Ashtanga Hrudaya Sutra Sthana Chapter 14: Dvividhopakramaniyam Adhyayam (Two Main Types of Treatments)

The 14th chapter of Sutrasthanam of Ashtanga Hridayam is Dvividhopakramaniyam Adhyayam. Dvividha means two types. Upakrama means treatment. The two main types of treatments namely nourishing (bulk promoting) and depleting (lightening) treatments will be explored in detail in this chapter, hence the name – Dvividha Upakramaneeyam Adhyayam.

अथातो द्विविधोपक्रमणीयमध्यायं व्याख्यास्याम: इति ह स्माहुरात्रेयादयो महर्षय: ।
Atreya and other sages pledge that they would henceforth be explaining the chapter named Dvividhopakramaneeyamadhyayam.

Two types of treatment

उपक्रम्यस्य हि द्वित्वाद्द्विधैवोपक्रमो मतः|
एकः सन्तर्पणस्तत्र द्वितीयश्चापतर्पणः|१|
Since the diseases (upakramya) are mainly of two types (sama and nirama), the treatment (upakrama) is also of two types.
1. Santarpana (nourishing therapy)
2. Apatarpana (reduction therapy)

बृंहणो लङ्घनश्चेति तत्पर्यायावुदाहृतौ|
बृंहणं यद्बृहत्वाय लङ्घनं लाघवाय यत्||२||
Brimhana (bulk promoting therapy) and Langhana (lightening therapy) are the synonyms of Santarpana and Apatarpana respectively.
Brimhana is that which makes the body stout and fat (brihatvaya)
Langhana is that which makes the body light and thin (laghavaya).

Mahabhuta composition of brimhana and langhana treatments

देहस्य भवतः प्रायो भौमापमितरच्च ते |
Among these two therapies, generally Brimhana treatment is predominant with bhauma (Earth element) and ap (water element) whereas
Langhana is predominantly made up of the other elements (i.e. fire, air and ether elements).

स्नेहनं रूक्षणं कर्म स्वेदनं स्तम्भनं च यत्||३||
भूतानां तदपि द्वैध्याद्द्वितयं नातिवर्तते|
The karma (functions) which are considered of 4 types namely
Snehana (oleation),
Rukshana (imparting dryness),
Swedana (sweating therapy, sudation) and
Stambhana (withholding, obstructing, and constipating)
are also not apart from these two types of treatment (brimhana and langhana) because the bhutas (five elements of nature) which make up the above karmas (functions) are also distributed among brimhana and langhana.

Types of Langhana or lightening treatments

शोधनं शमनं चेति द्विधा तत्रापि लङ्घनम्||४||
Langhana (lightening treatments) is of two types –
Shodhana (purification procedures i.e. Panchakarma treatments) and
Shamana (palliative treatments).

Meaning, types of Shodhana

यदीरयेद्वहिर्दोषान् पञ्चधा शोधनं च तत्|
निरूहो वमनं कायशिरोरेकोऽस्रविस्रुतिः||५||
That which forcibly expels the vitiated doshas out of the body is called Shodhana.
Shodhana is of five kinds, they are –
Niruha – decoction enema,
Vamanam – emesis, vomiting therapy,
Kaya reka – virechana, purgation of the body,
Shiro reka –nasya, nasal instillation of the medicines,
Asravisruti – raktamokshana, bloodletting.

Shamana Therapy: Meaning, types

न शोधयति यद्दोषान् समान्नोदीरयत्यपि|
समीकरोति विषमान् शमनं तच्च सप्तधा||६||
पाचनं दीपनं क्षुत्तृड्व्यायामातपमारुताः|
Shamana (palliative treatment) is that which
Na shodhayati – does not expel the increased Doshas out of the body,
Samannodirayatyapi – it does not increase the normal Dosha,
Sameekasotivishaman – but brings the abnormal Doshas back to normalcy.

Shamana is of 7 types –
Pachana – digestive, carminatives,
Deepana – hunger producing, stomachic,
Kshut – withstanding hunger, avoidance of food, fasting,
Trut – withstanding thirst, avoiding liquid food intake,
Vyayama– physical activity,
Aatapa– exposure to sunlight and
Maruta– exposure to the breeze.

बृंहणं शमनं त्वेव वायोः पित्तानिलस्य च||७||
Brimhana (stoutening therapies) are also a form of shamana (palliative treatment) since they pacify the aggravated vata and vata–pitta.

Brimhaneeya – Persons indicated for stoutening (nourishing) therapies

बृंहयेद्व्याधिभैषज्यमद्यस्त्रीशोककर्शितान्|
भाराध्वोरःक्षतक्षीणरूक्षदुर्बलवातलान्||८||
गर्भिणीसूतिकाबालवृद्धान् ग्रीष्मेऽपरानपि|
Brimhana– stoutening therapy should be given to persons who are
Vyadhi karshita – emaciated by diseases,
Bhaishajya Karshita – emaciated by medicines / therapies,
Madya Karshita – emaciated by alcohol,
StriKarshita – Emaciated by excess sexual activity,
Shoka karshita – Emaciated by grief,
Bhara – who carries heavy loads frequently,
Adhva – who has travelled a long distance,
Urakshata – person with chest injury,
Kshatakseena – who is debilitated due to injury,
Ruksha – who has excess dryness,
Durbala – debilitated,
Vatala – Person with Vata body type,
Garbhini – pregnant,
Sutika –the women who has delivered,
Bala – children,
Vruddha – the aged and
Greeshme – in the month of summer, even the other people, who are not indicated above should be given brihmana (nourishing therapy).

Methods to administer Brihmana

मांसक्षीरसितासर्पिर्मधुरस्निग्धबस्तिभिः||९||
स्वप्नशय्यासुखाभ्यङ्गस्नाननिर्वृतिहर्षणैः|
Brihmana can be administered by the use of
Mamsa – meat,
Ksheera – milk,
Sita – sugar,
Sarpi – ghee,
Madhura snigdhavasti – enema prepared using sweet substances and fats,
Swapna – sleep,
Shayyasukha – comfortable bed,
Abhyanga – oil massage,
Snana – bath,
Nivritti – comforts, rest and
Harshana – happiness of the mind.

Langhaneeya – Persons indicated for lightening therapies

मेहामदोषातिस्निग्धज्वरोरुस्तम्भकुष्ठिनः||१०||
विसर्पविद्राधिप्लीहशिरःकण्ठाक्षिरोगिणः|
स्थूलांश्च लङ्घयेन्नित्यं शिशिरे त्वपरानपि||११||
Langhana (lightening therapy) should be done in the following conditions –
Meha – diabetics, urinary disorders,
Amadosha – persons suffering from Ama,
Atisnigdha – who has undergone excess oleation treatment,
Jvara – fever,
Urustambha – stiffness of the thighs,
Kushta – skin diseases,
Visarpa – herpes,
Vidradhi – abscess,
Pleeha – diseases of spleen,
Shira, KantaAkshiroga – diseases of head, throat, and eyes,
Sthula –obese,
In Shishira (winter), even the other people who are not indicated for langhana above should be subjected to it.

Indications for Langhana therapy by means of Shodhana (panchakarma)

तत्र संशोधनैः स्थौल्यबलपित्तकफाधिकान्|
आमदोषज्वरच्छर्दिरतीसारहृदामयैः||१२||
विबन्धगौरवोद्गारहृल्लासादिभिरातुरान्|
The patients should be treated with langhana (lightening therapies) administered in the form of shodhana (panchakarma, cleansing therapies) in the below mentioned conditions –
Sthoulya – those who are very obese,
Bala – strong,
Pitta kaphadhikan – having predominance of Pitta and Kapha,
Ama dosha – those suffering from Amadosha,
Jwara – fever,
Chardi – vomiting,
Atisara – diarrhoea ,
Hridamaya – heart diseases,
Vibandha – constipation,
Gaurava – feeling of heaviness,
Udgara – excess of belching,
Hrillasa – nausea, etc.

Indications for Langhana therapy by means of pachana (digestives) and deepana (carminatives)

मध्यस्थौल्यादिकान् प्रायः पूर्वं पाचनदीपनैः||१३||
Generally in obesity (sthoulya) and other conditions having moderate (madhya) strength and in patients having moderate strength, langhana should be initially administered in the form of pachana (digestives) and deepana (appetite or hunger producing medicines) and later should be subjected to shodhana (purification treatments).

Indications for Langhana therapy by means of kshut–trishnanigraha (control of hunger and thirst)

एभिरेवामयैरार्तान् हीनस्थौल्यबलादिकान्| क्षुत्तृष्णानिग्रहै:
In patients suffering from the same diseases like sthoulya etc. explained above having less (heena) strength and in patients having less strength, langhana (lightening therapies) should be administered in the form of kshut–trishnanigraha (forcible control of hunger and thirst).

Indications for Langhana therapy by means of samirana–atapa–ayasa (exposure to breeze, sunlight and exercise)

दोषैस्त्वार्तान् मध्यबलैर्दृढान्॥१४॥
समीरणातपायासैः किमुताल्पबलैर्नरान्|
For strong patients who have vitiated doshas of moderate strength, langhana should be administered in the form of
Samirana (exposure to wind or breeze),
Atapa (heat of the Sun) and
Ayasa (exercise).
For patients with less strength and when the vitiated doshas also have less strength, langana in the form of samirana, atapa and ayasa is recommended.

Rules for implementing nourishing and lightening therapies

न बृंहयेल्लङ्घनीयान् बृंह्यांस्तु मृदु लङ्घयेत्||१५||
युक्त्या वा देशकालादिबलतस्तानुपाचरेत्|
Those who are indicated for lightening therapy (langhana) should not be administered bulk promoting therapy (brihmana).
For those who are indicated for bulk promoting therapy (brihmana), lightening treatments (langhana) can be given in a milder (mridu) form.
Or skilfully both lightening (langhana) and bulk promoting (brihmana) therapies can be given together, after having considered the nature of habitat (desha), season (kala), strength (bala) and other factors in the patient.

Benefits of Brimhana therapy

बॄंहिते स्याद्बलं पुष्टिस्तत्साध्यामयसङ्क्षयः||१६||
In those who have undergone brimhana (stoutening therapy),
Bala – strength is obtained,
Pushti – body is nourished properly, and
Tat sadhya amaya samkshayah – diseases which are curable by that therapy are cured.