षं छेदी च भेषजम् । चिन्ताव्यवायव्यायामशोधनास्वपनं भजेत् ॥२८॥
देहापेक्षी तथा रूक्षं स्नानमुद्वर्तनादि च । मधुनां त्रिफलां लिह्यात् गुडूचीमभयां घनम् । रसाञ्जनस्य महतः पञ्चमूलस्य गुग्गुलोः ॥२९॥
शिलाह्वस्य प्रयोगश्च साग्निमन्थरसो हितः । विडङ्गं नागरं क्षारः काललोहरजो मधु ॥३०॥
यवामलकचूर्ण च योगोऽतिस्थौल्यदोषजित् । मदनं त्रिफला मुस्ता सप्ताह्वारिष्टवत्सकम् ॥३१॥
सपाठारग्वधं पीतमतिबृंहणरोगजित् । तद्वद्वत्सकशम्याकदेवदारुनिशाद्वयम् ॥३२॥
समुस्तपाठखदिरत्रिफलानिम्बगोक्षुरम् । मदनादीनि चालेपः स्त्रानादिष्वपि योजयेत् ॥३३॥
हिङ्गुगोमेदकव्योषकुष्ठक्रौञ्चास्थिगोक्षुरम् । एलावृक्षकषङ्ग्रन्थाखराश्वोपलभेदकम्॥३४॥
तक्रेण दधिमण्डेन पीतं कोलरसेन वा । मूत्रकृच्छं कृमीन् मेहं स्थूलतां च व्यपोहति ॥ ३५ ॥
कृमिघ्नत्रिफलं तैलसक्तुत्र्यूषणदीप्यकैः। लोहोदकाप्लुतो मन्थः शस्तो बृंहणरोगिणाम् ॥३६॥
Ingestion of foods which are hard to digest (or which are more in quantity) will lead to production of large quantity of essence of food which is in the Ama state (inadequately digested ). This ama (improperly processed essence) getting mixed with kapha residing in the dhatus (tissues) makes them weak and causes obesity.
Excessive hunger, thirst sweating, difficulty in breathing, too much of sleep, inability to withstand exertion, lassituade; decrease of life span, strength and vigour, bad smell of the body and stammering (hoarseness of voice, to be more apt) and increase of medas (adipose tissue, fat) – all these occur due to excess of nourishment.
The channels ( tissue pores, blood vessels, lymphatic ducts etc.,) become blocked by fat, Vata moving especially inside the alimentary tract, causes increase of digestive activity. Because of this, there will be great increase of hunger and thirst, which in turn, burn away the body just as fire and wind burn up a tree which has a big cavity inside it; by he presence of fat, at the (site of) origin of the channels of sweat, increase in secretary activity (moisture) and association of kapha – all make for a profound increase of sweat.
The fat getting digested in the alimentary tract and causing obstruction in the channels of the rasa, hinders it from going to the other dhatus, and make for increase of medas dhatu (fat) only. The remaining portion of rasa dhatu being very little in quantity is not enough, to nourish the rakta and other dhatus.
This increase (of fat) is similar to the increase of vata and others, “that which has undergone increase first will only undergo further increase” (but not others which have not increased first)” on this analogy there will be disparisty betwen medas (fat) and other dhatus. The increased medas (fat) will soon produce difficulty in breathing etc., fever, enlargement of the abdomen, rectal fistula, diabetes, loss of movement of the thighs, nodules, abscesses and such other diseases.
Atisthula chikitsa – treatment for obesity
A person is said to be very obese when he has lack of enthusiasm (in physical activities) disproportional to the growth of his body, and has movement of the buttocks, abdomen and breasts.
Such a person should be given such foods which mitigate vata, kapha and medas (fat) such as horsegram, small barley, barley, jowar, syamaka (black millet) green-gram etc., aristas (medicinal liquors) honeywater, mastu (whey) and takra (butter milk) as drinks; drugs which possess the properties of penetrating, hot in potency, dry and scaryfying; those who wish to retain their body thin should also be prescribed worry, sexual intercourse, physical exercise, purificatory therapies (emesis, purgations etc.) avoidance of sleep, dry bathing (without anointing oil) and massaging the body (without anointing oil or other faty materials).
Powder of triphala, guduci abhaya and ghana should be taken, mixed with honey.
Rasanjana, mahat pancamula, (guggulu), silajatu along with fresh juice of agnimantha is also good.
Vidanga, nagara, ksara, fine powder of iron (ash of iron), barley and amalaka along with honey, cures the disorders of profound obesity.
Madana, triphala, musta, saptahwa, arista, vatsaka, patha, aragwadha taken in the form of decoction cures diseases due to excessive nourishment.
Likewise, the decoction of vatsaka, samyaka, devadaru, the two nisas musta. patha, khadira, triphala, nimba and goksura.
Application of paste of madana and other drugs (mentioned above) to the body or bathing in water prepared by them should also be done.
Hingu, gomedaka, vyosa, kustha, bones of kraunca bird, goksura, ela, vrksaka, sadgrantha, kharahwa and upalabhedaka – all these taken with buttermilk, whey or juice of kola will cure difficulty of micturition, worms, diabetes and obesity.
A mantha prepared from krimighna, triphala, oil, flour of grains, tryushana and dipyaka mixed with water kept for some time in an iron vessel is ideal for patients who are overnourished. (18-36)
निशे बृहत्यौ हपुषा पाठा मूलं च केम्बुकात् । एषां चूर्ण मधु घृतं तैलं च सदृशांशकम् ॥ ३८ ॥
सक्तुभिः षोडशगुणैर्युक्तं पीतं निहन्ति तत् । अतिस्थौल्यादिकान् सर्वान् रोगानन्यांश्च तद्विधान् ।
बुद्धिमेधास्मृतिकरं सन्नस्याग्नेश्च दीपनम् । योज्यं तथा यथाव्याधि स्वेदासृक्स्त्रावणान्यपि ॥४०॥
Vyosa, katvi, vara, sigru, vidanga, ativisa, sthira, hingu, sauvarcala salt, ajaji, yavani, dhany, citraka, the two nisas, the two brhatis, hapusa, patha and kembuka mula – all equal parts making together one part added with equal quantities of each of honey, ghee and sesamum oil and sixteen parts of corn flour – is made into a beverage. This recipe cures obesity and other allied diseases, diseases of the heart, jaundice, leucoderma, dyspnoea, cough and hoarseness of voice; improves intelligence and memory; kindles the digestive activity, cures other diseases also used appropriately, relieves the disorders of perspiration and haemorrhage. (37-40)
Atikrisa chikitsa – treatment of very emaciated person
अतिकाशर्यं भ्रमः कासस्तृष्णाधिक्यमरोचकः। स्नेहाग्निनिद्राद्दक्श्रोत्रशुक्रौजः क्षुत्स्वरक्षयः॥४१॥
बस्तिहृन्मूर्द्धजङ्गोरुत्रिकपार्श्वरुजा ज्वरः । प्रलापोर्ध्वानिलग्लानिः छर्द्दिपर्वास्थिभेदनम् ॥४२॥
वर्चोमूत्रग्रहाद्याश्च जायन्तेऽतिविलङ्घनात् । अतिकार्येन नायासवर्षशीतोष्णतृक्षुधः ॥४३॥
तृप्तिव्याध्यौषधमदान् सहतेऽल्पबलत्वतः । श्वासकासक्षयप्लीहगुल्मार्शोवह्निमन्दताः ॥४४॥ कृशं प्रायश्च धावन्ति रक्तपित्तानिलामयाः ।
Profound emaciation, cough, severe thirst, loss of appetite; decrease of moistnes, digestive activity, sleep acuity of vision and hearing, sukra, ojas, hunger and voice; appearance of pain in the urinary bladder, heart, head, calves, thighs, waist and flanks; fever, delerium, upward movement of air (reverse peristalisis), exhaustion, vomitting, cutting pain in the joints and bones and obstruction for movement of feces, and urine are caused by too much of langhana (severe undernourishment).
The emaciated person, being poor in strength will not be able to tolerate exertion, exposure to rain, cold, heat, thirst, hunger, contentment, toxicity of the diseases and drugs (treatments); the emaciated person soon becomes a victim of dyspnoea, cough, consumption diseases of the spleen, abdominal tumors, haemorrhoids, dyspepsia and diseases of rakta (blood), pitta and vata origin. (4144)
कार्यमेव वरं स्थौल्यान्न हि स्थूलस्य भेषजम् । बृंहणं लङ्घनं नालमतिमेदोऽग्निवातजित् ॥ ४५ ॥
मधुरस्निग्धसौहित्यैर्यत् सौख्येन च नश्यति । क्रशिमा स्थविमात्यन्तविपरीतनिषेवणैः ॥४६॥
शुष्कस्फिगुदरग्रीवा स्थूलपर्वा सिराततः । उच्यते ऽतिकृशस्तन प्रागुक्तो बृंहणो विधिः ॥४७॥
अश्वगन्धाविदार्याद्या वृष्याश्चौषधयो हिताः । अचिन्तया हर्षणेन ध्रुवं सन्तर्पणेन च ॥४८॥ स्वप्नप्रसङ्गाच्च कृशो वराह इव पुष्यति ।
Emaciation is better than corpulence (obesity) because there is no (effective) treatment for the obese; neither fattening therapy nor thinning therapy are sufficient to control excessive fat accumulation, mitigation of agni (digestive activity) and vata; while the use of sweet and unetous foods and other comforts cure emaciation easily, obesity will not be so easily cured by the use of opposites.
The person whose buttocks, abdomen and neck have dired up, joints of bones have become prominent and the body full of (net work of) veins is to be called as highly emaciated.
He should be given all the nourishing therapies described earlier; aphrodisiac drugs like ashwagandha, vidari etc., will be good to him. An emaciated man will become stout like a boar, by the absence of worry, the feeling of happiness, quick nourishments (foods and drugs) and sound sleep. (47-48)
Notes: Indu the commentator expalins the above as follows
Brimhana therapy (more nourishment) given to an obese person will mitigate agni (digestive activity) and Vata but not the medas (fat); whereas Langhana therapy (lack of nourishment) will mitigate medas (fat) but not agni and vata. So treatment is very difficult.
Sweet, unctous foods and comforts are highly nourishing and so the emaciated person derives its benefits soon. The opposite of these i.e., pungent and dry foods and exertion etc, will not give quick benefits to the obese person because he is unable to indulge in them adequately.
लङ्घनोत्थेषु रोगेषु शेषेष्वप्युपकल्पयेत् । यत्तदात्वे समर्थं स्याद्यच्चाभ्यासेन पुष्टये ॥४९॥
सद्यः क्षीणो यतः सद्यो बृंहणेनोपचीयते । चिरं क्रमेण च क्षीणस्तदभ्यासेन तत्र च ॥५०॥ बृंहणं देहमात्राग्निबलादीन् वीक्ष्य योजयेत् ।
In diseases, which arise from lack of nourishment the use of those (foods and drugs) which are effective quickly and accustomed to the person should be prescribed. The person who has become emaciated suddenly will improve quickly by quick nourishment whereas he who has become emaciated over a long time will improve slowly by the use of accustomed things (foods and drugs). All these are to be used in accordance with the strength of the body, the digestive activity and other factors. (49-50)
न हि मांससमं किञ्चदन्यदेहबृहत्त्वकृत् ॥ मांसादमांसं मांसेन सम्भृतत्वाद्विशेषतः ॥५१॥
क्रव्यान्मांसरसांस्तस्माद्दकलावणिकान् लघून् । वेशवारीकृतैस्तद्वज्जाङ्गलैश्च कृताकृतान् ।
रसांस्तथा च क्षीरादीन् तर्पर्णांस्तर्पणान् पुनः ॥५२॥
युञ्ञ्ज्यात् कृशानां ज्वरिणां कासिनां मूत्रकृच्छ्रिणाम् । तृष्यातामूर्ध्वावातानां मूढमारुतवर्चसाम्॥५३॥
There is nothing other than meat which makes the body stout; especially so, the meat of carnivorous animals because meat of such animals is nourished by meat (of other animals) only. So the soup of meat of carnivorous animals and dakalavanika (thin broth with little quantity of meat, spices, oil and salt) vesavara(meat without bones cooked in steam, added with ghee and molasses) prepared from meat of animals of desert-like region, either processed with spices or without; milk mixed with nourishing flour of grains and ghee or only cornflour with ghee sugar etc., should be given to emaciated persons and those suffering form fever, cough, difficulty of micturition, thirst, reverse peristalisis (upward movement of gas) and obstruction to the movement of flatus and faeces. (51-53)
समैः कृष्णासितातैलक्षौद्राद्यैर्व्यंशतर्पणैः । मन्थस्तद्वत् सिताक्षौद्रमदिरासक्तुयोजितः ॥५४॥
फाणितं सक्तवः सर्पिर्दधिमण्डोऽम्लकाञ्जिकम् । तर्पणं मूत्रकृच्छ्रघ्नमुदावर्त्तहरं परम् ॥ ५५ ॥
मन्थः खर्जूरमृद्धीकावृक्षाम्लाम्लीकदाडिमैः । परूषकैः सामलकैः सद्यस्तृष्णादिरोगजित् ॥५६॥
स्वादुरम्लो जलकृतः सस्नेहो रूक्ष एव वा । सद्यः सन्तर्पणो मन्थः स्थैर्यवर्णबलप्रदः ॥५७॥
Equal quantities of krsna, sugar, oil, honey and cornflour mixed with water and a mantha (thick liquid) prepared out of these is also useful. Likewise is the liquid prepared with sugar, honey, sweet and cornflour. Half-cooked molasses. Cornflour, ghee, whey, sour gruel and corn flour are made into tarpana (a thick mess) is also beneficial in difficulty in micturition and upward movement of gas; mantha prepared from kharjura, mrdwika, vrksamala, amlika, dadima, parusaka and amalaka cures thrist and allied disorders quicly; mantha prepared with sweet and sour substances, added with water and with or without fatty materials is a quick nourishing drink and gives strength, colour (complexion) and strength. (54-57)
गुरु चातर्पणं स्थूले विपरीतं हितं कृशे । यवगोधूममुभयोस्तद्योग्याहितकल्पनम् ॥५८ ॥
For the obese person, foods which are difficult to digest and which make the person thin should be prescribed (as diet) and for the emaciated person the opposite (i.e. which are easily digestible and make the person stout). Yava (barley) and godhuma (wheat) may be prescribed to both, prepared in such a way that it will be suitable to each. (58)
स्यौल्यकार्ये प्रकृत्यापि स्यातां तत्राऽप्ययं विधिः । सततं व्याधिततया सदा योज्यो विभज्य च ॥५९ ॥
मात्रादियुक्तेसेवेत यस्तु लङ्घनबृंहणे । समधात्वग्निदेहोऽसौ समसंहननो भवेत् ॥६०॥
दृढेन्द्रियबलत्वाच्च न द्वन्द्वैरभिभूयते । दोषगत्यातिरिच्यन्ते ग्राहिभेद्यादिभेदतः ॥ उपक्रमा न तु द्वित्वाद्भिन्ना अपि गदा इव ॥६१ ॥
The above methods of treatment will hold good even for those who, by their constitution are either obese or emaciated. They being constant sufferers require these treatments as suited to them.
Only judicious (regulated, limited) use of both thinning and stoutening therapies will help the achievement of balanced growth of tissues, good digestive ability and building of well grown and compact body, keenness of sensory perceptions and strength. By these, persons will remain unaffected by the duels (of cold and heat, happiness and misery etc.)
Therapies such as grahi (water absorbent) etc., though appear to be different in accordance with the treatment of the doshas, are not really different from these two therapies (brimhana and langhana); in the same way, the diseases also.
Notes: All therapies can be included under the two therapies brimhana and langhana itself. So also all the different diseases can be included under these two therapies only-bribmhana sadhya (curable by stoutening therapy) and langhana sadhya (curable by thinning therapy).
॥ इति चतुर्विशोध्यायः ॥
Thus ends the twenty-fourth chapter..