Astang Hrudayam Sutrasthan (Doshopakramaniyam Adhyaya)

Doshopakramaniyam adhyaya is the 13th chapter of Sutrasthan of Astang Hrudya text book or Samhinta.

In this chapter we are learning the treatment options for Dosha imbalance, how Tridosha reach with Ama and produce symptoms, what is the line of treatment for this condition. We also learn about time of administration of medicines based on disease.

Vriddha Vata chikitsa(treatment of increased vata)—

Line of Treatment for increased Vata Dosha is- 

• Snehan / oleation-in this procedure oral administration of oil / ghee / fat and external oil massage is done
• Svedan/ Sudation – diaphoresis, sweating therapy
• Mrudu Samshodhana – it is a Mild purification procedure, Mild Panchakarma (Vamana and Virechana). Excess use of Panchakarma might lead to Vata increase.
•  Svadu Amla Lavana Ushna Bhojya – foods which are of sweet, sour and salt taste
•  Abhyanga – Oil massage
•  Mardana – simple massage
•  Veshtana – wrapping / covering the body/ organ with cloth
•  Trasana – Threatening, frightening
•  Seka – pouring of luke warm herbal decoctions / oils on the affected area
•  Paishtika Goudika Madya – wine prepared from corn flour and jaggery/molasses
• Basti –in this procedure give  enema with fat-oil, enema with drugs of hot potency 
•  Deepana Pachana Siddha Sneha – medicated fats and oils of different kinds- sources prepared with drugs causing increase of digestive fire and improving appetite.
•  Medya Pishita Taila Anuvasana – oleation enema prepared from juice of fatty meat and oil-

Vriddha pitta ckikitsa(Treatment of  increased Pitta Dosha)  –

• Sarpi paana – intake of Ghrita (clarified Butter). It can be plain or medicated .
•  Svadu, sheeta Virechana – purgation therapy with drugs of sweet taste and cold potency, consuming of foods items and drugs having sweet, bitter and astringent tastes.
• Sheet   Vihaar-Residing on terraces lit by moonlight in the evenings and  Residing in houses equipped with 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  enjoying pleasant music and soft cold breeze, company of friends who do not restrain him, of sons who speak cordially and with innocence. 
• Intake of cold milk and plain ghee  
• Purgation therapy (Virechana)

Vriddha Kapha Chikitsa( Treatment of increased  Kapha)-

 Treatment options for increased Kapha Dosha are-

•  Teekshna Vamana Virechana – Strong emesis and purgation in accordance with prescribed procedure
• Aahar (food)-intake of food which are dry in properties (ruksha gunaa), Consuming food in limited quantity Consuming food should be Teekshna , Ushna (hot ptency), pungent, bitter and astringent taste, Old wine is good for aggravated kapha doshas. intake of soups of grains, honey and fasting decrease kapha.
• Vihaar- keeping awake at night (Ratrijagarana ),worry (chinta),Exercises of different kinds,Dry massage of the body( udawartan) and gargling.
• Use of Therapies and medicines that reduce fat
• Inhalation of medicinal smoke

Treatment of vatta-pitta doshas-

For the combination of Vata and Pitta the treatment is similar to the regimen of Summer.

Treatment of vata-kapha doshas-

For Kapha and Vata combination treatment is similar to the regimen of Vasanta ritu (spring)

Because Maruta/ Vata is Yogavahi in nature; Yogavahi means when vata associated with Pitta it boosts

Pitta Dosha, when it get engaged with Kapha, it elongates Kapha Dosha.

Treatment of pitta-kapha doshas-

The treatment for the combination of Kapha and Pitta t shall be similar to the regimen of Sarad ritu (autumn).

Adarsh chikitsa/ideal treatment–

That treatment, which cures one disease and gives rise to another disease- sooner or later, is not appropriate (shuddha); A pure treatment is that which cures one – diseases and does not give rise to another.

Movement of Dosha From Alimantory Canal To Body Tissues –

1. Movement of doshas from Koshta to Shakha –

 By the effect of excessive exercise, 

Incriment  of heat unsuitable/unhealthy activities, and due to quick movement of Vata,

 The aggaravated  Doshas move out of the Kostha (GI tract) to the Shakhas- tissues, Asthi (bones) and Marmas (vital organs and vulnerable points).

2. Movement of doshas from Shakha to Koshta –

 Doshas move from body channels and tissues to the gastro intestinal tract, by the effect of exculpation, clearing and widening of the minute body channels. 

By further increase of Doshas, 

By liquefaction, by maturity, 

By balancing and controlling Vata.

 When Doshas relocate from one place to other, they stay  there for some time, waiting for prevailing  factor. After receiving strength by season, time etc, they get further aggravated and move to other places as well.

Origin of Ama (Amotpatti)- 

Soon after digestion process, the useful part (essense of food) gets separated from the waste part. The usable, nutrition enrich part is known as Rasa dhatu. 

Due to lack of digestion strength (diminished digestive fire), The Rasa Dhatu does not form well, and it remains in raw, weak form. Indigested rasa dhatu gets vitiated and stays in the Amashaya (stomach and intestines) itself, and becomes ‘Ama’.

 Elimination Of Dosha According To Season (Ritu)–

• Vata dosha  mild increment (Chaya) are seen in summer season (Greeshma ritu) .Vata dosha should be removed from the body by enema (Basti) in Shravana masa (August) .

• Pitta which undergoes mild increase in rainy season (Varsha ritu), should be remove from the body in kartika Month by purgation therapy (Virechana) .
• Kapha which undergoes mild increase in Shishira (winter) should be expelled out in April (Chaitra masa) by emesis therapy (Vamana). 
• Greeshma, Varsa and Hemanta [summer, rainy season and winter]- have too much of heat, rain and cold respectively; these three seasons known as Sadharana Kala; the Doshas should be cleared out. 
• After having overcome the effects of cold, hot and rainy seasons suitably- by adopting appropriate protective methods necessary treatment – therapies should be administered; Astanga Hridaya Sutrasthan 

Aushadha Sevana Kala (Time Of Administration Of Medicines)-

1. Ananna ( empty stomach) – For diseases arising from increase of Kapha, which are severe and for persons who are strong, the time of administration of medicine shall be when there is no food- in the stomach 
2. Annadau – just before food or at the beginning of food intake – in disorders of Apanavata
3. Anna Madhye (During food intake) – in disorders of Samana vata
4. Anna ante (at the end of food intake) – in disorders of Vyana vata at the end of the morning meal, in disorders of Udana vata at the end of evening meal. 
5. Kavalantare –( in between morsels )– in disorders of Prana- vata
6. Grase Grase – With each morsel – in anorexia, loss of taste it shall be mixed with different kinds of tasty foods
7. Muhurmuha (Repeatedly)- many a times a day – in diseases produced by poison, vomiting, hiccup, thirst, dysponea and cough 
8. Saannam (Mixed with food) – in anorexia  condition
9. Samudgam (before and after food) – in tremors, Akshepaka (convulsions), Hiccup
10. Nishi/ bed time – for diseases affecting head and neck.