Dr Chandrashekhar Thite

Module 1

Introduction
Ayu means life. One of the synonyms of Ayu is Nityaga, which
literally means constantly moving. Life undergoes constant
change. We are taking in nutrients in the form of food that
nourish and generate new tissues and old tissues are shed off.
We cannot stop this process of continuous change taking
place in human body. However, we can make this change
to be in our favor in such a way that this change would not
lead to disease, but it will maintain a continuous state of
health.
In other words, change is nothing but digestion. Anything
that is taken inside our body is never passed on as it is. It
is first digested and changed so as to suit our physiological
needs. There is constant wear and tear going on inside our
body. We need regular food for nourishment of our body.
This food comes from the natural resources and it needs to
be digested, to be made suitable for human body. Our body
is actually built, brick by brick, from the food that we take in
from outside. This is an ongoing process and the balance
of incoming material and the wear and tear must be kept
in equilibrium. Therefore, health can only be achieved and
maintained by improving our digestion.
Ancient Indian sciences have tried to categorize all the
elements of nature into five types: earth, water, fire, wind, and
space. These elements are called as Pancha-Mahabhootas.
We get our daily nourishment from external sources, the

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pancha-maha-bhutas, in the form of veg or non-veg foods,
salt, and water. But our body needs those to be changed
into a form that is similar to the human body tissues.
Digestion is as important as the action of sunlight is to the
mother earth, especially the flora and fauna. Conversion of
five elements into the Nature as we currently see it does not
occur just by chance. It is a result of complex process which
needs more than the chemical reactions, and it cannot be
explained only by the laws of physics.
Creation, preservation, and destruction is the cycle of any
existence. Whatever comes into physical existence stays for
some time and then ultimately vanishes. This is a universal
principle, a law of nature.
Ancient Indian philosophy acknowledges that conversion
of the so-called non-living objects into a living being needs
many different forces of nature, and one of them is called
Agni. This all-powerful Agni is considered as god of fire or a
god of energy. In our solar system, this Agni is represented by
the Sun. This Agni is represented in human body as Jathar-
Agni, which is the digestive fire. All our food is first converted
into a nourishing fluid called Rasa Dhatu. This Rasa Dhatu is
later transformed into different tissues by the action of Agni.
The breakdown of food into small particles, the metabolism
of carbohydrates, fats, and proteins; the transformation of
glucose into energy are all governed by the Agni. In our
body this Agni energy is carried by a bodily principle called
Pitta Dosha.
Agni is responsible to transform whatever comes into our
system, not only the food, but the external stimuli through
our sense organs, ears, skin, eyes, nose, and tongue. The
information that we receive from the sense organs is
transformed according to our Agni, according to our Prakriti,
to suit individual needs. This is why understanding of the
same situation is different in every individual. Individual
perception is generated from the digestion of information

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received by our sense organs. If our Agni is good, obviously,
this information will be converted into beneficial knowledge,
not only beneficial for your own self but also beneficial for the
whole society.
In India there is a ritual called Agnihotra wherein a small fire
is kept burning continuously throughout the life of the person
who is performing it. This fire is given offerings in the form of
ghee, rice, etc. This is done in the honor of the Fire God.
Similarly, in case of humans, we are alive only as long as this
fire is present. When this fire is doused, we cease to exist.
We should regard the food we eat as a tribute to this Fire
God. The act of eating is not merely a means to keep us
alive, but it will help us evolve into a better human being if we
learn to respect it.
Ayurveda perceives the human body as a combination
of its material form and the essence of life, the soul. The
physical form of our body is otherwise a lifeless mass of Panch
Mahabhootas. When a baby is conceived in the womb of
the mother, three things happen when the soul enters into
this mass of Pancha Mahabhootas. It is the soul itself that
manifests into various life-processes in our body, and the
otherwise lifeless Pancha Mahabhootas spring into action.
The process of continuous transformation begins and it
goes on and on. Despite so much action and transformation
going on, there is a definite form that is always maintained.
These three processes continue throughout the life. There are
three unique life-forces that govern these three processes.
The unique life-force that keeps the body in action, is called
as Vata. The life-force that transforms the body is called
Pitta. The life-force that keeps the bodys functions and
form stable, is called Kapha. All the three life-forces are the
manifestations of our soul, the being.
This is the basis of a very important theory of Ayurveda - the
Tridosha theory. It postulates that these three basic principles
of action, transformation, and stability, called as Vata, Pitta,

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and Kapha actually form and run our body throughout the life.
The three Doshas - Vata, Pitta, and Kapha are the principles
that govern each and every function that is going on in our
body. Although, basically they are a kind of energy forms, they
do manifest in our body in a physical or a material form. They
function by virtue of their properties. Though all-pervading,
Doshas predominantly manifest at certain places in our body.
Vata, Pitta, and Kapha manifest in lower, middle, and upper
parts of the body sequentially. With respect to time, life itself is
divided in three parts as Kapha(childhood), Pitta(adulthood),
and Vata (old age). Each and every event in our body is
manifestation of these three life-forces called three Doshas.
When the Doshas work in harmony, you get a healthy, long,
and fulfilling life. When there is disharmony in these Doshas, it
creates an imbalance, which itself is a disease.
In this course, since our focus is on digestion, we will see how
Doshas affect the function of digestion.

Doshas and Digestive Fire

Good functioning digestive fire is as important for our body
as a heartbeat or brainwave. Of course, the all-pervading
Vata, Pitta and Kapha affect the baseline Agni of each
person. Every person may have his unique quality of Agni.
But in general, four types of Agni are found.

Vishama Agni Vishama means irregular or

uncertain digestive fire, attributed to Vata. Vata
affects Agni like a wind does to a fire. Little
wind is needed to light a good fire. If vata is
in a balanced shape, we get a good flaring
Agni. If too much wind blows and the flame is small, the
wind nearly extinguishes the flame. People with Vishama
Agni can sometimes digest even a heavy food and at other
times they cant even digest very light food. Their digestive

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capacity is often limited so they may eat more than they can
properly digest. In general, those with Vishama Agni should
eat a Vata-pacifying diet. They should adjust the size of the
meal according to the Agni. Train yourself to look inside your
body functions. Every person knows himself and his Agni
better than some other person, even a doctor. In general,
using light-to-digest food and adjusting the quantity, a Vata
person can keep his Agni in a limited range of fluctuation.
Moderate quantity of ghee and sesame oil helps. Establish
some routine. Awaken, eat, and go to sleep at similar times
from one day to the next and do your best to follow a vata
pacifying daily routine. Yoga practices such as Pranayama
(focusing on your breathing) and stretching your body in a
relaxing fashion help stabilize the Agni.

Tikshna Agni Tikshna means sharp. This kind of

digestive fire is attributed to Pitta. The intense
heat of Pitta creates insatiable hunger and a
blazing digestive fire. Those having Tikshna Agni
can digest heaviest of the foods. They have
ravenous appetite and burn through their food very quickly.
If they do not get food in time, the Agni can even hurt their
tissues. Tiskhna Agni can handle heavy, hard-to-digest foods
like dairy products and meat and need sweet cooling foods
to cool their fire. This kind of fire requires big portions of food.
Buffalo milk is preferred than cow milk as it is heavier to digest.
Generally a Pitta-pacifying diet is good for them.

Manda Agni Manda means slow. This kind of

digestive fire is attributed to Kapha. Kapha affects
Agni like a covering, keeping it like a steady low
flame all the time. You cannot build a blazing
fire in a lamp that is covered with glass. It may
take many hours for Manda Agni to digest one meal. Those
with Manda Agni should eat lightly and sparingly and favor
Kapha-reducing foods are good for them. This kind of Agni
is does not show irregularity, but cannot digest heavy foods.

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Because of steadiness of Manda Agni, if one maintains light
diet, it can even help to build good Dhatus. There are some
spices that kindle the fire such as pepper, ginger, and bay
leaf. Judicious use of these spices can help Manda Agni
people to increase their Agni to a certain extent.

Sama Agni This is the ideal or well-balanced

digestive fire . Attributed to balanced state of
all three Doshas. The person having Sama Agni,
only has to keep it that way. It is true that this
Agni can tolerate occasional variations in your
diet. However, one should be cautious that his Doshas stay
in balanced state. Otherwise, if the balance of Doshas is
lost, your Agni no longer remains in the same state until you
establish the balance again.

These types are linked to the Prakriti. They are individual baselines
and in that sense they are not necessarily abnormalities.
Prakriti is only the individual baseline metabolism. In the
context of the disease, the word imbalance of Doshas should
be taken as deviation from your baseline. Prakriti can be
very easily confused with the different situations that a person
could encounter with imbalance of Doshas. Consideration of
Prakriti is important diagnostic factor. But that is only used to
find out the deviation from normal baseline. Therefore, during
consultation with a physician, prakriti analysis is given its due
share of importance.

Pitta Dosha and Agni seem similar in many ways, but they are
not the same. Pitta is the seat of Agni. Pitta is the material
form and Agni is more like an energy. Presence of Pitta can
be felt in the form of bilious vomit, etc. However, presence of
Agni must be inferred from its results.

Every individual has his own pattern of digestion. This

personalized Agni can be maintained with compatible foods

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according to individual habits, Prakriti, etc. We are supposed
to eat according to our baseline Agni. There could be many
variations according to individual needs. Food is needed for
nourishment of our body. Hence, using just the anti-Dosha
food is not enough. We must focus on proper nourishment
of all tissues and also nourishment of Doshas. That is to say,
bad Doshas should be reduced and good Doshas should be
maintained at their normal levels.

On the other hand, maintaining Doshas at normal level

requires you to have healthy body tissues. Therefore, it is
necessary to know more about Dhatus.

Concept of Dhatu: We have seen that Doshas are life-

energies that constitute and run the body. In order to run
various functions of the body the Doshas need some medium.
This medium is Dhatus. Dhatus represent 7 main functions of
the body. These functions are as follows: 1. To supply the
nutrients in material form to all the tissues. 2. To supply the
Prana (essence of life) to whole body. 3. To cover the bony
frame of the body. 4. To provide the oily lubrication. 5. To
give hard support all the tissues. 6. To fill the inner essence of
tissues, especially bones. 7. To regenerate (depleted tissues)
and reproduce (progeny). Functioning of Dhatus are also
considered at two levels, as an energy form which is mainly
functional and as a material form.

According to the above functions, Ayurveda has categorized

our body building materials in 7 types.

Rasa Dhatu: After completion of digestion of the food in the

gut, the first nourishing liquid is formed. It is absorbed in the
body and through the heart, it is spread all over the body.
This liquid supplies material and nourishes all other tissues.

Rakta Dhatu: This is basically similar to blood tissue. Each and

every part of our body is alive because of blood tissue. An
organ can be alive even if nerve supply is cut off. However,

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if there is no blood supply, the essence of life cannot be
available to that part, leading to cell death and gangrene.

Mamsa Dhatu: This is similar to muscle tissue and other tissue

covering either a cavity containing a fluid or other solid or
semisolid tissues. Every part of the body needs a covering. In
this perspective, whole body other than bones is made up of
Mamsa Dhatu.

Medo Dhatu: This is similar to fat tissue. Lubrication and oilyness

is needed for many functions in the body. This Dhatu provides
a background for formation of Asthi and Majja Dhatu.

Asthi Dhatu: This is similar to bony tissue. The solid framework

of the body is made up of Asthi Dhatu. It is made up of the
Prithvi Mahabhoot. Asthi Dhatu is a seat of Vata Dosha.

Majja Dhatu: Function of this Dhatu is described as filling.

It fills the cavities of bones. The innermost part of bones and
other tissues is Majja Dhatu. This Dhatu is similar to bone
marrow.

Shukra Dhatu: Shukra Dhatu is necessary for any process

of regeneration. For wound healing, there is a need for
regeneration of new Dhatus. This is not possible without
the normal Shukra Dhatu in our body. Also, function of
reproduction is attributed to Shukra Dhatu. This is similar to
sperms, spermatic fluid in males and and eggs in the ovaries
in females.

As said earlier, the Doshas work through the Dhatus. Dhatus

provide the medium for Dosha action. There is particular
relation of Dhatus with different Doshas.

Kapha: Rasa, Mamsa, Meda, Majja, and Shukra these Dhatus

are seats of Kapha. Mutra, Purisha these Malas are also
seats of Kapha. Therefore, same medicines can be used to
increase or decrease these Dhatus and Kapha

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Pitta: Rakta Dhatu (blood tissue) and Sweda-Mala (sweat)
are seats of Pitta. To certain extent Rasa Dhatu also carries
Pitta. Therefore, same medicines can be used to increase or
decrease these Dhatus and Kapha

Vata: Asthi Dhatu is the seat of Vata. However, Vata has

no form on the contrary, it requires stability in the form of
healthy bony tissues. Therefore, relation of Asthi and Vata is
quite peculiar. Same medicines cannot be used to increase
or decrease Asthi and Vata. Asthi increases with nourishing
medicines. On the contrary, Vata increases with depleting
medicines.

Kapha is the most tangible of the Doshas. It provides the form

and stability to the body. Therefore, it is logical that Kapha is
present in most of the Dhatus and Malas. Therefore, our food
naturally contains mostly Kapha-enhancing items. However,
for proper nourishment, food must be properly digested and
assimilated. This is where Pitta plays its role through Rasa and
Rakta Dhatus. Lastly, Vata is responsible for transport of this
digested food to its proper place. But Vata is most unstable
entity in our body. It is constantly moving. Therefore, Vata
has a strong footing in the form of Asthi Dhatu.

Whenever there is deviation from your personal baseline

Agni, it could lead to a disease. This deviation should be
treated promptly and properly. Ayurveda postulates that
malfunction of Agni in present in all the diseases that occur
in mankind. There is not a single disease where there is
normal Agni. However, there are many different shades of
malfunctions of Agni in any given disease. This is the reason
why there are many different diseases. Furthermore, there
could be different shades of malfunction of Agni during
various stages of the same disease. Because of the vastness
of the variables, e.g. Dhatu, Dosha, time, prakriti, age, etc., all
these stages cannot be categorized by any single objective
criterion. These stages must be diagnosed and treated by
the Vaidya (Ayurvedic physician), with the help of his own

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(subjective) diagnosis. All this may seem a little confusing at
the outset, but this will be explained in subsequent chapters.

The holistic concept of organs and channels is much different

than that in modern science. To understand how the actual
process of digestion occurs, it is important to know which
organs and channels take part in this process.

Module 2
Avayava (organs) and
Srotasa (channels)
An Ayurvedic Holistic Approach
During the last century, there was tremendous interest in
science community to know the structure and function of
human body. This interest triggered the study of human
anatomy and physiology. Great efforts have been taken in
that direction. Especially after the invention of instruments
such as microscope, there has been vast research in the
field of anatomy and organ-related physiology. Practice of
modern medicine was based on this research. The science of
physics and chemistry was the basis of this research. However,
in the effort to know the structure and function of individual
organs in terms of physics and chemistry, the holistic nature of
body-function was somewhat overlooked. Modern scientists
focused more on organs and their relevant functions in overall
physiology. Many linkages about the functionality of organs
were established beyond doubt. E.g. function of endocrine
glands, function of organs like liver, kidneys, and brain, were
proved with the help of many experiments. Invention of
hormones such as insulin was considered a breakthrough.

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However, there is a certain limitation to this approach. There is
a logical problem here. No matter how many linkages we find,
there would always be many things that are still unknown to us.
This will never end. Also, focusing on anatomical approach
may limit our research in physiological entities. E.g. current
treatment of coronary artery blockages is bypass surgery or
stenting. This is certainly useful in treating the problem at hand,
but the fact that prevention is better than cure is somewhere
overlooked. Also, there are more than one ways that can be
of help in this situation. Development of collateral circulation
of heart is equally important. Enhancement of cardiac
muscular function is also necessary. Betterment in the health
of all the arteries, veins, and circulatory system as a whole
should be our goal. All this is possible when all other organs
like liver, kidneys, brain, intestines are functioning properly
and functioning in harmony. Not only heart is dependent on
other organs but each one of these organs is also dependent
on the other. All of these organs should work in harmony.

However, modern science cannot answer questions about

the nature of life itself. The subtle faculties of mind, intellect,
consciousness cannot be explained with the help of physics
and chemistry. The existence of a human being is not just the
sum total of functions of all the organs. The life-force (Prana),
the mind (Satva), the self (Ahankara), and further the soul
(Atman) are also very important for human life and these all
are different from physical organs. These all are subtle entities
that keep the body going.

Diseases like IHD (Ischemic heart disease), diabetes, and

obesity are very appropriately called as lifestyle diseases.
These diseases arise because of our wrong lifestyle. Lifestyle
includes work, environment, food, emotional status, etc.
When all or some of these factors are not compatible with
our body function, it leads to deterioration of the function.

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Our emotional status also can affect our Agni. Emotions
are, in a way, related to the food we eat. Pitta is cause for
the emotion of anger. Therefore, sour and spicy foods can
cause the anger. On the other hand our emotions affect the
process of digestion. Food eaten when you are emotionally
disturbed is not properly digested.

These factors show that there is a certain limitation to the

organ-based research. These subtle factors must be taken
into consideration while treating the lifestyle diseases. This
is where holistic sciences like Ayurveda and Yoga have an
important role to play.

Srotas: Ayurvedic concept of Srotas is much more

comprehensive. It has evolved from the holistic understanding
of the body. Functioning of the body is understood at the
levels of Dosha, Dhatus, and Malas. The concept of Srotas
encompasses all of these entities. The Sanskrit word Srotas
arises from original root Sru which means to seep through or
to flow. Srotas is basically a space that allows something to
flow or to seep through. Human body is said to be miniature
form of the universe. The Akash (the space) is one of the
Pancha Mahabhootas. This outer space in the universe is
represented in human body as various cavities or potential
cavities. Function of this space element is to allow any other
element to be there. This function is little bit difficult to
understand. This can be compared with the mathematical
concept of zero. It fulfills a central role in mathematics as
the additive identity of the integers, real numbers, and
many other algebraic structures. Therefore zero plays a very
important role. Zero itself has no value of its own but it can
change the values when put after other numbers. Similarly
space itself can be of immense importance even if it does
not have any existence as a material form.

Hollow organs, blood vessels, and lymph vessels all fall under
this category. Hollow organs and microscopic cavities are
not in the hollow form all the time. They could be filled with

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material. For example blood in the vessels and urine in the
bladder. Also, these hollow organs could be in a collapsed
state when blood or urine is not there. In this situation these
are called as potential cavities. There are many potential
cavities in our body. These potential cavities are called
Srotasas. Because they provide the pathway for the matter
flowing in them and/or they provide place for the matter to
be stored for some time.

Srotas is also described as a pathway. Not only these big

cavities and big vessels but very small spaces are also
considered as Srotasas. At microscopic level also there are
pathways that allow particular substances to pass through.
Even at cellular level, the walls of the cell have selective
permeability. Inside the cell there are pathways through
which the molecules travel. These intracellular pathways
can also be considered as Srotasas. Therefore Srotas is not
necessarily a confined space.

The flow of material through the Srotasas can be unidirectional

as in case of urinary ducts. However, it can be bidirectional as
in case of mouth, i.e. we can take food in through mouth and
we can remove Doshas through induced vomiting through
mouth. Pores in the skin and mucous membrane also allow
bidirectional flow.

In ancient texts it is said that apart from large Srotasas, there

are millions of small channels in our body. In fact, they are
uncountable. Their number cannot be stated. Thus, Srotasas
can be described as micro channels of the body that run
throughout the body and through all the organ systems. As
said earlier, the human body is the reflection of the universe.
The complex network of body organs and channels is similar to
some natural phenomena such as rivers, seas, winds, tornados,
and solar system. The planets are moving in a definite orbit
similar to Srotasas. The winds on earth also move in a peculiar
fashion creating different seasons, similarly Vata in our body
moves in a certain direction. Rivers flow along their tortuous
path and ultimately end in the sea. Similarly, all watery waste

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in our body flows towards the urinary system and is collected
in the bladder. The winds sometimes behave abnormally and
create a tornado, similarly impaired flow of Vata creates pain.
There is a great deal of communication going on between
the organs. There is continuous communication between
all the cells present inside the body. There is a constant
signaling going on between the organs and cells. Ayurveda
believes that this communication is done through these micro
channels that are Srotasas. This signaling is carried out mainly
by Vata.

Srotasas also contain and carry nutrients. The Doshas work

their way through these channels. Our overall health depends
upon the functionality and efficiency of Srotasas.

Though innumerable, the Rishis have classified the Srotasas

under 13 major systems. Firstly, 7 major types are according
to the Dhatus. Three are for incoming materials that come
into the body from outside. Remaining 3 are for outgoing/
waste materials.

Dhatus are often compared with various tissues. But this is a

somewhat limited description. The exact nature of a Dhatu is
not just that of a particular tissue. Dhatu is basically associated
with certain set of functions in our body. It is a functional
unit. Dhatus are associated with life-energy, they are alive;
and in that sense, the Dhatus are also manifestations of the
Doshas themselves. Furthermore, when Dhatus mature, they
are converted into a form that cannot be converted back
into a Dhatu. This is called as Mala. It needs to go out of
the body, but until that time, it performs some function in the
body.

This is peculiarity of Ayurveda. It starts from the very soul.

The soul itself manifests into Doshas, the Doshas manifest
themselves in the form of Dhatus, and Dhatus also manifest
themselves in the form of Malas.

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 Srotasas for 7 Dhatus are as follows:
1. Rasavaha Srotasas. Rasa Dhatu is product of digestion of
food. It has the potential to nourish all other Dhatus. Rasavaha
Srotasas are macro/micro channels for Rasa Dhatu.

2. Raktavaha Srotasas: Rakta Dhatu provides the life-energy

to all other Dhatus. Raktavaha Srotasas are channels for
Rakta Dhatu. This Dhatu is often compared with blood tissue.

3. Mamsavaha Srotasas: Mamsa Dhatu is a covering Dhatu.

It covers many entities such as srotasas, organs, other Dhatus.
Mamsavaha Srotasas are channels for Mamsa Dhatu.
Mamsavaha Srotasas are often compared with muscle tissue.

4. Medovah Srotasas: These are the channels of Medo

Dhatu. Medo Dhatu is the entity whose function is oiling or
smoothening of all Dhatus. The oily nature of various parts
of body is due to Medo Dhatu. This tissue is often compared
with fat tissue.

5. Asthivah Srotasas: Asthi Dhatu gives firmness, support, and

strength. It gives definite form to our body. Skeletal tissue
represents the Asthi Dhatu.

6. Majjavah Srotasas: These are channels for Majja Dhatu.

Majja Dhatu is the filling entity. It fills bony cavities. Its major
seat is inside the large bony cavities. Majja Dhatu is often
compared with bone marrow.

7. Shukravah Srotasas: These are macro/micro channels for

all sorts of regenerative tissue. The sperm and spermatic fluid
is major manifestation of Shukra Dhatu. However, continuous
regeneration of our own tissues is also attributed to Shukra
Dhatu.

We constantly need air, food, and water to nourish the

depleted material in our body. Among the remaining six

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Srotasas, three are related to these factors which come from
the outside into the body. These three Srotasas are as follows:

8. Pranavaha Srotasas: Prana represents vital energy that is

taken in through nostrils when we breathe. Prana is not just
the air. These Srotasas carry this vital energy throughout the
body.

9. Annavaha Srotasas: Anna means food. These Srotasas carry

food and its product to be utilized by the body. In Ayurveda,
food is not considered just a mixture of carbohydrates,
proteins, and fats. Food should be something that has the
capacity to nourish not only your body but even the Indriyas
(sense organs) and Mana (mind).

10. Udakavaha Srotasas: Udaka means water. These

Srotasas carry water. Even water needs digestion to suit our
body. Udaka is a medium of many entities including Doshas,
Dhatus, and Malas. The watery part of blood, urine, etc. is
Udaka.

Prana, Anna, and Udaka are basically the energy materials

that come from outside of the body. All these three energy-
materials need to be converted to suit human body and its
functions.

The remaining three Srotasas are for outgoing or waste

materials. They are as follows:

11. Svedavaha Srotasas: Sveda means sweat. Sveda is

produced during digestion of Dhatus. A watery byproduct
is formed during the digestion of Dhatus. This is called as
Kleda. Part of this Kleda is converted into Sveda. Svedavaha
Srotasas are the channels where this conversion takes place.
Transport of Sveda also occurs through Svedavaha Srotasas.
Sveda comes out through the small pores on the skin. Thus
Sveda has excretory function. However, Sveda also does
regulatory function. It controls the amount of Kleda to be
removed.

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12. Mootravaha Srotasas: Mootra means urine. Mootra is
primarily a liquid waste produced during the process of
digestion of food. During the third stage of food digestion,
the food is divided into useful material and waste material.
The waste is further divided into solid and liquid wastes. This
division occurs mainly in Pakvashaya. Mootra represents the
liquid waste. Mootravaha Srotasas are the channels that
carry this liquid waste to be expelled out through the urinary
system.

13. Purishavaha Srotasas: Purisha means stools. Purisha is

primarily a semisolid waste that is produced during the
process of digestion of food. As said before, during the third
stage of food digestion, the food is divided into absorbable
material and waste. Purisha represents the semisolid waste.
Purishavaha Srotasas are the channels that carry this semisolid
waste to be stored for some time, solidified further, and later
expelled out through the anus.

Each of these Srotasas has its own communication

network and functionality. These micro channels are not
merely inactive conduits of lifeless material. They form an
essential functional tree and they serve all of the body cells.
Functionality of each and every body cell depends upon the
nourishment received through these channels. The channels
of waste material are also very important. The waste that
stays in the body also does some regulatory function before
getting expelled out. Sometimes a single channel may do
both the functions of nourishment and waste removal.

Health of the channels is largely dependent on the solid and

liquid food that we consume and also on the activities we
do. Our day-to-day lifestyle and the physical activities we
perform have great impact on the health of these channels.

Long-term use of improper diet and behavior leads to

distortion of the channels. This is called as Srotodushti. This is
a phenomenon where the Srotasa, the space of the channel

19
itself is distorted. This literally paves the way for disease.
Distorted channels are the seat of vitiated Doshas. Normal
channels never allow vitiated Doshas to pass to Dhatus or
to stay in the body. Whenever Doshas accumulate, they
are actively in search of distorted places. Vitiated Doshas
sometimes spread from their normal places to all over the
body. This spreading of Doshas is called as Prasara. Whenever
and wherever these Doshas find the abnormal Srotas, they
immediately get stuck there into these impaired channels.
This leads to a disease.

On the other hand when one adopts nutritious food, proper

physical workout (holistic exercises such as yoga, pranayama
and meditation) and healthy lifestyle (regular meal and sleep
timings, prayers, following religious rituals, etc.), one can
maintain flawless functionality of Srotasas.

Involvement of Srotasas is specific for every disease. For

example in Prameha (diabetes), where Medovaha,
Majjavaha, Rasavaha And Mootravaha Srotasas are
involved. In Jvara (fever), Rasavaha Srotas is involved.

As said earlier, the organs are considered as places that

facilitate functional entities. We cannot make rapid
structural alteration in the organ itself without a surgery or
similar procedure. It is the function that can be more easily
regulated with the help of appropriate diet, medicines, and
other treatment modalities such as Pancha karma. After the
regulation of function, structural changes may also take place
if the treatment is given long enough. This fact is especially
relevant when we are talking about organ-specific diseases
such as liver and gall-bladder diseases.

It is not that organs are not described in Ayurveda. But they

are described in different manner.

1. Description of organs according to surface anatomy: When

we try to look at our body in anatomical perspective, the first

20
thing we notice is its external surface. Then, we notice that
the body is divided in three parts: (1) Shira: The head and
neck region. (2) Shakha: The extremities, both upper and
lower. (3) Koshtha: The trunk region which consists of chest
and abdomen including the genitals.

The terms Shakha and Kostha also have a different

perspective. Kostha is any central cavity and Shakha is
periphery. There is continuous movement of Doshas from
Koshtha to Shakha and from Shakha to Koshtha in a peculiar
centrifugal and centripetal fashion. These movements are
called as Gati. The Koshtha-Shakha (centrifugal) Gati is
movement of Doshas from the center towards the periphery.
This movement occurs naturally in harmony with the process
of digestion. Nourishment of all Doshas, Dhatus, and Malas
occurs in the same way. After the assimilation and absorption,
the nourishing material is transported to various parts of body.

The Shakha-Koshtha (centripetal) Gati is the movement of

Doshas towards the center from the periphery. This movement
occurs naturally all the time to expel the excess Doshas and
Malas. This natural movement can be accentuated and
utilized to get rid of vitiated or harmful Doshas as it is done in
Pancha Karma treatments.

2. Description according to palpation/location of organs:

After surface anatomy, we try to go further inside the body by
feeling the internal organs by palpating them. We can feel
various musculoskeletal parts like bones, muscles, tendons,
etc. We can see the veins, we can feel the pulsating arteries,
and we can feel the lymphatic vessels and glands with some
more effort. In the trunk region, we can feel various abdominal
organs such as intestines, bladder (if it is full), and kidneys. If
we palpate deep enough, we can even feel the pulsation of
great abdominal vessels, especially in thin individuals. Liver
and spleen can be palpated.

There are many points or organs in our body that are quite
sensitive to external impact. You can get seriously hurt if these

21
points are compromised in any way, either by trauma or due
to internal accumulation of Doshas at these points. These are
called as Marmas. These include Nabhi (naval), heart, brain,
big arteries, etc. These parts are seats of Prana (vital energy).
Usually, these are the parts where two or many anatomical
structures come together. The effect of trauma or effect of
Dosha accumulation on each Marma is explained in detail in
the ancient texts.

3. Description of organs as functional units: This is most

important description. Ayurveda has described most of
the organs as functional units. There is great harmony in
the functions of all our internal organs at cellular level. The
connection between organs is not limited to the oxygenated
and deoxygenated blood flowing through circulatory system.
Any event occurring in one organ is immediately reflected on
other organs. This is similar to the colonies of insects, e.g. the
swarm of bees or a colony of ants use chemical signals to talk to
each other. Any event concerning the colonies is immediately
conveyed to all other insects. Although each insect is different,
still, they have such a harmony that the whole colony seems to
work as a single entity. They have a central point of reference
in the form of their queen. As a unit, they may have a physical
structure in form of a bee hive or an ant mound. Similar to this
wonderful phenomenon, there is constant dialogue going on
between each and every cell of our body. This interchange of
information may occur by release of various hormones in the
blood or by generation of nerve impulses. Therefore, there are
innumerable physiological processes going on in our body at the
same time. These cannot be understood separately. This is where
holistic approach is needed. This is the reason that organs are
described as functional entity rather than anatomical structure.
The ancient sages felt it prudent to describe the most relevant
physiological processes in a holistic way. The ultimate purpose of
this exercise is maintenance of health and treatment of diseases.

22
We will try to understand this with an example - the Hridaya.
You may find description of Hridaya at many places. Hridaya
is generally translated as heart. But this is true only in a limited
sense. Hridaya is one of the Marmas. Hridaya is seat of Rasa
Dhatu. Hridaya is even named as the actual entry point of
food in our body. The digested food in the form of Rasa Dhatu
has to pass through the Hridaya to be circulated to whole
body. If this Rasa Dhatu is of inferior quality, it may have its
impact on this physiological entity called Hridaya. Hridaya is
also said to be the seat of mind. We must understand that this
is a peculiar way of the ancient sages to describe different
physiological processes and different contexts by using same
name. The sages have used the name of main organ for
each of these physiological entities. The word Hridaya has
many different shades of meanings. Therefore, the word
Hridaya should be understood according to the context. For
example, the description of Hridaya as a Marma is different
than its description as a seat of Rasa Dhatu. This kind of
description is necessary for us to understand the intricate
relationship of each organ with multiple physiological systems
functioning in our body. This relationship is so complex that it
can only be understood as a whole, in a holistic way.

Module 3
Digestion
Principles of Ayurveda Some Basic Theories.
There are many theories that are postulated by seers of
Ayurveda. Out of those, we will consider a few theories that
are most relevant where digestion is concerned. These are:

23
1. Samanya-Vishesh theory (the theory of similarity and
difference).

2. Lok-Purush Theory (The theory of similarity and oneness of

universe with human).

1. The theory of similarity and difference: As explained

earlier, this law states that everything in the universe increases
with addition of similar entities (Samanya) and everything
decreases with addition of dissimilar entities (Vishesh). For
example, eating heavy, cool, food will increase the Kapha
Dosha with similar qualities. This is not limited to consumption
of food and medicine but if you follow certain behavioral
patterns having similar qualities to that of any of Doshas, it
will also increase the qualities of that specific Dosha in the
body. For example, sleeping during daytime after meals will
increase Kapha, spending sleepless nights or over-exercising
will increase Vata, etc. On the contrary, if you have food,
medicine or behavioral routine that has opposite quality to
any Dosha, then it will reduce the qualities of that particular
Dosha. E.g. If you eat food which is dry and light, it may
decrease normal Kapha. If the activity of mind and body are
too low, it may decrease normal Vata.

Same thing can be observed in case of Dhatus. In order to

increase the Mamsa Dhatu (muscle tissue), we can actually
eat meat itself. E.g., goat meat is said to be most similar to the
human Mamsa Dhatu. If you are a vegetarian, you can also
eat food that has similar properties as Mamsa like black gram.
Well-balanced Mamsa Dhatu will only be achieved if all these
similar things are used with appropriate methodology with
perfectly balanced Agni in place. Even external application
of finely crushed meat is used to increase the Mamsa Dhatu
in our body. It is the property of fleshiness (similarity to Mamsa)
which is common in all these foods. Hence it will increase the
Mamsa Dhatu.

24
On the other hand, the principle of Vishesh (dissimilar) is
applied to decrease the Dhatus. If you want to reduce the
excess Mamsa Dhatu, you can use herbs like black pepper
which is known to digest the meat very well. Qualities of
black pepper are dissimilar to Mamsa Dhatu. The activities
that are opposite to Mamsa are fasting and over exercising,
especially walking. These can reduce the excess Mamsa
Dhatu. However, the quantity and quality of all these things
affect the final outcome.

At the outset, this law seems very simple when we first hear
it. However, in case of our complex human body this law
does not apply in just a single dimension. There is one main
deterrent that makes it a little complicated. This deterrent is
Agni, the individual digestive fire. Agni can make changes
in the properties of food. If this digestive fire is very good, it
can digest the excess food and it can change the harmful
qualities of food so as to suit our needs. Thus, it is the Agni that
leads to the conversion of food into normal Dosha, Dhatu,
and Malas.

There can be some exceptions to this rule. E.g. generally, sour

foods or herbs increase the Pitta in our body. However, a herb
called Amla actually reduces excess Pitta despite being sour.
This happens because Aamla is cooling in property. Hence, it
actually reduces the heat of Pitta. Another example is ghee,
which is cool in property and it should reduce the digestive
fire, but it actually increases it. This happens because ghee
has an intrinsic power to increase the Agni despite being cool.
So, for the rule of similarity to work, any opposing condition
should not be present.

In case of activities, similarity and dissimilarity cannot be

proved on material level. Any activity cannot increase Dosha
or Dhatu in a material form. However, physical activity may
lead to qualitative increase or decrease of that particular
entity. E.g. daytime sleep causes the Kapha to become more

25
slow and heavy. Daytime sleep reduces the Vata activity.
Kapha does not move in the channels. The waste material
stays where it is. All this creates relative increase in Kapha.

Doshas have opposing qualities. Some attributes of Vata,

Pitta, and Kapha are opposite to each other. Their attributes
are as follows:

Vata: Ruksh (dry), Laghu (light), Shita (cool), Khara (rough),

Sukshma (subtle), Chala (mobile).

Pitta: Sasneha (variably oily), Tikshna (penetrating),

Ushna (hot), Laghu (light), Visra (strong unpleasant odor),
Sara(flowing), Drava (moistening).

Kapha: Snigdha (oily), Shita (cool), Guru (heavy), Manda

(slow), Shlakshna (soft) Mrutsna (shiny), Sthira (stable).

You will see that the Doshas have many qualities that are
opposite to each other. Vata and Kapha both are cool while
Pitta is hot. Kapha and Pitta are Snigdha (oily), while Vata
is Ruksha (dry). Kapha is Sthula (gross) and Vata is Sukshma
(subtle). When two or more Doshas are mixed together,
according to the principle of similarity and difference, the
interaction between opposing qualities should nullify each
other. In certain situations this may happen. Most of the
times, Doshas can work without losing their own attributes. It
is as if they have freedom to choose. Doshas are biomaterials
that can keep the body in equilibrium despite the opposite
qualities. E.g., the digestive Pitta has the potential to digest
the stomach tissue itself. But normally this does not happen,
because the delicate inner lining of our stomach is protected
by a special Kapha that can hold even these corrosive
digestive juices.

26
The rule of Samanya-Vishesh is extensively used in Ayurvedic
treatment. An appropriately used medicine will strengthen
the weak Doshas. At the same time it should reduce another
Doshas that are increased out of proportion. Prudent
application of Samanya Vishesh principle is a key for
successful treatment. Most effective treatment plan consists
of foods, activities, medicines, and other modalities like
cleansing of body (Pancha Karma). All of these should be
used in accordance with the law of similarity and difference.

2. Lok Purush Theory: The theory of similarity between universe

and human:

This theory postulates that the human body is a miniature

form of universe itself. Whatever we can observe in the
universe can also be found in human body in similar form.
Also, whatever we observe in human body has its similar
counterpart in the universe. The earth in external universe
is represented by bones and other solid tissues in human
body. The water present in the form of sea, clouds, rivers,
and waterholes is represented by urine, watery tissues such
as Rasa and Rakta, and to certain extent Kapha Dosha in
our body. The sun, heat, and fire are represented by Pitta in
human body. The air and wind felt in the external universe
cannot be seen by our naked eyes. Also the movement
of moon around earth and movement of planets around
the sun can be imagined, but we cannot actually see that
movement. These are similar to the Vata in the human
body. We experience the air moving through nostrils which
is similar to wind. We can perceive the internal movements
of heart, intestines, etc., these are similar to the movement of
planets. The air, the planets, and galaxies require space to
move around and this external outer space is represented by
various cavities, potential cavities, and many hollow channels
present in our body.

27
These are the examples of the similarity of external Pancha-
Mahabhootas with those within our body. The similarity does
not end here. There are similarities of Dhatus, Malas, and
even subtle entities like mind and sense organs.

It is interesting to know how the ancient sages were able to

postulate these theories and how this knowledge evolved.

Evolution of ancient doctrines:

The ancient sages have utilized the abovementioned
theories to find subtle similarities and dissimilarities between
the bodily substances and universal principles. For us, these
theories are very difficult to understand. To establish the
relationship of any universal phenomenon with that of our
body is sometimes beyond our abilities. The reason the sages
could find these subtle similarities is that they had unique
power of reasoning. The sages had extraordinary power of
relating these various facts. This was possible because of their
practices of meditation and Yoga.

The sages tried to sum up their realizations in very limited words.

Words that would express all the comprehensive thought
in a precise manner. This is a difficult task. Every language
has words that have many meanings. The sages salved this
problem by creating a set of rules. This set of rules is called as
Tantra Yukti. These rules define how to read the text written by
the sages. With the help of these rules, correct interpretation
of the text is possible. Words with many meaning are used
everywhere in the text. It is our job to infer the meaning that
is pertinent to the subject.

The Rishis had this realization of facts through years and years of
meditation. How would they preserve this great knowledge?
By writing on a paper? But paper will be destroyed within a
few years. By carving on a stone? But even stone carvings
are destroyed within a few thousand years. If not destroyed
by the warring kings and communities, the stone carvings will

28
be degenerated after a few thousand years.

They tried to put this knowledge in verbal form and transfer it

to their disciples. No other form of preservation is as effective
as a verbal tradition. This tradition still exists in India. Nobody
exactly knows since how many years this tradition has
been going on. Some say, this is going on since more than
ten thousand years, perhaps even more than that. Verbal
tradition can last as long as there is mankind. Thus, it cannot
be destroyed by time. The treasure of this great knowledge is
passed from the teacher to the students.

Sages with similar thinking started their own disciplines. Many

schools of thought are represented by different lineages.
Their effort was to preserve this knowledge through the
doctrines they had established on various subjects. These
doctrines are called as Samhitas. Charaka Samhita and
Sushruta Samhita are two prominent doctrines of ayurveda.
Charaka Samhita is known as the main text dedicated to the
branch of medicine. Sushruta Samhita is famous for surgery.
There are some differences in the views of different doctrines
as they are written with different perspectives. Therefore, it is
prudent to study them as a whole without mixing up the view
of one doctrine with another.

Even we can sense the relation between the universe and

our own body. We must think using all our abilities to establish
such linkages. In fact, the sages have advised us to do it
all the time. It will take many years of practice to do that
effectively. But we have the advantage of the work the
sages have already done. This is why students of Ayurveda
give so much importance to the words of ancient sages.

Application of basic laws:

We will try to see how these principles can be applied to find
the similarity and difference. We will take a simple example of
a coconut tree and its similarity with our body. So many facts

29
we can establish as similar and dissimilar. First, we can notice
the height of the tree. So, coconut tree can potentially be
utilized to increase our height. The outer covering of coconut
is similar to skin, the inner hard shell is similar to Asthi Dhatu,
the innermost coconut meat again is similar to Mamsa Dhatu,
the water inside the coconut is similar to Rasa Dhatu, the oil
when the coconut meat is squeezed out is similar to the Meda
Dhatu of our body, so on and so forth.

The practice of Ayurveda in every aspect revolves around

these and other theories. Every practicing Ayurvedic doctor
also has his unique style of practice. He/she may have his
own set of medicines, medicines that he/she knows better
than others. This is because there is a vast scope for every
doctor to have his own addition in the knowledge base
through his own experiences.

The understanding of relationships between universe and

man has no limitation if it is based on these theories. Further
application of these theories is done by every practicing
doctor in his own way during the day-to-day practice
of Ayurveda. You will find that this individuality is always
maintained in the field of Ayurveda.

These theories are very important as far as digestion is

concerned. Our body is created from whatever food material
we eat. Knowingly or unknowingly we inherit the properties
of the food material. Our body tissues are made up of these
external substances. Furthermore, the finest qualities of a
human being such as intellect, sensory function, and creative
talent are also affected by the kind of food one eats. Ancient
sages have discovered the food items that can affect the
subtlest and finest qualities of human being. E.g. cows milk
and ghee increases the intellect. Cow milk has very positive
calming effect on our body, mind, and sensory functions. On

30
the contrary, unhealthy combinations such as milk and acidic
fruit or using stale food have negative impact on these finer
qualities. Digestive capacity of the individual plays a very
important role. For person having a good digestive fire can
even digest the above-mentioned antagonistic foods.

Our ancient sages have made a peculiar observation.

Everything that is created out of a material form stays in that
form for some duration and ultimately is destroyed. These
are three distinct conditions that are observed in every
material form. These conditions are creation, preservation,
and destruction. It would be interesting to know that Indian
mythology has a concept of three supreme gods, Brahma,
Vishnu, and Mahesh. These three represent creation,
preservation, and destruction. This logic applies to our body
also. All body tissues undergo a process of wear and tear.
Everything in our body, all tissues, all cells, and even all waste
products, are constantly created, maintained for some time,
and ultimately destroyed. Therefore, in order to prevent our
body from destruction and to preserve it in the same form,
we need constant nourishment. Of course, time will still
affect this process in the form of age and season changes.
Ayurvedic concepts help us preserve our body not only in its
healthiest form, but also in its young form for longest duration
of time possible in given individual circumstances. Ideally,
such a body will weather all the storms of seasonal changes.
In ideal situation, such a person could stay young for a very
long duration. This will require herculean efforts on our part,
but yes, it is possible.

This nourishment is needed on all three levels, Dosha, Dhatu,

and Malas. We get this constant nourishment in the form of
our everyday food. Source of this food is mostly plants and

31
animals, although there are some minerals like salt and water
that are not of organic origin. All of this needs to be digested.
Digestion is nothing but the conversion of external Pancha
Mahabhootas into our present physical body.

On the background of these theories, let us learn more about

the digestion-related organs and channels.

The organs of digestion:

We all have learnt in the school about the organs taking part
in digestion. We are well aware of them. The organs as we
know are mouth, esophagus, stomach, intestines, rectum
and anus. Also, other organs such as liver, gallbladder,
and pancreas, have a role to play. Modern medicine has
analyzed the process of digestion in great details. However,
ayurveda has a completely different viewpoint. As explained
above, it is a holistic viewpoint.

According to ayurveda, the main organs that take part in

digestion are same as all the organs described above.
However, while describing the process of digestion we
come across many terms such as Amashaya (compared
with stomach), Grahani (compared with gut brain axis),
and Pakvashaya (compared with large intestine), Unduk
(compared with part of large intestine), Yakrit (compared with
liver), and Basti (compared with urinary bladder). Although
these terms are compared to modern anatomy, these are
not exactly the same. Ashaya means an organ that acts as a
reservoir. E.g. Ama literally means raw. Amashaya accepts
and retains the food material in a raw form. Most of the
digestion occurs in the Amashaya. Pakva means cooked.
When the form of the food is changed from raw to cooked, it
is passed into the next Ashaya, the Pakvashaya.

32
Thus, most of the times technical Ayurvedic term denotes
a functional unit rather than an anatomical organ. The
classification of organs goes according to the physiological
processes. Hence, we are going to study the organs
according to its physiology. Deviation from normal function is
pathology. It is necessary that pathology should be explained
on the basis of Ayurvedic physiology.

We will take a look at the two main Ashayas (reservoir-organs)

Amashaya and Pakvashaya that are most important
to understand the process of digestion. The third organ/
mechanism is Grahani, which controls the movement of food
from one organ to the other.

Amashaya: According to surface anatomy, location of

Amashaya is the area between breasts and navel. This is the
place where food goes first and stays there for some time.
The function of Amashaya is to retain the food and provide
the place where almost all the separation of particles takes
place. Amashaya is place of Kapha. Kapha provides the
stability to the organ. But Pitta is also dominant in the lower
part of Amashaya. Pitta carries the actual fire. Pitta has
thus more active part in digestion.

Pakvashaya: This functional unit accepts the digested food

when it is released from Amashaya by the Grahani. This is
main seat of Vata. This part generally lies below umbilicus.
Pakvashaya is root of Purishavaha Srotas. The sorting of
absorbable food and waste occurs here. Further sorting of
liquid and solid waste also occurs in this area. This whole
area is dominated by Vata. Hence, in this area, Vata must
be respected. Even if you have some Kapha disease in
Pakvashaya, we have to treat Vata first and then treat the
intruder Kapha.

Grahani: Another important part mentioned in the process

of digestion is Grahani. Main function of Grahani is to keep
the undigested food in Amashaya until it is fully digested.

33
Grahani and Agni are dependent on each other. The
process of digestion is often compared with cooking of rice.
The rice is food and the fire that cooks it is Agni. Similar to
this, when food is in Amashaya, the fire is in Grahani which is
said to be situated below Amashaya. Grahani is a functional
unit which includes small and large intestines. Grahani can
be compared with the modern concept of gut brain axis.
From this functional unit, signals are sent for timely secretion
of appropriate digestive enzymes and timely movement of
appropriate part of intestines. Emotional disturbance affects
this function of Grahani. This may lead to many gastrointestinal
illnesses such as irritable bowel syndrome, hyperacidity, and
even colitis.

Having seen the organs, let us now study more about the
main channels that are important for the process of digestion.

Channels of Digestion:
There are two cautions we must take while studying Ayurvedic
pathophysiological terms. First caution as far as possible,
not to relate any of the concepts to modern anatomy
or physiology. Second caution - we should not consider
different pathophysiological entities as synonymous to each
other. In this course, however, many modern terms are used
to denote technical Ayurvedic terms. This is strictly for the
sake of convenience in explanation, for those who are not
proficient in Sanskrit. I would request the learners to follow the
original Sanskrit terms as much as possible.

Ashayas (organs/reservoirs) and Srotasas (channels) represent

completely different perspectives. Ashayas are more like
locations or reservoirs and Srotasas are channels where
continuous transportation and transformation of Dhatus and
other entities is going on. We have already seen groupwise

34
classification of channels. We will now see the channels that
are most relevant to our subject, i.e. digestion.

Annavaha Srotasas (food channels): These are main channels

where the food travels and transformation takes places. The
roots of the food channels are said to be the Amashaya
(stomach area) and left flank. This is physiologically relevant
part where the food stays for some time and is processed
during digestion. These channels include all the hollow places
where many of the digestion processes are going on. This
includes the mixing of digestive juices, churning, and even
the process of absorption. It can be said that food channels
are mostly located in the first part of the digestive tract.

Purishavaha Srotasas (channels of solid/semisolid waste):

After the absorption of useful material, the remaining waste
material is further segregated. The solid waste flows and is
further transformed into these channels. Purishavaha Srotasas
are mostly located in the second part of digestive tract

From the perspective of digestion, it is important to know the

causes and symptoms of vitiation of food channels:

The causes of vitiation of Annavaha Srotasas: Foot intake

of excessive quantity, food intake at improper time, harmful
improper diet, and lastly impaired digestive fire (Agni). All
these causes lead to functional impairment of this Srotas.
This impairment could be short term or it could be long term
depending on the duration of exposure to the causes and
previous other disease conditions.

Symptoms of vitiation of Annavaha Srotasas: The first

symptom is no desire for food. This is a warning sign that we
should refrain from having more food. For the initial period,
even liquid foods should not be taken in. Second symptom is
impaired taste. The sense of taste goes down and we can feel
it. The food otherwise tasty is no longer the same as before.
This is also our bodys response to the Dosha accumulation.

35
The third symptom is indigestion. It appears if the prior two
symptoms are ignored and if we still keep on pushing solids
or liquids into our stomach. The fourth symptom is vomiting.
Now, body is trying to correct our wrongdoing. It tries to throw
up the excess food, to get rid of the buildup of Doshas, and
to avoid the generation of toxins. This symptom is actually
blessing in disguise. The nature is helping us to cure ourselves.

All these symptoms occur with a purpose. This is why

Ayurveda explains that these symptoms should be managed
very cautiously. Let us see the Ayurvedic perspective of
symptomatic treatment.

Limitation of Symptomatic treatment: Our interpretation of

these symptoms is completely opposite. We are ignoring
the first signs and misunderstanding the attempt of body to
correct itself. We feel that the symptoms must be stopped
immediately. Instead of symptomatic treatment, Ayurveda
advises prudent symptom management. The current
medical practice is to give anti-emetic medicines to patients
with vomiting. This way we are stopping the natural way of
body to cure itself. Furthermore, we are giving medicines
which are again a burden on our digestive system. Ayurveda
says the medicines also need to be digested. So during initial
stage of indigestion, even medicine should not be given. If
at all some medicine is given, it should help bodys natural
attempt to cure itself. Therefore, this vomiting must be initially
ignored or we can even give something that would help the
patient to vomit properly in order to get rid of the unwanted
material. However, if the symptom itself is very severe, the
vomiting is profuse, and is becoming intolerable, causing
excessive weakness, etc. it must be stopped. The Dosha and
toxin buildup can be dealt with later.

This is prudent symptom management according to Ayurveda.

We must weigh the risks and benefits of treatment. This is an
ongoing process. Ayurveda advises that we must watch the

36
patient for every moment if any troublesome symptoms are
arising. If improperly treated, this condition leads to further
indigestion. The pathology worsens. The Srotas, the cavity
itself, becomes kind of functionally distorted. This leads to
even further Srotodushti.

Having seen the organs and channels that take part in

digestion let us proceed with the actual step-by-step process
of digestion.

The process of digestion:

Both in living and non-living universe, a continuous process of
transformation is going on. A rock changes its color and form
and is transformed into an amorphous form and later into the
soil. Metals become rusty. A leaf of tree, born with delicate
purple color, turns beautiful green, later becomes yellow,
and ultimately sheds off. Apple juice if kept standing for
some time, turns into vinegar. Grape juice is transformed into
wine. All this transformation occurs because of the principle
transforming force in the universe, the Agni. In human body,
it is the same Agni that transforms food into something that
can be used by our body. This process of transformation is
called as digestion.

Ayurveda has tried to understand this process in a holistic

way. The process is grossly divided into three stages. These
three stages are in accordance with the natural actions of
three Doshas.

The first stage can be called as the Kapha stage. It starts

when food is seen and smelt. When we see or smell the food,
immediate response of our body is salivation. Salivation is
actually the secretion of a Kapha called Bodhak Kapha. The
seat of this Kapha is tongue itself. Function of this Kapha is
mainly to facilitate the process of tasting the food. We cannot
know or enjoy the real taste of the food unless this Kapha is

37
in good condition. If this Kapha is too heavy or sticky, the full
flare or burst of the taste cannot be felt on our tongue. If this
Kapha is abnormal, we may get an altered taste. This altered
taste may be according to the abnormality. E.g. if we are
suffering from fever, otherwise normal food will taste bitter.

Further, when food is chewed and swallowed, it goes into

stomach where it becomes more moist. This property of
moistening the food is attributed to a kind of Kapha called
Kledak Kapha. The seat of Kledak Kapha is Amashaya. Dry
and hard foods need more moistening and softening which
is done by the Kledak Kapha. On the contrary, liquid food
needs less Kledak Kapha.

It should be noted that during this first stage not only the
Kapha is secreted but new Kapha is also generated from the
food.

Let us see what happens at the level of Mahabhootas during

the first stage of digestion. The particles of earth (Prithvi) and
water (Jala) get released from the foodstuff. These same
Mahabhootas are the basis of sweet taste (Madhura Rasa).
These same two Mahabhotas are also the basis of Kapha
Dosha. Thus, this stage is completely dominated by Kapha
Dosha.

The second stage of digestion is Pitta stage and it occurs

when food is moving from Amashaya to the lower parts.
Secretion of Pitta becomes prominent in this stage. This Pitta
is called as Pachak Pitta which is the main of five types of
Pitta. Here in this stage, sour taste is generated because of
the semi-digested food. This again gives rise to generation
of Pitta Dosha in general. On Mahabhoot level fire (Tej)
particles are released.

The third stage of digestion is, of course, the Vata stage.

This occurs when the food reaches Pakvashaya. During this
stage the peculiar event of drying or dehydration of food

38
takes place, but the cause of this drying is Agni, not Vata.
On Mahabhoot level Vayu (wind) particles and Akasha
(space) are released. A pungent taste is generated leading
to generation of Vata Dosha.

At the end of all these stages, the food is divided into two
parts. One is Sara that goes into the body for nourishment
of all Dhatus. And the other part is Kitta which is the waste
material. As explained earlier, the waste material is further
divided into two parts, liquid and solid.

From overall physiological standpoint, the waste material also

is very important. Some part of this waste material always
stays in your body for some time. This waste also has a
specific function for a brief period, until it is expelled out of
the body. The solid waste, Purisha, actually helps to stabilize
the Agni. This is similar to the earthen stove used for cooking.
The earthen material has a capacity to hold the fire. Hence,
it provides a solid base for the fire. Jathara Agni also needs
some solid base to cook the food. This base should sustain the
corrosive nature of Agni. Similar to the earthen stove, Purisha
is such material. It protects soft body parts from burning due
to the digestive fire. On the other hand, Mootra is a liquid
waste. It has natural tendency to go out through the bladder.
But while it is there in our body it helps to remove the excess
Kleda that is present in our body.

Thus you will notice that all the Doshas, Dhatus, and Malas
have their own role to play for normal functioning. It is not a
passive role. It is very much active role. Out of these three,
Doshas have the most freedom and they are manifested as
life-energy forms. Dhatus are associated with this life-energy.
Malas are left with very little part of that life energy. Each of
these entities has a potential to mend our body in either way,
for good or bad. If these entities are functioning normally, our
body stays healthy. If these are impaired, something goes
wrong, and it leads to disease.

39
There are so many factors that affect this whole process. The
ongoing season, the time of the day, condition of your overall
health, everything affects your Agni. Even the ambience
where you are eating and your mood at that time affects your
Agni. A subtle smell of good food kindles your Agni whereas
an unpleasant situation destroys it. The physiological process
of digestion is dependent on all these seemingly trivial factors.
But these are not trivial at all.

Digestion at the level of Dhatus:

After the completion of digestion of food, the final product
formed is called as Ahara-Rasa. This is technically still food
and not the Rasa Dhatu. This Ahara-Rasa is in a fluid that
is further processed in the body. In other words, this fluid is
digested further to create the first Dhatu that is Rasa Dhatu. It
is digested by the internal fire called Rasagni, which is an Agni
present at the level of Dhatus. Anytime when a digestion
occurs anywhere in the body, there are two products. One
is final product and the other is the waste material. When
the digestion of Ahara-Rasa occurs, the final product is Rasa
Dhatu and the waste material is said to be Kapha. Although,
this Kapha is a waste material. It eventually goes out of the
body. During the digestion of Ahara Rasa, two byproducts
are also produced the breast milk and menstrual flow.
Therefore, any problem with breast milk and menstrual flow,
Rasa Dhatu must be given a consideration. They are called
as Upa-dhatus (sub Dhatus) of Rasa Dhatu.

The quality of Rasa Dhatu depends on Rasagni (the digestive

fire of Rasa Dhatu). When the Rasagni is good, a healthy
Rasa Dhatu is produced along with minimal Kapha-Mala.

40
In other words, transformation of Ahara Rasa is done most
efficiently, and there is little waste product. However, when
the Rasagni is low, the efficiency of the transformation is less.
The quantity of Rasa Dhatu thus produced could be either
less or more, and could be of low quality. Furthermore,
more waste material is produced in the form of Kapha-Mala.
Kapha here is called as Mala because in this case, it does
not do the primary function of Dosha. It is actually a waste
product. When the Rasagni is blazing high, it converts most
of the Ahara Rasa to Rasa Dhatu. In this case the amount of
waste is also less. Thus, less Kapha is produced as a waste.

After Rasa Dhatu is produced, some part of it is converted by

Raktagni into Rakta Dhatu. This occurs in the similar fashion
as explained above. The Rasa Dhatu thus supplies to all the
Dhatus. Agnis of other Dhatus pick up their nourishing elements
from the Rasa. All Dhatvagnis are dependent upon Jatharagni.
If Jatharagni is healthy, all other Agnis will also be good. In order
to examine and decide the function of any Dhatvagni, it is
necessary to observe the quality of that Dhatu.

For example, the Rasa Dhatu can be examined by evaluating

the state of the skin and mucous membranes of the body
as well as the quality of breast milk or menstrual flow that is
produced. Good Rasa Dhatu presents with fresh, supple, and
moist skin. The mucous membranes are not dry.

Digestion at the level of Mahabhootas:

As explained earlier, Agni is a universal phenomenon. It is
present in every particle of every substance. When we eat
our food, the Agni which is already present in every particle of
food actually aids the function of Jatharagni. Every particle
of food contains all the five basic elements the Pancha
Mahabhootas. Every element has its own fire which coverts

41
its own section into a human-compatible form. These are the
the Agnis of Pancha Mahabhootas. Thus the Jatharagni with
the aid of the elemental fires digests the food to match the
needs of our body.

We have seen the process of digestion up to the level of

Mahabhootas. There are certain factors that greatly affect
this process of conversion of food to Dhatus. Next, we will see
these factors that affect overall process of digestion.

Factors that affect the digestion:

The nourishment of Dhatus is possible only through a balanced
and nutritious diet. A balanced diet is responsible for the
growth and development of human body. The food should
be freshly prepared. For good digestion, food should have
normal color, smell, taste and touch. Diet provides bala or
power to all the living beings in the universe. The continuity
of life is maintained by proper balanced diet. Fasting leads
to a breach in this continuity. Food gives physical and
psychological strength, good complexion and healthy well-
developed tissues. The Indriyas or sense organs are also need
nourishment and they are replenished by food.

The ancient sages have identified that there are many

factors that affect this whole process of digestion. They have
categorized these factors under six headings. Ushma (the
fire), Vayu (Vata), Sneha (oil or ghee), Kleda (liquid), Kala
(time), and Samayoga (perfect balance of other factors).

Ushma: In view of maintaining our Agni, cooked food is

always preferred over raw food. The food should be served
immediately after cooking. When we reheat the food, it loses
both its taste and its nutritional value. Thus, internal heat of
the food, which is called as Ushma, is important. Also, Ushma

42
implies the inherent Agni of food itself. This Agni helps in overall
process of digestion. Every particle of food has certain heat
locked inside it even before we cook it.

Vayu: The action of Vata is very important for digestion. It

moves the foods, helps the Pitta to secrete, and it also kindles
the Agni. When you eat your food, imagine three parts of
your stomach. You should fill one part with solid food, one
part with liquid, and one part should be left empty for the
movement of Vata.

Sneha: Certain quantity of oil, ghee, or other fat is necessary

for digestion. This makes the food soft. It also helps the Agni
to be lit properly. Although, fat is a food material itself, it has
unique property of stimulating the fire. It must be used in
moderate quantity, otherwise, if you use a lot of fat material,
it may extinguish the Agni.

All these factors affect the process of digestion. However, in

order to get all the benefits, a healthy and balanced food
should be taken. Next, we will see the important facts about
food preparation and method of eating.

How should we eat our food?

Food should be chosen, prepared, and eaten in a proper
manner. Ayurveda has described a method of eating. There
are certain basic rules that one needs to follow. Ayurveda
has classified these rules according to following factors. These
are Prakruti, Karan, Samyoga, Rashi, Desha, Kala, Upyokta,
and Upayoga-Samstha.

Prakruti: - Prakruti has many meanings. Here it means the

essence of any substance that is used as food. The material
of which the food is made of is its Prakriti. There are some
attributes of every substance that cannot be changed
or altered. These attributes which are elemental in that

43
substance are known as Prakruti. These attributes are the
basic nature of any food stuff. E.g. Moong dal is Laghu or
light in nature and it is easy to digest while the black gram is
Guru or heavy in nature and hard to digest.

Karan: Karan implies the processing of the food while we

prepare it for eating. The different processes of cutting,
grinding, churning roasting, frying, boiling, steaming, etc.
are done while we are making the food. This way we make
changes in the properties of the food to make it better for
human consumption. E.g. the process of cooking the rice
makes it palatable and easily digestible. The curd is heavy to
digest. So we churn it and we get buttermilk which is light to
digest. The alteration in attributes of a substance is possible
by treating the raw food with the help of various processes.

Sanyoga (mixture): The mixing of two or more different

substances is called as Sanyoga. This mixing of substances
may result into a recipe which may be either beneficial
or harmful to the body. E.g. the mixture of milk and sugar
is beneficial while the mixing of fish and milk might cause
harmful effects on the body.

Rashi (quantity): The quantity of food is very much important.

It depends on your Agni. You should only take as much as
you can completely digest. Heavy food should be eaten in
less quantity. The diet consumed in appropriate amount is
digested properly. Hence, as said earlier, it is advised that
one should eat much less than a full stomach. Even if we
improve our Agni to a great extent, with the help of exercise,
etc., it is always advised that the quantum of the food should
remain within a certain limit. More than necessary food always
causes harm sooner or later. It is advised to wean down your
quantity of food from large to moderate. The quantity also
depends on the variety of foods you are eating. E.g. meat,

44
vegetables, and cereals are eaten in certain proportion to
each other. If this proportion is not suitable for your needs, it
may lead to imbalance of Doshas.

Desha (Location): All over the world, various food cultures

have evolved. This is the result of the traditions which have
developed over the years. With years of experience, people
know which food is suitable in that area. You may have
noticed that some foods are better digested in that particular
area. Also, the quality of food should be such that it should
be suitable for the nature of the land you are living in. E.g. in
dry arid land, butter and ghee are needed more and in wet
marshlands we need dry and light food.

Kala (Time): Season causes specific Doshas to rise. Some

changes in food are necessary according to the season.
One should also decide the type and the proportion of the
diet according to different stages of life which are childhood,
youth, and old age.

Upayokta: Upayokta is the person who consumes the food.

The body type of the person, the habits, and the likings or
choice of the food are also of immense importance. You
already know that Vata needs hot oily diet, Pitta needs
cooling diet, and Kapha needs drying, pungent or bitter
food, etc.

Upayogasamstha (manners and etiquettes while eating):

Proper way of eating described in Ayurveda is far different
than the prevailing customs. We should sit down for eating
with proper ambience. Meals should be consumed in
clean and pleasant dining area with all the required things
at hand. One should have meals in a pleasant calm mood
and with full attention towards the food. There should be
no talking or laughing. One should not gulp down food in a
hurry or ruminate on it for a very long time. All this is needed
for proper digestion and absorption of optimum nutrients
from the consumed diet. Food consumed in such pleasant

45
atmosphere proves to be very nourishing for overall well being
of body and mind.

Now we know many things about digestion. But there are

some questions. How the qualities of different foods affect
the digestion? Are there any criteria that can guide us
about the effects of food and medication on our body? For
this, Ayurveda has explained the theory of Rasa, Virya, and
Vipaka. Let us know more about it.

Module 4
Theory of Rasa, Guna, Virya, Vipaka,
and Prabhava:
We can know about our universe only with the help of our
sense organs, and to some extent with our mind, with logical
reasoning. The modern tools such as microscopes, x-rays, and
chemical tests are just the extension of these natural faculties.
Today we are so influenced by modern tools that we are not
trying to enhance our natural powers. The lenses for eyes are
no longer considered a sign of weak eyes. We use the lenses
as if it is most natural to use them.

Our ancestors, before the influence of modern physics and

chemistry, used these original faculties to its fullest extent.
They primarily used their sense organs to know about the
world surrounding them. This is the wisest thing to do because
it gives you a real perspective. You can never get this holistic
perspective with any other technologically advanced tools.
The sense of hearing, touch, vision, taste, and smell tell us so
many things about the substance. The sages with the help
of controlled diet and meditation had developed these skills
to a great extent. With the help of these extraordinary skills,
it was possible for them to know the finest variations in the

46
qualities of taste, smell, etc. Even today we can see that some
individuals have extraordinary ability to perceive any one of
these senses. Some would come to know the tiny variation in
different tastes. This is why there are professional tea testers in
big tea producing corporations. This is the only way they can
maintain the finest quality of tea. Some can discern between
thousands of different smells that are constantly entering our
nostrils. We are not even aware of the minute details of these
sensory variations. If you do not have these qualities by birth,
sure they can be acquired through practice to a certain limit.
But, meditation and yoga help us improve this awareness of
senses to a great extent. The ancient sages had extraordinary
powers of senses. They also had outstanding powers of
reasoning and logical thinking. They could see with their
mind, the similarities and differences between the universal
phenomena and their effects on human body.

In case of our food, the first and foremost sense is that of

taste. Nature has given us this tool to identify what is good
for us and what is not. If this sense is used prudently, it can
tell us lot of things about our food. Therefore, sense of taste
has been given lot of importance in Ayurveda. The sense of
taste is called as Rasa. This should not be confused with the
first Dhatu, the Rasa Dhatu. Taste is the sensation that cannot
be available to us if Jala Mahabhoot (water element) is not
present in the substance.

There is an interesting event described in Charaka Samhita

(an ancient text of Ayurveda) about the how the theory of six
tastes developed. Initially, the different sages held different
views about the number of tastes. Some felt that tastes can
be categorized only as hot and cold while others felt that
there are five tastes according the Pancha Mahabhootas.
Some sages felt that since there are innumerable foods, the
tastes are also accordingly innumerable. So, they held a
conference to decide how to categorize the tastes in a way
that could be ultimately useful for diagnosis and treatment.

47
This conference was held under the guidance of the great
sage Atreya. Everybody put forth his views. Finally, Atreya
concluded that there are only six tastes and all other views
are not useful for our purpose. Combination of tastes gives
the feeling of them being innumerable. However, properties
of combination cannot be described. The purpose of
Ayurveda is to establish the equilibrium of Doshas and
Dhatus. This equilibrium can only be maintained if we know
how the increase and decrease of Doshas takes place. The
classification of tastes therefore must be done according to
our purpose. Therefore, it was finally established that there
are six tastes.

This is why the theory of six tastes has utmost importance in

Ayurveda. All the description of properties of substances
including food and medicine starts with Rasas. Combinations
of Rasas is utilized to pacify the vitiated Doshas. Improper
food is main cause of the Dosha buildup. Therefore, causes
of Doshas can be explained mainly with the help of Rasas.
Understanding the causes of diseases is thus impossible
without knowing the Rasas.

These six tastes are created by permutation and combination

of five Mahabhootas. Brief description of these is as follows:

48
Taste and Mahabhoota and General effect on
Mahabhoota effect on Doshas body
Sweet Increases Kapha. It has nourishing,
Prithvi and Jala Reduces Vata and soothing, and
Pitta. Increases satisfying effect on
all Dhatus tour mind and senses.
Sour Increases Pitta Generally, it stimulates
Agni and Prithvi and Kapha. It the digestive fire.
also normalizes
movements of Vata
Salty Increases Kapha Enhances the
Jala and Agni and Pitta digestive fire. Brings
Reduces Vata clarity to other tastes.
Bitter Increases Vata. Does cleansing of the
Akash and Decreases Pitta Srotasas. Excess intake
Vayu and Kapha. may lead to thinning.
Pungent Increases Pitta Destroys the
Agni and Vayu and Vata buildup of Kapha
Decreases Kapha and Meda Dhatu.
Promotes sweating
Astringent Increases Vata It causes shrinking
Prithvi and Decreases Kapha and tightening of
Vayu and Pitta tissues or vessels

Guna: Guna means property. Every substance has some

basic properties. As stated above, these properties can be
understood using our sense organs. We learned how we
can understand and interpret the information we get by
the sense of taste. There is one more way we can get more
informa tion about any substance. Using all five of our sense
organs, and also our reasoning power, we can know specific
set of properties about each substance. The information
thus obtained is again classified under the heading Guna.
There are many perspectives for understanding the Gunas.
Gunas are classified in many ways. E.g. Three basic Gunas

49
- Satva, Raja & Tama - represent creation, preservation, and
destruction. Also, six Atmagunas (properties of Atman), etc.

However in Ayurveda, more emphasis is placed on applied

classification. Most relevant to us is the classification of
Gurvadi Gunas. The beauty of this classification is that it can
be applied to both causes of the disease (Doshas) and the
medicines (herbs, minerals, and even modalities). In this view
the Gurvadi Guna classification is most important.

What are Gurvadi Gunas? These are ten pairs of reciprocating

properties described in all ancient texts of Ayurveda. Each
one Guna in this pair is opposite to the other. These are as
follows-

1. Guru (heavy) and in its opposite sense-Laghu (light).

2. Manda (slow/insipid) and in its opposite sense-Tikshna
(penetrating).
3. Sheeta (cold) and in its opposite sense-Ushna (hot).
4. Snigdha (oily) and in its opposite sense-Ruksha (dry)
5. Shlakshna (slippery/soft) and in its opposite sense-Khara (rough)
6. Sandra (coagulating) and in its opposite sense-Drava
(moistening/loosening/flowing)
7. Mrudu (soft) and in its opposite sense-Kathina (hard)
8. Sthira (fixed/firm) and in its opposite sense-Sara (runny) or
Chala (mobile)
9. Sukshma (subtle/micro) and in its opposite sense-Sthula (macro/
tangible)
10. Vishada (cleansing) and in its opposite sense-Pichhila (slippery)

The theory of twenty Gunas is very useful in Ayurvedic

treatment. Both the Doshas and medicines can be described
in terms of Gunas. This has immense benefits. We can use
opposite qualities of foods and medicines to treat Doshas that
are increased with specific attributes. E.g. Vata increased
because of cold and dry winds should be treated with warm
oil massage followed by steam and covering with warm

50
blankets. The cold is treated with warmth, dryness is treated
with oil and steam, and effect of wind (Chala Guna) is treated
by wrapping in a blanket (creating Sthira Guna). This kind of
comprehensive management always yields excellent results.
To increase the depleted Dhatus, foods with Gunas similar to
those Dhatus can be used. E.g. Rasa Dhatu is sweet, Snigdha
and Drava. If it is depleted due to diarrhea, a rice soup with
little ghee, which is also sweet, Snigdha and Drava, should be
used. This would increase the depleted Rasa Dhatu.

Virya: Virya refers to the potency of any substance. Virya

accounts for the effect of the substance from the time it
comes into contact with the body until it stays there. It is
important to note that food acts mostly according to its Rasa
(taste). Medicines need to be more potent than food. Every
medicine has some potency to perform the actions. The
main potency with which a medicine does its action on the
body is called Virya. Potency of all the substances can be
assessed in terms of Gunas.

Virya primarily manifests as Ushna (Hot) or Sheeta (Cool).

Of course, food also has a Virya, and it must be considered
before advising specific diet regimen for any person, normal
or otherwise. Rasa and Virya has a typical relationship.
Generally sweet, bitter, and astringent substances are cool
in potency and sour, salty, and pungent are hot in potency.
However, there are many exceptions. E.g. Aamla has cooling
potency despite being sour and Guduchi is hot despite being
bitter.

Vipaka: Vipaka is a special property in a substance. Vipaka

is expressed in terms of the tastes. After the digestion of food
or medicine, it displays different qualities than its original
taste. This different quality is defined as Vipaka. Vipaka of
any substance is manifested at the end of three stages of
digestion. Curiously, Vipaka is actually said to be a new
taste that develops at the end of the digestion. However,
from the six original tastes, only three Vipakas (new tastes)

51
can manifest. These three new tastes are - Madhura Vipaka,
Amla Vipaka, and Katu Vipaka.

Usually, the Rasa and Vipaka has a specific relation. It is as

follows:

Madhura Rasa and Lavana Rasa substances after digestion

get Madhura Vipaka.

Amla Rasa substances get Amla Vipaka.

Katu, Tikta, and Kashaya substances get Katu Vipaka.

The tastes decide how a substance should behave in our

body. However, it would become very easy and simple
if all the substances had this straightforward one-to-one
relationship of Rasa and Vipaka! There are exceptions. For
example, the pungent dry ginger has a sweet Vipaka. So,
even a pungent substance can have sweet Vipaka. This
occurs because of the typical structure of the Mahabhootas.
In case of these exceptional substances, the arrangement
of Mahabhootas is such that the Mahabhootas producing a
certain taste in our mouth may be different than the original
majority constituents of that substance.

Prabhava: Prabhava is specific action of a substance. This

specific action is not necessarily categorized under Rasa,
Virya, or Vipaka. The disease-specific actions of the herbs or
foods fall under this category. That specific action cannot be
explained by Rasa, Virya, or Vipaka. Eg. the herb Guduchi
balances all the three Doshas and also it is best medicine for
any type of Jvara (fever). Both these properties are due to
Prabhava.

Now that we have learned the basics of normal digestion

and properties of food, we will turn towards abnormalities of
digestion.

52
 Module 5
Abnormalities in Digestion:
Agnimandya and Ama:
Mandya means becoming weak or getting hampered.
When digestive fire becomes weak, it cannot digest the usual
quantity of food fully within the usual and normal time limit.
Agnimandya again is very much subjective. Every person
has his baseline digestive capacity. Whenever this individual
capacity is hampered, either acutely or chronically, it can
be called as Agnimandya. For example, a Kapha Prakriti
persons baseline Agni is low. If this baseline Agni goes even
below the usual level, then it will be called Agnimandya in
that person. Some chronic diseases such as piles, colitis, IBS,
are directly linked to low Agni.

It is interesting to know that all three Doshas, when they are

abnormal, can hamper the Agni in their own way. Abnormal
Kapha lowers the Agni with its heaviness. Because of abnormal
Vata, the digestive fire becomes erratic. One may wonder
how abnormal Pitta will hamper the digestive fire. Pitta itself
has almost all properties similar to Agni. Pitta has a unique
additional quality than Agni. It is Drava (moist/wet) in nature.
It is this increased wetness in abnormal Pitta can reduce the
Agni. It is similar to pouring hot water on the fire. Even if the
water is hot, this heat will not help the fire to increase. Instead,
the fire will become wet and will be doused.

It is important for every person to eat only in such a way that

he should be able to digest that particular meal. If a person
finds that due to some reason, his digestive capacity is low,
he should either reduce the quantity of food or he should
use light-to-digest food to suit that particular situation. If this

53
rule is not followed there are bound to be consequences.
Half-digested food creates bad Doshas. These Doshas can
spread in the body or they can get accumulated in their
respective locations. The excess undigested food creates
a harmful substance called Ama and this also can create
severe problems.

Ama is a peculiar concept in Ayurveda. Because of the

excess quantity, food remains half digested. Absorption
of half-digested food becomes sluggish and the food
gets retained in the intestine for a longer time. Due to this
retention, it becomes fermented or it may even get putrefied.
This toxic material remains unabsorbed in the intestine
because of its incomplete digestion, and it is the root cause
of many diseases. This Ama cannot be correlated with any
biochemical material. It is one of the important causative
factors in generation of diseases and in modification of
disease process.

Ama is generated from improperly digested food in the form

of toxic substance that clogs the channels in our body. These
channels include the primary channels that carry the food
and the products of digestion and also include the channels
of Dhatus. All small channels in our intestines, lymph vessels,
arteries, veins, capillaries, and even genitourinary channels
may get affected by this toxic material. This toxic material
gets accumulated wherever it can find a tortuous areas or
improper Srotasas. The Srotasas that had been previously
compromised in some way, either as a result of disease or
trauma, are most vulnerable. Ama can get mixed with other
Doshas, Dhatus and/or Malas. Then they are called as Sama
meaning with Ama. Unless appropriately treated, all these
processes may result in a disease. Furthermore, even the
diseases with Ama are also called as Sama diseases.

Other Causes of Ama production : In addition to the

Agnimandya, there is one more condition where Ama may

54
be produced. Sometimes the excessively vitiated Doshas get
mixed up with each other in a peculiar way and this toxic
substance is formed. This also has the same properties as the
Ama created due to Agnimandya.

First and foremost treatment of Agnimandya is to take care

of the cause of the Agnimandya. Since most of the times
the cause is excessive eating, the first treatment is Langhana
(fasting). Next treatment is to get rid of the Ama that is
generated in our body. This can be done with the help
of appropriate treatment modalities called as Pachana
(digesting the Ama). Next, one should consume very light-
to-digest food. The quantity of this light food also should be
small. You should only take whatever the low Agni would be
able to digest. Finally, one should gradually buildup the Agni
again. This is done by starting with very light food, and then,
slowly going to heavier and more nourishing foods.

Fire can only be increased by increasing the fuel. In case of

digestive fire, the fuel is food, which has to be increased in
order to increase the Agni. But this must be done very gradually
and carefully. Going from light foods to heavier foods very
gradually builds a digestive fire that ultimately becomes very
stable. This stable digestive fire will not be hampered by little
bit of misbehavior. In short, fasting, digesting the Ama, and
building the Agni, these three steps are the bottom line of
the treatment of low Agni. However, if you encounter such
conditions while treating more serious diseases, a complex
detailing may be needed.

If one does not know the proper course of action to treat

Agnimandya or if one ignores Agnimandya despite knowing
the treatment, an important event occurs in the body.
Because of the excess food that is present in the body,
a condition called Ajeerna arises. Ajeerna is a disease
condition which occurs because of the undigested foodstuff
that causes many ill effects on the body.

55
In this condition of indigestion, there are three possibilities:
First, undigested food can be removed by the way of vomiting
or diarrhea. Second, if we decide to wait it out, it will be
digested in due course of time. Third, if neither of these two
occurs, the undigested food may lead to profuse vitiation of
Doshas.

This vitiation of Doshas can have many forms. It can be so

severe that the Doshas can wreck havoc in our body leading
to serious complications or even death. It can be very mild
and may not cause immediate symptoms. But if this kind
of mild-to-moderate indigestion occurs again and again,
it leads to chronic accumulation of vitiated Doshas. These
accumulated Doshas may spread all over the body and
create a disease. They may stay in dormant stage waiting
for the opportunity. They may manifest suddenly because
of triggering factors such as season change or some other
cause.

This is what happens in case of many of the chronic diseases

such as asthma, diabetes, chronic liver diseases, rheumatic
conditions, etc. Flare up of the chronic disease, which are
called acute-on-chronic condition, are seen in many such
diseases. Even in case of some infectious diseases which are
chronic in nature such as leprosy, tuberculosis, and filariasis,
ayurveda always considers Dosha imbalance due to Ajeerna
as one of the real causes.

Normal and balanced Doshas give us strong immunity. It

can be observed that some individuals do have capacity
to resist even virulent forms of infection and some are quite
susceptible to even milder forms. This phenomenon can be
observed In case of epidemics where some individuals in the
same family do not get the disease at all or may have milder
manifestation of the same disease.

Effects of indigestion are thus far reaching. The Doshas thus

accumulated can stay in a dormant phase for years together.

56
They can infiltrate slowly into deeper Dhatus. Further, they
can affect even most subtle parts as sense organs and even
mind.

Practical aspects of digestion:

How to maintain our Agni?
We must be aware of our Agni. We can self-examin our
Agni by watching the daily digestion. Watch the amount
of the food that you are taking every day. There are some
symptoms which show that the food is completely digested.
Most of these symptoms are subjective, and they can be felt
only by the person himself. When you get up in the morning,
take a moment, and try to look for these symptoms. When
food is fully digested, there is a feeling of freshness and
energy. Your stomach does not feel stuffed. You feel light
instead of feeling heavy. When belching occurs, it is clean
and without smell. There is timely passage of natural urges of
urine and stools. Lastly, there is normal hunger and thirst.

When your digestion is good, there is no abnormal craving for

food or water. This abnormal craving for food or water may
occur if you have excess Pitta. Often the craving for food is
mistaken for a real hunger. To judge real hunger and thirst, sip
some hot water, if you get smelly burps with smell of previous
food, your hunger is not real.

If you keep track of these symptoms, then only you can know
when to eat your next meal. Eating before the previous food
is digested leads to production of Ama. Especially all your
days meals must be fully digested until the morning of the
next day. When you get up in the morning your Agni should
be ready for the next meal.

57
By these symptoms you will come to know about the capacity
of your Agni. You may find out which foods usually take more
time to digest. You will know the symptoms you may be
experiencing because of specific foods. You may even come
to know what Doshas are increased by which food items.
Thereby, you can change your food habits accordingly.

If you are eating in excess, you should decrease the amount

of food you are taking. Surprisingly, you may find that despite
the decrease in the amount of food, you are feeling more
energetic. If your Agni can digest the food completely, good
Rasa Dhatu is generated. This will increase your energy level.
Following this practice definitely gives you long-term health
benefits. If a digestive fire does not get any food, it starts
digesting the Doshas. After the excess Doshas are digested,
the digestive fire goes on to digest Dhatus. At this time, you
may experience some weakness. Then you know where to
stop fasting.

Next, we will discuss some common symptoms and diseases

that occur due to low Agni and indigestion along with some
therapeutic measures.

Module 6
Constipation:
Constipation is seen more frequently in the people who
are following a typical urban lifestyle. Most of the urban
professionals working in cities have sedentary lifestyle.
Number of such people is increasing day-by-day. Whenever
an apparently healthy person starts experiencing a feeling
of incomplete bowel evacuation, it should never be ignored
and it should be addressed immediately. Efforts to reestablish
your normal pattern should be followed without delay.
Constipation can prove to be a beginning or even a cause
of many harmful illnesses.

58
As we have seen in the previous chapters, the concept of
Mala is comprehensive. The food material that is digested is
divided in two parts, waste and useful part. The useful part
is again further digested to get more useful part in the form
of Dhatus again leaving some amount of waste material. All
these waste materials are called as Mala. There are many
Malas in the body and there are many methods of getting
rid of those Malas. Urine, stools, nose, ear, eyes etc. many
outlets are letting out waste materials. Constipation indirectly
affects the quantity of these Malas. It also affects removal of
these other Malas. But here in this chapter, we are dealing
with Purisha, the waste that is thrown out of the anus.

After digestion is complete, the waste material in the large

intestine and surrounding area stays there for some time and
then expelled. This whole physiology is more important for our
health than we really think it is. All these stages should occur
properly and at proper time. If this waste is thrown out too
early, it is not good. It if stays there longer than necessary, it
leads to accumulation of waste, that goes back to increase in
other Malas. With evacuation of bowel early in the morning,
you are ready to spend your day with enthusiasm and vigor. If
it does not happen, you feel heavy, you dont feel like eating,
even food doesnt taste good, and you feel dull.

Some people spend months together in this situation. This

greatly affects their life, even affects performance in their
jobs. The energy and enthusiasm needed for your work is
lacking. The work they are doing is not enjoyable and the
work becomes a tiring routine. They cannot help themselves,
let alone the society.

Diet that is not suitable for your Prakriti, jobs, location, time,
etc. is the main reason for constipation. Eating at irregular
timings, eating in improper proportion, either too much or too
less, are the causes. There are many other causes such as
unsuitable climate, water, or even the location that you are
living in. Too much tea or coffee or other bitter/astringent
drinks are also causative factors.

59
Normally we should eat only twice or at the most thrice a day.
At least a little abdominal exercise is also needed. This routine
is generally sufficient for good digestion. But deviation from
normal food and behavior causes the abdominal organs to
slow down. Heaps of waste material goes on accumulating
in the intestines.

Because of the explosion of information through internet,

many simple remedies are available to each and every
person who can use a search button. It is now more likely that
one may use some wrong practices for a long time. Some
people never think that before using such remedies, especially
purgatives, for long time, it is necessary to see if they are in
accordance with their Prakriti, Bala, Agni, etc. Also, once the
purgative does its job, they feel free to eat whatever they like.
This leads to weakening of their digestive organs and channels.
The Agni becomes low. Even if constipation seems to be
relieved, some other disease process may be taking place
because of ignoring the real cause. Therefore, it is necessary
to seek medical guidance before using the remedies for a
long time. This is the only way to avoid permanent damage to
the functional entities like Agni.

When constipation is concerned, the first thing comes into

mind is that there is deficiency of water. Many people think
that drinking water is proportionate to the bowel movement
they have. Many people advise to drink some extra water
as a remedy for any type of constipation. We must follow
these practices very carefully. Ayurveda says that we should
drink water only as much as we need. The need for water is
expressed by the feeling of thirst. Some people fear that if I let
myself to be thirsty, I will be dehydrated. This is not always true.
Thirst is not a disease. No doubt, it should be honored and we
should drink water as and when needed. All the bodily urges
such as hunger, thirst, bowel movements, etc. (there are 13
such urges) are never to be suppressed or forced and must
be honored. But, drinking excess water also has some other

60
consequences. Many people may develop ailments such as
swelling, runny nose, even vomiting, because of excess water
intake. I have even seen a patient with joint pain who felt
better when excess water was stopped. Excess water is Jala
Mahabhoota which is opposite to Agni. Therefore, excess
water actually decreases digestive fire. There are many other
rules how one should drink water. Those with low appetite
should not drink water or take little water only when thirsty.
A thin person should drink after meals and an obese person
should drink before meals. As the unwanted food creates
indigestion, unwanted water also creates indigestion. This can
also create Ama which needs to be managed with restriction
on water intake and other treatments. If you have excess thirst,
we should find its reasons. There could be excess heat in your
body which is creating this desire for water. In this case, the
heat should be addressed by finding its cause and treating it.

Many people have habit of taking purgatives very frequently.

After some time, they may need to take them on daily basis.
This leads to further weakening of the intestines. There is a
very good anecdote for this. If a horse is not walking properly
because of weakness, you can make him walk by whipping
him hard. But this is not only inelegant, but it will work only
for very short time. Proper way to deal with this situation is
to treat the weakness and feed the horse until he becomes
strong enough to gallop. Wrongly taken medicines may hurt
your Yakrit in the long run. Occasional purgation is okay for
a young and strong person. Before taking purgation one
has to make sure that his tissues are not dry. If it is not so,
one needs to take 2-3 teaspoons of ghee daily for three to
seven days followed by fomentation with steam. Because of
this preparation, creating oilyness and the fomentation, the
waste material gets separated from the insides of the small
and large intestines. Also, after taking any purgation, it is
mandatory to take light, hot, soupy diet, eating only when
hungry. Even after that one should increase the diet very
gradually.

61
 Treating the constipation:
Constipation is often considered as result of low roughage in
the food. In some individuals, after the digestion, the waste
part is produced in less quantity. This can be increased
with roughage. To increase the roughage, green leafy
vegetables are advised by many. However, according to
ayurveda, green leafy vegetables are not so friendly with
the Vata. They should not be used very regularly. Ayurveda
advises gourd-like vegetables such as bottle gourd, snake
gourd, ridge gourd, etc., especially in patients with this type
of constipation.

Constipation is more often a result of improper digestion of

food. The process of defecation is governed by a Vata called
Apana. Because of incomplete digestion, the sensation of
passing of stools is not generated in the intestines. This leads to
feeling of heaviness and restlessness. Body is telling us that the
food that we had on the previous day is not yet fully digested.
In this case, best way is to aid our Agni and Apana with some
simple measures. First thing is to avoid eating heavy food.
When you are hungry, take soupy and light-to-digest foods
such as vegetable soups. Taking hot water with some lemon
juice helps relieving the obstruction of Apana Vata. For more
troublesome symptoms, mixture of equal amounts of ginger,
black pepper, and long pepper powders can be taken with
rock salt. This mixture increases the Agni and also corrects the
Vata movements.

Treatment of constipation also varies according to whether

the patient is thin or obese.

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Treatment of obese individuals: No exercise, excess intake
of sweet, fats, meat, etc. cause accumulation of Meda
Dhatu. There is laxity of the areas where this excess Meda is
accumulated. This laxity extends to the intestines also. Due to
excessive sweating, obese people lose a lot of water through
the sweat. Even if the stools are oily, because of the laxity,
the intestines cannot throw them out.

These individuals should completely stop sweets and oily

foods. Grains such as Millet, Bajra, Varai should be used
regularly. Lentils, Moong dal, soups should be used but without
ghee. Food with pungent, bitter, and astringent tastes should
be used more. Plenty of green vegetables and gourds are
good. Eating only boiled vegetables is also useful. Drinking
hot water whenever thirsty helps in many ways.

Here are some simple remedies: Haritaki (Terminalia chebula)

powder to 1 teaspoonful daily with hot water is very useful.
Those with flatulence should use Haritaki along with a pinch
of Saindhava (rock salt). Triphala powder may also be used
in the same way.

Treatment of thin individuals: There are again two types:

1. Some people hate fatty foods very much. Eventually,

these people develop dryness in their intestines. They are
lacking the necessary oilyness which is provided by the little
bit of fatty food. For these individuals, one should increase
the fat intake by giving them 2-3 teaspoons of ghee mixed
with a pinch of rock salt before meals.

2. Some individuals take enough fat in their diet, but because

of low Agni they cannot digest it. The oil and fat goes through
the intestines but without being digested, it reaches the last
part of the intestines as it is. In this case, usually the stools
are not dry, but they are oily, heavy, smelly, and they sink
in the water. On the other hand, the Dhatus that need the
fat are devoid of it. They may develop a habit of straining

63
and putting more pressure to evacuate the bowel. This again
aggravates Vata. If ignored, this kind of constipation later
gets converted into some serious illnesses such as Grahani
and Amavata.

These people should first try to increase their Agni. However,

increasing Agni in these people is a difficult task. First
Langhana (fasting) should be done until the accumulated
Malas are digested completely. This may take a couple of
days, sometimes even four to five days. Until that time even
water should be taken only if you are thirsty and it should be
hot. The time allows the Agni to digest the accumulated Mala,
and even if you are taking no food, you may still get bowel
movement. To make it more easy, you can take some Haritaki
or Triphala with hot water. After completion of Langhana,
you should start with a soupy rice preparation. Later, increase
the diet with Moong dal soup, boiled vegetables. Checking
each time whether previous meal is digested, very gradually
resume a regular diet. To boost the Agni, take half a cup
of water with a pinch of black pepper powder mixed in
it. Take this before meals. You can also use a preparation
called Abhayarishta 20 ml with equal quantity of water. This
can be taken halfway through the meals, because this is the
time when action of Vata is at its peak. This will help digest
the fat in the food and a little part of this fat will even reach
the Dhatus. The Dhatus will gradually get nourished properly
and the channels that are closed will open up. Gradually,
the intestines will become strong enough to get rid of waste
material. Constipation will be relieved completely.

64
 Module 7
Acid reflux, flatulence and
bloating:
The symptoms generated because of abnormal digestion
are diverse and can appear in combinations. Constipation
is a symptom that appears when the abnormality is mainly in
the lower part of the gastrointestinal tract. The symptoms that
appear due to abnormalities in the upper and middle part of
the digestive tract generally present as acid reflux, flatulence,
and bloating.

Many abnormalities in digestion are a result of urbanization.

With industrialization, lifestyle has changed very drastically.
The routine of industry work and the fixed timings of duty
have compelled us to adopt a fixed lifestyle. We have
limited ourselves in every aspect, even in choice of food.
Advertisements of various artificial soft drinks and readymade
foods are hammered into our psyche since childhood. No
wonder we never suspect many foods as a causative factor
for chronic diseases.

Even improper foods can be digested if taken in little quantity

and you are having a great Agni. Both the quality and
quantity affect our digestion. Excess of pungent, sour, salty
foods directly increases bad Pitta. Excess quantity of any
food also can cause even more Pitta to be generated by the
body. Despite increased Pitta, this excess quantity of food
cannot be digested fully and the food stays in the stomach
for longer time. This generates acid and later the food is
fermented and becomes more acidic and toxic in nature.
Acid reflux and eructation is an attempt of our body to get rid
of this unhealthy mixture.

65
If you feel burning sensation in your chest and throat, sour
eructation, and headache, that means you have excess and
misdirected Pitta in your stomach which is trying to come
out. Normal Pitta should digest the food, but in this case it is
abnormal and is misdirected. If we keep on ignoring this, it
affects the intestines in various ways. The mucous membrane
of mouth is affected and we get mouth ulcers. A nagging
sensation of something stuck in the throat could be because
acid reflux. Irritating cough not relieved with cough syrups is
often due to acid reflux. The esophagus may become red
and inflamed, and we may experience burning and gripping
sensation in chest. Sometimes the delicate lining of the
stomach gets disrupted and ulcers may develop. The upper
and lower intestines may undergo similar changes. The acid
and Ama can go down to lower intestines and later this may
convert into more serious diseases like colitis.

If not vomited out, this Ama and abnormal Pitta create

abnormal Rasa Dhatu. This abnormal Rasa Dhatu again
supplies to further Dhatus generating overall imbalance in the
system. Some may experience urticaria - rash on the skin. The
further Dhatus can also get affected in various ways.

Pitta is very fast in nature. It always shows immediate

symptoms, and if treated properly, the Pitta symptoms also
subside in relatively short time. This is not the case with Agni.
Agni once lowered, generally takes time to rebuild. This is one
of the differences between Agni and Pitta.

Treatment of acute acidity is similar to that of Ajeerna. If you

have vomiting, it is always better to ignore the vomiting initially.
Sometimes this Pitta goes further down in the gastrointestinal
tract causing loose motions. Initially, you must not stop this. Let
the abnormal Doshas go away. After a while you will feel better.
Usually the vomiting and loose motions stop when the abnormal
Doshas and products of indigestion go away. If these symptoms
still persist, then we should proceed to stop them.

66
There are many different causes for acidity symptoms. Excess
of hot liquids like tea and coffee, soft drinks, sour fruit juices,
in addition to large quantity of water causes a different kind
of acidity. This excess liquid cannot be fully digested. The
channels that manage fluids in our body can handle limited
amounts. The excess has to come out. This leads to large
vomits of liquid nature. To treat this condition, we must stop the
cause first. Stop the tea, coffee, and other liquids. Gradually
reduce the water intake. Initially, ignore the vomits. You may
do fasting to allow the Agni to digest the previous undigested
material. There are some simple remedies that are useful for
this kind of acidity. Take some dry Amla powder in a metal
pan and heat it until it turns black and becomes a charcoal.
A pinch of this can be taken two to three times a day with
very little or no water. Charcoal adsorbs the excess liquid
Pitta. The symptoms are immediately relieved.

Some people, especially women, love sour taste. They

prefer something sour during meals such as pickle, yogurt,
jams or sour fruits. They even drink sour juices, mostly citrus
fruits. Lemon is a favorite. Some people do not show
symptoms because they are used to this kind of food since
childhood. But at some point in time they may start showing
the symptoms. The reflux in this kind of patients is very much
acidic in nature. For any condition that involves sour acidic
Pitta, special medicines called Kshara are very useful. These
medicines are prepared by burning some herbs, dissolving the
ash in water, and then reducing that water to some extent.
This gives you a very strong Kshara. Kshara have alkaline
properties. Lime and baking soda have Kshara properties.
According to Ayurveda, mixture of Kshara and Amla (sour
taste) immediately turns into sweet taste. This is nothing but
neutralization of the alkali with an acid. A simple remedy of
taking a pinch of baking soda with a cup of water is useful in
neutralizing the acid. Some herbs such as dry ginger have
Kshara property. However, ginger is also hot and penetrating
and for acidity symptoms it can be used only if directed by an
Ayurvedic physician.

67
Sometimes this excess of sour taste does not always cause
acidity. It then may cause some other ailment. I will tell you
one example of this. A middle age man was suffering from
cold, runny nose, and sneezing since many years. Many
therapies were tried. Then, he came to my guru Late Vaidya
M.V. Kolhatkar, who was a legendary figure in diagnosis, an
expert in finding effects of different tastes. He asked the
patient whether he likes sour foods. Yes, of course he did.
He also had a history of acidity. Vaidya Kolhatkar diagnosed
him as a case of excessive use of sour taste. He used some
medicines of Kshara property and advised him to stop the
sour foods altogether. His symptoms subsided within a week
or two and never came back again.

Causative factor and clinical presentation of every patient

is different. Careful analysis of acidity symptoms needs to
be done for optimum results. Every herb has a distinct set of
qualities. These can be used judiciously to counteract the
exact abnormality of Pitta.

Flatulence and bloating: There is always some air present

in the stomach. It is advised by ayurveda that while eating,
some part of the stomach must remain empty for the
movement of air. This is necessary for its function. However,
sometimes amount of this air increases or there is production
of gas in the stomach due to indigestion and fermentation of
food. This gas is also called as Vata-Mala. This needs to be
expelled because it is in Mala form. Otherwise, it may cause
abdominal distention. It is the function of normal Vata to expel
out this abnormal Vata-Mala. Distention and belching occurs
because movement of intestines and action of Apana Vata is
not proper. Some foods such as legumes and chickpeas tend
to cause gas in the stomach and intestines. These should be
avoided. There are some simple remedies that can be used
in this condition. Mix a teaspoonful of lemon juice with half a
teaspoon of ginger juice and a pinch of rock salt. Taking this
before meals twice a day gives very good relief. However,

68
those who have Pitta symptoms should avoid this. They can
use Aamla juice 2 teaspoonfuls or pomegranate juice half a
cup mixed with a pinch of salt twice a day.

Ajeerna: If you find that the food you had on the previous
day is not yet fully digested, you are still feeling heavy, you
have belching which is foul, excess salivation, nausea, and
vomiting, you have what Ayurvedic physician calls Ajeerna.
The best thing to do in this situation ignore the vomiting. You
can even help it come out. Take a glassful of warm water
and mix teaspoon of salt in it. Drink this mixture to help
induce the vomiting. Dont push yourself too much. Let it
come out on its own. When it all comes out, you will feel
much better. After this, when hungry, you must follow gentle
diet. Beginning with Moong dal soup, soupy cooked rice, and
later Khichri. Do not take the food too frequently, maybe two
or three times a day. Space it out. You must wait for previous
portion to be digested. In a few days, increasing the amount
of food very gradually, you may come to your regular diet.

The abovementioned symptoms are really warnings given

by our body. These symptoms must be addressed promptly.
Otherwise, frequent occurrence of Ajeerna and other
symptoms gradually worsens our Srotasas. Doshas keep on
accumulating. Gradually, the Doshas start going in wrong
directions. As explained earlier, this is Koshtha Shakha Gati.
Doshas are going from central part towards the periphery.
Symptoms will appear according to where they go. For
example, if the Doshas go to skin, initially, you may get
mild skin rash. If you still ignore it, it may progress to a skin
disease. If the Doshas go to urinary system, you may get
burning sensation, or cloudy urine. If this is ignored, they may
graduate to a disease called Prameha (diabetes).

If the Doshas so accumulated stay in abdomen, the location

of Agni, Grahani itself, may be affected. Now the Doshas are

69
taking a very serious turn. This kind of damage may lead to
many chronic diseases of gastrointestinal system. There are
three main conditions that occur because of the vitiation of
Agni. These are Arsha (piles), Atisar (a disease marked by
increased/frequent motions), and Grahanidosha (a disease
marked by alternate constipation and loose motions).

We will discuss one of such diseases in detail Grahanidosha

often compared with irritable bowel syndrome.

Module 8
Grahanidosha (chronic
indigestion/Irritable Bowel
Syndrome):
Grahanidosha is a disease that occurs because of the
malfunction of the organ Grahani. As explained earlier,
Grahani is an organ that is responsible for control of movement
of food. When this organ is vitiated with Doshas, the control
on the process of digestion is lost. This leads to the disease
Grahanidosha or sometimes simply called Grahani.

Grahanidosha is a group of disorders. Common symptom

in this group is abnormality of Agni. According to modern
science there could be many different diseases that are
Ayurvedically diagnosed under Grahanidosha. But among
those, irritable bowel syndrome is the most prominent and
common disease of all. Therefore, here we will refer to this
disease while we discuss Grahanidosha.

Irritable bowel syndrome (IBS) or spastic colon is a noted

chronic disorder of digestion. It is characterized by chronic

70
abdominal pain, discomfort, bloating, and alteration of
bowel habits. Diarrhea or constipation may predominate, or
they may alternate. For some days the patient may have
constipation and later diarrhea may appear.

Ayurvedic diagnosis of the patient diagnosed as IBS varies

according to the causative factors, Doshas, involvement of
Dhatus, etc. Irritable bowel syndrome has many presentations.
Some patients may have pain in abdomen and constipation
as prominent symptoms while others may have diarrhea or
vomiting as a prominent symptoms. According to ayurveda,
all those presentations are manifested in only four ways -
Vata, Pitta, Kapha, and Sannipata (all three together). The
Ayurvedic diagnosis of Grahani is made according to the
symptoms that are present in the patient.

The pathology again starts from indigestion. In some

patients, some causes such as sudden psychological trauma
may initiate this disease. As described above, ignoring
the symptoms results in vitiation of the digestive fire itself.
The functional entity of Grahani, which is seat of Agni, is
also vitiated. Grahani normally works as a regulating unit.
Main function of Grahani is to keep the undigested food in
Amashaya, and when fully digested pass it to Pakvashaya.
This function is hampered because of the above reasons.
When vitiation of Grahani happens, there are two possibilities.
One, even digested food sits in amashaya for long periods;
and two, undigested food is prematurely passed on to
Pakvashaya. Due to this, the patient gets alternating periods
of constipation and loose motions. When the food sits in the
system for long duration, the patient is constipated. When it
is passed on prematurely, usually the patient gets frequent
motions of undigested food. These episodes may alternate
with or without any triggering factor.

There is a general notion that we should follow regular timings

for food. Breakfast, lunch, and dinner should be taken daily

71
at certain time. This is true, but one more important thing is
often ignored, your Agni should be ready at those timings to
digest that food. People working in information technology
field and other similar jobs have strict office timings have
a certain routine. They have to eat their breakfast even if
they are not hungry. On the other hand they cannot have
lunch if they are hungry earlier than the lunch break. Many
people do not care about the time of food at all. They may
leave large gaps between meals or some even keep on
munching food whole day long. This irregularity creates Vata
imbalance. Their Agni becomes irregular.

Eating before previous food is digested causes the two foods

to mix together. Now, new food also cannot be digested
completely. Eating too much food than the Agni can handle
creates Doshas. Eating unusual food, too heavy, and too cold
food creates Doshas. Suffering from prolonged illness, sudden
changes in place, time, season, ignoring the natural urges,
etc. all these cause lead to disturbance in overall functioning
of Agni in some or other way. Each and every cause
mentioned above leads to a specific kind of disturbance.
Hence there are slight variations in the treatment according
to the causes. However, sometimes it is very difficult to find
the causes. In such cases, symptoms can show us which
Dosha is predominant and we can treat accordingly.

Vata disturbance causes dryness of mouth and throat and

ringing noise in ears. There could be pain in the back, chest,
neck, or groins. Pain in the chest makes some people think
they have heart condition. This feeling of fear again creates
more Vata. In the long run, Vata makes you thin and weak.
Some people develop fissure in the anus. Bloating is very
common but it feels better with food. The bowel movements
occur mostly late in the day, sometimes watery sometimes
dry, and may have painful bowel movement.

Pitta disturbance causes the stools to be very loose, colored,

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green or even blue. Acidic and smelly burps, heartburn, and
excess thirst are common.

Kapha disturbance causes nausea and vomiting of sticky

mucous. There is a feeling of heaviness in chest and abdomen.
There is an abnormal sweet taste in the mouth. The stools are
heavy, and mushy. Feeling week without being thin is typical
of Kapha.

This is a generalized grouping of symptoms. There could be a

mixed picture indicating there are all three Doshas together
and this situation becomes difficult treat.

Ayurveda has given us these great tools to find out the causes
of imbalance. If we can find the cause and link it to the effect,
and apply the logic of Rasa, Guna, Vipaka, for the treatment,
we can be successful in treating these conditions. The real
treatment of this condition is correction of Agni. For this, we
need to find the real causes of diminution of Agni. There
could be many reasons, dietary, behavioral, psychological,
etc. Further, the Dosha accumulation should be considered
separately. The treatment needs full evaluation of the
patients diet, lifestyle, past history, etc. Grahanidosha of
Vata origin is most common. It is actually the advanced
version of the irregular Agni.

Treatment: First and foremost thing to do is look for symptoms

of Ama. If they are present, you should first take care of
that. Ama that is present in the stomach and intestines can
be removed by induced vomiting or purgation. Ama that is
spread all over the body should be digested using Pachana
medications. After this, when Amashaya is clean, very light
diet with soupy rice can be started with Deepan kind of
medications. This procedure is same for all three types. Next
objective is to increase Agni according to Dosha. There are
variations in the treatment according to Dosha.

Vata: Once Ama is taken care of, we can proceed with little

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ghee along with Deepan medicines such as ginger, pepper,
Ajmoda, etc. To remove the vitiated Vata from the affected
organs, intermittently we have to use purgation with castor
oil and other medicines. In the later stages, various Basti
(medicated enema) preparations can be used. Action of
Basti is multifold. It can be used remove Mala and remaining
Ama from the Pakvashaya. For this purpose cleansing
medications are used for Basti. If there is Kapha Dosha stuck
in the Pakvashaya, we can use Basti to liquefy and remove
that. Basti of cooling property herbs can be used if there is
Pitta present in the Pakvashaya. There are various kinds of
Basti that can be used to increase Agni, increase Dhatus, and
increase the Bala of the patients. This is why Basti is a major
treatment modality, and it is called as half the treatment.

Pitta: Pitta has same properties with Agni except one. Pitta
is Drava (moist). Therefore, in this case, after Ama is digested
and Doshas removed with Pancha Karma, we should use
various Churna (powder) preparations. Medicines in powders
form soak up the liquid Pitta that is present in the intestines.

Using the form of medicine to suit the abnormality is a specialty

of Ayurveda. The thinkers of Ayurveda have thought about it
very minutely. Various forms of medicines are utilized to deliver
the medications. Decoctions, powders, cold water extracts,
Asavas (alcoholic extracts), tablets, Avaleha (jams), and many
other forms are used frequently. All of these forms have their
own peculiar mode of action. Decoctions can get readily
absorbed and they go directly into Rasa Dhatu. Powders can
adsorb the Drava Pitta. Asavas again do not need digestive
fire to get absorbed, they can work directly. When tablets are
taken, they disintegrate much later in the intestines and their
action is late. Avaleha medicines are to be licked very slowly,
hence their action can be used to deliver the medicine slowly.
Avaleha method also pacifies Pitta.

Many herbs such as sandalwood, Kirata, Dhamasa, Patha

74
are used in combinations. These bitter Churnas take out the
moist Pitta that is covering the Agni. Improvement in Agni
could be quite dramatic.

Kapha: After taking care of Ama and doing Vamana if

necessary, Kapha is treated with pungent, sour, salty, and
Kshara medications. To improve the Agni, herbs such as
Chitrak, Chavya, Pippalimoola, are quite effective. Very
strong Asava preparations have wonderful results. Kshara
and Asava are hot and they have a specific Agni of their
own. Hence they are prudently used according to their
specific action on Kapha. When Agni is diminished due to
Kapha, it is similar to a covering of clay on the fire. This hard
covering of clay must be melted or pierced with suitable
chemicals and instruments. Similarly, covering on digestive
fire can only be removed by either corrosive action of Kshara
or penetrating action of Asava. Even the herbs mentioned
above have similar action.

In general, there are certain foods such as buttermilk,

ghee, Panchakola (five pungent herbs) that are very good
for Grahani. Ayurvedic physician makes the choice of
medicines after a lot of deliberation. It needs weighing up all
the causative factors of a disease. To judge the weightage
of causative factors, detailed understanding of these factors
is necessary. However, ultimately all these factors are
translated in terms of Doshas and Gunas.

During treatment, every food and medicine that is to be used

is chosen considering its Gunas. Those Gunas of medicine
should be opposite to the specific Gunas of Dosha. The food
or medicine can be utilized to exploit its properties so as to
get maximum benefits. This will be better explained by an
example.

Buttermilk is said to be very good in Grahani. It works on the

seat of Agni as a whole functional unit. It can be very cleverly
utilized to balance all three Doshas. This seems impossible

75
because the Doshas have opposite Gunas and one may
wonder how a single substance can balance all the three
Doshas. There is a sound logic behind it. Buttermilk works on
the Grahani and Agni because it is Deepan, Laghu (light),
and Grahi (helps formation of stools). Let us see how it acts
on Vata: Thick form of buttermilk can be used to pacify
Vata. If given along with the butter which is Snigdha, it can
act against the Ruksha (dry) property of Vata. The sour taste
of buttermilk helps Vata to move normally. The sweetness of
buttermilk balances Vata directly. Let us see how buttermilk
acts on Pitta: Sour quality of buttermilk is the only thing that
can aggravate Pitta. Fresh buttermilk although little sour,
has sweet Vipak and hence it does not aggravate Pitta.
Buttermilk is not too penetrating and not very hot in property.
Hence, it does not aggravate Pitta. Let us see how the
buttermilk acts on Kapha: The astringent nature of buttermilk,
the heat trapped inside it during preparation, the dryness if
taken without butter, the cleansing property that can be
experienced in mouth, all help to balance Kapha.

Another very strong logic to use buttermilk is its processing. To

prepare the buttermilk from cow milk, it goes through many
stages. At every stage or process, there is action of a natural
Agni. First, milk is boiled and cooled. Some curd is added
and it is allowed to stand for a couple of days. It is a kind
of natural Agni that does the process of fermentation. Then
the well-formed curd is churned. We all know that using two
pieces of wood and using churning process, we can create
a spark and light a fire. Thus the churning itself creates an
Agni in the buttermilk. This is application of the Lok-Purush
Theory that we have seen in the previous chapters. The finer
we think about the similarity and difference of universe and
man, the better understanding we will have.

Agnimandya, Ajeerna, and Gahani are sequentially more

severe manifestations of low Agni. This whole sequence is a
general disease process that is related to Agni.

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Next, we are going to go little deeper, and we will specifically
try to know more about an important organ liver - and its
diseases. In those chapters, using an example of a single
disease, we will see how all diagnostic aspects of a disease
should be studied.

Module 9
Liver and Gallbladder Diseases
Overview

Liver is often compared with an entity described in Ayurveda

called Yakrit. Although, the terms Yakrit and liver are not
exactly the same, for the sake of convenience we are going
to use these words as synonymous.

Yakrit is an organ described in ancient Ayruvedic texts that has

same location and similar functions as liver. As per the texts,
Yakrit is an organ complex that mainly refers to the origin of
Rakta Dhatu, and therefore, Yakrit is related to the Pitta which
is produced as Mala of Rakta Dhatu. Gallbladder, although,
is not mentioned separately, it is incorporated under the
terms Yakrit, Pittashaya, and Pittavaha Dhamani (pulsating
channel that carries Pitta).

Modern View: With the advancement of modern sciences,

organ-centric studies were done by thousands of researchers.
Vast amount of knowledge was gathered through these
studies. Many metabolic relations were established.
According to modern science, liver is the biggest gland in our
body. It is one of the vital organs in our body. It is located
in the right upper quadrant of the abdomen. The main
functions of liver are protein synthesis and the production of
biochemicals that are necessary for digestion of the food.

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There are many metabolic processes that are going on in
the liver. All these processes are mainly related to the food
we eat. Modern scientists have categorized the food into
three types- carbohydrate, proteins, and fats. All these are
metabolized in liver. Also, decomposition of red blood cells
occurs in the liver. Some hormones are also produced in
the liver. Detoxification is also considered as main function
of liver. The food that is absorbed in the intestine contains
many harmful toxins. These are removed and neutralized
in the liver. If the toxins cannot be removed or neutralized,
they are stored in the liver. Liver cells regulate a wide variety
of complex biochemical reactions, including the synthesis
and breakdown of small and complex molecules. Estimates
regarding the organs total number of known functions could
go beyond 500.

It is quite obvious that even if we find so many complex

interrelations between the organs, cells, nutrients, hormones,
etc. there are still so many things that are unknown. Organ-
based approach will definitely have limitations. Therefore, a
holistic view of functions is necessary for our ultimate goal of
achieving complete health.

Ayurveda has categorized all physiological processes into

Doshas, Dhatus, and Malas. All these three are classifications
with different criterion. Doshas represent a life force that
expresses itself in different form. Dhatus have material form
but they are also life-energies. Malas are final waste products
of digestion and they need to be regulated. Disease is
nothing but malfunction of these physiological processes.
Instead of finding each and every process, this holistic view
can be utilized for treatment of diseases.

Ayurveda has described Yakrit (liver) and Pleeha (spleen) as

origins of Rakta Dhatu. Therefore, all diseases that are related
to Rakta Dhatu definitely have some relation to both Yakrit
and Pleeha. Therefore, some diseases such as jaundice,

78
Raktapitta (a group of hemorrhagic diseases), Pandu
(anemia), are related to Yakrit and Pleeha. There are a few
diseases related to liver such as cirrhosis, hepatitis, tumors, that
cause tenderness, pain, enlargement, and hardening of liver.

According to ayurveda, classification of diseases is done

mainly according to its pathogenesis (Samprapti). The
pathogenesis is invariably described in the form of imbalance
of Doshas and involvement of Dhatus and Malas. As described
above, even if liver has specific functions, it is intimately linked
with other organs. All Doshas, Dhatus, and Malas are present
in whole body. Therefore, even if a disease is manifested on
a single organ, Ayurveda always tries to find its linkages with
the body as a whole.

We will now study some diseases that are mainly related to

liver and gallbladder. We will see how they can be diagnosed
and treated with Ayurvedic holistic approach.

Liver cirrhosis
Modern View: Liver cirrhosis is a progressive disease of the
liver. The common symptoms of cirrhosis are jaundice, ascites,
bleeding in stomach, and ultimately liver failure. Cirrhosis is
characterized by damage to the liver cells, generation of a fiber-
like tissue in the liver, and disturbance of normal architecture of
the liver. This is associated with failure in the function of liver cells
and interference with blood flow in the liver.

Most of the liver cirrhosis patients develop ascites in the later

stages. Ascites is accumulation of fluid in the peritoneal
cavity. According to ayurveda, this condition is consistent
with a disease entity described as Yakrit-Udara. Yakrit means
liver and Udara means water in the abdomen. This is a
symptom which appears as a result of a variety of chronic
disease processes. In this type, the liver is most prominently

79
vitiated. Udara always has low Agni as one of the causes.

Causes: Accumulation of Doshas occurs due to Dosha-

specific causes. These are same for all diseases. However,
any disease also has its specific causes. The disease-
specific causes in case of Yakrit-Udara are alcohol abuse,
incompatible foods, Pitta and Rakta aggravating foods,
and toxic material. These lead to structural and functional
impairment of liver.

There are many causes that can cause damage to liver.

During digestion at Dhatu level, Rakta Dhatu has a waste
product as the Pitta-Mala. As explained earlier, Yakrit is origin
of Rakta Dhatu therefore many metabolic wastes especially
in the form of Pitta-Mala could be accumulated here. Yakrit
is a location of a functional entity called Purishadhara Kala.
This is a structure that is responsible for separation of liquid
and solid wastes. It is therefore understandable that many
unwanted byproducts of digestion can also be deposited
here. This causes impairment of channels in this organ. Further,
the Doshas that have accumulated due to their own causes
get attracted towards these impaired channels. This leads
to manifestation of the disease in this area. Accumulation
and deposition of Doshas in this area causes this organ to
be enlarged and it can be palpated along the right upper
quadrant of the abdomen, just below the rib cage.

Alcohol and toxic materials:

There are certain substances that cause damage to the

Yakrit. These include alcohol, tobacco, toxic materials.
Some people are ingesting many chemicals knowingly or
unknowingly that could potentially damage the liver. These
chemicals include pesticides, and preservatives that are used
in food, drugs, petrochemical products, etc.

Ayurveda has described certain food combinations that are

known to be harmful, such as eating milk and salt or sour

80
foods together. These combinations are called as Viruddha.
These combinations create toxic materials that may lead to
many diseases including Udara.

During digestion, when waste is separated, there are some

foods that can generate more waste material. These foods
could be a cause of Udara. Food that is dirty is called as
Malina Anna. Such food also leads to channel malfunction
and further leads to Udara.

Excessive and improper Madya (alcohol) use is a major cause

of liver cirrhosis. Alcohol has the same properties as Visha
(poison). It is hot and penetrating. This causes Rakta Dhatu to
be vitiated. Yakrit becomes vulnerable because of too much
alcohol and this paves way for the disease. The qualities
of alcohol are Laghu (light), Ushna (hot), Tikshna (sharp),
Sukshma (subtle), Amla (sour), Vyavayi (pervading whole
body), Aashuga (swift), Ruksha (rough), Vikasi (expansive),
and Vishada (cleansing). All these qualities are the opposite
to the qualities of Dhatus. Alcohol causes increase in Pitta
and vitiation of Rakta Dhatu. When consumed, alcohol
quickly reaches the heart. Heart is a seat of the vital essence
of all Dhatus which is called as Ojas. Alcohol has antagonistic
effect on the Ojas. The abovementioned qualities of alcohol
are directly opposite to those of Ojas. Alcohol even affects
mind leading to agitation or intoxication. The heart-liver
complex is the seat of many important functional principles of
the body that are necessary for life. These important organs
are thus injured by the excessive intake of alcohol.

In general, ayurveda advises to refrain from alcohol use

as much as possible. However, there are many qualities in
alcohol that can be utilized to our benefit. There are many
conditions described in ayurveda where judicious use of
alcohol could be of great help. It is a boon for many patients
if used appropriately. Ancient text Ashtanga Hridaya has
described the methodology of alcohol use in great details.
Since the ancient times, medicinal wines are made in India.

81
In ancient texts, many types of drinks containing alcohol are
described with their properties. There are certain important
rules about the use of alcohol. It should be used only with
food. The person using alcohols must have absolute control
on himself. He should be very clear about the purpose of the
usage and he should know where to stop. To certain extent,
alcohol can be used to stabilize the mind. If used properly,
alcohol can even bring out finest creative qualities of man.

Qualities of liquor also depend on its base, i.e., from

what substance it is made, how it is aged, and what is its
concentration. The person using alcohols should see that all
these factors are compatible to his Prakriti.

E.g. As far as possible, Pitta prakriti people should not use

alcohol. However, sometimes even a Pitta person may need
to use it as a medicine. At that time, he should take following
precautions. He can take it during cold weather with lot of
water in it. He should take sweet taste food with it. This way
it may not be very harmful to even a Pitta person. On the
contrary, the rules are little flexible for a Kapha person. In any
case, every person should follow all other rules such as using
it around meals, avoiding too many spices with it, avoiding
exposure to heat such as going in sun and fomentation, etc.

Thus the etiogenicity, the causal nature of alcohol, hinges on

many factors. Treatment will vary according to whether the
patient has abused beer, whisky, rum, or any other type of
alcohol.

Dietary Causes:

Viruddha (Incompatible food): This is a major cause of

diseases of Yakrit and especially of Udara. When two or more
foods having incompatible tastes and incompatible Virya
(potency) are combined, it becomes harmful. Its effects may
not be manifested immediately. Improperly cooked food or
untimely eaten food also may become Viruddha. Again, there

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is one exception here. Some people have very balanced
digestive fire and it can digest even Viruddha kind of foods.
If your Agni is able to digest even incompatible foods, then it
may not lead to a disease. Examples of Viruddha food are
as follows:

Curds consumed at nighttime or in hot season become

Viruddha. However, curds can be taken during daytime.
Even then, you should mix some ghee and sugar with it to
balance its bad effects. Honey, Aamla, and Moong soup
can also nullify the bad effects of curd. Milk mixed with fish
becomes incompatible. Milk is of cold nature whereas fish
is of hot nature. As a result, the combination of milk and fish
vitiates the blood and causes obstruction of channels.

Any sour food mixed with milk is incompatible. Fruits,

especially sour fruits mixed with milk are incompatible. These
combinations decrease Agni. These are noted to cause
allergic symptoms of cough and cold.

Cooking the honey is Viruddha. Although honey itself is cool

in property, cooking leads to destruction of its good properties
and makes it incompatible. Also, honey should not be used
in very hot season.

Excessive hot spicy diet: This also is one of the major causes
of Udara. The hot property foods such as chilly, garlic,
pepper, and other spices vitiate the Pitta Dosha. This vitiated
and excess quantity of Pitta gets deposited in the liver. This
may further lead to dysfunction of the liver. The liver tissue
tries to get rid of this excess hot property material. But if the
causes are too many, the excess cannot be removed, and

83
then the tissue itself gets vitiated. The normal functioning
of liver is disrupted. This leads to further accumulation of
Doshas. A vicious cycle thus sets in. Doshas from all over
the body always tend to manifest where they find weakness.
In this case as the Rakta Dhatu is vitiated most due to hot
spicy food, Doshas flowing through Rakta Dhatu take refuge
in liver. It is tendency of the Doshas to vitiate the place
they get in. This leads to malfunction of digestive Pitta. This
again causes indigestion leading to abnormal Rasa Dhatu.
This clogs the micro channels. The watery part escapes into
the peritoneum. Finally, there is accumulation of fluid in the
abdominal cavity.

The abovementioned 3 causes are mainly the causative

factors for liver damage. In addition to these causes, there
are multiple causes of individual Dosha imbalance or buildup.
These general causes are same as the foods and behaviors
that are similar to the properties of individual Doshas. E.g.
dry, unwholesome food causes Vata, hot, penetrating food
causes Pitta, and sweet, oily, and heavy food causes Kapha.

(Samprapti) Pathogenesis of Udara:

As we have seen, there are two conditions that lead to

manifestation of Udara. One is buildup and imbalance of
Doshas and second is organ damage. When Agni is very low,
these unhealthy Doshas increase so much that they spill out
from their natural location. The susceptibility of liver channels
leads the Doshas to get attracted to the liver. The liver tissue
becomes swollen and its function deteriorates further. This
leads to imbalance in Rakta and other Dhatus. Because of
the accumulation of Malas, the channels of Sweda (sweat)
and other water channels get obstructed. Obstruction of
Apana Vata causes the Doshas to get stuck in the abdominal
cavity. The water metabolism in our body is disturbed and
accumulation of watery Doshas occurs in the peritoneal

84
cavity. The subtle energies of Prana and Agni are affected
during this process. Thus, Udara manifests because the water
channels and sweat channels get clogged and the Doshas
get accumulated in these micro-channels. The excess water
in the channels seeps into the abdominal cavity.

Purvarupa (Presymptoms):

The symptoms that appear before the manifestation of

disease are called as Purvarupa.

It all begins with low Agni. Sweet, unctuous, and heavy foods
start taking more time to digest. The person cannot tolerate
even a little bit excess of food. There is slight swelling on the
legs. The person is not sure whether the food is digested or
not. There is slight swelling on the legs. There is constant loss of
strength. There is shortness of breath even with small exercise.
There is excessive accumulation of stools because of bloating
and upward movement of the Vata in the abdomen. Pain
and distention in the lower part of the abdomen is present.
Even with little quantity of food, the size of the abdomen
increases disproportionately. Network of veins becomes
visible on the abdomen. The folds and the creases on the
abdomen disappear. Almost all these symptoms are related
to low Agni. The disease is not yet fully manifested. This
stage can continue for a prolonged period. If this is ignored,
the Samprapti progresses further and full blown symptoms
appear.

Rupa (Symptoms):

Rupa means the symptoms that appear when the disease is

fully manifested.

In this stage, the abdominal distention is apparent even on

both the sides. There is gurgling noise in the abdomen. The
swelling becomes clearer and appears on hands and feet.

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Digestive fire is diminished even further. A peculiar smoothness
appears on the cheekbones. Weight loss is a symptom which
appears in later stages.

Although, eight types of Udara are described in the text,

here we will see only Yakrit-Udara. There are specific causes
of Yakrit-Udar as mentioned in the description of causes.
However, every patient has specific causes. Treatment must
be designed to counteract those specific causes. Thus, the
pathogenesis (Samprapti) of each patient will be different.
Both spleen and liver are the organs that can be origin of the
disease of Udara.

Spleen is located on the left side of the abdomen and liver

is on the right side. The whole spleen-liver complex works in
harmony with other organs. The effect of alcohol and other
causes the channels of different Dhatus to get distorted.
The other Dhatus get deposited in the spleen and liver. This
phenomenon is called as Vimarga-Gamana (meaning - going
in wrong direction). This is the reason for the enlargement of
liver in cirrhosis and even some tumors. Therefore, establishing
a normal transportation of Dhatus is an important aspect of
treatment of these conditions.

Most of the times, Rakta Dhatu is increased out of proportion

because liver and spleen are origins of Rakta Dhatu. Some
properties of Rakta Dhatu such as heat, penetrative nature,
and flow are increased to a great extent. Due to excess
heat, liquid portion of other Dhatus comes into the blood. This
portion gets deposited in the liver causing liver enlargement.
All systems and organs must be examined to look for symptoms
of Dhatu involvement. Specific symptoms of each Dhatu can
be seen. E.g. if liver is stony hard to touch one may infer that
Asthi Dhatu is deposited in the liver.

86
Sometimes bleeding disorders develop in the late stages of
liver disorders. These are critical conditions. The cause of
bleeding most of the times is excessive increase in the hot,
penetrating, and vitiated blood flowing though the channels.
The capillaries become fragile. The bleeding may occur from
any place such as stomach, rectum, or even skin. Ayurvedic
treatment is of great help even in these patients. If we could
find the exact pathogenesis and treat accordingly, we get
wonderful results.

To find out the exact causes it is necessary to get complete

history of the patient. Sometimes we still may not find them.
In these cases, there is a specific examination done to
determine the Dosha and Dhatu taking part in the pathology.
This test is called Upashaya and Anupashaya. Let us learn
more about this.

Upashaya and Anupashaya:

Upashaya literally means feeling better. Anupashaya is

opposite of Upashaya, meaning not feeling better. These are
basically exacerbating and relieving factors. This is a kind of
test administered to the patient in order to find out the exact
causative Dosha. If the patient has vague symptoms and we
are not sure which Dosha is causing it, we can treat any one
of the Doshas. If the patient feels better, we know it is correct
Dosha. This is called as Upashaya. If the patient does not feel
better, it is called as Anupashaya.

This test of Upashaya can be applied practically by using

any of the following - medicine, food, behavior, or season.
Effect of season is very good clue which can be observed
without any intervention. E.g., if ones symptoms get reduced
during winter, we can deduce that he has Pitta as the cause
of those symptoms. We can use some foods to find out the
Dosha. E.g., if the patient feels better with use of milk, you
may infer that the cause may be Vata or Pitta.

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Having studied the diagnostic aspects of Udara in detail,
let us see some other diseases of liver in short. The principles
of diagnosis are same in all conditions. However, there are
variations in causes and their effects in the form of organ
pathology.

Kamala (Jaundice)

The word kamala literally means the condition where desires

are lost. Kamala is originated from Pitta imbalance. This
disease is marked by yellow discoloration of nails, white of the
eye, and urine. Excessively vitiated Pitta is cause for Kamala.

As explained previously, Ayurvedic diagnosis of the symptom

of yellowness on skin, eyes, etc. can vary a lot. Pittaja varieties
of many disease conditions show the same symptom. The
word Pittaja means originating from Pitta. The yellowness is
present in Pittaja Jvara (fever), Pittaja Pandu (anemia), Pittaja
Gulma (a disease marked by painful abdominal mass), etc.
Therefore, jaundice can be diagnosed as a symptom of any
of this disease if other appropriate symptoms of that disease
are present.

However, here in this chapter we will use the word jaundice

as a synonym to a disease called Kamala which is chronic in
nature.

Modern View: Jaundice according to modern science is

presence of excess bile pigments (bilirubin) in the bloodstream
and tissues, causing a yellow to orangeeven greenish
color in the skin, the whites of the eyes, and the mucous
membranes. Normally, liver produces bilirubin and it is passed
through the biliary system into the gut. Due to liver disorders,
bilirubin may be overproduced or inadequately removed by
the liver and biliary system. Excess bilirubin thus goes back into

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the bloodstream. Jaundice may also occur due to impaired
bile flow. Causes include anemia, pneumonia, and liver
disorders (e.g., infection or cirrhosis). While bilirubin excess
usually does no harm, retention jaundice signals severe liver
malfunction.

Hetu (Causes): There are two ways by which a person can

get Kamala. First is due to excess Pitta. General causes for
excess Pitta are as follows:

Foods with sour and salty tastes, foods with Kshara property
and excessively hot property cause Pitta. Fermentation of
food in stomach due to daytime sleep, too much exercise,
wrongly done Pancha karmas, abnormal seasons, holding
the bodily urges like hunger, thirst, etc., all of these cause
Pitta.

Causes of accumulation of Kapha are as follows:

Sweet, sour, and salty foods cause Kapha. Cool property

foods and also cool temperature foods or drinks, heavy and
oily foods (e.g. cheese, red meat, cake, frozen, deep fried
foods) cause Kapha. Overeating or eating heavy meals,
eating too frequently also causes Kapha. Daytime sleep
after meals causes Kapha and Pitta.

Samprapti (Pathogenesis): Ayurvedic interpretation of two

types of pathogenesis of Kamala is little different.

1. In advanced cases of a disease called Pandu (severe

anemia), when Rakta and Mamsa Dhatus of these patient
get burnt by the heat of aggravated Pitta. However, every
patient of Kamala does not have Pandu. Some patients
with very hot and penetrating Pitta may directly get Kamala
without having Pandu. This type of Kamala is marked by
shortage of Rakta and Mamasa Dhatu. The excess Pitta
present in blood causes the nails, white of the eyes, skin, and
urine to become yellow. This is called as Bahu-Pitta (too much
Pitta) Kamala.

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2. Obstruction due to Kapha stops the normal outward flow
of Pitta. This Pitta then accumulates and goes back into the
channels. This is called as Ruddhapatha Kamala. This type is
marked by yellow skin, nails, etc., but whitish or clay colored
stools. Kapha Dosha is the main culprit in this type.

Symptoms: Indigestion is foremost symptom as normal Pitta

is not available for digestion. There is no desire for food. This
leads to weakness. Burning sensation in stomach and other
places is also present.

The obstructive jaundice also has the same symptoms as

above. However, since the flow of Pitta is obstructed the
stools passed do not have normal yellow color but they are
whitish in color.

Due to anatomical vicinity, liver and gallbladder are part of

the same system which is Yakrit. We will therefore proceed
with studying some gallbladder conditions in Ayurvedic
perspective.

Gallbladder diseases
Ayurvedic diagnosis of this condition varies according to the
interpretation of pathology that has occurred in an individual.
Many patients have a history of Pitta diet, hot, sour, pungent,
spicy foods combined with some Kapha-causing foods. This
Pitta is in the form of Mala. This should be expelled out of the
body. Combination of Pitta and Kapha causes a stone to be
formed inside the gallbladder.

Modern View: There are two main conditions that are

most frequent when diseases of gallbladder is concerned.
These are: 1. Cholelithiasis (stones in the gallbladder). 2.
Cholecystitis (inflammation of gallbladder). Both of these
present in the form of pain in the abdomen. Gallstones can

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form when there is an imbalance in the substances that make
up bile. For instance, cholesterol stones may develop as a
result of too much cholesterol in the bile. Another cause may
be the inability of the gallbladder to empty properly. Pigment
stones are more common in people with certain medical
conditions, such as cirrhosis or blood diseases such as sickle
cell anemia.

Formation of stone anywhere in the body is a similar process. In

the context of urinary stones, this process is described in detail
by ancient texts. Buildup of the Doshas and Malas anywhere
in the body create a background for this. A peculiar type of
gluey Kapha causes this Dosha and Mala buildup to solidify
and turn it into a stone. Therefore, for any stone-like formation
in the body, Kapha imbalance is always one of the causative
factors. This is the real cause of the gallstone formation
also. Due to the stone formation there is obstruction of the
Srotas. Obstruction causes the symptom of pain. Again, to
treat this pain obstruction should be removed. There is inner
mechanism in all small channels of our body to remove any
obstruction. This can be utilized.

Modern approach towards the treatment of this condition is

focused on surgical removal of the stone. However, Ayurvedic
approach towards removal of any obstruction is first focused
on using the bodys own natural mechanism to deal with
this problem. Body has a system in place where solid mass
can be expelled out where they are formed. Small ducts
have a peristaltic movement. This is like the movement of an
earthworm, a wave of contraction and relaxation traveling
along the tubular structure. According to ayurveda this motion
is function of Vata. Normal Vata never allows anything to get
stuck. Vata function is facilitated by prudent use of oil and other
Snigdha material like Ghee. Fomentation treatment causes the
structure to relax and move normally. Thus expulsion of waste
material can be achieved. This procedure of promoting normal

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movement is called as Anuloman of Vata. Expulsion of urine and
stools is also done with this kind of movement by a Vata called
as Apana Vata. Apana Vata is responsible for waste removal
from the lower side of our body. Direction of Apana Vata is
towards the lower side. Therefore, Anulomana of Apana vata
is very important for any waste material removal. Movement
of all other types of Vata can be facilitated by normalizing
the direction of Apana Vata. This is why Basti (treatment of
medicated enemas) is very effective in treatment of all Vata
obstructions.

Our body has some natural mechanisms for removal of waste

from many places. For example, hard impacted ear wax
sometimes causes ear pain. Very small hair-like structures on
the inner lining of ear pushes the wax out. Simple methods
of putting some warm medicated oil can stimulate the inner
lining of the ear canal. Ayurveda emphasizes on utilizing
and improving these mechanisms by using most natural
medicines and treatment modalities. With the advent of
sophisticated modern surgical techniques, these modalities
were somewhat neglected.

Ayurveda is not against surgery. Cataract surgery, intestinal

surgeries, and even urine stone surgeries were done in the
ancient times. Detailed description of the techniques of the
surgery performed in those times is available to us for reading.
However, surgery was seen as a last resort.

There are many patients with gallstones with no symptoms at

all. In fact gallstone is an incidental finding during abdominal
ultrasonography done for some other reason. Many people
have gallstones that remain unnoticed throughout the life.
Women are noticed to have more chance of having a
gallstone. Most of the persons who have the gallstones do
not realize it. The gallstones that are simply floating around
inside the gallbladder generally cause no symptoms. Small
gallstones can dissolve inside the gallbladder. Healthy food

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and lifestyle definitely helps the body to take care of itself.

The main cause of formation of stones is the vitiation of Doshas

and abnormal functioning of the channels. Most of the patients
show involvement of all the three Doshas. Pitta in the form of
increased bile, Kapha becomes sticky in property, and Vata
movement is obstructed in many patients. Combination of all
three leads to hampered excretion process. Accumulation
of sticky bile thus leads to formation of a stone. Therefore, all
the usual causes of Dosha vitiation are applicable here.

There are some particular causes also. Some modern

medications are known to cause accumulation and
impairment of bile. I have seen one such patient who was
taking a medicine called Dapsone which is a medicine
for leprosy. She developed gallstone that later caused
obstruction in her bile duct leading to severe jaundice.
She was advised surgery. She was treated with Ayurvedic
medicines for 6 months, and the size of the stone reduced
considerably. Later, she opted for surgery and had her
gallbladder removed. Ironically, she developed a new bile
stone inside the hepatic duct itself causing the same symptoms
of jaundice and pain. Therefore, gallbladder removal surgery
is not an answer for prevention of bile stones. The exact
causes of the formation of gallstones must be addressed.
Ayurveda could be of great help in such situations.

Cholecystitis occurs when the gallbladder becomes inflamed.

Ayurvedic diagnosis, of course, would depend on the signs
and symptoms of the patient. Most often, the patients
diagnosed with cholecystitis have causes and symptoms
consistent with Pitta. Increased Pitta can sometimes be a
reason for pain even if there is no obstruction. Also, Pitta
may cause other Doshas to behave abnormally leading to
obstruction. This leads to difficulty in movements of Vata and
subsequent right upper abdominal pain. Concentrated bile,
increased pressure, and increased heat irritate and damage

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the gallbladder wall, causing swelling of the gallbladder. This
may further lead to formation of stones. The symptoms are
colicky pain in the abdomen particularly in the right upper
part which may be episodic. Nausea and vomiting may be
present. Fever also can be one of the features. Bad breath,
Indigestion, constipation, and diarrhea may be present.
Pressure on the area may cause pain.

From Ayurvedic standpoint, the presentation of above

conditions varies according to the Dosha predominance.
This disease may manifest with many group of symptoms.
These groups of symptoms are to be interpreted to find out
exact Samprapti (Dosha movement). Detailed history to find
probable causes is therefore necessary.

There are some disease conditions that are explained in the

text as separate entities which may match the clinical picture
of abovementioned conditions. Eg. Pittaja Shula (pain), Jvara
(fever), Ajeerna (indigestion), etc. We have already discussed
the Ajeerna, therefore, let us learn more about the most
frequent occurrence that is seen in patients with inflammation
of gallbladder and gallstones, which is Shula (pain).

Shula (Pain): According to ayurveda, any symptom is

considered as a separate disease entity if we can state
distinct causes and pathogenesis of that symptom. Many
patients with inflammation in gallbladder and gallstones
present with a clinical picture of a disease described in the
text as Shula meaning pain. Sushruta has explained this as
a separate disease entity in detail. As you know, Sushruta
was a surgeon. Therefore, many symptoms are described
according to surgical standpoint. There are four types of
Shula described in the text.

Pain does not occur without Vata. Pain is generated

whenever there is obstruction to the flow of Vata. Vata

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pain can be of various types- spasmodic pain, cutting pain,
pricking sensation, splitting pain, aching pain, pulsating, etc.
Vata pain is exacerbated in cold season, cloudy weather,
or rainy season. It is of changing quality. It tends to come
and go irregularly. There could be associated symptoms of
constipation and flatulence. Vata pains are relieved with
application of oil, fomentation, and other oily and hot foods
and treatments.

Pain due to Pitta generally occurs when digestion of food is

going on, during midnight or midday, and during hot season.
Pitta pains are relieved with cool, sweet, and soothing foods
and treatments. Pitta pain often starts elsewhere but travels
towards the navel. It is associated with burning sensation,
restlessness, sweating, thirst, giddiness, and vertigo. Patient
may feel severe burning sensation as if a burning coal is put
on the affected area. The common causes for Pitta Shula are
excess intake of spicy foods, such as pepper, chilly, and other
dry and hot pungent foods. Tobacco and alcohol exposure
to heat or sunlight are also some of the causes.

Pain due to Kapha generally occurs after eating. There is fullness

of abdomen, nausea, and general heaviness in the body. The
patient feels better with heat. Fasting helps a lot, and in the
later stages, light and dry foods reduce the discomfort.

All three Doshas combined may also cause pain. In this case,
there are mixed symptoms and the severity is much more.
The treatment also consists of sequential pacification of all
three Doshas.

The patient diagnosed with inflammation of gallbladder most

often present with Pitta type of pain. Many patients have
Kapha background as in Kapha prakriti. Some may also have
Kapha-vitiating causes such as combination of carbohydrate
and fat in excess quantity. The word excess here is subjective.
It means that the amount that your particular Agni cannot
completely digest that particular quantity. Viruddha
(incompatible) food such as milk+fruit is not uncommon. This

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kind of diet usually vitiates the Yakrit. Most probably, the
Pitta that is produced in the liver as a Mala of Rakta Dhatu
develops a tendency to solidify. This leads to formation of
solid mass of the Pitta. This may or may not obliterate the
path of the usual flow of Pitta. If it does, then symptom of
pain may appear. Some patients do not have pain but they
may develop jaundice which we have seen earlier.

There is another group of patients who show more acute

signs such as heartburn, fever, eructation, and vomiting.
The intensity of pain is more and has all the features of Pitta.
There is tenderness in the right upper quadrant. Usually, these
patients have a history of hot spicy foods, salty, sour diet,
etc. They feel better with cold milk or sweet foods. In these
patients, the excess Pitta is trying to express itself through liver
and gallbladder. These are natural locations of Pitta.

Many times a strange presentation occurs. Vata imbalance

could occur due to Pitta. In this case, Pitta must be treated
primarily because it is the root cause or the originating
cause. The Dosha that is main trouble instigator is called as
Pradhan (main) Dosha. It is a fact that when this main Dosha
is balanced, the other Dosha automatically subsides.

This is a peculiar concept in Ayurveda. We must attempt to

treat the very root of any condition, otherwise, we get minimal
result. Finding a main Dosha sometimes poses a clinical
challenge. As we have learned in the previous chapters,
the test of Upashaya is of great diagnostic help. When you
suspect, but not sure, that the pain is due to Pitta, try using
anti-Pitta food/modality/medicine. If the patient feels little
better, you can be sure of your diagnosis.

We have discussed many possible causes and conditions

surrounding the topic of digestion with special reference
to liver and gallbladder. The subject is vast and it is not
possible to cover all the conditions here. However, I hope this
short course will be helpful to give you general idea about
Ayurvedic perspective of digestion and liver metabolism.

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 Module 10
Principles of Ayurvedic diagnosis:
For an Ayurvedic physician, arriving at a particular diagnosis
is a complicated process. It is like solving a riddle. The
causes of the disease may consist of so many diverse factors.
Usually, there is not a single cause that we can blame for
any disease. E.g. the patient consuming excess alcohol may
also be eating too spicy foods. His lifestyle may consist of lot
of stress and no exercise. Ayurveda believes in establishing
the distinct cause-effect relationship of all these factors. The
Pitta increased by pungent spicy food has different qualities
than the Pitta increased by excessive sour foods. Pitta may
also increase with the heat produced by excessive exercise.
Anger also increases Pitta. Exposure to heat and sunlight
may also increase Pitta. Pitta increased with all these causes
has different characteristics. It must be treated with cause-
specific food, medicine, and behavior. E.g. Pitta increased
with anger should be treated by tender loving care. Pitta
increased with alcohol is treated with milk, because milk has
exactly opposite qualities to that of alcohol.

Usually, there is combination of many causes. There may be

vitiation of more than one Doshas. The patient with alcohol
abuse may also be using foods that increase Kapha. In this
case, there could be combination of Kapha and Pitta. This
poses even more difficult problem to treat because Kapha
and Pitta has many opposing qualities. Ayurveda has found
ways to treat these conditions also. There are treatment
modalities that can take care of combinations of two and
even three Doshas.

Ayurvedic diagnosis involves five main factors that must

be studied before treating a patient. 1. Hetu (causes).
2. Purvarupa (pre-symptoms). 3. Rupa. (Symptoms). 4.

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Upashaya and Anupashaya (relieving and exacerbating
factors). 5. Samprapti (Pathogenesis). We will see how these
five factors affect the treatment aspect of any disease.

1. Hetu (causes): The science of Ayruveda always tries to

go to the root of everything. Ayruveda says that the wrong
perception of the truth is the basic cause of all diseases. The
misunderstanding of the situation and making wrong choices
knowingly or unknowingly is the basic cause of the imbalance.
The overuse, underuse or improper use of our sense organs
also leads to imbalance in body function. These all are very
basic causes of all the diseases. Essentially, wrong choices in
terms of behavior, food, and thought process cause various
physical and mental imbalances.

Establishing a cause and effect relationship is science.

According to ayurveda, it is necessary to search for the causes
of any disease. The treatment also should vary according
to the causes. E.g. sore throat could be due to varieties of
causes ranging from cold weather, sweet or oily food, spicy
food or exposure to wind. The treatment of sore throat will be
different for each cause. If the cause is cold weather or wind,
then a warming treatment such as warm gargles would help.
If it is due to spicy food, a cooling, gentle, and soothing herb
such as licorice should be used.

Causes often tell us about the exact Dosha and its qualities.
E.g. Kapha increased by cheese and buffalo milk is definitely
heavy in property. It may lower the Agni due to heaviness. The
treatment should consist of light and Agni-enhancing herbs
such as black pepper. Of course, the other conditions like
Prakriti, time, age should be thought of. E.g. we cannot give
black pepper to an infant. We cannot give it to those who
have delicate tissues and mucous membranes. We should think
twice before giving black pepper in very hot season. However,
a Kapha individual may tolerate it even in hot season. Again
if a Pitta Prakriti individual has Kapha increase, one should

98
use clinical judgment to decide whether he can tolerate the
black pepper. The dose and method of administration of the
medicine also hinges on all the above factors.

Purvarupa (pre-symptoms): There is a certain time frame for

occurrence of causes and actual manifestation of disease.
It is during this phase we get some warning symptoms and
signs. These are called as presymptoms. Once we notice the
presymptoms, we know what disease is evolving and we can
start the treatment for that disease. E.g. the presymptoms of
restlessness, heaviness, bodyache, irritability, etc. suggest us
that we are likely to get a Jvara (fever). We can immediately
start the first treatment of fever which is Langhana (fasting).
Of course it is not very easy to diagnose a disease at this
stage, because the presymptoms of many diseases overlap.
Diagnosis made in early stages helps us to treat it promptly.

Rupa (symptoms): When the disease is fully manifested, it

shows clear symptoms. We can feel the fever by elevated
temperature. At this stage, we are sure of the diagnosis.
However, the fever could be arising from multiple causes.
Many causes can lead to same symptom, and many
symptoms can arise from one cause. Hence, any symptom
is not always treated with the same medicine. Pitta fever
which is caused by heat is treated with cooling herbs. Vata
and Kapha fevers are treated with hot fomentation.

Upashaya and Anupashaya (relieving and exacerbating

factors): Upashaya are relieving factors. Anupashaya are
exacerbating factors. When in doubt about the exact Dosha,
this is test is used. The testing with Upashaya can be done with
the help of medicine, food, behavior, or season. Upashaya
is often same as the treatment of the disease. However, the
relief felt with Upashaya should be long term. Otherwise, it
can be misleading. E.g. a patient with indigestion may feel
temporarily better with spicy food, but this is not a proper
thing to do. It can mislead the diagnosis also.

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Samprapti (Etiopathology): The complete process of
development and progression of disease right from the
exposure to causes, course of Doshas, to manifestation of
disease is called as Samprapti. Samprapti explains how the
causes vitiate the Doshas, how the vitiated Doshas travel,
where they lodge themselves, what is the site and mode of
their manifestation, etc. Treatment is nothing but complete
reversal of this process. This reversal should be done in such a
way that it should protect the Dhatus and normal organs. With
the varieties of causes and movement of Doshas, an infinite
number of Samprapties can occur. Different techniques of
the treatment must be used for different Samprapties. Names
of the diseases are merely groups of similar Samprapties.
The criterion for such grouping may be different. Also, one
symptom can appear as a result of many Samprapties. A
fever can be a symptom in jaundice, abscess, tuberculosis,
rheumatism, leukemia, gout, or even heatstroke. Or fever
itself can be a separate disease. It is the interpretation of the
individual situation that is most important.

Finding a single cause for a single condition is an ideal situation.

But, most of the times this does not the case. There are many
causes or causative factors that create the particular disease
situation. Various different factors that create a certain
situation are categorized under ten diagnostic considerations.
Let us learn more about these factors.

Ten diagnostic considerations:

Apart from Doshas there are ten other factors that must be
taken into consideration while diagnosing and treating a
disease. These are as follows:

1. Dushya: This is mostly the Dhatu, Mala, or other element

that is vitiated by the Doshas. Treatment should be aimed
at correcting the abnormality in any of these. E.g. in case of
fever, only fasting is not sufficient. There is another event that

100
occurs in fever. It is the depletion and vitiation of Rasa Dhatu.
This also needs to be corrected with the help of a specific
medicinal soupy diet.

2. Desha: This means location. The treatment may depend

on whether the patient is living in a dry land or a marshy land,
etc. E.g. people living in dry areas are prone to get Pitta and
Vata diseases. On the other hand, those living in or near
wetland are likely to have Kapha diseases.

Bala: This means stamina and power. This is not just physical
stamina which is necessary for exercise. But this also reflects
level of your endurance when your body is going through
difficult situations. If your Bala is good, you can tolerate
intense treatment modalities. Bala reflects on your Agni also.
If your physical Bala is good, your Agni also stays good.

Time: Time plays important role in diagnosis. This can give you
a clue about Dosha. Exposure to causative factors for a long
time makes it more deep rooted. Some symptoms are time
bound. E.g. it takes 3 to 7 days for a fever to subside. Time
itself is said to be the remedy for some diseases like fever, you
have to wait for specific time for the fever to subside. Time
of the year creates cyclical changes in nature and human
body. Thus, both causative factors and therapeutic decisions
are affected by time.

Agni: Agni is very important to decide the food and

medicine to be given. If your Agni is good, you can tolerate
high-potency medications. Vata pacifying foods are usually
heavy to digest. Heavy Dhatus such as Mamsa cannot be
increased without heavy foods. You can digest these foods
only if your Agni is good.

Prakriti: This is a well-known concept. Since birth, people

in general have different predispositions in terms of body
functions. These are classified according to three Doshas

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and their combinations. In short, prakriti means individual
tendency of body and mind according to the Doshas. Out
of these ten considerations, Prakriti is definitely important.
But, contrary to popular belief, when it comes to treatment of
illnesses, prakriti is not a singular major consideration. Other
considerations are equally important.

Age: Age must be considered while taking diagnostic and

therapeutic decisions. Generally, Kapha is prominent during
childhood, Pitta in adulthood, and Vata is prominent during
old age. Children should be given mild medications. But
if there is Kapha imbalance in a child, it may need harsh
treatments, and sometimes it could be a challenging situation.
Young people can tolerate Pancha Karma and other harsh
treatments. Old age needs more soothing and nourishing
kind of treatments.

Satva: Satva here means strength of mind. A person with

positive attitude can fight with even severe diseases. Strong
desire to get cured makes the person to do right things.
Intention is a very powerful tool. Good intentions keep you
healthy. Purification of mind is necessary for happy and
healthy life. Mind can affect Doshas. The emotion of anger
increases Pitta. Fear and sorrow increase Vata. Therefore,
treatment of Pitta involves calming the anger with soothing
music, pleasant atmosphere, and company of innocent
children. Treatment of Vata involves restful atmosphere and
assuring friendly touch. These work better than counseling.

Satmya: Every person is accustomed to certain food, climate,

and location, etc. One feels better with the same place
and food that he/she is accustomed to. This is why Upashay
and Satmya are synonymous, but their meaning only differs
with the context. Sudden changes in food and routine may
create sudden imbalance. Therefore, Ayurveda advises
that even wrong practices should be decreased gradually.
E.g. if a person wants to quit alcohol/tobacco or any other

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addiction, he is advised to reduce the quantity by th each
time at regular intervals every 3 days or 7 days. Even good
habits such as exercise should be increased very gradually in
the same way.

Aahar: This means diet. All aspects of diet including the

quantity and quality are important considerations. We have
already discussed this in details in previous chapters.

All the above factors create a unique situation at any given

time. This unique situation is called as Avastha.

Avastha: There is great variation in all the above ten factors

in every person. Every person, healthy or unhealthy, is going
through different situations. These situations change with
time. By permutation and combination of all the ten factors
mentioned above, infinite possibilities arise. During the
treatment, selection of medicine, food, and modality thus
varies according to this unique situation at any given point in
time. This explains why Ayurvedic treatment of same disease
is different in different individuals.

Any situation may appear at a given point in time. However,

when the physician is examining the patient, he is dealing
with a unique situation at that point. This situation must be
correctly interpreted by the physician. Only then, he can find
the best therapeutic solution at that point in time. This is why
every clinical encounter is unique. Even if a plan of treatment
is designed, there is every possibility that the Avastha of the
patient would change. This may lead to slight change of plan.
Therefore, it is advised by Charaka that the physician should
observe the patient every moment. Similar to the diagnostic
variation, treatment plans also may have infinite variations. It
is the duty of the physician to design the best possible solution
at that point in time.

All the above factors must be thought of before designing a

treatment plan.

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 Module 11
Ayurvedic treatment Application
of cause and effect theory:
Ayurvedic treatment is not just limited to usage of some
herbs for a disease condition. Many people have a notion
that treatment is usage of medicines or drugs. There is a
difference between treatment and a drug. Treatment is all
about the cause and effect relationship. There are multiple
causes for any condition. Whatever symptoms you are
having is an outcome of many causative factors with very
long process that may even go back to your childhood. It
may even go beyond that. Your parents health at the time
when you were conceived is again a cause of your current
situation. For example, an Ayurvedic physician may diagnose
a headache as an effect of some severe fever long back
in the childhood. Study of causative factors is so important
that it could be a specialty in itself.

Since a long time, clinical practice of Ayurveda in India has

been based on many schools of thoughts. I was fortunate to
meet a great Ayurvedic physician in Maharashtra province of
India, Late Vd. A.V. Datar who treated thousands of chronic
conditions very successfully. He was very keen on finding
the causes from the remote past, especially childhood. He
theorized that diseases such as measals and prolonged
fevers leave a lasting impact on three organs Yakrit, Pleeha,
and Basti (urinary system). He used to examin the patients
by touching and palpating on these areas. He could discern
slightest variation in the temperature and texture of these
organs by palpation and percussion on these areas. His
diagnosis was in terms variations of Pancha Mahabhootas.

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A hard Yakrit meant accumulation of excess Prithvi
and a warm touch on that area meant accumulation or
excess of Tej (fire) Mahabhoota. His treatment consisted of
judiciously prepared medicines based on theory of Pancha
Mahabhootas. He was very successful with his methods.

After the discovery of microbes as a cause of disease and

their treatment with antibiotics, the concept of one disease
and one medicine became popular. Use of antibiotics
became rampant for even minor infections. Developing the
immunity of an individual meant taking vaccine for particular
microbe. Importance of overall nutrition and holistic health
was somewhat overlooked. However, during the past few
years we have seen the limitation to the use of antibiotics
for the infectious diseases. Newer bacteria and new virus
forms keep on arising. This leads to frantic search for new
antimicrobials because the older ones are not effective.
Resistance to antibiotics is the cause of multi-drug-resistant
tuberculosis and other such problems. Effect of climate
on outbreaks like swine flu is quite evident and climate is
accepted as a risk factor for outbreaks.

All these facts support the multiple-causes theory of

Ayurveda. Similar logic applies to use of pain killers and
other symptomatic medicines. Aspirin has analgesic and
antipyretic properties and it is commonly used as a medicine
for fever. Ayurveda, however, thinks quite differently. Since
the digestion is hampered in fever, undigested food material
creates a toxic material called Ama. Therefore, to allow our
body to digest this Ama, we must give some time for our Agni
to do its job. Therefore, according to Ayurveda, fasting
is a real treatment for fever, and drug that will lower the
temperature has less importance. On the contrary, using a
drug may actually hamper the Agni further. Later, after the
Ama is digested, Doshas causing the fever can be balanced
with bitter herbs such as Guduchi. This sequence is called
as Kriya-Krama (Kriya means action and Krama means

105
sequence). This kind of treatment would not create other
Doshas. Hence it is called as Shuddha Chikitsa i.e. treatment
without side effect.

It is very difficult to treat multiple causative factors. So,

ayurveda advises to find and use a modality that will take
care of all the factors. This logic is called as Yukti. Let us learn
more about it.

Yukti : Smart treatment for

multiple causes:
Many herbs are described with their action in terms of
Rasa (taste), Gunas(attributes), Vipak (effective taste) and
Prabhava (specific action). All these should be analyzed to
suit the Avastha (current situation) of the patient. The Avastha
of the patient is also a result of many factors as we have seen
previously. Now we have to find a herb or a combination
which is against all the causative factors considering the
Doshas, Dushyas, location, Bala, time, Agni, Prakriti, etc. This
logic of combining many factors to find the best option is
called as Yukti.

For example, if a young man who eats a lot of Kapha-

increasing foods such as milkshakes and cheese, with low
Agni, a beer drinker, usually is sick during winter seasons,
stays near wetlands, is weak for his age, the pathology will
constitute more of Kapha Dosha leading to Kapha buildup in
the liver or other areas. The treatment should be designed to
decrease the Kapha, to counteract the alcohol, to increase
the bala, to increase the Agni, suitable for the season factor,
should be enhancing Agni, etc. The best treatment may be
an Asava medicine which has all above properties. Also
Asavas are against Kapha Dosha, it has a food value so it

106
will increase Bala, etc. Asava itself contains alcohol, but
judicious use of Asava is advised to treat the effects misuse
of alcohol. The time of use of Asava should be after meals so
that it will be tolerated well. Also, medications that are given
after meals act on Kapha Dosha. In this way, the logic of
Yukti can be applied.

However, in practice, we come across more complex

situations. There could be many different things such
as combination of two or more Doshas, many dushyas,
many opposing causes, etc. All these must be taken into
consideration before designing the treatment plan.

Designing a treatment plan that should combine many

etiopathological factors, is a special expertise. This is
necessary for successful treatment of any disease. One
important advice given by the ancient sages to the
Ayurvedic physicians is that they should always try to improve
their abilities and knowledge. One should enhance this
Yukti, the ability of interrelating many causative factors and
finding an appropriate solution. Again, the solution could be
chosen from many treatment options that are available to
him. Therefore, the choice of medicine also is made using
the Yukti.

Dvividha Upakrama (two types of treatment): The eternal

clinical dilemma.

While examining the patients, the physician is continuously

observing the patient and trying to diagnose the exact
causes of his current condition. The moment a patient enters
into the clinic, an Ayurvedic physician immediately looks at
him and says to himself, Oh, this man looks thin, Vata seems
to be dominant, I should use medicines and foods that are
nourishing, sweet, and soothing. Then, the patient starts telling
about the symptoms that are related to Kapha. Immediately,

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the physician is trying to think of the treatment to reduce
Kapha, but it should be suitable for a thin person! Next, the
physician finds that he is having low Agni that explains the
Kapha symptoms. Then comes up a past history of some
illness that explains why he is thin. Now, the physician further
knows that first Kapha and low Agni should be addressed,
and later, he should look for the remnants of his past illness
and try to address those remaining pathologies.

Thus, this process of diagnosis and treatment dilemma goes

on continuously in the mind of the physician. This whole
process of diagnostic thinking and subsequent therapeutic
considerations is explained under the heading of Dvividha
Upakrama. In order to facilitate this diagnostic decision
making, the ancient sages have classified the treatment
modalities in such a way that this mental process can occur
naturally and without any conflicting ideas.

Ayurvedic treatment modalities are classified mainly on the

basis of their anabolic or catabolic actions. These are called
as Santarpan (nourishing or anabolic) and Apatarpan (non-
nourishing or catabolic).

Santarpan treatments are aimed to nourish depleted Dhatus

and Doshas. Apatarpan treatment is aimed to remove the
excess of Dosha, Dhatus, and Malas.

Santarpan: To build up the depleted Dhatus, one needs to

administer foods that are full of material and energy. The
Prithvi and Jala Mahabhootas need to be more in the food.
Medicines that we are using also should be of nourishing
quality. Santarpan is same as calming of aggravated Vata.

Apatarpan: To reduce the excess of Doshas and Dhatus, one

needs to administer treatments and foods so as to remove
the excess. This can be done by two ways. 1. Shodhan -
actually removing the Doshas out from the body. 2. Shaman
(palliation)- Balancing the imbalance of Doshas while they
are inside the body.

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1. Shodhan: (Removal of Doshas): This is done by special
treatments called Pancha Karma treatment. Pancha Karma
are five treatments that include vomiting, purgation, and
medicated enemas, bloodletting, and cleansing of head
and neck through nasal route.

2. Shaman: Reducing the excess Doshas while they are still

inside the body: This is done using medicines that consist of
Tej, Akasha, and Vayu Mahabhootas.

For successful treatment, there is a certain methodology that

needs to be followed. The treatment plan should be stepwise.
There is a certain sequence that must be followed to achieve
easy and early cure of the disease. This method of sequential
treatment is unique for every disease and is called as Kriya
Krama.

Kriya Krama: Sequence of treatment modalities:

We have already seen that any disease evolves with many

events occurring with a certain sequence that is called as
Samprapti. Accordingly, treatment also must follow a certain
sequence.

E.g. as seen earlier, treatment of fever has certain sequence.

First the patient should do fasting. After the digestion of Ama,
he can take medicines to balance the Doshas. Balancing
the Doshas involves many sub-sequences. These can involve
Pancha-Karma and various palliative treatments. Pancha
Karma also has certain sequence. First induced vomiting
is performed. Then purgation is done. That is followed by
medicated enema, nasal medicines, etc. During all these
steps, one should increase the Agni in a stepwise pattern,
by starting with very light foods and going towards heavy
foods. When Agni is stabilized, we should go for rebuilding
the depleted Dhatus. After that is accomplished, one should
use Rasayana treatment which basically improves the quality
of Dhatus and strengthens the immunity of Dhatus. Only after
this, the treatment is complete.

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However, during the course of treatment, many different
situations arise. This may warrant the change of sequence. The
situation at hand must be addressed first. As per the urgency,
the priority of the treatment is decided by the physician.

Four pillars of treatment:

One must understand that any disease is a complex
phenomenon, involving many factors. Achieving health
again is also dependent on so many factors. We must obey
and respect the rules of nature. For better outcome of the
treatment, all aspects of lifestyle and diet must be carefully
judged to suit the individual condition. The approach
towards treatment of all disease conditions, especially serious
diseases, must be comprehensive and dynamic. This needs
complete devotion on part of the physician, attention and
love from the nursing person, and also full cooperation and
trust from the patient. Charaka has said that physician,
medicine, nurse, and the patient himself are the four pillars of
successful management of the disease.

Now that we know some basics of Ayurvedic treatment,

we will turn towards the classical treatment of liver and
gallbladder diseases.

Ayurvedic treatment for liver and gallbladder conditions:

We have already seen the variations in Ayurvedic diagnoses

of these conditions. In this section, we will see the classical
treatment of previously mentioned diseases relevant to Yakrit
and Pleeha along with some symptom management.

In case of Yakrit, as any disease, objective of treatment

is removal of bad Doshas, building up normal Dhatus, and

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establishment of equilibrium in all functions to the level of the
baseline status (Prakriti) of an individual.

Appropriate treatment modality - Selection and Sequence:

According to Kriyakrama, (the sequence/priority), removal of

excess and vitiated Doshas is considered to be the first and
foremost objective.

If the patient is having enough Bala (physical and mental

ability or stamina) to tolerate harsh treatments, then we can
go for removal or detoxification procedures such as Vamana
(induced vomiting) and Virechana (purgation). Deciding this
ability is a skillful job and that should be left to an expert. The
preferred sequence here is first Vamana and then Virechana.

To chose between Vamana and Virechana, again there

are selection criteria. Vamana is primarily good for Kapha
Dosha or a combination of Kapha and Pitta. Virechana is
primarily good for Pitta and combination of Pitta and Kapha.
Virechana is also good for purification of Rakta Dhatu. Liver
and gallbladder are location of Pitta and Rakta Dhatu.
Therefore, Virechan is often considered a better modality
to treat liver and gallbladder conditions. There are specific
purgative medications that are used for cleansing of liver and
gallbladder. These medications have a specific action. They
remove the vitiated Pitta from Yakrit. But these treatments must
be taken under guidance of a qualified Ayurvedic physician.

If the patient is not able to tolerate a full-fledged Virechana

treatment, mild variants of the procedure can be used. These
are as follows:

Sransana (removing the Doshas after digesting them):

Sransana means to slide. This modality is utilized when sticky
Dosha are present in the abdomen. Some herbs such as
Aragvadha are utilized for this purpose.

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Bhedana (breaking the concretion of Doshas): This is
particularly useful in case of gallstones and other similar
conditions. Doshas and Malas come together to form a
concrete mass. This can happen in a hollow organ or even a
tubular structure. There are some herbs such as Katuka that
are very useful in this condition. Capacity of the medicines to
go to specific organ is called as Gamitva. This phenomenon
can be very effectively used for treatment of gallstones and
liver abnormalities.

Anulomana (improving the Vata movement): When Doshas

are not coming down because of immobile or sluggish Vata,
this modality is utilized. Anulomana medicines such as Haritaki
bring the Mala and Dosha down by increasing the motility of
the intestines.

Cleansing treatment can be utilized both as a major

procedure or a minor procedure. Major procedure is done
by using very strong drugs and by hospitalizing the patient
under continuous medical observation. Strong purgation
puts lot of strain on all the systems of the patient. The benefit
of this major procedure is that we can remove large quantity
of Doshas at one go. With proper selection of the patient
and using good setting, the risks involved can be minimized
to a great extent.

For minor procedure, abovementioned variants of purgation

can be used in a milder form. Minor Virechana can be
repeated even on a day-to-day basis. This removes the
Dosha in a gentle fashion. But this takes a little longer time.

For the disease of Udara, Virechana treatment is very

important. In this disease, there is accumulation of watery
fluid in the peritoneal cavity (ascites). In modern medicine,
diuretics are used to remove excess fluid from the body.

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Ayurvedic method of removing the fluid is Virechana therapy.
It has been observed in many patients that Virechana therapy
is very effective. Through Virechana, we can remove the
causative Doshas along with the excess fluid in the body.

Snehana: Vata does not have a physical form like Kapha

and Pitta. Therefore, removal of Doshas usually means
removal of Kapha and Pitta. Vata needs pacification more
than removal. Pacification of Vata is nothing but creation
of supple channels to facilitate the movement of Vata.
This can be done with Snehan. Snehan is a modality that
comes under the Santarpana variety. Snehana can be done
in various ways. Taking medicated ghee or oil internally is
called as Snehana. Snehana also mewans application of
oil on the skin. Snehana is done every time before doing
Virechana and Vaman. It softens the tissues and facilitates
removal of Doshas. Snehana also has many dos and donts,
the rules to be followed. It is contraindicated in case of
Udara. However, if the situation warrants the physician can
always make exceptions to these rules. Apart from all the
rules around all these modalities, the purpose of the modality
is more important. Purpose of Snehana is to create an oily
suppleness inside our body so that Vata movements all over
the body are facilitated. There are some symptoms by which
we can judge whether our purpose is fulfilled. Skin becomes
soft, stools become loose, and there is repulsion to take further
ghee or oil. When the target is achieved, we should move on
to the next modality that is relevant in the treatment plan. For
the purpose of snehan, medicated oil enema is also used.

Svedana: This means fomentation. Like Snehana this

procedure is necessary before Pancha Karma. Fomentation
loosens up the buildup of Doshas and facilitates their
movement from periphery to the centre. Solid and firm Kapha
Dosha needs to be melted in order to bring it to the Koshtha
from where it can be removed. Action of fomentation on
Vata is also peculiar. Fomentation reduces Vata with its hot

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property. It also makes the channels softer thus facilitating
movement of Vata.

Niruha Basti (Decoction Enema): Decoction enema is a

cleansing procedure for Vata. Overall, this modality is so
important in Ayurveda that it is called as half the treatment.
However, enema is contraindicated in case of Udara. Still, there
are some Vata conditions such as severe constipation where
this enema can be utilized even for the patients with Udara.

Rakta Mokshan(Bloodletting): The Rakta is always considered

as most accessible Dhatu in our body, especially for the
purpose of cleansing treatment. Doshas that are circulating
throughout the body can be removed by bloodletting. Rakta
sometimes behaves similar to Dosha. Vitiated Rakta is stated
as cause for many diseases. Yakrit is origin of Rakta Dhatu,
hence, involvement of Yakrit is present in almost every Rakta
condition. Sometimes, all the treatment with various anti-
Dosha medicines fail to give results. In these cases, Rakta is
considered as major causative factor. Bloodletting is done
by either piercing the vein or using a leech.

Shaman:Palliation (Balancing the Doshas without Pancha Karma)

As seen above, for selection of the treatment modality, the first

consideration is given to the built of the patient, whether he is
thin, obese, or medium built . Usually, the patients suffering for
a long time are thin because of the loss of Dhatus. Removal
of Doshas by Pancha Karma is not possible in these patients.
Also, if quantity of Doshas is less, then Pancha Karma is not
necessary. Palliative treatment is sufficient to take care of
those less-quantity Doshas.

Shaman treatment of Vata is same as Santarpana. This

includes Snehana as explained above - usage of oil, ghee,
animal fat, etc. Also, nourishing diet that will build the Dhatus
is also actually Shamana. When Pitta and Vata are together,
then also this same type of treatment is used.

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Shaman treatment of Kapha and Pitta - alone or together
- is divided in seven parts. Pachan (digesting the Doshas),
Deepan (improving the Agni), Kshudha Nigraha (fasting-
controlling the hunger), Trushna Nigraha (controlling the
thirst), Vyayam (Exercise), Atapa (exposure to sunlight),
Maruta (exposure to wind).

Pachana (digesting the Ama and Doshas): To get rid of Ama

is the first line of treatment in almost all conditions of liver and
galbladder. If Ama is going out on its own by vomiting or
loose motions, we should ignore it, or even help it go out.
If it is not going out, instead, it spreads all over the body, it
must be digested with the help of medicines. This action is
called as Pachana. The Pachana medicines ultimately act
by increasing Agni.

Deepan (Sequential increment in the Agni): Deepan is a

process of gradual sequential increment in Agni. During
disease conditions, the flame of the Agni is very low. We
need to increase it gradually. This can only be done by
adding more fuel to the Agni. This is why ghee is Deepan
in quality. It helps to increase the Agni because it proves to
be a good initial fuel. There are some medicines that are
Deepan in quality. It is like boosting the Agni by creating a
burst of flame.

Almost all medicinal preparations other than those for

Pancha Karma fall under Pachana and Deepana categories.
Whatever medicine, herb, mineral, animal origin, all ultimately
either do Pachana of the Ama or Pachana of Doshas. Most
of these medicines contain Vayu and Akasha Mahabhootas.
Both Pachana and Deepan work on Agni. Hence, Agni is the
basis of all treatments in ayurveda.

Kshudha and Trisha Nigraha (Controlling the hunger and thirst):

Fasting is necessary in order to allow our digestive fire to digest
the Ama and the Doshas. For this purpose we must control
the hunger and thirst. In diseases like Udara, it is necessary

115
to restrict the water intake. Our body thus uses the excess
water from the watery exudates that are accumulated in the
abdomen. The pathology of accumulation can be reversed
with the help of this modality. Excessive water intake is a cause
in many disease, e.g. runny nose, sinusitis, and swelling over
the legs, etc. There is a misconception about water intake. It
is a general notion that drinking as much as water possible is
good for health. This is not true. According to Ayurveda, you
should drink only according to your needs.

Vyayama ( exercise): Vyayam can be used to reduce the

Kapha and Meda. Diseases like fatty liver that are result of
Meda accumulation can be treated very effectively with
Vyayama. The Sanskrit origin of the word Vyayama is Ayama
which means to stretch. Therefore, according to Ayurveda
stretching your body is Vyayama. Stretching should be part
of your daily routine. This is so important that the science of
Yoga is based on stretching practices. To reduce excess
Meda and Kapha, brisk walking can be very helpful. Word
of caution about exercise is that it can increase Vata. Heavy
exercise such as wrestling is advised only for professionals and
strong individuals and mostly to be done in winter season.
Weight lifting is a popular exercise. Body building as it is
currently known, it essentially increases the muscle bulk. This
is not the objective of Ayurveda. Strength and longevity with
well-balanced and healthy Dhatus is the real objective of
Ayurveda.

Atapa (sunlight) and Maruta (wind) can be used to reduce

Kapha. With current lifestyle, we spend most of our time
indoor. Exposure to these elements is necessary for our
physiology. Both sunlight and wind are drying in nature.
Sometimes accumulation of water needs to be dried. This
can be achieved with prudent use of both wind and sunlight.

This completes all the seven Shamana treatments. To treat

the liver and gallbladder diseases, all or some of the above
modalities are chosen according to individual Avasthas.

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When the disease is cured, we must take care that there is
no recurrence of disease. For this purpose, during and after
completion of the treatment of these conditions, proper diet
must be advised. This is called as Pathya.

Pathya (proper diet): Once the Doshas are removed or

balanced with the above treatments, we must follow a specific
diet and behavior so that the Doshas stay in the equilibrium.
This diet should be the same lines as have discussed previously.
However, there are some special precautions for patients with
Udara. Heavy foods and excess water or other fluids must
be avoided for at least one year. All causative factors such
as alcohol must be avoided. Protecting the Agni should be
given priority. Eating in moderate quantity, not suppressing
the urges, and regular exercise keeps you healthy for a long
period.

There is some guidance about how to boost your immunity

against these diseases. This is called as Rasayana.

Rasayana (Building up the immunity): There are certain

medicines and procedures that build up good Dhatus so
that resistance to disease is improved. We cannot avoid
some causative factors such as climate change hereditary
tendencies, etc. Therefore, we should boost our resistance
by other means. This can be achieved with the help of
Rasayana. After taking the Rasayana, the risk of recurrence
becomes very low and slight misconduct in terms of diet and
behavior would not hurt you immediately. Herbs such as
Amla, Pippali, Haritaki, and Chitraka are used to perform the
Rasayana treatments of Udara.

There are two methods of taking Rasayana:

1. Kuti-Praveshika Kuti means a small hut. The person taking

this type of Rasayana should stay alone in a specially prepared
hut for a few days, completely isolated from wind and sun.
He would eat only certain foods. Rasayana property herbs

117
such as Amla and Pippali, etc. to be taken at specific timings.
This treatment was done in ancient times. There have been
few attempts to perform these treatments in recent times with
moderate success.

2. Vata-Atapika In this type of Rasayana, there is no need

to be isolated from wind and sun. Food and diet restrictions
remain same. Medicines given are similar to that of Kuti
Praveshika. In this type of Rasayana, the duration of treatment
is more.

Rasayana is not just used in disease-free state, but is also

used during ongoing treatment of disease. Although the
main purpose and action of Rasayana is improving Dhatus,
Rasayana works also by improving Agni and removing Doshas.
Therefore, it can be used for all these purposes at stage of the
treatment. Most important factor for Rasayana treatments to
be successful is that the person on whom these treatments
are done should be pure at heart. His approach towards
universe should be kind and understanding. He should be
a giver, truthful, forgiving, and worshipper of goodness. In
fact, any person having these virtues automatically gets the
benefits of Rasayana even if he is not taking those medicines.

Liver and Gallbladder-Some Treatments

Aspects:
Treatment of any disease is principally the same as explained
very shortly in the previous chapters. Liver and gallbladder
diseases are no exception to this. However, there are many
variations with respect to choice of the herbs and choice
of exact modalities. Liver and spleen area is dominated by
Rakta Dhatu and Pitta Dosha. Lot of metabolic events take
place in this area. Rakta Dhatu is seat of Pitta and also it

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carries Prana. Therefore, herbs acting on Rakta and Pitta
should be used.

To summarize, the diagnostic process involves finding the

causes and predisposing factors, translating them in terms of
Dosha and their Gunas. Symptoms and signs can also tell us
many things about the causative Doshas. Finding the course
that the Doshas have taken inside our body is very important.
It is done by careful scrutiny of all this information.

The therapy is done considering all the above points. Equipped

with the knowledge of nature of the Doshas and nature of
the person, the physician tries to find out ways to balance the
Doshas and cleanse the Dhatus. A generalized treatment
plan designed. There could be variations in the treatment
plan. To get rid of the excess Doshas by Pancha Karma,
the physician first tries to decide whether the patient is fit to
undergo that procedure. Then after lot of deliberation about
the specific herbs to be used, preparation of the patient is
done. For Vamana and Virechana, this preparation typically
takes a week which involves application of oil and taking
medicated ghee internally. Carefully induced vomiting and
purgation is then performed using appropriate medications
considering all the factors.

For conditions such as advanced Udara, mild regular

purgation with herbs such as Triphala, Katuka, and Castor oil
are used. After this, Dosha-balancing treatment with many
different herbs and herbomineral preparations is continued for
a long time. Use of these treatments is according to different
situations of Vata, Pitta, and Kapha. Dietary changes are
also made according to the situations that may arise during
the course of the treatment. Many patients are advised to
take only milk diet. Cow milk is a boon to the Udara patients,
especially if there is alcohol as a cause. Nourishment of all
Dhatus can be achieved with milk. Milk also has cleansing
property. It gives you enough liquid to drink as water is
restricted in these patients.

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Treatment of Kamala is aimed at removing the excess Pitta
by the way of Virechan (purgation). To reduce the excess
Pitta, cool and soothing medications need to be used. This
includes rice, moong dal soup, etc. Ghee can be given at
appropriate time. Some herbs that are generally used are
Katuka for purgation and Anantamula for balancing the
excess Pitta. Ruddhapatha Kamala should be first treated
with food and medicines that remove the Kapha that is
obstructing the channels. Triphala is used for mild purgation.
To remove Kapha obstruction, dried radish soup with a pinch
of Trikatu (which is a mixture of equal parts of ginger, black
pepper, and long pepper) can be used.

Gallbladder conditions show symptoms consistent with

Kamala or Pittja shula. Treatment of this condition varies
according to two Avasthas: Acute and long-term. For the
patients presenting with acute conditions, Vata obstruction
must be considered as basis of the treatment. If we can
pacify vata, the pain is immediately controlled. Snehan and
Svedan are main modalities that must be used in this situation.
However, since the causative factor is Pitta, fomentation must
be done very carefully. Warm compresses may help in some
patients. Basti treatment using various Pitta-Vata pacifying
herbs such as licorice help a lot. However, acute conditions
must be treated under guidance of a qualified Ayurvedic
physician. For long-term treatment, after doing the Pancha
Karma as explained above, internal treatment with herbs
such as Dhamasa and Kiratatikta are very useful. With all the
above treatments, the causative Doshas are treated and
symptoms are relieved even if the gallstones are still there. If
given sufficient time, gallstones can dissolve and vanish with
appropriate treatment.

Liver diseases pose a great challenge for treatment. Outcome

of the treatment depends on many factors. Even if there are
irreversible changes, Ayurvedic treatment can be very useful
in terms of prolongation of life and to maintain quality of life.

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