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Grahani Chikitsa (view source)

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[[Grahani Chikitsa]] consists of three parts. The first part explains the concept of normal digestion process. The second part describes the abnormal digestion and third part is about diseases caused by abnormality of digestive factors and its interaction with proximal intestine or ''grahani''. These disorders are called ''grahanidosha''.

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''Agni'' (digestive and metabolic agents), based on their specific functions of conversion of food into biological elements of the body are classified into thirteen types. First, the ''jatharagni'' is most important because it is the initiator of digestive process and it strengthens the digestive ability of other twelve ''agnis''. Five ''bhutagnis'' transform the ''panchmahabhauika'' components of ''ahara rasa'' created by ''jatharagni'' into different structures of the body. Seven ''dhatvagnis'' create seven tissues elements(''dhatu'').

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''Agni'' (digestive and metabolic agents), based on their specific functions of conversion of food into biological elements of the body are classified into thirteen types. First, the ''jatharagni'' is most important because it is the initiator of digestive process and it strengthens the digestive ability of other twelve ''agnis''. Five ''bhutagnis'' transform the ''panchmahabhauika'' components of ''ahara rasa'' created by ''jatharagni'' into different structures of the body. Seven ''dhatvagnis'' create seven tissues elements(''[[dhatu]]'').

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''Jatharagni'' initiates the first phase of digestion process by conversion of food into nutrient fluid (''ahara rasa''). This nutrient fluid is further trifurcated into three biological substances ''kapha, pitta'' and ''vata'' in three stages to ''madhura, amla'' and ''katu awastha paka'' respectively. This biofluid is separated into excretable waste or impure products by ''samana vata'' in ''grahani'' (middle part of GI Tract) and useful, pure circulable products. ''Samana vata'' analyzes and separates the useful products (''prasada'') and waste (''kitta''). Useful products get absorbed by ''rasayani'' (villi) of the intestine, sent to the micro channels (''srotas'') by ''vyanvata'', simutaneouly, to the entire body. Waste products are excreted out by ''apana vayu'' through urine, feces and sweat.

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''Jatharagni'' initiates the first phase of digestion process by conversion of food into nutrient fluid (''ahara rasa''). This nutrient fluid is further trifurcated into three biological substances ''[[kapha]], [[pitta]]'' and ''[[vata]]'' in three stages to ''madhura, amla'' and ''katu awastha paka'' respectively. This biofluid is separated into excretable waste or impure products by ''samana vata'' in ''grahani'' (middle part of GI Tract) and useful, pure circulable products. ''Samana vata'' analyzes and separates the useful products (''prasada'') and waste (''kitta''). Useful products get absorbed by ''rasayani'' (villi) of the intestine, sent to the micro channels (''srotas'') by ''vyanvata'', simutaneouly, to the entire body. Waste products are excreted out by ''apana vayu'' through urine, feces and sweat.

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Now second and third phase of digestion process occur simultaneously in the ''srotas'' (microchannels). Five ''bhutagnis'' work on the formation of anatomical structure of the body from respective ''panchamahabhuta'' in the form of micro channels, by digesting needful components present in biofluid. Each gross and subtle particle of body is ''panchabhautika'', but each one is having different proportion of ''mahabhuta''.

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Now second and third phase of digestion process occur simultaneously in the ''srotas'' (microchannels). Five ''bhutagnis'' work on the formation of anatomical structure of the body from respective ''[[panchamahabhuta]]'' in the form of micro channels, by digesting needful components present in biofluid. Each gross and subtle particle of body is ''[[panchabhautika]]'', but each one is having different proportion of ''[[mahabhuta]]''.

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Now the third phase of digestion is processed in seven micro channels (''srotas'') specified for seven body tissues (''dhatu'') for the formation of body tissues by their specific seven tissue transformers (''dhatvagnis'') Excreable waste products are carried out by three excreatory channels as feces, urine and sweat, along with sub tissues and sub excreta of sensory organs.

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Now the third phase of digestion is processed in seven micro channels (''srotas'') specified for seven body tissues (''[[dhatu]]'') for the formation of body tissues by their specific seven tissue transformers (''dhatvagnis'') Excreable waste products are carried out by three excreatory channels as feces, urine and sweat, along with sub tissues and sub excreta of sensory organs.

Second part of this chapter explains the etiopathology of abnormal digestion, and formation of intermediate products as seed cause of various diseases in the form of ''ama, shukta'' and ''amavisha''.

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Protection of ''agni'' is very essential in treatment of all diseases.[Chakrapani,Cha.Sa.[[ Chikitsa Sthana ]]14/244-246 ]''Arsha, atisara'' and ''grahanidosha'' are said to be ''paraspara hetu'' which means one disease becomes cause for another disease[Cha.Sa. [[ Chikitsa Sthana ]]14/244] e.g. in patients with chronic colitis, intestinal polyps are seen, in patients suffering from diarrhea colitis is observed. Therefore, one finds interrelation between these disorders and as explained earlier, special precaution should be taken with respect to ''agni bala''.

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Certain drugs like ''chitraka'' (Plumbago zeylanica), ''pippali'' (Piper longum), ''pippalimula'' (root of Piper longum), ''shunthi'' (Zingiber officinale), ''nagakesara, haridra, danti, duralabha, haritaki'' etc have been used in combinations with other drugs for the treatment of ''arsha'' considering the concept of ''agnibala vriddhi'' and ''vata anulomanam'' (facilitating passage of ''vata'') and the same drugs have been used in ''grahani chikitsa'' with the same concept. Charak explains that all the above three diseases are caused by ''agnimandya'' and if increase in ''agni'' is done then relief in the disease takes place. [Chakrapani Cha.Sa.[[Chikitsa Sthana]] 14/244-246]

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Certain drugs like ''chitraka'' (Plumbago zeylanica), ''pippali'' (Piper longum), ''pippalimula'' (root of Piper longum), ''shunthi'' (Zingiber officinale), ''nagakesara, haridra, danti, duralabha, haritaki'' etc have been used in combinations with other drugs for the treatment of ''arsha'' considering the concept of ''agnibala vriddhi'' and ''vata anulomanam'' (facilitating passage of ''[[vata]]'') and the same drugs have been used in ''grahani chikitsa'' with the same concept. Charak explains that all the above three diseases are caused by ''agnimandya'' and if increase in ''agni'' is done then relief in the disease takes place. [Chakrapani Cha.Sa.[[Chikitsa Sthana]] 14/244-246]

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Further, ''vata'' is said to be ''agnisakha'' i.e. ''agnibala'' depends on ''vata''. ''Vatakshaya'' or ''prakopa'' results in ''agnimandya''. Therefore, ''anna, pana'' and ''ausadha'' which bring about ''vata anulomana'' are very useful in treatment of diseases like ''arsha'' and ''grahani dosha''.

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Further, ''[[vata]]'' is said to be ''agnisakha'' i.e. ''agnibala'' depends on ''[[vata]]''. ''Vatakshaya'' or ''prakopa'' results in ''agnimandya''. Therefore, ''anna, pana'' and ''ausadha'' which bring about ''vata anulomana'' are very useful in treatment of diseases like ''arsha'' and ''grahani dosha''.

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''Vata anulomanam'' means to facilitate the ''gati'' (motion) of ''vata'' downwards to anus. Among five types of ''vata, samana'' and ''apana'' have major role in diseases like ''arsha, atisara'' and ''grahanidosha''. Obstruction to movement of ''vata'' (''avarudha gati'') or diarrhea (''atisaraṇa'') leads to ''agni kshaya''. ''Avarudha gati'' is the cause for ''vibandha'' (constipation), ''malavibandha'' (obstruction to feces) along with ''pravahana'' (urge to defecate) which increases the intra-lumen pressure leading to incompetency of valves in rectal veins leading to their varicosity which causes hemorrhoids where as ''atisarana'' (diarrhea) causes increased motility of intestine. Hence ''vata anulomanam'' should not be understood as ''virechana'' or laxation but regularization of ''vata gati'' so that there is no ''avarodha'' or ''atisarana''. The same concept of ''vata anulomana'' is also mentioned in [[Grahani Chikitsa]].[Cha.Sa. [[Chikitsa Sthana]] 14/247]

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''Vata anulomanam'' means to facilitate the ''gati'' (motion) of ''[[vata]]'' downwards to anus. Among five types of ''[[vata]], samana'' and ''apana'' have major role in diseases like ''arsha, atisara'' and ''grahanidosha''. Obstruction to movement of ''[[vata]]'' (''avarudha gati'') or diarrhea (''atisaraṇa'') leads to ''agni kshaya''. ''Avarudha gati'' is the cause for ''vibandha'' (constipation), ''malavibandha'' (obstruction to feces) along with ''pravahana'' (urge to defecate) which increases the intra-lumen pressure leading to incompetency of valves in rectal veins leading to their varicosity which causes hemorrhoids where as ''atisarana'' (diarrhea) causes increased motility of intestine. Hence ''vata anulomanam'' should not be understood as ''[[virechana]]'' or laxation but regularization of ''[[vata]] gati'' so that there is no ''avarodha'' or ''atisarana''. The same concept of ''vata anulomana'' is also mentioned in [[Grahani Chikitsa]].[Cha.Sa. [[Chikitsa Sthana]] 14/247]

Therefore, the line of treatment used in ''arsha'' with regard to ''agni bala'' and ''vata anulomanam'' is basically similar to that of ''grahanidosha'' hence Charak has explained [[Grahani Chikitsa]] after [[Arsha Chikitsa]].[Chakrapani Cha.Sa.[[Chikitsa Sthana]]15/1] Charak could have restricted the name of chapter to [[Grahani Chikitsa]] i.e. treatment of the ''avayava grahani'' whereas he has increased the scope of chapter by using the word ''grahanidosha''.[Chakrapani, Cha.Sa. [[Chikitsa Sthana]] 15/1].

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There is always an inter-relationship between ''avayava'' (organ) and ''avayavi'' (part of organ) or ''ashraya''(seat) and ''ashrayi'' (seated). Either of the one has an impact on the other, hence if ''grahaniavayava'' is in normal state then ''agni'' the ''avayavi'' functions normally and vice versa also holds true, whereas if ''dusti'' of ''grahani'' takes place ''agni vaishamyata'' (imbalance) is seen e.g. ileitis, wherein digestion is hampered. ''Grahani'' is the seat for ''jatharagni''. [Cha.Sa.[[Chikitsa Sthana]] 15 /56] ''Agni'' is responsible for ''ayu'' (longevity of life), ''varna'' (complexion), ''bala'' (strength), ''svasthya'' (health), ''utsaha'' (enthusiasm), ''upachaya'' (proper metabolism), ''prabha'' (glow) and ''oja'' (core energy). ''Prakrita agni'' (normal digestive power) is essential for long and healthy life while, vitiated ''agni'' is responsible for ''roga avastha''(disease).[Cha. Sa. [[Chikitsa Sthana]] 15/3-4]

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There is always an inter-relationship between ''avayava'' (organ) and ''avayavi'' (part of organ) or ''ashraya''(seat) and ''ashrayi'' (seated). Either of the one has an impact on the other, hence if ''grahaniavayava'' is in normal state then ''agni'' the ''avayavi'' functions normally and vice versa also holds true, whereas if ''dusti'' of ''grahani'' takes place ''agni vaishamyata'' (imbalance) is seen e.g. ileitis, wherein digestion is hampered. ''Grahani'' is the seat for ''jatharagni''. [Cha.Sa.[[Chikitsa Sthana]] 15 /56] ''Agni'' is responsible for ''ayu'' (longevity of life), ''varna'' (complexion), ''bala'' (strength), ''svasthya'' (health), ''utsaha'' (enthusiasm), ''upachaya'' (proper metabolism), ''prabha'' (glow) and ''[[oja]]'' (core energy). ''Prakrita agni'' (normal digestive power) is essential for long and healthy life while, vitiated ''agni'' is responsible for ''roga avastha''(disease).[Cha. Sa. [[Chikitsa Sthana]] 15/3-4]

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In this chapter, Charak describes formation of body tissues in detail with the role of ''ahara'' which is supplied continuously to maintain homeostasis. ''Vyana vata'' is promoter of ''rasa ~~raktadi~~'' circulation.[ Cha. Sa. [[Chikitsa Sthana]] 15/36] It transports ''rasa ~~raktadi~~ drava'' ''dhatu'' throughout body continuously and as per metabolic demand. This explanation shows that closed circulation in human was known to Charak.

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In this chapter, Charak describes formation of body tissues in detail with the role of ''ahara'' which is supplied continuously to maintain homeostasis. ''Vyana vata'' is promoter of ''[[rasa]] [[rakta]]di'' circulation.[ Cha. Sa. [[Chikitsa Sthana]] 15/36] It transports ''[[rasa]] [[rakta]]di drava'' ''[[dhatu]]'' throughout body continuously and as per metabolic demand. This explanation shows that closed circulation in human was known to Charak.

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''Grahani'' is prime place where digestion and absorption of ''ahara rasa'' takes place. ''Ahara rasa'' provides nutrition for the ''~~rasadi~~ sapta dhatu'', along-with three ''sharirika dosha'' and three ''manasika dosha''. Nourishment of ''sattva, raja'' and ''tama'' is influenced by ''sattvika, rajasika'' and ''tamasika ahara''. ''Tamasika'' and ''rajasika ahara'' suppresses ''sattva guna'' thereby causing ''alpa sattva'' in individual, a common predisposing factor of psychiatric disorders for e.g. ''alpa sattva'' as mentioned in ''unmada'' [Cha.Sa [[Chikitsa Sthana]] 9/5] In ''vataja grahanivyadhishanka'' (feeling of suffering from disease) manifests in patients with ''alpa sattva''.

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''Grahani'' is prime place where digestion and absorption of ''ahara rasa'' takes place. ''Ahara rasa'' provides nutrition for the ''[[rasa]]di sapta [[dhatu]]'', along-with three ''sharirika [[dosha]]'' and three ''manasika dosha''. Nourishment of ''[[sattva]], [[raja]]'' and ''[[tama]]'' is influenced by ''sattvika, rajasika'' and ''tamasika ahara''. ''Tamasika'' and ''rajasika ahara'' suppresses ''[[sattva]] [[guna]]'' thereby causing ''alpa sattva'' in individual, a common predisposing factor of psychiatric disorders for e.g. ''alpa sattva'' as mentioned in ''unmada'' [Cha.Sa [[Chikitsa Sthana]] 9/5] In ''vataja grahanivyadhishanka'' (feeling of suffering from disease) manifests in patients with ''alpa sattva''.

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Homeostasis at cellular level and gross level is maintained by ''vata, pitta'' and ''kapha'' in which digestive and metabolic contributions are due to ''agni''. This chapter has been dedicated to ''agni'' to understand the manner in which it gets vitiated by ''dosha'' and accordingly the line of treatment for the ''agni dosha'' is explained. As the functions of ''agni'' take place in ''grahani'' hence disease related to ''grahani'' has been given the name.

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Homeostasis at cellular level and gross level is maintained by ''[[vata]], [[pitta]]'' and ''[[kapha]]'' in which digestive and metabolic contributions are due to ''agni''. This chapter has been dedicated to ''agni'' to understand the manner in which it gets vitiated by ''[[dosha]]'' and accordingly the line of treatment for the ''agni dosha'' is explained. As the functions of ''agni'' take place in ''grahani'' hence disease related to ''grahani'' has been given the name.

Secondly, ''pandu roga'' is due to ''alpata'' of ''raktaposhaka sara bhaga'' [Chakrapani, Cha. Sa. [[Chikitsa Sthana]] 16/3-7] and, one of the main causes of this ''alpata'' is mal-digestion and mal-absorption which takes place in ''grahani''. It is well known fact, that various contributory factors for blood formation have their absorption in gastrointestinal tract such as folic acid, vitamin B12, iron, etc which if not absorbed causes anemia this is the reason why Charak has placed this chapter in between ''arsha'' and ''pandu roga''.

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</div></div>

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''Dehagni'' (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''ojas'', normal body temperature and various other forms of ''agni''. Even the existence of an individual is said to be because of ''dehagni'' [3]

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''Dehagni'' (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''[[ojas]]'', normal body temperature and various other forms of ''agni''. Even the existence of an individual is said to be because of ''dehagni'' [3]

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</div></div>

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The food one consumes becomes capable of nourishing the body tissues and of promoting the ''ojas'' (vital essence), strength, complexion etc., only in the presence of normally functioning ''agni''. In the absence of normal digestion (and metabolism), the normal body tissues such as ''rasa'' cannot be formed nor nourished [5]

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The food one consumes becomes capable of nourishing the body tissues and of promoting the ''[[ojas]]'' (vital essence), strength, complexion etc., only in the presence of normally functioning ''agni''. In the absence of normal digestion (and metabolism), the normal body tissues such as ''[[rasa]]'' cannot be formed nor nourished [5]

=== Process of digestion-first phase ===

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</div></div>

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The ingested food is carried to ''koshtha'' by ''prana vata''. The food disintegrates because of the liquids, and further it becomes soft because of the fatty substances. The ''samana vata'', that has an inherent ability to intensify the ''agni,'' intensifies the digestive enzymes and properly digests the food that one consumes timely and in an appropriate quantity, thus leading to longevity. This process of digestion by ''agni'' in the gut which leads to the formation of ''rasa'' and ''mala'' is comparable to the process of cooking of the raw rice kept in an earthen vessel containing water on a fire [6-8]

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The ingested food is carried to ''koshtha'' by ''prana vata''. The food disintegrates because of the liquids, and further it becomes soft because of the fatty substances. The ''samana vata'', that has an inherent ability to intensify the ''agni,'' intensifies the digestive enzymes and properly digests the food that one consumes timely and in an appropriate quantity, thus leading to longevity. This process of digestion by ''agni'' in the gut which leads to the formation of ''[[rasa]]'' and ''[[mala]]'' is comparable to the process of cooking of the raw rice kept in an earthen vessel containing water on a fire [6-8]

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=== Three states of digestion and provoking ''dosha'' ===

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=== Three states of digestion and provoking ''[[dosha]]'' ===

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</div></div>

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As soon as the food that has all the six tastes is consumed, it undergoes the first stage of digestion known as ''madhura'' (sweet) state during which ''kapha'' is produced which is like froth. Afterwards, while the food undergoing digestion is in its partially digested form, it attains ''amla'' (sour) state.

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As soon as the food that has all the six tastes is consumed, it undergoes the first stage of digestion known as ''madhura'' (sweet) state during which ''[[kapha]]'' is produced which is like froth. Afterwards, while the food undergoing digestion is in its partially digested form, it attains ''amla'' (sour) state.

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When the semi-digested food leaves the stomach, the release of liquid form of pitta known as ''accha-pitta'' occurs.

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When the semi-digested food leaves the stomach, the release of liquid form of [[pitta]] known as ''accha-pitta'' occurs.

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When the ''pakva'' part (the non-absorbable remnant part after the absorption of the nutrients), reaches the ''pakvashaya'' (the colon), the drying effect of ''agni'' converts it into a solid mass. There also occurs the release of ''vata'' which is ''katu'' (pungent) state [9-11]

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When the ''pakva'' part (the non-absorbable remnant part after the absorption of the nutrients), reaches the ''pakvashaya'' (the colon), the drying effect of ''agni'' converts it into a solid mass. There also occurs the release of ''[[vata]]'' which is ''katu'' (pungent) state [9-11]

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=== Second phase of digestion by ''~~pancha-mahabhuta~~'' ===

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=== Second phase of digestion by ''[[panchamahabhuta]]'' ===

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The food that possesses pleasant smell (taste, appearance, consistency,) etc., nourishes the similar entities in the body such as the sensory organs of smell by ''gandha'' etc (e.g. taste, vision, touch etc senses by respective ''mahabhuta'') [12]

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The food that possesses pleasant smell (taste, appearance, consistency,) etc., nourishes the similar entities in the body such as the sensory organs of smell by ''gandha'' etc (e.g. taste, vision, touch etc senses by respective ''[[mahabhuta]]'') [12]

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</div></div>

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There are five types of ''agni'' namely, ''bhauma, apya, agneya, vayavya'' and ''nabhasa''. These five ''bhutagni'' are one of each ''mahabhuta'' transform/metabolize those components of the food that are homologous to them in their composition of structure of human organism. (such as ''parthiva, apya'' etc) [13]

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There are five types of ''agni'' namely, ''bhauma, apya, agneya, vayavya'' and ''nabhasa''. These five ''bhutagni'' are one of each ''[[mahabhuta]]'' transform/metabolize those components of the food that are homologous to them in their composition of structure of human organism. (such as ''parthiva, apya'' etc) [13]

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</div></div>

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Specific categories of entities in the body having specific attributes can be nourished by only those substances that belong to the same category having those same attributes. This means that ''parthiva'' entities in the body (one that is dominated by ''prithvi mahabhuta'' in its composition) can be nourished only by the ''parthiva'' substances in the food and so on. The same rule applies to the whole body [14]

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Specific categories of entities in the body having specific attributes can be nourished by only those substances that belong to the same category having those same attributes. This means that ''parthiva'' entities in the body (one that is dominated by ''[[prithvi mahabhuta]]'' in its composition) can be nourished only by the ''parthiva'' substances in the food and so on. The same rule applies to the whole body [14]

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=== Third phase of digestion and metabolism at level of ''dhatu'' ===

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=== Third phase of digestion and metabolism at level of ''[[dhatu]]'' ===

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Further, the seven components that sustain the body, known as ''dhatu'' (tissues), are metabolized/transformed into two kinds of products known as ''sara'' (nutrition) and ''kitta'' (waste). This process is the function of seven specific entities known as ''dhatvagni''; each ''dhatvagni'' is specific for its corresponding ''dhatu'' [15]

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Further, the seven components that sustain the body, known as ''[[dhatu]]'' (tissues), are metabolized/transformed into two kinds of products known as ''sara'' (nutrition) and ''kitta'' (waste). This process is the function of seven specific entities known as ''dhatvagni''; each ''dhatvagni'' is specific for its corresponding ''[[dhatu]]'' [15]

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</div></div>

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''Rakta'' is produced after ''rasa'' and then ''mamsa''. After ''mamsa'' the ''medas'' is formed and then ''asthi'' is produced. After ''asthi'' the ''majja'' is derived and then ''shukra'' is produced and finally fine ''shukra'' leads to ''garbha'' [16]

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''[[Rakta]]'' is produced after ''[[rasa]]'' and then ''[[mamsa]]''. After ''[[mamsa]]'' the ''[[medas]]'' is formed and then ''[[asthi]]'' is produced. After ''[[asthi]]'' the ''[[majja]]'' is derived and then ''[[shukra]]'' is produced and finally fine ''[[shukra]]'' leads to ''[[garbha]]'' [16]

=== ''Upadhatu'' (metabolic products) ===

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</div></div>

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''Stanya'' (breast milk) and the menstrual blood are derived after rasa. ''Kandara'' (tendon) and ''sira''(vein) are derived after ''rakta''. ''Vasa''(muscle fat) and the six layers of ''tvacha'' (skin) are derived after ''mamsa'' (muscle) and ''snayu''(ligament) are derived after ''medas'' (adipose tissue) [17]

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''Stanya'' (breast milk) and the menstrual blood are derived after rasa. ''Kandara'' (tendon) and ''sira''(vein) are derived after ''[[rakta]]''. ''Vasa''(muscle fat) and the six layers of ''tvacha'' (skin) are derived after ''[[mamsa]]'' (muscle) and ''snayu''(ligament) are derived after ''[[medas]]'' (adipose tissue) [17]

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=== ''Mala'' formed at tissue level metabolism ===

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=== ''[[Mala]]'' formed at tissue level metabolism ===

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</div></div>

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The feces and the urine are the ''kitta'' (non-nutrient portion/waste portion/byproduct) of ingested food. The ''kitta'' of ''rasa'' is ''mala-kapha'' (excretions). ''Mala-pitta'' (bile pigment) is the ''kitta'' of ''rakta''. ''Kha-mala'' (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the ''kitta'' of ''mamsa''. ''Sweda'' (sweat) is the ''mala'' of ''medas''. ''Kesha'' (hairs on the head) and ''loma'' (body hair) are the ''mala'' of ''asthi''. The ''mala'' of ''majja'' is the oily excretion of the eye and the skin (sebum). Thus, the ''~~dhatus~~'' continuously undergo two kinds of transformation: ''prasada'' (nutrient portion) and ''kitta'' (non-nutrient portion). This entire sequence of transformation and metabolism of ''dhatu'' is thus inter dependent [18-19½]

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The feces and the urine are the ''kitta'' (non-nutrient portion/waste portion/byproduct) of ingested food. The ''kitta'' of ''[[rasa]]'' is ''[[mala]]-[[kapha]]'' (excretions). ''[[Mala]]-[[pitta]]'' (bile pigment) is the ''kitta'' of ''[[rakta]]''. ''Kha-mala'' (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the ''kitta'' of ''[[mamsa]]''. ''Sweda'' (sweat) is the ''[[mala]]'' of ''[[medas]]''. ''Kesha'' (hairs on the head) and ''loma'' (body hair) are the ''[[mala]]'' of ''[[asthi]]''. The ''[[mala]]'' of ''[[majja]]'' is the oily excretion of the eye and the skin (sebum). Thus, the ''[[dhatu]]s'' continuously undergo two kinds of transformation: ''prasada'' (nutrient portion) and ''kitta'' (non-nutrient portion). This entire sequence of transformation and metabolism of ''[[dhatu]]'' is thus inter dependent [18-19½]

=== Modes of transformation ===

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''Vrishya'' substance (the substance that promotes sexual vigor) nourishes the ''shukra'' immediately due to its specific influential effect (''prabhava'') [20]

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''Vrishya'' substance (the substance that promotes sexual vigor) nourishes the ''[[shukra]]'' immediately due to its specific influential effect (''prabhava'') [20]

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</div></div>

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Some scholars believe that the conversion of ''rasa'' up to ''shukra'' occurs in a span of six days and six nights. This process of transformation of nourishing portion of the digested food is continuous similar to rotating wheel [21]

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Some scholars believe that the conversion of ''[[rasa]]'' up to ''[[shukra]]'' occurs in a span of six days and six nights. This process of transformation of nourishing portion of the digested food is continuous similar to rotating wheel [21]

Note: Adulterated Verses:

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(After listening to the above explanation by his teacher, the student asked the following doubt:

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How is it that ''rakta'' is formed in the body out of ''rasa,'' though being different from it? ''Rasa'' is in fact colorless, and how does it attain the red color of ''rakta''? How is it that a solid structure such as ''mamsa'' is formed out of ''rakta'' which is a fluid by its nature? How is it that, again, from the ''mamsa'', which is solid, a fluid substance such as ''meda'' is formed?

+

How is it that ''[[rakta]]'' is formed in the body out of ''[[rasa]],'' though being different from it? ''[[Rasa]]'' is in fact colorless, and how does it attain the red color of ''[[rakta]]''? How is it that a solid structure such as ''[[mamsa]]'' is formed out of ''[[rakta]]'' which is a fluid by its nature? How is it that, again, from the ''[[mamsa]]'', which is solid, a fluid substance such as ''[[meda]]'' is formed?

−

How is it that a rough ''asthi'' is formed out of smooth structures such as ''mamsa'' and ''meda''? How does the soft and fatty ''majja'' form out of rough structures such as ''asthi''? If at all ''shukra'', which is present everywhere in the body is formed out of ''majja'' that is located inside the ''asthi'', how does it come out as one cannot see pores on ''asthi''? [22-26]

+

How is it that a rough ''[[asthi]]'' is formed out of smooth structures such as ''[[mamsa]]'' and ''[[meda]]''? How does the soft and fatty ''[[majja]]'' form out of rough structures such as ''[[asthi]]''? If at all ''[[shukra]]'', which is present everywhere in the body is formed out of ''[[majja]]'' that is located inside the ''[[asthi]]'', how does it come out as one cannot see pores on ''[[asthi]]''? [22-26]

−

=== Formation of ''rasa'' and ''rakta'' ===

+

=== Formation of ''[[rasa]]'' and ''[[rakta]]'' ===

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After listening to the query raised by the student, the teacher replied as follows:

−

The nourishment fluid formed, known as ''rasa'', undergoes transformation by the ''ushma'' (heat) of ''pitta'' and gets converted into the red colored tissue known as ''rakta'' [27-28]

+

The nourishment fluid formed, known as ''[[rasa]]'', undergoes transformation by the ''ushma'' (heat) of ''[[pitta]]'' and gets converted into the red colored tissue known as ''[[rakta]]'' [27-28]

−

=== Formation of ''mamsa dhatu'' ===

+

=== Formation of ''[[mamsa dhatu]]'' ===

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</div></div>

−

Due to the action of heat along with the ''vata, ambu'' (water) and ''~~tejas~~,'' the ''rakta'' is converted into stable ''mamsa,'' after being acted upon by its own ''agni'' (''mamsadhatvagni'') [29]

+

Due to the action of heat along with the ''[[vata]], ambu'' (water) and ''[[teja]]s,'' the ''[[rakta]]'' is converted into stable ''[[mamsa]],'' after being acted upon by its own ''agni'' (''mamsadhatvagni'') [29]

−

=== Formation of ''meda dhatu'' ===

+

=== Formation of ''[[meda dhatu]]'' ===

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</div></div>

−

Because of the action of ''medo-dhatvagni'' on the excessively dominant ''snigdha'' attribute of aṃbu, the ''medo-dhatu'' is formed [29½]

+

Because of the action of ''medo-dhatvagni'' on the excessively dominant ''snigdha'' attribute of aṃbu, the ''[[medo dhatu]]'' is formed [29½]

−

=== Formation of ''asthi dhatu'' ===

+

=== Formation of ''[[asthi dhatu]]'' ===

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</div></div>

−

Because of the action of ''asthi dhātvagni'' on the aggregation of ''prithvi, agni'' and ''anila'', roughness is attained during the formation of the ''asthi'' [30]

+

Because of the action of ''asthi dhātvagni'' on the aggregation of ''[[prithvi]], [[agni]]'' and ''anila'', roughness is attained during the formation of the ''[[asthi]]'' [30]

−

=== Formation of ''majja dhatu'' ===

+

=== Formation of ''[[majja dhatu]]'' ===

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</div></div>

−

''Vata'' produces hollowness inside the ''asthi dhatu'', and after which, these hollow cavities get filled up by fatty tissue which is known as ''majja'' [31]

+

''[[Vata]]'' produces hollowness inside the ''[[asthi dhatu]]'', and after which, these hollow cavities get filled up by fatty tissue which is known as ''[[majja]]'' [31]

−

=== Formation of ''shukra dhatu'' ===

+

=== Formation of ''[[shukra dhatu]]'' ===

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</div></div>

−

The ''sneha'' (fatty) portion of ''majja'' produces shukra. The porosity in the ''asthi'' is produced because of the factors such as ''vata'' and ''akasha.'' ''Shukra'' comes out of ''asthi'' through these pores just as the water comes out of a new earthen vessel. Through the channels known as ''shukravaha srotamsi'', this ''shukra'' spreads all over the body. This ''shukra'' is discharged through the urethra (which is connected to the urinary bladder) because of several factors such as sexual excitation, reflex activities (''vega''), and mental determination (''samkalpa''). Just as the ghee moves out with ease when heated, the ''shukra'' too, is discharged due to the heat liberated during the sexual activity. This process of seminal discharge is comparable with the movement of water from a place of lower altitude to a place of higher altitude) [32-35]

+

The ''sneha'' (fatty) portion of ''[[majja]]'' produces shukra. The porosity in the ''[[asthi]]'' is produced because of the factors such as ''[[vata]]'' and ''akasha.'' ''[[Shukra]]'' comes out of ''[[asthi]]'' through these pores just as the water comes out of a new earthen vessel. Through the channels known as ''shukravaha srotamsi'', this ''[[shukra]]'' spreads all over the body. This ''[[shukra]]'' is discharged through the urethra (which is connected to the urinary bladder) because of several factors such as sexual excitation, reflex activities (''vega''), and mental determination (''samkalpa''). Just as the ghee moves out with ease when heated, the ''[[shukra]]'' too, is discharged due to the heat liberated during the sexual activity. This process of seminal discharge is comparable with the movement of water from a place of lower altitude to a place of higher altitude) [32-35]

−

=== Continuous circulation of ''rasa'' all over the body ===

+

=== Continuous circulation of ''[[rasa]]'' all over the body ===

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</div></div>

−

Because of being forcefully propelled (out of the heart) by the action of ''vyana vata'', the ''rasa dhatu'' spreads all over the body simultaneously, continuously and for the entire life [36]

+

Because of being forcefully propelled (out of the heart) by the action of ''vyana vata'', the ''[[rasa dhatu]]'' spreads all over the body simultaneously, continuously and for the entire life [36]

=== Significance of ''Kha-Vaigunya'' (abnormality in body system) in causing disease state ===

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</div></div>

−

Wherever the ''rasa'' experiences obstacle due to abnormality in ''srotas, rasa'' readily produces disease in that very same location. This process is comparable with that of the clouds producing rainfall in a localized region that is favorable for rainfall [37]

+

Wherever the ''[[rasa]]'' experiences obstacle due to abnormality in ''srotas, [[rasa]]'' readily produces disease in that very same location. This process is comparable with that of the clouds producing rainfall in a localized region that is favorable for rainfall [37]

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</div></div>

−

This principle is applicable even in case of ''dosha'', where ''ekadesha prakopa'' (abnormal increase at a local site) occurs [37½]

+

This principle is applicable even in case of ''[[dosha]]'', where ''ekadesha prakopa'' (abnormal increase at a local site) occurs [37½]

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</div></div>

−

Excessive starvation, indulging in food intake although there is indigestion, overeating, irregular habit of eating, eating unwholesome food, indulging in food which is heavy to digest or having excessive nutritional value, food which is having cold qualities or eating chilled or frozen items, food which is dry in nature or food which brings about emaciation, contaminated food, perversion of procedures like ''vamana, virechana'' and ''sneha'', emaciation of body due to disease, sudden migration to unsuitable place and of time and of season, suppression of natural urges are causes for vitiation of ''agni''. Thus, vitiated ''agni'' is unable to digest even the light food. [42-43]

+

Excessive starvation, indulging in food intake although there is indigestion, overeating, irregular habit of eating, eating unwholesome food, indulging in food which is heavy to digest or having excessive nutritional value, food which is having cold qualities or eating chilled or frozen items, food which is dry in nature or food which brings about emaciation, contaminated food, perversion of procedures like ''[[vamana]], [[virechana]]'' and ''sneha'', emaciation of body due to disease, sudden migration to unsuitable place and of time and of season, suppression of natural urges are causes for vitiation of ''agni''. Thus, vitiated ''agni'' is unable to digest even the light food. [42-43]

−

This vitiated digestive agent forms an intermediate substance called ''ama'', which turns sour (''shukta'') during fermentation and ~~finaly~~ turns in poisonous substance (''amavisha'') [44]

+

This vitiated digestive agent forms an intermediate substance called ''ama'', which turns sour (''shukta'') during fermentation and finally turns in poisonous substance (''amavisha'') [44]

=== Signs and symptoms of ''ajirna''(indigestion) ===

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</div></div>

−

The ''annavisha'' when associated with ''pitta'' causes ''daha'', morbid thirst, oral diseases, ''amlapitta'' (acid peptic disorders) and various other ''pitta'' related disorders.

+

The ''annavisha'' when associated with ''[[pitta]]'' causes ''daha'', morbid thirst, oral diseases, ''amlapitta'' (acid peptic disorders) and various other ''[[pitta]]'' related disorders.

−

The same ''annavisha'' when gets associated with ''kapha'' it leads to condition like ''yakshma'' (pthiasis), ''peenas'' (coryza) and ''prameha'' (20 types of diabetes) and various other ''~~kaphaja~~'' disorders, whereas several ''vatika'' disease are caused by association of ''vata'' with the ''annavisha''.

+

The same ''annavisha'' when gets associated with ''[[kapha]]'' it leads to condition like ''yakshma'' (pthiasis), ''peenas'' (coryza) and ''prameha'' (20 types of diabetes) and various other ''[[kapha]]ja'' disorders, whereas several ''vatika'' disease are caused by association of ''[[vata]]'' with the ''annavisha''.

The ''annavisha'' when enters renal system, urine related disorders occur; similarly, ''kukshigata roga'' (ailments related to abdomen) have their origin when ''sakrita'' (feces) is involved. ''Rasadi pradoshaja vikara'' (tissue related ailments) occur when ''rasadi srotas'' are involved [47-49]

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</div></div>

−

The ''vishamagni'' (improper ''agni'') causes irregularity in digestion and therefore defective formation of ''dhatu'' takes place whereas, ''tikshanagni'' (excessive ''agni'') when associated with little quantity of fuel (in the form of food) causes depletion of ''dhatu'' (tissue elements) [50]

+

The ''vishamagni'' (improper ''agni'') causes irregularity in digestion and therefore defective formation of ''[[dhatu]]'' takes place whereas, ''tikshanagni'' (excessive ''agni'') when associated with little quantity of fuel (in the form of food) causes depletion of ''[[dhatu]]'' (tissue elements) [50]

=== ''Samagni'' ===

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</div></div>

−

If ''agni'' is ''sama'' i.e. in balanced condition and correct diet regimen (as explained in Ca. Su. 5 and Ca.Vi.1/21) are also followed then there is proper digestion of food which helps in maintaining proper balance within the ''dhatu'' [50½]

+

If ''agni'' is ''sama'' i.e. in balanced condition and correct diet regimen (as explained in [Cha.Sa.[[Sutra Sthana]] 5] and [Cha.Sa.[[Vimana Sthana]] 1/21] are also followed then there is proper digestion of food which helps in maintaining proper balance within the ''[[dhatu]]'' [50½]

=== ''Durbala'' (weak) ''agni'' ===

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</div></div>

−

''Grahani'' is seat of ''agni'' and it is so called since it holds/retains the food (for proper digestion and assimilation). It holds the food just above the umbilical region and it is supported and nourished by the ''agni''. ''Grahani'' with help of ''agni'' holds the undigested food and pushes forward digested food, but when ''agni'' becomes weak and vitiated due to ''vidagdha ahara murchita dosha'' (afflicted by improperly digested food) i.e ''sama dosha''(''dosha'' associated with ''ama'') it vitiates the ''grahani'' and releases food in the form of ''ama'' i.e. undigested form [56-57]

+

''Grahani'' is seat of ''agni'' and it is so called since it holds/retains the food (for proper digestion and assimilation). It holds the food just above the umbilical region and it is supported and nourished by the ''agni''. ''Grahani'' with help of ''agni'' holds the undigested food and pushes forward digested food, but when ''agni'' becomes weak and vitiated due to ''vidagdha ahara murchita dosha'' (afflicted by improperly digested food) i.e ''sama dosha''(''[[dosha]]'' associated with ''ama'') it vitiates the ''grahani'' and releases food in the form of ''ama'' i.e. undigested form [56-57]

=== Four types of ''grahani'' disease ===

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</div></div>

−

''Grahani'' is classified into four types viz ''~~vataja~~, ~~pittaja~~, ~~kaphaja~~'' and ''sannipataja''. On the basis of the classification, etiological factors, symptoms and signs are being mentioned one by one [58]

+

''Grahani'' is classified into four types viz ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' and ''sannipataja''. On the basis of the classification, etiological factors, symptoms and signs are being mentioned one by one [58]

−

=== Causes of ''~~vataja~~ grahani'' ===

+

=== Causes of ''[[vata]]ja grahani'' ===

Line 1,063: Line 1,063:

</div></div>

−

Excessive indulgence in diet having ''katu'' (pungent), ''tikta'' (bitter), ''kashaya'' (astringent) dominant food, which is dry in nature or having absorptive or emaciative qualities; cold, chilled or frozen items, eating quantitatively less amount of food, suppression of natural urges and excessive sexual intercourse contribute to aggravation of ''vata dosha'' which encompass the ''agni'' causing suppression of ''agni'' [59½]

+

Excessive indulgence in diet having ''katu'' (pungent), ''tikta'' (bitter), ''kashaya'' (astringent) dominant food, which is dry in nature or having absorptive or emaciative qualities; cold, chilled or frozen items, eating quantitatively less amount of food, suppression of natural urges and excessive sexual intercourse contribute to aggravation of ''[[vata dosha]]'' which encompass the ''agni'' causing suppression of ''agni'' [59½]

−

=== Symptoms of ''~~vataja~~ grahani'' ===

+

=== Symptoms of ''[[vata]]ja grahani'' ===

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Stools are evacuated with difficulty and consume time. Feces are either watery, dry, small sized associated with flatus and undigested food. Frequency of stool is increased and patient may suffer from cough and breathing difficulty [60-64]

−

=== Causes of ''~~pittaja~~ grahani'' ===

+

=== Causes of ''[[pitta]]ja grahani'' ===

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</div></div>

−

''Katu'' (spicy), ''ajeerna'' (undigestable food), ''vidahi'' (food causing eructation), ''amla'' (sour), ''kshara'' (alkali) and other food items which aggravate ''pitta'' are causes for ''~~pittaja~~ grahani''. The aggravated ''pitta'' hampers the function of ''agni'' similar to condition wherein hot water extinguishes fire [65]

+

''Katu'' (spicy), ''ajeerna'' (undigestable food), ''vidahi'' (food causing eructation), ''amla'' (sour), ''kshara'' (alkali) and other food items which aggravate ''pitta'' are causes for ''[[pitta]]ja grahani''. The aggravated ''[[pitta]]'' hampers the function of ''agni'' similar to condition wherein hot water extinguishes fire [65]

−

=== Symptoms of ''~~pittaja~~ grahani'' ===

+

=== Symptoms of ''[[pitta]]ja grahani'' ===

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</div></div>

−

The stools have undigested food particles having either bluish-yellowish tinge or yellow in color and are loose/watery. The eructions have foul smell and sour taste, there is burning sensation in the cardiac region (retro-sternal) and throat, anorexia and thirst are the symptoms of ''~~pittaja~~ grahani'' [66]

+

The stools have undigested food particles having either bluish-yellowish tinge or yellow in color and are loose/watery. The eructions have foul smell and sour taste, there is burning sensation in the cardiac region (retro-sternal) and throat, anorexia and thirst are the symptoms of ''[[pitta]]ja grahani'' [66]

−

=== Causes of ''~~kaphaja~~ grahani'' ===

+

=== Causes of ''[[kapha]]ja grahani'' ===

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</div></div>

−

Heavy to digest or excessively unctuous foods, frozen or chilled items or food having cold nature or food which has qualities similar to ''kapha'', excessive intake of food and sleeping just after the meals hamper the function of ''agni'' and simultaneously vitiates ''kapha'' [67]

+

Heavy to digest or excessively unctuous foods, frozen or chilled items or food having cold nature or food which has qualities similar to ''[[kapha]]'', excessive intake of food and sleeping just after the meals hamper the function of ''agni'' and simultaneously vitiates ''[[kapha]]'' [67]

−

=== Symptoms of ''~~kaphaja~~ grahani'' ===

+

=== Symptoms of ''[[kapha]]ja grahani'' ===

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</div></div>

−

''Sannipataja grahani'' occurs by simultaneous vitiation of ''vata, pitta'' and ''kapha''. In such conditions etiological factors, symptoms and signs are of all the three ''dosha'' appear. Hereafter treatment of ''grahanidosha'' is expounded [72]

+

''Sannipataja grahani'' occurs by simultaneous vitiation of ''[[vata]], [[pitta]]'' and ''[[kapha]]''. In such conditions etiological factors, symptoms and signs are of all the three ''[[dosha]]'' appear. Hereafter treatment of ''grahanidosha'' is expounded [72]

−

=== ''Vamana'' in ''grahanidosha'' ===

+

=== ''[[Vamana]]'' in ''grahanidosha'' ===

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</div></div>

−

When the ''~~doshas~~'' are located in ''grahani'' and are associated with incomplete digested food then ''vishtambha'' (constipation), excessive salivation, bodyache, burning sensation, anorexia and heaviness is felt by patient which are symptoms of ''ama'' and in such a condition ''vamana'' (emetic therapy) with lukewarm water or with decoction of ''madanaphala'' (Randia spinosa), ''pippali'' (Piper longum) and ''sarshapa'' (Brassica campestris) should be administered [73-74]

+

When the ''[[dosha]]s'' are located in ''grahani'' and are associated with incomplete digested food then ''vishtambha'' (constipation), excessive salivation, bodyache, burning sensation, anorexia and heaviness is felt by patient which are symptoms of ''ama'' and in such a condition ''[[vamana]]'' (emetic therapy) with lukewarm water or with decoction of ''madanaphala'' (Randia spinosa), ''pippali'' (Piper longum) and ''sarshapa'' (Brassica campestris) should be administered [73-74]

−

=== Treatment of ''leena dosha'' ===

+

=== Treatment of ''leena [[dosha]]'' ===

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</div></div>

−

If the ''ama'' is in ''pakvashaya'' and in ''anutklishtha'' (stuck, not ready to come out) condition then ''stravana'' (increasing secretion) with ''deepana dravyas'' should be administered whereas if ama gets absorbed along with ''rasa dhatu'' and if it pervades throughout the body then ''langhana'' and ''pachana'' should be advised [75]

+

If the ''ama'' is in ''pakvashaya'' and in ''anutklishtha'' (stuck, not ready to come out) condition then ''stravana'' (increasing secretion) with ''[[deepana]] dravyas'' should be administered whereas if ama gets absorbed along with ''[[rasa dhatu]]'' and if it pervades throughout the body then ''[[langhana]]'' and ''[[pachana]]'' should be advised [75]

=== ''Panchakoladi shritam and peya'' ===

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</div></div>

−

After cleansing of ''amashaya'', liquid gruel of rice (''peya'') fortified with ''panchakola'' etc. drugs should be administered. Light and easy to digest food along with ''deepana'' drugs may be given [76]

+

After cleansing of ''amashaya'', liquid gruel of rice (''peya'') fortified with ''panchakola'' etc. drugs should be administered. Light and easy to digest food along with ''[[deepana]]'' drugs may be given [76]

Line 1,356: Line 1,356:

</div></div>

−

In patients with ''~~vataja~~ grahani'' after ascertaining that ''ama'' is digested, medicated ghee starting with very minimum quantity prepared from ''deepaneeya gana'' be administered [Cha.Sa.[[Sutra Sthana ]]4/9/6]- [77]

+

In patients with ''[[vata]]ja grahani'' after ascertaining that ''ama'' is digested, medicated ghee starting with very minimum quantity prepared from ''deepaneeya gana'' be administered [Cha.Sa.[[Sutra Sthana ]]4/9/6]- [77]

−

=== ''Niruha basti'' ===

+

=== ''Niruha [[basti]]'' ===

Line 1,375: Line 1,375:

</div></div>

−

As stimulation of ''agni'' is observed and still if patient finds difficulty in passing stool, urine and flatus then in such condition every two or three days ''niruha basti'' should be administered after proper ''snehana'' and ''swedana'' [78]

+

As stimulation of ''agni'' is observed and still if patient finds difficulty in passing stool, urine and flatus then in such condition every two or three days ''niruha [[basti]]'' should be administered after proper ''[[snehana]]'' and ''[[swedana]]'' [78]

−

=== ''Virechana'' ===

+

=== ''[[Virechana]]'' ===

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</div></div>

−

After ''niruha'', the ''strasta dosha'' (''dosha'' ready to come out) should be cleaned with purgative drugs like ''eranda taila'' (castor oil) or ''tilvaka ghrita'' mixed with ''kshara'' (medicine with alkaline nature) [79]

+

After ''niruha'', the ''strasta dosha'' (''[[dosha]]'' ready to come out) should be cleaned with purgative drugs like ''eranda taila'' (castor oil) or ''tilvaka ghrita'' mixed with ''kshara'' (medicine with alkaline nature) [79]

−

=== ''Anuvasana basti'' ===

+

=== ''Anuvasana [[basti]]'' ===

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</div></div>

−

After ''shodhana'' of intestine if ''rukshata'' and ''baddha'' (pellet-like) stools are seen then ''anuvasana basti'' with ''taila'' fortified with ''deepana'' drugs having sour and ''vata'' alleviating action may be administered [80]

+

After ''[[shodhana]]'' of intestine if ''rukshata'' and ''baddha'' (pellet-like) stools are seen then ''anuvasana [[basti]]'' with ''taila'' fortified with ''[[deepana]]'' drugs having sour and ''[[vata]]'' alleviating action may be administered [80]

Line 1,430: Line 1,430:

</div></div>

−

After appropriate administration of ''niruha, virechana'' and ''anuvasana'', light diet should be taken daily and ghee should be taken repeatedly [81]

+

After appropriate administration of ''niruha, [[virechana]]'' and ''anuvasana'', light diet should be taken daily and ghee should be taken repeatedly [81]

=== ''Dashamooladya ghrita''===

Line 1,503: Line 1,503:

</div></div>

−

Boil the ''svarasa'' of two ''panchamoola'' (''brihat'' and ''laghu''), ''sarala'' ((''trivrita'') Operculina turpethum), ''devadaru'' (Cedrus deodara), ''nagara'' (Zingiber officinale), ''pippali'' (Piper longum), ''pippalimoola, chitraka'' (Plumbago zeylanica), ''gajapippali'' (Piper retofractum), ''sanabeeja'' (seeds of Crotalaria juncea), barley, ''kola, kulatta'' and ''susavi'' (Woodfordia fruticosa) with ''aranala, dadhimanda'' or ''sauviraka''. After one fourth reductions add one ''adhaka'' (3.073 kg) of ghee and ''svarjikakshara'' and ''yavashukakshara'' as per ''yukti pramana'' i.e. either in small quantity or at the time of ''ghrita siddhi lakshana'' alongwith ''saindhava'' (rock salt), ''audbhida'' (salts derived from plants), ''samudra'' (table salt), ''bidha'' (red granular salt), ''romaka, sauvarchala'' and ''pakya'' (''pakaja'') types of salt in two ''pala'' quantity each (96 gm each). After preparation, it may be administered up to one ''prasrita'' i.e. 96 gm. It increases ''agni'', strength and complexion and helps in alleviation of ''vata'' and thus digestion of food [82-86]

+

Boil the ''svarasa'' of two ''panchamoola'' (''brihat'' and ''laghu''), ''sarala'' ((''trivrita'') Operculina turpethum), ''devadaru'' (Cedrus deodara), ''nagara'' (Zingiber officinale), ''pippali'' (Piper longum), ''pippalimoola, chitraka'' (Plumbago zeylanica), ''gajapippali'' (Piper retofractum), ''sanabeeja'' (seeds of Crotalaria juncea), barley, ''kola, kulatta'' and ''susavi'' (Woodfordia fruticosa) with ''aranala, dadhimanda'' or ''sauviraka''. After one fourth reductions add one ''adhaka'' (3.073 kg) of ghee and ''svarjikakshara'' and ''yavashukakshara'' as per ''yukti pramana'' i.e. either in small quantity or at the time of ''ghrita siddhi lakshana'' alongwith ''saindhava'' (rock salt), ''audbhida'' (salts derived from plants), ''samudra'' (table salt), ''bidha'' (red granular salt), ''romaka, sauvarchala'' and ''pakya'' (''pakaja'') types of salt in two ''pala'' quantity each (96 gm each). After preparation, it may be administered up to one ''prasrita'' i.e. 96 gm. It increases ''agni'', strength and complexion and helps in alleviation of ''[[vata]]'' and thus digestion of food [82-86]

=== ''Tryushanadya ghrita'' ===

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Make paste of ''panchamoola'' (''bilva, shyonaka, gambhari, patala'' and ''gambharika''), ''abhaya'', ''trikatu, pippalimoola, saindhava, rasna,'' two ''kshara'' (''sarjika'' and ''yavakshara''), ''ajaji, vidanga'' and ''sati'' and prepare medicated ghee with ''sukta,'' juice of ''matulunga'' and ''ardraka, suṣkamoolaka, kolambu, chukrika,'' pomengranate, butter milk, ''mastu'' (supplement liquid portion in the curd/yoghurt), ''suramanda'' (indigenous beer beverage prepared from fermented cereals) ''sauviraka'' (acidic fermented liquid obtained from wheat), ''tushodaka'' (fermented liquid using the coarse grains of barley) and ''kanji'' (fermented liquid).

−

The medicated ghee helps in digestion and increase strength of ''agni'' and cures colicky pain, ''gulma, udara'', asthma and cough. It also pacifies ''vata'' and ''kapha''. ''Beejapuraka svarasa'' can also be used for ''sneha siddhi''.

+

The medicated ghee helps in digestion and increase strength of ''agni'' and cures colicky pain, ''gulma, udara'', asthma and cough. It also pacifies ''[[vata]]'' and ''[[kapha]]''. ''Beejapuraka svarasa'' can also be used for ''sneha siddhi''.

''Taila siddhi'' with above medicine may be used for ''abhyanga'' (massage) and the ''choorna'' used in above preparation may be taken with lukewarm water.

−

In condition such as ''kapha avrite vata'' (''vata'' occluded by ''kapha''), ''sama kapha'' and ''vata'' aggravated due to ''kapha'' give the above ''choorna'' for digestion and to stimulate ''agni''. The medicine is known as ''panchamooladyam ghritam choornam'' [88-93]

+

In condition such as ''kapha avrite vata'' (''[[vata]]'' occluded by ''[[kapha]]''), ''sama [[kapha]]'' and ''[[vata]]'' aggravated due to ''[[kapha]]'' give the above ''choorna'' for digestion and to stimulate ''agni''. The medicine is known as ''panchamooladyam ghritam choornam'' [88-93]

=== Examination of feces ===

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</div></div>

−

''Sama mala'' (stools) sinks into water due to ''gurutva'' (heaviness) of ''ama'' whereas ''pakva'' or ''nirama mala'' floats over the water; provided the stools consistency is not watery or not very compact and if not vitiated by ''sheeta guna'' and ''kapha'' [94]

+

''Sama mala'' (stools) sinks into water due to ''gurutva'' (heaviness) of ''ama'' whereas ''pakva'' or ''nirama mala'' floats over the water; provided the stools consistency is not watery or not very compact and if not vitiated by ''sheeta [[guna]]'' and ''[[kapha]]'' [94]

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</div></div>

−

Patient should be evaluated for ''amadosha'' whether ''samata'' or ''niramta'' is present or not and then appropriately treated with ''pachana'' etc. treatment [95]

+

Patient should be evaluated for ''amadosha'' whether ''samata'' or ''niramta'' is present or not and then appropriately treated with ''[[pachana]]'' etc. treatment [95]

=== ''Chitrakadya gutika'' ===

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''Chitraka, pippalimoola,'' two ''kshara'' (''yavakshara'' and ''sarjikshara''), salt, ''trikatu, hingu, ajamoda'' and ''chavya'' are mixed together and trichurated with either ''matulunga svarasa'' or ''dadima svarasa'' and tablets are prepared. This ''chitrakadya guthi'' is useful for digestion of ''ama'' and stimulation of the ''agni'' [96-97]

−

=== Recipes for ''pachana'' of ''ama'' ===

+

=== Recipes for ''[[pachana]]'' of ''ama'' ===

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</div></div>

−

''Shunthi, ativisha'' and ''musta'' decoction helps in ''pachana'' of ''ama''. ''Kalka'' (paste) of ''shunthi, ativisha'' and ''musta'' or ''haritaki'' or ''shunthi'' alongwith warm water also does ''ama pachana'' [98]

+

''Shunthi, ativisha'' and ''musta'' decoction helps in ''[[pachana]]'' of ''ama''. ''Kalka'' (paste) of ''shunthi, ativisha'' and ''musta'' or ''haritaki'' or ''shunthi'' alongwith warm water also does ''ama pachana'' [98]

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</div></div>

−

Paste of ''bilva, chitraka'' and ''nagara'' should be added with ''vida lavana'' and administered in ''sama'' stool or mucus in stool and pain in abdomen due to ~~vāta~~ aggravation [100]

+

Paste of ''bilva, chitraka'' and ''nagara'' should be added with ''vida lavana'' and administered in ''sama'' stool or mucus in stool and pain in abdomen due to [[vata]] aggravation [100]

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''Kalinga, hingu, ativisha, vacha, sauvarchala'' and ''haritaki'' with warm water is useful in vomiting, ''arshogranthi'' (analpolyp with pellet stool) and pain in abdomen. Similarly, combination of ''haritaki, sauvarchala'' and ''ajaji'' along with maricha can be used for same condition [101-102]

−

=== Recipe for ''pitta-kapha grahani'' ===

+

=== Recipe for ''[[pitta]]-[[kapha]] grahani'' ===

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</div></div>

−

Decoction of the ''haritaki, pippalimoola, vacha, katukarohineem, patha,'' seeds of ''kutaja, chitraka, vishvabheshaja'' (''sunthi'') or ''choorna'' of the above contents should be administered with warm water. It is helpful when colic pain is associated with ''pitta-kapha'' dominant ''grahani'' [103-104]

+

Decoction of the ''haritaki, pippalimoola, vacha, katukarohineem, patha,'' seeds of ''kutaja, chitraka, vishvabheshaja'' (''sunthi'') or ''choorna'' of the above contents should be administered with warm water. It is helpful when colic pain is associated with ''[[pitta]]-[[kapha]]'' dominant ''grahani'' [103-104]

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</div></div>

−

''Choorna'' of ''pippali, nagara, patha, sariva, brihatidvayam'' (''brihati, kantakari''), ''chitraka,'' seeds of ''kutaja'', five types of ''lavana'', along with ''yavakshara,'' curd, hot water and different types of fermented liquids such as ''kanji, sauviraka'' etc is taken for increasing the power of ''agni'' and to eliminate the ''vata'' in abdomen [106-107]

+

''Choorna'' of ''pippali, nagara, patha, sariva, brihatidvayam'' (''brihati, kantakari''), ''chitraka,'' seeds of ''kutaja'', five types of ''lavana'', along with ''yavakshara,'' curd, hot water and different types of fermented liquids such as ''kanji, sauviraka'' etc is taken for increasing the power of ''agni'' and to eliminate the ''[[vata]]'' in abdomen [106-107]

=== ''Marichadya choorna'' ===

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</div></div>

−

''Marichadyam choornam'' contains one ''kudava'' (192 gm) of ''maricha, kunchika, ambashtha'' (''patha''), ''vrikshamlah'', ten ''pala'' (480 gm) of ''amlavetas,'' half ''pala'' (24 gm) each of ''sauvarchala, bidha, pakya, yavakshara, saindhava, sathi, pushkaramoola, hingu'' and ''hingushivatika'' (''vamsapatri''). It is useful in ''vata'' dominant ''grahani'' and anorexia [108-110]

+

''Marichadyam choornam'' contains one ''kudava'' (192 gm) of ''maricha, kunchika, ambashtha'' (''patha''), ''vrikshamlah'', ten ''pala'' (480 gm) of ''amlavetas,'' half ''pala'' (24 gm) each of ''sauvarchala, bidha, pakya, yavakshara, saindhava, sathi, pushkaramoola, hingu'' and ''hingushivatika'' (''vamsapatri''). It is useful in ''[[vata]]'' dominant ''grahani'' and anorexia [108-110]

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</div></div>

−

Fortified soup with ''panchakola'' or soup of ''mulaka'' with ''maricha'' or medicated soup prepared from animals inhabiting in arid land added with ghee, ''dadima, takra, amla dravyas'' or soup of animals that eat other animals fortified with medicines having ''deepana'' qualities be given for drink.

+

Fortified soup with ''panchakola'' or soup of ''mulaka'' with ''maricha'' or medicated soup prepared from animals inhabiting in arid land added with ghee, ''dadima, takra, amla dravyas'' or soup of animals that eat other animals fortified with medicines having ''[[deepana]]'' qualities be given for drink.

Patient may be given buttermilk, ''aranala'' (sour drink), ''madya'' (medicated alcohol) and ''arishtha'' as liquid diets [115-116]

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</div></div>

−

Buttermilk due to its ''~~dīpana~~, grahi'' (substances which increases appetite and digestive power and absorb fluid from the stool) and easy to digest actions is very useful in ''grahanidosha''. It is ''madhura'' in ''vipaka'' therefore reduces ''pitta''; due to ''kashaya'' (astringent) taste, ''ushna virya'' (hot potency), ''vikashi'' and ''ruksha guna'' it is useful in ''kapha'' dominated disorders and due to ''madhura'' and ''amla rasa, sandra guna'' it reduces ''vata''. Freshly churned butter milk does not cause burning sensation; therefore, buttermilk is very useful in treatment of ''udara, arśa'' and all ''grahanidosha'' [117-119]

+

Buttermilk due to its ''[[deepana]], grahi'' (substances which increases appetite and digestive power and absorb fluid from the stool) and easy to digest actions is very useful in ''grahanidosha''. It is ''madhura'' in ''vipaka'' therefore reduces ''[[pitta]]''; due to ''kashaya'' (astringent) taste, ''ushna virya'' (hot potency), ''vikashi'' and ''ruksha [[guna]]'' it is useful in ''[[kapha]]'' dominated disorders and due to ''madhura'' and ''amla rasa, sandra guna'' it reduces ''[[vata]]''. Freshly churned butter milk does not cause burning sensation; therefore, buttermilk is very useful in treatment of ''udara, arśa'' and all ''grahanidosha'' [117-119]

=== ''Takrarishtha'' ===

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Take ''yavani, amalaki, haritaki'' and ''maricha'' each in three ''pala'' (144 gm) and ''pancha-lavana'' in one ''pala'' (48 gm) and powder together and add buttermilk to it and ferment till sour taste is obtained. This preparation called ''takrarishtha'' stimulates the digestive power and relieves ''sotha, gulma, arsha, krimi, prameha'' and ''udara roga'' [120-121]

−

=== Management of ''pitta'' dominant ''grahani'' ===

+

=== Management of ''[[pitta]]'' dominant ''grahani'' ===

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</div></div>

−

If ''agnimandyata'' is due to ''utklishtha'' (ready to come out) ''pitta'' in its own place then in such a situation ''virechana'' or ''vamana'' should be administered for removal of ''pitta'' [122]

+

If ''agnimandyata'' is due to ''utklishtha'' (ready to come out) ''[[pitta]]'' in its own place then in such a situation ''[[virechana]]'' or ''[[vamana]]'' should be administered for removal of ''[[pitta]]'' [122]

−

=== Diet after ''shodhana'' ===

+

=== Diet after ''[[shodhana]]'' ===

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</div></div>

−

After proper ''shodhana'', diet which does not cause burning sensation, which is easy to digest and added with ingredients having bitter taste should be taken. Soup of animals of arid zone, soup of cereals such as ''mudga'', etc. and ''khada'' should be given.

+

After proper ''[[shodhana]]'', diet which does not cause burning sensation, which is easy to digest and added with ingredients having bitter taste should be taken. Soup of animals of arid zone, soup of cereals such as ''mudga'', etc. and ''khada'' should be given.

−

Pomegranate having sour taste should be taken along with ghee, ''deepana'' and ''grahi dravyas''. With help of powders of ''deepaniya'' drugs and ghee fortified with bitter drugs, the digestive power should be increased (123-124).

+

Pomegranate having sour taste should be taken along with ghee, ''[[deepana]]'' and ''grahi dravyas''. With help of powders of ''deepaniya'' drugs and ghee fortified with bitter drugs, the digestive power should be increased (123-124).

=== ''Chandanadya ghrita'' ===

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</div></div>

−

Take two ''pala'' (96 gm) each of ''chandana, padmaka, usheera, patha, murva, kuthannatha'' (''kaivarta musta''), ''shadhgrantha'' (''vacha''), ''sariva, asphota'' (''aspurmallika''), ''saptaparna, aṭarushakana'' (''vasa''), ''patola, udumbara, ashvattha, vata, plaksa, kapeetana'' (''gandha musta''), ''kathuki, musta'' and ''nimba'' and prepare decoction by adding one ''drona'' (12.228 Kg) of water with 1/4th reduction. ''Ghrita siddhi'' is done adding one ''prastha'' (96 gm) of ghee to the above decoction and paste of one ''aksa'' (12 gm) each of ''kiratatikta, indrayava, vira, pippalī'' and ''utpala'' is added. This medicated ghee is known as ''chandanadya ghrita'' and is indicated in ''~~pittaja~~ grahani'' [125-127]

+

Take two ''pala'' (96 gm) each of ''chandana, padmaka, usheera, patha, murva, kuthannatha'' (''kaivarta musta''), ''shadhgrantha'' (''vacha''), ''sariva, asphota'' (''aspurmallika''), ''saptaparna, aṭarushakana'' (''vasa''), ''patola, udumbara, ashvattha, vata, plaksa, kapeetana'' (''gandha musta''), ''kathuki, musta'' and ''nimba'' and prepare decoction by adding one ''drona'' (12.228 Kg) of water with 1/4th reduction. ''Ghrita siddhi'' is done adding one ''prastha'' (96 gm) of ghee to the above decoction and paste of one ''aksa'' (12 gm) each of ''kiratatikta, indrayava, vira, pippalī'' and ''utpala'' is added. This medicated ghee is known as ''chandanadya ghrita'' and is indicated in ''[[pitta]]ja grahani'' [125-127]

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</div></div>

−

''Tikta ghrita'' as mentioned in [[Kushtha Chikitsa]] [Cha. Sa. [[Chikitsa Sthana]] 7/140-150] may also be prescribed in ''~~pittaja~~ grahani'' [128]

+

''Tikta ghrita'' as mentioned in [[Kushtha Chikitsa]] [Cha. Sa. [[Chikitsa Sthana]] 7/140-150] may also be prescribed in ''[[pitta]]ja grahani'' [128]

=== ''Nagaradya churna'' ===

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Mix powder of ''kiratatikta, shadgrantha, trayamana, trikatu, chandana, padmaka, usheera,'' bark of ''darvi, katurohini,'' bark and fruit of ''kutaja, mushta, yavani, devadaru, patola,'' leaves of ''nimba, ela, saurashtra, ativisha, tvak,'' seeds of ''madhushigru, murva'' and ''parpataka'' and prescribe it as linctus prepared with honey or may be taken with water or alcoholic preparation. This preparation is known as ''kiratadyam churna'' whih cures ''hridaya roga, pandu, grahaniroga, gulma, shula, aruchi, jwara, kamala, sannipatika'' type of diarrhea and eight types of ''mukharoga'' [137-140]

−

=== Treatment of ''~~kaphaja~~ grahani'' ===

+

=== Treatment of ''[[kapha]]ja grahani'' ===

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</div></div>

−

In ''~~kaphaja~~ grahani'' first administer ''vamana'' and then increase ''agni'' (digestive power) with help of drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' [141]

+

In ''[[kapha]]ja grahani'' first administer ''[[vamana]]'' and then increase ''agni'' (digestive power) with help of drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' [141]

Line 2,527: Line 2,527:

</div></div>

−

Take one ''drona'' (12.22 kg/l) flowers of ''madhuka,'' half ''drona'' (6.11 kg/l) of ''vidanga, chitraka'' half of ''vidanga'' i.e. 1/4th ''drona'' (3.05 kg/l), ''bhallataka'' one ''adhaka'' (3.073 kg) and eight ''pala'' (384 gm) of ''manjishtha'' and mix with three ''drona'' (36.66 kg/l) of water and reduce to one ''drona'' (12.22 L) and after the decoction comes to room temperature add half ''adhaka'' (1.53 kg) of honey. Keep this preparation in a pot lined with paste of ''ela, mrinala, agaru'' and ''chandana'' and store for period of one month till ''asava siddhi'' occurs. This preparation is called ''madhukasava'' and is useful in ''grahani,'' helps empowering of ''agni,'' promotes nutrition and normalizes ''kapha'' and ''pitta''. It is indicated in ''shotha, kushtha, kilasa'' and ''prameha'' [146-149]

+

Take one ''drona'' (12.22 kg/l) flowers of ''madhuka,'' half ''drona'' (6.11 kg/l) of ''vidanga, chitraka'' half of ''vidanga'' i.e. 1/4th ''drona'' (3.05 kg/l), ''bhallataka'' one ''adhaka'' (3.073 kg) and eight ''pala'' (384 gm) of ''manjishtha'' and mix with three ''drona'' (36.66 kg/l) of water and reduce to one ''drona'' (12.22 L) and after the decoction comes to room temperature add half ''adhaka'' (1.53 kg) of honey. Keep this preparation in a pot lined with paste of ''ela, mrinala, agaru'' and ''chandana'' and store for period of one month till ''asava siddhi'' occurs. This preparation is called ''madhukasava'' and is useful in ''grahani,'' helps empowering of ''agni,'' promotes nutrition and normalizes ''[[kapha]]'' and ''[[pitta]]''. It is indicated in ''shotha, kushtha, kilasa'' and ''prameha'' [146-149]

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</div></div>

−

Boil two ''prastha'' (1.53 kg) each of ''duralabha'' and ''amalaki'', one ''mushthi'' each of ''danti'' and ''chitraka'' and two hundred matured fruits of ''haritaki'' in four ''drona'' (48.88 kg/l) of water and reduce to one ''drona'' (12.228 kg/l). When it comes to room temperature add two hundred ''pala'' (9600 gm) of jaggery and one ''kudava'' (192 gm) of honey as well as powder of ''priyangu, pippali'' and ''vidanga'' each in one ''kudava'' (192 gm) and keep in jar pasted with ghee on the inner wall for period of fifteen days. This preparation is known as ''duralabhasava'' and is indicated in ''grahani, pandu, arsha, kushtha, visarpa'' and ''prameha''. It promotes voice and complexion and cures ''raktapitta'' and other ''~~kaphaja~~'' disorders [152-155]

+

Boil two ''prastha'' (1.53 kg) each of ''duralabha'' and ''amalaki'', one ''mushthi'' each of ''danti'' and ''chitraka'' and two hundred matured fruits of ''haritaki'' in four ''drona'' (48.88 kg/l) of water and reduce to one ''drona'' (12.228 kg/l). When it comes to room temperature add two hundred ''pala'' (9600 gm) of jaggery and one ''kudava'' (192 gm) of honey as well as powder of ''priyangu, pippali'' and ''vidanga'' each in one ''kudava'' (192 gm) and keep in jar pasted with ghee on the inner wall for period of fifteen days. This preparation is known as ''duralabhasava'' and is indicated in ''grahani, pandu, arsha, kushtha, visarpa'' and ''prameha''. It promotes voice and complexion and cures ''raktapitta'' and other ''[[kapha]]ja'' disorders [152-155]

=== ''Moolasava'' ===

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</div></div>

−

Boil five ''pala'' (240 gm) each of ''haridra,'' two types of ''panchamoola'' i.e. ''brihat'' and ''laghu panchamoola, veera'' (''shatavari''), ''rishabhaka, jeevaka'' in four ''drona'' (48.88 kg/l) of water and reduce to one ''drona'' (12.22 kg/l); to this add two hundred ''pala'' (9600 gm) of jaggery and half ''kudava'' (96 gm) of honey as well as powders of ''priyangu, musta, manjishtha, vidanga, madhuka, plava,'' and ''sabaraka lodhra'' and fermented for a fortnight. This ''mulasava'' does ''deepana'' and is effective in ''raktapitta, anaha, ~~kaphaja~~ vikara, hridroga, pandu'' and ''angasada'' [156-159]

+

Boil five ''pala'' (240 gm) each of ''haridra,'' two types of ''panchamoola'' i.e. ''brihat'' and ''laghu panchamoola, veera'' (''shatavari''), ''rishabhaka, jeevaka'' in four ''drona'' (48.88 kg/l) of water and reduce to one ''drona'' (12.22 kg/l); to this add two hundred ''pala'' (9600 gm) of jaggery and half ''kudava'' (96 gm) of honey as well as powders of ''priyangu, musta, manjishtha, vidanga, madhuka, plava,'' and ''sabaraka lodhra'' and fermented for a fortnight. This ''mulasava'' does ''[[deepana]]'' and is effective in ''raktapitta, anaha, [[kapha]]ja vikara, hridroga, pandu'' and ''angasada'' [156-159]

=== ''Pindasava'' ===

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</div></div>

−

New earthen pot should be pasted internally by ''pippali'' and honey and fumigated with ''aguru''. One ''adhaka'' (3.073 kg) of honey and equal quantity of water should be added. To this add half ''kudava'' (1.53 kg) of powder of ''vidanga'' and one ''kudava'' (192 gm) of ''pippali,'' one fourth ''kudava'' (48 gm) of ''vamsha'' and one ''karsha'' (12 gm) each of ''tvak, ela, keshara, maricha, patra, sati, kramuka, ativisha, ghana'' (''chandana''), ''harenu, elvaluka, tejohva, pippalimoola'' and ''chitraka'' and fermented for period of one month and later on administered. It stimulates the power of digestion and regularizes the ''vishama agni''. It is useful in ''hridroga, pandu, grahani, kushtha, arsha, shvayathu, jwara'' and other disorders caused by ''vata'' and '' kapha dosha''. Thus, completes description of ''madhvariṣṭa'' [163-167]

+

New earthen pot should be pasted internally by ''pippali'' and honey and fumigated with ''aguru''. One ''adhaka'' (3.073 kg) of honey and equal quantity of water should be added. To this add half ''kudava'' (1.53 kg) of powder of ''vidanga'' and one ''kudava'' (192 gm) of ''pippali,'' one fourth ''kudava'' (48 gm) of ''vamsha'' and one ''karsha'' (12 gm) each of ''tvak, ela, keshara, maricha, patra, sati, kramuka, ativisha, ghana'' (''chandana''), ''harenu, elvaluka, tejohva, pippalimoola'' and ''chitraka'' and fermented for period of one month and later on administered. It stimulates the power of digestion and regularizes the ''vishama agni''. It is useful in ''hridroga, pandu, grahani, kushtha, arsha, shvayathu, jwara'' and other disorders caused by ''[[vata]]'' and '' [[kapha dosha]]''. Thus, completes description of ''madhvariṣṭa'' [163-167]

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</div></div>

−

''Pippali, pippalimoola,'' two types of ''kshara'' (''yavakshara, svarjikakshara''), five types of ''lavana, matulunga, haritaki, rasna, saṭi, maricha'' and ''nagara'' are taken in equal quantity and powdered and administered with warm water early in the morning. It cures ''~~kaphaja~~ grahani dosha'' and improves ''bala,'' complexion and ''agni''.

+

''Pippali, pippalimoola,'' two types of ''kshara'' (''yavakshara, svarjikakshara''), five types of ''lavana, matulunga, haritaki, rasna, saṭi, maricha'' and ''nagara'' are taken in equal quantity and powdered and administered with warm water early in the morning. It cures ''[[kapha]]ja grahani dosha'' and improves ''bala,'' complexion and ''agni''.

−

''Ghrita'' fortified with above medicines is useful in ''kapha'' associated with ''~~vataja~~ grahanidosha'' [168-169]

+

''Ghrita'' fortified with above medicines is useful in ''[[kapha]]'' associated with ''[[vata]]ja grahanidosha'' [168-169]

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</div></div>

−

''Pippali, pippalimoola, patha, chavya, indrayava, nagara, chitraka, ativisha, hingu, svadamishthra'' (''gokshura''), ''katurohini'' and ''vacha'' are taken in one ''karsha'' (12 gm) quantity each. To this one ''pala'' (12 gm) of ''panchalavana'' is added along with two ''prastha'' of curds and two ''kudava'' (384 gm) of ''taila'' and ''ghrita''. The combination is boiled till water is completely evaporated. It is again burned by ''antaradhooma'' method and the end product is powdered and mixed with ghee its dosage is one ''panitala'' and when medicine gets digested patient is advised to take sweet diet. It is indicated in ''vata ~~kaphaja~~'' disorders and in ''visha'' and ''gara visha'' [173-176]

+

''Pippali, pippalimoola, patha, chavya, indrayava, nagara, chitraka, ativisha, hingu, svadamishthra'' (''gokshura''), ''katurohini'' and ''vacha'' are taken in one ''karsha'' (12 gm) quantity each. To this one ''pala'' (12 gm) of ''panchalavana'' is added along with two ''prastha'' of curds and two ''kudava'' (384 gm) of ''taila'' and ''ghrita''. The combination is boiled till water is completely evaporated. It is again burned by ''antaradhooma'' method and the end product is powdered and mixed with ghee its dosage is one ''panitala'' and when medicine gets digested patient is advised to take sweet diet. It is indicated in ''[[vata]] [[kapha]]ja'' disorders and in ''visha'' and ''gara visha'' [173-176]

=== ''Kshara'' preparations ===

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</div></div>

−

''Triphala, kaṭabhi, chavya,'' pulp of ''bilva'', powder of ''ayoraja'' (''mandura''), ''katutki, musta, kushtha, patha, hingu, madhuka, kshara'' of ''muskaka'' and ''yavakshara, trikatu, vacha, vidanga, pippalimoola, svarjikakshara, nimba, chitraka, murva, ajamoda, indrayava, guḍuchi'' and ''devadaru'' are taken in one ''karsha'' (12 gm) quantity and one ''pala'' each of five salts are taken. All are mixed with three ''kudavas'' (576 gm) of ''dadhi, ghrita'' and ''taila''. The mixture is burned by ''antardhooma'' method. One ''panitala'' is the dose which is given with ghee. It is indicated in ''kapha'' and ''~~vataja~~ arsha, grahani, pandu, pleeha, mutragraha, svasa, hikka, kasa, krimi, jwara, sosha, atisara, sotha, prameha, anaha, hridgraha'' and in all types of toxicity.

+

''Triphala, kaṭabhi, chavya,'' pulp of ''bilva'', powder of ''ayoraja'' (''mandura''), ''katutki, musta, kushtha, patha, hingu, madhuka, kshara'' of ''muskaka'' and ''yavakshara, trikatu, vacha, vidanga, pippalimoola, svarjikakshara, nimba, chitraka, murva, ajamoda, indrayava, guḍuchi'' and ''devadaru'' are taken in one ''karsha'' (12 gm) quantity and one ''pala'' each of five salts are taken. All are mixed with three ''kudavas'' (576 gm) of ''dadhi, ghrita'' and ''taila''. The mixture is burned by ''antardhooma'' method. One ''panitala'' is the dose which is given with ghee. It is indicated in ''[[kapha]]'' and ''[[vata]]ja arsha, grahani, pandu, pleeha, mutragraha, svasa, hikka, kasa, krimi, jwara, sosha, atisara, sotha, prameha, anaha, hridgraha'' and in all types of toxicity.

It is one among the best stimulants of ''agni''. Once the medicine is digested ''mamsarasa'' or sweet diet or milk should be administered. This ends the explanation of the ''panchamakshara'' [188-193]

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</div></div>

−

In ''tridoshaja grahani, [[Panchakarma]]'' should be carried out as per predominance of ''dosha''. Various ghee, ''kshara, asava'' and ''arishtha'' preparation useful in stimulation of ''agni'' should be administered.

+

In ''tridoshaja grahani, [[Panchakarma]]'' should be carried out as per predominance of ''[[dosha]]''. Various ghee, ''kshara, asava'' and ''arishtha'' preparation useful in stimulation of ''agni'' should be administered.

−

Previously described line of treatment for ''~~vataja~~'' etc ''grahani'' should be accordingly followed. This line of treatment should be done either separately or jointly after finding the predominance of ''dosha'' [194-195]

+

Previously described line of treatment for ''[[vata]]ja'' etc ''grahani'' should be accordingly followed. This line of treatment should be done either separately or jointly after finding the predominance of ''[[dosha]]'' [194-195]

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</div></div>

−

''Snehana, swedana, shodhana, langhana, deepana,'' various powder preparation of ''lavana, kshara, madhvarishtha, surasava,'' various ''takra'' preparation, ''deepaniya ghrita'' are to be prescribed to the ''grahanidosha'' patient [196-197]

+

''[[Snehana]], [[swedana]], [[shodhana]], [[langhana]], [[deepana]],'' various powder preparation of ''lavana, kshara, madhvarishtha, surasava,'' various ''takra'' preparation, ''deepaniya ghrita'' are to be prescribed to the ''grahanidosha'' patient [196-197]

−

=== Treatment of various states of disease and ''dosha'' aggravation ===

+

=== Treatment of various states of disease and ''[[dosha]]'' aggravation ===

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Henceforth treatment as per condition is being mentioned.

−

In ''~~kaphaja~~ grahani'' if there is excess sputum, then ''ruksha'' (ununctuous) and ''deepana'' drugs having bitter taste should be administered [198]

+

In ''[[kapha]]ja grahani'' if there is excess sputum, then ''ruksha'' (ununctuous) and ''[[deepana]]'' drugs having bitter taste should be administered [198]

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</div></div>

−

If patient is weak, but ''kapha'' is excessive then alternately ununctous and unctuous therapies should be administered repeatedly. After complete examination; if ''pachana'' of ''ama'' has taken place than administer ghee fortified by ''deepaniya'' medicines [199]

+

If patient is weak, but ''[[kapha]]'' is excessive then alternately ununctous and unctuous therapies should be administered repeatedly. After complete examination; if ''[[pachana]]'' of ''ama'' has taken place than administer ghee fortified by ''deepaniya'' medicines [199]

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</div></div>

−

If ''pitta'' is aggravated then ''deepana'' drugs having bitter taste along with medicines having sweet taste should be administered whereas if ''vata'' is aggravated then ''deepaniya'' drugs along with ''sneha, lavana'' and ''amla'' dominated drugs should be administered [200]

+

If ''[[pitta]]'' is aggravated then ''[[deepana]]'' drugs having bitter taste along with medicines having sweet taste should be administered whereas if ''[[vata]]'' is aggravated then ''deepaniya'' drugs along with ''sneha, lavana'' and ''amla'' dominated drugs should be administered [200]

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</div></div>

−

Proper management as mentioned in earlier verses stimulates the ''agni'' (digestive power). ''Sneha'' is the best among the ''deepana dravya'' which helps in stimulating the inefficient ''agni'' [201]

+

Proper management as mentioned in earlier verses stimulates the ''agni'' (digestive power). ''Sneha'' is the best among the ''[[deepana]] dravya'' which helps in stimulating the inefficient ''agni'' [201]

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</div></div>

−

If the patient has inefficient digestive power and voids undigested food in excess in stools or frequency of motions is more, then appropriate quantity of ''ghrita'' fortified by ''deepana'' medicines should again be given. Thus, ''samana vata'' is regularized and moves in its normal tract. As ''samana vata'' is associated with ''agni'' it instantaneously promotes the strength of ''agni''.

+

If the patient has inefficient digestive power and voids undigested food in excess in stools or frequency of motions is more, then appropriate quantity of ''ghrita'' fortified by ''[[deepana]]'' medicines should again be given. Thus, ''samana vata'' is regularized and moves in its normal tract. As ''samana vata'' is associated with ''agni'' it instantaneously promotes the strength of ''agni''.

Digestive power thus stimulated by ''ghrita'' cannot be suppressed even by heavy meals [202-203]

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</div></div>

−

If ''agni'' is suppressed due to ''ruksha guna'' then either ''ghrita'' or ''taila'' fortified with ''deepaniya'' drugs should be administered [205]

+

If ''agni'' is suppressed due to ''ruksha [[guna]]'' then either ''ghrita'' or ''taila'' fortified with ''deepaniya'' drugs should be administered [205]

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</div></div>

−

If ''udavarta'' (mis-peristalsis) is responsible for suppression of ''agni'' then ''niruha'' and ''sneha basti'' should be administered; whereas if ''dosha vriddhi'' is the cause for suppression of ''agni'' then ''shodhana'' as per ''dosha'' is indicated [207]

+

If ''udavarta'' (mis-peristalsis) is responsible for suppression of ''agni'' then ''niruha'' and ''sneha [[basti]]'' should be administered; whereas if ''[[dosha]] vriddhi'' is the cause for suppression of ''agni'' then ''[[shodhana]]'' as per ''[[dosha]]'' is indicated [207]

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</div></div>

−

If suppression of ''agni'' has taken place due to diseases than ''ghrita'' is best for ''agni deepana'' but if fasting is the causes of ''agni'' suppression than ''yavagu'' (gruel) along with ''ghrita'' should be taken. ''Ghrita'' when taken in between the meal, it increases the strength, stimulates the digestion and nourishes the body [208]

+

If suppression of ''agni'' has taken place due to diseases than ''ghrita'' is best for ''agni [[deepana]]'' but if fasting is the causes of ''agni'' suppression than ''yavagu'' (gruel) along with ''ghrita'' should be taken. ''Ghrita'' when taken in between the meal, it increases the strength, stimulates the digestion and nourishes the body [208]

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Eating wholesome diet in appropriate quantity after previously eaten food is digested helps in maintaining good health for long duration.

−

A person should workout so that ''agni vriddhi'' takes place without disturbing the balance of ''~~dhatus~~''. Such ''agni'' digests the food, maintains health and nourishment, promotes longevity and increases strength. The same ''dosha'' when vitiated causes ''mandagni, tikshnagni'' and ''vishamagni'' and such a vitiated ''agni'' gives rise to various diseases.

+

A person should workout so that ''agni vriddhi'' takes place without disturbing the balance of ''[[dhatu]]s''. Such ''agni'' digests the food, maintains health and nourishment, promotes longevity and increases strength. The same ''[[dosha]]'' when vitiated causes ''mandagni, tikshnagni'' and ''vishamagni'' and such a vitiated ''agni'' gives rise to various diseases.

Management of ''mandagni'' has been explained previously henceforth management of ''ativriddha agni'' will be explained [214-216]

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</div></div>

−

Person having diminished ''kapha'', aggravated ''pitta'' and associated ''vata'' leads to increase in the ''ushma'' of ''agni'' resulting in enhancing the capacity and power of ''agni''. In such patient if the body is already undernourished, ''vata'' increases which further strengths the ''agni'' wherein both, together with help of ''tikshna guna'' digests the food even if taken frequently. After digestion of food, the increased ''agni'' starts digesting ''rakta'', etc ''~~dhatus~~'' also [217-219]

+

Person having diminished ''[[kapha]]'', aggravated ''[[pitta]]'' and associated ''[[vata]]'' leads to increase in the ''ushma'' of ''agni'' resulting in enhancing the capacity and power of ''agni''. In such patient if the body is already undernourished, ''[[vata]]'' increases which further strengths the ''agni'' wherein both, together with help of ''tikshna [[guna]]'' digests the food even if taken frequently. After digestion of food, the increased ''agni'' starts digesting ''[[rakta]]'', etc ''[[dhatu]]s'' also [217-219]

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</div></div>

−

Milk medicated with ''syama'' and ''trivritta'' may be advised for ''virechana'' for alleviating the ''pitta'' followed by diet of milk pudding. Expert physician should follow the line of treatment after proper examination of patient [231]

+

Milk medicated with ''syama'' and ''trivritta'' may be advised for ''[[virechana]]'' for alleviating the ''[[pitta]]'' followed by diet of milk pudding. Expert physician should follow the line of treatment after proper examination of patient [231]

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</div></div>

−

Foods which are sweet in taste, fatty, increases ''kapha'' and heavy to digest should be given. All food items are good for ''atyagni'' and sleeping after meals during day time is beneficial in ''atyagni''. Patient who takes fatty diet even though he is not hungry does not succumb to death. If he is suffering from ''atyagni'' on the other hand such diet pattern is nutritional. Whenever due to medication and diet, ''kapha'' is increased; it subdues ''pitta'' and ''vata'' and normalizes the ''agni''.

+

Foods which are sweet in taste, fatty, increases ''[[kapha]]'' and heavy to digest should be given. All food items are good for ''atyagni'' and sleeping after meals during day time is beneficial in ''atyagni''. Patient who takes fatty diet even though he is not hungry does not succumb to death. If he is suffering from ''atyagni'' on the other hand such diet pattern is nutritional. Whenever due to medication and diet, ''[[kapha]]'' is increased; it subdues ''[[pitta]]'' and ''[[vata]]'' and normalizes the ''agni''.

−

When ''~~dhatus~~'' are in equilibrium ''anna'' gets digested resulting in increase in nutrition, longevity and strength [232-234]

+

When ''[[dhatu]]s'' are in equilibrium ''anna'' gets digested resulting in increase in nutrition, longevity and strength [232-234]

=== Improper dietary habits ===

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</div></div>

−

If morning eaten food is undigested and still if anyone takes evening food it may not be more vitiative since in day time all the ''srotas'' (channels) are dilated and heart is active similar to the lotus which blossoms with sunrise. During daytime, exercise, other physical and mental activities (cause heart to pump blood properly to) prevent the genesis of ''kleda'' (excess moisture) in various ''~~dhatus~~'' [237-239]

+

If morning eaten food is undigested and still if anyone takes evening food it may not be more vitiative since in day time all the ''srotas'' (channels) are dilated and heart is active similar to the lotus which blossoms with sunrise. During daytime, exercise, other physical and mental activities (cause heart to pump blood properly to) prevent the genesis of ''kleda'' (excess moisture) in various ''[[dhatu]]s'' [237-239]

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</div></div>

−

In the night, the channels are closed, so is the heart which functions at slow rate as demand is less, the ''apakva ahara rasa'' increases in viscosity; thus ''ama'' adheres to the ''~~dhatus~~'' and if another food is taken the indigestion causes more ''apakva ahara rasa'' causing disease. The condition resembles, wherein uncooked milk mixed with warm milk gets spoiled. Therefore, a wise person should not take meals if food taken at night is not digested; this will surely effect strength and life of a person [241-243]

+

In the night, the channels are closed, so is the heart which functions at slow rate as demand is less, the ''apakva ahara rasa'' increases in viscosity; thus ''ama'' adheres to the ''[[dhatu]]s'' and if another food is taken the indigestion causes more ''apakva ahara rasa'' causing disease. The condition resembles, wherein uncooked milk mixed with warm milk gets spoiled. Therefore, a wise person should not take meals if food taken at night is not digested; this will surely effect strength and life of a person [241-243]

=== Summary ===

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#How digested food functions?

#How different types of ''agni'' does nutrition after digesting the fuel?

−

#Development of ''~~rasadi dhatus~~'' and their associated waste products after digestions at ''dhatu'' level (tissue level)

+

#Development of ''[[rasa]]di [[dhatu]]s'' and their associated waste products after digestions at ''[[dhatu]]'' level (tissue level)

−

#How aphrodisiacs act instantly and time taken for the ''dhatu'' formation and order of development?

+

#How aphrodisiacs act instantly and time taken for the ''[[dhatu]]'' formation and order of development?

#Reason why diseases are located in one part of the body and role of ''antaragni'' in disease formation,

#Diseases caused by abnormal ''agni''

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== Tattva Vimarsha (Fundamental Principles) ==

−

*''Dehagni'' (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''ojas'', normal body temperature and various other forms of ''agni''. Even the existence of an individual is said to be because of ''dehagni'' (3).

+

*''Dehagni'' (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ''[[ojas]]'', normal body temperature and various other forms of ''agni''. Even the existence of an individual is said to be because of ''dehagni'' (3).

*When the ''agni'' stops functioning, the individual dies; if the ''agni'' functions normally, the individual can lead a healthy and long life. Similarly, if the ''agni'' becomes abnormal, the individual suffers from various diseases; and hence, the ''agni'' is said to be the root cause of health and longevity (4).

−

*Normal functioning of ''agni'' is essential to make the consumed food capable of nourishing the body tissues and of promoting the ''ojas'' (vital essence), strength, complexion etc. In the absence of normal digestion (and metabolism), the normal body tissues such as ''rasa'' cannot be formed nor nourished (5).

+

*Normal functioning of ''agni'' is essential to make the consumed food capable of nourishing the body tissues and of promoting the ''[[ojas]]'' (vital essence), strength, complexion etc. In the absence of normal digestion (and metabolism), the normal body tissues such as ''[[rasa]]'' cannot be formed nor nourished (5).

−

*''Vata dosha'', specifically ''prana vata'' and ''samana vata'' play significant role in process of digestion and metabolism.

+

*''[[Vata dosha]]'', specifically ''prana vata'' and ''samana vata'' play significant role in process of digestion and metabolism.

−

*Three ''~~doshas~~'' are produced in three consequent stages of digestion after consumption of food. ''Kapha'' is produced in first stage of ''madhura avasthapaka''; pitta in second stage of ''amla avasthapaka'' and ''vata'' is produced in third stage of ''katu avasthapaka''. The site of production and time of production of ''dosha'' is in sequence as the process of digestion proceeds. Increase or decrease in quantity of ''dosha'' depends upon similarity or dis-similarity of basic composition of food consumed.

+

*Three ''[[dosha]]s'' are produced in three consequent stages of digestion after consumption of food. ''[[Kapha]]'' is produced in first stage of ''madhura avasthapaka''; pitta in second stage of ''amla avasthapaka'' and ''[[vata]]'' is produced in third stage of ''katu avasthapaka''. The site of production and time of production of ''[[dosha]]'' is in sequence as the process of digestion proceeds. Increase or decrease in quantity of ''[[dosha]]'' depends upon similarity or dis-similarity of basic composition of food consumed.

*The first phase of digestion is carried out by ''jatharagni'', second phase by ''bhutagni'' and third phase by ''dhatvagni''. These are different levels of action of ''agni'' where various digestive and metabolic processes take place.

−

*During the processing by ''dhatvagni, stanya'' (breast milk) and the menstrual blood are derived after ''rasa''. ''Kandara'' (tendon) and ''sira''(vein) are derived after ''rakta''. ''Vasa''(fat) and the six layers of ''tvacha'' (skin) are derived after ''mamsa'' (muscle) and ''snayu''(ligament) are derived after ''~~medas~~'' (adipose tissue) (17).

+

*During the processing by ''dhatvagni, stanya'' (breast milk) and the menstrual blood are derived after ''[[rasa]]''. ''Kandara'' (tendon) and ''sira''(vein) are derived after ''[[rakta]]''. ''Vasa''(fat) and the six layers of ''tvacha'' (skin) are derived after ''[[mamsa]]'' (muscle) and ''snayu''(ligament) are derived after ''[[meda]]s'' (adipose tissue) (17).

−

*The feces and the urine are the ''kitta'' (non-nutrient portion/waste portion/byproduct) of ingested food. The ''kiṭṭa'' of ''rasa'' is ''mala-kapha'' (excretions). ''Mala-pitta'' (bile pigment) is the ''kitta'' of ''rakta''. ''Kha-mala'' (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the ''kitta'' of ''mamsa''. ''Sweda'' (sweat) is the ''mala'' of ''medas''. ''Kesha'' (hairs on the head) and ''loma'' (body hair) are the ''mala'' of ''asthi''. The ''mala'' of ''majja'' is the oily excretion of the eye and the skin (sebum). Thus, the ''~~dhatus~~'' continuously undergo two kinds of transformation: ''prasada'' (nutrient portion) and ''kitta'' (non-nutrient portion). This entire sequence of transformation and metabolism of ''dhatu'' is thus inter dependent (18-19½ ).

+

*The feces and the urine are the ''kitta'' (non-nutrient portion/waste portion/byproduct) of ingested food. The ''kiṭṭa'' of ''[[rasa]]'' is ''mala-[[kapha]]'' (excretions). ''Mala-[[pitta]]'' (bile pigment) is the ''kitta'' of ''[[rakta]]''. ''Kha-mala'' (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the ''kitta'' of ''[[mamsa]]''. ''Sweda'' (sweat) is the ''[[mala]]'' of ''[[medas]]''. ''Kesha'' (hairs on the head) and ''loma'' (body hair) are the ''[[mala]]'' of ''[[asthi]]''. The ''[[mala]]'' of ''[majja]]'' is the oily excretion of the eye and the skin (sebum). Thus, the ''[[dhatu]]s'' continuously undergo two kinds of transformation: ''prasada'' (nutrient portion) and ''kitta'' (non-nutrient portion). This entire sequence of transformation and metabolism of ''[[dhatu]]'' is thus inter dependent (18-19½ ).

−

*Disorders of various factors mentioned above shall be treated after considering the original ''dhatu'' from which the factor is derived.

+

*Disorders of various factors mentioned above shall be treated after considering the original ''[[dhatu]]'' from which the factor is derived.

−

*''Vyana vata'' forcefully propels the ''rasa dhatu'' out of the heart and spreads it all over the body simultaneously, continuously and for the entire life (36).

+

*''Vyana vata'' forcefully propels the ''[[rasa dhatu]]'' out of the heart and spreads it all over the body simultaneously, continuously and for the entire life (36).

*Disease is produced only at the site of abnormality of body systems.

*Life and strength of an individual depends on ''agni'' hence one should take utmost care to maintain the ''agni'' by providing fuel in the form of food and drinks which should be taken as per the rules mentioned. (40)

*If the rules of diet and dietary habits are not followed due to greed, then disease of ''grahani'' occurs.

*The ''anna-visha'' (toxins) produced due to improper digestion and metabolism causes diseases at the sites of affliction.

−

*The ''vishamagni'' (improper ''agni'') causes irregularity in digestion and therefore defective formation of ''dhatu'' takes place. Whereas, ''teekshnagni'' (excessive ''agni'') when associated with little quantity of fuel (in the form of food) causes depletion of ''dhatu'' (tissue elements) (50).

+

*The ''vishamagni'' (improper ''agni'') causes irregularity in digestion and therefore defective formation of ''[[dhatu]]'' takes place. Whereas, ''teekshnagni'' (excessive ''agni'') when associated with little quantity of fuel (in the form of food) causes depletion of ''[[dhatu]]'' (tissue elements) (50).

*The digestive disorder of ''grahani'' can lead to secondary disorders related with other body systems along with digestive system.

−

*''Grahani'' disease is classified into four types viz ''~~vataja~~, ~~pittaja~~, ~~kaphaja~~'' and ''sannipataja'' depending upon the dominance of ''dosha'' and on the basis of the classification, etiological factors, symptoms and signs are varied.

+

*''Grahani'' disease is classified into four types viz ''[[vata]]ja, [[pitta]]ja, [[kapha]]ja'' and ''sannipataja'' depending upon the dominance of ''[[dosha]]'' and on the basis of the classification, etiological factors, symptoms and signs are varied.

−

*When the ''~~doshas~~'' are located in ''grahani'' and are associated with incomplete digested food then ''vamana'' (emetic therapy) is advised.

+

*When the ''[[dosha]]s'' are located in ''grahani'' and are associated with incomplete digested food then ''[[vamana]]'' (emetic therapy) is advised.

−

*If the ''ama'' is in ''pakvashaya'' and in ''anutklishta'' (stuck, not ready to come out) condition, then ''stravana'' (increasing secretion) with ''deepana dravyas'' should be administered.

+

*If the ''ama'' is in ''pakvashaya'' and in ''anutklishta'' (stuck, not ready to come out) condition, then ''stravana'' (increasing secretion) with ''[[deepana]] dravyas'' should be administered.

−

*If ''ama'' gets absorbed along with ''rasa dhatu'' and if it pervades throughout the body then ''langhana'' and ''pachana'' should be advised.

+

*If ''ama'' gets absorbed along with ''[[rasa dhatu]]'' and if it pervades throughout the body then ''[[langhana]]'' and ''[[pachana]]'' should be advised.

−

*Various purification procedures are advised as per the state of ''dosha'' aggravation and site of affliction in disease. Ghee processed with digestive stimulant drugs,sour media like buttermilk is advised.

+

*Various purification procedures are advised as per the state of ''[[dosha]]'' aggravation and site of affliction in disease. Ghee processed with digestive stimulant drugs,sour media like buttermilk is advised.

−

*Patient should be evaluated for ''amadosha'' whether ''samata'' or ''niramta'' is present or not and then appropriately treated with ''pachana'' etc. treatment (95).

+

*Patient should be evaluated for ''amadosha'' whether ''samata'' or ''niramta'' is present or not and then appropriately treated with ''[[pachana]]'' etc. treatment (95).

−

*Buttermilk due to its ''deepana, grahi'' (substances which increases appetite and digestive power and absorb fluid from the stool) and easy to digest actions is very useful in ''grahanidosha''.

+

*Buttermilk due to its ''[[deepana]], grahi'' (substances which increases appetite and digestive power and absorb fluid from the stool) and easy to digest actions is very useful in ''grahanidosha''.

−

*''Vata'' dominant ''grahani'' shall be treated with ''basti, virechana'' and unctuous preparations.

+

*''[[Vata]]'' dominant ''grahani'' shall be treated with ''[[basti]], [[virechana]]'' and unctuous preparations.

−

*If ''pitta'' is dominant in its own place then ''virechana'' or ''vamana'' should be administered for removal of ''pitta'' (122).

+

*If ''[[pitta]]'' is dominant in its own place then ''[[virechana]]'' or ''[[vamana]]'' should be administered for removal of ''[[pitta]]'' (122).

−

*In ''~~kaphaja~~ grahani'', ''vamana'' and then drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' shall be administered to increase ''agni'' (digestive power) (141).

+

*In ''[[kapha]]ja grahani'', ''[[vamana]]'' and then drugs having ''katu, amla, lavana, kshara'' and ''tikta rasa'' shall be administered to increase ''agni'' (digestive power) (141).

−

*In ''tridoshaja grahani'', [[Panchakarma]] should be carried out as per predominance of ''dosha''. Various ghee, ''kshara'', ''asava'' and ''arishta'' preparation useful in stimulation of ''agni'' should be administered.

+

*In ''tridoshaja grahani'', [[Panchakarma]] should be carried out as per predominance of ''[[dosha]]''. Various ghee, ''kshara'', ''asava'' and ''arishta'' preparation useful in stimulation of ''agni'' should be administered.

−

*''Sneha'' is the best among the ''deepana dravya'' which helps in stimulating the inefficient ''agni'' (201)

+

*''Sneha'' is the best among the ''[[deepana]] dravya'' which helps in stimulating the inefficient ''agni'' (201)

*Fasting or over eating doesn’t stimulate ''agni''. Proper intake of ''sneha'', followed by eating proper food preparations as well as appropriate use of various ''churna, arishta, sura'' and ''asava'' along with proper medication as per condition, enhances the power of ''agni''.

−

*''Atyagni'' is caused by diminished ''kapha'', aggravated ''pitta'' and associated ''vata''. This leads to emaciation if proper food is not consumed. Excessively increased digestive power can be pacified by taking foods and drinks which are heavy to digest, unctuous, cold, sweet and liquid.

+

*''Atyagni'' is caused by diminished ''[[kapha]]'', aggravated ''[[pitta]]'' and associated ''[[vata]]''. This leads to emaciation if proper food is not consumed. Excessively increased digestive power can be pacified by taking foods and drinks which are heavy to digest, unctuous, cold, sweet and liquid.

*''Samashana'' is taking wholesome and unwholesome foods together in diet. ''Vishamashana'' is taking food either in excess quantity or very little quantity and also if taken before or after appropriate time. ''Adhyashana'' is having food even though previously eaten food is not yet digested. All the above three are causes for death or give rise to serious disorders (235-236).

−

*If morning eaten food is undigested and still if anyone takes evening food, it may not be more vitiative since in day time all the ''srotas'' (channels) are dilated and heart is active similar to the lotus which blossoms with sunrise. During daytime, exercise, other physical and mental activities (cause heart to pump blood properly to) prevent the genesis of ''kleda'' (excess moisture) in various ''~~dhatus~~''. In the night, the channels are closed, so is the heart which functions at slow rate as demand is less, the ''apakva ahara rasa'' increases in viscosity; thus ''ama'' adheres to the ''~~dhatus~~'' and if another food is taken in the morning the indigestion causes more ''apakva ahara rasa'' causing disease.

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*If morning eaten food is undigested and still if anyone takes evening food, it may not be more vitiative since in day time all the ''srotas'' (channels) are dilated and heart is active similar to the lotus which blossoms with sunrise. During daytime, exercise, other physical and mental activities (cause heart to pump blood properly to) prevent the genesis of ''kleda'' (excess moisture) in various ''[[dhatu]]s''. In the night, the channels are closed, so is the heart which functions at slow rate as demand is less, the ''apakva ahara rasa'' increases in viscosity; thus ''ama'' adheres to the ''[[dhatu]]s'' and if another food is taken in the morning the indigestion causes more ''apakva ahara rasa'' causing disease.

== Vidhi Vimarsha (Applied Inferences ) ==

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=== Importance of ''agni'' ===

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The functions of gut are vital for maintenance and preservation of health. ''Grahani'' is the seat of ''jatharagni'', which is the initiator of digestive process and strengthens the other 12 ''agnis''. ''Jatharagni'' transforms food into biological substance (''ahara rasa'') which is further trifurcated into ''madhura, amla'' and ''katu avastha paka'' which gets transformed into three biological energies ''kapha, pitta'' and ''vata'' respectively. From the physiological point of view, the ''jatharagni'' or the active form of ''pachaka pitta'' is responsible for the digestion of all kinds of foods in the gut. Therefore, this should include all amylolytic, proteolytic and lipolytic enzymes secreted by various kinds of exocrine glands in the gut, which actually cause digestion, i.e., breaking down of different macromolecules into their constituent units.

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The functions of gut are vital for maintenance and preservation of health. ''Grahani'' is the seat of ''jatharagni'', which is the initiator of digestive process and strengthens the other 12 ''agnis''. ''Jatharagni'' transforms food into biological substance (''ahara rasa'') which is further trifurcated into ''madhura, amla'' and ''katu avastha paka'' which gets transformed into three biological energies ''[[kapha]], [[pitta]]'' and ''[[vata]]'' respectively. From the physiological point of view, the ''jatharagni'' or the active form of ''pachaka pitta'' is responsible for the digestion of all kinds of foods in the gut. Therefore, this should include all amylolytic, proteolytic and lipolytic enzymes secreted by various kinds of exocrine glands in the gut, which actually cause digestion, i.e., breaking down of different macromolecules into their constituent units.

There are five ''bhutagnis'' and their function is to metabolize ''panchabhautic'' components of the food that are homologous to them in their composition. For instance, ''bhauma agni'' acts on the component that is ''bhauma'' or ''parthiva'' in its composition. ''Bhutagnis'' act on the products of digestion (''jatharagni paka''), hence, must be acting after the absorption of the nutrients, but before the action of ''dhatvagni''. The major site where the absorbed nutrients undergo biochemical transformation is in the liver, which plays an important role in metabolism, wherein several processes such as trans-amination, de-amination, beta-oxidation of fatty acids, glycolysis etc. take place. Therefore, the overall intermediary metabolism (involving fats, carbohydrates and proteins) can be understood as the functioning of the ''bhutagni''.

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''Dhatvagni'' acts at tissue-level (in fact, at cellular level) upon the products of ''bhutagni paka'' and are responsible for the building of the respective ''~~dhatus~~''. In other words, the bio-energetic processes of a cell seem to be under the regulation of ''dhatvagni''. For instance, the common product of intermediary metabolism (involving fats, carbohydrates and proteins) is Acetyl-Co-A, which enters into Kreb’s cycle in the mitochondria of a cell. This is followed by electron transfer and oxidative phosphorylation. <ref>Chatterjea MN, Shinde Rana. In:Textbook of Medical Biochemistry. ISBN: 9788184481341. DOI: 10.5005/jp/books/10917. Edition:7/e. 2007. Pages: 824</ref> It is interesting to note that the Kreb’s cycle is also known as the ‘final common pathway’ in the process of catabolism of carbohydrates, proteins and fats. However, for the entry of amino acids, glucose and fatty acids into the cell, certain other factors such as hormones too are needed. For instance, insulin promotes the transportation of glucose, amino acids and fatty acids into the cell. Therefore, all these hormones (such as insulin, growth hormone, thyroid hormones, testosterone etc.) that promote the transportation of various nutrients into the cells, along with the enzymes participating in the Kreb’s cycle are to be included under the term ''dhatvagni''.

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''Dhatvagni'' acts at tissue-level (in fact, at cellular level) upon the products of ''bhutagni paka'' and are responsible for the building of the respective ''[[dhatu]]s''. In other words, the bio-energetic processes of a cell seem to be under the regulation of ''dhatvagni''. For instance, the common product of intermediary metabolism (involving fats, carbohydrates and proteins) is Acetyl-Co-A, which enters into Kreb’s cycle in the mitochondria of a cell. This is followed by electron transfer and oxidative phosphorylation. <ref>Chatterjea MN, Shinde Rana. In:Textbook of Medical Biochemistry. ISBN: 9788184481341. DOI: 10.5005/jp/books/10917. Edition:7/e. 2007. Pages: 824</ref> It is interesting to note that the Kreb’s cycle is also known as the ‘final common pathway’ in the process of catabolism of carbohydrates, proteins and fats. However, for the entry of amino acids, glucose and fatty acids into the cell, certain other factors such as hormones too are needed. For instance, insulin promotes the transportation of glucose, amino acids and fatty acids into the cell. Therefore, all these hormones (such as insulin, growth hormone, thyroid hormones, testosterone etc.) that promote the transportation of various nutrients into the cells, along with the enzymes participating in the Kreb’s cycle are to be included under the term ''dhatvagni''.

Thus, the three major stages of the catabolism (involving fats, carbohydrates and proteins) i.e. digestion, intermediary metabolism and Kreb’s cycle - seem to represent the three sets of ''agnis,'' viz., ''jatharagni, bhutagni'' and ''dhatvagni'' respectively.

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=== Role of ''vata'' in digestion ===

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=== Role of ''[[vata]]'' in digestion ===

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''Samana vayu'' separates nutritive (''prasad'') and waste (''kitta'') part from ''ahara rasa''. Nutritive part is circulated to entire body after absorption through ''rasayini'' (villi) by ''vyana vayu''. Waste part is excreted as feces, urine and sweat through their excretory channels by ''apana vata''. Absorbed nutritive substances circulate all over the body through seven specific micro channels of each of the seven ''~~dhatus~~''.

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''Samana vayu'' separates nutritive (''prasad'') and waste (''kitta'') part from ''ahara rasa''. Nutritive part is circulated to entire body after absorption through ''rasayini'' (villi) by ''vyana vayu''. Waste part is excreted as feces, urine and sweat through their excretory channels by ''apana vata''. Absorbed nutritive substances circulate all over the body through seven specific micro channels of each of the seven ''[[dhatu]]s''.

=== ''Dhatvagni'' ===

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Each ''dhatu'' has its own transforming ''agni'' and ''srotas''. ''Srotas'' or micro channels have two functions of carrying and transforming the tissues with the help of their specific ''dhatvagni''. Five ''bhutagnis'', one for each ''mahabhuta'', transform five ''bhautic'' elements into the body tissues and organs. Seven ''dhatvagni'' or tissue transformers, form the tissue elements of seven ''~~dhatus~~'' by their needed nutrients. After formation of ''dhatu'', the microchannels permeates them into the organs for functioning. During this transformation process, ''upadhatu'' or subtissues and ''dhatumala'' or waste products are formed. ''Updhatus'' of ''rasa dhatu'' is breast milk; menstrual blood is ''upadhatu'' of ''rakta''; tendons and six layers of skin are ''upadhatu'' of ''mamsa dhatu'' etc.

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Each ''[[dhatu]]'' has its own transforming ''agni'' and ''srotas''. ''Srotas'' or micro channels have two functions of carrying and transforming the tissues with the help of their specific ''dhatvagni''. Five ''bhutagnis'', one for each ''[[mahabhuta]]'', transform five ''bhautic'' elements into the body tissues and organs. Seven ''dhatvagni'' or tissue transformers, form the tissue elements of seven ''[[dhatu]]s'' by their needed nutrients. After formation of ''[[dhatu]'', the microchannels permeates them into the organs for functioning. During this transformation process, ''upadhatu'' or subtissues and ''dhatumala'' or waste products are formed. ''Updhatus'' of ''[[rasa dhatu]]'' is breast milk; menstrual blood is ''upadhatu'' of ''[[rakta]]''; tendons and six layers of skin are ''upadhatu'' of ''[[mamsa dhatu]]'' etc.

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Apart from digestion, the gut performs various other significant functions as well. The gut has its own protective mechanism in the form of gut-associated lymphoid tissue, which prevents the entry of pathogens into the bloodstream. The micro-biota in the gut serves vital functions related to various aspects of health. The enteric nervous system of the gut has its own functional significance and has been proven to be very closely associated with the central nervous system functions. The gut secretes several hormone-like substances that are helpful in regulating long-term energy balance. All the factors mentioned are either directly or indirectly dependent on these functional domains of the gut. <ref>W I Khan, J E Ghia. Gut hormones: emerging role in immune activation and inflammation. Clin Exp Immunol. 2010 July; 161(1): 19–27</ref> <ref>Andrew L. Kau, Philip P. Ahern, Nicholas W. Griffin, Andrew L. Goodman, Jeffrey I. Gordon. Human nutrition, the gut microbiome, and immune system: envisioning the future. Nature. 2011 June 15; 474(7351): 327–336. doi: 10.1038/nature10213</ref> Other forms of ''agni'' in this context are indicative of ''bhutagni'' and ''dhatvagni'', which in turn, are functionally dependent on ''jatharagni''. ''Prana'' in this context may stand for all types of ''vata'' as well.

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Apart from digestion, the gut performs various other significant functions as well. The gut has its own protective mechanism in the form of gut-associated lymphoid tissue, which prevents the entry of pathogens into the bloodstream. The micro-biota in the gut serves vital functions related to various aspects of health. The enteric nervous system of the gut has its own functional significance and has been proven to be very closely associated with the central nervous system functions. The gut secretes several hormone-like substances that are helpful in regulating long-term energy balance. All the factors mentioned are either directly or indirectly dependent on these functional domains of the gut. <ref>W I Khan, J E Ghia. Gut hormones: emerging role in immune activation and inflammation. Clin Exp Immunol. 2010 July; 161(1): 19–27</ref> <ref>Andrew L. Kau, Philip P. Ahern, Nicholas W. Griffin, Andrew L. Goodman, Jeffrey I. Gordon. Human nutrition, the gut microbiome, and immune system: envisioning the future. Nature. 2011 June 15; 474(7351): 327–336. doi: 10.1038/nature10213</ref> Other forms of ''agni'' in this context are indicative of ''bhutagni'' and ''dhatvagni'', which in turn, are functionally dependent on ''jatharagni''. ''Prana'' in this context may stand for all types of ''[[vata]]'' as well.

=== Three stages of digestion ===

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There are three stages of digestion in the gut. The first stage (''madhura'') takes place in the upper gastro-intestinal tract, i.e., inside the esophagus and stomach; the second stage (''amla'') takes place in the middle portion of the gut, i.e., in the small intestine; and the last stage (''katu'') takes place in the colon.

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The froth-like ''kapha'' seems to be the thick mucus that covers the entire stomach, providing a protective coating that prevents the gastric mucosa being digested and damaged due to the acid-pepsin mixture.

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The froth-like ''[[kapha]]'' seems to be the thick mucus that covers the entire stomach, providing a protective coating that prevents the gastric mucosa being digested and damaged due to the acid-pepsin mixture.

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''Accha pitta'' is ‘liquid’ in nature, released in the duodenum and can be correlated with bile.

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''Accha [[pitta]]'' is ‘liquid’ in nature, released in the duodenum and can be correlated with bile.

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''Pachaka pitta'' has the functional site between ''amashaya'' (stomach) and ''pakvashaya'' (colon), which is indicative of small intestine. It is composed of five ''~~mahabhutas~~'' but the ''agni mahabhuta'' is predominant; and hence, it becomes devoid of fluidity and therefore is also known as ''agni''. It splits the food into sāra (nutritive) and ''kitta'' (non-nutritive) portions.<ref>Vagbhata. Sutra Sthana, Cha.12 Doshabhediya Adhyaya verse 10-12. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

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''Pachaka pitta'' has the functional site between ''amashaya'' (stomach) and ''pakvashaya'' (colon), which is indicative of small intestine. It is composed of five ''[[mahabhuta]]s'' but the ''[[agni mahabhuta]]'' is predominant; and hence, it becomes devoid of fluidity and therefore is also known as ''agni''. It splits the food into sāra (nutritive) and ''kitta'' (non-nutritive) portions.<ref>Vagbhata. Sutra Sthana, Cha.12 Doshabhediya Adhyaya verse 10-12. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>

''Sara'' of the food is the minutest fraction (''parama sukshma''). This portion reaches the heart in the form of ''ahara rasa''. From the heart, it then gets re-distributed into 24 pulsatile vessels to be carried into the whole body.<ref>Sushruta. Sutra Sthana, Cha.14 Shonitavarnaniya Adhyaya verse 3. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1</ref>

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The portion that reaches the colon is the one that is designated as ''kitta''. During the third stage of digestion, there occurs the solidification of fecal matter and formation of certain pungent gases such as ammonia, methane, hydrogen sulfide etc. The term ''pakva'' in this context indicates ''pakva mala''; not ''pakva ahara'' (Verse 9-11).

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=== Formation of the seven ''~~dhatus~~'' ===

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=== Formation of the seven ''[[dhatu]]s'' ===

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''Rasa, rakta, mamsa, meda, asthi, majja'' and ''shukra'' are the seven fundamental entities that sustain the human body. These can be called ‘tissues’ for the sake of convenience, though some of them are not tissues in a strict sense. It will be pertinent to look into these individual entities at this stage to understand what they really are in terms of anatomy.<ref>Patwardhan K. Human Physiology in Ayurveda. Varanasi, India: Chaukhambha Orientalia, 2013, Jiakrishnadas series no. 134.</ref>

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''[[Rasa]], [[rakta]], [[mamsa]], [[meda]], [[asthi]], [[majja]]'' and ''[[shukra]]'' are the seven fundamental entities that sustain the human body. These can be called ‘tissues’ for the sake of convenience, though some of them are not tissues in a strict sense. It will be pertinent to look into these individual entities at this stage to understand what they really are in terms of anatomy.<ref>Patwardhan K. Human Physiology in Ayurveda. Varanasi, India: Chaukhambha Orientalia, 2013, Jiakrishnadas series no. 134.</ref>

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''Rasa'': A colorless fluid that gets ejected out of the heart and nourishes the entire body.

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''[[Rasa]]'': A colorless fluid that gets ejected out of the heart and nourishes the entire body.

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''Rakta'': The red colored fraction that is formed in liver and spleen after the action of ''ranjaka pitta'' on ''rasa''. It is essential for life and its function is to supply the life principle (''jeeva'').

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''[[Rakta]]'': The red colored fraction that is formed in liver and spleen after the action of ''ranjaka pitta'' on ''[[rasa]]''. It is essential for life and its function is to supply the life principle (''jeeva'').

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''Rasa'' and ''rakta'' together form what is generally known as blood: ''rakta'' being the red fraction (red blood corpuscles) and ''rasa'' being the colorless fluid (plasma).

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''[[Rasa]]'' and ''[[rakta]]'' together form what is generally known as blood: ''[[rakta]]'' being the red fraction (red blood corpuscles) and ''[[rasa]]'' being the colorless fluid (plasma).

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''Mamsa'': The correct translation of this term would be ‘flesh’. Flesh generally means all kinds of muscles and also the parenchyma of the different viscera such as thyroid, liver, spleen, kidneys etc.

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''[[Mamsa]]'': The correct translation of this term would be ‘flesh’. Flesh generally means all kinds of muscles and also the parenchyma of the different viscera such as thyroid, liver, spleen, kidneys etc.

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''Medas'': This generally stands for fatty tissue, however, it is to be noted that it is of two types: ''Baddha'' (bound, stable, fixed, stored) and ''abaddha'' (free, unbound). The ''baddha'' form, therefore, must include the stored fat in the form of adipose tissue; and the ''abaddha'' form must include the circulating lipids such as cholesterol, LDL, HDL etc.

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''[[Medas]]'': This generally stands for fatty tissue, however, it is to be noted that it is of two types: ''Baddha'' (bound, stable, fixed, stored) and ''abaddha'' (free, unbound). The ''baddha'' form, therefore, must include the stored fat in the form of adipose tissue; and the ''abaddha'' form must include the circulating lipids such as cholesterol, LDL, HDL etc.

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''Asthi'': Though the term ''asthi'' generally stands for bony tissue, it may in some contexts, include all such relatively hard structures that resist easy decaying, viz., teeth, nails and hair.

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''[[Asthi]]'': Though the term ''[[asthi]]'' generally stands for bony tissue, it may in some contexts, include all such relatively hard structures that resist easy decaying, viz., teeth, nails and hair.

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''Majja'': Generally, the substance that fills all the bony cavities is called ''majja''. However, the brain substance that fills the cranial cavity too, must be included in ''majja''. Therefore, ''majja'' is of two types: ''asthigata'' (bony) and ''mastakagata'' (cranial).

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''[[Majja]]'': Generally, the substance that fills all the bony cavities is called ''[[majja]]''. However, the brain substance that fills the cranial cavity too, must be included in ''[[majja]]''. Therefore, ''[[majja]]'' is of two types: ''asthigata'' (bony) and ''mastakagata'' (cranial).

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''Shukra'': The term ''shukra'' has been described to be of two forms in [[Ayurveda]] textbooks:

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''[[Shukra]]'': The term ''[[shukra]]'' has been described to be of two forms in [[Ayurveda]] textbooks:

#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis.

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#The one that is formed from ''majja'' (the tissue that fills the bony cavities) which in turn circulates all over the body both in males and females. Reproduction is the function of this second form of ''shukra'' too. Therefore, on careful examination, it seems that the first form of ''shukra'' stands for the semen in general and for sperms in particular; and, the second form of ''shukra'' stands for hypothalamo-pituitary-gonadal axis of hormones that circulate all over the body.

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#The one that is formed from ''[[majja]]'' (the tissue that fills the bony cavities) which in turn circulates all over the body both in males and females. Reproduction is the function of this second form of ''[[shukra]]'' too. Therefore, on careful examination, it seems that the first form of ''[[shukra]]'' stands for the semen in general and for sperms in particular; and, the second form of ''[[shukra]]'' stands for hypothalamo-pituitary-gonadal axis of hormones that circulate all over the body.

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=== The process of nourishment of ''dhatu'' ===

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=== The process of nourishment of ''[[dhatu]]'' ===

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The process of nourishment of ''~~dhatus~~'' is explained by three analogies: ''Ksheera-dadhi'' (milk curdling analogy), ''khalekapota'' (analogy of pigeons picking up the choicest grains) and ''kedari-kulya'' (irrigation analogy).

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The process of nourishment of ''[[dhatu]]s'' is explained by three analogies: ''Ksheera-dadhi'' (milk curdling analogy), ''khalekapota'' (analogy of pigeons picking up the choicest grains) and ''kedari-kulya'' (irrigation analogy).

=== ''Ksheera-dadhi nyaya'' (milk curdling analogy) ===

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According to this analogy, the nourishment of a ''dhatu'' takes place according to the rule of conversion (of one substance into another). Just as the milk is converted into different forms (from milk to curd, curd to butter, butter to ghee) successively, the preceding ''dhatu'' too is converted into the next one. The sequence of this conversion is as follows: ''rasa, rakta, mamsa, meda, asthi, majja'' and ''shukra'' in the same order.

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According to this analogy, the nourishment of a ''[[dhatu]]'' takes place according to the rule of conversion (of one substance into another). Just as the milk is converted into different forms (from milk to curd, curd to butter, butter to ghee) successively, the preceding ''[[dhatu]]'' too is converted into the next one. The sequence of this conversion is as follows: ''[[rasa]], [[rakta]], [[mamsa]], [[meda]], [[asthi]], [[majja]]'' and ''[[shukra]]'' in the same order.

The transformation of various substances that takes place due to various biochemical reactions could be one way of understanding this analogy. For instance, the process of glycolysis involves different enzymes acting on different substrates at different steps and converting them from one to another. The ability of one kind of stem cell derived from one tissue in giving rise to different forms of cell types of different tissues is known. The response of mesenchymal stem cells to certain stimuli such as hypoxia in the form of migration and tissue regeneration is also known, which can further support this analogy.

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=== ''Khalekapota nyaya'' (analogy of pigeons picking up the choicest grains) ===

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According to this analogy, the nourishment of different ''~~dhatus~~'' takes place according to the rule of selectivity. Just as the pigeons coming from far off places, picking up the grains of their choice from the granary (a storehouse for thrashed grain, ''khala'') and flying back to their destination, the different ''~~dhatus~~'' too, pick up the required nourishment from the common nutrient pool known as ''rasa''. The ''dhatu'' that is situated nearer to ''rasa'' is nourished first and the remaining later, just as the pigeon from a nearer place gets a chance to pick up grains quickly in the given analogy.

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According to this analogy, the nourishment of different ''[[dhatu]]s'' takes place according to the rule of selectivity. Just as the pigeons coming from far off places, picking up the grains of their choice from the granary (a storehouse for thrashed grain, ''khala'') and flying back to their destination, the different ''[[dhatu]]s'' too, pick up the required nourishment from the common nutrient pool known as ''[[rasa]]''. The ''[[dhatu]]'' that is situated nearer to ''[[rasa]]'' is nourished first and the remaining later, just as the pigeon from a nearer place gets a chance to pick up grains quickly in the given analogy.

In this analogy, the choice that the pigeons have in picking up the grain (selectivity) and the energy they spend in the process of obtaining grains (actively) are the vital features. The tissue metabolism can influence the extent of vasodilatation and thus its own perfusion. This is known as auto-regulation of blood supply. Similarly, the specific kind of tissue has affinity for specific nutrient and other substances. For example, the calcium gets deposited normally in bones, but not in the mucous membranes. Similarly, vitamin B-12 is stored in liver and not in other tissues.

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=== ''Kedari-kulya nyaya'' (analogy of irrigation) ===

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According to this analogy, the nourishment of ''dhatu'' takes place according to the rule of irrigation. Just as the ''kulyas'' (small canals / trenches / channels) receive water from the ''kedarika'' (the bigger water reservoir) and then irrigate the nearest field first, the ''rasa'' too, nourishes the ''~~dhatus~~'' in a sequential fashion depending on the location of the ''dhatu''.

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According to this analogy, the nourishment of ''[[dhatu]]'' takes place according to the rule of irrigation. Just as the ''kulyas'' (small canals / trenches / channels) receive water from the ''kedarika'' (the bigger water reservoir) and then irrigate the nearest field first, the ''[[rasa]]'' too, nourishes the ''[[dhatu]]s'' in a sequential fashion depending on the location of the ''[[dhatu]]''.

The anatomical location of a cell in the body can influence the amount of perfusion it receives. For instance, the apical regions of the lungs are less perfused than the other areas of the lung, and hence, are susceptible to be affected in some infectious conditions such as tuberculosis. Similarly, the hepatocytes that surround the central vein in a hepatic lobule are more susceptible to hypoxic injury than those situated in the periphery. Sub-endocardial region of the heart is, in the same manner, is more susceptible to ischemia than the epicardial region.

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Another important feature to be noted in this analogy is the passive flow of water from higher altitude to lower altitude, where no external energy is spent. This is in contrast to the pigeons expending their energy to pick up the grains of their choice actively. It is interesting to note the process of transportation of substances across the cell membrane, which has been divided into two major types: active transport and passive transport (Verse-16).

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Bilirubin is a metabolic byproduct of heme portion of the hemoglobin. This is secreted into bile juice in the liver which is in turn released during the process of digestion. Features of pitta ''vriddhi'' therefore, are yellowish discoloration of sclera, skin, urine and feces. Mucous is rich in water that is derived from extracellular fluid while it is being formed. The cerumen, sebum, and other similar external secretions perform some functions such as providing a waxy protective layer. Sweat and urine share similarities in function as well as composition. Therefore, ''vrikka'' mentioned as the site of origin of ''medavaha srotas'' makes sense when one considers ''sweda'' as the ''mala'' of ''meda''. Hair and bones share similarity when it comes to the power to resist easy biodegradation. They also grow weaker in old age. Therefore, hair are the ''mala'' of ''asthi'' (Verse 19).

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Bilirubin is a metabolic byproduct of heme portion of the hemoglobin. This is secreted into bile juice in the liver which is in turn released during the process of digestion. Features of [[pitta]] ''vriddhi'' therefore, are yellowish discoloration of sclera, skin, urine and feces. Mucous is rich in water that is derived from extracellular fluid while it is being formed. The cerumen, sebum, and other similar external secretions perform some functions such as providing a waxy protective layer. Sweat and urine share similarities in function as well as composition. Therefore, ''vrikka'' mentioned as the site of origin of ''medavaha srotas'' makes sense when one considers ''sweda'' as the ''[[mala]]'' of ''[[meda]]''. Hair and bones share similarity when it comes to the power to resist easy biodegradation. They also grow weaker in old age. Therefore, hair are the ''[[mala]]'' of ''[[asthi]]'' (Verse 19).

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Circulating provoked ''dosha'' settles in a tissue whose channels are defective (''kha-vaigunya'') and perfuce the lesion. This pathogenesis has been compared with rain production. The obstruction to the moving ''rasa'' by the abnormality of ''srotas,'' results in causation of disease, just as the obstruction to the cloud laden monsoon winds by the tall mountains results in the causation of rainfall (Verse 37).

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Circulating provoked ''[[dosha]]'' settles in a tissue whose channels are defective (''kha-vaigunya'') and perfuce the lesion. This pathogenesis has been compared with rain production. The obstruction to the moving ''[[rasa]]'' by the abnormality of ''srotas,'' results in causation of disease, just as the obstruction to the cloud laden monsoon winds by the tall mountains results in the causation of rainfall (Verse 37).

=== Causes of ''grahani'' disorder ===

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''Abhojana'' (starvation) leads to increase in ''vata'' and in turn ''agnimandya''.[Cha. Sa. [[Vimana Sthana]] 2/7] Starvation and protein malnutrition disrupts the normal indigenous gastrointestinal tract micro-flora and impairs host antibacterial defenses. Both starvation and protein malnutrition increases the cecal levels of gram negative enteric bacilli and decrease the level of lactobacillus and promote growth of anaerobes that in turn disturb the gut flora. Gut flora also known as gut microbiome has a unique role in digestion and absorption. Once the gut microbiome gets vitiated it leads to indigestion and malabsorption.

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''Abhojana'' (starvation) leads to increase in ''[[vata]]'' and in turn ''agnimandya''.[Cha. Sa. [[Vimana Sthana]] 2/7] Starvation and protein malnutrition disrupts the normal indigenous gastrointestinal tract micro-flora and impairs host antibacterial defenses. Both starvation and protein malnutrition increases the cecal levels of gram negative enteric bacilli and decrease the level of lactobacillus and promote growth of anaerobes that in turn disturb the gut flora. Gut flora also known as gut microbiome has a unique role in digestion and absorption. Once the gut microbiome gets vitiated it leads to indigestion and malabsorption.

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''Atibhojana'' (excessive intake) causes provocation of all the ''dosha'' and thereby causing ''agnimandya''. Protein rich diet or fat laden diet or excessive diet takes longer time for emptying of stomach. Longer stay of food explains increase of acidic pH. Therefore, whenever such chyme enters the duodenum the liver and pancreas need to increase secretion of alkali pH. Repeated, such dietary habits lead to indigestion. Further increase of alkali pH causes reduced transit time in small intestine leading to the symptoms like diarrhea. Diet which is ''atiguru'' (heavy) and indulging ''vishamashana''( irregular food habit) will have similar effect. ''Atiruksha ahara'' or diet has low protein value. Protein malnutrition leads to decrease of enzyme secretion as proteins are the building blocks of enzymes. ''Asatmya desha, kala, ritu'' only explain the dietary changes which dramatically alter the balance of bacteria in the gut on daily basis. Research shows that these fluctuations could lead to various digestive and absorptive problems. ''Dushita bhojana'' or contaminated food reacts directly with intestinal flora disturbing their quantitative and qualitative growth causing indigestion. Intake of unctuous substances in ''sama pitta'' condition leads to ''grahani dosha'' and various other disorders.[ Cha. Sa. [[Sutra Sthana]] 13/76] Emaciation due to disease also has its own impact on digestion. ''Mandagni'' is a causative factor for all diseases but if patient continuously indulges in ''apathya'' then complications may increase or the prognosis turns bad.

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''Atibhojana'' (excessive intake) causes provocation of all the ''[[dosha]]'' and thereby causing ''agnimandya''. Protein rich diet or fat laden diet or excessive diet takes longer time for emptying of stomach. Longer stay of food explains increase of acidic pH. Therefore, whenever such chyme enters the duodenum the liver and pancreas need to increase secretion of alkali pH. Repeated, such dietary habits lead to indigestion. Further increase of alkali pH causes reduced transit time in small intestine leading to the symptoms like diarrhea. Diet which is ''atiguru'' (heavy) and indulging ''vishamashana''( irregular food habit) will have similar effect. ''Atiruksha ahara'' or diet has low protein value. Protein malnutrition leads to decrease of enzyme secretion as proteins are the building blocks of enzymes. ''Asatmya desha, kala, ritu'' only explain the dietary changes which dramatically alter the balance of bacteria in the gut on daily basis. Research shows that these fluctuations could lead to various digestive and absorptive problems. ''Dushita bhojana'' or contaminated food reacts directly with intestinal flora disturbing their quantitative and qualitative growth causing indigestion. Intake of unctuous substances in ''sama [[pitta]]'' condition leads to ''grahani dosha'' and various other disorders.[ Cha. Sa. [[Sutra Sthana]] 13/76] Emaciation due to disease also has its own impact on digestion. ''Mandagni'' is a causative factor for all diseases but if patient continuously indulges in ''apathya'' then complications may increase or the prognosis turns bad.

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Suppression of manifested natural urges may have impact on nervous system resulting in effect either on enzymatic secretion or on the hormonal secretion.These factors have role in digestion and absorption as may be understood in case of ''adhovata'' (accumulation of ''vata'' in rectum and pelvic region) and ''purisha vegadharana'' (suppression of urge of defecation), wherein regular urge suppression disturbs the intestinal pro-kinetic movement.[Cha. Sa. [[Sutra Sthana ]] 7/ 6,8,12] Disturbed pro-kinesia increases the transit time leading to the change in pH which further has its impact on electrolytes and enzymatic secretion leading to reduced digestive power (''agnimandya'').

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Suppression of manifested natural urges may have impact on nervous system resulting in effect either on enzymatic secretion or on the hormonal secretion. These factors have role in digestion and absorption as may be understood in case of ''adhovata'' (accumulation of ''[[vata]]'' in rectum and pelvic region) and ''[[purisha]] vegadharana'' (suppression of urge of defecation), wherein regular urge suppression disturbs the intestinal pro-kinetic movement.[Cha. Sa. [[Sutra Sthana ]] 7/ 6,8,12] Disturbed pro-kinesia increases the transit time leading to the change in pH which further has its impact on electrolytes and enzymatic secretion leading to reduced digestive power (''agnimandya'').

Further ''kshudha vegadharana'' (avoiding sense of hunger) effect will be similar to ''abhojana'' (not eating). It may also be noted that repeated ''kshudha vegadharana'' leads to atrophy of the stomach which further weakens the perception of hunger which is controlled by the percentage of the stomach that remains empty similar to the explanation given by Charak that excessive fasting leads to diminution in ''agni''.[Cha.Sa. [[Sutra Sthana]] 22/37] ''Trishna vegadharana'' (avoiding thirst) leads to reduced fluid balance in the body.

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Nearly seven liters of water is secreted during various gastrointestinal secretions. Reduced water intake in long term will reduce gastrointestinal secretion leading to impaired digestion.

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Abnormal digestion is from faulty food habits and unwholesome diet, that causes ''jatharagni dushti'' or vitiation of digestive power. The improperly digested food turns into toxic substance called aamavisha, basic cause of most diseases. If ''amavisha'' associates with any balanced ''dosha'' or healthy ''dhatu'', they turn pathogenic. ''Grahanidosha'' is an important example of ''amavisha'' and ''agnidushti''.

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Abnormal digestion is from faulty food habits and unwholesome diet, that causes ''jatharagni dushti'' or vitiation of digestive power. The improperly digested food turns into toxic substance called aamavisha, basic cause of most diseases. If ''amavisha'' associates with any balanced ''[[dosha]]'' or healthy ''[[dhatu]]'', they turn pathogenic. ''Grahanidosha'' is an important example of ''amavisha'' and ''agnidushti''.

''Grahanidosha'' is of four types. It starts with inflammation of elementary canal at different places and is called by different names e.g gastritis, duodenitis and colitis. In the second stage erosions and ulcers develop. In third stage mental symptoms like anxiety, illusions, fear, and IBS like symptoms. Fourth stage is ''sannipatic'' with clinical features resembling ulcerative colitis.

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=== Effect on immunity ===

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''Prayatna'' (effort), ''urja'' (energy) and ''bala'' (strength) are the role played by ''vata, pitta'' and ''kapha'' in building up of immunity. When the ''dosha'' gets vitiated ''prayatna, urja'' and ''bala'' are hampered leading to suppression of immunity.

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''Prayatna'' (effort), ''urja'' (energy) and ''bala'' (strength) are the role played by ''[[vata]], [[pitta]]'' and ''[[kapha]]'' in building up of immunity. When the ''[[dosha]]'' gets vitiated ''prayatna, urja'' and ''bala'' are hampered leading to suppression of immunity.

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Exogenous and endogenous factors vitiate the doṣha which when associated with ama produce either local or systemic disorders.

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Exogenous and endogenous factors vitiate the [[doṣha]] which when associated with ama produce either local or systemic disorders.

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''Tridosha'' play role in impairing immunity and depending on the dominance of a particular ''dosha'' they are classified as ''~~vataja~~, ~~pittaka~~'' and ''~~kaphaja~~'' disorders.[Cha.Sa. [[Sutra Sthana]] 28/7]

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''Tridosha'' play role in impairing immunity and depending on the dominance of a particular ''[[dosha]]'' they are classified as ''[[vata]]ja, [[pitta]]ka'' and ''[[kapha]]ja'' disorders.[Cha.Sa. [[Sutra Sthana]] 28/7]

=== Equilibrium of ''agni'' ===

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''Agni'' should be associated with balance of ''vata, pitta'' and ''kapha'' or ''samagni''. Digestive enzyme secretion is controlled by sympathetic and parasympathetic nerve supply. ''Samagni'' may be compared with balanced state of sympathetic/ parasympathetic activity which explains the role of balanced or ''samana vata''. It may also be noted that ''prana vata'' and ''apana vata'' also have impact on balancing the normal status of ''agni''.

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''Agni'' should be associated with balance of ''[[vata]], [[pitta]]'' and ''[[kapha]]'' or ''samagni''. Digestive enzyme secretion is controlled by sympathetic and parasympathetic nerve supply. ''Samagni'' may be compared with balanced state of sympathetic/ parasympathetic activity which explains the role of balanced or ''samana vata''. It may also be noted that ''prana vata'' and ''apana vata'' also have impact on balancing the normal status of ''agni''.

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Acidic and alkaline pH of digestive secretions explains the balanced ''pitta''. Modern science explains specific range of pH of digestive secretions e.g. pancreatic juice has pH in range of 7.1 – 8.2 that buffers acidic gastric juice in chyme, stops the action of pepsin from the stomach and creates proper pH for action of digestive enzymes in small intestine. Specific pH of gastric juice is essential to convert pepsinogen into pepsin, an active form of proteolytic enzyme thus improper pH will cause variation in digestion.

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Acidic and alkaline pH of digestive secretions explains the balanced ''[[pitta]]''. Modern science explains specific range of pH of digestive secretions e.g. pancreatic juice has pH in range of 7.1 – 8.2 that buffers acidic gastric juice in chyme, stops the action of pepsin from the stomach and creates proper pH for action of digestive enzymes in small intestine. Specific pH of gastric juice is essential to convert pepsinogen into pepsin, an active form of proteolytic enzyme thus improper pH will cause variation in digestion.

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Mucosal resistance explains role of ''kapha'' in maintaining ''samagni''. Intact mucosal lining is present in stomach and small intestine. Breach in mucosal lining causes gastritis, burning sensation etc whereas increased size of mucosal cells alters the pH thereby a balanced ''kapha'' plays essential role in ''samagni''. Role of prostaglandins to maintain gastric mucosal resistance to prevent the action of HCl in gastric mucosa is to be considered as part of ''kledaka kapha'' as sodium bicarbonate and mucus is secreted by prostaglandins. Drugs which inhibit prostaglandins e.g. aspirin, impairs gastric mucosal barriers leading to gastritis, duodenitis and peptic ulcers.

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Mucosal resistance explains role of ''[[kapha]]'' in maintaining ''samagni''. Intact mucosal lining is present in stomach and small intestine. Breach in mucosal lining causes gastritis, burning sensation etc whereas increased size of mucosal cells alters the pH thereby a balanced ''[[kapha]]'' plays essential role in ''samagni''. Role of prostaglandins to maintain gastric mucosal resistance to prevent the action of HCl in gastric mucosa is to be considered as part of ''kledaka kapha'' as sodium bicarbonate and mucus is secreted by prostaglandins. Drugs which inhibit prostaglandins e.g. aspirin, impairs gastric mucosal barriers leading to gastritis, duodenitis and peptic ulcers.

=== Clinical features ===

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Etiological factors as mentioned in the text have impact mainly on the neural stimulation of digestive secretions affecting the flow of gastrointestinal secretions into the gastrointestinal tract thereby hampering the digestion.

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Hence it is explained that aggravated ''vata'' encompasses the ''agni''. Altered canalicular functions hampers digestion, easily understood in primary biliary cirrhosis wherein biliary secretion is restricted. Atrophy of gastric mucosa reduces HCl secretion causing indigestion. The gastric gland contains three types of exocrine gland cells that secrete their products into stomach lumen.''Srotasam kharatvam'' (hardness in channels) quality of ''tikta rasa'' destroys the exocrine gland cell reducing their secretions. Gastric glands include a type of enteroendocrine cell, the G cell which is located mainly in the pyloric antrum and secretes the hormone gastrin into the blood stream which stimulates parietal cells to secrete HCl and chief cells to secrete pepsinogen, it also contracts the lower esophageal sphincter, increases motility of the stomach and relaxes pyloric sphincter.

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Hence it is explained that aggravated ''[[vata]]'' encompasses the ''agni''. Altered canalicular functions hampers digestion, easily understood in primary biliary cirrhosis wherein biliary secretion is restricted. Atrophy of gastric mucosa reduces HCl secretion causing indigestion. The gastric gland contains three types of exocrine gland cells that secrete their products into stomach lumen.''Srotasam kharatvam'' (hardness in channels) quality of ''tikta rasa'' destroys the exocrine gland cell reducing their secretions. Gastric glands include a type of enteroendocrine cell, the G cell which is located mainly in the pyloric antrum and secretes the hormone gastrin into the blood stream which stimulates parietal cells to secrete HCl and chief cells to secrete pepsinogen, it also contracts the lower esophageal sphincter, increases motility of the stomach and relaxes pyloric sphincter.

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G cells when get destroyed the above action of ''kapha'', in turn, ''agni'' is hampered so also contraction and relaxation karma of ''vata'' is vitiated.

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G cells when get destroyed the above action of ''[[kapha]]'', in turn, ''agni'' is hampered so also contraction and relaxation karma of ''[[vata]]'' is vitiated.

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Further ''kashaya rasa'' reduces peristaltic movements called as mixing waves which reduces the maceration and mixing of food with secretions of gastric glands, thus improper chyme is formed. Deficiency of gastrointestinal secretions due to damage to the glands or canaliculi or intestine may be mostly considered as having ~~vātaja~~ origin. Loss of ''pravartana karma'' is to be understood where the transport of secretions is hampered (except in obstructive pathology where ''kapha'' to be considered). Hartnup’s syndrome a defect in neutral amino acid transport and cystinuria a defect in dibasic amino acid transport explain the rare genetic disorders (''Bija Dusti'') involved in protein digestion absorption.

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Further ''kashaya rasa'' reduces peristaltic movements called as mixing waves which reduces the maceration and mixing of food with secretions of gastric glands, thus improper chyme is formed. Deficiency of gastrointestinal secretions due to damage to the glands or canaliculi or intestine may be mostly considered as having [[vata]]ja origin. Loss of ''pravartana karma'' is to be understood where the transport of secretions is hampered (except in obstructive pathology where ''[[kapha]]'' to be considered). Hartnup’s syndrome a defect in neutral amino acid transport and cystinuria a defect in dibasic amino acid transport explain the rare genetic disorders (''Bija Dusti'') involved in protein digestion absorption.

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Further due to ''vata prakopa'', intestinal activity is increased which is manifested as malabsorption. For e.g. lactose intolerance is related to rate of gastric emptying. Symptoms are more likely when gastric emptying is rapid than when gastric emptying is slower. Therefore it is more likely that skim milk will be associated with symptoms of lactose intolerance than with whole milk as rate of gastric emptying is more rapid in skim milk. Milk proteins, particularly caseins have appropriate amino acids composition for growth and development of young.

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Further due to ''[[vata]] prakopa'', intestinal activity is increased which is manifested as malabsorption. For e.g. lactose intolerance is related to rate of gastric emptying. Symptoms are more likely when gastric emptying is rapid than when gastric emptying is slower. Therefore it is more likely that skim milk will be associated with symptoms of lactose intolerance than with whole milk as rate of gastric emptying is more rapid in skim milk. Milk proteins, particularly caseins have appropriate amino acids composition for growth and development of young.

Caseins are highly digestible in intestine and high quality source of amino acids. Most of whey proteins are relatively less digestible in intestine, although all of them are digested to some degree. When substantial whey proteins are not digested fully, some of intact protein may stimulate a localized intestinal or systemic immune response this is due to beta lactoglobullin referred to milk protein allergy. Similarly, diarrhea observed following subtotal gastrectomy is often a result of lactose intolerance as gastric emptying is accelerated in patients with gastrojejunostomy, rapid small intestinal transit time develops symptoms of lactose intolerance.

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Increased appetite (''Kshudha'') is seen because of a negative feedback due to malabsorption or it may be understood under ''rasasheshajeerna''.

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''Trishna'' is manifested due to increased ''ruksha guna'' of ''vata'' and decreased ''jaladi ansha'' due to diarrhea and low fluid intake.

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''Trishna'' is manifested due to increased ''ruksha [[guna]]'' of ''[[vata]]'' and decreased ''jaladi ansha'' due to diarrhea and low fluid intake.

''Timira'' (blurred vision) results from vitamin A malabsorption and anemia.

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Patient doubts as if he may be suffering from following of the disorders like ''vatavikara, gulma, hridroga'' and ''pleeha''. Due to formation of flatus and later on bloating of abdomen makes the patient feel he is suffering from ''vatika'' disorders related to gastrointestinal tract. Especially ''gulma'' since the patient feels the movement of flatus, so doubts about ''gulma''.

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''Ushna'' and ''teekshna guna'' of ''pitta'' trigger inflammatory response by irritating the intestinal mucosa.

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''Ushna'' and ''teekshna [[guna]]'' of ''[[pitta]]'' trigger inflammatory response by irritating the intestinal mucosa.

Indigestion causes depletion of beneficial gut bacteria thus breakdown in the balance between the putative protective and harmful intestinal bacteria leads to chronic inflammation.

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Antigenic nature of endogenous factors can be understood when helpful bacteria and ''ushna, teekshna guna'' of [[pitta dosha]] trigger inflammatory response leading to autoimmune pathogenesis.

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Antigenic nature of endogenous factors can be understood when helpful bacteria and ''ushna, teekshna [[guna]]'' of [[pitta dosha]] trigger inflammatory response leading to autoimmune pathogenesis.

In case of hypersecretion of gastrin in gastrinoma (Zollingers – Ellison Syndrome) stimulate the parietal cells of the stomach to secrete acid to their maximal capacity and increase the parietal cell mass three to six fold. The acid output may be so great that it reaches the upper small intestine reducing the luminal pH to two or less.

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Other than excessive secretion, condition like ileal dysfunction caused by either Crohn’s disease or surgical resection results in a decrease in bile acid re absorption in the ileum and an increase in the delivery of bile acids to the large intestine. The resultant is a diarrhea with or without steatorrhea. It becomes a cause for mal-absorption syndrome.

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Inflammatory Bowel Disease needs consideration in ''~~pittaja~~ grahani''. Exogenous factors trigger inflammatory response that the mucosal immune system may fail to control. With mild inflammation the mucosa is erythematous and in severe condition the mucosa becomes hemorrhagic, edematous and ulcerated (Verse 65).

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Inflammatory Bowel Disease needs consideration in ''[[pitta]]ja grahani''. Exogenous factors trigger inflammatory response that the mucosal immune system may fail to control. With mild inflammation the mucosa is erythematous and in severe condition the mucosa becomes hemorrhagic, edematous and ulcerated (Verse 65).

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Loose motions (''Drava Mala Pravritti'') are mainly due to excessive secretion of bile juice (''Drava guna'' of ''pitta''). Excessive secretion may be due excessive formation in liver or decrease absorption in the intestine.

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Loose motions (''Drava Mala Pravritti'') are mainly due to excessive secretion of bile juice (''Drava [[guna]]'' of ''[[pitta]]''). Excessive secretion may be due excessive formation in liver or decrease absorption in the intestine.

Bile acids are not present in the diet but are synthesized in the liver by a series of enzymatic steps that also include cholesterol catabolism. Bile acids are either primary or secondary. Primary bile acids are synthesized in the liver from cholesterol and secondary bile acids are synthesized from primary bile acids in the intestine by colonic bacterial enzymes. Bile acids are primarily absorbed by active, sodium dependent process that is located exclusively in the ileum; secondly bile acids can also be absorbed to a lesser extent by non carrier mediated transport processes in the jejunum, ileum and colon. Conjugated bile acids that enter the colon are de-conjugated by colonic bacterial enzyme to unconjugated bile acids and are rapidly absorbed. Colonic bacterial enzymes also dehydroxylate bile acids to secondary bile acids, thus if exogenous factors like diet as discussed above disturb the colonic bacterial growth than bile acids are not absorbed. A decrease in the amount of bile acids returning to the liver from the intestine is associated with an increase in bile acids synthesis/cholesterol catabolism, which helps keep bile acid pool size relatively constant. Defects in any of the steps of the enterohepatic circulation of bile acids can result in decrease in duodenal concentration of conjugated bile acids as a result steatorrhea. Thus steatorrhea can be caused by abnormalities in bile acid synthesis and excretion, their physical state in the intestinal lumen and reabsorption. The bile gives the yellowish nature to the stools (Verse 66).

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''Guru, snigdha'' and ''seeta ahara'' is dominated by ''prithvi'' and ''jala mahabhuta'', these qualities help in reducing the impact of ''agni mahabhuta'' thus causing ''jatharagni mandyata'' resulting in indigestion leading to formation ''ama''. Such ''ama'' is responsible for ''dosha prakopa''.<ref> Madhavakara. Madhava Nidanam (Roga vinischaya) Chap 2, jwara Adhyaya, Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--</ref>

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''Guru, snigdha'' and ''seeta ahara'' is dominated by ''[[prithvi]]'' and ''[[jala mahabhuta]]'', these qualities help in reducing the impact of ''[[agni mahabhuta]]'' thus causing ''jatharagni mandyata'' resulting in indigestion leading to formation ''ama''. Such ''ama'' is responsible for ''[[dosha]] prakopa''.<ref> Madhavakara. Madhava Nidanam (Roga vinischaya) Chap 2, jwara Adhyaya, Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--</ref>

''Klinna''(moist), ''guru, pishtanna''(malt), ''abhishyandi''(which increases secretions) ''ahara''(food) and ''adhyashana''(over eating) are source for extra calories. Fast foods are defined as any food that contributes little or no nutrient values to the diet, but instead provides excess calories and fat. Common foods include salted snack foods, gum, sweet desserts, fried fast foods, carbonated beverages and candy.

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Diets rich in trans-fatty acids like deep fried fast food, cake mixes, chips and packed cookies, all have inclusion in ''guru, pishtanna, vishtambi''(causing obstruction) ''ahara''. People consuming ''snigdha ahara'' (fatty food) and have sedentary lifestyle with very little energy expenditure, and most fat is stored. The above two concepts explain why ''agnimandya'' and ''ajeerna'' have been mentioned after taking heavy food. Excessive heavy food (''guru ahara'') slows down emptying of stomach (''samana vata karma'' is hampered) and enzymes are not secreted into lumen (''pitta'' action hampered) causing ''agnimandya''.

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Substances of ''seeta veerya'' causes constriction reducing the secretion (''stambhana'') of gastrointestinal juices thus hampering lipase activity therefore leading to steatorrhea.

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Substances of ''seeta veerya'' causes constriction reducing the secretion (''[[stambhana]]'') of gastrointestinal juices thus hampering lipase activity therefore leading to steatorrhea.

Further heavy meals increase the transit time causing functional stasis which may cause bacterial overgrowth syndrome. Sleeping just after meals may also lead to functional stasis (further study required). Peristalses are also reduced with heavy meals and sleeping after meals causes bacterial overgrowth. Bacteria deconjugate conjugated bile acids and as a result intraduodenal concentration of bile acids will be reduced resulting in steatorrhoea and macrocytic anemia. Bacterial overgrowth also occurs with stasis from a blind loop, small bowel diverticulum or dysmotility.

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Nausea and vomiting are both caused by stimulation at one of the four sites: the gastrointestinal tract, the vestibular system, the chemoreceptor trigger zone and the cerebral cortex. Nausea and vomiting occurs due to disturbed gastric motility caused by heavy meal and delayed gastric emptying. The same is the cause for heavy abdomen and eructation with foul smell and sweet taste. As the food stays for long time in gastrointestinal tract blood flow increases centrally and reduces the enthusiasm and decrease in libido. The sluggish activity of gastrointestinal tract causes symptoms such as absence of movement in the abdomen (''udaram stimitam guru''). The heavy abdomen puts pressure on the diaphragm causing symptoms of heaviness in chest (''hridayam manyate styanam'').

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Bacterial overgrowth due to undigested ''guru, klinna, snigdha'' and ''abhishyandi ahara'' causes increased mucoid secretion, thus formed stool is not observed instead ''bhinnamashleshma-samsrishta varcha''(loose stools with ''ama'' and ''kapha'') is seen; which is also cause for heaviness of stools (''guru-varchah-pravartanam'') Due to diet pattern and sedentary lifestyle there is accumulation of fat (obesity) but due to decrease protein absorption and malabsorption of essential elements patient feels weakness and laziness without weight loss (Verse 68-70).

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Bacterial overgrowth due to undigested ''guru, klinna, snigdha'' and ''abhishyandi ahara'' causes increased mucoid secretion, thus formed stool is not observed instead ''bhinnamashleshma-samsrishta varcha''(loose stools with ''ama'' and ''[[kapha]]'') is seen; which is also cause for heaviness of stools (''guru-varchah-pravartanam'') Due to diet pattern and sedentary lifestyle there is accumulation of fat (obesity) but due to decrease protein absorption and malabsorption of essential elements patient feels weakness and laziness without weight loss (Verse 68-70).

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Normalcy of ''vata pitta'' and ''kapha'' keeps the ''agni'' in balanced condition, it means that a specific pH is maintained (''pitta''); secretion, transportation and villi movement are normal (''vata'') and mucosal bed secretes normal mucus and is healthy (''kapha''), thus maintains ''samagni'' or a normal digestive process (Verse 71).

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Normalcy of ''[[vata]] [[pitta]]'' and ''[[kapha]]'' keeps the ''agni'' in balanced condition, it means that a specific pH is maintained (''[[pitta]]''); secretion, transportation and villi movement are normal (''[[vata]]'') and mucosal bed secretes normal mucus and is healthy (''[[kapha]]''), thus maintains ''samagni'' or a normal digestive process (Verse 71).

Protein losing enteropathy is increased protein loss into the gastrointestinal tract which is classified into three groups.

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#Mucosal ulceration; there is protein loss by exudation across damaged mucosa e.g. Ulcerative colitis, peptic ulcer, gastro intestinal carcinoma. In such cases dominance of ''pitta dosha'' needs to be considered.

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#Mucosal ulceration; there is protein loss by exudation across damaged mucosa e.g. Ulcerative colitis, peptic ulcer, gastro intestinal carcinoma. In such cases dominance of ''[[pitta dosha]]'' needs to be considered.

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#Non ulcerated mucosa but evidence of mucosal damage; Protein loss primarily represents loss across epithelia with altered permeability e.g. celiac sprue and menetrier’s disease in small intestine and stomach respectively, ''vata dosha'' and/or ''kapha dosha'' dominance should be considered.

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#Non ulcerated mucosa but evidence of mucosal damage; Protein loss primarily represents loss across epithelia with altered permeability e.g. celiac sprue and menetrier’s disease in small intestine and stomach respectively, ''[[vata dosha]]'' and/or ''[[kapha dosha]]'' dominance should be considered.

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#Lymphatic dysfunction, represents either primary lymphatic disease or secondary to partial lymphatic obstruction that may occur as a result of enlarged lymph nodes or cardiac disease. Patient with increased protein loss into gastrointestinal tract due to lymphatic obstruction often have steatorrhea and diarrhea. The steatorrhea is a result of altered lymphatic flow as lipid containing chylomicrons exit from intestinal epithelial cells via intestinal lymphatic’s which may be compared with flow of ''ahara rasa'' and/ or presence of ''vata'' and ''kapha''.

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#Lymphatic dysfunction, represents either primary lymphatic disease or secondary to partial lymphatic obstruction that may occur as a result of enlarged lymph nodes or cardiac disease. Patient with increased protein loss into gastrointestinal tract due to lymphatic obstruction often have steatorrhea and diarrhea. The steatorrhea is a result of altered lymphatic flow as lipid containing chylomicrons exit from intestinal epithelial cells via intestinal lymphatic’s which may be compared with flow of ''ahara rasa'' and/ or presence of ''[[vata]]'' and ''[[kapha]]''.

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Genetic factors (''bija dushti'') almost all patients with celiac sprue express the HLA-DQ2 allele. Environmental factor, gliadin a component of gluten that is present in wheat, barley and rye contributes to the disease. Immunologic component (''prayatna, bala'' and ''urja'' of ''vata, kapha'' and ''pitta'' respectively), serum antibodies – IgA antigliadin, IgA antiendomyasial and IgA antibodies and IgG antibodies are present. In addition, gliadin peptides may interact with gliadin specific T cells that may either mediate tissue injury or induce the release of one or more cytokines that cause tissue injury (Verse 72).

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Genetic factors (''bija dushti'') almost all patients with celiac sprue express the HLA-DQ2 allele. Environmental factor, gliadin a component of gluten that is present in wheat, barley and rye contributes to the disease. Immunologic component (''prayatna, bala'' and ''urja'' of ''[[vata]], [[kapha]]'' and ''[[pitta]]'' respectively), serum antibodies – IgA antigliadin, IgA antiendomyasial and IgA antibodies and IgG antibodies are present. In addition, gliadin peptides may interact with gliadin specific T cells that may either mediate tissue injury or induce the release of one or more cytokines that cause tissue injury (Verse 72).

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Further research shows that incase of uncontrolled growth of gut microbiome, flushing of gut reduces both psycho-somatic symptoms. ''Shodhana'' therapy not only flushes the vitiated gut microbiome but also flushes out the substrata due to which growth of microbiome is controlled (Verse 73-74).

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Further research shows that incase of uncontrolled growth of gut microbiome, flushing of gut reduces both psycho-somatic symptoms. ''[[Shodhana]]'' therapy not only flushes the vitiated gut microbiome but also flushes out the substrata due to which growth of microbiome is controlled (Verse 73-74).

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''Kshara'' has been advised along with ''tilvaka sneha; kshara'' has alkaline pH. In duodenum and small intestine, enzymes with alkaline pH are secreted. ''Ushna, teekshna'' and ''laghu guna'' help in digestion. ''Kledayati ado paschata visoshayati''[Cha.Sa.[[ Vimana Sthana]] 1/17 ] i.e. secretion are first increased and later on absorbed is very essential in ''grahani dosha''. Both these actions help in secretion of digestive enzymes thereby increasing ''agni'' and by absorption correct the malabsorption. Therefore use of ''kshara'' is more in ''grahani dosha'' and ''gulma'' (Verse 79).

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''Kshara'' has been advised along with ''tilvaka sneha; kshara'' has alkaline pH. In duodenum and small intestine, enzymes with alkaline pH are secreted. ''Ushna, teekshna'' and ''laghu [[guna]]'' help in digestion. ''Kledayati ado paschata visoshayati''[Cha.Sa.[[ Vimana Sthana]] 1/17 ] i.e. secretion are first increased and later on absorbed is very essential in ''grahani dosha''. Both these actions help in secretion of digestive enzymes thereby increasing ''agni'' and by absorption correct the malabsorption. Therefore use of ''kshara'' is more in ''grahani dosha'' and ''gulma'' (Verse 79).

''Aranala''(a fermented preparation), ''dadhimanda''(curd whey) or ''sauviraka'' are all fermented liquids. Fermented liquids contain probiotic organisms. Probiotic foods are produced by chemical action of lactic acid, bacteria, yeast or combination of both. These useful microorganisms help in breaking down carbohydrates, sugars making them easily digestible. Probiotics improves absorption of nutrients; improve synthesis of vitamins, essential fatty acids and enhance nutritional qualities of food grains. Fermented foods increase the absorption of vital minerals from gastrointestinal tract thus preventing mineral deficiencies and also treat the diarrhea. It explains the role of helpful gut microbiome (Verse 82-86). Use of fermented products explains the concept of gut microbiome and use of ''kshara'' and ''amla'' drug for maintaining pH (Verse 88-93).

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''Vamana'' (medicated emesis) reduces gastro-paresis by emptying the gastrointestinal contents (Verse 101-102).

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''[[Vamana]]'' (medicated emesis) reduces gastro-paresis by emptying the gastrointestinal contents (Verse 101-102).

Fermented liquids are rich source of gut microbiome which will help to replace the unhealthy microbiome. These fermented liquids also help to balance the pH of the gastrointestinal tract. Further study is required to decide impact of above mentioned liquid diet on pH and specific enzymes (Verse 115-116).

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Hypermetabolism is accompanied by a variety of internal and external symptoms most notably extreme weight loss. External symptoms of hypermetabolism may include anemia, fatigue, elevated heart rate, irregular heartbeat, insomnia, shortness of breath, dysautonomia, muscle weakness, excessive sweating while internal symptoms include peripheral insulin resistance, elevated catabolism of proteins, carbohydrates triglycerides and negative nitrogen in the body.

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In this context there is increased function due to excess secretion of thyroid hormones. Thyroid hormones act as catabolic hormones and promote calorigenesis and develops hypermetabolic state which may result in gluconeogenesis, lipolysis and glycogenolysis causing decreased muscle mass and weight loss. Metabolic rate is enhanced, because of vitiated ''pitta'' and associated ''vata''.

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In this context there is increased function due to excess secretion of thyroid hormones. Thyroid hormones act as catabolic hormones and promote calorigenesis and develops hypermetabolic state which may result in gluconeogenesis, lipolysis and glycogenolysis causing decreased muscle mass and weight loss. Metabolic rate is enhanced, because of vitiated ''[[pitta]]'' and associated ''[[vata]]''.

This is the condition where increased appetite with weight loss is seen due to insufficient supply of nutrients in relation to ''agnibala''. Thyroid storm/ thyroid-toxic crisis is rare and life threatening exacerbation of hyperthyroidism, accompanied by fever, delirium, seizures, vomiting, diarrhea and jaundice. Death may occur due to cardiac failure, arrhythmia and hyperthermia.

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Revision as of 20:24, 16 August 2021

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