By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Chikitsa means treatment given to a disease. It may be in form of medicines, therapies or dietetic corrections. While treatment is given to a disease, same treatment is also applicable for doshas causing disease. This is because no systemic disease manifests without involvement of vitiated doshas.
Read – Chikitsa: Treatment Types, Ayurvedic classification
Dosha – treatment
Relationship of Doshas with Treatment of Diseases
Dosha-treatment relationship from perspective of ‘word derivation of chikitsa’
Keeping away causative factors of a disease is called Chikitsa (treatment).
We need to remember that doshas are invariably causative factors of a disease. No disease occurs without aggravation of doshas. Therefore, treatment is all about getting rid of a disease by taking control over doshas which have caused that disease and expelling those doshas.
Dosha pratyanika chikitsa is a type of treatment, which means ‘dosha specific treatment’.
Read – Atma Rupas of Doshas – Cardinal Symptoms Of Doshas In Diseases
Root derivation of term chikitsa helps us to know that treatment is focused towards mitigating and expelling morbid doshas and hence treat diseases caused by them.
Dosha-treatment relationship from perspective of ‘synonyms of chikitsa’
Chiktsaa has many synonyms. Among them, below mentioned two synonyms explain dosha-treatment relationship.
- Prashamana – means that which pacifies diseases. When something pacifies a disease, it should also pacify doshas related to and causing that disease.
- Prakruti sthapana – means ‘that which establishes normalcy in body’. This can be done by curing disease. But disease is caused by imbalances brought about in body by vitiated doshas. Health will become normal only when equilibrium of doshas is established by providing treatment.
Prakruthi sthapana also means to establish dhatu samya i.e. equilibrium of body tissues. Here, word dhatu is taken in wider sense. Dhatu not only includes tissues but also ‘doshas in a state of balance’.
Read – Functions Of Doshas In Balance In The Body – Prakrita Dosha Karma
Thus, prakruthi sthapana = synonym of treatment = bringing doshas to balance.
Dosha-treatment relationship from perspective of ‘definition of chikitsa’
Any approach which alleviates a disease, which brings about an equilibrium in physical doshas i.e. vata, pitta and kapha, mental doshas i.e. rajas and tamas, 7 tissues and three excreta by correcting abnormal deviations of these entities is called chikitsa (treatment).
Thus, treatment modalities essentially and compulsorily involved dosha correction, balancing and excreting.
All those methods through which doshas, tissues and excreta of body revert back to their normalcy by losing their morbidity are called Chikitsa.
Selfless indulgence of 4 limbs of treatment enriched in their qualities towards establishing equilibrium of doshas, tissues and excreta by eradicating disease is called Chikitsa.
Clues of dosha-treatment relationship from ‘disease classification’ point of view
Sheeta upachara and Ushna upachara
Sheeta upachara means cold comforts. Cold is opposite to hot. When disease is manifested due to excessive heat or causes inducing heat in body, treatment should be antagonistic. Thus cold comforts and food should be administered in diseases manifested due to excess heat.
Ushna upachara means hot comforts. Hot is opposite to cold. When disease is manifested due to cold or due to causes inducing cold, then treatment should be opposite to cold. Thus hot comforts and food should be administered in diseases manifested due to excess cold.
Coldness and related diseases are caused due to excessive vata, kapha or vata-kapha. Similarly, heat and related diseases are caused due to excessive pitta. Opposite measures as explained above in form of hot and cold comforts is therefore anti-dosha.
Santarpana and Apatarpana Chikitsa
Santarpana means nourishing treatment. This is a treatment for diseases caused due to malnutrition. It also enhances bulk in thin people. Therefore it is an ideal treatment for low weight.
Apatarpana means depleting treatment. They are also called starvation, thinning therapies and lightening therapies. This is a treatment for diseases caused due to over-nutrition. This is also used to deplete fat stores, to emaciate fat people. Therefore it is an ideal treatment for obesity and over-weight conditions.
Read – Two Types Of Ayurveda Treatments – Ashtanga Hrudaya Sutrasthana 14
There will be loss of tissues in conditions suited for nourishing treatment. This would eventually cause vata increase. On other hand these diseases may also be manifested due to vata increase. Therefore santarpana treatments are also vata alleviating treatments.
There will be formation of tissue(s) in conditions suited for depleting treatments. This would eventually increase kapha. On other hand these diseases may also be manifested due to kapha increase. Therefore apatarpana treatments are also kapha alleviating treatments.
Shodhana and Shamana treatments
Shodhana means cleansing treatments. These treatments are administered to expel morbid doshas, unwanted metabolic wastes and tissue toxins out of body. This treatment is preferred when there is excessive accumulation of doshas in body. They are administered to those who have good strength and muscle bulk.
Read – Ayurvedic Panchakarma Treatment: Relation With Dosha
Shamana means palliative form of treatment. This is preferred when there is less or moderate accumulation of doshas in body, i.e. conditions not needing cleansing treatments and in those having less strength and muscle bulk.
Dravyabhuta and Adravyabhuta treatments
In dravyabhuta treatments medicines are used in treatment of diseases. Medicines given to treat diseases are also antagonistic to doshas.
In adravyabhuta chikitsa medicines are not used for treatment. Rather, different non-medicinal methods are employed in treating patients. Example – causing fear, making one forget things, provoking, causing joy, hitting, tying etc are employed. Even these methods address doshas, mainly mind doshas and balance them.
Daiva-vyapashraya, Yukti-vyapashraya and Satvavajaya treatments
This is one kind of classification of treatments in which daiva-vyapashraya treatments are based on divine remedies, generally preferred in chronic and idiopathic diseases. Other two treatments are directly related to dosha balance and curing diseases.
Yukti-vyapashraya treatments include skillful administration of medicines, dietetic and lifestyle changes in treating diseases. All these are employed to correct and balance doshas other than treating diseases.
Satvavajaya treatments are treatments given to cure diseases related to mind and senses. Thus, it helps in balancing mind doshas directly and also to balance physical doshas indirectly in psychosomatic disorders.
Antah parimarjana, Bahi parimarjana and Shastra pranidhana treatments
Among these shastra pranidhana means surgical treatments. They are preferred in surgical cases and in those conditions wherein medicinal treatments are not effective.
Antah parimarjana means to cleanse body from within. Medicines are administered orally. These medicines act on doshas and balance them.
Bahih parimarjana means to cleanse the body from outside. Here medicines are administered over the body. Example, herbal oil massage, foot massage, stream pouring of medicated oils and milk on body is highly effective in combating morbid vata. Application of medicinal pastes is preferred to address particular doshas and their symptoms in case of arthritis.
Read – Lepa Kalpana: Ayurvedic Dosage Forms For External Application
Explanation of other types of treatments which establish dosha-treatment relationship
Above said were only examples. We shall find that explanation of treatment in various other classifications too establish dosha-treatment relationship. I would like to highlight only those parts of classification which show this relationship.
Asuri-Manushi-Daivi chikitsa –
Manushi chikitsa is a type where treatments are done using medicines like powder, decoction, infusion, tablets etc.
Daivi chikitsa includes administering rejuvenators, immune-modulators and aphrodisiacs.
Asuri chikitsa deals with surgical interventions.
Read – Procedure of surgical operation: Ashtanga Hrudaya Sutrasthana 29
Bhouma, Audbhida and Jaangama Chikitsa –
These three types of treatments deals with use of metals, herbs and animal products respectively as medicines.
Animal products include use of ghee, honey etc.
Hetu vipareeta, Vyadhi vipareeta and Ubhayarthakaari treatments – Hetu Vipareeta – medicines, food and activities antagonistic to causative factors of disease are administered.
Example, foods and medicines having light, dry and hot qualities which are antagonistic to disease causing qualities heavy, oily and cold qualities respectively are administered.
Vyadhi Vipareeta – disease pacifying medicines are administered.
Example, Cissampelos pareira, Holarrhena antidysenterica etc herbs are used to stop loos stools in diarrhoea.
Ubhayarthakari Chikitsa – In this, medicines, food and activities antagonistic to both cause and disease are administered.
Example, in swelling caused due to vitiated vata, Dashamula decoction which is remedy for both vitiated vata and swelling is used.
Read – 4 Basic Elements Of Ayurvedic Treatment – Charak Samhita Sutrasthan 9
Langhana, Langhana-Pachana and Doshavasechana –
Langhana means treatment which produces lightness in body.
Langhana-Pachana is combining ama digesting interventions with lightening therapies.
Doshavasechana means expelling morbid doshas from body.
Read – Langhana Therapy – A Unique Ayurvedic Treatment Principle
They are preferred in people having less, moderate and more quantity of dosha accumulation, strength and tolerance respectively. All these three interventions are focused to balance doshas apart from curing diseases.
Brimhitavya, Prashamayitavya, Nirhartavya and Paripaalya treatments –
Brimhitavya – administered to increase doshas which have decreased and bring them back to normalcy.
Prashamayitavya – administered to decrease increased doshas so as to bring them back to normalcy.
Nirhartavya – administered to expel vitiated doshas from body.
Paripaalya – administered to balance doshas which are already in equilibrium status.
Read – Brimhana Therapy – Nourishing Ayurvedic Treatment Principle
Samshodhana, Samshamana, Aahara and Aachara –
These are cleansing therapies, palliative interventions, dietetic corrections and lifestyle corrections respectively. Intention of all these four types of treatments is to bring doshas to balance and eradicate diseases caused by them.
Panchakarma treatments –
These are set of five great therapies which are predominantly cleansing and evacuation treatments. They can be considered as samshodhana treatments mentioned above.
Among them, vamana i.e. therapeutic emesis, virechana i.e. therapeutic purgation and vasti i.e. medicated enemas are administered to expel morbid kapha, pitta and vata and to effectively treat kapha pitta and vata diseases respectively.
Nasya i.e. nasal medication is used to combat doshas aggravated in head, eyes, ears and nose.
Raktamokshana i.e. bloodletting is used to balance doshas vitiated in blood and to treat diseases caused due to blood vitiation.
Read – Importance Of Diet (Pathya) For Specific Diseases
Six therapies –
1. Langhana therapies as already mentioned produce lightness in body.
This is of 10 subtypes. Among them, therapeutic emesis, purgation, nasal medications and evacuation enemas are focused towards expulsion of morbid doshas and treating diseases caused by them, as already discussed.
Not drinking water, exposure to breeze and sunlight and ama digesting medicines, fasting and exercise helps in combating doshas, chiefly increased kapha, ama and ama association with doshas.
Read – Six Basic Ayurvedic Therapies – Shat Upakrama – Charaka Sutrasthana 22
7 types of shamana / palliative treatments –
They comprise of below mentioned interventions and act in balancing doshas just as mentioned in case of 10 forms of lightening therapies above.
- Paachana – digestants, ama digesting medicines
- Deepana – fire kindling medicines
- Trushna – controlling thirst
- Kshudha – controlling hunger, fasting
- Vyaayama – Exercise
- Aatapa – Exposure to heat of sun
- Vayu – Exposure to wind
2. Brimhana –
This includes measures to enhance muscle bulk. This is also an anti-vata treatment. Maintenance of muscle bulk is said to be one of the signs of good health. When any tissue depletion occurs, vata increases. This rule is applicable to muscle tissue too. Thus, brimhana is biphasic intervention.
3. Rukshana –
Any treatment that brings about dryness and roughness in body is called Rukshana. This is an effective remedy for high kapha, ama and related disorders.
Read – Rookshana Therapy – Drying Principle For Excess Oiliness
4. Snehana –
Means to produce unctuousness in body. Anything treatment or medicine that produces oiliness and softness in body is called Snehana. It can be applied either internally or externally. Snehana is best remedy for increased vata.
5. Swedana –
Means sudation. Any form of treatment that destroys stiffness, coldness and heaviness and induces sweating is called Swedana. This is best treatment for vata, kapha, vata-kapha and related disorders.
6. Stambhana –
Means to stop. Any form of treatment that stops loss of fluids from body is called stambhana. This principle is used to treat diarrhea, excessive bleeding etc conditions. Such conditions are caused by hyper-activity of vata or increase in liquid quality of pitta or kapha.
18 types of upashaya-anupashaya treatments
Upashaya means relieving factors. Anupashaya means aggravating or non-relieving factors of a disease. These are therapeutic methods administered after trial and error methods, whenever there is a doubt about diagnosis of disease or involved dosha(s).
They are of 18 types. They are not only tools of examination of a disease but also become treatment of disease because while doing trial and errors we would have many times administered perfect treatment or medication for disease in question.
Something given as trail may work as remedy. If it relieves disease or suppresses an involved dosha, upashaya is continued as treatment.
If a medicine or treatment given by considering it as relieving factor worsens disease or dosha, it means that they are antagonistic to disease or dosha or both. In such case treatment which is worsening condition is withdrawn and proper disease and dosha relieving treatments is started. Thus, upashaya-anupashaya helps in diagnosing a disease and also to choose or reject a treatment on basis of relief or aggravation, following trial and error method.
Shashta Vidha Chikitsa / Shashti Upakrama – 60 types of treatment
These treatments are mentioned by Sushruta and are mainly used in surgical practice. We will just touch upon selected interventions amongst these 60 which has a direct role to play in balancing doshas.
- Apatarpana – starvation – is beneficial for high kapha conditions and doshas associated with ama
- Abhyanga – massage – mitigates vata
- Sweda – sudation – beneficial to combat vata, vata-kapha vitiation
- Sneha – inducing unctuousness – beneficial for vata control, in various combinations of herbs and in form of various formulations it is also beneficial in pitta and kapha disorders
- Vamana – therapeutic emesis – expels morbid kapha and pitta
- Virechana – therapeutic purgation – expels morbid pitta, good for high vata conditions also
- Vasti karma – medicinal enemas – useful remedy for vitiated vata, even for disorders caused by vitiated pitta, kapha and blood
- Uttara vasti karma – enemas given through urinary and genital passages – useful in vata disorders afflicting mentioned organs
- Shiro virechana – nasal instillation of medicines – expels doshas from head, eyes, nose and ears
- Nasya – nasal instillation of medication – mitigates doshas in head, eyes, nose and ears
- Brimhana – bulk promoting and strengthening treatments – mitigates vata
- Nirvapana – application and stream pouring of medicines which are cold in nature – mitigates pitta and pitta related symptoms like burning sensation, rise in warmth etc.
- Kavala dharana – rinsing of mouth with medicinal liquids – pacifies and expels doshas from mouth
- Kashaaya – administering herbal decoctions – prepared with specific dosha alleviating herbs, suppresses all three doshas
- Sarpi – medicated ghee – mitigates vitiated pitta and vata
- Taila – medicated oils – mitigates vata
- Aahara – dietetic regimen – beneficial for comprehensive health, source of nutrition, balances all doshas
- Krushna karma – inducing black colour – hypo-pigmentation area made normal like surrounding tissue, corrects bhrajaka pitta
- Pandu karma – inducing white colour – hyper-pigmentation area made normal like surrounding tissue – balances bhrajaka pitta
Below mentioned treatments balances local doshas and relieves their symptoms when administered externally –
- Alepa – anointment of medicinal pastes
- Parisheka – stream pouring of medications
- Upanaha – poultices
- Paachana – causing maturity in suppuration, helping pus to form properly so as to drain it out
- Utkaarika – warm semi-solid pastes prepared with medicines which alleviate vata, mainly used in inflamed and or necrosed wounds
- Kalka – application of herbal pastes
- Rasa kriya – administration of semi-solid extracts of medicines