Langhanabrimhaniya Adhyaya

Sutra Sthana Chapter 22. Reduction and nourishing therapies

Langhanabrimhaniya Adhyaya

Section/Chapter	Sutra Sthana Chapter 22
Tetrad/Sub-section	Yojana Chatushka
Preceding Chapter	Ashtauninditiya Adhyaya
Succeeding Chapter	Santarpaniya Adhyaya
Other Sections	Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator	Murthy K.N., Deole Y. S.
Reviewer	Byadgi P.S.
Editors	Dwivedi R.B., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s01.024

Abstract

In continuation with the earlier chapter, the main course of treatments for the morbidly obese and the extremely thin/skinny/emaciated persons are described in this chapter. Ayurvedic therapeutics are categorized broadly under two categories like reducing (Apatarpana) or nourishing (Santarpana); It is further classified into six types: Langhana (Fasting, reducing), Brimhana (nourishing), Rukshana (drying), Stambhana (astringent/styptic), Snehana (oleation), and Swedana (sudation). Besides providing insights into these therapeutic measures, this chapter also describes specific advantages of these therapeutic procedures, pharmacological actions of properties and their indications in detail. The features of optimally administered techniques while understanding the consequences of their over and under-application are also included.

Keywords: Ayurvedic therapeutics, Santarpana(nourishing), Apatarpana(reducing), Langhana (fasting/reducing), Brimhana(nourishing), Snehana(oleation), Swedana(sudation), Stambhana(astringent/styptic), Rukshana(drying).

Introduction

In the earlier chapter on eight undesirable body features, the focus of the study was on two of the most undesirable kinds - sthula (obesity) and krisha (too thin/skinny/emaciated). The present chapter deals with types of treatments suitable for both conditions as well as other similar pathologies. There are four types of pathologies described in Ayurveda: atipravritti(excessive elimination), sanga (obstruction), sira granthi(tumor/varicosity), and vimarga gamana(improperly directed circulation). A disease could be of any of these four pathology types, but its affliction could manifest in different forms depending upon the unique body constitution of the patient and combination of dosha, dhatu, mala, etc., explained in prior chapters. To tackle such afflictions, Ayurveda describes six types of therapeutic measures: Langhana(reduction), Brimhana (nourishing), Rukshana (drying), Stambhana (astringent/styptic),Snehana (oleation), and Swedana (sudation). In the case of excessive discharge of anything from the body, Stambhana (a procedure that slows or stops the discharge) is advised. While in the case of obstructions,Langhana, Swedana, or Rukshana are advised. In cases of excessively vitiated dosha, Langhana (reducing therapy) is indicated to bring the elevated dosha to a state of equilibrium, whereas in a case of degeneration, Brimhana(nourishing therapy) and Snehana (oleation) are prescribed. The Snehana and Swedana therapies are described in detail in thirteenth and fourteenth chapters of this section respectively. This chapter describes remaining four therapies , i.e.,Langhana, Brimhana, Stambhana, and Rukshana.

Sanskrit text, Transliteration and English Translation

अथातो लङ्घनबृंहणीयमध्यायं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः||२||

athātō laṅghanabr̥ṁhaṇīyamadhyāyaṁ vyākhyāsyāmaḥ ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAto la~gghanabRuMhaNIyamadhyAyaM vyAkhyAsyAmaH ||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter “Langhanabrimhaniya" (Reducing and nourishing therapies). Thus said Lord Atreya. [1-2]

Six types of therapies

तपःस्वाध्यायनिरतानात्रेयः शिष्यसत्तमान्|

षडग्निवेशप्रमुखानुक्तवान् परिचोदयन्||३||

लङ्घनं बृंहणं काले रूक्षणं स्नेहनं तथा|

स्वेदनं स्तम्भनं चैव जानीते यः स वै भिषक्||४||

तमुक्तवन्तमात्रेयमग्निवेश उवाच ह||५||

भगवँल्लङ्घनं किंस्विल्लङ्घनीयाश्च कीदृशाः|

बृंहणं बृंहणीयाश्च रूक्षणीयाश्च रूक्षणम्||६||

के स्नेहाः स्नेहनीयाश्च स्वेदाः स्वेद्याश्च के मताः|

स्तम्भनं स्तम्भनीयाश्च वक्तुमर्हसि तद्गुरो!||७||

लङ्घनप्रभृतीनां च षण्णामेषां समासतः|

कृताकृतातिवृत्तानां लक्षणं वक्तुमर्हसि||८||

tapaḥsvādhyāyaniratānātrēyaḥ śiṣyasattamān|

ṣaḍagnivēśapramukhānuktavān paricōdayan||3||

laṅghanaṁ br̥ṁhaṇaṁ kālē rūkṣaṇaṁ snēhanaṁ tathā|

svēdanaṁ stambhanaṁ caiva jānītē yaḥ sa vai bhiṣak||4||

tamuktavantamātrēyamagnivēśa uvāca ha||5||

bhagavamँllaṅghanaṁ kiṁsvillaṅghanīyāśca kīdr̥śāḥ|

br̥ṁhaṇaṁ br̥ṁhaṇīyāśca rūkṣaṇīyāśca rūkṣaṇam||6||

kē snēhāḥ snēhanīyāśca svēdāḥ svēdyāśca kē matāḥ|

stambhanaṁ stambhanīyāśca vaktumarhasi tadgurō!||7||

laṅghanaprabhr̥tīnāṁ ca ṣaṇṇāmēṣāṁ samāsataḥ|

kr̥tākr̥tātivr̥ttānāṁ lakṣaṇaṁ vaktumarhasi||8||

tapaHsvAdhyAyaniratAnAtreyaH shiShyasattamAn|

ShaDagniveshapramukhAnuktavAn paricodayan||3||

la~gghanaM bRuMhaNaM kAle rUkShaNaM snehanaM tathA|

svedanaM stambhanaM caiva jAnIte yaH sa vai bhiShak||4||

tamuktavantamAtreyamagnivesha uvAca ha||5||

bhagava@mlla~gghanaM kiMsvilla~gghanIyAshca kIdRushAH|

bRuMhaNaM bRuMhaNIyAshca rUkShaNIyAshca rUkShaNam||6||

ke snehAH snehanIyAshca svedAH svedyAshca ke matAH|

stambhanaM stambhanIyAshca vaktumarhasi tadguro!||7||

la~gghanaprabhRutInAM ca ShaNNAmeShAM samAsataH|

kRutAkRutAtivRuttAnAM lakShaNaM vaktumarhasi||8||

To initiate a discussion, Lord Atreya addressed to his six disciples, who are dedicated to a life of penance and learning and who are led by Agnivesha, “He indeed is the true physician who knows the timely use of therapies to produce lightness, strength, dryness, unctuous, sweating and astringent effects.” Once Lord Atreya had spoken, Agnivesha asked the following questions, “O Thou, our worshipful preceptor, Sir, what are the therapies that are Langhana (reducing), Brimhana (nourishing), Rukshana (dryness-causing), Snehana (oleation) and, Swedana (sudation), and Stambhana (astringent/styptic)? Who are fit for this, O beloved teacher? You may kindly tell us all about them, and you may also tell briefly about the symptoms of proper application, improper application, and over-application of these six therapies.” [3-8]

Definitions

तदग्निवेशस्य वचो निशम्य गुरुरब्रवीत्|

यत् किञ्चिल्लाघवकरं देहे तल्लङ्घनं स्मृतम्||९||

बृहत्त्वं यच्छरीरस्य जनयेत्तच्च बृंहणम्|

रौक्ष्यं खरत्वं वैशद्यं यत् कुर्यात्तद्धि रूक्षणम्||१०||

स्नेहनं स्नेहविष्यन्दमार्दवक्लेदकारकम् |

स्तम्भगौरवशीतघ्नं स्वेदनं स्वेदकारकम्||११||

स्तम्भनं स्तम्भयति यद्गतिमन्तं चलं ध्रुवम्|

tadagnivēśasya vacō niśamya gururabravīt|

yat kiñcillāghavakaraṁ dēhē tallaṅghanaṁ smr̥tam||9||

br̥hattvaṁ yaccharīrasya janayēttacca br̥ṁhaṇam|

raukṣyaṁ kharatvaṁ vaiśadyaṁ yat kuryāttaddhi rūkṣaṇam||10||

snēhanaṁ snēhaviṣyandamārdavaklēdakārakam |

stambhagauravaśītaghnaṁ svēdanaṁ svēdakārakam||11||

stambhanaṁ stambhayati yadgatimantaṁ calaṁ dhruvam|

tadagniveshasya vaco nishamya gururabravIt|

yat ki~jcillAghavakaraM dehe talla~gghanaM smRutam||9||

bRuhattvaM yaccharIrasya janayettacca bRuMhaNam|

raukShyaM kharatvaM vaishadyaM yat kuryAttaddhi rUkShaNam||10||

snehanaM snehaviShyandamArdavakledakArakam |

stambhagauravashItaghnaM svedanaM svedakArakam||11||

stambhanaM stambhayati yadgatimantaM calaM dhruvam|

Hearing these words of Agnivesha, the mentor (Atreya) explained the therapies thus.

• Whatever produces lightness or reduction in the body is known as Langhana (reducing/lightening) therapy.
• Whatever increases the bulk of the body and makes it strong is known as Brimhana (nourishing therapy).
• Rukshana(dryness causing) therapy is that which causes dryness, roughness, and coarseness.
• Whatever moisturizes and smoothens, causes unction, fluidity, and ooziness is called Snehana (oleation) therapy.
• Swedana (sudation) therapy is that which produces sweat, abolishes rigidity, heaviness, and coldness.

The therapy which results in inhibition of mobility and flow of bodily substances and stabilizes is called Stambhana (astringent or styptic therapy). [9-11]

Pharmaco-therapeutic properties behind these effects

लघूष्णतीक्ष्णविशदं रूक्षं सूक्ष्मं खरं सरम्||१२||

कठिनं चैव यद्द्रव्यं प्रायस्तल्लङ्घनं स्मृतम्|

गुरु शीतं मृदु स्निग्धं बहलं स्थूलपिच्छिलम्||१३||

प्रायो मन्दं स्थिरं श्लक्ष्णं द्रव्यं बृंहणमुच्यते|

रूक्षं लघु खरं तीक्ष्णमुष्णं स्थिरमपिच्छिलम्||१४||

प्रायशः कठिनं चैव यद्द्रव्यं तद्धि रूक्षणम्|

द्रवं सूक्ष्मं सरं स्निग्धं पिच्छिलं गुरु शीतलम्|

प्रायो मन्दं मृदु च यद्द्रव्यं तत्स्नेहनं मतम्||१५||

उष्णं तीक्ष्णं सरं स्निग्धं रूक्षं सूक्ष्मं द्रवं स्थिरम्|

द्रव्यं गुरु च यत् प्रायस्तद्धि स्वेदनमुच्यते||१६||

शीतं मन्दं मृदु श्लक्ष्णं रूक्षं सूक्ष्मं द्रवं स्थिरम्|

यद्द्रव्यं लघु चोद्दिष्टं प्रायस्तत् स्तम्भनं स्मृतम्||१७||

laghūṣṇatīkṣṇaviśadaṁ rūkṣaṁ sūkṣmaṁ kharaṁ saram||12||

kaṭhinaṁ caiva yaddravyaṁ prāyastallaṅghanaṁ smr̥tam|

guru śītaṁ mr̥du snigdhaṁ bahalaṁ sthūlapicchilam||13||

prāyō mandaṁ sthiraṁ ślakṣṇaṁ dravyaṁ br̥ṁhaṇamucyatē|

rūkṣaṁ laghu kharaṁ tīkṣṇamuṣṇaṁ sthiramapicchilam||14||

prāyaśaḥ kaṭhinaṁ caiva yaddravyaṁ taddhi rūkṣaṇam|

dravaṁ sūkṣmaṁ saraṁ snigdhaṁ picchilaṁ guru śītalam|

prāyō mandaṁ mr̥du ca yaddravyaṁ tatsnēhanaṁ matam||15||

uṣṇaṁ tīkṣṇaṁ saraṁ snigdhaṁ rūkṣaṁ sūkṣmaṁ dravaṁ sthiram|

dravyaṁ guru ca yat prāyastaddhi svēdanamucyatē||16||

śītaṁ mandaṁ mr̥du ślakṣṇaṁ rūkṣaṁ sūkṣmaṁ dravaṁ sthiram|

yaddravyaṁ laghu cōddiṣṭaṁ prāyastat stambhanaṁ smr̥tam||17||

laghUShNatIkShNavishadaM rUkShaM sUkShmaM kharaM saram||12||

kaThinaM caiva yaddravyaM prAyastalla~gghanaM smRutam|

guru shItaM mRudu snigdhaM bahalaM sthUlapicchilam||13||

prAyo mandaM sthiraM shlakShNaM dravyaM bRuMhaNamucyate|

rUkShaM laghu kharaM tIkShNamuShNaM sthiramapicchilam||14||

prAyashaH kaThinaM caiva yaddravyaM taddhi rUkShaNam|

dravaM sUkShmaM saraM snigdhaM picchilaM guru shItalam|

prAyo mandaM mRudu ca yaddravyaM tatsnehanaM matam||15||

uShNaM tIkShNaM saraM snigdhaM rUkShaM sUkShmaM dravaM sthiram|

dravyaM guru ca yat prAyastaddhi svedanamucyate||16||

shItaM mandaM mRudu shlakShNaM rUkShaM sUkShmaM dravaM sthiram|

yaddravyaM laghu coddiShTaM prAyastat stambhanaM smRutam||17||

• The drug or substance that possesses light, hot, sharply acting, clearing, dry, minute (subtle), rough, flowing (unstable) and hard qualities are used for langhana.
• The drug or substance that is used for brimhana (nourishing) therapy possesses heavy, cold, soft, unctuous, thick, gross, slimy, sluggish, stable and smooth qualities.
• The drug or substance that possesses dry, light, rough, sharply acting, hot, stable, non-slimy and primarily hard qualities is used for rukshana (drying) therapy.
• Snehana (oleation) therapy requires the drug or substance that possess liquid, minute (subtle), flowing (unstable), unctuous, slimy, heavy, cold, sluggish and soft qualities.
• The drug or substance that is used for swedana (sudation) therapy possesses hot, acute, flowing (unstable), unctuous, dry, minute (subtle), liquid, stable and heavy qualities.
• Finally,stambhana requires the drugs to possess cold, sluggish, soft, smooth, dry, minute (subtle), liquid, stable and light qualities. [12-17]

Langhana (reducing or lightening) therapy

Methods of langhana (reducing/lightening) therapy

चतुष्प्रकारा संशुद्धिः पिपासा मारुतातपौ|

पाचनान्युपवासश्च व्यायामश्चेति लङ्घनम्||१८||

catuṣprakārā saṁśuddhiḥ pipāsā mārutātapau|

pācanānyupavāsaśca vyāyāmaścēti laṅghanam||18||

catuShprakArA saMshuddhiH pipAsA mArutAtapau|

pAcanAnyupavAsashca vyAyAmashceti la~gghanam||18||

The four purification therapies viz. vamana (emesis), virechana (purgation), Niruha basti (non-unctuous enema) and Nasya (nasal drug administration). Six other procedures viz. pipasa (control of thirst), maruta (exposure to wind/breathing exercises), aatapa (exposure to sunlight), pachana (applications of digestive measures), upawasa (fasting) and vyayama (exercise) are the ten methods of langhana (reducing) therapy. [18]

Indications of langhana

प्रभूतश्लेष्मपित्तास्रमलाः संसृष्टमारुताः| बृहच्छरीरा बलिनो लङ्घनीया विशुद्धिभिः||१९||

येषां मध्यबला रोगाः कफपित्तसमुत्थिताः| वम्यतीसारहृद्रोगविसूच्यलसकज्वराः||२०||

विबन्धगौरवोद्गारहृल्लासारोचकादयः| पाचनैस्तान् भिषक् प्राज्ञः प्रायेणादावुपाचरेत्||२१||

एत एव यथोद्दिष्टा येषामल्पबला गदाः| पिपासानिग्रहैस्तेषामुपवासैश्च ताञ्जयेत्||२२||

रोगाञ्जयेन्मध्यबलान् व्यायामातपमारुतैः| बलिनां किं पुनर्येषां रोगाणामवरं बलम्||२३||

त्वग्दोषिणां प्रमीढानां स्निग्धाभिष्यन्दिबृंहिणाम्| शिशिरे लङ्घनं शस्तमपि वातविकारिणाम्||२४||

prabhūtaślēṣmapittāsramalāḥ saṁsr̥ṣṭamārutāḥ| br̥haccharīrā balinō laṅghanīyā viśuddhibhiḥ||19||

yēṣāṁ madhyabalā rōgāḥ kaphapittasamutthitāḥ| vamyatīsārahr̥drōgavisūcyalasakajvarāḥ||20||

vibandhagauravōdgārahr̥llāsārōcakādayaḥ| pācanaistān bhiṣak prājñaḥ prāyēṇādāvupācarēt||21||

ēta ēva yathōddiṣṭā yēṣāmalpabalā gadāḥ| pipāsānigrahaistēṣāmupavāsaiśca tāñjayēt||22||

rōgāñjayēnmadhyabalān vyāyāmātapamārutaiḥ| balināṁ kiṁ punaryēṣāṁ rōgāṇāmavaraṁ balam||23||

tvagdōṣiṇāṁ pramīḍhānāṁ snigdhābhiṣyandibr̥ṁhiṇām| śiśirē laṅghanaṁ śastamapi vātavikāriṇām||24||

prabhUtashleShmapittAsramalAH saMsRuShTamArutAH| bRuhaccharIrA balino la~gghanIyA vishuddhibhiH||19||

yeShAM madhyabalA rogAH kaphapittasamutthitAH| vamyatIsArahRudrogavisUcyalasakajvarAH||20||

vibandhagauravodgArahRullAsArocakAdayaH| pAcanaistAn bhiShak prAj~jaH prAyeNAdAvupAcaret||21||

eta eva yathoddiShTA yeShAmalpabalA gadAH| pipAsAnigrahaisteShAmupavAsaishca tA~jjayet||22||

rogA~jjayenmadhyabalAn vyAyAmAtapamArutaiH| balinAM kiM punaryeShAM rogANAmavaraM balam||23||

tvagdoShiNAM pramIDhAnAM snigdhAbhiShyandibRuMhiNAm| shishire la~gghanaM shastamapi vAtavikAriNAm||24||

Those who are suffering from excessive vitiation of kapha, pitta,blood and waste products, are afflicted with obstructed vata and who have bulky and strong bodies should be treated using shodhana (purificatory) procedures of Langhana.

Those who are suffering from diseases caused by moderate increase of kapha and pitta such as vomiting, diarrhea, heart disease, acute intestinal irritation (cholera), intestinal sluggishness (alasaka), fever, constipation, heaviness of body, eructation, nausea, anorexia and similar conditions should first be treated with applications of digestive measures by wise physician.

Above mentioned diseases, with mild intensity, should be mitigated by the restraint from food and drink (fasting and control of thirst).

In a strong person with diseases of moderate intensity, any treatment measure should include physical exercise and exposure to sunlight and the wind. Further, strong patients suffering from mild disease or a little imbalance of dosha should be treated in the same manner i.e. exercise and exposure to the sun and the wind.

Those who are suffering from skin disorders, urinary disorders, those consuming excess of unctuous food, with excess discharges in the body and undergone excess nourishing therapy should be treated with langhana therapy. In a season of shishira (winter), langhana is suitable for patients with vata-dominant disorders also (in addition to above). [19-24]

Brimhana (nourishing) therapy

अदिग्धविद्धमक्लिष्टं वयस्थं सात्म्यचारिणाम्|

मृगमत्स्यविहङ्गानां मांसं बृंहणमुच्यते||२५||

क्षीणाः क्षताः कृशा वृद्धा दुर्बला नित्यमध्वगाः|

स्त्रीमद्यनित्या ग्रीष्मे च बृंहणीया नराः स्मृताः||२६||

शोषार्शोग्रहणीदोषैर्व्याधिभिः कर्शिताश्च ये|

तेषां क्रव्यादमांसानां बृंहणा लघवो रसाः||२७||

स्नानमुत्सादनं स्वप्नो मधुराः स्नेहबस्तयः|

शर्कराक्षीरसर्पींषि सर्वेषां विद्धि बृंहणम्||२८||

adigdhaviddhamakliṣṭaṁ vayasthaṁ sātmyacāriṇām|

mr̥gamatsyavihaṅgānāṁ māṁsaṁ br̥ṁhaṇamucyatē||25||

kṣīṇāḥ kṣatāḥ kr̥śā vr̥ddhā durbalā nityamadhvagāḥ|

strīmadyanityā grīṣmē ca br̥ṁhaṇīyā narāḥ smr̥tāḥ||26||

śōṣārśōgrahaṇīdōṣairvyādhibhiḥ karśitāśca yē|

tēṣāṁ kravyādamāṁsānāṁ br̥ṁhaṇā laghavō rasāḥ||27||

snānamutsādanaṁ svapnō madhurāḥ snēhabastayaḥ|

śarkarākṣīrasarpīṁṣi sarvēṣāṁ viddhi br̥ṁhaṇam||28||

adigdhaviddhamakliShTaM vayasthaM sAtmyacAriNAm|

mRugamatsyaviha~ggAnAM mAMsaM bRuMhaNamucyate||25||

kShINAH kShatAH kRushA vRuddhA durbalA nityamadhvagAH|

strImadyanityA grIShme ca bRuMhaNIyA narAH smRutAH||26||

shoShArshograhaNIdoShairvyAdhibhiH karshitAshca ye|

teShAM kravyAdamAMsAnAM bRuMhaNA laghavo rasAH||27||

snAnamutsAdanaM svapno madhurAH snehabastayaH|

sharkarAkShIrasarpIMShi sarveShAM viddhi bRuMhaNam||28||

The meat of adult (mature) animals, fish, and birds which are found roaming in their suitable natural surroundings, which are healthy (or disease-free) and have not been killed by poisonous weapons and is unspoiled, is considered to be ideal for brimhana(nourishing therapy).

The persons requiring such therapy are those suffering from wasting of the body, wounded, consumptive, emaciated, old, weak, weary of long journeys, and excessively indulged in sexual intercourse, alcohol addiction, and for all persons in the summer season.

Light to digest soup made up of meat of carnivorous animals and birds is nourishing to persons who have been weakened due to diseases such as consumption, piles, assimilation disorders (grahani dosha), or have been wasted by other (similar) diseases.

Bath, unction, sleep, medicated enema with sweet drugs, unctuous enema, sugar mixed milk, and ghee are considered ideal for brimhana (nourishing). [25-28]

Rukshana (drying) therapy

कटुतिक्तकषायाणां सेवनं स्त्रीष्वसंयमः|

खलिपिण्याकतक्राणां मध्वादीनां च रूक्षणम्||२९||

अभिष्यण्णा महादोषा मर्मस्था व्याधयश्च ये|

ऊरुस्तम्भप्रभृतयो रूक्षणीया निदर्शिताः||३०||

स्नेहाः स्नेहयितव्याश्च स्वेदाः स्वेद्याश्च ये नराः|

स्नेहाध्याये मयोक्तास्ते स्वेदाख्ये च सविस्तरम्||३१||

kaṭutiktakaṣāyāṇāṁ sēvanaṁ strīṣvasaṁyamaḥ|

khalipiṇyākatakrāṇāṁ madhvādīnāṁ ca rūkṣaṇam||29||

abhiṣyaṇṇā mahādōṣā marmasthā vyādhayaśca yē|

ūrustambhaprabhr̥tayō rūkṣaṇīyā nidarśitāḥ||30||

snēhāḥ snēhayitavyāśca svēdāḥ svēdyāśca yē narāḥ|

snēhādhyāyē mayōktāstē svēdākhyē ca savistaram||31||

kaTutiktakaShAyANAM sevanaM strIShvasaMyamaH|

khalipiNyAkatakrANAM madhvAdInAM ca rUkShaNam||29||

abhiShyaNNA mahAdoShA marmasthA vyAdhayashca ye|

UrustambhaprabhRutayo rUkShaNIyA nidarshitAH||30||

snehAH snehayitavyAshca svedAH svedyAshca ye narAH|

snehAdhyAye mayoktAste svedAkhye ca savistaram||31||

Regular use of substances having pungent, bitter and astringent tastes, indulgence in women, use of oil-cakes of mustard and tila(sesame), buttermilk, honey and similar things tend to induce dryness.

Rukshana is indicated in diseases caused by blocking of bodily channels by excess discharges or in cases of greater morbidity of dosha diseases of vital organs, in stiffening of thighs (urustambha), and in similar conditions. Unctuousness, persons suitable for oleation therapy, and suitable for sudation therapy have been described in detail in earlier chapters concerned. [29-31]

Stambhana (astringent/styptic) therapy

द्रवं तन्वसरं यावच्छीतीकरणमौषधम्|

स्वादु तिक्तं कषायं च स्तम्भनं सर्वमेव तत्||३२||

पित्तक्षाराग्निदग्धा ये वम्यतीसारपीडिताः|

विषस्वेदातियोगार्ताः स्तम्भनीया निदर्शिताः||३३||

dravaṁ tanvasaraṁ yāvacchītīkaraṇamauṣadham|

svādu tiktaṁ kaṣāyaṁ ca stambhanaṁ sarvamēva tat||32||

pittakṣārāgnidagdhā yē vamyatīsārapīḍitāḥ|

viṣasvēdātiyōgārtāḥ stambhanīyā nidarśitāḥ||33||

dravaM tanvasaraM yAvacchItIkaraNamauShadham|

svAdu tiktaM kaShAyaM ca stambhanaM sarvameva tat||32||

pittakShArAgnidagdhA ye vamyatIsArapIDitAH|

viShasvedAtiyogArtAH stambhanIyA nidarshitAH||33||

All the drugs that are characterized by liquid, thin, stable, cold properties and possessing sweet, bitter and astringent tastes are used for Stambhana (astringent/styptic) therapy. Stambhana is indicated in patients afflicted with pitta, burned with kshara (alkali) and fire, those who are afflicted with vomiting, diarrhea, and those who are suffering from complications of excess sudation and poisoning. [32-33]

Signs of adequate and excess langhana

वातमूत्रपुरीषाणां विसर्गे गात्रलाघवे|

हृदयोद्गारकण्ठास्यशुद्धौ तन्द्राक्लमे गते||३४||

स्वेदे जाते रुचौ चैव क्षुत्पिपासासहोदये|

कृतं लङ्घनमादेश्यं निर्व्यथे चान्तरात्मनि||३५||

पर्वभेदोऽङ्गमर्दश्च कासः शोषो मुखस्य च|

क्षुत्प्रणाशोऽरुचिस्तृष्णा दौर्बल्यं श्रोत्रनेत्रयोः||३६||

मनसः सम्भ्रमोऽभीक्ष्णमूर्ध्ववातस्तमो हृदि|

देहाग्निबलनाशश्च लङ्घनेऽतिकृते भवेत्||३७||

vātamūtrapurīṣāṇāṁ visargē gātralāghavē|

hr̥dayōdgārakaṇṭhāsyaśuddhau tandrāklamē gatē||34||

svēdē jātē rucau caiva kṣutpipāsāsahōdayē|

kr̥taṁ laṅghanamādēśyaṁ nirvyathē cāntarātmani||35||

parvabhēdō'ṅgamardaśca kāsaḥ śōṣō mukhasya ca|

kṣutpraṇāśō'rucistr̥ṣṇā daurbalyaṁ śrōtranētrayōḥ||36||

manasaḥ sambhramō'bhīkṣṇamūrdhvavātastamō hr̥di|

dēhāgnibalanāśaśca laṅghanē'tikr̥tē bhavēt||37||

vAtamUtrapurIShANAM visarge gAtralAghave|

hRudayodgArakaNThAsyashuddhau tandrAklame gate||34||

svede jAte rucau caiva kShutpipAsAsahodaye|

kRutaM la~gghanamAdeshyaM nirvyathe cAntarAtmani||35||

parvabhedo~a~ggamardashca kAsaH shoSho mukhasya ca|

kShutpraNAsho~arucistRuShNA daurbalyaM shrotranetrayoH||36||

manasaH sambhramo~abhIkShNamUrdhvavAtastamo hRudi|

dehAgnibalanAshashca la~gghane~atikRute bhavet||37||

The signs of proper administration of langhana include thorough elimination of flatus, urine, and feces, feeling of lightness in body, cleansing in heart, eructation, throat and mouth, the disappearance of drowsiness and exhaustion, the appearance of perspiration and reappearance of taste, hunger and thirst along with a feeling of well-being.

The signs of excessive administration of langhana include pain in the joints, body aches, cough, dryness of the mouth, complete loss of hunger, anorexia, thirst, weakness of hearing and vision, confusion of mind, frequent eructation, fainting, frequent upward movement of vata, feeling of darkness in the heart (tamo hridi), loss of body weight, loss of digestive power and strength. [34-37]

Signs of adequate and excess brimhana (nourishing) therapy

बलं पुष्ट्युपलम्भश्च कार्श्यदोषविवर्जनम्|

लक्षणं बृंहिते स्थौल्यमति चात्यर्थबृंहिते||३८||

कृतातिकृतलिङ्गं यल्लङ्घिते तद्धि रूक्षिते |३९|

balaṁ puṣṭyupalambhaśca kārśyadōṣavivarjanam|

lakṣaṇaṁ br̥ṁhitē sthaulyamati cātyarthabr̥ṁhitē||38||

kr̥tātikr̥taliṅgaṁ yallaṅghitē taddhi rūkṣitē |39|

balaM puShTyupalambhashca kArshyadoShavivarjanam|

lakShaNaM bRuMhite sthaulyamati cAtyarthabRuMhite||38||

kRutAtikRutali~ggaM yalla~gghite taddhi rUkShite |39|

Through the proper administration of brimhana, one gets strength, robustness, and freedom from the diseases of emaciation. On excessive application of brimhana, one suffers from corpulence (obesity). The symptoms of proper and excessive administration of rukshana are the same as those of langhana. [38-38½]

Signs of adequate and excess stambhana (astringent/styptic) therapy

स्तम्भितः स्याद्बले लब्धे यथोक्तैश्चामयैर्जितैः||३९||

श्यावता स्तब्धगात्रत्वमुद्वेगो हनुसङ्ग्रहः|

हृद्वर्चोनिग्रहश्च स्यादतिस्तम्भितलक्षणम्||४०||

stambhitaḥ syādbalē labdhē yathōktaiścāmayairjitaiḥ||39||

śyāvatā stabdhagātratvamudvēgō hanusaṅgrahaḥ|

hr̥dvarcōnigrahaśca syādatistambhitalakṣaṇam||40||

stambhitaH syAdbale labdhe yathoktaishcAmayairjitaiH||39||

shyAvatA stabdhagAtratvamudvego hanusa~ggrahaH|

hRudvarconigrahashca syAdatistambhitalakShaNam||40||

Properly administered stambhana helps the patient to regain his strength and get rid of afflicted diseases as told earlier. Excessive administration of stambhana causes blackish discoloration, stiffness in body parts, uneasiness, the stiffness of jaw, feeling of constriction in cardiac region, and constipation. [39-40]

लक्षणं चाकृतानां स्यात् षण्णामेषां समासतः|

तदौषधानां धातूनामशमो वृद्धिरेव च||४१||

इति षट् सर्वरोगाणां प्रोक्ताः सम्यगुपक्रमाः|

साध्यानां साधने सिद्धा मात्राकालानुरोधिनः||४२||

lakṣaṇaṁ cākr̥tānāṁ syāt ṣaṇṇāmēṣāṁ samāsataḥ|

tadauṣadhānāṁ dhātūnāmaśamō vr̥ddhirēva ca||41||

iti ṣaṭ sarvarōgāṇāṁ prōktāḥ samyagupakramāḥ|

sādhyānāṁ sādhanē siddhā mātrākālānurōdhinaḥ||42||

lakShaNaM cAkRutAnAM syAt ShaNNAmeShAM samAsataH|

tadauShadhAnAM dhAtUnAmashamo vRuddhireva ca||41||

iti ShaT sarvarogANAM proktAH samyagupakramAH|

sAdhyAnAM sAdhane siddhA mAtrAkAlAnurodhinaH||42||

The signs and symptoms of all these six therapies, if inadequately administered, leave the dosha unpacified. Rather, they get aggravated.

Thus, these six most useful therapies, if administrated properly in all diseases which have been described, with due consideration of time and dosage, are sure to accomplish the cure of all curable disorders. [41-42]

Summary

भवति चात्र-

दोषाणां बहुसंसर्गात् सङ्कीर्यन्ते ह्युपक्रमाः|

षट्त्वं तु नातिवर्तन्ते त्रित्वं वातादयो यथा||४३||

bhavati cātra-

dōṣāṇāṁ bahusaṁsargāt saṅkīryantē hyupakramāḥ|

ṣaṭtvaṁ tu nātivartantē tritvaṁ vātādayō yathā||43||

bhavati cAtra-

doShANAM bahusaMsargAt sa~gkIryante hyupakramAH|

ShaTtvaM tu nAtivartante tritvaM vAtAdayo yathA||43||

As there are many combinations of dosha, these therapies also have multiple variations. However, the number of these therapies do not exceed than six, just like dosha are three in number. [43]

तत्र श्लोकाः-

इत्यस्मिँलङ्घनाध्याये व्याख्याताः षडुपक्रमाः|

यथाप्रश्नं भगवता चिकित्सा यैः प्रवर्तते||४४||

tatra ślōkāḥ-

ityasmimँlaṅghanādhyāyē vyākhyātāḥ ṣaḍupakramāḥ|

yathāpraśnaṁ bhagavatā cikitsā yaiḥ pravartatē||44||

tatra shlokAH-

ityasmi@mla~gghanAdhyAye vyAkhyAtAH ShaDupakramAH|

yathAprashnaM bhagavatA cikitsA yaiH pravartate||44||

Now the (re-capitulatory) verse –

Thus in the chapter titled “Reducing and nourishing therapies," the six therapies which comprise the entire field of therapeutics have been expounded by the Lord Atreya (teacher) as per the inquiries of the disciples. [44]

Tattva Vimarsha (Fundamental Principles)

• Langhana(reducing) therapy is indicated in obese persons and those diseases with obstructive pathology due to excessively vitiated dosha.
• Brimhana (nourishing) therapy is indicated in emaciated persons and those diseases with degenerative pathology.
• The group of six treatments (shadupakramas) includes langhana, rukshana, swedana, brimhana, snehana, and stambhana. The first three of these are reducing in nature, while the latter three are nourishing.

Vidhi Vimarsha (Applied Inferences)

Above described six therapies are grouped into "Apatarpana" (langhana, or reducing) and "Santarpana" (brimhana, or nourishing). In "Apatarpana"– lightening, dryness, and sudation therapies, and in "Santarpana"– nourishing, unctuousness, and astringent therapies have been mentioned. (3-8)

The rukshana (dryness) therapy produces dryness, roughness, and coarseness. In unctuous therapy, fluidity is due to liquefaction or melting or dissolution of dosha,dhatu, and mala. The mode of action of sudation therapy is due to warmth or internal heat produced by therapy. The mode of action of astringent therapy is due to inhibition of mobility and flow of dosha, dhatu,and mala. Here the meaning to be understood is that the materials - dosha, dhatu,and mala, which are flowing by slow or fast in rate by nature, to be checked or stopped. This condition refers only to the effects of atisara (diarrhea), raktasrava(bleeding), visha(poisoning), daha(burning), and vedana(pain). The drugs described here for each therapy are understood to possess such qualities as associated with them. There are, however, exceptional cases. For example, pippali and bhallataka have "ushna" guna (heat), but their action is brimhana. Priyangu is "sheeta" guna(cool) but has langhana effect.

Table 1: Pharmaco-therapeutic properties of six therapies

S. No.	Langhana	Brimhana	Rukshana	Snehana	Swedana	Stambhana
1	Laghu	Guru	Laghu	Guru	Guru	Laghu
2	Ushna	Shita	Ushna	Shita	Ushna	Shita
3	Tikshna	Mridu	Tikshna	Mridu	Tikshna	Mridu
4	---	----	-----	Drava	Drava	Drava
5	Vishada	Pichchila	Vishada	Pichchila	--------	----------
6	----------	Bahala	----------------	------------	-----------	----------
7	Ruksha	Snigdha	Ruksha	Snigdha	Ruksha– Snigdha	Ruksha
8	------------	Manda	------------	Manda	-------------	Manda
9	Sukshma	Sthula	------------	Sthula	Sukshma	Sukshma
10	Khara	Shlakshna	Khara	---------	-------------	Shlakshna
11	Sara	Sthira	Sthira	Sara	Sthira- Sara	Sthira
12	kathina	------------	Kathina	-----------	------------	------------

There are seven overlapping qualities in the drugs employed in brimhana and snehana and five overlapping qualities in the drugs employed in brimhana and stambhana.

Though they are of similar qualities, they should not be concluded to be one and the same. In langhana drugs, the qualities of lightness are dominant, while in rukshana, the drugs employed possess predominantly drying or desiccating qualities. Further, lightness can be induced through non-drug based therapies (adravyabhuta) such as fasting. However, dryness can only be brought about by drugs.

Thus, all these therapies are distinct even when possessing similarities in certain qualities. The "Apatarpana" type of treatments is related to agni + vayu + akasha mahabhuta dominant qualities in general whereas the '"Santarpana" type of treatments is related to Prithvi + jala.

All these (above mentioned) six types of treatments should be used in treating all the diseases. (9-17)

Exposure to the wind can produce lightness in the body, but exposure to cold wind cannot produce lightness. The practical mode of "maruta sevana" includes walking or running in open place as exercise. The various types of breathing exercises including "pranayama" are included in this category. The drugs which are employed to improve digestion are dominant in vayu and agni mahabhuta. "Atapa sevana" includes sunbath or exposure to ultraviolet rays present in the sunlight of early morning. (18)

Langhana is contraindicated in diseases / disorders caused purely by vata. But when vata gets associated with excessively provoked kapha, pitta, rakta,and mala, shodhana (purificatory) method of lightening therapy should be used. Even though asthapana basti (non-unctuous enema) is vata shamaka (pacifying), it is ruksha in nature and can aggravate the vata. So asthapana basti (non-unctuous enema) should be used judiciously wherever indicated.

The word adau (आदौ) is used for disorders caused by a moderate intensity of kapha and pitta, such as chhardi (vomiting). In these conditions, after reducing dosha by digestive medicines (pachana), pacification of dosha (samshamana) shall be done. But sometimes the pachana method may not be enough to treat the disease, requiring other methods of langhana to be explored. In strong people where the diseases manifest with the mild or little intensity of dosha, any treatment course includes vyayama (exercise) and maruta atapa sevana(exposure to wind and the sun).

The increase of dhatus takes place naturally in the winter season (shishira ritu) due to visarga kala (winter solstice). This increase in dhatus occurs in conjunction with kapha. At this juncture, the rational application of langhana does not produce any adverse effect in people afflicted with vata diseases or possessing vata Prakriti.14/10-11]

The three categories of langhana according to the intensity of disease and dosha aggravation are described in detail in the third chapter of Vimana Sthana.

Contemporary researches

A case study by Kambale et.al. showed that rukshana upakrama therapy in the form of Takra Siddha Yavagu (Gruel for adverse effects due to improper administration of ghee)and Udvartana helped in normalizing lipid profile, reduction of weight; BMI, body circumference and skin fold thickness in case of dyslipidemia.