Chapter 6. Roganika Vimana adhyaya (Chapter on Classification of Diseases)

Chapter 6. Roganika Vimana adhyaya (Chapter on Classification of Diseases)

अथातो रोगानीकं विमानं व्याख्यास्यामः||१|| 

इति ह स्माह भगवानात्रेयः||२||

We shall now expound the chapter on the “restructuring the groups of diseases” Thus said Lord Atreya. [1-2]

Types of diseases

Following are the two categories of diseases:

द्वे रोगानीके भवतः प्रभावभेदेन- साध्यम्, असाध्यं च;  

1. On the basis of Prognosis / PRABHAVA– 

i. Curables / SADHYA

ii. Incurables / ASADHYA

द्वे रोगानीके बलभेदेन- मृदु, दारुणं च;

2. On the basis of Intensity - / BALA

i. Mild / MRDU

ii. Severe / DARUNA

द्वे रोगानीके अधिष्ठानभेदेन- मनोऽधिष्ठानं, शरीराधिष्ठानं च;

3.On the basis of Location - ADHISHTANA

i. Physical / SARIRA

ii. Mental /MANA

 द्वे रोगानीके निमित्तभेदेन- स्वधातुवैषम्यनिमित्तम्, आगन्तुनिमित्तं च;  

4.On the basis of Causes - NIMITTA

i. Endogenous / स्वधातुवैषम्यनिमित्तम्

ii. Exogenous / आगन्तुनिमित्तं 

द्वे रोगानीके आशयभेदेन- आमाशयसमुत्थं, पक्वाशयसमुत्थं चेति|

5.On the basis of Origin -  ASAYA

i. Digestive origin(Amashaya) 

ii. Excretory(pakwashaya) origin

एवमेतत् प्रभावबलाधिष्ठाननिमित्ताशयभेदाद्द्वैधं सद्भेद

 

Thus there are two categories of diseases based upon 

• prognosis/ PRABHAVA, 
• intensity/ BALA, 
• location/ ADHISHTANA, 
• cause / NIMITTAand 
• origin / ASAYA. 

प्रकृत्यन्तरेण भिद्यमानमथवाऽपि सन्धीयमानं स्यादेकत्वं बहुत्वं वा|

There might be 

• only one type of disease or 
• many types of diseases 

 - based upon the classification (permutation and combination). 

एकत्वं तावदेकमेव रोगानीकं, दुःखसामान्यात्; 

• Only one type of disease is based on similarity in causing pain and 

बहुत्वं तु दश रोगानीकानि प्रभावभेदादिना भवन्ति; 

• multiple types based upon ten categories and criteria mentioned above prognosis etc. 

 बहुत्वमपि सङ्ख्येयं स्यादसङ्ख्येयं वा| 

तत्र सङ्ख्येयं तावद्यथोक्तमष्टोदरीये, अपरिसङ्ख्येयं पुनर्यथा- महारोगाध्याये रुग्वर्णसमुत्थानादीनामसङ्ख्येयत्वात्||३||

- That may be numerable or innumerable. 

• Numerable as mentioned in the chapter Ashtodariya and 
• innumerable as described in Maharoga Adhyaya owing to innumerability of nature of pain, change in colour, variation in origin etc. factors. [3]

Justification for different types of classification

न च सङ्ख्येयाग्रेषु भेदप्रकृत्यन्तरीयेषु विगीतिरित्यतो दोषवती स्यादत्र काचित् प्रतिज्ञा, न चाविगीतिरित्यतः स्याददोषवती| भेत्ता हि भेद्यमन्यथाभिनत्ति, अन्यथा पुरस्ताद्भिन्नं भेदप्रकृत्यन्तरेण भिन्दन् भेदसङ्ख्याविशेषमापादयत्यनेकधा, न च पूर्वं भेदाग्रमुपहन्ति| समानायामपि खलु भेदप्रकृतौ प्रकृतानुप्रयोगान्तरमपेक्ष्यम्[१] |सन्ति ह्यर्थान्तराणि समानशब्दाभिहितानि, सन्ति चानर्थान्तराणि पर्यायशब्दाभिहितानि| 

If something, already classified in a particular manner, is reclassified in another way following different criteria, there may be change in the number of groups, and such a charge should not render the statement suggesting such a classification incorrect.

An individual has the liberty to classify things as he likes. 

If something is already classified into some groups in a particular manner, he may reclassify it on the basis of different criteria which may result in changes in the number of groups in different ways. This does not invalidate the number of groups according to some other mode of classification. 

In some cases the criterion of classification may appear to be the same as the previous one but the specific features of each of these criteria should be observed in deciding about the validity of this classification. 

समानो हि रोगशब्दो दोषेषु च व्याधिषु च; दोषा ह्यपि रोगशब्दमातङ्कशब्दं यक्ष्मशब्दं दोषप्रकृतिशब्दं विकारशब्दं च लभन्ते, व्याधयश्च रोगशब्दमातङ्कशब्दं यक्ष्मशब्दं दोषप्रकृतिशब्दं विकारशब्दं च लभन्ते| तत्र दोषेषु चैव व्याधिषु च रोगशब्दः समानः, शेषेषु तु विशेषवान्||४||

The same term may carry different meanings e.g. the word roga, antanka, yakshman, doshaprakriti and vikara (morbidity – these terms carry the meaning of or are synonymous with both dosha and vyadhi (disease). 

Thus the term roga is synonymous with both the doshaand vyadhi. For the rest like hetu (etiology) etc., this term, viz. roga carries a different meaning. [4]

Physical and psychic doshas and their vitiators

तत्र व्याधयोऽपरिसङ्ख्येया भवन्ति, अतिबहुत्वात्| दोषास्तु खलु परिसङ्ख्येया भवन्ति, अनतिबहुत्वात्| तस्माद्यथाचित्रं विकारानुदाहरणार्थम्, अनवशेषेण च दोषान् व्याख्यास्यामः|  

• Because of their multitudinous nature, diseases are innumerable. 
• On the other hand, doshas are numerable because of their limited number. 

 So only some of the diseases will be explained by way of illustrations whereas doshas will be explained in their entirety. 

रजस्तमश्च मानसौ दोषौ| तयोर्विकाराः कामक्रोधलोभमोहेर्ष्यामानमदशोकचित्तो(न्तो)द्वेगभयहर्षादयः|

• Rajas and tamas are the doshas pertaining to the mind and 

      -    the types of morbidity caused by them are

• kama (passion), 
• anger, 
• greed, 
• attachment, 
• envy, 
• ego, 
• pride 
• grief, 
• worry, 
• anxiety, 
• fear, 
• excitement etc. 
• 
  

वातपित्तश्लेष्माणस्तु खलु शारीरा दोषाः| तेषामपि च विकारा ज्वरातीसारशोफशोषश्वासमेहकुष्ठादयः| इति दोषाः केवला व्याख्याता विकारैकदेशश्च||५|| 

Vata, pitta and kapha- these three are the doshas pertaining to the body. 

Diseases caused by them are 

• fever, 
• diarrhea, 
• edema, 
• consumption, 
• dyspnoea, 
• meha (obstinate urinary disorder including diabetes), 
• kushtha (obstinate skin disease including leprosy) etc. 

          - Thus doshas in their entirety and diseases in parts are explained.

तत्र खल्वेषां द्वयानामपि दोषाणां त्रिविधं प्रकोपणं; तद्यथा- असात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः परिणामश्चेति||६||

Both of these types of doshas have three types of etiological factors, viz.

1. unwholesome contact with the object of senses / ASATMYA INDRIYARDHA SAMYOGA
2. intellectual errors/ PRAJNAPARADHA and
3. seasonal vagaries / KALA [5-6]

Factors responsible for manifestation of innumerable diseases

प्रकुपितास्तु खलु ते प्रकोपणविशेषाद्दूष्यविशेषाच्च विकारविशेषानभिनिर्वर्तयन्त्यपरिसङ्ख्येयान्||७||
 
Depending upon the specific nature of the causative factors and also the specificity of the tissue elements afflicted, doshas when aggravated manifest innumerable types of diseases. [7]

Psycho-somatic diseases

ते च विकाराः परस्परमनुवर्तमानाः कदाचिदनुबध्नन्ति कामादयो ज्वरादयश्च||८||
When allowed to persist for long, these psychic diseases viz. kama (passion) etc., and somatic diseases viz. fever etc., at times get combined with each other. [8]

Psychic doshas- their eternal union

नियतस्त्वनुबन्धो रजस्तमसोः परस्परं, न ह्यरजस्कं तमः प्रवर्तते ||९||

There is an eternal union between the two doshas pertaining to mind, viz. rajas and tamas. Tamas cannot manifest its actions without rajas. [9]

Combination of physical doshas

(प्रायः) शारीरदोषाणामेकाधिष्ठानीयानां सन्निपातः संसर्गो वा समानगुणत्वात्; दोषा हि दूषणैः समानाः||१०||

The three somatic doshas located at the same place and having identical attributes mostly 

• combine with one another (samsarga) or 
• with all taken together (sannipata). 

Attributes of doshas resemble those of the factors which vitiate those doshas. [10]

Primary and Secondary diseases

तत्रानुबन्ध्यानुबन्धकृतो विशेषः- स्वतन्त्रो व्यक्तलिङ्गो यथोक्तसमुत्थानप्रशमो भवत्यनुबन्ध्यः, तद्विपरीतलक्षणस्त्वनुबन्धः| अनुबन्ध्यलक्षणसमन्वितास्तत्र यदि दोषा भवन्ति तत्त्रिकं सन्निपातमाचक्षते, द्वयं वा संसर्गम्| अनुबन्ध्यानुबन्धविशेषकृतस्तु बहुविधो दोषभेदः| एवमेष सञ्ज्ञाप्रकृतो भिषजां दोषेषु व्याधिषु च नानाप्रकृतिविशेषव्यूहः ||११||


Characteristic features of primary and secondary (subordinate) diseases are as follows:

• The primary disease manifests its own symptoms independently; 
• this morbid condition is caused by factors specific to the manifestation of the disease. 
• This can be cured by the therapies prescribed for that particular disease. 
• The subordinate disease is characterized by opposite features. 
• If all the three doshas are primarily vitiated at a time, the condition is known as sannipata. 
• If only two of the doshas are vitiated, it is called samsarga. 

Depending upon the primary and subordinate nature of doshas, they are of many types. 

Considering such characteristic features, physicians attribute various names (like jwara or fever and atisara or diarrhea) to different conditions caused by doshas and diseases. [11]

Four types of Agni

अग्निषु तु शारीरेषु चतुर्विधो विशेषो बलभेदेन भवति| 

तद्यथा- तीक्ष्णो, मन्दः, समो, विषमश्चेति|

Depending upon their intensity, agnis (factors responsible for digestion and metabolism) located in the body of human beings can be classified under four categories, viz. 

1. tikshna (severe), 

2. manda (low), 

3. sama (normal) and 

4. vishama (irregular).

 तत्र तीक्ष्णोऽग्निः सर्वापचारसहः, 

1. The tikshna type is capable of tolerating all types of irregularities 

तद्विपरीतलक्षणस्तु मन्दः,

2. whereas the manda type is of opposite nature, i.e. even a small irregularity will impair its functioning. 

 

समस्तु खल्वपचारतो विकृतिमापद्यतेऽनपचारतस्तु प्रकृताववतिष्ठते,

3. The sama or balanced type of agni gets impaired even by minor irregularities; it maintains its normalcy so long as there is no irregularity. 

 

समलक्षणविपरीतलक्षणस्तु विषम इति| 

4. The irregular type of agni, as opposed to sama or balanced type, sometimes gets impaired and sometime it does not get impaired by irregularities.

एते चतुर्विधा भवन्त्यग्नयश्चतुर्विधानामेव पुरुषाणाम्| 

These four types of agni occur in the four types of individuals.

तत्र समवातपित्तश्लेष्मणां प्रकृतिस्थानां समा भवन्त्यग्नयः, 

 1. In individuals having vata, pitta and kapha in their balanced and normal state, the agnis are regular or balanced. 

वातलानां तु वाताभिभूतेऽग्न्यधिष्ठाने विषमा भवन्त्यग्नयः, 

2. In the case of individuals having the dominance of vata constitution, due to the affliction of the site of agni by vata, their agnis are irregular. 

पित्तलानां तु पित्ताभिभूते ह्यग्न्यधिष्ठाने तीक्ष्णा भवन्त्यग्नयः, 

3. In the case of individuals having the dominance of pitta, the agnis are sharp. 

श्लेष्मलानां तु श्लेष्माभिभूतेऽग्न्यधिष्ठाने मन्दा भवन्त्यग्नयः||१२||

4. Similarly, in the case of individuals having the dominance of kapha in the constitution, the agnis are mild due to the affliction of the site of agni by kapha. [12]

Physical constitution

तत्र केचिदाहुः- न समवातपित्तश्लेष्माणो जन्तवः सन्ति, विषमाहारोपयोगित्वान्मनुष्याणां; तस्माच्च वातप्रकृतयः केचित्, केचित् पित्तप्रकृतयः, केचित् पुनः श्लेष्मप्रकृतयो भवन्तीति| 

Some scholars hold the view that living beings cannot have a balanced state of vata, pitta and kapha in their body because they are accustomed to the intake of diets which are seldom balanced. 

Therefore, according to them some individuals have 

1. vata prakriti (vatika constitution), 
2. some have pitta prakriti (pattika constitution) and 
3. the rest have kapha prakriti (shlaishmika constitution). 

तच्चानुपपन्नं, कस्मात् कारणात्?

समवातपित्तश्लेष्माणं ह्यरोगमिच्छन्ति भिषजः, यतः प्रकृतिश्चारोग्यम्,

 - This is not correct because physicians take an individual to be healthy only when vata, pitta and kapha in his body are in a state of equilibrium and health represents the natural state of the body. 

  

आरोग्यार्था च भेषजप्रवृत्तिः,  

It is with a view to maintaining good health that all types of treatments are prescribed. 

सा चेष्टरूपा, तस्मात् सन्ति समवातपित्तश्लेष्माणः;

That state of the body is the most cherished one. Therefore, there are individuals having the balanced state of vata, pitta and kapha in their body.

न खलु सन्ति वातप्रकृतयः पित्तप्रकृतयः श्लेष्मप्रकृतयो वा| तस्य तस्य 

किल दोषस्याधिक्यात् सा 

The use of terms like vataprakriti, pittaprakriti and kaphaprakriti is not correct because in these types of constitutions, there is always a dominance of doshas in the bodies of individuals. 

सा दोषप्रकृतिरुच्यते मनुष्याणां, न च विकृतेषु दोषेषु प्रकृतिस्थत्वमुपपद्यते, तस्मान्नैताः प्रकृतयः सन्ति; 

Prakriti means a normal or natural state and there should not be any dominance of doshas in the bodies of such individuals. So such individuals as are having the dominance of one or the other doshas cannot be described to have the normal state of their body. 

सन्ति तु खलु वातलाः पित्तलाः श्लेष्मलाश्च, अप्रकृतिस्थास्तु ते ज्ञेयाः||१३||

Thus to use the correct term, 

• they are vatala(having the dominance of vata), 
• pittala (having the dominance of pitta) and 
• shlesmala (having the dominance of kapha), and 

 - these do not indicate the normal state of their body. [13]

Management of persons having different types of physical constitution

तेषां तु खलु चतुर्विधानां पुरुषाणां चत्वार्यनुप्रणिधानानि श्रेयस्कराणि भवन्ति| तत्र समसर्वधातूनां सर्वाकारसमम्, 

Four types of regimens are prescribed for the benefit of these four categories of individuals. 

• For an individual having the balance state of all doshas, all the regimens to be adopted by him should be of balanced type. 

अधिकदोषाणां तु त्रयाणां यथास्वं दोषाधिक्यमभिसमीक्ष्य दोषप्रतिकूलयोगीनि त्रीण्यनु(न्न)प्रणिधानानि श्रेयस्कराणि भवन्ति 

• When there is predominance of doshas, depending upon the nature of the doshas involved, it is useful to adopt such three regimens as would be in contradiction with these three predominating doshas till there is normalcy of agni. 

यावदग्नेः समीभावात्, समे तु सममेव कार्यम्; एवं चेष्टा भेषजप्रयोगाश्चापरे|  

• It is only after the normalcy of the agni is attained, balanced regimens should be adopted. 
• Similarly, various therapies and other regimens should be administered to these four categories of individuals. 

तान् विस्तरेणानुव्याख्यास्यामः||१४||

We shall now explain them in detail. [14]

Characteristic of constitutions and management of vata dominance

त्रयस्तु पुरुषा भवन्त्यातुराः, ते त्वनातुरास्तन्त्रान्तरीयाणां भिषजाम्| तद्यथा- वातलः,पित्तलः, श्लेष्मलश्चेति| तेषामिदं विशेषविज्ञानं- वातलस्य वातनिमित्ताः, पित्तलस्य पित्तनिमित्ताः, श्लेष्मलस्य श्लेष्मनिमित्ता व्याधयः प्रायेण बलवन्तश्च भवन्ति||१५|| 

Vatala (dominance of vata), pittala (dominance of pitta) and shleshmala (dominance of kapha)- these three are the morbid state in individuals, even though, according to another school of thought they represent the natural states of the body.

 Their characteristic features are as given below: 

       - vatala, pittala and shleshmala types of individuals are more susceptible to vatika, pittika and shlaishmika diseases respectively and such diseases in the respective types of individual become very severe.

तत्र वातलस्य वातप्रकोपणान्यासेवमानस्य क्षिप्रं वातः प्रकोपमापद्यते, न तथेतरौ दोषौ; स तस्य प्रकोपमापन्नो यथोक्तैर्विकारैः शरीरमुपतपति बलवर्णसुखायुषामुपघाताय|

If vatala type of individual resorts to such things which are aggravators of vata, vata in his body gets aggravated immediately. 

- This does not happen in case of remaining two doshas. The aggravated vata afflicts individuals by the manifestation of disease already described, 

• resulting in the impairment of strength, 
• complexion, 
• happiness and 
• longevity. 

 

तस्यावजयनं-     

The following therapies alleviate this dosha:

स्नेहस्वेदौ विधियुक्तौ,

1. Proper administration of oleation / SNEHA and fomentation/ SWEDA ;

मृदूनि च संशोधनानि

स्नेहोष्णमधुराम्ललवणयुक्तानि,

2. Mild purgative prepared by the addition of fat, hot things and substances having sweet, sour and saline tastes

तद्वदभ्यवहार्याणि, 

3. Food having the ingredients of the above mentioned properties.

अभ्यङ्गोपनाहनोद्वेष्टनोन्मर्दनपरिषेकावगाहनसंवाहनावपीडनवित्रासनविस्मापनविस्मारणानि,

4. Massage, poultices, bandages, kneading, effusion, bath, samvahana (pressing and massaging by hand), pressing, using means of terrifying, methods of surprising and making oneself to forget (bad memories)

सुरासवविधानं,  

5. Use of wine and asavas (fermented drinks)

स्नेहाश्चानेकयोनयो

दीपनीयपाचनीयवातहरविरेचनीयोपहितास्तथा शतपाकाः सहस्रपाकाः सर्वशश्च प्रयोगार्थाः, बस्तयः, 

6. Fats from different sources mixed with drugs having 

• digestive, 
• stimulant, 
• carminative, 
• vata alleviating and 
• purgative properties

- they may be boiled hundred and thousand times and be used for being administered in different ways, viz. internal use, massage, enema, etc., and

बस्तिनियमः सुखशीलता चेति||१६||

7. Observance of enema regimens, its regulations and adopting comfort (in behavior and lifestyle) [15-16]

Characteristics of pittala constitution and its management

पित्तलस्यापि पित्तप्रकोपणान्यासेवमानस्य क्षिप्रं पित्तं प्रकोपमापद्यते, न तथेतरौ दोषौ; तदस्य प्रकोपमापन्नं यथोक्तैर्विकारैः शरीरमुपतपति बलवर्णसुखायुषामुपघाताय|

If a pittaja individual resorts to such things as are aggravators of pitta, pitta in his body gets aggravated immediately. This does not happen in the case of remaining two doshas. 

The aggravated pitta afflicts the individual by the manifestation of diseases already described resulting in the impairment of strength, complexion, happiness and longevity. 

The following therapies alleviate this dosha:

तस्यावजयनं-    मधुरतिक्तकषायशीतानां चौषधाभ्यवहार्याणामुपयोगः, मृदुमधुरसुरभिशीतहृद्यानां गन्धानां चोपसेवा, 

सर्पिष्पानं, 

1. Consumption of ghee;

सर्पिषा च स्नेहनम्,

2. Oleation by ghee;

अधश्च दोषहरणं,

3. Purgation;

मधुरतिक्तकषायशीतानां चौषधाभ्यवहार्याणामुपयोगः, 

1. Use of drugs and diets having sweet, bitter and astringent tastes; and cooling property;

मृदुमधुरसुरभिशीतहृद्यानां गन्धानां चोपसेवा, 

1. Use of scents which are mild, sweet, fragrant, cooling and cordial;
2. 
   

मुक्तामणिहारावलीनां च परमशिशिरवारिसंस्थितानां धारणमुरसा,

1. Use in the chest of pearls, jewels and garlands which are kept in excessively cold water;

 क्षणे क्षणेऽग्र्यचन्दनप्रियङ्गुकालीयमृणालशीतवातवारिभिरुत्पलकुमुदकोकनदसौगन्धिकपद्मानुगतैश्च वारिभिरभिप्रोक्षणं, 

1. Frequent sprinkling of cold water and cold air of agryachandana (Santalum album Linn.), priyangu (Callicarpa macrophylla), kaliya (yellow variety of chandana) and mrinala (lotus stalk) mixed with utpala (Nymphaea alba Linn.), kumuda (a variety of utpala), kokanada (a variety of utpala red in color), saugandhika (a variety of utpala) and padma (Nelumbo nucifera Gaertn.)

श्रुतिसुखमृदुमधुरमनोऽनुगानां च गीतवादित्राणां श्रवणं, 

1. Hearing of songs and music which are pleasing to ears, mild, sweet and agreeable;

श्रवणं चाभ्युदयानां,

1. Hearing the information regarding prosperity;

सुहृद्भिः संयोगः,

1. Keeping company of friends;

  संयोगश्चेष्टाभिः स्त्रीभिः शीतोपहितांशुकस्रग्धारिणीभिः,  

1. Company of agreeable ladies wearing cooling garments and garlands;

निशाकरांशुशीतलप्रवातहर्म्यवासः,

1. Residence in buildings which is cooled by the moon rays and exposed to the breezes from all sides;

शैलान्तरपुलिनशिशिरसदनवसनव्यजनपवनसेवनं, 

1. Residence in cold places in mountains and river banks, use of cold apparel and exposure to the cold winds of fans;

रम्याणां चोपवनानां सुखशिशिरसुरभिमारुतोपहितानामुपसेवनं, 

1. Visiting beautiful garden having pleasing, cold and fragrant wind;

सेवनं चपद्मोत्पलनलिनकुमुदसौगन्धिकपुण्डरीकशतपत्रहस्तानां , 

1. Use of flower of padma (Nelumbo ncifera Gaertn.), utpala (Nymphaea alba linn.), nalina (a type of lotus), kumuda (a variety of utpala), saugandhika (a variety of utpala), pundarika( Nymphaea lotus Linn.) and satapatra ( a variety of lotus); and

सौम्यानां च सर्वभावानामिति||१७||

1. Adoption of such other regimens as are of soothing nature. [17]

Characteristics of shlaishmala constitution and its management

श्लेष्मलस्यापि श्लेष्मप्रकोपणान्यासेवमानस्य [१] क्षिप्रं श्लेष्मा प्रकोपमापद्यते, न तथेतरौ दोषौ; स तस्य प्रकोपमापन्नोयथोक्तैर्विकारैः शरीरमुपतपति बलवर्णसुखायुषामुपघाताय| 

If shlaishmala types of individual resorts to such things as are aggravators of kapha, then kapha in his body gets aggravated immediately; this does not happen to the remaining two doshas. The aggravated kapha afflicts the individual by the manifestation of diseases already described, resulting in the impairment of strength, complexion, happiness and longevity. 

तस्यावजयनं-   

The following therapies alleviate this dosha:

विधियुक्तानि तीक्ष्णोष्णानि संशोधनानि,

1. Proper administration of strong and hot elimination therapies;

रूक्षप्रायाणि चाभ्यवहार्याणि कटुकतिक्तकषायोपहितानि,

2. Intake of diet which is mostly ununctuous and is composed of ingredients having pungent, bitter and astringent tastes;

तथैवधावनलङ्घनप्लवनपरिसरणजागरणनियुद्धव्यवायव्यायामोन्मर्दनस्नानोत्सादनानि,  

3. Running, jumping, swimming, whirling, keeping awake during night, fighting, sexual intercourse, exercise, unction, bath and oil massage;

विशेषतस्तीक्ष्णानां दीर्घकालस्थितानां चमद्यानामुपयोगः, 

4. Intake of strong wines preserved for a long time;

सधूमपानः सर्वशश्चोपवासः,

5. All lightening therapies along with herbal smoking;

तथोष्णं वासः, 

6. Use of warm apparel; and

सुखप्रतिषेधश्च सुखार्थमेवेति||१८||

7. Giving up comforts of life with a view to enjoying happiness ultimately. [18]

Characteristics of royal physician

भवति चात्र- सर्वरोगविशेषज्ञः सर्वकार्यविशेषवित्| 

सर्वभेषजतत्त्वज्ञो राज्ञः प्राणपतिर्भवेदिति||१९||

Thus it is said:- 

1.  Sarvaroga visheshajna / A man well versed with the specific features of all diseases, 
2. Sarvakarya visheshajna / principles of their treatment and 
3. Sarvabheshaja tatvajna / properties of all medicaments 

 - is entitled to be a royal physician. [19]

Summary

तत्र श्लोकाः- प्रकृत्यन्तरभेदेन रोगानीकविकल्पनम्| परस्पराविरोधश्च सामान्यं रोगदोषयोः||२०|| दोषसङ्ख्या विकाराणामेकदेशः प्रकोपणम्| जरणं प्रति चिन्ता च कायाग्नेर्धुक्षणानि च||२१|| नराणां वातलादीनां प्रकृतिस्थापनानि च| रोगानीके विमानेऽस्मिन् व्याहृतानि महर्षिणा||२२||

To sum up, in this chapter, 

• groups of diseases based upon vata etc. prakriti types, 
• non-contradiction of classified categories of diseases, 
• similarity in dosha and roga, 
• numbers of doshas, 
• diseases with one type, 
• causes of vitiation of dosha, 
• description of agni, 
• and means to stimulate it’s functions, 
• vata etc. dominant types of persons 
• and their management to maintain normalcy of dosha 

 - are described in details by sage Atreya. [20-22]

Chapter 2. Trividhakukshiya Vimana (Chapter on the Principles of Dietary Intake)

Chapter 2. Trividhakukshiya Vimana (Chapter on the Principles of Dietary Intake)

अथातस्त्रिविधकुक्षीयं विमानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||

We shall now describe the chapter on the “3 divisions of stomach based on  the Capacity of the Stomach”. Thus said Lord Atreya. [1-2]

Three divisions of stomach

त्रिविधं कुक्षौ स्थापयेदवकाशांशमाहारस्याहारमुपयुञ्जानः; तद्यथा- एकमवकाशांशं मूर्तानामाहारविकाराणाम्, एकं द्रवाणाम्, एकं पुनर्वातपित्तश्लेष्मणाम्; एतावतीं ह्याहारमात्रामुपयुञ्जानो नामात्राहारजं किञ्चिदशुभं प्राप्नोति||३||

The consumer of the food should divide the total capacity of his stomach into three parts – 

• a third of the portion of the space should be allocated to solid food articles, 
• a third to liquid food substances and 
• the remaining third should be left for the (movement of) vata, pitta and kapha. 

- One who keeps this basic thumb-rule during dietary intake, does not get affected by any adverse effect arising out of improper amount of diet. [3]

न च केवलं मात्रावत्त्वादेवाहारस्य कृत्स्नमाहारफलसौष्ठवमवाप्तुं शक्यं, प्रकृत्यादीनामष्टानामाहारविधिविशेषायतनानां प्रविभक्तफलत्वात्||४||

It is not possible to derive all the beneficial effects of any diet only on the basis of the quantity of food consumed because the other seven factors (discussed in the preceding chapter, such as prakriti (nature of food) etc.) have their own individual role to play.[4]

तत्रायं तावदाहारराशिमधिकृत्य मात्रामात्राफलविनिश्चयार्थः प्रकृतः| एतावानेव ह्याहारराशिविधिविकल्पो यावन्मात्रावत्त्वममात्रावत्त्वं च||५||

However, the focus of this chapter is only to analyze the effect of the quantum of food (rashi) ingested, with the objective of determining appropriate and inappropriate quantities. This is the only consideration to decide how much is the proper and improper amount of food. [5]

Signs after consuming proper amount of food

तत्र मात्रावत्त्वं पूर्वमुद्दिष्टं कुक्ष्यंशविभागेन, तद्भूयो विस्तरेणानुव्याख्यास्यामः| तद्यथा- कुक्षेरप्रणीडनमाहारेण, हृदयस्यानवरोधः, पार्श्वयोरविपाटनम्, अनतिगौरवमुदरस्य, प्रीणनमिन्द्रियाणां, क्षुत्पिपासोपरमः स्थानासनशयनगमनोच्छ्वासप्रश्वास -हास्यसङ्कथासु सुखानुवृत्तिः, सायं प्रातश्च सुखेन परिणमनं, बलवर्णोपचयकरत्वं च; इति मात्रावतो लक्षणमाहारस्य भवति||६||


Whether the amount of food to be consumed is appropriate or not is determined on the basis of the capacity of the stomach and its division into three parts, as mentioned earlier. This will again be described here in detail. 

Any quantity of food to be consumed can be considered appropriate 

• if it does not exert undue pressure on the abdomen, 
• does not cause obstruction in the proper functioning of the heart, 
• does not exert any pressure on the sides of the chest, 
• does not leave a feeling of excessive heaviness in the abdomen, 
• properly nourishes(satisfies) the sense organs, 
• subsides hunger and thirst, 
• after consuming which the person is able to perform activities such as standing, sitting, walking, exhaling, inhaling, laughing, and talking with ease, and 
• is easy to digest when taken in the morning and evening hours. 
• Food consumed in the appropriate quantity enhances strength, complexion, and nourishment of tissues. [6]

Signs after consuming improper amount of food

अमात्रावत्त्वं पुनर्द्विविधमाचक्षते- हीनम्, अधिकं च| 

Amatra / Inappropriate quantity is of two types - 

1. deficient / hinam or 
2. excessive in quantity / adhikam – as briefly mentioned earlier.

तत्र हीनमात्रमाहारराशिं बलवर्णोपचयक्षयकरमतृप्तिकरमुदावर्तकरमनायुष्यवृष्यमनौजस्यं शरीरमनोबुद्धीन्द्रियोपघातकरं सारविधमनमलक्ष्म्यावहमशीतेश्च वातविकाराणामायतनमाचक्षते, 

The food taken in deficient quantity / hina matra is said to be the cause of 

• reduction in strength, complexion and nourishment of body tissues, 
• non–satisfaction, 
• altered peristalsis and 
• misplacement of vayu, 
• impairments in life-functions, body tissues (sara), sexual stamina (virility) and ojas (vitality), 
• damage to the body, mind, intellect, and sense organs,
•  inducing inauspiciousness and 
• also making the person home to a variety of disorders of vata.

अतिमात्रं पुनः सर्वदोषप्रकोपणमिच्छन्ति कुशलाः| यो हि मूर्तानामाहारजातानां सौहित्यं गत्वा द्रवैस्तृप्तिमापद्यते भूयस्तस्यामाशयगता वातपित्तश्लेष्माणोऽभ्यवहारेणातिमात्रेणातिप्रपीड्यमानाः सर्वे युगपत् प्रकोपमापद्यन्ते, ते प्रकुपितास्तमेवाहारराशिमपरिणतमाविश्य कुक्ष्येकदेशमन्नाश्रिता विष्टम्भयन्तः सहसा वाऽप्युत्तराधराभ्यां मार्गाभ्यां प्रच्यावयन्तः पृथक् पृथगिमान् विकारानभिनिर्वर्तयन्त्यतिमात्रभोक्तुः|

One who eats solid foods in excess and also drinks beverages beyond satiation / adhika matra will have 

• all the three doshas- vata, pitta and kapha - in his stomach vitiated simultaneously due to their getting compressed by all the excess food. 
• Thus, vitiated doshas in the undigested food mass get localized into a part of the stomach, 
• which then either obstruct the movements in the abdomen or suddenly get eliminated through upper and lower channels of the alimentary tract. 

 तत्र वातः शूलानाहाङ्गमर्दमुखशोषमूर्च्छाभ्रमाग्निवैषम्यपार्श्वपृष्ठकटिग्रहसिराकुञ्चनस्तम्भना-नि करोति, पित्तं पुनर्ज्वरातीसारान्तर्दाहतृष्णामदभ्रमप्रलपनानि, श्लेष्मा तु छर्द्यरोचकाविपाकशीतज्वरालस्यगात्रगौरवाणि||७||

They produce distinct features in the person as follows:

• Vata causes colic pain, distension of the abdomen, body ache, dryness of the mouth, fainting, giddiness, variability in digestive power, rigidity in flanks, back and waist and contraction (spasm) and hardening of vessels.

• Pitta causes fever, diarrhea, burning sensation inside body, thirst, intoxicated state, giddiness and delirium, and

• Kapha causes vomiting, anorexia, indigestion, fever with cold, laziness and heaviness in the body .[7]

Other causative factors for ama formation

न च खलु केवलमतिमात्रमेवाहारराशिमामप्रदोषकरमिच्छन्ति अपि तु खलु गुरुरूक्षशीतशुष्कद्विष्टविष्टम्भिविदाह्यशुचिविरुद्धानामकाले चान्नपानानामुपसेवनं,कामक्रोधलोभमोहेर्ष्याह्रीशोकमानोद्वेगभयोपतप्तमनसा वा यदन्नपानमुपयुज्यते, तदप्याममेव प्रदूषयति||८||

• The quantum of food is not the only cause of formation of ama (undigested and non-metabolized food) in the body 
• but also the use of diet and drinks which are heavy to digest, and 
• with properties like dry, cold, dehydrated, disliked by the consumer, constipation-causing, causing a burning sensation, unclean, incompatible, and/or consumed untimely.
•  Intake of food while the mind being afflicted with passion/desires, anger, greed, infatuation, envy, bashfulness, grief, conceit, excitement and fear are also the cause of formation of ama. [8]

भवति चात्र- मात्रयाऽप्यभ्यवहृतं पथ्यं चान्नं न जीर्यति| चिन्ताशोकभयक्रोधदुःखशय्याप्रजागरैः||९||

Thus it can be said that any wholesome food, even if taken in the right amount, does not get digested if the mental state of the person is riddled with 

• anxiety / chintha 
• grief / sokha 
• fear / bhaya 
• anger/ krodha or 
• restless / dukha and
•  irritable due to lack of sleep / shayya prajagara.[9]

Two types of ama disorders

तं द्विविधमामप्रदोषमाचक्षते भिषजः- विसूचिकाम्, अलसकं च||१०||

Physicians describe two types of diseases caused by ama dosha –

1. visuchika (cholera) and 
2. alasaka (sluggish bowels). [10]

Visuchika(cholera)

तत्र विसूचिकामूर्ध्वं चाधश्च प्रवृत्तामदोषां यथोक्तरूपां विद्यात्||११||

The expulsion of ama dosha (undigested food) through both upper and lower passages of the gastrointestinal tract with the features already described above is visuchika (cholera).[11]

Alasaka(sluggish bowel)

अलसकमुपदेक्ष्यामः- दुर्बलस्याल्पाग्नेर्बहुश्लेष्मणो वातमूत्रपुरीषवेगविधारिणः स्थिरगुरुबहुरूक्षशीतशुष्कान्नसेविनस्तदन्नपानमनिलप्रपीडितं श्लेष्मणा च विबद्धमार्गमतिमात्रप्रलीनमलसत्वान्न बहिर्मुखीभवति, 

  

If a weak person 

• having weak digestive power and 
• excess of kapha in the body, 
• habitually suppresses the urges of passing flatulence, micturition and bowel movement and 
• at the same time consumes solid, heavy, excessively dry, and cold, dehydrated foods in excessive quantities, 

- his ingested food gets afflicted by vayu. 

• Even exerting pressure does not push the undigested food out of the passage since it is obstructed by kapha, by excreta accumulated already, and also because of sluggishness caused by all these factors. 

 - This condition is called alasaka. 

ततश्छर्द्यतीसारवर्ज्यान्यामप्रदोषलिङ्गान्यभिदर्शयत्यतिमात्राणि 

• All the characteristic features of ama dosha, devoid of vomiting and diarrhea, are manifested severely in alasaka. 

Dandalasaka 

अतिमात्रप्रदुष्टाश्च दोषाः प्रदुष्टामबद्धमार्गास्तिर्यग्गच्छन्तः कदाचिदेव केवलमस्य शरीरं दण्डवत् स्तम्भयन्ति, ततस्तं दण्डालसकमसाध्यं ब्रुवते|

• The extremely vitiated doshas move towards oblique passages as the other passages are blocked by aggravated ama. 

• This will sometimes cause the body to become rigid, like a wooden rod/staff. 
• This incurable clinical condition is known as dandaalasaka. 

Ama Visha

विरुद्धाध्यशनाजीर्णाशनशीलिनः पुनरामदोषमामविषमित्याचक्षते भिषजः, विषसदृशलिङ्गत्वात्; तत् परमसाध्यम्, आशुकारित्वाद्विरुद्धोपक्रमत्वाच्चेति||१२||

The ama dosha of an individual who regularly consumes incompatible diet, multiple heavy meals (in short intervals) and eats even before the previous meal is digested is called ama visha (clinical state of indigestion characterized by manifestation of toxic symptoms) 

• because of resemblance of manifested symptoms to that of poisoning. 
• It is considered incurable because of its acute presentation and 
• also because of its contradictory line of management .[12]

Management of ama disorders

तत्र साध्यमामं प्रदुष्टमलसीभूतमुल्लेखयेदादौ पाययित्वा सलवणमुष्णं वारि, 

ततः  स्वेदनवर्तिप्रणिधानाभ्यामुपाचरेदुपवासयेच्चैनम्| 

The curable variety of ama dosha should be eliminated through 

• emesis, 
• by administering warm saline water and 
• thereafter fomentation / swedanam and 
• application of suppositories / varti
• while the patient is kept on fasting.

 

विसूचिकायां  लङ्घनमेवाग्रे विरिक्तवच्चानुपूर्वी| 

In case of visuchika,

•  treatment should start with langhana measures (therapy that reduces heaviness in the body) and 
• purgation therapies followed by specific dietary regimens.

आमप्रदोषेषु त्वन्नकाले जीर्णाहारं पुनर्दोषावलिप्तामाशयं स्तिमितगुरुकोष्ठमनन्नाभिलाषिणमभिसमीक्ष्य आमप्रदोषदुर्बलो च, नत्वेवाजीर्णाशनम्; पाययेद्दोषशेषपाचनार्थमौषधमग्निसन्धुक्षणार्थं ह्यग्निर्नयुगपद्दोषमौषधमाहारजातं च पक्तुम्| शक्तः अपि पुनर्विकाराणामपतर्पणेनैवोपरमो सहसैवातुरमबलमतिपातयेत्| 

If in the state of vitiation of ama, the patient has finally digested the previously eaten meal, but while ingesting the present meal, if the doshas still adhere inside the stomach and the feeling in the abdomen is stimita /cold/ inactive, guru koshta /heavy and annanabhilasham / aversion to food,

• then the patient should be advised medicines for digestion of the remaining doshas (pachana drugs) and also for stimulation of digestive fire (deepana drugs).
• The patient should not be given food during indigestion since the agni (digestive power) which is already weak by excessive vitiation of ama is incapable of simultaneously digesting the dosha, the drug and the diet. 
• In a patient who is already weak and has low digestive ability, the cumulative effect of excessively morbid ama (ama pradosha), food and drug will further deplete the strength of the patient and could even lead to death.

आमप्रदोषजानां चामप्रदोषाहारौषधविभ्रमोऽतिबलत्वादुपरतकायाग्निं भवति, सति त्वनुबन्धे कृतापतर्पणानां व्याधीनां निग्रहे निमित्तविपरीतमपास्यौषधमातङ्कविपरीतमेवावचारयेद्यथास्वम्|सर्वविकाराणामपि च निग्रहे वा| कुशलाः, तदर्थकारि हेतुव्याधिविपरीतमौषधमिच्छन्ति 

• The diseases caused by ama dosha is treated by apatarpana i.e. depletion therapy. 
• If the disease further progresses even after depletion therapy, appropriate measures should be adopted to counter the morbid condition. 
• Experts recommend the use of measures antagonistic to both the disease as well as its etiological factors, hetu - vyadhi viparitha oushadhi especially medications that could treat them both.

विमुक्तामप्रदोषस्य पुनः परिपक्वदोषस्य दीप्ते चाग्नावभ्यङ्गास्थापनानुवासनं विधिवत् स्नेहपानं च युक्त्या प्रयोज्यं प्रसमीक्ष्य दोषभेषजदेशकालबलशरीराहार सात्म्यसत्त्वप्रकृतिवयसामवस्थान्तराण विकारांश्च सम्यगिति||१३||

When the patient is relieved from excessive vitiation of ama, 

• the doshas are in completely digested form and 
• once his digestive fire has been rekindled/restored, 

- he should be administered, systematically and skillfully, measures such as 

• oleation, corrective and unctuous enema (asthapana and anuvasana types of basti), and 
• appropriate internal administration of unctuous substances following the specific procedure after careful assessment of the status of doshas, drugs, place, time, strength, body, diet, satmya, psyche, constitution, age etc. and also the diseases .[13]

भवति चात्र- 

आहारविध्यायतनानि चाष्टौ सम्यक् परीक्ष्यात्महितं विदध्यात्| 

अन्यश्च यः कश्चिदिहास्ति मार्गो हितोपयोगेषु भजेत तं च||१४||

Thus it is said-
The person should promote his wellbeing himself by properly examining the eight factors of dieting which determine the wholesomeness of the food. In addition, other measures which are conducive to health and wellbeing (that are described elsewhere) should also be adopted (per the recommendations of Ayurveda practitioners). [14]

Description of Amashaya(stomach)

अशितं खादितं पीतं लीढं च क्व विपच्यते| एतत्त्वां धीर! पृच्छामस्तन्न आचक्ष्व बुद्धिमन्||१५||

Where all the food that is eaten, masticated, drunk and licked up are digested, O perseverant? We ask this question to you, so please solve our query, O enlightened one! [15]

इत्यग्निवेशप्रमुखैः शिष्यैः पृष्टः पुनर्वसुः| 

आचचक्षे ततस्तेभ्यो यत्राहारो विपच्यते||१६||

Thus having been questioned by the disciples led by Agnivesha, Lord Atreya described them the organ where food is digested [16]

Location of amasaya and functions

नाभिस्तनान्तरं जन्तोरामाशय इति स्मृतः| 

अशितं खादितं पीतं लीढं चात्र विपच्यते||१७||

It is the part of the human body- the amashaya - situated between umbilicus / nabhi and the breast line / sthanantharam 

wherein all that is 

• eaten / अशितं
• masticated / खादितं
• drunk /पीतं and 
• licked up /लीढं

               - is digested .[17]

आमाशयगतः पाकमाहारः प्राप्य केवलम्| 

पक्वः सर्वाशयं पश्चाद्धमनीभिः प्रपद्यते||१८||

All the food articles are fully digested after reaching the amashaya. 

- Once the digestion is complete, the digested essence of food reaches all the organs of the body by means of the vessels / dhamani. [18]

Summary

तत्र श्लोकः- तस्य मात्रावतो लिङ्गं फलं चोक्तं यथायथम्| अमात्रस्य तथा लिङ्गं फलं चोक्तं विभागशः||१९||

Now, to sum up the above verses:
The symptoms and final outcome of the diet taken in proper and improper quantities have been described here. [19]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते विमानस्थाने त्रिविधकुक्षीयविमानं नाम द्वितीयोऽध्यायः||२||
Thus ends the second chapter on characteristics of three divisions of the capacity of the stomach, of the Vimana Section of Agnivesha’s treatise, redacted by Charaka. ||2||