Treatment For Diseases Of Over And Under Nourishment – Charaka Sutra 23

Ayurveda emphasizes that over nourishment and undernourishment are the two major causes of many diseases. Based on this principle, many diseases can be categorized into these two divisions. This concept and detailed treatment and remedies are explained in chapter Santarpaneeya Adhyaya – “The Nourishment Regimen”. As a learner of Ayurveda, please concentrate on the herbs that are listed in this chapter which are used to treat over or under nourishment. 

Excessive nourishment disadvantages

Disadvantages of taking excessive nourishing diet:
सन्तर्पयति यः स्निग्धैर्मधुरैर्गुरुपिच्छिलैः|
नवान्नैर्नवमद्यैश्च मांसैश्चानूपवारिजैः||३||
गोरसैर्गौडिकैश्चान्नैः पैष्टिकैश्चातिमात्रशः|
चेष्टाद्वेषी दिवास्वप्नशय्यासनसुखे रतः||४||
रोगास्तस्योपजायन्ते सन्तर्पणनिमित्तजाः|
प्रमेहपिडकाकोठकण्डूपाण्ड्वामयज्वराः||५||
कुष्ठान्यामप्रदोषाश्च मूत्रकृच्छ्रमरोचकः|
तन्द्रा क्लैब्यमतिस्थौल्यमालस्यं गुरुगात्रता||६||
इन्द्रियस्रोतसां लेपो बुद्धेर्मोहः प्रमीलकः|
शोफाश्चैवंविधाश्चान्ये शीघ्रमप्रतिकुर्वतः||७||
santarpayati yaḥ snigdhairmadhurairgurupicchilaiḥ|
navānnairnavamadyaiśca māṃsaiścānūpavārijaiḥ||3||
gorasairgauḍikaiścānnaiḥ paiṣṭikaiścātimātraśaḥ|
ceṣṭādveṣī divāsvapnaśayyāsanasukhe rataḥ||4||
rogāstasyopajāyante santarpaṇanimittajāḥ|
pramehapiḍakākoṭhakaṇḍūpāṇḍvāmayajvarāḥ||5||
kuṣṭhānyāmapradoṣāśca mūtrakṛcchramarocakaḥ|
tandrā klaibyamatisthaulyamālasyaṃ gurugātratā||6||
indriyasrotasāṃ lepo buddhermohaḥ pramīlakaḥ|
śophāścaivaṃvidhāścānye śīghramapratikurvataḥ||7||

One who over indulges in nourishing himself with
Snigdha, Madhura, Guru, Picchila Ahara – food with oily, sweet, heaviness and stickiness qualities,
Nava anna –  newly harvested rice and grains
Nava Madya – newly made wine,
Anupa Mamsa, Varija Mamsa – meat of marshy and aquatic animals,
Gorasa, Gaudika, Paishtika – cow’s milk and its preparations and food preparations made of jaggery and pastry
Cheshtadveshi – who is averse to physical activities,
Divaswapna – indulges in sleep during daytime,
Shayyasukhe rata  – indulging in sleeping and resting all the time.

Such a person often suffers from diseases like
Prameha – urinary disorders including diabetes,
Pidaka – carbuncles,
Kota – urticaria,
Kandu – itching,
Pandu (anemia),
Jwara – fever,
Kushta – skin diseases,
diseases due to Ama,
Mutrkrichra – dysuria,
Arochaka – anorexia,
Tandra – drowsiness,
Klaibya – sterility, infertility,
Atisthoulya – excessive obesity,
Alasya – laziness,
Gurutva – heaviness of the body,
adhesion of the channels in sensory organs,
Moha – delusion,
Pramilaka – wandering,
Shopha – oedema and such other diseases.
Unless the effects of a nourishing regimen are neutralized by suitable antidotes, these diseases are bound to occur. [3-7]

Management of Excessive Nourishment

Management of the diseases caused by over nourishment:
Ullekhana – Vamana (Emesis therapy)
Virechana – purgation therapy,
Raktamokshana – blood-letting,
Vyayama – physical exercise,
Upavasa – fasting,
Dhumapana – herbal smoking,
Swedana – fomentation / sweating treatment,
intake of Abhayaprasha, Agastya haritaki etc. with honey,
Rooksha anna sevana – intake of rough and dry food,

Churna Pradeha – application of powders and ointments that are mentioned (in the Aragvadheeya chapter of Sutrasthana) for the cure of pruritus and urticaria.

Water decoction made of of Triphala, Aragvadha (Cassia fistula), Patha (Cissampelos pareira Linn), Saptaparna (Alstonia scholaris .Br), Vatsaka (Holarrhena antidysenterica Wall.), Musta (Cyperus rotundus), Madana (Randia dumetorum Lam), and nimba – neem.

One can be cured of all the above listed diseases if he takes every morning the Kashaya (water decoction) of:
Musta (Cyperus rotundus), Aragvadha (Cassia Fistula Linn), Patha (Cissampelos pareira Linn), Triphala, Devadaru (Cedrus deodara), Shvadamstra (Tribulus terrestris Linn), Khadira (Acacia catechu), Nimba – Neem, Haridra (turmeric), Daru Haridra – Tree Turmeric (stem) – Berberis aristata) and the skin of Vatsaka (Holarrhena antidysenterica Wall.).

The above mentioned drugs mixed with oily substance and applied as unction with or without massage or as bath, helps to cure skin diseases.

Medicine for dysuria, urinary disorder and diabetes

Kustha ( Saussureu Lappa C.B Clarke), Gomedaka (Onyx), Hingu – Asa foetida (Ferula narthex Boiss), bone of Krauilca (Demoiselle crane), Shunthi (ginger), Pippali (Long pepper fruit), Maricha (Black pepper fruit), Vacha (Acorus calamus Linn.), Vasa (Ahatoda vasica Nees), Ela (cardamom), Gokshura (Tribulus terrestris Linn), Kharahva (Ttrachyspermum roxburghianum), Ashmabheda (Bergenia Ligulata Eng;)
These drugs mixed with buttermilk, whey and the juice of sour type of Badara – Ziziphus jujuba when taken, are useful in dysuria and urinary disorders including diabetes mellitus.

By the administration of Haritaki (Terminalia Chebula Linn) with buttermilk,
Triphala and Arishtas ( different types of alcoholic preparation), are useful in urinary disorders, diabetes mellitus and such other diseases.

Mantha (thin gruel) prepared of Trikatu ( pepper, long pepper and ginger), Triphala, honey, Vidanga (Embelia Ribes Burm f. ) Ajamoda – Ajowan (fruit) – Trachyspermum roxburghianum, roasted corn flour, oil and the decoction of Agaru (aquilaria agallocha Roxb. ) help to cure diseases due to over nourishment.

Trikatu ( pepper, long pepper and ginger), Vidanga(Embelia ribes Burm.f.), varieties of Shigru (Moringa oleifera Lam), Triphala, Katurohini – Picrorhiza kurroa, Brihati – Solanum indicum, Kantakari – Solanum xanthocarpum, Haridra (turmeric), Daru Haridra – Tree Turmeric (stem), two varieties of Patha (Cissampelos pareira Linn), Ativisha (Aconitum heterophyllum wall), Shalaparni (Desmodium, Gangericum DC), Hingu – Asa foetida (Ferula Narthex Boiss), root of Kebuka, Yavani (Trachysperumum Ammi Sprague), Dhanyaka (Coriander), Chitraka – Leadwort – Plumbago zeylanica, sochal salt, Ajaji (Cuminum cyminum Linn), and Hapusha (Juniperus communis Linn)
The recipe prepared with the powder of these drugs along with equal quantity of the each of oil, ghee and honey added with sixteen times of roasted corn flour and water is useful in the treatment of urinary disorders including diabetes mellitus, Mudhavata (claudication caused by Vata), skin diseases including leprosy, piles jaundice, diseases of spleen, anaemia, edema, anorexia, heart disease, tuberculosis, cough, dyspnoea, spasmodic obstruction of the throat, parasitic infestation, sprue, leucoderma and over corpulence caused by enhances memory and intellect.

नराणां दीप्यते चाग्निः स्मृतिर्बुद्धिश्च वर्धते||२४||
व्यायामनित्यो जीर्णाशी यवगोधूमभोजनः|
सन्तर्पणकृतैर्दोषैः स्थौल्यं मुक्त्वा विमुच्यते||२५||
उक्तं सन्तर्पणोत्थानामपतर्पणमौषधम्|२६|
narāṇāṃ dīpyate cāgniḥ smṛtirbuddhiśca vardhate||24||
vyāyāmanityo jīrṇāśī yavagodhūmabhojanaḥ|
santarpaṇakṛtairdoṣaiḥ sthaulyaṃ muktvā vimucyate||25||
uktaṃ santarpaṇotthānāmapatarpaṇamauṣadham|26|

Individuals desirous of reducing obesity should do daily exercise, intake of food like barley and wheat only after the digestion of the previous meal.

Thus, the emaciating therapies (Apatarpana) for the cure of diseases caused by over-nourishment (Santarpana) have been described.[9-25]

Nutritional deficiency diseases

Diseases caused by nutritional deficiency – Apatarpana Janya Vikara
वक्ष्यन्ते सौषधाश्चोर्ध्वमपतर्पणजा गदाः||२६||
देहाग्निबलवर्णौजःशुक्रमांसपरिक्षयः|
ज्वरः कासानुबन्धश्च पार्श्वशूलमरोचकः||२७||
श्रोत्रदौर्बल्यमुन्मादः प्रलापो हृदयव्यथा|
विण्मूत्रसङ्ग्रहः शूलं जङ्घोरुत्रिकसंश्रयम्||२८||
पर्वास्थिसन्धिभेदश्च ये चान्ये वातजा गदाः|
ऊर्ध्ववातादयः सर्वे जायन्ते तेऽपतर्पणात्||२९||
तेषां सन्तर्पणं तज्ज्ञैः पुनराख्यातमौषधम्|
यत्तदात्वे समर्थं स्यादभ्यासे वा तदिष्यते [१] ||३०||
vakṣyante sauṣadhāścordhvamapatarpaṇajā gadāḥ||26||
dehāgnibalavarṇaujaḥśukramāṃsaparikṣayaḥ|
jvaraḥ kāsānubandhaśca pārśvaśūlamarocakaḥ||27||
śrotradaurbalyamunmādaḥ pralāpo hṛdayavyathā|
viṇmūtrasaṅgrahaḥ śūlaṃ jaṅghorutrikasaṃśrayam||28||
parvāsthisandhibhedaśca ye cānye vātajā gadāḥ|
ūrdhvavātādayaḥ sarve jāyante te’patarpaṇāt||29||
teṣāṃ santarpaṇaṃ tajjñaiḥ punarākhyātamauṣadham|
yattadātve samarthaṃ syādabhyāse vā tadiṣyate [1] ||30||

Diseases caused by the improper use of emaciating regimen along with their treatment are as follows:
Deha kshaya – Emaciation of the body,
reduction in the power of digestion, strength, complexion, Ojas, Semen and muscle tissue,
continuous fever and cough, pain in chest, anorexia, weakness in the power of hearing sounds, insanity, pain in cardiac region, obstruction to the passage of stool and urine, pain in calf, thigh and lumbar regions.
Cracking pain in fingers, bones and joints and such diseases due to the vitiation of Vata like Urdhvavata (upward movement of Vayu) etc.
For their treatment, therapies resulting in long term nourishment should be administered. [26-30]

Treatment

Management of the patients suffering from nutritional deficiency:
One suffering from an attack of emaciation can soon be cured by the administration of refreshing regimen but one suffering from chronic type of emaciation would require slow and long acting nourishment therapy.

In cases of patients having chronic types of emaciation, the nourishing therapy (Santarpana) should be administered slowly –
Mamsarasa – meat-soup,
Paya, Ghrita – milk and ghee of different animals,
different types of bath, enema, massage and nourishing drinks are useful.

For these patients suffering from continuous fever, cough, emaciation, dysuria, thirst and upward movement of Vata, the following type of nourishing drink is useful:

Aphrodisiac gruel: Mantha (thin gruel) prepared of sugar candy, Pippali (Long pepper fruit), Oil, Ghee, Honey –all in equal quantity added with double the quantity of roasted corn flour is aphrodisiac and useful for such conditions.

These patients may be given drinks prepared of roasted corn flour, Alcohol, Honey and sugar which help in elimination of faeces, urine, Vayu, Kapha and Pitta.

The nourishing drink prepared of Phanita ( a preparation of sugar candy), roasted corn flour, ghee, whey, sour gruel which cures dysuria and Udavarta should be given.

Recipe for alcoholism

मन्थः खर्जूरमृद्वीकावृक्षाम्लाम्लीकदाडिमैः|
परूषकैः सामलकैर्युक्तो मद्यविकारनुत्||३८||
Mantha (thin gruel ) prepared of Date- palm, dry grapes, Vrikshamala (Garcinia indica Ehois), Amlika (Tamarindus indica Linn), Dadima – Pomegranate – Punica granatum Linn, Parushaka (Grewia Asiatica Linn), and Amalaki (emblica Officinalis Gaertn, are useful for curing alcoholism.[31-38]

Recipe of Nutrition Therapy

स्वादुरम्लो जलकृतः सस्नेहो रूक्ष एव वा|
सद्यः सन्तर्पणो मन्थः स्थैर्यवर्णबलप्रदः||३९||
Mantha (gruel) prepared of water by adding sweet or sour things like Dadima – Pomegranate, with or without oily substance refreshes immediately, and promotes steadiness, complexion and strength.[39]

To sum up:-
तत्र श्लोकः-
सन्तर्पणोत्था ये रोगा रोगा ये चापतर्पणात्|
सन्तर्पणीये तेऽध्याये सौषधाः परिकीर्तिताः||४०|
Diseases due to over refreshing and emaciating regime along with their management are described in the chapter on “Refreshing Regimen”[40].

Thus, ends the twenty-third chapter on “Refreshing Regimen” of the Sutra of Agnivesa’s work as redacted by Charaka.[23]