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== Definition ==

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<ol style='text-align:justify;'><li>Weak digestive factors (jatharagni) cause poor digestion (avipaka) of rasa (primary product of digested food). This poorly formed product is called ‘ama’. This is the cause for vitiation of all [[Dosha|dosha]] (aggravation of all [[Dosha|dosha]]). [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/44]</li>

+

<ol style='text-align:justify;'><li>Weak digestive factors (jatharagni) cause poor digestion (avipaka) of [[Rasa|rasa]] (primary product of digested food). This poorly formed product is called ‘ama’. This is the cause for vitiation of all [[Dosha|dosha]] (aggravation of all [[Dosha|dosha]]). [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/44]</li>

<li>Ama is the root cause for almost all the [[Vyadhi|diseases]].<ref name="ref2"/></li>

<li>Ama is the first component formed due to weak digestive processes. It is in amashaya (site of storage of food in intermediary stage of digestion and metabolism). [A. H. [[Sutra Sthana|Sutra Sthana]]. 13/25]</li>

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<li>The first state of vitiated [[Dosha|dosha]] is called ‘ama’.<ref name="ref2"/></li>

<li>The byproducts of metabolism if not properly eliminated or utilized in the [[Sharira|body]] are considered as ama.<ref name="ref2"/></li>

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<li>The uncooked food (or annarasa) if, retained for longer time in stomach undergoes fermentation/putrefaction, this state of rasa is ama. This ama further joined with [[Dosha|dosha]] is termed as amadosha. It is as toxic as [[Visha Chikitsa|visha (poison)]] produced by spoiled kodrava (Paspalum scrobiculatum L., Italian millet contaminated by fungus). [A. H. [[Sutra Sthana|Sutra Sthana]] 13/26-27]</li></ol>

+

<li>The uncooked food (or annarasa) if, retained for longer time in stomach undergoes fermentation/putrefaction, this state of [[Rasa|rasa]] is ama. This ama further joined with [[Dosha|dosha]] is termed as amadosha. It is as toxic as [[Visha Chikitsa|visha (poison)]] produced by spoiled kodrava (Paspalum scrobiculatum L., Italian millet contaminated by fungus). [A. H. [[Sutra Sthana|Sutra Sthana]] 13/26-27]</li></ol>

== Causes ==

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* Suppression of natural urges (vegadharana) [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/42-44]

* Food with qualities such as heavy to digest (guru), dry (ruksha), [[Sheeta|cold (sheeta)]], dried/dehydrated (shushka), disliked by consumer (dvishta), constipation-causing (vishtambhi), those causing burning sensation (vidahi), unclean (ashuchi), incompatible food intake ([[Viruddha Ahara|viruddha anna]]), consumed untimely (akala bhojana)

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* Mental status while taking food: Intake of food when mind is affected by desires (kama), anger (krodha), greed (lobha), infatuation (moha), envy (irshya), shame (hri), grief (shoka), conceit (maana), anxiety (udvega), fear (bhaya), etc. [Cha.Sa. Vimana Sthana 2/8]

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* Mental status while taking food: Intake of food when mind is affected by desires (kama), anger (krodha), greed (lobha), infatuation (moha), envy (irshya), shame (hri), grief (shoka), conceit (maana), anxiety (udvega), fear (bhaya), etc. [Cha.Sa. [[Vimana Sthana|Vimana Sthana]] 2/8]

== Diseases caused by ama ==

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The undigested food gets fermented (shuktata) leading to onset of toxic symptoms. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/42-44] Ama further leads to various digestive disorders like amajirna (indigestion due to saama pitta), vishtabdhajirna (indigestion due to saama vata), vidagdha ajirna (indigestion due to saama kapha), [[Visuchika|visuchika]] (non-infectious gastroenteritis), [[Alasaka|alasaka]] (sluggish bowels), vilambika (gastro-intestinal stasis). [Su. Sa. Uttara Sthana 56/3] The [[Vyadhi|diseases]] caused by ama at various dhatu level are [[Jwara|jwara (fever)]], [[Atisara Chikitsa|atisara (diarrhoea)]], pravahika (dysentery), etc. The chronic conditions caused by ama are such as grahini-dosha (functional impairment of [[Agni|agni]]), [[Udara Chikitsa|udara]] roga (ascites and abdominal enlargement), yakrit vyadhi (liver disorders), jalodara (ascites), [[Shvayathu Chikitsa|shotha]] (oedema), [[Pandu Chikitsa|pandu (anemia)]], [[Prameha Nidana|prameha]] (obstinate urinary [[Vyadhi|disease]]), [[Amavata|amavata]] (rheumatism), etc.

+

The undigested food gets fermented (shuktata) leading to onset of toxic symptoms. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/42-44] Ama further leads to various digestive disorders like amajirna (indigestion due to saama pitta), vishtabdhajirna (indigestion due to saama vata), vidagdha ajirna (indigestion due to saama kapha), [[Visuchika|visuchika]] (non-infectious gastroenteritis), [[Alasaka|alasaka]] (sluggish bowels), vilambika (gastro-intestinal stasis). [Su. Sa. Uttara Sthana 56/3] The [[Vyadhi|diseases]] caused by ama at various [[Dhatu|dhatu]] level are [[Jwara|jwara (fever)]], [[Atisara Chikitsa|atisara (diarrhoea)]], pravahika (dysentery), etc. The chronic conditions caused by ama are such as grahini-dosha (functional impairment of [[Agni|agni]]), [[Udara Chikitsa|udara]] roga (ascites and abdominal enlargement), yakrit vyadhi (liver disorders), jalodara (ascites), [[Shvayathu Chikitsa|shotha]] (oedema), [[Pandu Chikitsa|pandu (anemia)]], [[Prameha Nidana|prameha]] (obstinate urinary [[Vyadhi|disease]]), [[Amavata|amavata]] (rheumatism), etc.

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The acidic nature ([[Amla|amla]] bhava) of undigested food (apakva anna) is called as suktata (acidic /sour nature of undigested food) which further acts like a [[Visha Chikitsa|visha (poison)]] that will further produce number of other [[Vyadhi|diseases]], so this can be compared to symptoms of amavisha.<ref name="ref3">Chakrapani. Charaka Samhita. [[Chikitsa Sthana~~|Chikitsa Sthana]]~~. Chapter 15/44. Edited by Jadavaji Trikamji Aacharya. Chaukambha Surbharti Prakashana. Varanasi;2005.pg no. 517.</ref> This uncooked food further combines with [[Dosha|dosha]] (regulatory functional factors of the [[Sharira|body]]), dhatu (major structural components of the [[Sharira|body]]) or mala (metabolic waste or byproducts) and produces their respective symptoms accordingly. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/46-49]

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The acidic nature ([[Amla|amla]] bhava) of undigested food (apakva anna) is called as suktata (acidic /sour nature of undigested food) which further acts like a [[Visha Chikitsa|visha (poison)]] that will further produce number of other [[Vyadhi|diseases]], so this can be compared to symptoms of amavisha.<ref name="ref3">Chakrapani. Charaka Samhita. Chikitsa Sthana. Chapter 15/44. Edited by Jadavaji Trikamji Aacharya. Chaukambha Surbharti Prakashana. Varanasi;2005.pg no. 517.</ref> This uncooked food further combines with [[Dosha|dosha]] (regulatory functional factors of the [[Sharira|body]]), [[Dhatu|dhatu]] (major structural components of the [[Sharira|body]]) or [[Mala|mala]] (metabolic waste or byproducts) and produces their respective symptoms accordingly. [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/46-49]

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When ama combines with pitta dosha, it produces pitta dominant [[Vyadhi|diseases]] such as burning sensation (daha), thirst (pipasa), [[Vyadhi|diseases]] of oral cavity (mukha roga), hyperacidity (amlapitta) etc. When it combines with kapha dosha, it produces kapha dominant [[Vyadhi|diseases]] such as rajayakshma (consumption), pinasa (chronic rhinitis), [[Prameha Nidana|prameha]] (obstinate urinary [[Vyadhi|disease]]), etc. When combines with vata dosha, it produces different types of vata dominant [[Vyadhi|diseases]]. When combines with mutra (urine) or gets lodged in mutravaha srotasa (urinary tract), to produce mutra roga such as mutrakrichhra (dysuria), mutraghata (urinary retention), [[Prameha Nidana|prameha]] (obstinate urinary [[Vyadhi|disease]]), etc. When combines with purisha (feces) produces [[Vyadhi|diseases]] of kukshi (pelvis) or [[Udara Chikitsa|udara]] roga ([[Vyadhi|diseases]] of abdomen). When combines with rasa etc. dhatu (seven major structural components of the [[Sharira|body]]), then produces their respective [[Vyadhi|diseases]].

+

When ama combines with [[Pitta dosha|pitta dosha]], it produces [[Pitta|pitta]] dominant [[Vyadhi|diseases]] such as burning sensation (daha), thirst (pipasa), [[Vyadhi|diseases]] of oral cavity (mukha roga), hyperacidity (amlapitta) etc. When it combines with [[Kapha dosha|kapha dosha]], it produces [[Kapha dosha|kapha]] dominant [[Vyadhi|diseases]] such as [[Rajayakshma Chikitsa|rajayakshma]] (consumption), pinasa (chronic rhinitis), [[Prameha Nidana|prameha]] (obstinate urinary [[Vyadhi|disease]]), etc. When combines with [[Vata dosha|vata dosha]], it produces different types of [[Vata dosha|vata]] dominant [[Vyadhi|diseases]]. When combines with [[Mutra|mutra (urine)]] or gets lodged in mutravaha srotasa (urinary tract), to produce [[Mutra|mutra]] roga such as mutrakrichhra (dysuria), mutraghata (urinary retention), [[Prameha Nidana|prameha]] (obstinate urinary [[Vyadhi|disease]]), etc. When combines with [[Purisha|purisha (feces)]] produces [[Vyadhi|diseases]] of kukshi (pelvis) or [[Udara Chikitsa|udara]] roga ([[Vyadhi|diseases]] of abdomen). When combines with [[Rasa|rasa]] etc. [[Dhatu|dhatu]] (seven major structural components of the [[Sharira|body]]), then produces their respective [[Vyadhi|diseases]].

== Premonitory features (ama purvarupa) ==

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Purvarupa (prodromal symptoms) of ama in general are, such as stiffness of [[Sharira|body]], anorexia, excessive sleep, pallor, dullness and especially irritation to food or playing activities in case of children. [Ka. Sa. [[Sutra Sthana|Sutra Sthana]] 25/32-33]

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[[Purvarupa|Purvarupa]] (prodromal symptoms) of ama in general are, such as stiffness of [[Sharira|body]], anorexia, excessive sleep, pallor, dullness and especially irritation to food or playing activities in case of children. [Ka. Sa. [[Sutra Sthana|Sutra Sthana]] 25/32-33]

== Characteristics of ama ==

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== Clinical features of dosha (saama dosha) and dhatu (saama dhatu) associated with ama ==

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Ama state of dosha or dhatu is termed as a saama dosha or saama dhatu respectively. These manifest different symptoms and produces number of [[Vyadhi|diseases]]. [A. H. [[Sutra Sthana|Sutra Sthana]] 13/26-27]

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Ama state of [[Dosha|dosha]] or [[Dhatu|dhatu]] is termed as a saama dosha or saama dhatu respectively. These manifest different symptoms and produces number of [[Vyadhi|diseases]]. [A. H. [[Sutra Sthana|Sutra Sthana]] 13/26-27]

=== These produce general features of saama and nirama state as below: ===

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Blockage or clogging of srotasa (channels)

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Blockage or clogging of [[Srotasa|srotasa]] (channels)

* Loss of strength

* Feeling of heaviness

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* Improper functions of vata dosha

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* Improper functions of [[Vata dosha|vata dosha]]

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* Accumulation of mala (metabolic wastes)

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* Accumulation of [[Mala|mala]] (metabolic wastes)

* Lethargy

* Low digestive capacity

* Excessive salivation

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* Retention of mala (waste products)

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* Retention of [[Mala|mala]] (waste products)

* Aversion towards food and tiredness. [A. H. [[Sutra Sthana|Sutra Sthana]] 13/23-24]

In case of state without ama (nirama), the opposite of above features are observed.

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|'''Saama vayu'''

−

'''(vata dosha associated with ama)'''

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'''([[Vata dosha|vata dosha]] associated with ama)'''

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|constipation (vibandha), weak digestive capacity, [[Sharira|body]] stiffness, gargling sound in abdomen(antrakunjan), painful sensation (vedana), swelling (shopha), pricking pain (nistoda), sequential and fleeting pain in various [[Sharira|body]] parts, pain increases after oleation therapy, during morning and evening time, during cloudy weather

+

|constipation (vibandha), weak digestive capacity, [[Sharira|body]] stiffness, gargling sound in abdomen(antrakunjan), painful sensation (vedana), swelling ([[Shvayathu Chikitsa|shopha]]), pricking pain (nistoda), sequential and fleeting pain in various [[Sharira|body]] parts, pain increases after [[Snehana (unction therapy)|oleation therapy]], during morning and evening time, during cloudy weather

|-

|'''Saama pitta'''

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'''(pitta dosha associated with a'''

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'''([[Pitta dosha|pitta dosha]] associated with a'''

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|Foul smell, color of pitta will be greenish/ light blackish, [[Amla|amla]] bhava of pitta (sour nature of pitta), heaviness, sour eructation, burning sensation in throat and cardiac region.

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|Foul smell, color of [[Pitta|pitta]] will be greenish/ light blackish, [[Amla|amla]] bhava of [[Pitta|pitta (sour nature of [[Pitta|pitta]]), heaviness, sour eructation, burning sensation in throat and cardiac region.

|-

|'''Saama kapha'''

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'''(kapha dosha associated with ama)'''

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'''([[Kapha dosha|kapha dosha]] associated with ama)'''

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|Avila (increase turbidity in mala), thick in consistency, feeling of sticky phlegm in throat, foul smell cough, lack of appetite.

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|Avila (increase turbidity in [[Mala|mala]]), thick in consistency, feeling of sticky phlegm in throat, foul smell cough, lack of appetite.

|}

{| class="wikitable"

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|'''Nirama vayu'''

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'''(vata dosha not associated with ama)'''

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'''([[Vata dosha|vata dosha]] not associated with ama)'''

−

|Proper elimination of metabolic wastes (mala), dryness of skin, no obstruction of [[Sharira|body]] channels, mild pain, vitiated vata subsides by [[Snehana (unction therapy)|snehana (oleation therapy)]].

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|Proper elimination of metabolic wastes ([[Mala|mala]]), dryness of skin, no obstruction of [[Sharira|body]] channels, mild pain, vitiated [[Vata dosha|vata]] subsides by [[Snehana (unction therapy)|snehana (oleation therapy)]].

|-

|'''Nirama pitta'''

−

'''(pitta dosha not associated with ama)'''

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'''([[Pitta dosha|pitta dosha]] not associated with ama)'''

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|Coppery and yellowish color of pitta, increased [[Sharira|body]] temperature, pungent taste of pitta, does not yield bad smell, improves taste, appetite and strength.

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|Coppery and yellowish color of [[Pitta dosha|pitta]], increased [[Sharira|body]] temperature, pungent taste of [[Pitta dosha|pitta]], does not yield bad smell, improves taste, appetite and strength.

|-

|'''Nirama kapha'''

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'''(kapha dosha not associated with ama)'''

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'''([[Kapha dosha|kapha dosha]] not associated with ama)'''

|Frothy in nature, free from threads, pallor, cough, light in nature, cleans oral cavity.

|}

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|-

|'''Saama rakta dhatu'''

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|Various types of skin disorders and abscess, raktapitta (hemorrhagic disorders), inflammation of anus/penis/oral cavity, kamala (jaundice), vatarakta (gout), arsha (piles).

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|Various types of [[Skin diseases in Integrative Medicine|skin disorders]] and abscess, [[Raktapitta|raktapitta]] (hemorrhagic disorders), inflammation of anus/penis/oral cavity, [[Kamala|kamala]] (jaundice), [[Vatarakta Chikitsa|vatarakta]] (gout), [[Arsha Chikitsa|arsha (piles)]].

|-

|'''Saama mamsa dhatu'''

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|-

|'''Saama meda dhatu'''

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|Prameha purvarupa (prodromal features of [[Prameha Nidana|prameha]]), galaganda (goiter), madhumeha (diabetes mellitus), atisthaulya (obesity).

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|-

|'''Saama asthi dhatu'''

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== Features of state without ama (nirama dhatu lakshana) [A. H. [[Sutra Sthana|Sutra Sthana]] 11/4] ==

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In stage devoid of ama (nirama avastha), all seven dhatus perform their normal functions and are devoid of symptoms of ama.

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In stage devoid of ama (nirama avastha), all seven [[Dhatu|dhatus]] perform their normal functions and are devoid of symptoms of ama.

{| class="wikitable"

|+Table no. 4: Saama mala lakshana : [Cha. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/49, 94]

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== Clinical presentations due to ama ==

There are mainly two types of ama dosha or ama dosha vikara (disease) viz; [[Visuchika|visuchika]] (non-infectious gastroenteritis /choleretic diarrhoea) and [[Alasaka|alasaka]] (sluggish bowel/intestinal obstruction). [Cha. Sa. [[Vimana Sthana|Vimana Sthana]]. 2/10] Food taken in excessive quantity is the cause for sudden aggravation of all three [[Dosha|dosha]] and formation of ama. All aggravated three [[Dosha|dosha]] combine with ama and produce [[Vyadhi|diseases]] like [[Alasaka|alasaka]] and [[Visuchika|visuchika]]. [A. H. [[Sutra Sthana|Sutra Sthana]]. 8/5-12]

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<ol style='text-align:justify;'><li style="font-weight:bold">[[Visuchika|Visuchika]] (gastro-enteritis): The word [[Visuchika|visuchika]] derived from “suchi” means needle or “suchi vidh vedana” (pricking pain). The expulsion of ama dosha (undigested food) through both upper and lower passages of the gastrointestinal tract is called [[Visuchika|visuchika]] (non-infectious gastroenteritis). The [[Dosha|doshas]] when tend to move outwards from both upper and downwards routes means both vomiting and diarrhoea occurs simultaneously. Due to aggravation of vata and other [[Dosha|doshas]] different types of pain occur as the patients feels as if his [[Sharira|body]] is being pricked by needles (suchi) so the [[Vyadhi|disease]] is named [[Visuchika|visuchika]]. It can be compared with gastro-enteritis due to pathogens such as Cholera bacilli. Complications caused by [[Visuchika|visuchika]] are, abdominal colic, vertigo, abdominal distension, tremors and rigidity by vata dosha. Pitta causes [[Jwara|jwara (fever)]], [[Atisara Chikitsa|atisara (diarrhoea)]], burning sensation within [[Sharira|body]], thirst, fainting and drowsiness. Kapha dosha leads to chardi (vomiting), heaviness of the [[Sharira|body]], unable to speak, excessive salivation and cough. </li>

+

<ol style='text-align:justify;'><li style="font-weight:bold">[[Visuchika|Visuchika]] (gastro-enteritis): The word [[Visuchika|visuchika]] derived from “suchi” means needle or “suchi vidh vedana” (pricking pain). The expulsion of ama dosha (undigested food) through both upper and lower passages of the gastrointestinal tract is called [[Visuchika|visuchika]] (non-infectious gastroenteritis). The [[Dosha|doshas]] when tend to move outwards from both upper and downwards routes means both vomiting and diarrhoea occurs simultaneously. Due to aggravation of [[Vata dosha|vata]] and other [[Dosha|doshas]] different types of pain occur as the patients feels as if his [[Sharira|body]] is being pricked by needles (suchi) so the [[Vyadhi|disease]] is named [[Visuchika|visuchika]]. It can be compared with gastro-enteritis due to pathogens such as Cholera bacilli. Complications caused by [[Visuchika|visuchika]] are, abdominal colic, vertigo, abdominal distension, tremors and rigidity by [[Vata dosha|vata dosha]]. [[Pitta dosha|Pitta]] causes [[Jwara|jwara (fever)]], [[Atisara Chikitsa|atisara (diarrhoea)]], burning sensation within [[Sharira|body]], thirst, fainting and drowsiness. [[Kapha dosha|Kapha dosha]] leads to chardi (vomiting), heaviness of the [[Sharira|body]], unable to speak, excessive salivation and cough. </li>

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<li style="font-weight:bold">[[Alasaka|Alasaka]] (sluggish bowels): The word [[Alasaka|Alasaka]] derived from word “Alasa” means no movement. When frail person having weak digestive power and excess of kapha in the [[Sharira|body]], it habitually suppresses the urges of passing flatulence, micturition and bowels and at the same time consumes sthira (solid), guru (heavy), atishushka (excessively dry), and [[Sheeta|sheeta (cold)]], in excessive quantities then his ingested food gets afflicted by vayu (vata dosha). Even exerting pressure does not push the undigested food out of the passage since it is obstructed by kapha, by excreta accumulated already, and also because of sluggish nature caused by all these factors. Vishtambhan (stasis) of [[Dosha|dosha]] occurs so the ama remains/stagnated within the stomach i.e., food neither passes upwards nor downward. This condition is called [[Alasaka|alasaka]]. All the characteristic features of ama dosha, except vomiting and diarrhoea, are manifested severely in [[Alasaka|alasaka]]. This can be compared with Cholera sicca where, the entire [[Sharira|body]] fluids are dragged into the intestines and intestines gets paralyzed and the patients dies because of tissue dehydration. Aggravated vata dosha vitiates the consumed food and kapha dosha obstructs the channels. The undigested food remains in gut without any further process. It causes irritation and colicky pain without vomiting or diarrhoea. </li></ol>

+

<li style="font-weight:bold">[[Alasaka|Alasaka]] (sluggish bowels): The word [[Alasaka|Alasaka]] derived from word “Alasa” means no movement. When frail person having weak digestive power and excess of [[Kapha dosha|kapha]] in the [[Sharira|body]], it habitually suppresses the urges of passing flatulence, micturition and bowels and at the same time consumes sthira (solid), guru (heavy), atishushka (excessively dry), and [[Sheeta|sheeta (cold)]], in excessive quantities then his ingested food gets afflicted by [[Vayu mahabhuta|vayu]] ([[Vata dosha|vata dosha]]). Even exerting pressure does not push the undigested food out of the passage since it is obstructed by [[Kapha dosha|kapha]], by excreta accumulated already, and also because of sluggish nature caused by all these factors. Vishtambhan (stasis) of [[Dosha|dosha]] occurs so the ama remains/stagnated within the stomach i.e., food neither passes upwards nor downward. This condition is called [[Alasaka|alasaka]]. All the characteristic features of ama dosha, except vomiting and diarrhoea, are manifested severely in [[Alasaka|alasaka]]. This can be compared with Cholera sicca where, the entire [[Sharira|body]] fluids are dragged into the intestines and intestines gets paralyzed and the patients dies because of tissue dehydration. Aggravated [[Vata dosha|vata dosha]] vitiates the consumed food and [[Kapha dosha|kapha dosha]] obstructs the channels. The undigested food remains in gut without any further process. It causes irritation and colicky pain without vomiting or diarrhoea. </li></ol>

'''Dandaka alasaka''' (delayed and obstructive digestive process wherein [[Sharira|body]] becomes stiff like a stick):

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== Ama visha ==

−

An individual who regularly consumes incompatible diet, indulge in adhyashana (multiple heavy meals in short intervals) and ajirnashana (eats even before the previous meal is digested), the ama dosha is formed. It resembles and manifests features of poisoning. Hence it is called ama visha. It is a difficult to cure because of its acute presentation and its contradictory line of management. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/12] The symptoms produced by ama visha are such as stasis in body (vishtambha), fatigue (sadana), indigestion (ajirna), headache (shirashoola), fainting (moorcha), vertigo (bhrama), stiffness of back (pristha-kati graha), yawning (jrimbha), malaise (angamarda), thirst(trishna), [[Jwara|fever (jwara)]], vomiting (chhardi), tenesmus(pravahana), anorexia (arochaka), indigestion (avipaka).

+

An individual who regularly consumes incompatible diet, indulge in adhyashana (multiple heavy meals in short intervals) and ajirnashana (eats even before the previous meal is digested), the ama dosha is formed. It resembles and manifests features of poisoning. Hence it is called ama visha. It is a difficult to cure because of its acute presentation and its contradictory line of management. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/12] The symptoms produced by ama visha are such as stasis in body (vishtambha), fatigue (sadana), indigestion (ajirna), headache (shirashoola), fainting (moorcha), vertigo (bhrama), stiffness of back (pristha-kati graha), yawning (jrimbha), malaise (angamarda), [[Trishna Chikitsa|thirst(trishna)]], [[Jwara|fever (jwara)]], [[Chhardi Chikitsa|vomiting (chhardi)]], tenesmus(pravahana), anorexia (arochaka), indigestion (avipaka).

== Chikitsa (management) ==

===Treatment of ama dosha: ===

* The following principles are adopted to manage a clinical condition associated with ama.

−

* Deepana (stimulating the digestive process)

+

* [[Deepana|Deepana]] (stimulating the digestive process)

−

* Pachana (assisting the digestion and metabolism)

+

* [[Pachana|Pachana]] (assisting the digestion and metabolism)

−

* Sneha (oleation with medicines having digestion stimulant properties)

+

* [[Snehadhyaya|Sneha]] (oleation with medicines having digestion stimulant properties)

−

* Sweda (fomentation)

+

* [[Sweda|Sweda]] (fomentation)

−

* Shodhana (purification) at appropriate time when [[Dosha|dosha]] are in a state of getting expelled out.

+

* [[Shodhana|Shodhana (purification)]] at appropriate time when [[Dosha|dosha]] are in a state of getting expelled out.

−

In a condition without ama, the main principle of treatment is shamana (palliative). Shodhana is indicated based on the state of [[Dosha|dosha]]. If the [[Dosha|dosha]] are in dormant (leena) state, then shodhana is prohibited. [A. H. [[Sutra Sthana|Sutra Sthana]] 13/28-29] Apatarpana (depleting procedure) is the prime line of treatment for ama dosha. The apatarpana is of three types viz., langhana (fasting), langhana- pachana and dosha avasechana (shodhana). Based on the avastha of dosha the type of apatarpana is to be advised i.e., in low grade (alpa) dosha stage, langhana (fasting) as it stimulates the digestive process by predominance of [[Agni|agni]] (fire element) and vayu (air element) mahabhuta. In moderate grade (madhyama) dosha stage, langhana and pachana (fasting with digestant) should be adopted. In highly aggravated (bahu) dosha state, dosha avasechana or shodhana (purification) as to remove out vitiated dosha and ama from the [[Sharira|body]]. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/43-44]

+

In a condition without ama, the main principle of treatment is [[Shamana|shamana]] (palliative). [[Shodhana|Shodhana]] is indicated based on the state of [[Dosha|dosha]]. If the [[Dosha|dosha]] are in dormant (leena) state, then [[Shodhana|shodhana]] is prohibited. [A. H. [[Sutra Sthana|Sutra Sthana]] 13/28-29] [[Apatarpana|Apatarpana]] (depleting procedure) is the prime line of treatment for ama dosha. The [[Apatarpana|apatarpana]] is of three types viz., [[Langhana|langhana]] (fasting), [[Langhana|langhana]]- [[Pachana|pachana]] and [[Dosha|dosha]] avasechana ([[Shodhana|shodhana]]). Based on the avastha of [[Dosha|dosha]] the type of [[Apatarpana|apatarpana]] is to be advised i.e., in low grade (alpa) [[Dosha|dosha]] stage, [[Langhana|langhana]] (fasting) as it stimulates the digestive process by predominance of [[Agni|agni]] (fire element) and [[Vayu mahabhuta|vayu (air element) mahabhuta]]. In moderate grade (madhyama) dosha stage, [[Langhana|langhana]] and [[Pachana|pachana]] (fasting with digestant) should be adopted. In highly aggravated (bahu) [[Dosha|dosha]] state, dosha avasechana or [[Shodhana|shodhana]] (purification) as to remove out vitiated [[Dosha|dosha]] and ama from the [[Sharira|body]]. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 3/43-44]

=== Treatment of alasaka: ===

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The curable variety of ama dosha should be eliminated through [[Vamana|vamana (emesis)]], by administering warm saline water and thereafter swedana (fomentation) and application of phala varti (suppositories) while the patient is kept on upavasa (fasting). [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/13]

+

The curable variety of ama dosha should be eliminated through [[Vamana|vamana (emesis)]], by administering warm saline water and thereafter [[Swedana|swedana]] (fomentation) and application of phala varti (suppositories) while the patient is kept on [[Upavasa|upavasa (fasting)]]. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/13]

=== Treatment of visuchika: ===

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In case of [[Visuchika|visuchika]], treatment should start with langhana (fasting) followed by specific dietary regimen as followed in therapeutic purgation ([[Virechana|virechana]]). [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/13]

+

In case of [[Visuchika|visuchika]], treatment should start with [[Langhana|langhana (fasting)]] followed by specific dietary regimen as followed in therapeutic purgation ([[Virechana|virechana]]). [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/13]

=== Amadosha chikitsa: ===

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In case of reoccurrence of the [[Vyadhi|diseases]] caused by ama, the first line of treatment is apatarpana i.e., depletion therapy. If the [[Vyadhi|disease]] further progresses even after depletion therapy, appropriate measures should be adopted to counter the morbid condition. Experts recommend the use of vyadhi viprit ausadha measures (treatment which is antagonistic to the [[Vyadhi|disease]]) rather than hetu viprita aushadha (treatment which is antagonistic to the etiological factors). [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/13]

+

In case of reoccurrence of the [[Vyadhi|diseases]] caused by ama, the first line of treatment is [[Apatarpana|apatarpana]] i.e., depletion therapy. If the [[Vyadhi|disease]] further progresses even after depletion therapy, appropriate measures should be adopted to counter the morbid condition. Experts recommend the use of vyadhi viprit ausadha measures (treatment which is antagonistic to the [[Vyadhi|disease]]) rather than hetu viprita aushadha (treatment which is antagonistic to the etiological factors). [Cha. Sa. [[Vimana Sthana|Vimana Sthana]] 2/13]

== Prevention of recurrence of ama dosha ==

When the patient is relieved from excessive morbidity of ama, and his digestive capacity ([[Agni|agni]]) is restored, the following treatment shall be administered to prevent recurrence of ama:

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* Abhyanga (therapeutic massage)

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* [[Abhyanga|Abhyanga]] (therapeutic massage)

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* Niruha basti (enema with decoction) and anuvasana basti (unctuous enema)

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* [[Asthapana basti|Niruha basti]] (enema with decoction) and [[Anuvasana|anuvasana basti (unctuous enema)]]

* Appropriate snehapana (internal administration of unctuous substances)

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Careful assessment of the status of [[Dosha|dosha]], drugs, place, time, strength, [[Sharira|body]], diet, satmya (habituation), psyche, constitution, age etc. and [[Vyadhi|diseases]] shall be done during the treatment. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]]. 2/13]

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Careful assessment of the status of [[Dosha|dosha]], drugs, place, time, strength, [[Sharira|body]], diet, [[Satmya|satmya]] (habituation), psyche, constitution, age etc. and [[Vyadhi|diseases]] shall be done during the treatment. [Cha. Sa. [[Vimana Sthana|Vimana Sthana]]. 2/13]

== Treatment of ama in other disease conditions ==

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If ama dosha is in grahani (duodenum) and symptoms of ama dosha are present, then emesis is advised by warm water, madanphala (Randia dumetorum) (Emetic nut) or pippali (Piper longum) or sarshapa (Brassica campestris).

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If ama dosha is in [[Grahani Chikitsa|grahani]] (duodenum) and symptoms of ama dosha are present, then emesis is advised by warm water, madanphala (Randia dumetorum) (Emetic nut) or pippali (Piper longum) or sarshapa (Brassica campestris).

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If ama dosha is in leena avastha (dormant state), deepana medicines are advised first. If amadosha is spread throughout the [[Sharira|body]] then first langhana is to be given followed by pachana medicines. [Ca. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/73-75]

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If ama dosha is in leena avastha (dormant state), [[Deepana|deepana]] medicines are advised first. If amadosha is spread throughout the [[Sharira|body]] then first [[Langhana|langhana]] is to be given followed by [[Pachana|pachana]] medicines. [Ca. Sa. [[Chikitsa Sthana|Chikitsa Sthana]] 15/73-75]

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If stomach is free from amadosha, then panchakola churna (powder) and peyadi laghu ahara (light to digest thin gruel) and deepana (drugs which kindles digestive fire) medicines should be given. [Cha. Sa. [[Chikitsa Sthana|Chikitsa sthana]] 15/76]

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If stomach is free from amadosha, then panchakola churna (powder) and peyadi laghu ahara (light to digest thin gruel) and [[Deepana|deepana]] (drugs which kindles digestive fire) medicines should be given. [Cha. Sa. [[Chikitsa Sthana|Chikitsa sthana]] 15/76]

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Following measures to be adopted for shamana chikitsa (palliative therapy) in general during the treatment of Ama:<ref name="ref5">Yog ratnakara with Vidyotini tika by Vaidya Lakshmipati Sastri. Purvakhanda. Editted by Brahmashankar Sastri. Chaukambha Prakshana. Varanasi. Ed: 2017. Pg. no. 19.</ref>

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Following measures to be adopted for [[Shamana|shamana]] chikitsa (palliative therapy) in general during the treatment of Ama:<ref name="ref5">Yog ratnakara with Vidyotini tika by Vaidya Lakshmipati Sastri. Purvakhanda. Editted by Brahmashankar Sastri. Chaukambha Prakshana. Varanasi. Ed: 2017. Pg. no. 19.</ref>

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* Langhana (fasting)

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* [[Langhana|Langhana (fasting)]]

* Ushna peya (lukewarm gruel)

* Laghu anna sevana (light diet)

* Ruksha odana (un-unctuous preparation cooked cereals)

* Tikta yusha sevana (intake of soup prepared with tikta rasa (bitter taste))

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* Pachana drugs (digestant drugs)

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* [[Pachana|Pachana]] drugs (digestant drugs)

−

* Swedana (fomentation)

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* [[Swedana|Swedana]] (fomentation)

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* Urdhwa or adha shodhana (elimination of [[Dosha|doshas]] from upper body channels or lower body channels) i.e., [[Vamana|vamana (emesis)]] or [[Virechana|virechana (purgation)]].

+

* Urdhwa or adha [[Shodhana|shodhana]] (elimination of [[Dosha|doshas]] from upper body channels or lower body channels) i.e., [[Vamana|vamana (emesis)]] or [[Virechana|virechana (purgation)]].

−

* Niruha basti (un-unctuous enema)

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* [[Asthapana basti|Niruha basti]] (un-unctuous enema)

Line 243: Line 243:

== Free-radical theory<ref name="ref6">J.S. Tripathi, R. H. Singh. Possible Correlates of Free Radicals and Free Radical Mediated Disorders in [[Ayurveda|Ayurveda]] with Special Reference to Bhutagni Vyapara and Ama at Molecular Level. Ancient Science of Life. Vol. No. XIX (1&2) July, August, September, October 99. </ref> ==

In recent years, the concept of free radical theory of oxidative damage in human [[Vyadhi|diseases]] is accepted widely. Free radicals consist of an atom or molecule which have an unpaired electron. The tendency of such atom to gain an electron from other substances makes it highly reactive species to have a high capacity to oxidize biological molecules such as lipids, nucleic acids, proteins, etc. During the [[Vyadhi|disease]] process, infections, toxins and trauma, these free radicals get released in [[Sharira|body]] and cause [[Vyadhi|diseases]]. Free radicals play a significant role in some of the [[Vyadhi|diseases]] like rheumatoid arthritis, inflammatory gut disorder like ulcerative colitis, [[Vyadhi|diseases]] of connective tissue, atherosclerosis, myocardial infarction, stroke, cancer, parkinsonism, Alzheimer’s, dementia, diabetes mellitus, etc.

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Ama refers to intermediate or by product of metabolism which have a tendency to block the microchannels of the [[Sharira|body]] (srotas avarodha). So ama is an important factor for the manifestation of local or systemic [[Vyadhi|diseases]]. So, ama plays a key role in pathogenesis of all [[Vyadhi|diseases]]. [[Agni|Agni]] (digestive capacity) is not just pertaining to amashaya (stomach) or grahani only, but its present at every cellular level. So disturbance in [[Agni|agni]] can lead to formation of ama at cellular level also. This ama formation at cellular level can produce various disorders like rheumatoid arthritis etc. as mentioned above. Ama can be related with free radicals at cellular level.

+

Ama refers to intermediate or by product of metabolism which have a tendency to block the microchannels of the [[Sharira|body]] (srotas avarodha). So ama is an important factor for the manifestation of local or systemic [[Vyadhi|diseases]]. So, ama plays a key role in pathogenesis of all [[Vyadhi|diseases]]. [[Agni|Agni]] (digestive capacity) is not just pertaining to amashaya (stomach) or [[Grahani Chikitsa|grahani]] only, but its present at every cellular level. So disturbance in [[Agni|agni]] can lead to formation of ama at cellular level also. This ama formation at cellular level can produce various disorders like rheumatoid arthritis etc. as mentioned above. Ama can be related with free radicals at cellular level.

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== Theory of Auto-immune diseases<ref name="ref7">Yadav, Parag. Medical Perspective on Ama as per ~~[[Ayurveda|~~Ayurveda]] and Modern Consideration: A Review. Journal of Drug Delivery and Therapeutics. (2020). 10. 205-207. 10.22270/ jddtv10i1-s.3861.</ref> ==

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== Theory of Auto-immune diseases<ref name="ref7">Yadav, Parag. Medical Perspective on Ama as per Ayurveda and Modern Consideration: A Review. Journal of Drug Delivery and Therapeutics. (2020). 10. 205-207. 10.22270/ jddtv10i1-s.3861.</ref> ==

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Auto-immune [[Vyadhi|diseases]] occur when immune system is attacked by anticipated response against antigen or toxins. These antigens or toxins trigger the inflammatory response. This concept of auto-immune disorders can be compared with the concept of ama. The antigen/toxins can be compared with ama, that produce improper metabolites/toxins within the [[Sharira|body]]. This ama triggered inflammatory response in [[Sharira|body]] results in number of the [[Vyadhi|diseases]]. Ama at cellular level modulates the response of the [[Sharira|body]] leading to develop incompatible autoimmune response that damages tissues. Crohn’s [[Vyadhi|disease]], psoriasis, rheumatoid arthritis, ankylosing spondylitis, are auto immune [[Vyadhi|diseases]] caused by response against ama or antigen. The immune cells of the [[Sharira|body]] do not attack the [[Sharira|body]] cells suddenly, it happens because of lack of cellular communication as the cells being covered by ama or toxins. The ama is caused by weak digestive fire which affects the proper tissue production and oja (immunity) formation. So, we can consider the poor digestion and weak immunity is the root cause for auto-immune disorders. Therefore, by adopting [[Ayurveda|ayurveda]] principles of treatment of ama, one can manage the auto-immune disorders.

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Auto-immune [[Vyadhi|diseases]] occur when immune system is attacked by anticipated response against antigen or toxins. These antigens or toxins trigger the inflammatory response. This concept of auto-immune disorders can be compared with the concept of ama. The antigen/toxins can be compared with ama, that produce improper metabolites/toxins within the [[Sharira|body]]. This ama triggered inflammatory response in [[Sharira|body]] results in number of the [[Vyadhi|diseases]]. Ama at cellular level modulates the response of the [[Sharira|body]] leading to develop incompatible autoimmune response that damages tissues. Crohn’s [[Vyadhi|disease]], psoriasis, rheumatoid arthritis, ankylosing spondylitis, are auto immune [[Vyadhi|diseases]] caused by response against ama or antigen. The immune cells of the [[Sharira|body]] do not attack the [[Sharira|body]] cells suddenly, it happens because of lack of cellular communication as the cells being covered by ama or toxins. The ama is caused by weak digestive fire which affects the proper tissue production and [[Ojas|oja]] (immunity) formation. So, we can consider the poor digestion and weak immunity is the root cause for auto-immune disorders. Therefore, by adopting [[Ayurveda|ayurveda]] principles of treatment of ama, one can manage the auto-immune disorders.

== Theses works on ama ==

Following are the some theses work of ama

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<ol style='text-align:justify;'><li style="font-weight:bold">A clinical study on the role of ama in relation to Grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita Discussion over role of ama in relation to Grahani [[Vyadhi|disease]]: When the vitiated [[Dosha|dosha]] get confined only to the organ grahani (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated [[Dosha|doshas]] travels throughout the rasadi dhatus (seven bodily tissues) i.e. throughout the [[Sharira|body]], then it should be called as ‘Grahani roga’ (functional impairment of [[Agni|agni]]). The grahani and [[Agni|agni]] (digestive process) are having co-existing nature/dependent on each other (adhara adheya sambandha). This view is confirmed by corroborative evidence from recent development in pathology. The mucosal damage in the form of villous atrophy and other microvillus changes in different enteropathies affect the enzymes present in the enterocyte brush borders. When the [[Vyadhi|disease]] process progresses, further it affects the pancreatic secretion as it depends upon cholecystokinin and secretin secretion from the enterocyte. The immature epithelial cells are unable to secrete the required amount of cholecystokinin and secretin. In the pathogenesis (samprapti) of ~~grahani~~ [[Vyadhi|disease]], Acharya Charak elaborated a series of events as below.

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<ol style='text-align:justify;'><li style="font-weight:bold">A clinical study on the role of ama in relation to Grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita Discussion over role of ama in relation to [[Grahani Chikitsa|Grahani]] [[Vyadhi|disease]]: When the vitiated [[Dosha|dosha]] get confined only to the organ [[Grahani Chikitsa|grahani]] (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated [[Dosha|doshas]] travels throughout the rasadi [[Dhatu|dhatus]] (seven bodily tissues) i.e. throughout the [[Sharira|body]], then it should be called as ‘Grahani roga’ (functional impairment of [[Agni|agni]]). The [[Grahani Chikitsa|grahani]] and [[Agni|agni]] (digestive process) are having co-existing nature/dependent on each other (adhara adheya sambandha). This view is confirmed by corroborative evidence from recent development in pathology. The mucosal damage in the form of villous atrophy and other microvillus changes in different enteropathies affect the enzymes present in the enterocyte brush borders. When the [[Vyadhi|disease]] process progresses, further it affects the pancreatic secretion as it depends upon cholecystokinin and secretin secretion from the enterocyte. The immature epithelial cells are unable to secrete the required amount of cholecystokinin and secretin. In the pathogenesis ([[Samprapti|samprapti]]) of [[Grahani Chikitsa|grahani]] [[Vyadhi|disease]], Acharya Charak elaborated a series of events as below.

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Indulgence in causes that vitiate [[Agni|agni]] (digestive f) → [[Agni|agni]] dushti (vitiation og [[Agni|agni]]) → indigestion (apachana) → production of ama (non-metabolized, poorly formed product) → putreification (shukta paka)→ advanced condition of ama manifestating as a poisoning codition (anna visha or ama visha) → grahani dosha (functional impairement of grahini) → grahani dushti (vitiation of grahani)→ grahini roga ([[Vyadhi|diseases]] manifestating as functional impairement of [[Agni|agni]]/digestive funtions). Ama is the root cause of almost all [[Vyadhi|diseases]] produced in the [[Sharira|body]] and the treatment of any [[Vyadhi|disease]] can be based on stage of the [[Vyadhi|disease]] associated with ama (saama) & stage of the [[Vyadhi|disease]] not associated with ama (nirama avastha).

+

Indulgence in causes that vitiate [[Agni|agni]] (digestive f) → [[Agni|agni]] dushti (vitiation og [[Agni|agni]]) → indigestion (apachana) → production of ama (non-metabolized, poorly formed product) → putreification (shukta paka)→ advanced condition of ama manifestating as a poisoning codition (anna visha or ama visha) → [[Grahani Chikitsa|grahani dosha]] (functional impairement of [[Grahani Chikitsa|grahini]]) → [[Grahani Chikitsa|grahani]] dushti (vitiation of [[Grahani Chikitsa|grahani]])→ grahini roga ([[Vyadhi|diseases]] manifestating as functional impairement of [[Agni|agni]]/digestive funtions). Ama is the root cause of almost all [[Vyadhi|diseases]] produced in the [[Sharira|body]] and the treatment of any [[Vyadhi|disease]] can be based on stage of the [[Vyadhi|disease]] associated with ama (saama) & stage of the [[Vyadhi|disease]] not associated with ama (nirama avastha).

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Outcome of clinical study: This clinical trial was carried out in 66 patients of 16-60 year of age group having cardinal sign and symptoms of grahani [[Vyadhi|disease]]. Patients were selected randomly into Group A, Group B and Group C treated by kallingadi ghanavati, tryushnadi ghrita and combination of both (ghanavati & ghrita) respectively for 2 weeks. The overall effect of therapies showed that better results observed in group B in comparison to group A. In comparison of all three groups, group C showed slight better results than those of rest two groups.<ref name="ref8">A clinical study on the role of ama in relation to grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita by Alpesh P. Sorathiya, Dept. of Kayachikitsa, IPGT&RA, Jamnagar, 2009. </ref> </li>

+

Outcome of clinical study: This clinical trial was carried out in 66 patients of 16-60 year of age group having cardinal sign and symptoms of [[Grahani Chikitsa|grahani]] [[Vyadhi|disease]]. Patients were selected randomly into Group A, Group B and Group C treated by kallingadi ghanavati, tryushnadi ghrita and combination of both (ghanavati & ghrita) respectively for 2 weeks. The overall effect of therapies showed that better results observed in group B in comparison to group A. In comparison of all three groups, group C showed slight better results than those of rest two groups.<ref name="ref8">A clinical study on the role of ama in relation to grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita by Alpesh P. Sorathiya, Dept. of Kayachikitsa, IPGT&RA, Jamnagar, 2009. </ref> </li>

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<li style="font-weight:bold">Association of stress inducing factors (manoabhitapakara bhava) and free radical over madhumeha Discussion over association of stress inducing factors (manoabhitapakara bhava) and free radicals with chronic metabolic [[Vyadhi|diseases]] such as diabetes mellitus type 2 (madhumeha): This research explains about how adherence with stress (manobhitapakara bhava) lead to produce ama or free radical, and in turn produces chronic metabolic [[Vyadhi|diseases]]. The harmony of mind (manas) responsible for the perfect harmony of [[Sharira|body]]. Altered external living sources like demographic alteration, change in family system, urbanization, industrialization, westernisation have a potent role to induce the pathogenesis at psychic level as well as [[Sharira|body]] level by the faulty pattern of adaptataion. Repeated attachment with stress (kamadi bhavas) are the potent cause for morbidity and mortality rate of obstinate urinary [[Vyadhi|disease]]/diabetes melitus type 2(madhumeha). This is not only for the cause but it also responsible for the complication. Excessive generation of free radical sustained affection of stress (manobhitapakara bhavas) altered the [[Sharira|body]] defence mechanism, which in terms can be understand. Treatment like pacifying vitiated manasika dosha (manasa doshahara), counseling, antistress approach, dipana (appetizers), pachana (digestives), can check the vicious pathogenesis involved in madhumeha (obstinate urinary [[Vyadhi|disease]]/ diabetes mellitus type 2). Outcome of the study: There is a direct relation of the mean score of manobhitapakara bhavas (stress), lipid peroxide and fasting blood sugar. By changing mode of [[Ayu|life]] style, optimistic attitude, keeping faith in good, decreasing the high blood pressure level stress hormones can be reduced. Which it reflects through the sufficient decrease in signs and symptoms of the [[Vyadhi|disease]].<ref name="ref9">Manoabhitapakara bhava, free radical, madhumeha by Bishnupriya, Dept. of Basic principles, IPGT& RA, Jamnagar,2001.</ref></li>

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<li style="font-weight:bold">Association of stress inducing factors (manoabhitapakara bhava) and free radical over [[Prameha Chikitsa|madhumeha]] Discussion over association of stress inducing factors (manoabhitapakara bhava) and free radicals with chronic metabolic [[Vyadhi|diseases]] such as diabetes mellitus type 2 ([[Prameha Chikitsa|madhumeha]]): This research explains about how adherence with stress (manobhitapakara bhava) lead to produce ama or free radical, and in turn produces chronic metabolic [[Vyadhi|diseases]]. The harmony of [[Manas|mind (manas)]] responsible for the perfect harmony of [[Sharira|body]]. Altered external living sources like demographic alteration, change in family system, urbanization, industrialization, westernisation have a potent role to induce the pathogenesis at psychic level as well as [[Sharira|body]] level by the faulty pattern of adaptataion. Repeated attachment with stress (kamadi bhavas) are the potent cause for morbidity and mortality rate of obstinate urinary [[Vyadhi|disease]]/diabetes melitus type 2([[Prameha Chikitsa|madhumeha]]). This is not only for the cause but it also responsible for the complication. Excessive generation of free radical sustained affection of stress (manobhitapakara bhavas) altered the [[Sharira|body]] defence mechanism, which in terms can be understand. Treatment like pacifying vitiated manasika dosha (manasa doshahara), counseling, antistress approach, [[Deepana|dipana (appetizers)]], [[Pachana|pachana]] (digestives), can check the vicious pathogenesis involved in [[Prameha Chikitsa|madhumeha]] (obstinate urinary [[Vyadhi|disease]]/ diabetes mellitus type 2). Outcome of the study: There is a direct relation of the mean score of manobhitapakara bhavas (stress), lipid peroxide and fasting blood sugar. By changing mode of [[Ayu|life]] style, optimistic attitude, keeping faith in good, decreasing the high blood pressure level stress hormones can be reduced. Which it reflects through the sufficient decrease in signs and symptoms of the [[Vyadhi|disease]].<ref name="ref9">Manoabhitapakara bhava, free radical, madhumeha by Bishnupriya, Dept. of Basic principles, IPGT& RA, Jamnagar,2001.</ref></li>

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<li style="font-weight:bold">A critical and comparative study of Ama and Free radical theory with special reference to [[Amavata|Amavata]] Outcome of study: Free radical is an atom/molecule that contains one or more unpaired electron, which requires neutralisation by free radical scavengers. Thus it exists in an incomplete metabolic state which is also the state of ama described as incompletely digested (avipakvam). Free radicals cause damage to cell membrane and thus the cell is destroyed. This destruction may lead to putrification and foul smell generations which is similar to one of the property of ama described as unpleasant smell (durgandham). Though ama remains in the [[Sharira|body]] as isolated or not mized (asamyuktam), but due to its properties like excessive sliminess (bahupicchilam) etc. it sticks to normal healthy [[Sharira|body]] tissues very quickly, similar is the case with free radicals. To seek stability in their structure they quickly attack the healthy molecules of the [[Sharira|body]] and thus setting a chain reaction. The cells throughout [[Sharira|body]] are continously exposed to these damaging molecules, same has been described for ama as causing sluggishness of whole body (sadanam sarva gatranam). From above one can observe that properties of free radicals are similar to the properties of ama described in classics. Now the process of production of free radicals in [[Sharira|body]] and production of ama would be considered. So it may be concluded that the causative factors (nidana) such as heavy to digest (guru ), unctuousness (snigdha) etc. qualities of diet (ahara) of [[Amavata|amavata]] (rheumatism) as mentioned in the classics have a specific role to play in production of ama and also in the generation of free radicals. Also the line of treatment of ama advocated in the classics is effective in reducing the level of ama as well as free radicals. So it can be inferred that a positive correlation exists between ama and free radicals.<ref name="ref10">A critical and comparative study of Ama and Free radical theory with special reference to Amavata by Gaurav sharma, Department of Basic principles, IPGT& RA, Jamnagar, 2001.</ref></li>

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<li style="font-weight:bold">A critical and comparative study of Ama and Free radical theory with special reference to [[Amavata|Amavata]] Outcome of study: Free radical is an atom/molecule that contains one or more unpaired electron, which requires neutralisation by free radical scavengers. Thus it exists in an incomplete metabolic state which is also the state of ama described as incompletely digested (avipakvam). Free radicals cause damage to cell membrane and thus the cell is destroyed. This destruction may lead to putrification and foul smell generations which is similar to one of the property of ama described as unpleasant smell (durgandham). Though ama remains in the [[Sharira|body]] as isolated or not mized (asamyuktam), but due to its properties like excessive sliminess (bahupicchilam) etc. it sticks to normal healthy [[Sharira|body]] tissues very quickly, similar is the case with free radicals. To seek stability in their structure they quickly attack the healthy molecules of the [[Sharira|body]] and thus setting a chain reaction. The cells throughout [[Sharira|body]] are continously exposed to these damaging molecules, same has been described for ama as causing sluggishness of whole [[Sharira|body]] (sadanam sarva gatranam). From above one can observe that properties of free radicals are similar to the properties of ama described in classics. Now the process of production of free radicals in [[Sharira|body]] and production of ama would be considered. So it may be concluded that the causative factors ([[Nidana|nidana]]) such as heavy to digest (guru), unctuousness (snigdha) etc. qualities of [[Ahara|diet (ahara)]] of [[Amavata|amavata]] (rheumatism) as mentioned in the classics have a specific role to play in production of ama and also in the generation of free radicals. Also the line of treatment of ama advocated in the classics is effective in reducing the level of ama as well as free radicals. So it can be inferred that a positive correlation exists between ama and free radicals.<ref name="ref10">A critical and comparative study of Ama and Free radical theory with special reference to Amavata by Gaurav sharma, Department of Basic principles, IPGT& RA, Jamnagar, 2001.</ref></li>

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<li style="font-weight:bold">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management Outcome of study: In this study, 2 groups are there, group I (treatment group) patients have been given chaturushna churna (powder) followed by wholesome diet (pathya) and light to digest food. Whereas, in group II (control group) patients received placebo treatment and wholesome diet (pathya) and light to digest food.. [[Dosha|Dosha]] (ama dosha and tridosha (vata,pitta and kapha)) when adhere to amashaya (stomach), the desired response of the medicine may not be obtained which is observed in clinical study. Due to this the 21 days duration of therapy did not produce total cure response. So, we can say that if in [[Vyadhi|disease]], treatment regimens opposite to [[Vyadhi|disease]] (vyadhi viparita ausadha) doesn’t produce good response, then it is to be inferred that here amashaya (stomach) is adhered with ama dosha. In this stage, as advised in Trividhakuksiyavimana adhyaya (2nd chapter of Charak Samhita [[Vimana Sthana|Vimana Sthana]]), depleting therapy (apatarpna) should be administered. If presence of [[Vyadhi|disease]] stage (vyadhi anubandha) remains, then the treatment regimens opposite to [[Vyadhi|disease]] (vyadhi viparita aushadha) is to be advised.<ref name="ref11">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management by Mihir vyas, Dept. of Basic principles, IPGT& RA, Jamnagar, 2005.</ref></li></ol>

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<li style="font-weight:bold">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management Outcome of study: In this study, 2 groups are there, group I (treatment group) patients have been given chaturushna churna (powder) followed by wholesome diet (pathya) and light to digest food. Whereas, in group II (control group) patients received placebo treatment and wholesome diet (pathya) and light to digest food.. [[Dosha|Dosha]] (ama dosha and [[Tridosha|tridosha]] ([[Vata dosha|vata]], [[Pitta dosha|pitta]] and [[Kapha dosha|kapha]])) when adhere to [[Amashaya|amashaya (stomach)]], the desired response of the medicine may not be obtained which is observed in clinical study. Due to this the 21 days duration of therapy did not produce total cure response. So, we can say that if in [[Vyadhi|disease]], treatment regimens opposite to [[Vyadhi|disease]] (vyadhi viparita ausadha) doesn’t produce good response, then it is to be inferred that here amashaya (stomach) is adhered with ama dosha. In this stage, as advised in Trividhakuksiyavimana adhyaya (2nd chapter of [[Preface- Charak Samhita New Edition|Charak Samhita]] [[Vimana Sthana|Vimana Sthana]]), depleting therapy (apatarpna) should be administered. If presence of [[Vyadhi|disease]] stage (vyadhi anubandha) remains, then the treatment regimens opposite to [[Vyadhi|disease]] (vyadhi viparita aushadha) is to be advised.<ref name="ref11">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management by Mihir vyas, Dept. of Basic principles, IPGT& RA, Jamnagar, 2005.</ref></li></ol>

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