Ashtanga Hrudaya Sutra Sthana Chapter 13: Doshopakramaniyam Adhyayam (Treatment Options to Combat Dosha Imbalance)

The 13th chapter of Sutrasthanam of Ashtanga Hridayam is Doshopakramaniyam Adhyayam. This chapter explains treatment options to combat dosha imbalance. The concept of ama, the way in which the doshas combine with ama to produce disease symptoms and the ways of treating these conditions, time of administration of medicines based on the disease are also explained in this chapter.

अथातो दोषोपक्रमणीयमध्यायं व्याख्यास्याम: इति ह स्माहुरात्रेयादयो महर्षय: ।
Atreya and other sages pledge that they will henceforth explain the chapter named Doshopakramaniyam (pertaining to treatment of Dosha imbalance).

Treatment for increased Vata – Vriddha Vata Chikitsa

वातस्योपक्रमः स्नेहः स्वेदः संशोधनं मृदु ।
स्वाद्वम्ललवणोष्णानि भोज्यान्यभ्यङ्गमर्दनम् ॥ १ ॥
वेष्टनं त्रासनं सेको मद्यं पैष्टिकगौडिकम् ।
स्निग्धोष्णा वस्तयो वस्तिनियमः सुखशीलता ॥ २ ॥
दीपनैः पाचनैः सिद्धा: स्नेहाश्चानेकयोनयः ।
विशेषान्मेद्यपिशित रसतैलानुवासनम् ॥ ३ ॥

The treatment for increased Vata includes –
Sneha – oleation,
Sveda – sudation,
Mrudu Samshodhana – mild purification procedures,
Svadu Amla Lavana Bhojya – foods which are of sweet, sour and salt taste,
Ushna Bhojya – foods that are hot,
Abhyanga – oil massage,
Mardana – mild massage,
Veshtana – binding / bandaging with cloth,
Trasana – 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 which is unctuous, enema prepared with drugs of hot potency,
Bastiniyama – habitual use of enema,
Sukhasheelata – comforting the patient,
Deepana Pachana Siddha Sneha – medicated fats prepared with drugs causing increase of hunger and improving digestion,
Medya Pishita rasa – intake of meat and meat soup which is nourishing,
Taila – use of oil,
Anuvasana – oil enema.

Treatment for increased Pitta – Vriddha Pitta Chikitsa

पित्तस्य सर्पिषः पानं स्वादुशीतैर्विरेचनम् ।
स्वादुतिक्तकषायाणि भोजनान्यौषधानि च ॥ ४ ॥
सुगन्धिशीतहृद्यानां गन्धानामुपसेवनम् ।
कण्ठेगुणानां हाराणां मणीनामुरसा धृतिः ॥ ५ ॥
कर्पूरचन्दनोशीरैरनुलेपः क्षणे क्षणे ।
प्रदोषश्चन्द्रमाः सौधं हारि गीतं हिमोऽनिलः ॥ ६ ॥
अयन्त्रणसुखं मित्रं पुत्रः सन्दिग्धमुग्धवाक् ।
छन्दानुवर्तिनो दाराः प्रियाः शीलविभूषिताः ॥ ७ ॥
शीताम्बुधारागर्भाणि गृहाण्युद्यानदीर्घिकाः ।
सुतीर्थविपुलस्वच्छ सलिलाशयसैकते ॥ ८ ॥
साम्भोजजलतीरान्ते कायमाने द्रुमाकुले ।
सौम्या भावाः पयः सर्पिर्विरेकश्च विशेषतः ॥ ९ ॥

The treatment for increased Pitta includes –
Sarpi paana – drinking of Ghrita (ghee),
Svadu, sheeta virechana – purgation therapy with drugs of sweet taste and cold potency,
Svadu, tikta kashayani bhojanani aushadhani – Intake of foods and drugs having sweet, bitter and astringent tastes,
Sugandhi gandhanam upasevanam – Inhaling of fumes from herbs that are sheeta (coolant) and hridya (pleasant and cordial),
Anulepa – Anointing the body with karpura (camphor), chandana (sandalwood paste), ushira (vetiver) paste, very frequently.
Pradosha chandrama saudham – Residing on terraces lit by moonlight in the evenings,
Hari gitam – enjoying pleasant music and
Himo anila – soft cold breeze,
Ayantranam sukham mitram – company of friends who do not restrain him / her,
Putra sandigdhamugdhavak – of sons who speak cordially and with innocence.
Spending time with dara (wife), who is obedient, pleasing and virtuous;
Residing in griha (houses) equipped with sheetambu dhara (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 paya (milk), sarpi (ghee) and
Virechana – Purgation therapy.

Treatment for increased Kapha – Vriddha Kapha Chikitsa

श्लेष्मणो विधिना युक्तं तीक्ष्णं वमनरेचनम् ।
अन्नं रूक्षाल्पतीक्ष्णोष्णं कटुतिक्तकषायकम् ॥ १० ॥
दीर्घकालस्थितं मद्यं रतिप्रीतिः प्रजागरः ।
अनेकरूपो व्यायामश्चिन्ता रूक्षं विमर्दनम् ॥ ११ ॥
विशेषाद्वमनं यूषः क्षौद्रं मेदोघ्नमौषधम् ।
धूमोपवासगण्डूषा निःसुखत्वं सुखाय च ॥ १२ ॥

The treatment for increased Kapha includes –
Teekshna Vamana Virechana – Strong emesis and purgation,
Annam ruksha – Consuming food which are dry,
Alpa – Consuming food in limited quantity,
Consuming food that have Teekshna (strong, penetrating), Ushna (hot),
Katu tikta kashayakam – pungent, bitter and astringent taste,
Deerga kala sthitam madyam – old wine,
Ratipreeti – sexual activity,
Prajagarah – keeping awake at night,
Aneka roopo vyayama – exercises of different kinds,
Chinta – Worry,
Ruksham vimardanam – dry massage of the body,
Vamana – emesis therapy,
Yusha – drinking of soups prepared using grains,
Kshaudra – Use of honey,
Medognam aushadham – Therapies and medicines that reduce fat,
Dhuma – Inhalation of medicinal smoke,
Upavasa – Fasting,
Gandusha – Gargling,
Nishukhatvam – Facing difficulties.

Treatment for simultaneous increase of two doshas (samsarga) and three doshas (sannipata)

उपक्रमः पृथग्दोषान् योऽयमुद्दिश्य कीर्तितः ।
संसर्गसन्निपातेषु तं यथास्वं विकल्पयेत् ॥ १३ ॥
ग्रैष्मः प्रायो मरुत्पित्ते वासन्तः कफमारुते ।
मरुतो योगवाहित्वात् कफपित्ते तु शारदः ॥ १४ ॥
The different treatment prescribed for each Dosha individually, may be combined appropriately in conditions of combinations of two Doshas (samsarga) or three Doshas (sannipata).
Generally the treatment for the combination of Vata and Pitta is similar to the regimen of Grishma (summer).
For Kapha and Vata combination, the treatment is similar to the regimen of Vasanta (spring) because Maruta (Vata) is Yogavahi (it 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).

Dosha Treatment as per level of aggravation

चय एव जयेद्दोषं कुपितं त्वविरोधयन् ।
सर्वकोपो बलीयांसं शेषदोषाविरोधतः ॥ १५ ॥
The Doshas should be treated properly when they are in Chaya stage (stage of mild increase / accumulation) only.
In their stage of Kopa (Dosha aggravation), they should be vanquished without interfering with another Dosha.
When there is sarvakopa (simultaneous increase of all the three Doshas), the most aggravated Dosha should be controlled first, without opposing the remaining Doshas.

Shuddha Chikitsa – pure treatment

प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत् ।
नासौ विशुद्धः शुद्धस्तु शमयेद्यो न कोपयेत् ॥ १६ ॥
The treatment which cures one disease but gives rise to another disease is not a pure treatment.
A pure treatment is that which cures one disease but does not give rise to another.

Movement of Doshas from Koshta (digestive tract) to Shakha (tissues)

व्यायामादूष्मणस्तैक्ष्ण्यादहिताचरणादपि ।
कोष्ठाच्छाखास्थिमर्माणि द्रुतत्वान्मारुतस्य च ॥ १७ ॥
By the effect of
Vyayama – exercise,
Ushmana: taikshnyat – increase of body heat,
Ahita charanat – unhealthy activities and
Drutatvat marutasya – due to quick movement of Vata,
the increased Doshas move out of the Kostha (gastrointestinal tract) to the Shakha (tissues), Asthi (bones) and Marmas (vital organs and vulnerable points).

Movement of Doshas from Shakha (tissues) to Koshta (digestive tract)

दोषा यान्ति तथा तेभ्यः स्रोतोमुखविशोधनात् ।
वृद्ध्यभिष्यन्दनात् पाकात् कोष्ठं वायोश्च निग्रहात् ॥ १८ ॥
तत्रस्थाश्च विलम्बेरन् भूयो हेतुप्रतीक्षिणः ।
ते कालादिबलं लब्ध्वा कुप्यन्तान्याश्रयेष्वपि ॥ १९ ॥
Doshas move from body channels and tissues to the gastrointestinal tract,
by the effect of
Shrotomukha vishodhanat – purification, clearing and widening of the minute body channels,
Vriddhi – by further increase of Doshas,
Abhishandanat – by liquefaction,
Pakat – by maturity,
Vayoscha nigrahat – by balancing and controlling Vata.
When Doshas move from one place to another, they remain there for some time, waiting for an exciting factor. After deriving strength by kala (season) etc, they get further aggravated and move to other places as well.

Native (Sthayi) and foreign (Agantu) doshas

तत्रान्यस्थानसंस्थेषु तदीयामबलेषु तु ।
कुर्याच्चिकित्सां स्वामेव बलेनान्याभिभाविषु ॥ २० ॥
आगन्तुं शमयेद्दोषं स्थानिनं प्रतिकृत्य वा ।
For the abala (weak) doshas which have travelled into anyasthana (the sites of other doshas), treatment should be done for the local dosha (sthanika or sthayi dosha).
In case of doshas which have the capacity to dominate i.e. for strong doshas which have travelled into other sites, treatment for these strong doshas should be administered.
The foreign (agantu) dosha should be treated either after treating the native dosha (sthanika) or even otherwise.

Tiryak gata dosha (obliquely placed doshas)

प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम् ॥ २१ ॥
कुर्यान्न तेषु त्वरया देहाग्निबलवित् क्रियाम् ।
शमयेत् तान् प्रयोगेण सुखं वा कोष्ठमानयेत् ॥ २२ ॥
ज्ञात्वा कोष्ठप्रपन्नांश्च यथासन्नं विनिर्हरेत् ।
The tiryak gata doshas cause troubles to the atura (patient) for a long time (chira),
In these conditions, the physician knowing the deha bala (strength of the body) and agni bala (digestive activity) should not do the treatment in a hurry.
They should be mitigated with stipulated palliative treatment (shamana) or should be brought into the koshta (alimentary tract) without causing much trouble.
After knowing that the doshas have come into the alimentary tract, they should be expelled out by the nearby route (through mouth in the form of emesis – vamana or by anal route, by purgation – virechana).

Sama dosha lakshanas – Symptoms of doshas associated with ama

स्रोतोरोधबलभ्रंशगौरवानिलमूढताः ॥ २३ ॥
आलस्यापक्तिनिष्ठीव मलसङ्गारुचिक्लमाः ।
लिङ्गं मलानां सामानां निरामाणां विपर्ययः ॥ २४ ॥
When imbalanced Doshas get associated with Ama (factor of indigestion), it is called as Sama Dosha. (Sa ama 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 features of Nirama Doshas (Doshas not mixed up with the Ama) are opposite to the above symptoms.

Features of Nirama Doshas (Doshas not associated with Ama)

विण्मूत्रनखदन्तत्वक्चक्षुषां पीतता भवेत् ।
रक्तत्वमथ कृष्णत्वं पृष्ठास्थिकटिसन्धिरुक् ॥ २४१+१ ॥
शिरोरुक् जायते तीव्रा निद्रा विरसता मुखे ।
क्वचिच्च श्वयथुर्गात्रे ज्वरातीसारहर्षणम् ॥ २४१+२ ॥
The symptoms of Doshas not associated with Ama are –
Peetatvam (yellowish), raktatvam (reddish) or krishnatvam (bluish black) discolouration of vit (faeces), mutra (urine), nakha (nails), danta (teeth), tvak (skin) and chakshu (eyes),
Prishta asthi kati sandhi ruk – Pain in the hip, bones, low back and joints
Teevra shiroruk – severe headache,
Nidra – sleep,
Virasata mukhe – odd taste in mouth,
Shvayathu gatre – oedema,
Jwara – fever,
Atisara – diarrhoea,
Harshanam – horripilation.