Ama

Ama is a state of or products formed due to incomplete digestion, metabolism, or transformation. Agni (digestion and metabolism) is a factor responsible for changing the state of a substance. In human biology, the digestion and metabolic processes convert food and other substances into compatible and nourishing body components. If these processes are incomplete, poor or slow, then the final products formed are of poor quality. Agni is one of the most important factors responsible for health (prakrita) abnormalities, and diseases (vikriti). Life span, strength, health, and immunity all depends on agni. [Cha. Sa. Chikitsa Sthana 15/03] If agni is disturbed, then proper digestion does not occur which results in improperly transformed food/metabolites are termed as ‘Ama’. [A. H. Sutra Sthana 13/25] The concept of ama in ayurveda is very important in pathogenesis of disease. One of the synonyms of vyadhi (disease) is “aamaya” which means caused by ama. [Cha. Sa. Nidana Sthana 1/05] Classification of stages of diseases (vyadhi) is based on the presence and absence of ama i.e., sa-ama avastha (stage associated with ama) and nirama avastha (stage not associated with ama). The treatment protocol also depends on stages of ama such as in diarrhoea associated with ama(ama-atisara), styptic therapy (stambhana) is contraindicated. Whereas, in the diarrhoea without ama (nirama stage) / or chronic diarrhoea (jeerna atisara), styptinc therapy (stambhana) is advised. Thus, concept of ama is significant in understanding the etiopathogenesis, diagnosis as well as treatment of diseases. This chapter describes concept of ama with its contemporary views and researches done on it.

Contributors

Section/Chapter/topic	Concepts & Practices/Ama
Authors	Dubey M.1, Deole Y.S.2
Reviewer & Editor	Basisht G.3,
Affiliations	1Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India 2Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India 3Rheumatologist, Orlando, Florida, U.S.A.
Correspondence emails	dr.manish181@gmail.com, dryogeshdeole@gmail.com, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	August 01, 2023
DOI	10.47468/CSNE.2023.e01.s09.143

Etymology (nirukti)

1. Aamyate ishat pachyate: It means the product formed due to poor or improper digestion(apurna paka or paka rahita or alpa paka).
2. Soannajo rasa iti amah, annarasasyo va apakvasya tanyantare aam vyapdeshat: Ama is originated from the food. If the initial product of food after digestion (annarasa) is not properly formed, then the outcome of such digestion is known as ama.

Definition

1. Weak digestive factors (jatharagni) cause poor digestion (avipaka) of rasa (primary product of digested food). This poorly formed product is called ‘ama’. This is the cause for vitiation of all dosha (aggravation of all dosha). [Cha. Sa. Chikitsa Sthana 15/44]
2. Ama is the root cause for almost all the diseases.
3. Ama is the first component formed due to weak digestive processes. It is in amashaya (site of storage of food in intermediary stage of digestion and metabolism). [A. H. Sutra Sthana. 13/25]
4. Ama is the component formed during digestion of food.
5. The first state of vitiated dosha is called ‘ama’.
6. The byproducts of metabolism if not properly eliminated or utilized in the body are considered as ama.
7. The uncooked food (or annarasa) if, retained for longer time in stomach undergoes fermentation/putrefaction, this state of rasa is ama. This ama further joined with dosha is termed as amadosha. It is as toxic as visha (poison) produced by spoiled kodrava (Paspalum scrobiculatum L., Italian millet contaminated by fungus). [A. H. Sutra Sthana 13/26-27]

Causes

Impairment of agni (digestive process) due to following reasons causes ama.

• Fasting or not taking food (abhojana)
• Indigestion (ajirna)
• Intake of excessive quantity of food (atibhojana)
• Intake of unequal proportion of food (vishama bhojana)
• Taking incompatible or non-habitual food (asatmya bhojana)
• Intake of heavy, cold, excessively dry food products
• Untoward effects of improper virechana (purgation), vamana (emesis), snehana (oleation)
• Depletion of body tissues by chronic diseases
• Changes in climate/season
• Suppression of natural urges (vegadharana) [Cha. Sa. Chikitsa Sthana 15/42-44]
• Food with qualities such as heavy to digest (guru), dry (ruksha), cold (sheeta), dried/dehydrated (shushka), disliked by consumer (dvishta), constipation-causing (vishtambhi), those causing burning sensation (vidahi), unclean (ashuchi), incompatible food intake (viruddha anna), consumed untimely (akala bhojana)
• Mental status while taking food: Intake of food when mind is affected by desires (kama), anger (krodha), greed (lobha), infatuation (moha), envy (irshya), shame (hri), grief (shoka), conceit (maana), anxiety (udvega), fear (bhaya), etc. [Cha.Sa. Vimana Sthana 2/8]

Diseases caused by ama

The undigested food gets fermented (shuktata) leading to onset of toxic symptoms. [Cha. Sa. Chikitsa Sthana 15/42-44] Ama further leads to various digestive disorders like amajirna (indigestion due to saama pitta), vishtabdhajirna (indigestion due to saama vata), vidagdha ajirna (indigestion due to saama kapha), visuchika (non-infectious gastroenteritis), alasaka (sluggish bowels), vilambika (gastro-intestinal stasis). [Su. Sa. Uttara Sthana 56/3] The diseases caused by ama at various dhatu level are jwara (fever), atisara (diarrhoea), pravahika (dysentery), etc. The chronic conditions caused by ama are such as grahini-dosha (functional impairment of agni), udara roga (ascites and abdominal enlargement), yakrit vyadhi (liver disorders), jalodara (ascites), shotha (oedema), pandu (anemia), prameha (obstinate urinary disease), amavata (rheumatism), etc.
The acidic nature (amla bhava) of undigested food (apakva anna) is called as suktata (acidic /sour nature of undigested food) which further acts like a visha (poison) that will further produce number of other diseases, so this can be compared to symptoms of amavisha. This uncooked food further combines with dosha (regulatory functional factors of the body), dhatu (major structural components of the body) or mala (metabolic waste or byproducts) and produces their respective symptoms accordingly. [Cha. Sa. Chikitsa Sthana 15/46-49]
When ama combines with pitta dosha, it produces pitta dominant diseases such as burning sensation (daha), thirst (pipasa), diseases of oral cavity (mukha roga), hyperacidity (amlapitta) etc. When it combines with kapha dosha, it produces kapha dominant diseases such as rajayakshma (consumption), pinasa (chronic rhinitis), prameha (obstinate urinary disease), etc. When combines with vata dosha, it produces different types of vata dominant diseases. When combines with mutra (urine) or gets lodged in mutravaha srotasa (urinary tract), to produce mutra roga such as mutrakrichhra (dysuria), mutraghata (urinary retention), prameha (obstinate urinary disease), etc. When combines with purisha (feces) produces diseases of kukshi (pelvis) or udara roga (diseases of abdomen). When combines with rasa etc. dhatu (seven major structural components of the body), then produces their respective diseases.

Premonitory features (ama purvarupa)

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

Characteristics of ama

Ama possesses characteristics such as liquid (drava), heavy (guru), attains different colors, slimy (snigdha), viscid (pichchila), thready (tantumatva), foul smelling (durgandhi). Ama is etiological factor of all diseases and produces symptoms such as various types of pain (shoola), obstructs channels (srotorodhaka), undigested (avipakva), lethargic (sadanakaraka), etc.

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

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

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

Blockage or clogging of srotasa (channels)

• Loss of strength
• Feeling of heaviness
• Improper functions of vata dosha
• Accumulation of mala (metabolic wastes)
• Lethargy
• Low digestive capacity
• Excessive salivation
• Retention of mala (waste products)
• Aversion towards food and tiredness. [A. H. Sutra Sthana 13/23-24]

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

Saama and nirama features of dosha, dhatu and mala

Table no. 1: Features of saama dosha: [Bhavaprakash. Pratham khanda. Jwara chikitsa. 49-50, 52, 54]

Saama dosha (dosha associated with ama)	Lakshana (symptoms)
Saama vayu (vata dosha associated with ama)	constipation (vibandha), weak digestive capacity, body stiffness, gargling sound in abdomen(antrakunjan), painful sensation (vedana), swelling (shopha), pricking pain (nistoda), sequential and fleeting pain in various body parts, pain increases after oleation therapy, during morning and evening time, during cloudy weather
Saama pitta (pitta dosha associated with a	Foul smell, color of pitta will be greenish/ light blackish, amla bhava of pitta (sour nature of pitta), heaviness, sour eructation, burning sensation in throat and cardiac region.
Saama kapha (kapha dosha associated with ama)	Avila (increase turbidity in mala), thick in consistency, feeling of sticky phlegm in throat, foul smell cough, lack of appetite.

Table no.2: Nirama dosha lakshana: [Bhavaprakash. Pratham khand. Jwara chikitsa. 51,53,55]

Nirama dosha (dosha not associated with ama)	Lakshana (symptoms)
Nirama vayu (vata dosha not associated with ama)	Proper elimination of metabolic wastes (mala), dryness of skin, no obstruction of body channels, mild pain, vitiated vata subsides by snehana (oleation therapy).
Nirama pitta (pitta dosha not associated with ama)	Coppery and yellowish color of pitta, increased body temperature, pungent taste of pitta, does not yield bad smell, improves taste,                                                                            appetite and strength.
Nirama kapha (kapha dosha not associated with ama)	Frothy in nature, free from threads, pallor, cough, light in nature, cleans oral cavity.

Table no. 3: Saama dhatu lakshana: [Cha. Sa. Sutra Sthana 28/9-19]

Saama dhatu (dhatu associated with ama)	Lakshana (symptoms/diseases)
Saama rasa dhatu	Anorexia, tastelessness, hrillasa (nausea), pandu (pallor), jwara (fever), klaibya (impotency).
Saama rakta dhatu	Various types of skin disorders and abscess, raktapitta (hemorrhagic disorders), inflammation of anus/penis/oral cavity, kamala (jaundice), vatarakta (gout), arsha (piles).
Saama mamsa dhatu	Arbuda (tumor), galashundi (tonsilitis), gandamala (cervical adenitis), upajihivika (inflammation of epiglottis).
Saama meda dhatu	Prameha purvarupa (prodromal features of prameha), galaganda (goiter), madhumeha (diabetes mellitus), atisthaulya (obesity).
Saama asthi dhatu	Pain in teeth and bones, bony growth, disorders of hair/nails, toothache.
Saama majja dhatu	Pain in joints, giddiness, syncope (murchha), blackouts (tama)
Saama shukra dhatu	impotency (klaibya), sexual dysfunction, abortion, miscarriage, no conception, disorders of semen.

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

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

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

Saama mala (waste products associated with ama)	Symptoms
Saama mutra (urine associated with ama)	Mutra roga (urological disorders), obstruction to urinary passage
Saama purisha (feces associated with ama)	Heavy, pellet like hard, foul smelling, passing little quantity of stool with difficulty, sinks in water.

Table no. 4: Nirama mala lakshana:

Nirama mala (Waste products not associated with ama)	Symptoms
Nirama mutra (Urine not associated with ama)	Without any urinary disorders or abnormal symptoms.
Nirama purisha (Feces not associated with ama)	Stool floats on water, laghuta (lightness).

Send us your suggestions and feedback on this page.