Sushruta Samhita Sutrasthana Chapter 15: Dosha Dhatu Mala Kshaya Vruddhi Vijnaninya Adhyaya (Knowledge of Decrease and Increase of Dosha, Dhatu, and Mala)

Table of Contents

The 15th chapter of Sutrasthana of Sushruta Samhita is named as Dosha Dhatu Mala Kshaya Vruddhi Vijnaninya Adhyaya. This chapter deals with the Knowledge of Decrease and Increase of Dosha, Dhatu, and Mala.

अथातो दोषधातुमलक्षयवृद्धिविज्ञानीयमध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भगवान् धन्वन्तरिः ॥२॥

Now, we will expound the chapter by name Doshada Tumala Ksa Vrddhi Vijnaniya-knowledge of decrease and increase of Doshas, Dhatus and Malas as revealed by venerable Dhanvantari.

Sharirasya Mulam: Foundations of the body

दोषधातुमलमूलं हि शरीरं, तस्मादेतेषां लक्षणमुच्यमानमुपधारय ॥३॥

Doshas, Dhatus and Malas are the roots (root causes for the existence) of the body. Therefore, I would explain the symptoms (features) of these (doshas, dhatus and malas) in this context, hence listen carefully to their features.

Notes:

Doshas are three in number, they are –

– Vata
– Pitta and
– Kapha

Dhatus (tissues) are seven in number, they are –

– Rasa – plasma
– Rakta – blood
– Mamsa – muscles
– Medas – fat / adipose tissue
– Asthi – bones
– Majja – bone marrow,
– Sukra – semen / reproductive tissue

Apart from these tissues, there are also some secondary tissues. They are called upadhatus.

Malas i.e. excretory or waste products are three in number –

– Purisa – faeces,
– Mutra – sweat,
– Sveda – sweat

1. Dosha

Vata

तत्र, प्रस्पन्दनोद्वहनपूरणविवेकधारणलक्षणो वायु: पञ्चधा प्रविभक्तः शरीरं धारयति॥१॥

Among these, the vayu (vata) renders five main functions in the body, they are –

– Praspandana – movement
– Udvahana – perception
– Purana – filling
– Viveka – separation and
– Dharana – retaining

The vayu which is involved in these functions is divided into five divisions (types, subtypes) and supports the body (and all functions going on in the body).

Master Dalhana, the commentator of Sushruta Samhita has assigned each of the above-mentioned functions to one subtype of vata. They are –

Function of vata	Meaning	Type of vata involved
Praspandana	Movement – all kinds of movement of every part of the body	Vyana Vata
Udvahana	Perception – sensory perception (receiving, understanding and perceiving the sense objects by their respective sense organs)	Udana Vata
Purana	Filling – filling the body with food	Prana Vata
Viveka	Separation – helping in the process of digestion of food and separating its essence and wastes	Samana Vata
Dharana	Retention – retaining the wastes for some time and then eliminating them later	Apana Vata

The above mentioned are the chief functions of the mentioned vata types. There are many other functions contributory to vata when it is in a state of balance / normalcy.

Pitta

रगपक्त्योजसेजोमेधोष्मकृत् पितं पञ्चधा प्रविभक्तमग्रिकर्मणाऽनुग्रहं करोति॥२॥

The pitta renders five main functions in the body, they are –

– Raga – imparting redness,
– Pakti – cooking / digestion of food
– Teja – vision
– Medha – intelligence
– Ushma – heat, body temperature

The pitta which is involved in these functions is divided into five divisions (types, subtypes) and supports the body by its ‘agni karma’ i.e. fire like action.

Each of the above-mentioned functions have been assigned to one subtype of pitta. They are –

Function of pitta	Meaning	Type of pitta involved
Raga	Red colour – Imparting red colour or redness (here mainly to the rasa tissue in the liver and spleen and converting it into rakta – blood tissue)	Ranjaka
Pakti	Digestion – of food	Pachaka Pitta
Teja	Vision – providing vision	Alochaka Pitta
Medha	Intelligence – providing intelligence	Sadhaka Pitta
Ushma	Heat – providing heat and body temperature	Bhrajaka Pitta

The above mentioned are the chief functions of the mentioned pitta types. There are many other functions contributory to pitta when it is in a state of balance / normalcy.

Kapha

सन्धिसंश्लेषणस्नेहनरोपणपूरणबलस्थैर्यकृलेष्मा पञ्चधा प्रवीभक्त उदककर्मणाऽनुग्रहं करोति ॥४॥

The kapha renders five main functions in the body, they are –

– Samslesana – binding the joints
– Snehana – moistening / lubrication
– Ropana – healing
– Purana – filling
– Balasthairyakara – giving strength and stability

The kapha which is involved in these functions is divided into five divisions (types, subtypes) and supports the body by its ‘udaka karma’ i.e. water like action.

Each of the above-mentioned functions have been assigned to one subtype of kapha. They are –

Function of kapha	Meaning	Type of kapha involved
Samsleshana	Binding – the joints / keeping the joints of the body tight, firm and strong	Shlesaka Kapha
Snehana	Moistening / lubrication – of food	Kledaka Kapha
Ropana	Healing and perception of taste	Ropaka Kapha / Bodhaka Kapha
Purana	Filling – the sense organs and head	Tarpaka Kapha
Balasthairyakara	Giving strength and stability and maintaining them	Avalambaka Kapha

The above mentioned are the chief functions of the mentioned kapha types. There are many other functions contributory to kapha when it is in a state of balance / normalcy.

2. Dhatus: Primary tissues

रसस्तुष्टिं प्रीणनं रक्तपुष्टिं च करोति, रक्त्ं वर्णप्रसादं मांसपुष्टिं गीवयति च, मांसं शरीरपुष्टिं मेदसश्च, मेदः स्नेहस्वेदौ दृढत्वं पुष्टिमस्थनां च, अस्थीनि, देहधारणं मज्ज्ञः पुष्टिं च, मज्जा स्नेहं बलंशुक्रपुष्टिं पूरणमस्थ्नां च करोतिः शुक्रं धैर्यं च्यवनं प्रीतिं देहबलं हर्षं बीजार्थंच (॥५(२)॥)

Name of the Dhatu	Functions (what they provide)
Rasa Dhatu – Lymph / Plasma	Tushti – satiety, satisfaction Pushti – provides nutrition / strength Prinanam – nourishment to the entire body and all tissues Rakta Pushti – nourishes blood tissue
Rakta Dhatu – Blood tissue	Varna Prasada – enriches / enhances colour Mamsa Pushti – nourishes the muscle tissue Jivanam – maintains life activities
Mamsa Dhatu – Muscle tissue	Sharira Pushti – nourishes the body Medo Pushti – nourishes fat tissue
Medo Dhatu – Fat tissue	Sneha – bestows unctuousness Sweda – causes sweating Drdhatvam – provides stability to the body Asthi Pushti – nourishes bone tissue
Asthi Dhatu – Bone tissue	Deha Dharanam – provides support to the body Majja Pushti – nourishment to bone marrow tissue
Majja Dhatu – Bone Marrow tissue	Sneha – provides unctuousness / lubrication Bala – provides strength, endurance Shukra Pushti – provides nourishment of semen tissue and sperms Asthi Purana – fills up the bones
Shukra Dhatu – Semen tissue	Dhairyam – bestows courage Chyavanam – causes ejaculation of semen Pritim – induces love, affection, lust Dehabalam – provides strength to the body Harsham – exhilaration, sexual excitement, pleasantness Bijartham – is the purpose of the seed / semen (formation of embryo by causing fertilization)

3. Malas: Waste products

पुरिषमुपस्तम्भं वाय्वग्रिधारणं च, बस्तिपुरणविक्लेदकृन्मूत्रम्, स्वेदः क्लेदत्वक्सौकुमार्यकृत्ः (॥५(२)॥)

Name of the Mala – excreta	Functions
Purisha – faeces	Upastambha – provides support, strength Vayu Agni Dharanam – helps in maintenance of / supports vayu (vata) and agni
Mutra – urine	Basti purana – fills the urinary bladder Vikleda krt – helps in elimination of water / moisture
Sweda – sweat	Kledatvam krt – bestows moistness Saukumarya Krt – bestows softness of the skin

Upadhatus: Secondary tissues

रक्तलक्षणमार्तवं गर्भकृच्च, गर्भो गर्भलक्षणं स्तन्यं स्तनयोरापीनत्वजननं जीवनं चोति॥५(३)॥

Artava means menstrual blood. The term encompasses female reproductive tissue and ovum along with hormones regulating them. Artava is said to possess the same characteristic features as those of rakta dhatu i.e. blood tissue. Apart from that, it takes part in the formation of Garbha – embryo.

Garbha means foetus. It bestows Garbha lakshana – signs of pregnancy.

Stanya means breastmilk. It is responsible for development of stana i.e. breasts. It also bestows Jivana – life to the foetus by providing nourishment.

तत्र विधिवत् परिरक्षणं कुर्तीत ॥६॥

The doshas, dhatus, upadhatus and malas should be maintained and protected at their normal levels through appropriate methods so as to maintain health at optimum levels.

Dosha Kshaya Lakshana: Signs of decrease of Doshas

अत ऊर्ध्वमेषां क्षीणलक्षणं वक्ष्यामः । तत्र,वातक्षये मन्दचेष्टताऽल्पवाक्त्वमप्रहर्षो मूढ्संज्ञता च, पित्तक्षये मन्दोष्माग्रिता निष्प्रभता च, श्लेष्मक्षये रूक्षताऽन्तदांह आमाशयेतरश्लेष्माशयशून्यता सन्धिशैथिल्य (तृष्णा दौर्बल्यं प्रजागरणं) च ॥७॥

Henceforth, the symptoms of decrease of doshas will be explained –

Symptoms of vata decrease – When vata undergoes kshaya i.e. decrease, it will cause –

– Manda chestata – decrease or slowing down or loss of activities of the body parts,
– Alpa vaktva – deficit speech – the person speaks less
– Apraharsha – lack of contentment or excitement and
– Mudha sanjnata – reduced consciousness or mental activities, the intelligence of the person will be reduced

Symptoms of pitta decrease – When pitta would undergo decrease,

– Mandoshma – the body heat will decrease
– Mandagnita – there will be diminution of digestive fire and strength,
– Nishprabhata – it would cause loss of complexion

Symptoms of kapha increase – When Kapha undergoes decrease, it would cause –

– Rukshata – dryness,
– Antardaha – burning sensation inside the body, mainly in the alimentary tract
– Aashaya itara shleshma ashaya shunyata – emptiness in stomach and other seats of kapha
– Sandhi shaitilya – looseness of the joints,
– Trishna – thirst
– Daurbalya – debility
– Prajagarana – loss of sleep

तत्र स्वयोनिवर्धनान्येव प्रतीकारः ॥८॥

The methods to counter this i.e. decrease of doshas includes the use of things like foods, drinks and activities etc which would increase these doshas (and hence bring them to balance).

Dhatu Ksaya lakshana: Signs of decrease of Dhatu

रसक्षये हत्पीडा कम्पः शून्यता स्तृष्णा च, शोणितक्षये त्वकपारुष्यमम्लशीतप्रार्थना सिराशौथिल्यं च, मांसक्षये स्फिग्गण्डौष्ठोपस्थोरुवक्षः कक्षापिण्डिकोदग्रीवाशुष्कता रौक्ष्यतोदौ गात्राणां सदनं धमनीशौथिल्यं च, मेदःक्षये प्लीहाभिवृद्धिः सन्धिशून्यता रौक्ष्यं मेदुरमांसप्रार्थना च, अस्थिक्षयेऽस्थिशूलं दन्तनखभङ्गो रौक्ष्यं च मज्जक्षयेऽल्पशुक्रता पर्वभेदोऽस्थिनिस्तोदोऽस्थिशून्यता च, शुक्रक्षये मेढ्रवृषणवेदनाऽशक्तिर्मैथुने चिराद्वा प्रसेक चाल्परक्तशुक्रदर्शनम् ॥९॥

Name of the dhatu undergoing kshaya – decrease	Symptoms of decrease of dhatu
Rasa Dhatu – plasma, lymph	Pain Tremors or throbbing sensation Emptiness of the heart / region of the heart Thirst etc
Shonita / Rakta Dhatu – blood	Roughness of the skin Severe desire / craving for sour and cold foods, drinks or things Laxity of blood vessels / veins (blood vessels appear to be empty) etc
Mamsa Dhatu – muscles	Dryness and wasting of butts, cheeks, lips, penis, thighs, chest, armpits, calf muscles, abdomen and neck Dryness Pricking pain Debility of the body Looseness of the arteries / blood vessels
Medo Dhatu – fat	Enlargement of spleen Feeling of emptiness of the joints Dryness Extreme desire or craving for fatty foods etc
Asthi dhatu – bones	Pain in the bone, Breaking of teeth and nails Dryness etc
Majja Dhatu – bone marrow	Decrease in the quantity of semen Splitting pain in the small joints of hands and feet Throbbing or pulsating pain in the bones Emptiness in the bones
Shukra Dhatu – semen	Pain in penis and scrotum / testes Loss of libido / loss of capacity in performing sexual intercourse Delayed ejaculation of semen during sexual intercourse Only little quantity of semen is ejaculated and there is also presence of little blood in the ejaculate

तत्रापि स्वयोनिवर्धनद्रव्योपयोगः (प्रतीकारः) ॥१०॥

Counter measures should be done even for decrease of tissues. It includes use of foods, drinks and activities which bring about an increase in the dhatus.

Mala Kshaya: Decrease of wastes

Decrease of Purisa (faces) – causes pain (discomfort) in the region of the heart and flanks, upward movement of air (flatus) accompanied with sound and movement of air in the kukshi (abdomen, epigastrium) etc.

Decrease of Mutra (urine) – causes pain in the urinary bladder and less production and elimination of urine (scanty urination).

Just like in case of dhatus, foods, drinks etc which bring about increase in the malas is the treatment for their decrease.

Decrease of Sveda (sweat) – causes obstruction of hair follicles, dryness of skin, abnormalities of touch (tactile sensation) and absence of sweating etc. For this condition, the treatment includes massage with herbal oils (oil bath) and sudation.

Upadhatu Kshaya: Decrease of secondary tissues

आर्तवक्षये यथोचितकालादर्शनमल्पता वा योनिवेदना च ;तत्र संशोधनमाग्नेयानां च द्रव्याणां विधिवदुपयोगः । स्तन्यक्षये स्तनयोर्म्लानता स्तन्यासंभवोऽल्पता वा: तत्र श्लेष्पवर्धनद्रव्योपयोगः । गर्भक्षये गर्भास्पन्दनमनुन्नतकुक्षिता च ; तत्र प्राप्तबस्तिकालायाः क्षीरबस्तिप्रयोगश्चेति ॥१२॥

Decrease of Artava (menstrual fluid) – gives rise to the below mentioned symptoms –

– menstruation (menstrual blood) does not appear at the appropriate time
– scanty menstruation (deficit flow of blood during menstruation) even if menstruation occurs
– pain in the vagina etc

Treatment – includes purification of the body (by administration of panchakarma therapies including purgation and herbal enemas given through urinary / vaginal passages) and use of things i.e. foods, drinks and medicines which are ajgneya i.e. fiery (possess fire like qualities) in nature, in a suitable manner.

Decrease of Stanya (breast milk) – gives rise to laxity (sag) and wrinkles of the breasts, non-production or scanty production of breast milk etc.

Treatment – of this condition includes use of things i.e. foods, drinks and herbs which cause an increase of sleshma (kapha).

Decrease of Garbha (embryo / foetus) – The embryo which has undergone decrease causes –

– absence of movement of the foetus inside the abdomen of the pregnant woman
– non-enlargement of the abdomen of the mother etc.

Treatment – of this condition includes administration of ksirabasti (milk enema) at the appropriate time (8^th month of pregnancy) and use of fatty foods.

Dosha Vriddhi: Symptoms of increase of Dosha

अत ऊर्ध्वमतिवृद्धानां दोषधातुमलानां लक्षनं वक्ष्यामः । वृद्धिः पुनरेषां स्वयोनिवर्धनात्युपसेवनाद्भवति। तत्र, वातवृद्धौ वाक्फारुष्यं कार्श्यं काष्णर्यं गात्रस्फुरनमुष्णकामिता निद्रानाशोऽल्पबलत्वं गाढवर्चस्त्वं च; वित्तव्रुद्धौ पीतावभासता संतापः शितकामित्वमल्पनिद्रता मूर्च्छा बलहनिरिन्द्रियददौर्बल्यं पीतविण्मूत्रनेत्रत्वं श्लेष्मवृद्धौ शौक्ल्यं शौत्यं स्थैर्यं गौरवमवासादस्तन्द्रा निद्रा सन्धिविशलेषश्च ॥१३॥

Next, the signs and symptoms of great increase of Dosha, Dhatu and Mala shall be described. Increase of dosha, dhatu and mala is caused due to excessive indulgence in foods, drinks, activities etc. which bring about their increase.

Vata Vriddhi – Great increase of Vata, gives rise to harshness (hoarseness) of speech, emaciation of the body, blackish discolouration of the body / body parts, throbbing in the body parts, desire for warm things and comforts, loss of sleep, less (poor) strength and hardness of faeces.

Pitta Vrddhi – Great increase of Pitta gives rise to the appearance of yellowish discolouration of the skin or seeing all objects in and around as being yellow in colour, increased heat in the body, desire for cold things (foods, activities etc) and comforts, diminished sleep, fainting, loss of strength, weakness of sense organs, yellowish colouration of faeces, urine and eyes etc.

Sleshma / Kapha Vrddhi – Great increase of Slesma (Kapha) gives rise to whitish discolouration of the body parts, coldness in the body parts, stability / stillness (absence of movements), feeling of heaviness, weakness of the body and mind (debility), stupor, excessive sleep and looseness of joints and bones in the body etc.

Dhatu Vriddhi: Symptoms of increase of tissues

रसोऽतिवृद्धो हदयोत्वलेदं प्रसेकं चापादयति; रक्तं रक्ताङ्गाक्षितां सिरापूर्णत्वं च; मांसं स्फिग्गण्डौष्टोपस्थोरुबाहु जङ्घासु वृद्धिं गुरुगात्रतां च; मेदः स्निग्धाङ्गतामुदरपार्श्ववृद्धिं कासश्वासादीन् दौर्गन्ध्यं च ; अस्थ्यध्यस्थीन्यधिदन्तांश्च; मज्जा सर्वाङ्गनेत्रगौरवं च ; सुक्रं सुक्राश्मरीमतिप्रदुर्भावं च ॥१४॥

Rasa Dhatu Vriddhi –Abnormal increase of Rasa Dhatu i.e. plasma causes –

– oppression / discomfort in the region of the heart (nausea), and
– increased salivation etc.

Rakta Dhatu Vriddhi – Rakta Dhatu i.e. blood tissue which has abnormally increased causes –

– reddish colouration of the body and eyes and
– fullness of veins (blood vessels)

Mamsa Dhatu Vrddhi – Abnormal increase of Mamsa Dhatu i.e. muscle tissue causes –

– increase in size of butts, cheeks, lips, penis, thighs, arms and calves and
– heaviness of the body etc.

Meda Dhatu Vriddhi – Great increase of medo dhatu i.e. fat or adipose tissue causes –

– unctuousness of the body parts,
– increase in size of the abdomen and flanks, cough, dyspnoea and
– the foul smell of the body.

Asthi Dhatu Vriddhi – Abnormal increase of Asthi dhatu i.e. bone tissue causes –

– development of bones over the bones – formation of extra bone tissue or bone tumours, and
– formation of extra teeth i.e. malformation of teeth etc.

Majja Dhatu Vriddhi – Excessive increase of Majja Dhatu i.e. bone marrow tissue causes –

– heaviness of the entire body
– heaviness in the eyes

Shukra Dhatu Vrddhi – Excessive increase of Shukra Dhatu i.e. semen tissue produces –

– seminal calculus
– excessive production of semen,
– excessive elimination / discharge of semen etc.

Mala vidhi: Increase of waste

पुरीषमाटोपं कुक्षौ शूलं च; मूत्रं मूत्रवृद्धिं मुहुर्मुहुःप्रवृत्तिं बस्तितोदमाध्मानं च ; स्वेदस्त्वचो दौर्गन्ध्यं कण्डूं च ॥१५॥

Purisa Vrddhi – Great increase of Purisa (faeces) gives rise to –

– flatulence and sounds in the abdomen and
– pain in the abdomen

Mutra Vrddhi – Great increase of Mutra (urine) causes –

– increased frequency of urination,
– pain and distension of the urinary bladder etc.

Sveda Vrddhi – Excessive increase of Sweda (sweat) gives rise to –

– bad smell of the skin,
– itching etc.

Upadhatu vriddhi: Increase of secondary tissues

आर्तवमङ्गमर्दमतिप्रवृत्तिं दौर्गन्ध्यं च; स्तन्यं स्तनयोरापीनत्वं मुहुर्मुहुःप्रवृत्तिं तोदं च; गर्भो जठराभिवृद्धिं स्वेदं च ॥१६॥

Artava Vrddhi – Excessive increase of Artava (menstrual blood) produces –

– body aches,
– severe bleeding during menstruation (severe bleeding), and
– bad smell etc.

Stanya Vrddhi – Excessive increase of Great Stanya (breast milk) causes –

– increase in breast size
– discharge of breast milk from enlarged breasts and
– pricking pain in the breast etc.

Garbha Vrddhi – Excessive increase of Garbha i.e., foetus causes –

– enormous enlargement of the abdomen and
– increased perspiration etc.

तेषां यथास्वं संशोधनं क्षपणं च क्षयादविरुद्धैः क्रियाविशेषैः प्रकुर्वीत ॥१७॥

Samshodhana – purificatory and Kshapana – palliative treatments which are not against their decrease should be administered as treatment for these conditions.

Reasons to cause depletion of increased tissues

पूर्वः पूर्वोऽतिवृद्धत्वार्धयेद्धि परं परम् ।
तस्मादतिप्रवृद्धानां धातूनां ह्रासनं हितम् ॥१८॥

Excessive and abnormal increase of the preceding dhatus would cause excessive increase of its succeeding dhatu. Therefore, dhatu hrasana i.e. treatments to bring about decrease of the tissues which have undergone increase should be done.

Bala and Ojas-features of Ojas

बललक्षणं बलक्षयलक्षणं चात ऊर्ध्वमुपदेक्ष्यामः |
तत्र रसादीनां शुक्रान्तानां धातूनां यत् परं तेजस्तत् खल्वोजस्तदेव बलमित्युच्यते, स्वशास्त्रसिद्धान्तात् ||१९||

After this, the features of bala i.e. strength and bala kshaya i.e. loss of strength will be described –

Ojas is the essence of all the dhatus commencing from rasa and ending with shukra. Ojas itself, being the essence of all the tissues, is considered as bala. Bala here means strength or immunity. Therefore, Ojas is considered as and is responsible for bala according to Ayurveda.

तत्र बलेन स्थिरोपचितमांसता सर्वचेष्टास्वप्रतिघातः स्वरवर्णप्रसादो बाह्यानामाभ्यन्तराणां च करणानामात्मकार्यप्रतिपत्तिर्भवति॥२०॥

Bala i.e., strength is responsible for stability and growth of the muscles. Below mentioned are its benefits –

– bestows the ability to perform all activities without any hindrance,
– bestows purity and pleasantness of voice
– provides good complexion
– provides ability to perform their own functions and get indulged in the same to the external (karmendriya) and internal (jnanendriya and manas) sense organs

Ojas Lakshana-Characteristic features and functions of Ojas

भवन्ति चात्र :-
ओजः सोमात्मकं स्निग्धं शुक्लं शीतं स्थिरं सरम् ।
विविक्तं मृदु मृत्स्नं च प्राणायतनमुत्तमम् ॥२१॥
देहः सावयवस्तेन व्याप्तो भवति देहिनः ॥
तदभावाच्च शीर्यान्ते शरीराणि शरीरिणाम् ॥२२॥

Some Verses here

Ojas is similar to moon in properties i.e. Ojas has coolant properties. They are –

– unctuous,
– white colour
– cold potency
– stable
– freely flowing
– clear
– soft
– is uttama pranayatana – the chief among the seats of life
– it pervades in the entire body and all organs
– the body of all living beings would perish (cause death) in the absence of ojas

Ojas Kshaya Karna: Causes for decreases of Ojas and symptoms

अभिघातात्क्षयात्कोपाच्छोकाद्ध्चानाछ्रमात्क्षुधः ।
ओजः संक्षीयते ह्योभ्यो धातुग्रहणनिः सृतम् ॥
तेजः समीरितं तस्माद्विस्त्रंसयति देहनः ॥२३॥

Ojas undergoes decrease due to injury (to the body), loss of tissues, anger, grief, worry, exertion, and hunger (etc). Then this tejas (ojus) being instigated by vata flows out (leaks out) from the dhatugrahana i.e. srotas (channels which receive and transport the tissues) will hamper the body of its normal functioning (troubles the body in a great way).

Three abnormalities of ojas

तस्य विस्त्रंयो व्यापत् क्षय इति त्रयो दोषाः ; लिङ्गानि भवन्ति संधिविश्लेषो गात्राणां सदनं दोषच्यवनं क्रियासन्निरोधश्च विस्त्रंसे, स्तब्धगुरुगात्रता वातशोफो वर्णभेदो ग्लानिस्तन्द्रानिद्रा च व्यापन्ने, मूर्च्छा मांसक्षयो मोहः प्रलापो मरणमिति च क्षये ॥२४॥

There are three kinds of abnormalities (stages) of Ojas. They are –

1. Ojo Visramsa
2. Ojo Vyapat
3. Ojo Ksaya

Their symptoms are as below enumerated –

Ojo visramsa (first stage) – In this stage there occurs

– looseness of the joints,
– weakness of the body,
– displacement of the Doshas, (vata, Pitta and Kapha from their normal seats) and
– hindrance to all movements

Ojo Vyapat (second stage) – In this stage there occurs

– stiffness of the body
– heaviness of the body,
– oedema caused by Vata,
– discoloration,
– exhaustion,
– stupor and
– excessive sleep

Ojo Kshaya (third stage) – In this stage occurs,

– fainting,
– loss or decrease of muscles (emaciation),
– ignorance, bewilderment, delusion
– delirium and
– death

Also,

भवति चात्र:-
त्रयो दोषा बलस्योक्ता व्यापद्विस्त्रंसनक्षयाः ॥
विश्लेषसादौ गात्राणां दोषविस्त्रंसनं श्रमः ॥२५॥
अप्राचुर्यं क्रियाणां च बलविस्त्रंसलक्षणम् ॥
गुरुत्वं स्तब्धताऽङ्गेषु ग्लानिर्वर्णस्य भेदनम् ॥२६॥
तन्द्रा निद्रा वातशोफो बलव्यापदि लक्षणम् ॥
मूर्च्छा मांसक्षयो मोहः प्रलापोऽज्ञानमेव च ॥२७॥
पूर्वोक्तानि च लिङ्गानि मरणं च बलक्षये ।

Some verses here:-

The three abnormalities of bala – ojas are –

– Vyapat
– Visramsa
– Ksaya

Abnormality of Bala / Ojas	Symptoms
Bala Visramsa	Looseness of joints Debility of the body Displacement of tridoshas Fatigue Improper execution of movements
Bala Vyapad	Heaviness Stiffness of the body parts Exhaustion Discolouration Stupor Sleep Oedema of vata origin
Bala Kshaya	Fainting Loss / decrease of muscles / emaciation Delusion Delirium Ignorance Symptoms mentioned earlier Death

Treatment of abnormalities of ojas

तत्र विस्त्रंसे व्यापन्ने च क्रियावोशेषैरविरुद्धैर्बलमाप्याययेत्; इतरं तु मूढसंज्ञंवर्जयेत् ॥२८॥

Bala or ojas should be increased during the stages of visramsa and vyapat. This should be done by adopting the treatments which are not opposite to bala – strength, dosha and agni – digestive fire. Ojas Kshaya causes improper understanding or unconsciousness. Treatment should be refused in this condition. Even the patient of oja kshaya having unconsciousness should not be treated.

दोषधातुमलक्षीणो बलक्षीणोऽपि वा नरः ।
स्वयोनिबर्धनं यत्तदन्नपानं प्रकाङूक्षाति ॥१९॥
यद्यादाहरजातं तु क्षीणः प्रार्थयते नरः।
तस्य तस्य स लाभे तु तं तं क्षयमपोगति ॥३०॥
यस्य धातुक्षयाद्वायु: संज्ञ कर्म च नाशयेत् ।
प्रक्षीणं च बलं यस्य नासौ शक्यश्चिकित्सितुम् ॥३१॥

Desire for foods and drinks which cause increase of doshas, dhatus, mala or even bala – ojas (which have similar qualities and hence bring about their increase) when they have undergone decrease. When the person suffering from depletion of dhatus desires to have particular foods, and when the desire is fulfilled (by giving the desired foods), (the given foods) will ward off the depletion of related dhatus and bring them to a state of normalcy.

Those patients in whom the vayu has abnormally increased due to the depletion of dhatus and has caused loss of consciousness and functions, and also decrease of strength, cannot be treated at all.

Sthaulya and Karshya: Corpulence (obesity) and emaciation:-

रसनिमित्तमेव स्थौल्यं काशर्यं च । तत्र श्लेष्मलाहरसेविनोऽध्यशनशीलस्याव्यायामिनो दिवास्वप्ररतस्य चाम एवान्नरसो मधुरतरश्च शरीरमनुक्रामन्नतिस्नेहान्मेदो जनयति, तदतिस्थौल्यमापादयति;तमतिस्थूलं क्षुद्रश्वासपिपासाक्षुत्स्वप्रस्वेदगात्रदौर्गन्ध्यक्रथनगात्रसादगद्रदत्वानि क्षिप्रमेवावाविशन्ति, सौकुमार्यान्मेदसः सर्वक्रियास्वसमर्थः कफमेदोनिरुद्धमार्गत्वाच्चाल्पव्यवायोभवति, आवृतमार्गत्वादेव शेषा धातवोनाप्यायन्तेऽत्यर्थमतोऽल्पप्राणोभवति, प्रमेहपिडकाज्वरभगन्दरविद्रधिवातविकाराणामन्यतमं प्राप्य पञ्चत्वमुपयाति, सर्व एव चास्य रोगाबलवन्तो भवन्त्यावृतमार्गत्वात् स्त्रोतसाम् ; अतस्तस्योत्पत्तिहेतुं परिहरेत्। उत्पन्ने तु शिलाजतुगुग्गुलुगोमूत्रत्रिफलालोहरजोरसाञ्जनमधुयवमुद्राकोरदूषकश्यामाकोह्दालकादीनां विरूक्षणच्छेदनीयां च द्रव्याणां विधिवदुपयोगो व्यायामो लेखनबस्त्युपयोगश्र्चेति ॥३२॥

Both, Sthaulya (obesity – corpulence) and Karsya (emaciation) are caused due to rasa dhatu itself.

Sthaulya- Corpulence:

Causes –

– Excessive indulgence (for long periods) in kapha increasing foods,
– Those habituated to eat large quantities of food, often
– Those who are not indulged in any kinds of physical activities (sedentary and relaxed life)
– Those who are habituated to sleeping during day time etc.

In people who are indulged in the above mentioned etiological factors, the food remains inadequately digested (uncooked). This uncooked (ama) food having excessive sweetness will circulate in the entire body and due to its excessive unctuousness it will cause an increase of medas (fat). This excessively formed fat causes too much corpulence of the body (obesity).

Symptoms of Atisthula – The person suffering from obesity will have the below mentioned symptoms –

– Mild dyspnoea
– Thirst
– Excessive hunger,
– Excessive sleep (sleepiness)
– Excessive sweating,
– Bad smell from the body
– Indistinct sounds from the throat / Snoring (sounds from the throat while at sleep)
– Debility of the body,
– Stammering

Because of the softness of the fat, the obese person would become incapable of doing any activities. The person becomes poor in capacity copulation since his channels of semen are obstructed by vitiated kapha or fat. Because of the obstruction of the srotas (channels of other tissues) the remaining tissues will not receive sufficient nourishment which in turn makes the person poor in all the life activities (reduced longevity). Due to this the person becomes affected by diabetes, eruptions, fever, rectal abscess, vata disorders and many such diseases and will eventually face death. Due to the obstruction of all the channels by the increased fat, all the diseases would become powerful. As a result one should (in this condition) avoid all the causes which tend to increase fat tissue and cause obesity.

On the contrary if obesity has already developed one should make use of shalajatu, guggulu, gomutra, triphala, loha bhasma, rasanjana, madhu, yava, mudga, koradusaka, syamaka, uddalaka etc. things which would cause dryness and clear the obstructed channels (by separating the blocks) according to the stipulated procedure. One should also indulge in exercises and undergo Lekhana Vasti (scarifying / scraping enemas) etc.

Karshya: Emaciation

तत्र पुनर्वातलाहारसेविनोऽतिव्यायामव्यवायाध्ययनभयशोकध्यानरात्रिजागरणपिपासाक्षुत्कषायाल्पाशनप्रभृति भिरुपशोषितो रसधातु शरीरमननुक्रामन्नल्पत्वान्न प्रीणाति, तस्मादतिकर्श्यं भवति; सोऽतिकृशः क्षुत्पपासाशीतोष्णवातातवर्षभारादानेष्वसहिष्णुर्वातरोगप्रायोऽल्पप्राणश्चक्रियासु, भवति, श्वासकासशोषप्लीहोदराग्रिसादगुल्मरक्तपिनामन्यतममासाद्य मरणमुपयाति, सर्व एव चास्य रोगा बलबन्तो भवन्त्यल्पप्राणत्वात् ; अतस्तस्योत्पत्तिहेतुं परिहरेत् । उत्पन्ने तु पयस्याश्वगन्धाविदारिगन्धाशतावरीबलातिबमानागबलानां मधुराणामन्यासां चौषधीनामुपयोगः , क्षीरदधिघृतमांसशालिषष्टिकयवगोधूमानां च, दिवास्वप्रब्रह्मचर्यायामबृंहणबस्त्युपयोगश्चेति ॥३३॥

Causes of emaciation –

– Excessive indulgence in (for long periods) foods which cause vata increase
– Excessive exercise,
– Excessive indulgence in copulation,
– Fear, grief, worry in excess
– Habituated to keeping awake at night times,
– Thirst, hunger (suppression of thirst and hunger),
– Excessive use of astringent things (foods having astringent taste),
– Consumption of too less food

When the person consumes the above said etiological factors, the rasa dhatu gets dried up and hence will not be capable of nourishing the body in a proper and adequate way. This will lead to profound emaciation of the persons.

Symptoms of emaciation – The person who is extremely emaciated due to consumption of the above said etiological factors he will suffer from the below mentioned symptoms –

– Incapable of tolerating hunger, thirst, cold, heat, breeze, rain and carrying heavy weights,
– Dyspnoea, cough,
– Consumption,
– Enlargement of spleen,
– Enlargement of abdomen,
– Weakness of digestive power,
– Abdominal tumour,
– Bleeding disorders

The person would suffer from one or the other of the above mentioned symptoms and eventually will face death. All diseases occurring in these (severely emaciated) persons will be severe because of his poor strength.

Hence he should avoid all causes which produce this condition.

If the person has already developed severe emaciation he should use payasya, asvagandha, vidarigandha, satavari, bala, atibala, nagabala and other drugs which are sweet, according to the stipulated procedure.Apart from these, milk, curd, ghee, meat, Sali, sastika, Yava and Godhuma, shall be taken. One should also indulge in day sleep, celibacy, not doing any physical exercise and also should resort to brmhana basti (nutritive enema).

Madhya Sarira: Medium physique

यः पुनरुभयसाधारणान्यासेवेत तस्यान्नरसः शरीरमनुक्रामन् समान् धातूनुपचिनोति, समधातुत्वान्मध्यशरीरो भवति सर्वक्रियासु समर्थः क्षुत्पिपासाशीतोष्णवातर्षातपसहो बलवांश्च, स सततमनुपालयितव्य इति ॥३४॥

When a person consumes foods which are moderate in both unctuousness and non-unctuousness (dryness) properties, the essence formed from such foods is put into circulation throughout the body. This essence of food would cause nourishment and growth of tissues in equal and proper proportions. These persons will be capable of performing all the activities because they would have balance of all the tissues and medium sized body. He will have good tolerance towards hunger, thirst, cold, heat, breeze, rain and sunlight and will also be strong. Such a condition should be maintained constantly and the person should put all efforts to do so.

भवन्ति चात्र:-
अत्यन्तगर्हितावेतौ सदा स्थूलकृशौ नरौ ।
श्रेष्ठो मध्यशरीरस्तु कृशह् स्थूलात्तु पूजितः ॥३५॥

Another verse here:-

Both sthula – obese and krsha – emaciated persons should always be condemned. People of Madhya sharira – medium physique are the best. Those who fall in the frame between the obese and the emaciated persons are better. Being emaciated is always better than being obese.

Dosha Prabhava: Effect of Doshas

दोषः प्रकुपितो धातून् क्षपयत्यात्मतेजसा।
इद्धः स्वतेजसा वह्निरुखागतमिवोदकम् ॥३६॥

Just as the fire, when increased, would evaporate all the water in the pot by its own power, the doshas too when aggravated, bring about decrease of the dhatus by their own strength.

Dosha dhatu pramana: Quantity of Doshas and dhatus

वैलक्षण्याच्छरीराणामस्थायित्वात्तथैव च ।
दोषधातुमलानां तु परिमाणं न विद्यते ॥३७॥

Bodies of different persons will have different features and will differ from one person to the other and will also be unstable. Therefore, the quantity of the doshas, dhatus and malas cannot be stated accurately.

Balance of doshas etc. is a status of health

एषां समत्वं यच्चापि भिषग्भिरवधार्यते ।
न तत् स्वास्थ्यादृते शक्यं वक्तुमन्येन हेतुना ॥३८॥

The normality of these doshas, dhatus and malas , what so ever, understood and described by the physicians cannot be explained by any other causes (factors) other than health (i.e. the normalcy or balance of these things is nothing but health).

Inference of abnormalities (imbalances) of doshas etc.

दोषादीनां त्वसमतामनुमानेन लक्षयेत् ।
अप्रसन्नेन्द्रियं वीक्ष्य पुरूषं कुशलो भिषक् ॥३९॥

The inference of the abnormalities related to dosha etc should be done by the intelligent physician by observing the aprasanna indriyatvam i.e. unpleasantness of the sense organs (including the body and mind).

स्वस्थस्य रक्षणं कुर्यादस्वस्थस्य तु बुद्धिमान् ।
क्षपयेद्धंहयेच्चापि दोषधातुमलान् भिषक् ।
तावद्यावदरोगः स्यादेतत्साम्यस्य लक्षणम् ॥४०॥

The intelligent physician should always put efforts and indulge himself towards protecting healthy persons. In case of unhealthy persons, the person should try to balance the doshas, dhatus and malas. If the doshas, dhatus and malas have undergone increase should be decreased and if they are decreased, they should be increased. This should be done by the physician till the person becomes free from diseases. Freedom from diseases or abnormal symptoms is the feature of normalcy.

Svastha purusha: Healthy person

समदोषः समाग्रिश्च समधातुमलक्रियः ॥
प्रसन्नात्मेयमनाः स्वस्थ इत्यभिधीयते ॥४२॥

A person will be considered as Swastha i.e. healthy only in the presence of the below mentioned conditions (in him) –

– Sama dosha – equilibrium of doshas
– Sama agni – normal and balanced digestive fire
– Sama dhatu – equilibrium of tissues,
– Sama mala kriya – timely and properly excretion of excreta and their balance in the body
– Prasanna atma, indriya, mana – pleasantness / calmness of soul, sense organs and mind

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने दोषधातुमलक्षयवृद्धिविज्ञानीयो नाम पञ्चदशोऽध्यायः ॥१५॥

Thus end the Fifteenth chapter by name Doshada Tumala Ksa Vrddhi Vijnaniya in Sutra Sthana of Susruta Samhita.