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).

Clinical presentations due to ama

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

1. Visuchika (gastro-enteritis):
   The word 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 (non-infectious gastroenteritis). The 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 doshas different types of pain occur as the patients feels as if his body is being pricked by needles (suchi) so the disease is named visuchika. It can be compared with gastro-enteritis due to pathogens such as Cholera bacilli. Complications caused by visuchika are, abdominal colic, vertigo, abdominal distension, tremors and rigidity by vata dosha. Pitta causes jwara (fever), atisara (diarrhoea), burning sensation within body, thirst, fainting and drowsiness. Kapha dosha leads to chardi (vomiting), heaviness of the body, unable to speak, excessive salivation and cough.
2. Alasaka (sluggish bowels):
   The word Alasaka derived from word “Alasa” means no movement. When frail person having weak digestive power and excess of kapha in the 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 (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 occurs so the ama remains/stagnated within the stomach i.e., food neither passes upwards nor downward. This condition is called alasaka. All the characteristic features of ama dosha, except vomiting and diarrhoea, are manifested severely in alasaka. This can be compared with Cholera sicca where, the entire 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.

Dandaka alasaka (delayed and obstructive digestive process wherein body becomes stiff like a stick): Severely vitiated dosha associated with ama spreads all over the channels of body and spreads throughout the body. The extremely vitiated dosha move obliquely towards other body channels to block them. As all body channels are blocked by ama, the body becomes rigid like wooden rod/staff (danda). This condition is critical and needs urgent medical care. Such clinical condition is known as dandalasaka/ dandaka alasaka.

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 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), fever(jwara), 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)
• Pachana (assisting the digestion and metabolism)
• Sneha (oleation with medicines having digestion stimulant properties)
• Sweda (fomentation)
• Shodhana (purification) at appropriate time when 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. If the dosha are in dormant (leena) state, then shodhana is prohibited. [A. H. 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 (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 body. [Cha. Sa. Vimana Sthana 3/43-44]

Treatment of alasaka:

The curable variety of ama dosha should be eliminated through 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 2/13]

Treatment of visuchika:

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

Amadosha chikitsa:

In case of reoccurrence of the diseases caused by ama, the first line of treatment is apatarpana i.e., depletion therapy. If the 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 disease) rather than hetu viprita aushadha (treatment which is antagonistic to the etiological factors). [Cha. Sa. Vimana Sthana 2/13]

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