Ashtanga Hrudaya Sutra Sthana Chapter 12: Doshabhediya Adhyayam (Classification and Functions of Each Type of Tridosha)

Places of Pitta Dosha

नाभिरामाशयः स्वेदो लसीका रुधिरं रसः|
दृक् स्पर्शनं च पित्तस्य, नाभिरत्र विशेषतः||२||
The sites of Pitta Dosha are –
Nabhi – Umbilicus,
Amashaya– stomach and small intestine,
Sweda – sweat,
Lasika– lymph,
Rudhira – blood,
Rasa– plasma,
Druk – eye,
Sparshanam – skin,
Visheshasthana (important / special space) – Nabhi – Umbilicus.

Places of Kapha Dosha

उरःकण्ठशिरःक्लोमपर्वाण्यामाशयो रसः|
मेदो घ्राणं च जिह्वा च कफस्य, सुत्रामुरः||३||
The sites of Kapha Dosha are –
Ura – Chest,
Kantha – throat,
Shira – head,
Kloma – Pancreas,
Parvani – bone joints,
Amashaya – Stomach and small intestine,
Rasa –plasma,
Meda – fat,
Ghrana – nose and
Jihva – tongue
Visheshasthana (important / special space) – Uras – chest.

Five types of Vayu

प्राणादिभेदात्पञ्चात्मा वायुः
Vayu (vata) is of 5 types –
Prana Vata
Udana Vata
Vyana Vata
Samana Vata
Apana Vata

Karma Hinayoga, Atiyoga and Mithyayoga – deficit, excessive and perverted indulgence in actions

कायवाक्चित्तभेदेन कर्मापि विभजेत्त्रिधा|
कायादिकर्मणो हीना प्रवृत्तिर्हीनसंज्ञकः||४०||
अतियोगोऽतिवृत्तिस्तु, वेगोदीरणधारणम्|
विषमाङ्गक्रियारम्भपतनस्खलनादिकम्||४१||
भाषणं सामिभुक्तस्य रागद्वेषभयादि च|
कर्म प्राणातिपातादि दशधा यच्च निन्दितम्||४२||
मिथ्यायोगः समस्तोऽसाविह वाऽमुत्र वा कृतम्|
Karma (actions) are also classified into three types i.e.
kaya (physical, pertaining to body activities),
vak (speech, pertaining to speaking activities) and
chitta (mental, pertaining to mind activities).
Hina yoga of karma (deficit actions) is indulgence in very less physical activity, very less speaking and very less thought process.
Atiyoga of karma (excessive actions) is indulgence in excessive physical activities, excessive speaking and thinking.
Mithyayoga of kayika karma (perverted physical activities) includes –
forceful expulsion and suppression of natural urges,
improper postures (doing activities with weird body postures),
and activities like abrupt falling, abrupt jumping etc
Mithyayoga of vachika karma (perverted speech action) includes –
Speaking too much while taking food or immediately after food.
Mithyayoga of manasika karma (perverted mind actions) includes –
harbouring of desires, hatred, fear etc.
Committing the ten forbidden heinous actions in the present world or the world hereafter etc constitutes Mithyayoga of Karma.

Manifestation of diseases pertaining to viscera, tissues and vital organs

निदानमेतद्दोषाणां, कुपितास्तेन नैकधा||४३||
कुर्वन्ति विविधान् व्याधीन् शाखाकोष्ठास्थिसन्धिषु|
These are the causes for the increase of Doshas. The doshas thus increased, produce many kinds of diseases, involving the shaka (tissues), koshta (viscera), asthi (bones) and sandhi (joints).

Bahi Koshta / Bahi (bahya) Rogamarga – The external pathway of diseases

शाखा रक्तादयस्त्वक् च बाह्यरोगायनं हि तत्||४४||
तदाश्रया मषव्यङ्गगण्डालज्यर्बुदादयः|
बहिर्भागाश्च दुर्नामगुल्मशोफादयो गदाः||४५||
Rakta (blood) and others tissues (muscles, bone, fat, bone marrow and sex related secretions) and twak (skin) constitute the BahyaRogamarga – external pathway of diseases.
It is related with diseases such as
Masha – moles,
Vyanga – discoloured patches on face,
Gandalaji– goitre, glandular ulcer on the face,
Arbuda – malignant tumours,
and externally manifested (bahirbhagascha)
Durnama – haemorrhoids,
Gulma – abdominal tumour,
Shophadi – swelling and other external diseases.

Anta Koshta / Anta Rogamarga – The internal pathway of diseases

अन्तःकोष्ठो महास्रोत आमपक्वाशयाश्रयः|
तत्स्थानाः च्छर्द्यतीसारकासश्वासोदरज्वराः||४६||
अन्तर्भागं च शोफार्शोगुल्मवीसर्पविद्रधि|
Amashaya (stomach and small intestine), Pakvashaya (large intestine) along with the entire gastro intestinal tract is called Mahasrota (the big channel). This constitutes the Anta Koshta.
Diseases which affect this path are –
Chardi – vomiting,
Atisara – diarrhoea,
Kasa – cough,
Swasa – dyspnoea,
Udara – enlargement of the abdomen,
Jwara – fever,
and internally manifested (antarbhagam)
Shopha – oedema,
Arshas – haemorrhoids,
Gulma – abdominal tumours,
Visarpa – herpes, spreading skin diseases and
Vidradhi – abscess etc.

Madhyama Koshta / Madhyama Rogamarga – The middle pathway of diseases

शिरोहृदयबस्त्यादिमर्माण्यस्थ्नां च सन्धयः||४७||
तन्निबद्धाः शिरास्नायुकण्डराद्याश्च मध्यमः|
रोगमार्गः स्थितास्तत्र यक्ष्मपक्षवधार्दिताः||४८||
मूर्धादिरोगाः सन्ध्यस्थित्रिकशूलग्रहादयः|
Shira – head,
Hridaya – heart,
Bastyadimarmani – urinary bladder and such other vital organs,
Asthnam sandhi – joints of bones,
Sira – blood vessels,
Snayu – tendons,
Kandara – ligaments etc
constitute the Madhyama rogamarga.
From it arise,
Yakshma – tuberculosis,
Pakshavadha – hemiplegia,
Ardita – facial paralysis,
Murdhadiroga – diseases of the head and other organs,
Shoola (pain), graha (stiffness) of sandhi (joints), asthi (bones), trika (sacral region) etc.

Symptoms of increase of Vata

स्रंसव्यासव्यधस्वापसादरुक्तोदभेदनम्||४९||
सङ्गाङ्गभङ्गसङ्कोचवर्तहर्षणतर्षणम्|
कम्पपारुष्यसौषिर्यशोषस्पन्दनवेष्टनम्||५०||
स्तम्भः कषायरसता वर्णः श्यावोऽरुणोऽपि वा|
कर्माणि वायोः
The following are the abnormal signs and symptoms of increased Vata –
Sramsa – drooping down (ptosis),
Vyasa – dilation,
Vyadha – cutting pain,
Swapa – loss of sensation,
Sada – weakness, loss of function,
Ruk – pain,
Toda – continuous pain,
Bhedanam – splitting pain,
Sanga – constriction,
Angabhanga – body ache,
Sankocha – shrinking of the organ, reduction in size,
Varta – twisting,
Harshana – tingling sensation,
Tarshana – thirst,
Kampa – tremors,
Parushya – roughness,
Saushirya – feeling of emptiness,
Shosha – dryness,
Spandana – pulsating pain,
Veshtana – rigidity, as if tied,
Sthambha – stiffness,
Kashaya rasata – astringent taste in mouth,
ShyavaAruna Varna – appearance of blue or crimson discoloration.

Symptoms of increase of Pitta

पित्तस्य दाहरागोष्मपाकिताः||५१||
स्वेदः क्लेदः स्रुतिः कोथः सदनं मूर्च्छनं मदः|
कटुकाम्लौ रसौ वर्णः पाण्डुरारुणवर्जितः||५२||
The following are the symptoms of increased Pitta –
Daha – burning sensation,
Raga – reddish discoloration,
Ushmapakita – heat, increase in temperature, formation of pus, ulcers,
Sveda – sweating,
Kleda – excessive moistness,
Sruti – inflammation with pus / oozing / secretions,
Kotha – putrefaction– decomposition,
Sadana – debility,
Murchana – fainting,
Mada– toxicity,
Katuka Amla Rasa – pungent and sour taste in the mouth,
Varna panduarunavarjitaha – appearance of colours other than yellowish white and crimson.

Symptoms of increase of Kapha

श्लेष्मणः स्नेहकाठिन्यकण्डूशीतत्वगौरवम्|
बन्धोपलेपस्तैमित्यशोफापक्त्यतिनिद्रताः||५३||
वर्णः श्वेतो रसौ स्वादुलवणौ चिरकारिता|
The following are the symptoms of Kapha increase –
Sneha – unctuousness, oiliness,
Katinya – hardness,
Kandu – itching,
Sheetatva – coldness,
Gaurava – heaviness,
Bandha – obstruction,
Upalepa – coating, as if tied with a wet cloth,
Staimitya – stiffness, loss of movement,
Shopha – inflammation,
Apakti – indigestion,
Atinidrata – excessive sleep,
Shveta varna – white discolouration,
Svadulavana rasa – sweet, salt taste in mouth,
Chirakarita – delay in all activities.

इत्यशेषमयव्यापि यदुक्तं दोषलक्षणम्||५४||
दर्शनाद्यैरवहितस्तत्सम्यगुपलक्षयेत्|
व्याध्यवस्थाविभागज्ञः पश्यन्नार्तान् प्रतिक्षणम्||५५||
Thus, the above said symptoms of all the doshas should be properly learnt by darshana (inspection) and other measures of examination of the patient by a physician who is attentive, who knows the different stages of diseases,after observing the patients every moment.

अभ्यासात्प्राप्यते दृष्टिः कर्मसिद्धिप्रकाशिनी|
रत्नादिसदसज्ज्ञानं न शास्त्रादेव जायते||५६||
By abhyasa (constant practice), the karmasiddhi (practical knowledge and experience) is gained, which would reflect in the success of treatment just like the knowledge of identifying ratna (gems, gold, precious stones etc) will not be obtained just by theoretical knowledge.

Three kinds of diseases based on the cause

दृष्टापचारजः कश्चित्कश्चित्पूर्वापराधजः|
तत्सङ्कराद्भवत्यन्यो व्याधिरेवं त्रिधा स्मृतः||५७||
The diseases are said to be of three types,
Kaschitdrishtapacharajah – some are due to misdeeds done in the present life,
Kaschitpoorvaparadhaja –some occur due to the misdeeds done previously (in previous life)
Tatsankaradbhavatyanyo – and some manifest due to combination of both the above said factors.

यथानिदानं दोषोत्थः कर्मजो हेतुभिर्विना|
महारम्भोऽल्पके हेतावातङ्को दोषकर्मजः||५८||
Doshaja vyadhis (drishtapacharaja) are those diseases which get manifested due to the doshas (which are aggravated due to the causative factors which vitiate them).
Karmaja vyadhis (purvaparadhaja, adrushtaja) are those diseases which get manifested without the involvement of any causative factors.
Dosha karmaja vyadhis are diseases which get manifested with severe and profound symptoms in spite of minimum vitiating factors (caused due to mixed factors i.e. causative factors of a disease and misdeeds done previously).

विपक्षशीलनात्पूर्वः कर्मजः कर्मसङ्क्षयात्|
गच्छत्युभयजन्मा तु दोषकर्मक्षयात्क्षयम्||५९||
Doshaja vyadhis get cured by indulgence in food, activities and medicines which have opposite qualities to the causes of the disease.
Karmaja vyadhis get cured after the termination of the effects of acts or misdeeds done in previous lives.
Dosha–karmaja diseases get cured after the mitigation of doshas along with nullifying the effects of misdeeds done in previous life.

Swatantra (independent/primary) and Paratantra (dependent/secondary) types of diseases

द्विधा स्वपरतन्त्रत्वाद्व्याधयोऽन्त्याः पुनर्द्विधा|
Diseases are again of two types; they are
Swatantra (independent / primary) and
Paratantra (dependent / secondary) diseases.
The second type of disease (paratantra) is again of two types.

Classification of Paratantra (dependent/secondary) Roga

पूर्वजाः पुर्वरूपाख्या, जाताः पश्चादुपद्रवाः||६०||
Purvajavyadhis are also called as purvarupas (premonitory symptoms which manifest before the manifestation of the actual disease) and
Paschatjatavyadhis are manifested after the formation of the disease and are also called upadravas (complications of a disease).

Definition of Swatantra or primary disease

यथास्वजन्मोपशयाः स्वतन्त्राः स्पष्टलक्षणाः|
Swatantra vyadhi (independent, primary disease) are those which have
Svajanma – their own specific causes, due to which they get manifested,
Svaupashaya – their own comforting remedies which when administered will cure those diseases and
Spashtalakshana – clearly manifested signs and symptoms which are specific to those diseases.

Definition of Paratantra or secondary disease

विपरीतास्ततोऽन्ये तु
Paratantravyadhi (secondary disease) are those that will have opposite features as that of Swatantra vyadhi (primary disease).

Swatantra and Paratantra Doshas

विद्यादेवं मलानपि||६१||
तांल्लक्षयेदवहितो विकुर्वाणान् प्रतिज्वरम्|
Similarly, the doshas will also have swatantra (independent, primary) and paratantra (dependent, secondary) types of manifestation.
An attentive physician should understand this by observation with presence of mind.

Treatment of Paratantravyadhis and doshas

तेषां प्रधानप्रशमे प्रशमोऽशाम्यतस्तथा||६२||
पश्चाच्चिकित्सेत्तूर्णं वा बलवन्तमुपद्रवम्|
व्याधिक्लिष्टशरीरस्य पीडाकरतरो हि सः||६३||
Paratantra (secondary) diseases subside when the pradhana or swatantra (primary disease) disease is pacified.
The paratantra (secondary) diseases which do not get subsided in spite of the treatment of primary disease should be treated independently after the treatment of the primary disease, considering it as an independent disease.
Immediate treatment should be administered if the upadrava (complications) are very powerful because these complications will cause more trouble to the body which is already debilitated by the disease.

विकारनामाकुशलो न जिह्रीयात् कदाचन|
न हि सर्वविकाराणां नामतोऽस्ति ध्रुवा स्थितिः||६४||
The physician who does not know the nama (names) of all the diseases should never feel shy about it, because all the diseases do not have a definitive and fixed name.

Factors to be considered to treat diseases

स एव कुपितो दोषः समुत्थानविशेषतः|
स्थानान्तराणि च प्राप्य विकारान् कुरुते बहून्||६५||
तस्माद्विकारप्रकृतीरधिष्ठानान्तराणि च|
बुद्ध्वा हेतुविशेषांश्च शीघ्ह्रं कुर्यादुपक्रमम्||६६||
The very same vitiated dosha (doshas), depending upon the nature of their causative factors,on reaching the different parts of the body, will produce many vikara (diseases),
Therefore, the upakrama (treatment) of the disease should be done quickly, after knowing the
Vikara prakriti – main doshas causing the disease,
Adhishtana antarani – various parts of the body in which the vitiated doshas have caused the disease and
Hetu vishesha – specific causes for vitiation of doshas.

Factors to observe in the patient

दूष्यं देशं बलं कालमनलं प्रकृतिं वयः|
सत्त्वं सात्म्यं तथाऽऽहारमवस्थाश्च पृथग्विधाः||६७||
सूक्ष्मसूक्ष्माः समीक्ष्यैषां दोषौषधनिरूपणे|
यो वर्तते चिकित्सायां न स स्खलति जातुचित्||६८||
The physician should minutely examine and determine –
Dushya – the Dhatus and Malas involved in a diseases,
Desha – the area of the body where disease is manifested, the living place of the patient,
Bala – strength of the patient,
Kala– season, how old is the disease, age of the person etc.,
Anala– digestive power of the patient,
Prakriti– body constitution,
Vayas– age of the patient and disease,
Satva– mind, tolerance capacity of the patient,
Satmya– The food and activities to which the patient is accustomed to,
Ahara– food habits and
Avastha– stages of the disease.
The physician should watch for the above factors and then should decide on the aggravated Dosha and its appropriate treatment. Such a doctor will never commit mistakes in treatment.

Guru Vyadhi and Laghu Vyadhi (strong and weak disease)

गुर्वल्पव्याधिसंस्थानं सत्त्वदेहबलाबलात्|
दृश्यतेऽप्यन्यथाकारं तस्मिन्नवहितो भवेत्||६९||
Depending on the bala (strength) and abala (weakness) of the satva (mind) and deha (body), the symptoms of guru vyadhi (strong disease) and alpa vyadhi (weak disease) may appear in a contrasting way, hence the physician should be very attentive.

गुरुं लघुमिति व्याधिं कल्पयंस्तु भिषग्ब्रुवः|
अल्पदोषाकलनया पथ्ये विप्रतिपद्यते||७०||
An unintelligent physician who diagnoses a guru vyadhi (severe, grievous disease) as a laghuvyadhi (weak, mild disease) goes wrong in treatment because he considers the doshas to be alpa (less quantity of dosha aggravation) in a grievous disease (in which there is actually severe aggravation of doshas).
Effect of wrongly diagnosing grievous disease as mild disease and vice versa:

ततोऽऽल्पमल्पवीर्यं वा गुरुव्याधौ प्रयोजितम्|
उदीरयेत्तरां रोगान् संशोधनमयोगतः||७१||
शोधनं त्वतियोगेन विपरीतं विपर्यये|
क्षिणुयान्न मलानेव केवलं वपुरस्यति||७२||
Thus, when medicines in less quantity (alpam) and less potency (alpaveeryam) are administered in guru vyadhi (severe disease), it will lead to worsening of disease because of ayogasamshodhanam (deficit, ineffective cleansing).
In the opposite condition i.e. in a feeble or weak disease, if medicines and treatment in more quantity and more potency are administered,they will not only destroy the morbid doshas, but will also cause excessive destruction of the body because of atiyogenashodhanam (excessive cleansing).

Right approach of a determined physician towards comprehensive treatment

अतोऽभियुक्तः सततं सर्वमालोच्य सर्वथा|
तथा युञ्जीत भैषज्यमारोग्याय यथा ध्रुवम्||७३||
Hence, the physician who is constantly engaged and committed towards learning the science should determine the exact condition of all the factors (involved in the causation of a disease) and analyze everything in all ways and at all times and later should administer the treatment as needed for the sake of proper health.

Number of permutations and combinations of Doshas – Dosha Samyoga Samkhya

वक्ष्यन्तेऽतःपरं दोषा वृद्धिक्षयविभेदतः|
After this, we are going to explain the permutations and combinations of dosha vriddhi (increase) and kshaya (decrease).

Permutations and combinations of Doshas

पृथक् त्रीन् विद्धि संसर्गस्त्रिधा तत्र तु तान्नव॥७४॥
त्रीनेव समया वृद्ध्या षडेकस्यातिशायने।
त्रयोदश समस्तेषु षड् द्व्येकातिशयेन तु॥७५॥
एकं तुल्याधिकैः षट् च तारतम्यविकल्पनात्।
पञ्चविंशतिमित्येवं वृद्धैः क्षीणैश्च तावतः॥७६॥
(In the below explanation,
vriddhi = increase,
vriddhitara = more or moderate increase,
vriddhitama = severe increase)
Considering the vriddhi (increase) of Doshas, they are –
Eka Dosha Vriddhi (Single dosha increase) is of 3 types:
– Vata Vriddhi
– Pitta Vriddhi
– KaphaVriddhi

Samsarga, Dvi Dosha Vriddhi (two dosha increase) is of 9 types:

a. 3 types of increase in equal proportions –
– Vata–pitta vriddhi
– Vata–kaphavriddhi
– Pitta–kaphavriddhi

b. 6 types with preponderance of one dosha –
– Vata vriddhi–Pitta vriddhitaram
– Pitta vriddhi–Vata vriddhitaram
– Kaphavriddhi–Pitta vriddhitaram
– Pitta vriddhi–Kaphavriddhitaram
– Kaphavriddhi–Vata vridhhitaram
– Vata vriddhi–Kaphavriddhitaram

Sannipata, Tri Dosha Vriddhi (three dosha increase) is of 13 types:
a. 6 types with preponderance of any one dosha –
– Vata vriddhi–Pitta KaphaAtivriddhi
– Pitta vriddhi–Vata KaphaAtivridddhi
– Kaphavriddhi–Vata Pitta Ativriddhi
– Vata Ativriddhi–Pitta KaphaVriddhi
– Pitta Ativriddhi–Vata KaphaVriddhi
– KaphaAtivriddhi–Vata Pitta Vriddhi

b. 1 type with preponderance of all three doshas –
– Vata–Pitta–KaphaVriddhi

c. 6 types by disproportionate subdivisions –
– Vata vriddhi–Pitta vriddhitara–Kaphavriddhitama
– Vata vriddhi–Kaphavriddhitara–Kaphavriddhitama
– Pitta vriddhi–Kaphavriddhitara–Vata vriddhitama
– Pitta vriddhi–Vata vriddhitara–Kaphavriddhitama
– Kaphavriddhi–Vata vriddhitara–Pitta vriddhitama
– Kaphavriddhi–Pitta vriddhitara–Vata vriddhitama

Thus, the vriddhi of doshas is only of 25 types. Similarly the decrease of doshas is also of 25 types.

Other types of combinations of doshas

एकैकवृद्धिसमताक्षयैः षट् ते पुनश्च षट्।
एकक्षयद्वन्द्ववृद्ध्या सविपर्यययापि ते॥७७॥
भेदा द्विषष्टिर्निर्दिष्टाः त्रिषष्ट: स्वास्थ्यकारणम् ।
(In the below explanation –
vriddhi = increase,
sama = normalcy,
kshaya = decrease)

Increase, normalcy and decrease of one dosha each is of 6 types, they are –

– Vata vriddhi–Pitta sama–Kapha kshaya
– Pitta vriddhi–Vata sama–Kapha kshaya
– Kaphavriddhi–Pitta sama–Vata kshaya
– Kaphavriddhi–Vata sama–Pitta kshaya
– Vata vriddhi–Kaphasama–Pitta kshaya
– Pitta vriddhi–Kaphasama–Vata kshaya

In the combination of one dosha decrease and two dosha increase, and two dosha decrease and one dosha increase, they are once again of 6 types.

Decrease of 1 dosha and increase of two doshas is of 3 types, they are –
– Vata kshaya–Pitta Kapha vriddhi
– Pitta kshaya–Vata Kapha vriddhi
– Kaphakshaya–Vata Pitta vriddhi

Decrease of 2 doshas and increase of 1 dosha is of 3 types, they are –
– Vata Pitta kshaya–Kaphavriddhi
– Vata Kaphakshaya–Pitta vriddhi
– Pitta Kaphakshaya–Vata vriddhi

Thus 62 types of combination of dosha increase and decrease have been explained.
The 63rd is the condition where all the three doshas are in equilibrium, which is called as the state of health.

Permutations and combinations of doshas and dhatus are innumerable

संसर्गाद्रसरुधिरादिभिस्तथैषां दोषांस्तु क्षयसमताविवृद्धिभेदैः |
आनन्त्यं तरतमयोगतश्च यातान् जानीयादवहितमानसो यथास्वम्॥७८॥
Different levels of decrease, normalcy and increase of doshas when associated with rasa, rakta and other tissues, can result in innumerable permutations and combinations.
The physician should understand them by their features with anattentive mind.

इति श्रीवैद्यपतिसिंहगुप्तसूनुवाग्भटविरचितायां अष्टाङ्गहृदयसंहितायां सूत्रस्थाने दोषभेदीयो नाम द्वादशोऽध्याय: ॥
Thus ends the 12th chapter of Ashtangahridaya Samhita Sutrasthana, named DoshabhediyaAdhyaya, written by Shrimad Vagbhata, son of Shri VaidyapatiSimhagupta.