Treatment For Dosha Imbalance, Ama – Ashtanga Sutrasthana 13

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. 

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Treatment for Vata increase

Treatment for Vata imbalance (increase) –  Vriddha Vata Chikitsa—

Treatment options for increased Vata Dosha are-
Sneha – 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 increase

Treatment for Pitta imbalance (increase) – Vriddha Pitta Chikitsa

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)

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Treatment for Kapha increase

Treatment for Kapha imbalance (increase) – Vriddha Kapha Chikitsa
Treatment options for increased Kapha Dosha are-
Vidhiyukta 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, piercing), 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

The different treatment prescribed for each Dosha individually, may be combined appropriately in conditions of combinations of two or  three Doshas.  13

ग्रैष्मः प्रायो मरुत्पित्ते वासन्त कफमारुते ।
मरुतो योगवाहित्वात, कफपित्ते 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 Sarad- Autumn .14

चय एव जयेद्दोषं कुपितं तु अविरोधयन् ।
सर्वकोपे बलीयांसं शेषदोष अविरोधतः ॥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 another Dosha.
When there is simultaneous enhanced increase (Kopa) of all the three Doshas, the most powerful / most aggravated Dosha should be controlled first, without opposing the remaining Doshas. 15

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 disease and does not give rise to another. 16

Movement of Doshas

Movement of Dosha from Digestive Tract to Body Tissues and vice versa –

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.

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

Native and foreign Doshas:-  Sthayi- and Agantu Doshas:-
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 – 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

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; should not be treated in haste. They should be carefully treated only after determining 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 emesis – Vamana or by anal route, by purgation – Virechana). 21-22

Dosha with Ama symptoms

 Effects of Doshas associated with Ama  – Sama Dosha Lakshana –

When imbalanced Doshas get associated with Ama (a factor of indigestion / false metabolism), it is called 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

Ama origin

 Origin of Ama – Amotpatti-
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
Other authors opine that Ama gets formed from intimate mixing with one another of greatly increased Doshas. 26
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

Treatment of Sama Dosha

Saama Dosha chikitsa—treatment of Sama Doshas :-
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, purgation 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
– 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

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

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

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 Dosha elimination

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

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

After having overcome the effects of cold, hot and rainy seasons suitably- by adopting appropriate protective methods and necessary treatment – therapies should be administered;
The Kriyakala- period of abnormal activity, stages of disease evolution should not be allowed to progress- further. 36

Time of medicine administration

Aushadha Sevana Kala – time of administration of medicines:-

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.

9 thoughts on “Treatment For Dosha Imbalance, Ama – Ashtanga Sutrasthana 13”

  1. Dear Dr. Hebbar,

    Each time I go through your articles I feel so proud of our ancestors who have observed keenly and described the diagnosis and management of most of the diseases. Just look at the above list of timing of administration of drugs! I salute them and Thank you very much for introducing us to this beautiful but exuastive world in such simple words.

    Reply
  2. Does every kind of ama show up on the tongue. Is tongue the only organ to watch out for ama presence and it measurement ?

    Reply
    • Hi, white tongue coating is just one symptom of Ama.
      Other symptoms 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

      Reply
  3. Does your reply mean that even when the tongue is absolutely clear, there could be Ama elsewhere ? Could milk, sugar and ghee be taken while being on trikatu for ama pachan ?

    Reply
  4. One more question Sir, Could Milk with ghee be taken to induce loose motions to help the body eliminate Ama ?

    Reply
    • Bitter herbs which are not very hot – Guduchi, Patola (pointed gourd), Neem, Vasa – adhatoda vasica – so, they are Pitta balancing and not very hot. Hence, clear ama as well.

      Reply

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