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Line 1: + − + − + − + + + + + + + + + + + + + + + + + + + + + − + + + − Ama is an important principle to understand the etiopathogenetic of all disorders and to decide the treatment modalities. [[Agni]] is the digestive and metabolic factor responsible for any transformation in body. Transformation of food material predominantly takes place at the level of gastrointestinal tract ([[grahani]]-seat of jatharagni) and at the level of tissues (dhatvagni-abodes of [[dhatu]]). Dysfunction of [[agni]] results into undigested or partly digested intermediator product called as ama. Ama act as toxic element and form the basis for many pathological conditions. It can be considered raw, uncooked, unripe, immature, undigested or incompletely oxidized / metabolized or similar to a poisonous substance that disrupts body physiology. Accumulation of metabolic waste ([[mala]]) may takes place at various levels in body physiology. The amalgamation of aggravated [[dosha]] with metabolic waste results in ama formation, which is considered the initial stage of disease formation. Origin of ama is mainly considered from gastrointestinal tract ([[amashaya]]). [[Agni]] functions at different levels; hence, ama can be formed at different levels at different body sites. Forms of [[agni]] - jatharagni, bhutagni and dhatvagni functions at different level hence any impairment at the corresponding level leads to ama formation.+ + + + + + + + − Digestion process starts from mouth where mechanical and chemical digestion of food takes place. Thinking, smelling and seeing food secrets saliva, helps in digestion. Component of saliva like water, mucus, electrolytes and enzymes has a unique function. Starch breakdown starts here due to the enzyme in saliva called salivary amylase. Mucus lubricates the food and helps in the formation of bolus in mouth. Small food particles are dissolved by saliva and it makes dry food moist enough to swallow comfortably. If person is not following dietary codes, eating hurriedly without proper mastication, disturbed mental health while taking food will affect this cephalic phase of digestion. It will lead to ama formation due to improper digestion process in mouth. Mastication of food is subjected to condition of teeth. Studies have attempted to find a correlation between tooth loss and nutrition. Deteriorated dental health affects mechanical digestion process and leads to nutritional deficiency.<ref>Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Almas K. The role of nutrition in periodontal health: An Update. Nutrients. 2016 Aug 30;8(9):530. doi: 10.3390/nu8090530. PMID: 27589794; PMCID: PMC5037517. </ref> Another study observed that modifying the mastication rate alters the glycemic index of rice. Its glycemic index classification shows impact of digestion process on the final outcome of food.<ref>Ranawana, V., Leow, M. K.-S., & Henry, C. J. K. (2014). Mastication effects on the glycemic index: impact on variability and practical implications. European Journal of Clinical Nutrition, 68(1), 137–139. https://doi.org/10.1038/ejcn.2013.231</ref>+ + + + + + + + + + + + + + − Health of a person is essentially dependents on healthy gut. Mucosal integrity is more important for proper absorption of nutrient from villi. The intestines also play an essential role in protecting the body from harmful bacteria and toxins. If mucosal integrity is hampered it results into leaky gut syndrome. It affects the lining of intestinal mucosa leading to bacteria and other toxins to pass into the bloodstream. It also leads to the imbalance of gut microbiome.<ref>Gerwyn Morris, Michael Berk, André F. Carvalho, Javier R. Caso, Yolanda Sanz and Michael Maes, “The Role of Microbiota and Intestinal Permeability in the Pathophysiology of Autoimmune and Neuroimmune Processes with an Emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome”, Current Pharmaceutical Design (2016) 22: 6058. https://doi.org/10.2174/1381612822666160914182822</ref> + + + + − This gut leakage and dysbiosis leads to gut inflammation, also disrupt an immune homeostasis. It causes systemic immune activation, neurological disturbances and auto immune diseases. All these predisposing conditions cause ama formation which triggers many complex pathological conditions, act as route cause for many diseases.<ref>Sharma H. Leaky Gut Syndrome, Dysbiosis, Ama, Free Radicals, and Natural Antioxidants. AYU. 2009; 30 (2): 88-105.</ref>+ + − Formation of ama occurs at the level of tissues or cellular level due to impaired metabolism or due to free radical activity. Free radicals are highly reactive atom or molecule which is having one or more unpaired electrons. It always tries to have stability by giving its electron or by acquiring extra electron form adjacent molecules. After providing the electron adjacent molecule becomes unstable and acts as a free radical, a chain reaction sets in to damage many molecules. A higher concentration of free radicals causes damage to the cellular structure like DNA, protein, lipid, and other cell parts. It causes disturbance in homeostasis of body leading to disease condition.<ref>Sharma GN, Gupta G, Sharma P. A Comprehensive Review of Free Radicals, Antioxidants, and Their Relationship with Human Ailments. Crit Rev Eukaryot Gene Expr. 2018;28(2):139-154. doi:10.1615/CritRevEukaryotGeneExpr.2018022258</ref>+ + − + + − '''Metabolic waste functions as ama''': Tissue nutrients after action of metabolism (dhatvagni) nourishes body tissues and part is formed as excretory product ([[mala]]). Accumulation of this metabolic waste beyond certain limits disrupts the [[dosha]] hemostasis, leads to formation of ama. Depending on the type of metabolic waste and predominance of [[dosha]] exhibits many diseases.+ + + + + + + + + + + + − + − *[[Trividhakukshiya Vimana]] − *[[Matrashiteeya Adhyaya]] − *[[Rasa Vimana]] − *[[Sharira Vichaya Sharira]] − *[[Grahani Chikitsa]] − *[[Ahara vidhi]] − Page under construction+ + + + + + + +
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|title=Ama
|title=Ama (undigested, non-metabolized, poorly formed product or state)
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|keywords=carakasamhitaonline, charak samhita, caraka samhita, ayurved, Ama, Ama in ayurveda, Ama meaning, Contemporary views and research updates on ama, Metabolic waste functions as ama
|keywords=carakasamhitaonline, charak samhita, caraka samhita, ayurved, Ama, Ama in ayurveda, Ama meaning, Contemporary views and research updates on ama, Metabolic waste functions as ama
|description=Ama means the undigested and unmetabolized components present in the body
|description=Ama is a state of or products formed due to incomplete digestion, metabolism, or transformation.
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
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<p style='text-align:justify;'>Ama means the undigested and unmetabolized components present in the body. More information on concept of ama can be read [[Trividhakukshiya_Vimana#Concept_of_ama|here]]. </p>
<p style='text-align:justify;'>Ama is a state of or products formed due to incomplete digestion, metabolism, or transformation. Agni (digestion and metabolism) is a factor responsible for changing the state of a substance. In human biology, the digestion and metabolic processes convert food and other substances into compatible and nourishing body components. If these processes are incomplete, poor or slow, then the final products formed are of poor quality. Agni is one of the most important factors responsible for health (prakrita) abnormalities, and diseases (vikriti). Life span, strength, health, and immunity all depends on agni. [Cha. Sa. Chikitsa Sthana 15/03] If agni is disturbed, then proper digestion does not occur which results in improperly transformed food/metabolites are termed as ‘Ama’. [A. H. Sutra Sthana 13/25] The concept of ama in ayurveda is very important in pathogenesis of disease. One of the synonyms of vyadhi (disease) is “aamaya” which means caused by ama. [Cha. Sa. Nidana Sthana 1/05] Classification of stages of diseases (vyadhi) is based on the presence and absence of ama i.e., sa-ama avastha (stage associated with ama) and nirama avastha (stage not associated with ama). The treatment protocol also depends on stages of ama such as in diarrhoea associated with ama(ama-atisara), styptic therapy (stambhana) is contraindicated. Whereas, in the diarrhoea without ama (nirama stage) / or chronic diarrhoea (jeerna atisara), styptinc therapy (stambhana) is advised. Thus, concept of ama is significant in understanding the etiopathogenesis, diagnosis as well as treatment of diseases. This chapter describes concept of ama with its contemporary views and researches done on it.</p>
{{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = Concepts & Practices/[[Ama]]
|label2 = Authors
|data2 = Dubey M.<sup>1</sup>,<br/>Deole Y.S.<sup>2</sup>
|label3 = Reviewer & Editor
|data3 = Basisht G.<sup>3</sup>,
|label4 = Affiliations
|data4 = <sup>1</sup>[[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India <br/><sup>2</sup>Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India<br/><sup>3</sup>Rheumatologist, Orlando, Florida, U.S.A.
|label5 = Correspondence emails
|data5 = [mailto:dr.manish181@gmail.com dr.manish181@gmail.com], <br/>[mailto:dryogeshdeole@gmail.com dryogeshdeole@gmail.com], <br/>
[mailto:carakasamhita@gmail.com carakasamhita@gmail.com]
|label6 = Publisher
|data6 = [[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India
|label7 = Date of publication:
|data7 = August 01, 2023
|label9 = DOI
|data9 = {{DoiWithLink}}
}}
== Current research updates ==
== Etymology (nirukti) ==
<ol style='text-align:justify;'><li style="font-weight:bold"><i>Aamyate ishat pachyate: </i><span style="font-weight:normal">It means the product formed due to poor or improper digestion(apurna paka or paka rahita or alpa paka).<ref name="ref1"></ref></span></li>
<li style="font-weight:bold"><i>Soannajo rasa iti amah, annarasasyo va apakvasya tanyantare aam vyapdeshat:</i> <span style="font-weight:normal">Ama is originated from the food. If the initial product of food after digestion (annarasa) is not properly formed, then the outcome of such digestion is known as ama.<ref name="ref2"></ref></span></li></ol>
== Definition ==
<ol style='text-align:justify;'><li>Weak digestive factors (jatharagni) cause poor digestion (avipaka) of rasa (primary product of digested food). This poorly formed product is called ‘ama’. This is the cause for vitiation of all dosha (aggravation of all dosha). [Cha. Sa. Chikitsa Sthana 15/44]</li>
<li>Ama is the root cause for almost all the diseases.<ref name="ref2"/></li>
<li>Ama is the first component formed due to weak digestive processes. It is in amashaya (site of storage of food in intermediary stage of digestion and metabolism). [A. H. Sutra Sthana. 13/25]</li>
<li>Ama is the component formed during digestion of food.<ref name="ref2"/></li>
<li>The first state of vitiated dosha is called ‘ama’.<ref name="ref2"/></li>
<li>The byproducts of metabolism if not properly eliminated or utilized in the body are considered as ama.<ref name="ref2"/></li>
<li>The uncooked food (or annarasa) if, retained for longer time in stomach undergoes fermentation/putrefaction, this state of rasa is ama. This ama further joined with dosha is termed as amadosha. It is as toxic as visha (poison) produced by spoiled kodrava (Paspalum scrobiculatum L., Italian millet contaminated by fungus). [A. H. Sutra Sthana 13/26-27]</li></ol>
== Causes ==
<p style='text-align:justify;'>Impairment of agni (digestive process) due to following reasons causes ama.
* Fasting or not taking food (abhojana)
* Indigestion (ajirna)
* Intake of excessive quantity of food (atibhojana)
* Intake of unequal proportion of food (vishama bhojana)
* Taking incompatible or non-habitual food (asatmya bhojana)
* Intake of heavy, cold, excessively dry food products
* Untoward effects of improper virechana (purgation), vamana (emesis), snehana (oleation)
* Depletion of body tissues by chronic diseases
* Changes in climate/season
* Suppression of natural urges (vegadharana) [Cha. Sa. Chikitsa Sthana 15/42-44]
* Food with qualities such as heavy to digest (guru), dry (ruksha), cold (sheeta), dried/dehydrated (shushka), disliked by consumer (dvishta), constipation-causing (vishtambhi), those causing burning sensation (vidahi), unclean (ashuchi), incompatible food intake (viruddha anna), consumed untimely (akala bhojana)
* Mental status while taking food: Intake of food when mind is affected by desires (kama), anger (krodha), greed (lobha), infatuation (moha), envy (irshya), shame (hri), grief (shoka), conceit (maana), anxiety (udvega), fear (bhaya), etc. [Cha.Sa. Vimana Sthana 2/8] </p>
== Diseases caused by ama ==
<p style='text-align:justify;'>The undigested food gets fermented (shuktata) leading to onset of toxic symptoms. [Cha. Sa. Chikitsa Sthana 15/42-44] Ama further leads to various digestive disorders like amajirna (indigestion due to saama pitta), vishtabdhajirna (indigestion due to saama vata), vidagdha ajirna (indigestion due to saama kapha), visuchika (non-infectious gastroenteritis), alasaka (sluggish bowels), vilambika (gastro-intestinal stasis). [Su. Sa. Uttara Sthana 56/3] The diseases caused by ama at various dhatu level are jwara (fever), atisara (diarrhoea), pravahika (dysentery), etc. The chronic conditions caused by ama are such as grahini-dosha (functional impairment of agni), udara roga (ascites and abdominal enlargement), yakrit vyadhi (liver disorders), jalodara (ascites), shotha (oedema), pandu (anemia), prameha (obstinate urinary disease), amavata (rheumatism), etc.
<br/>The acidic nature (amla bhava) of undigested food (apakva anna) is called as suktata (acidic /sour nature of undigested food) which further acts like a visha (poison) that will further produce number of other diseases, so this can be compared to symptoms of amavisha.<ref name="ref3"></ref> This uncooked food further combines with dosha (regulatory functional factors of the body), dhatu (major structural components of the body) or mala (metabolic waste or byproducts) and produces their respective symptoms accordingly. [Cha. Sa. Chikitsa Sthana 15/46-49]
<br/>When ama combines with pitta dosha, it produces pitta dominant diseases such as burning sensation (daha), thirst (pipasa), diseases of oral cavity (mukha roga), hyperacidity (amlapitta) etc. When it combines with kapha dosha, it produces kapha dominant diseases such as rajayakshma (consumption), pinasa (chronic rhinitis), prameha (obstinate urinary disease), etc. When combines with vata dosha, it produces different types of vata dominant diseases. When combines with mutra (urine) or gets lodged in mutravaha srotasa (urinary tract), to produce mutra roga such as mutrakrichhra (dysuria), mutraghata (urinary retention), prameha (obstinate urinary disease), etc. When combines with purisha (feces) produces diseases of kukshi (pelvis) or udara roga (diseases of abdomen). When combines with rasa etc. dhatu (seven major structural components of the body), then produces their respective diseases.</p>
== Premonitory features (ama purvarupa) ==
<p style='text-align:justify;'>Purvarupa (prodromal symptoms) of ama in general are, such as stiffness of body, anorexia, excessive sleep, pallor, dullness and especially irritation to food or playing activities in case of children. [Ka. Sa. Sutra Sthana 25/32-33]</p>
== Characteristics of ama ==
<p style='text-align:justify;'>Ama possesses characteristics such as liquid (drava), heavy (guru), attains different colors, slimy (snigdha), viscid (pichchila), thready (tantumatva), foul smelling (durgandhi). Ama is etiological factor of all diseases and produces symptoms such as various types of pain (shoola), obstructs channels (srotorodhaka), undigested (avipakva), lethargic (sadanakaraka), etc.<ref name="ref4"></ref></p>
Ama formation occurs due to the accumulation of toxic or intermediate product of metabolism in the body termed as mala. These intermediate products are formed due to defect in the metabolism of protein, carbohydrate or lipid. Excessive uric acid is formed due to improper metabolism of protein which is hazardous to body tissue and joint structure. Lactic acid, acetone and ketone bodies are formed due to improper metabolism of carbohydrate and fats. Lack of insulin activity defunct carbohydrate metabolism and leads to formation of intermediate products in the body. This intermediate products act as ama and leads to many disease conditions.
== Clinical features of dosha (saama dosha) and dhatu (saama dhatu) associated with ama ==
<p style='text-align:justify;'>Ama state of dosha or dhatu is termed as a saama dosha or saama dhatu respectively. These manifest different symptoms and produces number of diseases. [A. H. Sutra Sthana 13/26-27]</p>
=== These produce general features of saama and nirama state as below: ===
Blockage or clogging of srotasa (channels)
* Loss of strength
* Feeling of heaviness
* Improper functions of vata dosha
* Accumulation of mala (metabolic wastes)
* Lethargy
* Low digestive capacity
* Excessive salivation
* Retention of mala (waste products)
* Aversion towards food and tiredness. [A. H. Sutra Sthana 13/23-24]
In case of state without ama (nirama), the opposite of above features are observed.
== Related chapters ==
== Saama and nirama features of dosha, dhatu and mala ==
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