Grahani Chikitsa

Grahani Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 15
Preceding Chapter	Arsha Chikitsa
Succeeding Chapter	Pandu Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 15, Chapter on Management of Digestive Disorders)

Abstract

Grahaṇīdōṣha chikitsā adhyāya consists of three parts. First part explains the concept of normal digestion process. Second part describes the abnormal digestion and third part is about diseases caused by abnormality of digestive fire and its interaction with proximal intestine or grahani. These disorders are called grahanidosha. Agni (digestive and metabolic agents), based on their specific functions of conversion of food into biological elements of the body are classified into 13 types. First, the jatharagni is most important because it is the initiator of digestive process and it strengthens the digestive abilty of other 12 agnis. Five bhutagnis transform the panchmahabhauic components of ahara rasa created by jatharagni into different structures of the body. Seven dhatuagnis create seven tissues elements(dhatu). Jatharagni initiates the first phase of digestion process by conversion of food into nutrient fluid (ahar rasa). This nutrient fluid is further trifurcated into three biological substances kapha, pitta and vata in three stages to madhur, amla and katu awastha paka respectively. This biofluid is separated into excretable waste or impure products by saman vata in grahani (middle part of GI Tract) and useful, pure circulable products. Samana vata analyzes and separates the useful products (prasada) and waste (kitta). Useful products get absorbed by rasayani (villi) of the intestine, sent to the micro channels (srotas) by vyanvata, simutaneouly, to the entire body. Waste products are excreted out by apaan vayu through urine, feces and sweat. Now second and third phase of digestion process occur simultaneously in the srotas (microchannels). 5 bhuagnis work on the formation of anatomical structure of the body from respective panchamahabhuta in the form of micro channels, by digestiing needful components present in biofluid. Each gross and subtle particle of body is panchbhoutik, but each one is having different proportion of mahabhuta. Now the third phase of digestion is processed in 7 micro channels (srotas) specified for 7 body tissues (dhatu) for the formation of body tissues by their specific 7 tissue transformers (dhatwagnis) Excreable waste products are carried out by three excreatory channels as feces, urine and sweat, along with sub tissues and sub excreta of sensory organs. Second part of this chapter explains the etiopathology of abnormal digestion, and formation of intermediate products as seed cause of various diseases in the form of ama, shukta and amavisha. Third part explicates the etiopathology, types, symptoms and treatments of grahanidosha as a syndrome of various digestive disorders. The chapter sums up in defining abnormal dietary habits.

Key words: Digestion in Ayurveda, metabolism in Ayurveda, jatharāgni, bhutāgni, dhatvāgni, grahani, grahanidosha, grahani roga, annaviṣa, atyagni, samaśana, viṣamaśana, adhyaśana.

Introduction

Grahaṇīdoṣacikitsita is one of the most important chapters of this compendium because most of the diseases originate from disorders of digestion. This chapter is described after arśha roga (hemorrhoids) because pathophysiology of arśha influences agni and before pānduroga chikitsā adhyāya because grahaṇīroga influences pānduroga. The initial portion of this chapter discusses the details of the physiological process of digestion and metabolism in human body. Agni, being the fundamental factor in maintaining health and in producing diseases, has been described in detail. The chapter begins with explanation of importance of normally functioning agni and then goes on to explain the various aspects of digestion, metabolism and tissue nourishment. Different theories of tissue nourishment as explained by the commentators play a crucial role in the entire process. The concept of upadhātu and dhātumala has also been dealt with. These descriptions are followed by the pathophysiology of grahaṇīdōṣha syndrome and its management. This chapter underscores that the knowledge of physiology is crucial in understanding the pathophysiology and therapeutics of a disease. Protection of agni is very essential in treatment of all diseases. (Chakrapani Ca.Ci.14/244-246 )Arśha, atisāra and grahaṇīdōṣha are said to be paraspara hetu which means one disease becomes cause for another disease(Ca.Ci.14/244) e.g. in patients with chronic colitis, intestinal polyps are seen, in patients suffering from diarrhea colitis is observed. Therefore, one finds interrelation between these disorders and as explained earlier, special precaution should be taken with respect to agni bala. Ceratain drugs like chitraka (Plumbago zeylanica), pippalī (Piper longum), pippalīmula (root of Piper longum), shunthi (Zingiber officinale), nāgkesar, haridrā, danti, duralabhā, haritaki etc have been used in combinations with other drugs for the treatment of arśha considering the concept of agnibala vriddhi and vāta anulomanaṁ (fascilitating passage of vata) and the same drugs have been used in grahani chikitsā with the same concept. Caraka explains that all the above three diseases are caused by agnimāndya and if increase in agni is done then relief in the disease takes place. (Chakrapani Ca.Ci.14/244-246) Further vāta is said to be agnisakhā i.e. agnibala depends on vāta. vātakṣaya or prakopa results in agnimāndya. Therefore, anna, pāna and ausadha which bring about vāta anuloman are very useful in treatment of diseases like arśha and grahaṇī dōṣha. Vāta anulomanaṁ means to fascilitate the gati (motion) of vāta downwards to anus. Among five types of vāta, samāna and apāna have major role in diseases like arśha, atisāra and grahaṇīdōṣha. Obstruction to movement of vata (avarudha gati) or diarrhea (atisāraṇa) leads to agni kṣaya. Avarudha gati is the cause for vibandha (constipation), malavibandha (obstruction to feces) alongwith pravāhana (urge to defecate) which increases the intra lumen pressure leading to incompetency of valves in rectal veins leading to their varicosity which causes hemorrhoids where as atisaraṇa (diarrhoea) causes increased motility of intestine. Hence vāta anulomanaṁ should not be understood as virechana or laxation but regularization of vāta gati so that there is no avarodha or atisaran. The same concept of vāta anuloman is also mentioned in grahani dōṣa chikitsā adhyāya.(Ca.Ci.14/247) Therefore, the line of treatment used in arśha with regard to agni bala and vāta anulomana is basically similar to that of grahaṇīdōṣha hence Charaka has explained grahaṇī dōṣa chikitsā adhyāya after arśa chikitsā adhyāya.( Chakrapani Ca.Ci.15/1) Caraka could have restricted the name of chapter to grahaṇīchikitsā i.e. treatment of the avayava grahaṇī whereas he has increased the scope of chapter by using the word grahaṇīdōṣha.(Chakrapani Ca.Ci.15/1). There is always an inter-relationship between avayava (organ) and avayavi (part of organ) or ashraya(seat) and ashrayi (seated). Either of the one has an impact on the other, hence if grahaṇīavayava is in normal state then agni the avayavi functions normally and vice versa also holds true, whereas if dusti of grahaṇī takes place agni vaishamyata (imbalance) is seen e.g. ileitis, wherein digestion is hampered. grahaṇī is the seat for jatharāgni. (Ca.Ci.15 /56) Agni is responsible for ayu (longevity of life), varṇa (complexion), bala (strength), svāasthya (health), utsāha (enthusiasm), upachaya (proper metabolism), prabhā (glow) and oja (core energy). Prākṛta agni (normal digestive power) is essential for long and healthy life while, vitiated agni is responsible for roga avasthā (disease).(Ca. Ci. 15/3-4) In this chapter, Caraka describes formation of body tissues in detail with the role of ahara which is supplied continuously to maintain homeostasis. Vyāna vāta is promoter of rasa raktādi circulation.( Ca. Ci. 15/36) It transports rasa raktādi drava dhātu throughout body continuously and as per metabolic demand. This explanation shows that closed circulation in human was known to Caraka. Grahaṇī is prime place where digestion and absorption of ahara rasa takes place. Āhara rasa provides nutrition for the rasādi sapta dhātu, along-with three sharirik dōṣha and three manasik dōṣha. Nourishment of satva, raja and tama is influenced by sātvika, rājasik and tāmasik ahāra. Tāmasika and rājasik ahāra suppresses satva guna thereby causing alpa satva in individual, a common predisposing factor of psychiatric disorders for e.g. alpa satva as mentioned in unmāda (Ca. Ci. 9/5)In vātaja grahaṇīvyādhishankā (feeling of suffering from disease) manifests in patients with alpa satva. Homeostasis at cellular level and gross level is maintained by vāta, pitta and kapha in which digestive and metabolic contributions are due to agni. This chapter has been dedicated to agni to understand the manner in which it gets vitiated by doṣha and accordingly the line of treatment for the agni dōṣha is explained. As the functions of agni take place in grahaṇī hence disease related to grahaṇī has been given the name. Secondly, pāndu roga is due to alpatā of raktaposhaka sāra bhāga (Chakrapani Ca. Ci. 16/3-7) and, one of the main causes of this alpatā is mal-digestion and mal-absorption which takes place in grahaṇī. It is well known fact, that various contributory factors for blood formation have their absorption in gastrointestinal tract such as folic acid, vitamin B12, iron, etc which if not absorbed causes anemia this is the reason why Caraka has placed this chapter in between arśha and pāndu roga.

Sanskrit Text, Transliteration and English Translation

अथातो ग्रहणीदोषचिकित्सितं व्याख्यास्यामः||१|| इति ह स्माह भगवानात्रेयः||२|| athātō Grahaṇī dōṣacikitsitaṁ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātrēyaḥ||2|| athAto grahaNIdoShacikitsitaM vyAkhyAsyAmaH||1|| iti ha smAha bhagavAnAtreyaH||2|| Now we shall describe the chapter on the management of ‘grahaṇī doṣha’, so said respectable Ātreya (1-2). Importance of dehāgni: आयुर्वर्णो बलं स्वास्थ्यमुत्साहोपचयौ प्रभा| ओजस्तेजोऽग्नयः प्राणाश्चोक्ता देहाग्निहेतुकाः||३|| āyurvarṇō balaṁ svāsthyamutsāhōpacayau prabhā| ōjastējō'gnayaḥ prāṇāścōktā dēhāgnihētukāḥ||3|| AyurvarNo balaM svAsthyamutsAhopacayau prabhA| ojastejo~agnayaH prANAshcoktA dehAgnihetukAH||3|| Dehāgni (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ojas, normal body temperature and various other forms of agni. Even the existence of an individual is said to be because of dehāgni (3). शान्तेऽग्नौ म्रियते, युक्ते चिरं जीवत्यनामयः| रोगी स्याद्विकृते, मूलमग्निस्तस्मान्निरुच्यते||४|| śāntē'gnau mriyatē, yuktē ciraṁ jīvatyanāmayaḥ| rōgī syādvikr̥tē, mūlamAgnistasmānnirucyatē||4|| shAnte~agnau mriyate, yukte ciraM jIvatyanAmayaH| rogI syAdvikRute, mUlamagnistasmAnnirucyate||4||When the agni stops functioning, the individual dies; if the agni functions normally, the individual can lead a healthy and long life. . Similarly, if the agni becomes abnormal, the individual suffers from various diseases; and hence, the agni is said to be the root cause of health and longevity (4). यदन्नं देहधात्वोजोबलवर्णादिपोषकम्| तत्राग्निर्हेतुराहारान्न ह्यपक्वाद्रसादयः||५|| yadannaṁ dēhadhātvōjōbalavarṇādipōṣakam| tatrāgnirhēturāhārānna hyapakvādrasādayaḥ||5|| yadannaM dehadhAtvojobalavarNAdipoShakam| tatrAgnirheturAhArAnna hyapakvAdrasAdayaH||5|| The food one consumes becomes capable of nourishing the body tissues and of promoting the ojas (vital essence), strength, complexion etc., only in the presence of normally functioning agni. In the absence of normal digestion (and metabolism), the normal body tissues such as rasa cannot be formed nor nourished (5). Process of digestion-first phase: अन्नमादानकर्मा तु प्राणः कोष्ठं प्रकर्षति| तद्द्रवैर्भिन्नसङ्घातं स्नेहेन मृदुतां गतम्||६|| समानेनावधूतोऽग्निरुदर्यः पवनोद्वहः| काले भुक्तं समं सम्यक् पचत्यायुर्विवृद्धये||७|| एवं रसमलायान्नमाशयस्थमधः स्थितः| पचत्यग्निर्यथा स्थाल्यामोदनायाम्बुतण्डुलम्||८|| annamādānakarmā tu prāṇaḥ kōṣṭhaṁ prakarṣati| taddravairbhinnasaṅghātaṁ snēhēna mr̥dutāṁ gatam||6|| samānēnāvadhūtō'gnirudaryaḥ [1] pavanōdvahaḥ| kālē bhuktaṁ samaṁ samyak pacatyāyurvivr̥ddhayē||7|| ēvaṁ rasamalāyānnamāśayasthamadhaḥ sthitaḥ| pacatyAgniryathā sthālyāmōdanāyāmbutaṇḍulam||8|| annamAdAnakarmA tu prANaH koShThaM prakarShati| taddravairbhinnasa~gghAtaM snehena mRudutAM gatam||6|| samAnenAvadhUto~agnirudaryaH [1] pavanodvahaH| kAle bhuktaM samaM samyak pacatyAyurvivRuddhaye||7|| evaM rasamalAyAnnamAshayasthamadhaH sthitaH| pacatyagniryathA sthAlyAmodanAyAmbutaNDulam||8|| The ingested food is carried to koshtha by prāṇa vāta. The food disintegrates because of the liquids, and further it becomes soft because of the fatty substances. The samāna vāta, that has an inherent ability to intensify the agni, intensifies the digestive enzymes and properly digests the food that one consumes timely and in an appropriate quantity, thus leading to longevity. This process of digestion by agni in the gut which leads to the formation of rasa and mala is comparable to the process of cooking of the raw rice kept in an earthen vessel containing water on a fire (6-8). Three states of digestion and provoking dosha: अन्नस्य भुक्तमात्रस्य षड्रसस्य प्रपाकतः| मधुराद्यात् कफो भावात् फेनभूत [४] उदीर्यते||९|| परं तु पच्यमानस्य विदग्धस्याम्लभावतः| आशयाच्च्यवमानस्य पित्तमच्छमुदीर्यते||१०|| पक्वाशयं तु प्राप्तस्य शोष्यमाणस्य वह्निना| परिपिण्डितपक्वस्य वायुः स्यात् कटुभावतः||११|| annasya bhuktamātrasya ṣaḍrasasya prapākataḥ| madhurādyāt kaphō bhāvāt phēnabhūta udīryatē||9|| paraṁ tu pacyamānasya vidagdhasyāmlabhāvataḥ| āśayāccyavamānasya Pittamacchamudīryatē||10|| pakvāśayaṁ tu prāptasya śōṣyamāṇasya vahninā| paripiṇḍitapakvasya Vātaḥ syāt kaṭubhāvataḥ||11|| annasya bhuktamAtrasya ShaDrasasya prapAkataH| madhurAdyAt kapho bhAvAt phenabhUta [4] udIryate||9|| paraM tu pacyamAnasya vidagdhasyAmlabhAvataH| AshayAccyavamAnasya pittamacchamudIryate||10|| pakvAshayaM tu prAptasya shoShyamANasya vahninA| paripiNDitapakvasya vAyuH syAt kaTubhAvataH||11|| As soon as the food that has all the six tastes is consumed, it undergoes the first stage of digestion known as ‘madhura’ (sweet) state’ during which kapha is produced which is like froth. Afterwards, while the food undergoing digestion is in its partially digested form, it attains ‘amla’ (sour) state. When the semi digested food leaves the stomach, the release of liquid form of pitta known as ‘accha-pitta’ occurs. When the pakva part (the non-absorbable remnant part after the absorption of the nutrients), reaches the pakvāśaya (the colon), the drying effect of agni converts it into a solid mass. There also occurs the release of vāta which is ‘kaṭu (pungent)’ state (9-11). Second phase of digestion by pancha-mahabhuta: अन्नमिष्टं ह्युपहितमिष्टैर्गन्धादिभिः पृथक्| देहे प्रीणाति गन्धादीन् घ्राणादीनीन्द्रियाणि च||१२|| annamiṣṭaṁ hyupahitamiṣṭairgandhādibhiḥ pr̥thak| dēhē prīṇāti gandhādīn ghrāṇādīnīndriyāṇi ca||12|| annamiShTaM hyupahitamiShTairgandhAdibhiH [1] pRuthak| dehe prINAti gandhAdIn ghrANAdInIndriyANi [2] ca||12|| The food that possesses pleasant smell (taste, appearance, consistency,) etc., nourishes the similar entities in the body such as the sensory organs of smell by gandha etc (e.g. taste, vision, touch etc senses by respective mahabhuta)-(12). भौमाप्याग्नेयवायव्याः पञ्चोष्माणः सनाभसाः| पञ्चाहारगुणान्स्वान्स्वान्पार्थिवादीन्पचन्ति हि||१३|| bhaumāpyāgnēyavāyavyāḥ pañcōṣmāṇaḥ sanābhasāḥ| pañcāhāraguṇānsvānsvānpārthivādīnpacanti hi||13|| bhaumApyAgneyavAyavyAH pa~jcoShmANaH sanAbhasAH| pa~jcAhAraguNAnsvAnsvAnpArthivAdInpacanti hi||13|| There are five types of agni namely, bhauma, apya, agneya, vāyavya and nābhasa. These 5 bhutagni are one of each mahabhuta transform/metabolize those components of the food that are homologous to them in their composition of structure of human organism. (such as pārthiva, apya etc)-(13). यथास्वं स्वं च पुष्णन्ति देहे द्रव्यगुणाः पृथक्| पार्थिवाः पार्थिवानेव शेषाः शेषांश्च कृत्स्नशः||१४|| yathāsvaṁ svaṁ ca puṣṇanti dēhē dravyaguṇāḥ pr̥thak| pārthivāḥ pārthivānēva śēṣāḥ śēṣāṁśca kr̥tsnaśaḥ||14|| yathAsvaM svaM ca puShNanti dehe dravyaguNAH pRuthak| pArthivAH pArthivAneva sheShAH sheShAMshca kRutsnashaH||14||

Specific categories of entities in the body having specific attributes can be nourished by only those substances that belong to the same category having those same attributes. This means that pārthiva entities in the body (one that is dominated by pṛthvi mahābhūta in its composition) can be nourished only by the pārthiva substances in the food and so on. The same rule applies to the whole body (14). Third phase of digestion and metabolism at level of dhatu: सप्तभिर्देहधातारो धातवो द्विविधं पुनः| यथास्वमग्निभिः पाकं यान्ति किट्टप्रसादवत् ||१५|| saptabhirdēhadhātārō dhātavō dvividhaṁ punaḥ| yathāsvamAgnibhiḥ pākaṁ yānti kiṭṭaprasādavat ||15|| saptabhirdehadhAtAro dhAtavo dvividhaM punaH| yathAsvamagnibhiH pAkaM yAnti kiTTaprasAdavat [1] ||15|| Further, the seven components that sustain the body, known as dhātu (tissues), are metabolized/transformed into two kinds of products known as sāra (nutrition) and kiṭṭa (waste). This process is the function of seven specific entities known as dhātvāgni; each dhātvāgni is specific for its corresponding dhātu (15). रसाद्रक्तं ततो मांसं मांसान्मेदस्ततोऽस्थि च| अस्थ्नो मज्जा ततः शुक्रं शुक्राद्गर्भः प्रसादजः||१६|| rasādraktaṁ tatō māṁsaṁ māṁsānmēdastatō'sthi ca| asthnō majjā tataḥ śukraṁ śukrādgarbhaḥ prasādajaḥ||16|| rasAdraktaM tato mAMsaM mAMsAnmedastato~asthi ca| asthno majjA tataH shukraM shukrAdgarbhaH prasAdajaH||16|| Rakta is produced after rasa and then māṃsa. After māṃsa the medas is formed and then asthi is produced. After asthi the majjā is derived and then shukra is produced and finally fine shukra leads to garbha (16). Upadhatu (metabolic products): रसात् स्तन्यं ततो रक्तमसृजः कण्डराः सिराः| मांसाद्वसा त्वचः षट् च मेदसः स्नायुसम्भवः||१७|| rasāt stanyaṁ tatō raktamasr̥jaḥ kaṇḍarāḥ sirāḥ| māṁsādvasā tvacaḥ ṣaṭ ca mēdasaḥ snāyusambhavaḥ ||17|| rasAt stanyaM tato [2] raktamasRujaH kaNDarAH sirAH| mAMsAdvasA tvacaH ShaT ca medasaH snAyusambhavaH [3] ||17|| Stanya (breast milk) and the menstrual blood are derived after rasa. Kaṇḍarā (tendon) and sirā(vein) are derived after rakta. Vasā(fat) and the six layers of tvachā (skin) are derived after māṃsa (muscle) and snāyu(ligament) are derived after medas (adipose tissue) (17). Mala formed at tissue level metabolism: किट्टमन्नस्य विण्मूत्रं, रसस्य तु कफोऽसृजः| पित्तं, मांसस्य खमला, मलः स्वेदस्तु मेदसः||१८|| स्यात्किट्टं केशलोमास्थ्नो, मज्ज्ञः स्नेहोऽक्षिविट्त्वचाम्| प्रसादकिट्टे धातूनां पाकादेवंविधर्च्छतः ||१९|| परस्परोपसंस्तब्धा धातुस्नेहपरम्परा | kiṭṭamannasya viṇmūtraṁ, rasasya tu kaphō'sr̥jaḥ| Pittaṁ, māṁsasya khamalā, malaḥ svēdastu mēdasaḥ||18|| syātkiṭṭaṁ kēśalōmāsthnō, majjñaḥ snēhō'kṣiviṭtvacām| prasādakiṭṭē dhātūnāṁ pākādēvaṁvidharcchataḥ ||19|| parasparōpasaṁstabdhā dhātusnēhaparamparā | kiTTamannasya viNmUtraM, rasasya tu kapho~asRujaH| pittaM, mAMsasya khamalA, malaH svedastu medasaH||18|| syAtkiTTaM keshalomAsthno, majj~jaH sneho~akShiviTtvacAm| prasAdakiTTe dhAtUnAM pAkAdevaMvidharcchataH [4] ||19|| parasparopasaMstabdhA dhAtusnehaparamparA [5] | The faeces and the urine are the kiṭṭa (non-nutrient portion/waste portion/byproduct) of ingested food. The kiṭṭa of rasa is mala-kapha (excretions). Mala-pitta (bile pigment) is the kiṭṭa of rakta. Kha-mala (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the kiṭṭa of māṃsa. Sweda (sweat) is the mala of medas. Keśa (hairs on the head) and loma (body hair) are the mala of asthi. The mala of majjā is the oily excretion of the eye and the skin (sebum). Thus, the dhātus continuously undergo two kinds of transformation: prasāda (nutrient portion) and kiṭṭa (non-nutrient portion). This entire sequence of transformation and metabolism of dhātu is thus inter dependent (18-19½ ). Modes of transformation: वृष्यादीनां प्रभावस्तु पुष्णाति बलमाशु हि||२०|| vr̥ṣyādīnāṁ prabhāvastu puṣṇāti balamāśu hi||20|| vRuShyAdInAM prabhAvastu puShNAti balamAshu hi||20|| Vṛśya substance (the substance that promotes sexual vigor) nourishes the shukra immediately due to its specific influencial effect (prabhāva). (20). षड्भिः केचिदहोरात्रैरिच्छन्ति परिवर्तनम्| सन्तत्या भोज्यधातूनां परिवृत्तिस्तु चक्रवत्||२१|| ṣaḍbhiḥ kēcidahōrātrairicchanti parivartanam| santatyā bhōjyadhātūnāṁ parivr̥ttistu cakravat||21|| ShaDbhiH kecidahorAtrairicchanti parivartanam| santatyA bhojyadhAtUnAM parivRuttistu cakravat||21|| Some scholars believe that the conversion of rasa up to shukra occurs in a span of six days and six nights. This process of transformation of nourishing portion of the digested food is continuous similar to rotating wheel (21). Note: Adultrated Verses: Verses from 22 to 35 are available in the text in bracket and Cakrapani has also not offered the commentary on these verses, hence these verses are considered as adultrated. (इत्युक्तवन्तमाचार्यं शिष्यस्त्विदमचोदयत्| रसाद्रक्तं विसदृशात् कथं देहेऽभिजायते||२२|| रसस्य च न रागोऽस्ति स कथं याति रक्तताम्| द्रवाद्रक्तात्स्थिरं मांसं कथं तज्जायते नृणाम्||२३|| द्रवधातोः स्थिरान्मांसान्मेदसः सम्भवः कथम्| श्लक्ष्णाभ्यां मांसमेदोभ्यां खरत्वं कथमस्थिषु||२४|| खरेष्वस्थिषु मज्जा च केन स्निग्धो मृदुस्तथा| मज्ज्ञश्च परिणामेन यदि शुक्रं प्रवर्तते||२५|| सर्वदेहगतं शुक्रं प्रवदन्ति मनीषिणः| तथाऽस्थिमध्यमज्ज्ञश्च शुक्रं भवति देहिनाम्||२६|| छिद्रं न दृश्यतेऽस्थ्नां च तन्निःसरति वा कथम्| (ityuktavantamācāryaṁ śiṣyastvidamacōdayat| rasādraktaṁ visadr̥śāt kathaṁ dēhē'bhijāyatē||22|| rasasya ca na rāgō'sti sa kathaṁ yāti raktatām| dravādraktātsthiraṁ māṁsaṁ kathaṁ tajjāyatē nr̥ṇām||23|| dravadhātōḥ sthirānmāṁsānmēdasaḥ sambhavaḥ katham| ślakṣṇābhyāṁ māṁsamēdōbhyāṁ kharatvaṁ kathamasthiṣu||24|| kharēṣvasthiṣu majjā ca kēna snigdhō mr̥dustathā| majjñaśca pariṇāmēna yadi śukraṁ pravartatē||25|| sarvadēhagataṁ śukraṁ pravadanti manīṣiṇaḥ| tathā'sthimadhyamajjñaśca śukraṁ bhavati dēhinām||26|| chidraṁ na dr̥śyatē'sthnāṁ ca tanniḥsarati vā katham| (ityuktavantamAcAryaM [6] shiShyastvidamacodayat| rasAdraktaM visadRushAt [7] kathaM dehe~abhijAyate||22|| rasasya ca na rAgo~asti sa kathaM yAti raktatAm| dravAdraktAtsthiraM mAMsaM kathaM tajjAyate nRuNAm||23|| dravadhAtoH [8] sthirAnmAMsAnmedasaH sambhavaH katham| shlakShNAbhyAM mAMsamedobhyAM kharatvaM kathamasthiShu||24|| khareShvasthiShu majjA ca kena snigdho mRudustathA| majj~jashca pariNAmena yadi shukraM pravartate||25|| sarvadehagataM shukraM pravadanti manIShiNaH|

(After listening to the above explanation by his teacher, the student asked the following doubt: How is it that rakta is formed in the body out of rasa, though being different from it? rasa is in fact colorless, and how does it attain the red color of rakta? How is it that a solid structure such as māṃsa is formed out of rakta which is a fluid by its nature? How is it that, again, from the māṃsa, which is solid, a fluid substance such as meda is formed? How is it that a rough asthi is formed out of smooth structures such as māṃsa and meda? How does the soft and fatty majjā form out of rough structures such as asthi? If at all shukra, which is present everywhere in the body is formed out of majjā that is located inside the asthi, how does it come out as one cannot see pores on asthi? (22-26). Formation of rasa and rakta: एवमुक्तस्तु शिष्येण गुरुः प्राहेदमुत्तरम्||२७|| तेजो रसानां सर्वेषां मनुजानां यदुच्यते| पित्तोष्मणः स रागेण रसो रक्तत्वमृच्छति||२८|| ēvamuktastu śiṣyēṇa guruḥ prāhēdamuttaram||27|| tējō rasānāṁ sarvēṣāṁ manujānāṁ yaducyatē| pittōṣmaṇaḥ sa rāgēṇa rasō raktatvamr̥cchati||28|| tathA~asthimadhyamajj~jashca shukraM bhavati dehinAm||26|| chidraM na dRushyate~asthnAM ca tanniHsarati vA katham| evamuktastu shiShyeNa guruH prAhedamuttaram||27|| tejo rasAnAM sarveShAM manujAnAM yaducyate| pittoShmaNaH sa rAgeNa raso raktatvamRucchati||28||

After listening to the query raised by the student, the teacher replied as follows: The nourishment fluid formed, known as rasa, undergoes transformation by the uṣmā (heat) of pitta and gets converted into the red colored tissue known as rakta (27-28). Formation of mamsa dhatu: वाय्वम्बुतेजसा रक्तमूष्मणा चाभिसंयुतम्| स्थिरतां प्राप्य मांसं स्यात् स्वोष्मणा पक्वमेव तत् ||२९|| vāyvambutējasā raktamūṣmaṇā cābhisaṁyutam| sthiratāṁ prāpya māṁsaṁ syāt svōṣmaṇā pakvamēva tat ||29|| vAyvambutejasA raktamUShmaNA cAbhisaMyutam| sthiratAM prApya mAMsaM syAt svoShmaNA pakvameva tat [9] ||29||

Due to the action of heat along with the vāta, aṃbu (water) and tejas, the rakta is converted into stable māṃsa, after being acted upon by its own agni (māṃsadhātvagni)-(29). Formation of meda dhatu: स्वतेजोऽम्बुगुणस्निग्धोद्रिक्तं मेदोऽभिजायते| svatējō'mbuguṇasnigdhōdriktaṁ mēdō'bhijāyatē| svatejo~ambuguNasnigdhodriktaM medo~abhijAyate|

Because of the action of medo-dhātvāgni on the excessively dominant snigdha attribute of aṃbu, the medo dhātu is formed (29½). Formation of asthi dhatu:

पृथिव्यग्न्यनिलादीनां सङ्घातः स्वोष्मणा कृतः||३०|| खरत्वं प्रकरोत्यस्य जायतेऽस्थि ततो नृणाम्| pr̥thivyagnyanilādīnāṁ saṅghātaḥ svōṣmaṇā kr̥taḥ||30|| kharatvaṁ prakarōtyasya jāyatē'sthi tatō nr̥ṇām| pRuthivyagnyanilAdInAM sa~gghAtaH svoShmaNA [10] kRutaH||30|| kharatvaM prakarotyasya jAyate~asthi tato nRuNAm|

Because of the action of asthi dhātvāgni on the aggregation of pṛthvi, agni and anila, roughness is attained during the formation of the asthi (30). Formation of majja dhatu:

करोति तत्र सौषिर्यमस्थ्नां मध्ये समीरणः||३१|| मेदसस्तानि पूर्यन्ते स्नेहो मज्जा ततः स्मृतः| karōti tatra sauṣiryamasthnāṁ madhyē samīraṇaḥ||31|| mēdasastāni pūryantē snēhō majjā tataḥ smr̥taḥ| karoti tatra sauShiryamasthnAM madhye samIraNaH||31|| medasastAni pUryante sneho majjA tataH smRutaH| Vāta produces hollowness inside the asthi dhātu, and after which, these hollow cavities get filled up by fatty tissue which is known as majjā (31). Formation of shukra dhatu: तस्मान्मज्ज्ञस्तु यः स्नेहः शुक्रं सञ्जायते ततः||३२|| वाय्वाकाशादिभिर्भावैः सौषिर्यं जायतेऽस्थिषु| तेन स्रवति तच्छुक्रं नवात् कुम्भादिवोदकम्||३३|| स्रोतोभिः स्यन्दते देहात् समन्ताच्छुक्रवाहिभिः | हर्षेणोदीरितं वेगात् सङ्कल्पाच्च मनोभवात्||३४|| विलीनं घृतवद्व्यायामोष्मणा स्थानविच्युतम्| बस्तौ सम्भृत्य निर्याति स्थलान्निम्नादिवोदकम्)||३५|| tasmānmajjñastu yaḥ snēhaḥ śukraṁ sañjāyatē tataḥ||32|| vāyvākāśādibhirbhāvaiḥ sauṣiryaṁ jāyatē'sthiṣu| tēna sravati tacchukraṁ navāt kumbhādivōdakam||33|| srōtōbhiḥ syandatē dēhāt samantācchukravāhibhiḥ | harṣēṇōdīritaṁ vēgāt saṅkalpācca manōbhavāt||34|| vilīnaṁ ghr̥tavadvyāyāmōṣmaṇā sthānavicyutam| bastau sambhr̥tya niryāti sthalānnimnādivōdakam)||35|| tasmAnmajj~jastu yaH snehaH shukraM sa~jjAyate tataH||32|| vAyvAkAshAdibhirbhAvaiH sauShiryaM jAyate~asthiShu| tena sravati tacchukraM navAt kumbhAdivodakam||33|| srotobhiH syandate dehAt samantAcchukravAhibhiH [11] | harSheNodIritaM vegAt sa~gkalpAcca manobhavAt||34|| vilInaM ghRutavadvyAyAmoShmaNA sthAnavicyutam| bastau sambhRutya niryAti sthalAnnimnAdivodakam)||35|| The sneha (fatty) portion of majjā produces shukra. The porosity in the asthi is produced because of the factors such as vāta and akāśa. Shukra comes out of asthi through these pores just as the water comes out of a new earthen vessel. Through the channels known as shukravaha srotāṃsi, this shukra spreads all over the body. This shukra is discharged through the urethra (which is connected to the urinary bladder) because of several factors such as sexual excitation, reflex activities (vega), and mental determination (saṃkalpa). Just as the ghee moves out with ease when heated, the shukra too, is discharged due to the heat liberated during the sexual activity. This process of seminal discharge is comparable with the movement of water from a place of lower altitude to a place of higher altitude)-(32-35). Continous circulation of rasa all over the body: व्यानेन रसधातुर्हि विक्षेपोचितकर्मणा| युगपत् सर्वतोऽजस्रं देहे विक्षिप्यते सदा||३६|| vyānēna rasadhāturhi vikṣēpōcitakarmaṇā| yugapat sarvatō'jasraṁ dēhē vikṣipyatē sadā||36|| vyAnena rasadhAturhi vikShepocitakarmaNA| yugapat sarvato~ajasraM dehe vikShipyate sadA||36|| Because of being forcefully propelled (out of the heart) by the action of vyāna vāta, the rasa dhātu spreads all over the body simultaneously, continuously and for the entire life (36). Kha-Vaigunya (abnormality in body system) is responsible for the disease state: क्षिप्यमाणः खवैगुण्याद्रसः सज्जति यत्र सः| करोति विकृतिं तत्र खे वर्षमिव तोयदः||३७|| kṣipyamāṇaḥ khavaiguṇyādrasaḥ sajjati yatra saḥ| karōti vikr̥tiṁ tatra khē varṣamiva tōyadaḥ||37|| kShipyamANaH khavaiguNyAdrasaH sajjati yatra saH| karoti [12] vikRutiM tatra khe varShamiva toyadaH||37|| Wherever the rasa experiences obstacle due to abnormality in srotas, rasa readily produces disease in that very same location. This process is comparable with that of the clouds producing rainfall in a localized region that is favorable for rainfall (37). दोषाणामपि चैवं स्यादेकदेशप्रकोपणम् | dōṣāṇāmapi caivaṁ syādēkadēśaprakōpaṇam | doShANAmapi caivaM syAdekadeshaprakopaNam [13] | This principle is applicable even in case of doṣha, where ekadeśa prakopa (abnormal increase at a local site) occurs (37½). इति भौतिकधात्वन्नपक्तॄणां कर्म भाषितम्||३८|| iti bhautikadhātvannapaktr̥̄ṇāṁ karma bhāṣitam||38||

iti bhautikadhAtvannapaktRUNAM karma bhAShitam||38|| Thus ends the description of the physiological functions of bhūtāgni, dhātvāgni and jaṭharāgni (38). Significance of jatharagni: अन्नस्य पक्ता सर्वेषां पक्तॄणामधिपो मतः| तन्मूलास्ते हि तद्वृद्धिक्षयवृद्धिक्षयात्मकाः||३९|| annasya paktā sarvēṣāṁ paktr̥̄ṇāmadhipō mataḥ| tanmūlāstē hi tadvr̥ddhikṣayavr̥ddhikṣayātmakāḥ||39||

annasya paktA sarveShAM paktRUNAmadhipo mataH| tanmUlAste hi tadvRuddhikShayavRuddhikShayAtmakAH||39||

Jaṭharāgni is known as the King among all the forms of agni. The intensification and diminution of all other forms of agni is in fact dependent on jaṭharāgni (39).

तस्मात्तं विधिवद्युक्तैरन्नपानेन्धनैर्हितैः| पालयेत् प्रयतस्तस्य स्थितौ ह्ययुर्बलस्थितिः||४०|| tasmāttaṁ vidhivadyuktairannapānēndhanairhitaiḥ| pālayēt prayatastasya sthitau hyayurbalasthitiḥ||40|| tasmAttaM vidhivadyuktairannapAnendhanairhitaiH| pAlayet prayatastasya sthitau hyayurbalasthitiH||40|| An individual should take utmost care to maintain the agni by providing fuel in the form of food and drinks which should be taken as per the rules mentioned, because life and strength of an individual depends on agni (40). Initiation of grahani dosha: यो हि भुङ्क्ते विधिं त्याक्त्वा ग्रहणीदोषजान् गदान्| स लौल्याल्लभते शीघ्रं, वक्ष्यन्तेऽतः परं तु ते||४१|| yō hi bhuṅktē vidhiṁ tyāktvā Grahaṇī dōṣajān gadān| sa laulyāllabhatē śīghraṁ, vakṣyantē'taḥ paraṁ tu tē||41|| yo hi bhu~gkte vidhiM tyAktvA grahaNIdoShajAn gadAn| sa laulyAllabhate shIghraM, vakShyante~ataH paraM tu te||41||

If an individual indulges in food without following the rules and regulation of diet intake, then he quickly suffers from diseases caused by the vitiation of grahani because of his greedy habits. Such diseases are being described henceforth (41).

Causes of vitiation of agni: अभोजनादजीर्णातिभोजनाद्विषमाशनात्| असात्म्यगुरुशीतातिरूक्षसन्दुष्टभोजनात्||४२|| विरेकवमनस्नेहविभ्रमाद्व्याधिकर्षणात्| देशकालर्तुवैषम्याद्वेगानां च विधारणात्||४३|| दुष्यत्यग्निः, स दुष्टोऽन्नं न तत् पचति लघ्वपि| अपच्यमानं शुक्तत्वं यात्यन्नं विषरूपताम् ||४४||

abhōjanādajīrṇātibhōjanādviṣamāśanāt| asātmyaguruśītātirūkṣasanduṣṭabhōjanāt||42|| virēkavāmanasnēhavibhramādvyādhikarṣaṇāt| dēśakālartuvaiṣamyādvēgānāṁ ca vidhāraṇāt||43|| duṣyatyāgniḥ, sa duṣṭō'nnaṁ na tat pacati laghvapi| apacyamānaṁ śuktatvaṁ yātyannaṁ viṣarūpatām ||44||

abhojanAdajIrNAtibhojanAdviShamAshanAt| asAtmyagurushItAtirUkShasanduShTabhojanAt||42|| virekavamanasnehavibhramAdvyAdhikarShaNAt| deshakAlartuvaiShamyAdvegAnAM ca vidhAraNAt||43|| duShyatyagniH, sa duShTo~annaM na tat pacati laghvapi| apacyamAnaM shuktatvaM yAtyannaM viSharUpatAm [14] ||44|| Excessive starvation, indulging in food intake although there is indigestion, overeating, irregular habit of eating, eating unwholesome food, indulging in food which is heavy to digest or having excessive nutritional value, food which is having cold qualities or eating chilled or frozen items, food which is dry in nature or food which brings about emaciation, contaminated food, perversion of procedures like vāman, virechan and sneha, emaciation of body due to disease, sudden migration to unsuitable place and of time and of season, suppression of natural urges are causes for vitiation of agni. Thus, vitiated agni is unable to digest even the light food. (42-43) This vitiated digestive agent forms an intermediate substance called ama, which turns sour (shukta) during fermentation and finaly turns in poisonous substance (amavisha) (44). Signs and symptoms of ajirna(indigestion): तस्य लिङ्गमजीर्णस्य विष्टम्भः सदनं तथा| शिरसो रुक् च मूर्च्छा च भ्रमः पृष्ठकटिग्रहः||४५|| जृम्भाऽङ्गमर्दस्तृष्णा च ज्वरश्छर्दिः प्रवाहणम्| अरोचकोऽविपाकश्च, घोरमन्नविषं च तत्||४६|| tasya liṅgāmajīrṇasya viṣṭambhaḥ sadanaṁ tathā| śirasō ruk ca mūrcchā ca bhrāmaḥ pr̥ṣṭhakaṭigrahaḥ||45|| jr̥mbhā'ṅgāmardastr̥ṣṇā ca jvaraśchardiḥ pravāhaṇam| arōcakō'vipākaśca, ghōrāmannaviṣaṁ ca tat||46|| tasya li~ggamajIrNasya viShTambhaH sadanaM tathA| shiraso ruk ca mUrcchA ca bhramaH pRuShThakaTigrahaH||45|| jRumbhA~a~ggamardastRuShNA ca jvarashchardiH pravAhaNam| arocako~avipAkashca, ghoramannaviShaM ca tat||46||

This poisonous substance (amavisha) manifests clinical features like flatulence, discomfortable physical and mental miseries, headache, altered connsciousness, giddiness, stiffness of back and lumbar region, yawning, bodyache, malaise, morbid thirst, fever, vomiting, tenesmus, anorexia and indigestion and it is similar to antigenic poison. (45-46). Associated disorders of annavisha: संसृज्यमानं पित्तेन दाहं तृष्णां मुखामयान्| जनयत्यम्लपित्तं च पित्तजांश्चापरान् गदान्||४७|| यक्ष्मपीनसमेहादीन् कफजान् कफसङ्गतम्| करोति वातसंसृष्टं वातजांश्च गदान् बहून्||४८|| मूत्ररोगांश्च मूत्रस्थं कुक्षिरोगान् शकृद्गतम्| रसादिभिश्च संसृष्टं कुर्याद्रोगान् रसादिजान्||४९|| saṁsr̥jyamānaṁ pittēna dāhaṁ tr̥ṣṇāṁ mukhāmayān| janayatyamlaPitta ṁ ca Pitta jāṁścāparān gadān||47|| yakṣmapīnasamēhādīn kaphajān kaphasaṅgatam| karōti Vātasaṁsr̥ṣṭaṁ Vātajāṁśca gadān bahūn||48|| mūtrarōgāṁśca mūtrasthaṁ kukṣirōgān śakr̥dgatam| rasādibhiśca saṁsr̥ṣṭaṁ kuryādrōgān rasādijān||49|| saMsRujyamAnaM [15] pittena dAhaM tRuShNAM mukhAmayAn| janayatyamlapittaM ca pittajAMshcAparAn gadAn||47|| yakShmapInasamehAdIn kaphajAn kaphasa~ggatam| karoti vAtasaMsRuShTaM vAtajAMshca [16] gadAn bahUn||48|| mUtrarogAMshca mUtrasthaM kukShirogAn shakRudgatam| rasAdibhishca saMsRuShTaM kuryAdrogAn rasAdijAn||49|| The annaviṣa when associated with pitta causes dāha, morbid thirst, oral diseases, amlapitta (acid peptic disorders) and various other pitta related disorders. The same annaviṣa when gets associated with kapha it leads to condition like yakshma (pthiasis), pīnas (coryza) and prameha (20 types of diabetes) and various other kaphaja disorders, whereas several vātika disease are caused by association of vāta with the annaviṣa. The annaviṣa when enters renal system, urine related disorders occur; similarly, kukshigata roga (ailments related to abdomen) have their origin when sakṛta (feces) is involved. Rasādi pradōṣaja vikāra (tissue related ailments) occur when rasādi srotas are involved (47-49). Effects of Vishāmagni (irregular agni) and tīkṣṇāgni( excessive agni): विषमो धातुवैषम्यं करोति विषमं पचन्| तीक्ष्णो मन्देन्धनो धातून् विशोषयति पावकः||५०|| viṣamō dhātuvaiṣamyaṁ karōti viṣāmaṁ pacan| tīkṣṇō mandēndhanō dhātūn viśōṣayati pāvakaḥ||50|| viShamo dhAtuvaiShamyaM karoti viShamaM pacan| tIkShNo mandendhano dhAtUn vishoShayati pAvakaH||50|| The vishāmagni (improper agni) causes irregularity in digestion and therefore defective formation of dhātu takes place whereas, tīkṣṇāgni (excessive agni) when associated with little quantity of fuel (in the form of food) causes depletion of dhātu (tissue elements) (50). Samāgni: युक्तं भुक्तवतो युक्तो धातुसाम्यं समं पचन्| yuktaṁ bhuktavatō yuktō dhātusāmyaṁ sāmaṁ pacan| yuktaM bhuktavato yukto dhAtusAmyaM samaM pacan|

If agni is sama i.e. in balanced condition and correct diet regimen (as explained in Ca. Su. 5 and Ca.Vi.1/21) are also followed then there is proper digestion of food which helps in maintaining proper balance within the dhātu (50½). Durbala (weak) agni: दुर्बलो विदहत्यन्नं तद्यात्यूर्ध्वमधोऽपि वा||५१|| durbalō vidahatyannaṁ tadyātyūrdhvāmadhō'pi vā||51|| durbalo vidahatyannaM tadyAtyUrdhvamadho~api vA||51||

Durbala (weak) agni brings about partial digestion of food. These partially digested bio substances then enter in circulation, which may move either in upward or downward direction (51). Grahaṇī gada:(diseases of grahani): अधस्तु पक्वमामं वा प्रवृत्तं ग्रहणीगदः| उच्यते सर्वमेवान्नं प्रायो ह्यस्य विदह्यते||५२|| अतिसृष्टं विबद्धं वा द्रवं तदुपदिश्यते| तृष्णारोचकवैरस्यप्रसेकतमकान्वितः||५३|| शूनपादकरः सास्थिपर्वरुक् छर्दनं ज्वरः| लोहामगन्धिस्तिक्ताम्ल [१७] उद्गारश्चास्य जायते||५४|| adhastu pakvamāmaṁ vā pravr̥ttaṁ Grahaṇī gadaḥ| ucyatē sarvamēvānnaṁ prāyō hyasya vidahyatē||52|| atisr̥ṣṭaṁ vibaddhaṁ vā dravaṁ tadupadiśyatē| tr̥ṣṇārōcakavairasyaprasēkatāmakānvitaḥ||53|| śūnapādakaraḥ sāsthiparvaruk chardanaṁ jvaraḥ| lōhāmagandhistiktāmla [17] udgāraścāsya jāyatē||54|| adhastu pakvamAmaM vA pravRuttaM grahaNIgadaH| ucyate sarvamevAnnaM prAyo hyasya vidahyate||52|| atisRuShTaM vibaddhaM vA dravaM tadupadishyate| tRuShNArocakavairasyaprasekatamakAnvitaH||53|| shUnapAdakaraH sAsthiparvaruk chardanaM jvaraH| lohAmagandhistiktAmla [17] udgArashcAsya jAyate||54||

When partially digested and partially undigested bio substances moves downward in gastrointestinal tract it produces a disorder known as grahaṇīgada. In this particular stage the entire food material remains in the state of vidagdha state (partially transformed/sour). In this condition the individual may pass stools in excessive quantity or frequency wherein stools may be loose, with thin consistency or in the form of pellety stools/bound stools (vibaddham) and morbid thirst, anorexia, distaste, excessive watering of mouth, blackout, edema of legs and hands, pain in bones and finger joints, vomiting, fever, eructation having either metallic smell or undigested food and having bitter or sour taste are observed (52-54). Premonitory symptoms of Grahaṇī gada: पूर्वरूपं तु तस्येदं तृष्णाऽऽलस्यं बलक्षयः| विदाहोऽन्नस्य पाकश्च चिरात् कायस्य गौरवम्||५५|| pūrvarūpaṁ tu tasyēdaṁ tr̥ṣṇālasyaṁ balakṣayaḥ| vidāhō'nnasya pākaśca cirāt kāyasya gauravam||55|| pUrvarUpaM tu tasyedaM tRuShNA~a~alasyaM balakShayaH| vidAho~annasya pAkashca cirAt kAyasya gauravam||55|| Premonitory signs and symptoms are thirst, malaise, diminution of strength, burning sensation; delay in digestion and heaviness in body (55). Functions of grahaṇī: अग्न्यधिष्ठानमन्नस्य ग्रहणाद्ग्रहणी मता| नाभेरुपर्यह्यग्निबलेनोपष्टब्धोपबृंहिता [१८] ||५६|| अपक्वं धारत्यन्नं पक्वं सृजति पार्श्वतः| दुर्बलाग्निबला दुष्टा [१९] त्वाममेव विमुञ्चति||५७||

agnyadhiṣṭhānāmannasya grahaṇādGrahaṇī  matā| 

nābhēruparyahyAgnibalēnōpaṣṭabdhōpabr̥ṁhitā [18] ||56|| apakvaṁ dhāratyannaṁ pakvaṁ sr̥jati pārśvataḥ| durbalāgnibalā duṣṭā [19] tvāmamēva vimuñcati||57|| agnyadhiShThAnamannasya grahaNAdgrahaNI matA| nAbheruparyahyagnibalenopaShTabdhopabRuMhitA [18] ||56|| apakvaM dhAratyannaM pakvaM sRujati pArshvataH| durbalAgnibalA duShTA [19] tvAmameva vimu~jcati||57||

Grahaṇī is seat of agni and it is so called since it holds/retains the food (for proper digestion and assimilation). It holds the food just above the umbilical region and it is supported and nourished by the agni. Grahaṇī with help of agni holds the undigested food and pushes forward digested food, but when agni becomes weak and vitiated due to vidagdha ahara murchita dōṣha (afflicted by improperly digested food) i.e sāma dōṣha(dosha associated with ama) it vitiates the grahaṇī and releases food in the form of ama i.e. undigested form (56-57). Four types of grahaṇī disease: वातात् पित्तात् कफाच्च स्यात्तद्रोगस्त्रिभ्य एव च| हेतुं लिङ्गं रूपभेदाञ् शृणु तस्य पृथक् पृथक्||५८||

vātāt pittāt kaphācca syāttadrōgastribhya ēva ca| hētuṁ liṅgaṁ rūpabhēdāñ śr̥ṇu tasya pr̥thak pr̥thak||58|| vAtAt pittAt kaphAcca syAttadrogastribhya eva ca| hetuM li~ggaM rUpabhedA~j [21] shRuNu tasya pRuthak pRuthak||58|| Grahaṇī disease is classified into four types viz vātaja, pittaja, kaphaja and sannipātaja. On the basis of the classification, etiological factors, symptoms and signs are being mentioned one by one (58). Causes of vātaja grahaṇī: कटुतिक्तकषायातिरूक्षशीतलभोजनैः| प्रमितानशनात्यध्ववेगनिग्रहमैथुनैः||५९|| करोति कुपितो मन्दमग्निं सञ्छाद्य मारुतः [२२] |

kaṭutiktakaṣāyātirūkṣaśītalabhōjanaiḥ| pramitānaśanātyadhvavēganigrahāmaithunaiḥ||59|| karōti kupitō mandāmAgniṁ sañchādya mārutaḥ [22] | kaTutiktakaShAyAtirUkShashItalabhojanaiH| pramitAnashanAtyadhvaveganigrahamaithunaiH||59|| karoti kupito mandamagniM sa~jchAdya mArutaH [22] |

Excessive indulgence in diet having kaṭu (pungent), tikta (bitter), kaṣāya (astringent) dominant food, which is dry in nature or having absorptive or emciative qualities; cold, chilled or frozen items, eating quantitatively less amount of food, suppression of natural urges and excessive sexual intercourse contribute to aggravation of vāta dōṣha which encompass the agni causing suppression of agni (59½). Symptoms of vātaja grahaṇī: तस्यान्नं पच्यते दुःखं शुक्तपाकं खराङ्गता||६०|| कण्ठास्यशोषः क्षुत्तृष्णा तिमिरं कर्णयोः स्वनः| पार्श्वोरुवङ्क्षणग्रीवारुजोऽभीक्ष्णं विसूचिका||६१|| हृत्पीडा कार्श्यदौर्बल्यं वैरस्यं परिकर्तिका| गृद्धिः सर्वरसानां च मनसः सदनं तथा||६२|| जीर्णे जीर्यति चाध्मानं भुक्ते स्वास्थ्यमुपैति च| स वातगुल्महृद्रोगप्लीहाशङ्की च मानवः||६३|| चिरादुःखं द्रवं शुष्कं तन्वामं शब्दफेनवत्| पुनः पुनः सृजेद्वर्चः कासश्वासार्दितोऽनिलात्||६४||

tasyānnaṁ pacyatē duḥkhaṁ śuktapākaṁ kharāṅgatā||60|| kaṇṭhāsyaśōṣaḥ kṣuttr̥ṣṇā timiraṁ karṇayōḥ svanaḥ| pārśvōruvaṅkṣaṇagrīvārujō'bhīkṣṇaṁ visūcikā||61|| hr̥tpīḍā kārśyadaurbalyaṁ vairasyaṁ parikartikā| gr̥ddhiḥ sarvarasānāṁ ca manasaḥ sadanaṁ tathā||62|| jīrṇē jīryati cādhmānaṁ bhuktē svāsthyamupaiti ca| sa Vātagulmahr̥drōgaplīhāśaṅkī ca mānavaḥ||63|| cirāduḥkhaṁ dravaṁ śuṣkaṁ tanvāmaṁ śabdaphēnavat| punaḥ punaḥ sr̥jēdvarcaḥ kāsaśvāsārditō'nilāt||64|| tasyAnnaM pacyate duHkhaM shuktapAkaM kharA~ggatA||60|| kaNThAsyashoShaH kShuttRuShNA timiraM karNayoH svanaH| pArshvoruva~gkShaNagrIvArujo~abhIkShNaM visUcikA||61|| hRutpIDA kArshyadaurbalyaM vairasyaM parikartikA| gRuddhiH sarvarasAnAM ca manasaH sadanaM tathA||62|| jIrNe jIryati cAdhmAnaM bhukte svAsthyamupaiti ca| sa vAtagulmahRudrogaplIhAsha~gkI ca mAnavaH||63|| cirAduHkhaM dravaM shuShkaM tanvAmaM shabdaphenavat| punaH punaH sRujedvarcaH kAsashvAsArdito~anilAt||64|| Symptoms of vātika grahani are as follow: Food is not easily digested and gets fermented (leading to sourness), roughness of skin, dryness of throat and mouth, craving for food and thirst is increased, timira (blurred vision), tinnitus, continuous pain in flanks, thighs, pelvis, neck region, visūchikā (piercing pain all over the body with vomiting and diarhea), chest pain/discomfort in cardiac region, emaciation, weakness, distaste, cutting pain, craving for sweets, sour and saline food (madhurādi rasa), reduced mental strength, adhmāna (distention of abdomen) occurs during digestion and after completion of digestion whereas the patient feels abdominal comfort just after eating the food. Patient expresses repeated doubts that he is suffering from vātika disorders, gulma (abdominal tumor), heart disease and splenomegaly. Stools are evacuated with difficulty and consume time. Feces are either watery, dry, small sized associated with flatus and undigested food. Frequency of stool is increased and patient may suffer from cough and breathing difficulty (60-64). Causes of pāittika grahaṇī: कट्वजीर्णविदाह्यम्लक्षाराद्यैः पित्तमुल्बणम्| अग्निमाप्लावयद्धन्ति [२३] जलं तप्तमिवानलम्||६५|| kaṭvajīrṇavidāhyamlakṣārādyaiḥ Pittamulbaṇam| Agnimāplāvayaddhanti [23] jalaṁ taptamivānalam||65|| kaTvajIrNavidAhyamlakShArAdyaiH pittamulbaNam| agnimAplAvayaddhanti [23] jalaM taptamivAnalam||65||

Kaṭu (spicy), ajīrṇa (undigestable food), vidāhi (food causing eructation), amla (sour), kṣāra (alkali) and other food items which aggravate pitta are causes for pittaja grahaṇī. The aggravated pitta hampers the function of agni similar to condition wherein hot water extinguishes fire (65).

Symptoms of paittika grahaṇī: सोऽजीर्णं नीलपीताभं पीताभः सार्यते द्रवम्| पूत्यम्लोद्गारहृत्कण्ठदाहारुचितृडर्दितः||६६|| sō'jīrṇaṁ nīlapītābhaṁ pītābhaḥ sāryatē dravam| pūtyamlōdgārahr̥tkaṇṭhadāhārucitr̥ḍarditaḥ||66|| so~ajIrNaM nIlapItAbhaM pItAbhaH sAryate dravam| pUtyamlodgArahRutkaNThadAhArucitRuDarditaH||66|| The stools have undigested food particles having either bluish-yellowish tinge or yellow in colour and are loose/watery. The eructions have foul smell and sour taste, there is burning sensation in the cardiac region (retro sternal) and throat, anorexia and thirst are the symptoms of pittaja grahaṇī (66). Causes of kaphaja grahaṇī: गुर्वतिस्निग्धशीतादिभोजनादतिभोजनात्| भुक्तमात्रस्य च स्वप्नाद्धन्त्यग्निं कुपितः कफः||६७|| gurvatisnigdhaśītādibhōjanādatibhōjanāt| bhuktamātrasya ca svapnāddhantyAgniṁ kupitaḥ kaphaḥ||67|| gurvatisnigdhashItAdibhojanAdatibhojanAt| bhuktamAtrasya ca svapnAddhantyagniM kupitaH kaphaH||67||

Heavy to digest or excessively unctuous foods, frozen or chilled items or food having cold nature or food which has qualities similar to kapha, excessive intake of food and sleeping just after the meals hamper the function of agni and simultaneously vitiates kapha (67). Symptoms of kaphaja grahaṇī: तस्यान्नं पच्यते दुःखं हृल्लासच्छर्द्यरोचकाः| आस्योपदेहमाधुर्यकासष्ठीवनपीनसाः||६८|| हृदयं मन्यते स्त्यानमुदरं स्तिमितं गुरु| दुष्टो मधुर उद्गारः सदनं स्त्रीष्वहर्षणम्||६९|| भिन्नामश्लेष्मसंसृष्टगुरुवर्चःप्रवर्तनम्| अकृशस्यापि दौर्बल्यमालस्यं च कफात्मके||७०|| tasyānnaṁ pacyatē duḥkhaṁ hr̥llāsacchardyarōcakāḥ| āsyōpadēhamādhuryakāsaṣṭhīvanapīnasāḥ||68|| hr̥dayaṁ manyatē styānamudaraṁ stimitaṁ guru| duṣṭō madhura udgāraḥ sadanaṁ strīṣvaharṣaṇam||69|| bhinnāmaślēṣmasaṁsr̥ṣṭaguruvarcaḥpravartanam| akr̥śasyāpi daurbalyamālasyaṁ ca kaphātmakē||70|| tasyAnnaM pacyate duHkhaM hRullAsacchardyarocakAH| AsyopadehamAdhuryakAsaShThIvanapInasAH||68|| hRudayaM manyate styAnamudaraM stimitaM guru| duShTo madhura udgAraH sadanaM strIShvaharShaNam||69|| bhinnAmashleShmasaMsRuShTaguruvarcaHpravartanam| akRushasyApi daurbalyamAlasyaM ca kaphAtmake||70|| Food is digested with difficulty, nausea, vomiting and anorexia are its symptoms. The other symptoms are feeling of coated mouth and sweet taste, has cough, increased tendency to spit, pinasa (nasal discharge), feeling of heaviness in chest, feeling as if there is no movement in abdomen, heavy abdomen, eructation with foul smelling and sweet taste; patient does not feel enthusiastic and there is suppression of libido. Stools are mixed with undigested items and mucous and are heavy; although patient is not emaciated still he feels weakness and laziness (68-70).

यश्चाग्निः पूर्वमुद्दिष्टो रोगानीके चतुर्विधः| तं चापि ग्रहणीदोषं समवर्जं प्रचक्ष्महे||७१|| yaścāgniḥ pūrvamuddiṣṭō rōgānīkē caturvidhaḥ| taṁ cāpi Grahaṇī dōṣaṁ sāmavarjaṁ pracakṣmahē||71|| yashcAgniH pUrvamuddiShTo rogAnIke caturvidhaH| taM cApi grahaNIdoShaM samavarjaM pracakShmahe||71|| Four types of agni have been previously explained in Rōgānīkē Adhyāya [Ca. Vi. 6/12]. Except samāgni other three types of agni contribute to the grahaṇīdōṣa (71). Sannipätaja grahaṇī: पृथग्वातादिनिर्दिष्टहेतुलिङ्गसमागमे| त्रिदोषं निर्दिशेत्तेषां भेषजं [२४] शृण्वतः परम्||७२|| pr̥thagvātādinirdiṣṭahētuliṅgasamāgamē| tridōṣaṁ nirdiśēttēṣāṁ bhēṣajaṁ [24] śr̥ṇVātaḥ param||72|| pRuthagvAtAdinirdiShTahetuli~ggasamAgame| tridoShaM nirdishetteShAM bheShajaM [24] shRuNvataH param||72||

Sannipätaja grahaṇī occurs by simultaneous vitiation of vāta, pitta and kapha. In such conditions etiological factors, symptoms and signs are of all the three dōṣha appear. Hereafter treatment of grahaṇīdōṣha is expounded (72). Vamana in grahaṇīdōṣha: ग्रहणीमाश्रितं दोषं विदग्धाहारमूर्च्छितम्| सविष्टम्भप्रसेकार्तिविदाहारुचिगौरवैः||७३|| आमलिङ्गान्वितं दृष्ट्वा सुखोष्णेनाम्बुनोद्धरेत्| फलानां वा कषायेण पिप्पलीसर्षपैस्तथा||७४|| Grahaṇī māśritaṁ dōṣaṁ vidagdhāhāramūrcchitam| saviṣṭambhaprasēkārtividāhārucigauravaiḥ||73|| āmaliṅgānvitaṁ dr̥ṣṭvā sukhōṣṇēnāmbunōddharēt| phalānāṁ vā kaṣāyēṇa pippalīsarṣapaistathā||74|| grahaNImAshritaM doShaM vidagdhAhAramUrcchitam| saviShTambhaprasekArtividAhArucigauravaiH||73|| Amali~ggAnvitaM dRuShTvA sukhoShNenAmbunoddharet| phalAnAM vA kaShAyeNa pippalIsarShapaistathA||74||

When the dōṣhas are located in grahaṇī and are associated with incomplete digested food then viṣṭambha (constipation), excessive salivation, bodyache, burning sensation, anorexia and heaviness is felt by patient which are symptoms of ama and in such a condition vamana (emetic therapy) with lukewarm water or with decoction of madanphala (Randia spinosa), pippalī (Piper longum) and sarshapa (Brassica campestris) should be administered (73-74).

Treatment of līna dōṣha: लीनं पक्वाशयस्थं वाऽऽप्यामं स्राव्यं सदीपनैः| शरीरानुगते सामे रसे लङ्घनपाचनम्||७५|| līnaṁ pakvāśayasthaṁ vāpyāmaṁ srāvyaṁ sadīpanaiḥ| śarīrānugatē sāmē rasē laṅghanapācanam||75|| lInaM pakvAshayasthaM vA~a~apyAmaM srAvyaM sadIpanaiH| sharIrAnugate sAme rase la~gghanapAcanam||75||

If the ama is in pakvāśaya and in anutkliṣṭa (stuck, not ready to come out) condition then stravan (increasing secretion) with dīpana dravyas should be administered whereas if ama gets absorbed along with rasa dhātu and if it pervades throughout the body then laṅghana and pāchana should be advised (75). Pañcakōlādi sr̥tam peyā: विशुद्धामाशयायास्मै पञ्चकोलादिभिः शृतम्| दद्यात् पेयादि लघ्वन्नं पुनर्योगांश्च दीपनान्||७६|| viśuddhāmāśayāyāsmai pañcakōlādibhiḥ śr̥tam| dadyāt pēyādi laghvannaṁ punaryōgāṁśca dīpanān||76|| vishuddhAmAshayAyAsmai pa~jcakolAdibhiH shRutam| dadyAt peyAdi laghvannaM punaryogAMshca dIpanAn||76|| After cleansing of amāśhaya, liquid gruel of rice (peyā) fortified with panchakola etc. drugs should be administered. Light and easy to digest food along with dīpana drugs may be given (76).

ज्ञात्वा तु परिपक्वामं मारुतग्रहणीगदम्| दीपनीययुतं सर्पिः पाययेताल्पशो भिषक्||७७|| jñātvā tu paripakvāmaṁ mārutaGrahaṇī gadam| dīpanīyayutaṁ sarpiḥ pāyayētālpaśō bhiṣak||77|| j~jAtvA tu paripakvAmaM mArutagrahaNIgadam| dIpanIyayutaM sarpiH pAyayetAlpasho bhiShak||77||

In patients with vātaja grahaṇī after ascertaining that ama is digested, medicated ghee starting with very minimum quantity prepared from dīpanīya gana be administered [Ca.Su.4/9/6]- (77). Nirūha basti: किञ्चित्सन्धुक्षिते त्वग्नौ सक्तविण्मूत्रमारुतम्| द्व्यहं त्र्यहं वा संस्नेह्य स्विन्नाभ्यक्तं निरूहयेत्||७८|| kiñcitsandhukṣitē tvagnau saktaviṇmūtramārutam| dvyahaṁ tryahaṁ vā saṁsnēhya svinnābhyaktaṁ nirūhayēt||78|| ki~jcitsandhukShite tvagnau saktaviNmUtramArutam| dvyahaM tryahaM vA saMsnehya svinnAbhyaktaM nirUhayet||78||

As stimulation of agni is observed and still if patient finds difficulty in passing stool, urine and flatus then in such condition every two or three days nirūha basti should be administered after proper snehan and swedana (78). Virechana: तत एरण्डतैलेन सर्पिषा तैल्वकेन वा| सक्षारेणानिले शान्ते स्रस्तदोषं विरेचयेत्||७९|| tata ēraṇḍatailēna sarpiṣā tailvakēna vā| sakṣārēṇānilē śāntē srastadōṣaṁ virēcayēt||79|| tata eraNDatailena sarpiShA tailvakena vA| sakShAreNAnile shAnte srastadoShaM virecayet||79||

After nirūha, the strasta dōṣha (dōṣha ready to come out) should be cleaned with purgative drugs like eranda taila (castor oil) or tilvaka ghr̥ita mixed with kṣāra (medicine with alkaline nature) (79). Anuvasana basti: शुद्धं रूक्षाशयं बद्धवर्चसं चानुवासयेत्| दीपनीयाम्लवातघ्नसिद्धातैलेन मात्रया||८०|| śuddhaṁ rūkṣāśayaṁ baddhavarcasaṁ cānuvāsayēt| dīpanīyāmlaVātaghnasiddhātailēna mātrayā||80|| shuddhaM rUkShAshayaM baddhavarcasaM cAnuvAsayet| dIpanIyAmlavAtaghnasiddhAtailena mAtrayA||80||

After śhodhana of intestine if rūkṣātā and baddha (pellety) stools are seen then anuvāsana basti with taila fortified with dīpana drugs having sour and vāta alleviating action may be administered (80). निरूढं च विरिक्तं च सम्यक् चैवानुवासितम्| लघ्वन्नं प्रतिसम्भुक्तं सर्पिरभ्यासयेत् पुनः||८१|| nirūḍhaṁ ca viriktaṁ ca samyak caivānuvāsitam| laghvannaṁ pratisambhuktaṁ sarpirabhyāsayēt punaḥ||81|| nirUDhaM ca viriktaM ca samyak caivAnuvAsitam| laghvannaM pratisambhuktaM sarpirabhyAsayet punaH||81|| After appropriate administration of nirūha, virechan and anuvāsana, light diet should be taken daily and ghee should be taken repeatedly (81). Daśamūlādya ghr̥ita: द्वे पञ्चमूले सरलं देवदारु सनागरम्| पिप्पलीं पिप्पलीमूलं चित्रकं हस्तिपिप्पलीम्||८२|| शणबीजं यवान् कोलन् कुलत्थान् सुषवीं तथा [२७] | पाचयेदारनालेन दध्ना सौवीरकेण वा||८३|| चतुर्भागावशेषेण पचेत्तेन घृताढकम्| स्वर्जिकायावशूकाख्यौ क्षारौ दत्त्वा च युक्तितः||८४|| सैन्धवौद्भिदसामुद्रबिडानां रोमकस्य च| ससौवर्चलपाक्यानां भागान्द्विपलिकान् पृथक्||८५|| विनीय चूर्णितान् तस्मात् पाययेत् प्रसृतं बुधः| करोत्यग्निं बलं वर्णं वातघ्नं भुक्तपाचनम्||८६|| इति दशमूलाद्यं घृतम् dvē pañcamūlē saralaṁ dēvadāru sanāgaram| pippalīṁ pippalīmūlaṁ citrakaṁ hastipippalīm||82|| śaṇabījaṁ yavān kōlan kulatthān suṣavīṁ tathā [27] | pācayēdāranālēna dadhnā sauvīrakēṇa vā||83|| caturbhāgāvaśēṣēṇa pacēttēna ghr̥tāḍhakam| svarjikāyāvaśūkākhyau kṣārau dattvā ca yuktitaḥ||84|| saindhavaudbhidasāmudrabiḍānāṁ rōmakasya ca| sasauvarcalapākyānāṁ bhāgāndvipalikān pr̥thak||85|| vinīya cūrṇitān tasmāt pāyayēt prasr̥taṁ budhaḥ| karōtyAgniṁ balaṁ varṇaṁ Vātaghnaṁ bhuktapācanam||86|| iti daśamūlādyaṁ ghr̥tam dve pa~jcamUle saralaM devadAru sanAgaram| pippalIM pippalImUlaM citrakaM hastipippalIm||82|| shaNabIjaM yavAn kolan kulatthAn suShavIM tathA [27] | pAcayedAranAlena dadhnA sauvIrakeNa vA||83|| caturbhAgAvasheSheNa pacettena ghRutADhakam| svarjikAyAvashUkAkhyau kShArau dattvA ca yuktitaH||84|| saindhavaudbhidasAmudrabiDAnAM romakasya ca| sasauvarcalapAkyAnAM bhAgAndvipalikAn pRuthak||85|| vinIya cUrNitAn tasmAt pAyayet prasRutaM budhaH| karotyagniM balaM varNaM vAtaghnaM bhuktapAcanam||86|| iti dashamUlAdyaM ghRutam Boil the svarasa of two pañchamūla (bruhat and laghu), sarala [(trivrita) Operculina turpethum], dēvadāru (Cedrus deodara), nāgara (Zingiber officinale), pippalī (Piper longum), pippalīmula, chitraka [Plumbago zeylanica], gajapippalī (Piper retofractum), saṇabīja (seeds of Crotalaria juncea), barley, kōla, kulatta and susavi [Woodfordia fruticosa] with aranāla, dadhimanda or sauvīraka. After one fourth reductions add one aḍhaka (3.073 kg) of ghee and svarjikākṣāra and yāvaśūkākṣāra as per yukti prāmana i.e. either in small quantity or at the time of ghr̥ita siddhi lakshana alongwith saindhava (rock salt), audbhida (salts derived from plants), sāmudra (table salt), biḍā (red granular salt), rōmaka, sauvarcala and pākya (pakaja) types of salt in two pala quantity each [96 gm each]. After preparation, it may be administered up to one prasr̥ta i.e. 96 gm. It increases agni, strength and complexion and helps in alleviation of vāta and thus digestion of food (82-86). Tryūṣaṇādya ghr̥ita: त्र्यूषणत्रिफलाकल्के बिल्वमात्रे गुडात् पले| सर्पिषोऽष्टपलं पक्त्वा मात्रां मन्दानलः पिबेत्||८७|| इति त्र्यूषणाद्यं घृतम् tryūṣaṇatriphalākalkē bilvamātrē guḍāt palē| sarpiṣō'ṣṭapalaṁ paktvā mātrāṁ mandānalaḥ pibēt||87|| iti tryūṣaṇādyaṁ ghr̥tam tryUShaNatriphalAkalke bilvamAtre guDAt pale| sarpiSho~aShTapalaM paktvA mAtrAM mandAnalaH pibet||87|| iti tryUShaNAdyaM ghRutam Prepare paste of trikatu and triphala in quantity of one bilva and add one pala (48g) of jaggery and do sneha siddhi by adding eight palas (384 gm) of ghee. This medicated ghr̥ita is indicated in mandāgni i.e. low digestive power (87). Pañchamūlādya ghr̥ita and chūrṇa: पञ्चमूलाभयाव्योषपिप्पलीमूलसैन्धवैः| रास्नाक्षारद्वयाजाजीविडङ्गशटिभिर्घृतम्||८८|| शुक्तेन मातुलुङ्गस्य स्वरसेनार्द्रकस्य च| शुष्कमूलककोलाम्बुचुक्रिकादाडिमस्य च||८९|| तक्रमस्तुसुरामण्डसौवीरकतुषोदकैः| काञ्जिकेन च तत् पक्वमग्निदीप्तिकरं परम्||९०|| शूलगुल्मोदरश्वासकासानिलकफापहम्| सबीजपूरकरसं सिद्धं वा पाययेद्घृतम्||९१|| सिद्धमभ्यञ्जनार्थं च तैलमेतैः प्रयोजयेत्| एतेषामौषधानां वा पिबेच्चूर्णं सुखाम्बुना||९२|| वाते श्लेष्मावृते सामे कफे वा वायुनोद्धते| दद्याच्चूर्णं पाचनार्थमग्निसन्दीपनं परम्||९३|| इति पञ्चमूलाद्यं घृतं चूर्णं च pañcamūlābhayāvyōṣapippalīmūlasaindhavaiḥ| rāsnākṣāradvayājājīviḍaṅgaśaṭibhirghr̥tam||88|| śuktēna mātuluṅgasya svarasēnārdrakasya ca| śuṣkamūlakakōlāmbucukrikādāḍimasya ca||89|| takrāmastusurāmaṇḍasauvīrakatuṣōdakaiḥ| kāñjikēna ca tat pakvāmAgnidīptikaraṁ param||90|| śūlagulmōdaraśvāsakāsānilakaphāpaham| sabījapūrakarasaṁ siddhaṁ vā pāyayēdghr̥tam||91|| siddhāmabhyañjanārthaṁ ca tailamētaiḥ prayōjayēt| ētēṣāmauṣadhānāṁ vā pibēccūrṇaṁ sukhāmbunā||92|| vātē ślēṣmāvr̥tē sāmē kaphē vā Vātanōddhatē| dadyāccūrṇaṁ pācanārthāmAgnisandīpanaṁ param||93|| iti pañcamūlādyaṁ ghr̥taṁ cūrṇaṁ ca pa~jcamUlAbhayAvyoShapippalImUlasaindhavaiH| rAsnAkShAradvayAjAjIviDa~ggashaTibhirghRutam||88|| shuktena mAtulu~ggasya svarasenArdrakasya ca| shuShkamUlakakolAmbucukrikAdADimasya ca||89|| takramastusurAmaNDasauvIrakatuShodakaiH| kA~jjikena ca tat pakvamagnidIptikaraM param||90|| shUlagulmodarashvAsakAsAnilakaphApaham| sabIjapUrakarasaM siddhaM vA pAyayedghRutam||91|| siddhamabhya~jjanArthaM ca tailametaiH prayojayet| eteShAmauShadhAnAM vA pibeccUrNaM sukhAmbunA||92|| vAte shleShmAvRute sAme kaphe vA vAyunoddhate| dadyAccUrNaM pAcanArthamagnisandIpanaM param||93|| iti pa~jcamUlAdyaM ghRutaM cUrNaM ca Make paste of pañchamūlā [bilva, shyonaka, gambhari, patala and gambharika], abhayā. trikatu, pippalīmūla, saindhava, rāsnā, two kṣāra [sarjika and yavakṣāra], ajājī, viḍaṅga and saṭi, and prepare medicated ghee with sukta, juice of mātuluṅga and ardraka, suṣkamūlaka, kōlāmbu, cukrikā, pomengranate, butter milk, mastu (supplement liquid portion in the curd/yoghurt), surāmaṇḍa (indigenous beer beverage prepared from fermented cereals) sauvīraka (acidic fermented liquid obtained from wheat), tuṣōdaka (fermented liquid using the coarse grains of barley) and kāñji (fermented liquid). The medicated ghee helps in digestion and increase strength of agni and cures colicky pain, gulma, udara, asthāma and cough. It also pacifies vāta and kapha. Bījapūraka svaras can also be used for sneha siddhi. Taila siddhi with above medicine may be used for abhyañga (massage) and the chūrṇa used in above preparation may be taken with lukewarm water. In condition such as kapha Āvr̥tē vāta (vata occluded by kapha), sāma kapha and vāta aggravated due to kapha give the above chūrṇa for digestion and to stimulate agni. The medicine is known as Pañcamūlādyaṁ ghr̥itaṁ chūrṇaṁ (88-93). Examination of faeces: मज्जत्यामा गुरुत्वाद्विट् पक्वा तूत्प्लवते जले| विनाऽतिद्रवसङ्घातशैत्यश्लेष्मप्रदूषणात्||९४|| majjatyāmā gurutvādviṭ pakvā tūtplavatē jalē| vinā'tidravasaṅghātaśaityaślēṣmapradūṣaṇāt||94|| majjatyAmA gurutvAdviT pakvA tUtplavate jale| vinA~atidravasa~gghAtashaityashleShmapradUShaNAt||94|| Sāma mala (stools) sinks into water due to gurutva (heaviness) of ama whereas pakva or nirāma mala floats over the water; provided the stools consistency is not watery or not very compact and if not vitiated by sīta guna and kapha (94). परीक्ष्यैवं पुरा सामं निरामं चामदोषिणम्| विधिनोपाचरेत् सम्यक् पाचनेनेतरेण वा||९५|| parīkṣyaivaṁ purā sāmaṁ nirāmaṁ cāmadōṣiṇam| vidhinōpācarēt samyak pācanēnētarēṇa vā||95|| parIkShyaivaM purA sAmaM nirAmaM cAmadoShiNam| vidhinopAcaret samyak pAcanenetareNa vA||95|| Patient should be evaluated for amadōṣa whether sāmatā or nirāmtā is present or not and then appropriately treated with pāchana etc. treatment (95). Citrakādyā guṭikā: चित्रकं पिप्पलीमूलं द्वौ क्षारौ लवणानि च| व्योषं हिङ्ग्वजमोदां च चव्यं चैकत्र चूर्णयेत्||९६|| गुटिका मातुलुङ्गस्य दाडिमस्य रसेन वा| कृता विपाचयत्यामं दीपयत्याशु चानलम्||९७|| इति चित्रकाद्या गुटिका citrakaṁ pippalīmūlaṁ dvau kṣārau lavaṇāni ca| vyōṣaṁ hiṅgvajamōdāṁ ca cavyaṁ caikatra cūrṇayēt||96|| guṭikā mātuluṅgasya dāḍimasya rasēna vā| kr̥tā vipācayatyāmaṁ dīpayatyāśu cālanam||97|| iti citrakādyā guṭikā citrakaM pippalImUlaM dvau kShArau lavaNAni ca| vyoShaM hi~ggvajamodAM ca cavyaM caikatra cUrNayet||96|| guTikA mAtulu~ggasya dADimasya rasena vA| kRutA vipAcayatyAmaM dIpayatyAshu cAlanam||97|| iti citrakAdyA guTikA

Chitraka, pippalīmūla, two kṣāra (yavakṣāra and sarjikṣāra), salt, trikatu, hiṅgu, ajamōdā and chavya are mixed together and trichurated with either mātuluṅga svarasa or dāḍima svarasa and tablets are prepared. This chitrakādyā guṭi is useful for digestion of ama and stimulation of the agni (96-97). Recipes for pāchana of ama: नागरातिविषामुस्तक्वाथः स्यादामपाचनः| मुस्तान्तकल्कः पथ्या वा नागरं चोष्णवारिणा||९८|| nāgarātiviṣāmustakvāthaḥ syādāmapācanaḥ| mustāntakalkaḥ pathyā vā nāgaraṁ cōṣṇavāriṇā||98|| nAgarAtiviShAmustakvAthaH syAdAmapAcanaH| mustAntakalkaH pathyA vA nAgaraM coShNavAriNA||98||

Shunthi, ativiṣā and musta decoction helps in pāchana of ama. Kalka (paste) of shunthi, ativiṣā and mustā or haritaki or shunthi alongwith warm water also does ama pāchana (98). देवदारुवचामुस्तनागरातिविषाभयाः| वारुण्यामासुतास्तोये कोष्णे वाऽलवणाः पिबेत्||९९|| वर्चस्यामे सशूले च पिबेद्वा दाडिमाम्बुना| dēvadāruvacāmustanāgarātiviṣābhayāḥ| vāruṇyāmāsutāstōyē kōṣṇē vā'lavaṇāḥ pibēt||99|| varcasyāmē saśūlē ca pibēdvā dāḍimāmbunā| devadAruvacAmustanAgarAtiviShAbhayAH| vAruNyAmAsutAstoye koShNe vA~alavaNAH pibet||99|| varcasyAme sashUle ca pibedvA dADimAmbunA|

Soak powder of dēvadāru, vacā, musta, nāgara, ativiṣā and haritaki in vāruṇi (fermented liquid obtained from palm trees like dates) and take with warm water without adding salt or be taken with juice of dāḍima in condition wherein there is colicky pain along with mucus or undigested food in stool (99-99½) विडेन [२९] लवणं पिष्टं बिल्वं चित्रकनागरम्||१००|| सामे वा सकफे वाते कोष्ठशूलकरे पिबेत्| viḍēna [29] lavaṇaṁ piṣṭaṁ bilvaṁ citrakanāgaram||100|| sāmē vā sakaphē vātē kōṣṭhaśūlakarē pibēt| Paste of bilva, chitraka and nāgara should be added with vida lavana and administered in sāma stool or mucus in stool and pain in abdomen due to vāta aggravation (100).

कलिङ्गहिङ्ग्वतिविषावचासौवर्चलाभयाः||१०१|| छर्द्यर्शोग्रन्थिशूलेषु पिबेदुष्णेन वारिणा| पथ्यासौवर्चलाजाजीचूर्णं मरिचसंयुतम्||१०२|| kaliṅgahiṅgvativiṣāvacāsauvarcalābhayāḥ||101|| chardyarśōgranthiśūlēṣu pibēduṣṇēna vāriṇā| pathyāsauvarcalājājīcūrṇaṁ maricasaṁyutam||102|| viDena [29] lavaNaM piShTaM bilvaM citrakanAgaram||100|| sAme vA sakaphe vAte koShThashUlakare pibet| kali~ggahi~ggvativiShAvacAsauvarcalAbhayAH||101|| chardyarshogranthishUleShu pibeduShNena vAriNA| pathyAsauvarcalAjAjIcUrNaM maricasaMyutam||102||

Kaliṅga, hiṅgu, ativiṣā, vacā, sauvarchala and haritaki with warm water is useful in vomiting, arśōgranthi (analpolyp with pellet stool) and pain in abdomen. Similarly, combination of haritaki, sauvarcala and ajājī alongwith maricha can be used for same condition (101-102). Recipe for pitta-kapha grahani: अभयां पिप्पलीमूलं वचां कटुकरोहिणीम्| पाठां वत्सकबीजानि चित्रकं विश्वभेषजम्||१०३|| पिबेन्निष्क्वाथ्य चूर्णं वा कृत्वा कोष्णेन वारिणा| पित्तश्लेष्माभिभृतायां ग्रहण्यां शूलनुद्धितम्||१०४|| abhayāṁ pippalīmūlaṁ vacāṁ kaṭukarōhiṇīm| pāṭhāṁ vatsakabījāni citrakaṁ viśvabhēṣajam||103|| pibēnniṣkvāthya cūrṇaṁ vā kr̥tvā kōṣṇēna vāriṇā| Pitta ślēṣmābhibhr̥tāyāṁ grahaṇyāṁ śūlanuddhitam||104|| abhayAM pippalImUlaM vacAM kaTukarohiNIm| pAThAM vatsakabIjAni citrakaM vishvabheShajam||103|| pibenniShkvAthya cUrNaM vA kRutvA koShNena vAriNA| pittashleShmAbhibhRutAyAM grahaNyAM shUlanuddhitam||104||

Decoction of the haritaki, pippalīmūla, vacā, kaṭukarōhiṇīm, pāṭhā, seeds of kutaj, chitraka, viśvabhēṣaja (sunthi) or chūrṇa of the above contents should be administered with warm water. It is helpful when colic pain is associated with pitta-kapha dominant grahani (103-104). सामे सातिविषं व्योषं लवणक्षारहिङ्गु च| निःक्वाथ्य पाययेच्चूर्णं कृत्वा वा कोष्णवारिणा||१०५|| sāmē sātiviṣaṁ vyōṣaṁ lavaṇakṣārahiṅgu ca| niḥkvāthya pāyayēccūrṇaṁ kr̥tvā vā kōṣṇavāriṇā||105|| sAme sAtiviShaM vyoShaM lavaNakShArahi~ggu ca| niHkvAthya pAyayeccUrNaM kRutvA vA koShNavAriNA||105||

In ama condition, decoction of ativiṣā, trikatu, lavana, kṣāra (yavakṣāra) and hingu may be given or powders of above medicines with warm water may be administered (105). पिप्पलीं नागरं पाठां सारिवां बृहतीद्वयम्| चित्रकं कौटजं बीजं लवणान्यथ पञ्च च||१०६|| तच्चूर्णं सयवक्षारं दध्युष्णाम्बुसुरादिभिः| पिबेदग्निविवृद्ध्यर्थं कोष्ठवातहरं नरः||१०७|| pippalīṁ nāgaraṁ pāṭhāṁ sārivāṁ br̥hatīdvayam| citrakaṁ kauṭajaṁ bījaṁ lavaṇānyatha pañca ca||106|| taccūrṇaṁ sayavakṣāraṁ dadhyuṣṇāmbusurādibhiḥ| pibēdAgnivivr̥ddhyarthaṁ kōṣṭhaVātaharaṁ naraḥ||107|| pippalIM nAgaraM pAThAM sArivAM bRuhatIdvayam| citrakaM kauTajaM bIjaM lavaNAnyatha pa~jca ca||106|| taccUrNaM sayavakShAraM dadhyuShNAmbusurAdibhiH| pibedagnivivRuddhyarthaM koShThavAtaharaM naraH||107||

Chūrṇa of pippalī, nāgara, pāṭhā, sārivā, br̥hatīdvayam [bruhati, kantakari] chitraka, seeds of kutaj, five types of lavana alongwith yavakṣāra, curd, hot water and different types of fermented liquids such as kānji, sauvīraka etc is taken for increasing the power of agni and to eliminate the vāta in abdomen (106-107). Maricādya chūrṇa: मरिचं कुञ्चिकाम्बष्ठावृक्षाम्लाः कुडवाः पृथक्| पलानि [३०] दश चाम्लस्य वेतसस्य पलार्धिकम्||१०८|| सौवर्चलं बिडं पाक्यं यवक्षारः ससैन्धवः| शटीपुष्करमूलानि हिङ्गु हिङ्गुशिवाटिका||१०९|| तत् सर्वमेकतः सूक्ष्मं चूर्णं कृत्वा प्रयोजयेत्| हितं वाताभिभूतायां ग्रहण्यामरुचौ तथा||११०|| इति मरिचाद्यं चूर्णम् maricaṁ kuñcikāmbaṣṭhāvr̥kṣāmlāḥ kuḍavāḥ pr̥thak| palāni [30] daśa cāmlasya vētasasya palārdhikam||108|| sauvarcalaṁ biḍaṁ pākyaṁ yavakṣāraḥ sasaindhavaḥ| śaṭīpuṣkaramūlāni hiṅgu hiṅguśivāṭikā||109|| tat sarvamēkataḥ sūkṣmaṁ cūrṇaṁ kr̥tvā prayōjayēt| hitaṁ vātābhibhūtāyāṁ grahaṇyāmarucau tathā||110|| iti maricādyaṁ cūrṇam maricaM ku~jcikAmbaShThAvRukShAmlAH kuDavAH pRuthak| palAni [30] dasha cAmlasya vetasasya palArdhikam||108|| sauvarcalaM biDaM pAkyaM yavakShAraH sasaindhavaH| shaTIpuShkaramUlAni hi~ggu hi~ggushivATikA||109|| tat sarvamekataH sUkShmaM cUrNaM kRutvA prayojayet| hitaM vAtAbhibhUtAyAM grahaNyAmarucau tathA||110|| iti maricAdyaM cUrNam Maricādyaṁ chūrṇam contains one kudava (192 gm) of maricha, kuñcikā, ambaṣṭhā (pāṭhā), vr̥kṣāmlāḥ, ten pala (480 gm) of amlavetas, half pala (24 gm) each of sauvarcala, biḍa, pākya, yavakṣāra, saindhava, saṭī, puṣkaramūlā, hiṅgu and hiṅguśivāṭikā (vamsapatri). It is useful in vāta dominant grahaṇī and anorexia (108-110).

चतुर्णां प्रस्थमम्लानां त्र्यूषणस्य पलत्रयम्| लवणानां च चत्वारि शर्करायाः पलाष्टकम्| सञ्चूर्ण्य शाकसूपान्नरागादिष्ववचारयेत्||१११|| कासाजीर्णारुचिश्वासाहृत्पाण्ड्वामयशूलनुत्| caturṇāṁ prasthāmamlānāṁ tryūṣaṇasya palatrayam| lavaṇānāṁ ca catvāri śarkarāyāḥ palāṣṭakam| sañcūrṇya śākasūpānnarāgādiṣvavacārayēt||111|| kāsājīrṇāruciśvāsāhr̥tpāṇḍvāmayaśūlanut| caturNAM prasthamamlAnAM tryUShaNasya palatrayam| lavaNAnAM ca catvAri sharkarAyAH palAShTakam| sa~jcUrNya shAkasUpAnnarAgAdiShvavacArayet||111|| kAsAjIrNArucishvAsAhRutpANDvAmayashUlanut|

Make powder of one prastha (768 gm) of four amla drugs, three pala (144 gm) of trikatu, four pala (192 gm) of lavana (saindhava) and eight pala (384 gm) of sugar and mix together. It is to be taken with vegetable preparations such as soup cooked food and rāga for cure of cough, indigestion, anorexia, dyspnea, heart disease, anemia and pain in abdomen (111).

Five types of yavāgu: चव्यत्वक्पिप्पलीमूलधातकीव्योषचित्रकान्||११२|| कपित्थं बिल्वमम्बष्ठां शाल्मलं हस्तिपिप्पलीम्| शिलोद्भेदं तथाऽजाजीं पिष्ट्वा बदरसम्मितम्||११३|| परिभर्ज्य घृते दध्ना यवागूं साधयेद्भिषक्| रसैः कपित्थचुक्रीकावृक्षाम्लैर्दाडिमस्य च||११४|| सर्वातिसारग्रहणीगुल्मार्शःप्लीहनाशिनी| cavyatvakpippalīmūladhātakīvyōṣacitrakān||112|| kapitthaṁ bilvāmambaṣṭhāṁ śālmalaṁ hastipippalīm| śilōdbhēdaṁ tathā'jājīṁ piṣṭvā badarasammitam||113|| paribharjya ghr̥tē dadhnā yavāgūṁ sādhayēdbhiṣak| rasaiḥ kapitthacukrīkāvr̥kṣāmlairdāḍimasya ca||114|| sarvātisāragrahaṇī gulmārśaḥplīhanāśinī| cavyatvakpippalImUladhAtakIvyoShacitrakAn||112|| kapitthaM bilvamambaShThAM shAlmalaM hastipippalIm| shilodbhedaM tathA~ajAjIM piShTvA badarasammitam||113|| paribharjya ghRute dadhnA yavAgUM sAdhayedbhiShak| rasaiH kapitthacukrIkAvRukShAmlairdADimasya ca||114|| sarvAtisAragrahaNIgulmArshaHplIhanAshinI| Make paste of chavya, tvak, pippalīmūla, dhātakī, trikatu, chitraka, kapittha, bilva, pāṭhā, sālmali, gajapippalī, slōdbhēda (shilajeet) and ajājī, each taken in quantity equal to badara (about 6 gm). Fry it in ghee and prepare yavāgu by adding curd or svarasa of kapittha or cukrikā or vr̥kshāmla or dāadima. It helps in curing all types of atisāra, grahaṇī, gulma, arśa and plīhā disease (112-114). Drink preparations: पञ्चकोलकयूषश्च मूलकानां च सोषणः||११५|| स्निग्धो दाडिमतक्राम्लो जाङ्गलः संस्कृतो रसः| क्रव्यादस्वरसः शस्तो भोजनार्थे सदीपनः||११६|| तक्रारनालमद्यानि पानायारिष्ट एव च| pañcakōlakayūṣaśca mūlakānāṁ ca sōṣaṇaḥ||115|| snigdhō dāḍimatakrāmlō jāṅgalaḥ saṁskr̥tō rasaḥ| kravyādasvarasaḥ śastō bhōjanārthē sadīpanaḥ||116|| takrāranālāmadyāni pānāyāriṣṭa ēva ca| pa~jcakolakayUShashca mUlakAnAM ca soShaNaH||115|| snigdho dADimatakrAmlo jA~ggalaH saMskRuto rasaH| kravyAdasvarasaH shasto bhojanArthe sadIpanaH||116|| takrAranAlamadyAni pAnAyAriShTa eva ca| Fortified soup with pañchakōla or soup of mulaka with maricha or medicated soup prepared from animals inhabiting in arid land added with ghee, dāḍima, takra, amla dravyas or soup of animals that eat other animals fortified with medicines having dīpana qualities be given for drink. Patient may be given buttermilk, āranāla (sour drink), madya (medicated alcohol) and ariṣṭa as liquid diets (115-116).

Qualities of buttermilk: तक्रं तु ग्रहणीदोषे दीपनग्राहिलाघवात्||११७|| श्रेष्ठं मधुरपाकित्वान्न च पित्तं प्रकोपयेत्| कषायोष्णविकाशित्वाद्रौक्ष्याच्चैव कफे हितम्||११८|| वाते स्वाद्वम्लसान्द्रत्वात् सद्यस्कमविदाहि तत्| तस्मात् तक्रप्रयोगा ये जठराणां तथाऽर्शसाम्||११९|| विहिता ग्रहणीदोषे सर्वशस्तान् प्रयोजयेत्| takraṁ tu Grahaṇī dōṣē dīpanagrāhilāghavāt||117|| śrēṣṭhaṁ madhurapākitvānna ca Pittaṁ prakōpayēt| kaṣāyōṣṇavikāśitvādraukṣyāccaiva kaphē hitam||118|| vātē svādvamlasāndratvāt sadyaskāmavidāhi tat| tasmāt takraprayōgā yē jaṭharāṇāṁ tathā'rśasām||119|| vihitā Grahaṇī dōṣē sarvaśastān prayōjayēt|

takraM tu grahaNIdoShe dIpanagrAhilAghavAt||117|| shreShThaM madhurapAkitvAnna ca pittaM prakopayet| kaShAyoShNavikAshitvAdraukShyAccaiva kaphe hitam||118|| vAte svAdvamlasAndratvAt sadyaskamavidAhi tat| tasmAt takraprayogA ye jaTharANAM tathA~arshasAm||119|| vihitA grahaNIdoShe sarvashastAn prayojayet|

Buttermilk due to its dīpana, grāhi (substances which increases appetite and digestive power and absorb fluid from the stool) and easy to digest actions is very useful in grahaṇīdōṣha. It is madhura in vipāka therefore reduces pitta; due to kaṣāya (astringent) taste, uṣṇa virya (hot potency), vikāśi and ruksha guna it is useful in kapha dominated disorders and due to madhura and amla rasa, sāndra guna it reduces vāta. Freshly churned butter milk does not cause burning sensation; therefore, buttermilk is very useful in treatment of udara, arśa and all grahaṇīdōṣha (117-119). Takrāriṣṭa: यवान्यामलके पथ्या मरिचं त्रिपलंशिकम्||१२०|| लवणानि पलांशानि पञ्च चैकत्र चूर्णयेत्| तक्रे तदासुतं [३१] जातं तक्रारिष्टं पिबेन्नरः| दीपनं शोथगुल्मार्शःक्रिमिमेहोदरापहम्||१२१|| इति तक्रारिष्टः yavānyāmalakē pathyā maricaṁ tripalaṁśikam||120|| lavaṇāni palāṁśāni pañca caikatra cūrṇayēt| takrē tadāsutaṁ [31] jātaṁ takrāriṣṭaṁ pibēnnaraḥ| dīpanaṁ śōthagulmārśaḥkrimimēhōdarāpaham||121|| iti takrāriṣṭaḥ yavAnyAmalake pathyA maricaM tripalaMshikam||120|| lavaNAni palAMshAni pa~jca caikatra cUrNayet| takre tadAsutaM [31] jAtaM takrAriShTaM pibennaraH| dIpanaM shothagulmArshaHkrimimehodarApaham||121|| iti takrAriShTaH Take yavāni, amalaki, haritaki and maricha each in three pala (144 gm) and pancha-lavana in one pala (48 gm) and powder together and add buttermilk to it and ferment till sour taste is obtained. This preparation called takrāriṣṭa stimulates the digestive power and relieves sōtha, gulma, arśa, krimi, prameha and udara roga (120-121). Management of pitta dominant grahani: स्वस्थानगतमुत्क्लिष्टमग्निनिर्वापकं भिषक्| पित्तं ज्ञात्वा विरेकेण निर्हरेद्वमनेन वा||१२२|| svasthānagatamutkliṣṭāmAgninirvāpakaṁ bhiṣak| Pittaṁ jñātvā virēkēṇa nirharēdvāmanēna vā||122||

svasthAnagatamutkliShTamagninirvApakaM bhiShak| 

pittaM j~jAtvA virekeNa nirharedvamanena vA||122||

If agnimāndyata is due to utkliṣṭa (ready to come out) pitta in its own place then in such a situation virechana or vāmana should be administered for removal of pitta (122). Diet after shodhana: अविदाहिभिरन्नैश्च लघुभिस्तिक्तसंयुतैः| जाङ्गलानां रसैर्यूषैर्मुद्गादीनां खडैरपि||१२३|| दाडिमाम्लैः ससर्पिष्कैर्दीपनग्राहिसंयुतैः| तस्याग्निं दीपयेच्चूर्णैः सर्पिर्भिश्चापि तिक्तकैः||१२४|| avidāhibhirannaiśca laghubhistiktasaṁyutaiḥ| jāṅgalānāṁ rasairyūṣairmudgādīnāṁ khaḍairapi||123|| dāḍimāmlaiḥ sasarpiṣkairdīpanagrāhisaṁyutaiḥ| tasyāgniṁ dīpayēccūrṇaiḥ sarpirbhiścāpi tiktakaiḥ||124|| avidAhibhirannaishca laghubhistiktasaMyutaiH| jA~ggalAnAM rasairyUShairmudgAdInAM khaDairapi||123|| dADimAmlaiH sasarpiShkairdIpanagrAhisaMyutaiH| tasyAgniM dIpayeccUrNaiH sarpirbhishcApi tiktakaiH||124|| After proper shodhana, diet which does not cause burning sensation, which is easy to digest and added with ingredients having bitter taste should be taken. Soup of animals of arid zone, soup of cereals such as mudga etc and khada should be given. Pomegranate having sour taste should be taken alongwith ghee, dīpana and grahi dravyas. With help of powders of dīpaniya drugs and ghee fortified with bitter drugs, the digestive power should be increased (123-124). Chandanādya ghr̥ita: चन्दनं पद्मकोशीरं पाठां मूर्वां कुटन्नटम्| षड्ग्रन्थासारिवास्फोतासप्तपर्णाटरूषकान्||१२५|| पटोलोदुम्बराश्वत्थवटप्लक्षकपीतनान्| कटुकां रोहिणीं मुस्तं निम्बं च द्विपलांशिकम्||१२६|| द्रोणेऽपां साधयेत् पादशेषे प्रस्थं घृतात् पचेत्| किराततिक्तेन्द्रयववीरामागधिकोत्पलैः||१२७|| कल्कैरक्षसमैः पेयं तत् पित्तग्रहणीगदे| इति चन्दनाद्यं घृतम् candanaṁ padmakōśīraṁ pāṭhāṁ mūrvāṁ kuṭannaṭam| ṣaḍgranthāsārivāsphōtāsaptaparṇāṭarūṣakān||125|| paṭōlōdumbarāśvatthavaṭaplakṣakapītanān| kaṭukāṁ rōhiṇīṁ mustaṁ nimbaṁ ca dvipalāṁśikam||126|| drōṇē'pāṁ sādhayēt pādaśēṣē prasthaṁ ghr̥tāt pacēt| kirātatiktēndrayavavīrāmāgadhikōtpalaiḥ||127|| kalkairakṣasāmaiḥ pēyaṁ tat Pitta Grahaṇī gadē| iti candanādyaṁ ghr̥tam candanaM padmakoshIraM pAThAM mUrvAM kuTannaTam| ShaDgranthAsArivAsphotAsaptaparNATarUShakAn||125|| paTolodumbarAshvatthavaTaplakShakapItanAn| kaTukAM rohiNIM mustaM nimbaM ca dvipalAMshikam||126|| droNe~apAM sAdhayet pAdasheShe prasthaM ghRutAt pacet| kirAtatiktendrayavavIrAmAgadhikotpalaiH||127|| kalkairakShasamaiH peyaM tat pittagrahaNIgade| iti candanAdyaM ghRutam Take 2 pala (96 gm) each of chandana, padmaka, uśīra, pāṭhā, mūrvā, kuṭannaṭa (kaivarta musta), ṣaḍgranthā (vaca), sārivā, asphōtā (aspurmallika), saptaparṇā, aṭarūṣakān (vasa), paṭōla, udumbarā, aśvattha, vata, plaksa, kapītana (gandha musta), kaṭuki, musta and nimba and prepare decoction by adding one drōna (12.228 Kg) of water with 1/4th reduction. ghr̥ita siddhi is done adding one prastha (96 gm) of ghee to the above decoction and paste of one aksa (12 gm) each of kirātatikta, indrayava, virā, pippalī and utpala is added. This medicated ghee is known as chandanadya ghr̥ita and is indicated in pittaja grahaṇī (125-127).

तिक्तकं यद्घृतं चोक्तं कौष्ठिके तच्च दापयेत्||१२८|| 

tiktakaṁ yadghr̥taṁ cōktaṁ kauṣṭhikē tacca dāpayēt||128||

Tikta ghr̥ita as mentioned in kushtha adhyāya [Ca.Ci.7/140-150] may also be prescribed in pittaja grahaṇī (128). Nāgarādya chūrṇa: नागरातिविषे मुस्तं धातकीं च रसाञ्जनम्| वत्सकत्वक्फलं बिल्वं पाठां कटुकरोहिणीम्||१२९|| पिबेत् समांशं तच्चूर्णं सक्षौद्रं तण्डुलाम्बुना| पैत्तिके ग्रहणीदोषे रक्तं यच्चोपवेश्यते||१३०|| अर्शांसि च गुदे शूलं जयेच्चैव प्रवाहिकाम्| नागराद्यमिदं चूर्णं कृष्णात्रेयेण पूजितम्||१३१|| इति नागराद्यं चूर्णम् nāgarātiviṣē mustaṁ dhātakīṁ ca rasāñjanam| vatsakatvakphalaṁ bilvaṁ pāṭhāṁ kaṭukarōhiṇīm||129|| pibēt samāṁśaṁ taccūrṇaṁ sakṣaudraṁ taṇḍulāmbunā| paittikē Grahaṇī dōṣē raktaṁ yaccōpavēśyatē||130|| arśāṁsi ca gudē śūlaṁ jayēccaiva pravāhikām| nāgarādyamidaṁ cūrṇaṁ kr̥ṣṇātrēyēṇa pūjitam||131|| iti nāgarādyaṁ cūrṇam nAgarAtiviShe mustaM dhAtakIM ca rasA~jjanam| vatsakatvakphalaM bilvaM pAThAM kaTukarohiNIm||129|| pibet samAMshaM taccUrNaM sakShaudraM taNDulAmbunA| paittike grahaNIdoShe raktaM yaccopaveshyate||130|| arshAMsi ca gude shUlaM jayeccaiva pravAhikAm| nAgarAdyamidaM cUrNaM kRuShNAtreyeNa pUjitam||131|| iti nAgarAdyaM cUrNam Take equal quantity of nāgara, ativiṣā, mustā, dhātakī, rasāñjan, bark and fruit of vatsaka, bilva, pāṭhā and katuki and powder together, is known as nāgarādya chūrṇa explained by kr̥ṣṇātrēyēṇa. It is to be taken along with honey and tandulōdak (rice water, prepared cold) by patient suffering from paittika grahaṇī with bloody stools; hemorrhoids, pain in anal area and dysentery. (129-131) Bhūnimbādya chūrṇa: भूनिम्बकटुकाव्योषमुस्तकेन्द्रयवान् समान्| द्वौ चित्रकाद्वत्सकत्वग्भागान् षोडश चूर्णयेत्||१३२|| गुडशीताम्बुना पीतं ग्रहणीदोषगुल्मनुत्| कामलाज्वरपाण्डुत्वमेहारुच्यतिसारनुत्||१३३|| इति भूनिम्बाद्यं चूर्णम् bhūnimbakaṭukāvyōṣamustakēndrayavān samān| dvau citrakādvatsakatvagbhāgān ṣōḍaśa cūrṇayēt||132|| guḍaśītāmbunā pītaṁ Grahaṇī dōṣagulmanut| kāmalājvarapāṇḍutvamēhārucyatisāranut||133|| iti bhūnimbādyaṁ cūrṇam bhUnimbakaTukAvyoShamustakendrayavAn samAn| dvau citrakAdvatsakatvagbhAgAn ShoDasha cUrNayet||132|| guDashItAmbunA pItaM grahaNIdoShagulmanut| kAmalAjvarapANDutvamehArucyatisAranut||133|| iti bhUnimbAdyaM cUrNam Bhūnimba, kutaki, trikatu, musta and indrayava are taken in equal quantity. Two parts of chitraka and 16 parts of bark and vatsaka are taken together and powdered. The combination is called as bhūnimbādya chūrṇa is advised with jaggery and cold water as anupana in grahaṇī doṣha, gulma, kāmalā, jwara, pāṇḍu, pramēhā, aruchi and atisāra (132-133). वचामतिविषां पाठां सप्तपर्णं रसाञ्जनम्| स्योनाकोदीच्यकट्वङ्गवत्सकत्वग्दुरालभाः||१३४|| दार्वीं पर्पटकं पाठां यवानीं मधुशिग्रुकम्| पटोलपत्रं सिद्धार्थान् यूथिकां जातिपल्लवान्||१३५|| जम्ब्वाम्रबिल्वमध्यानि निम्बशाकफलानि च| तद्रोगशममन्विच्छन् भूनिम्बाद्येन योजयेत्||१३६|| vacāmativiṣāṁ pāṭhāṁ saptaparṇaṁ rasāñjanam| syōnākōdīcyakaṭvaṅgavatsakatvagdurālabhāḥ||134|| dārvīṁ parpaṭakaṁ pāṭhāṁ yavānīṁ madhuśigrukam| paṭōlapatraṁ siddhārthān yūthikāṁ jātipallavān||135|| jambvāmrabilvāmadhyāni nimbaśākaphalāni ca| tadrōgaśāmamanvicchan bhūnimbādyēna yōjayēt||136|| vacAmativiShAM pAThAM saptaparNaM rasA~jjanam| syonAkodIcyakaTva~ggavatsakatvagdurAlabhAH||134|| dArvIM parpaTakaM pAThAM yavAnIM madhushigrukam| paTolapatraM siddhArthAn yUthikAM jAtipallavAn||135|| jambvAmrabilvamadhyAni nimbashAkaphalAni ca| tadrogashamamanvicchan bhUnimbAdyena yojayet||136|| The combination of vacā, ativiṣā, pāṭhā, saptaparna, rasāñjana, syōnāka, udīcya, kaṭvaṅga (type of syonaka having small fruits), bark of vatsaka, durālabha, dārvī, parpataka, pāṭhā, yavāni, madhuśigru, leaf of paṭōla, siddhārthā, yūthikā, fresh new leaf of jāti, seeds of jambu and amra, pulp of bilva and leaves and fruits of nimba is useful in all condition as mentioned for bhūnimbadya churna (134-136). Kirātādya chūrṇa: किराततिक्तः षड्ग्रन्था त्रायमाणा कटुत्रिकम्| चन्दनं पद्मकोशीरं दार्वीत्वक् कटुरोहिणी||१३७|| कुटजत्वक्फलं मुस्तं यवानी देवदारु च| पटोलनिम्बपत्रैलासौराष्ट्रयतिविषात्वचः||१३८|| मधुशिग्रोश्च बीजानि मूर्वा पर्पटकस्तथा| तच्चूर्णं मधुना लेह्यं पेयं मद्यैर्जलेन वा||१३९|| हृत्पाण्डुग्रहणीरोगगुल्मशूलारुचिज्वरान्| कामलां सन्निपातं च मुखरोगांश्च नाशयेत्||१४०|| इति किराताद्यं चूर्णम् kirātatiktaḥ ṣaḍgranthā trāyamāṇā kaṭutrikam| candanaṁ padmakōśīraṁ dārvītvak kaṭurōhiṇī||137|| kuṭajatvakphalaṁ mustaṁ yavānī dēvadāru ca| paṭōlanimbapatrailāsaurāṣṭrayativiṣātvacaḥ||138|| madhuśigrōśca bījāni mūrvā parpaṭakastathā| taccūrṇaṁ madhunā lēhyaṁ pēyaṁ madyairjalēna vā||139|| hr̥tpāṇḍuGrahaṇī rōgagulmaśūlārucijvarān| kāmalāṁ sannipātaṁ ca mukharōgāṁśca nāśayēt||140|| iti kirātādyaṁ cūrṇam kirAtatiktaH ShaDgranthA trAyamANA kaTutrikam| candanaM padmakoshIraM dArvItvak kaTurohiNI||137|| kuTajatvakphalaM mustaM yavAnI devadAru ca| paTolanimbapatrailAsaurAShTrayativiShAtvacaH||138|| madhushigroshca bIjAni mUrvA parpaTakastathA| taccUrNaM madhunA lehyaM peyaM madyairjalena vA||139|| hRutpANDugrahaNIrogagulmashUlArucijvarAn| kAmalAM sannipAtaM ca mukharogAMshca nAshayet||140|| iti kirAtAdyaM cUrNam Mix powder of kirātatikta, ṣaḍgranthā, trāyamāṇa, trikatu, chandana, padmaka, uśīra, bark of dārvī, kaṭurōhiṇī, bark and fruit of kutaja, musta, yavāni, dēvadāru, paṭōla, leaves of nimba, elā, saurāṣṭra, ativiṣā, tvak, Seeds of madhuśigru, mūrvā and parpataka and prescribe it as linctus prepared with honey or may be taken with water or alcoholic preparation. This preparation is known as kirātādyaṁ chūrṇa whih cures hr̥idaya roga, pāṇḍu, grahaṇīroga, gulma, shūlā, aruchi, jwara, kāmalā, sannipātika type of diarrhea and eight types of mukharōga (137-140). Treatment of kaphaja grahaṇī: ग्रहण्यां श्लेष्मदुष्टायां वमितस्य यथाविधि| कट्वम्ललवणक्षारैस्तिक्तैश्चाग्निं विवर्धयेत्||१४१|| grahaṇyāṁ ślēṣmaduṣṭāyāṁ vamitasya yathāvidhi| kaṭvamlalavaṇakṣāraistiktaiścāgniṁ vivardhayēt||141|| grahaNyAM shleShmaduShTAyAM vamitasya yathAvidhi| kaTvamlalavaNakShAraistiktaishcAgniM vivardhayet||141|| In kaphaja grahaṇī first administer vamana and then increase agni (digestive power) with help of drugs having katu, amla, lavana, kṣāra and tikta rasa (141). पलाशं चित्रकं चव्यं मातुलुङ्गं हरीतकीम्| पिप्पलीं पिप्पलीमूलं पाठां नागरधान्यकम्||१४२|| कार्षिकाण्युदकप्रस्थे पक्त्वा पादावशेषितम्| पानीयार्थं प्रयुञ्जीत यवागूं तैश्च साधयेत्||१४३|| palāśaṁ citrakaṁ cavyaṁ mātuluṅgaṁ harītakīm| pippalīṁ pippalīmūlaṁ pāṭhāṁ nāgaradhānyakam||142|| kārṣikāṇyudakaprasthē paktvā pādāvaśēṣitam| pānīyārthaṁ prayuñjīta yavāgūṁ taiśca sādhayēt||143|| palAshaM citrakaM cavyaM mAtulu~ggaM harItakIm| pippalIM pippalImUlaM pAThAM nAgaradhAnyakam||142|| kArShikANyudakaprasthe paktvA pAdAvasheShitam| pAnIyArthaM prayu~jjIta yavAgUM taishca sAdhayet||143|| Palāśa, chitraka, cavya, mātuluṅga, harītakī pippalī, pippalīmūla, pāṭhā, nāgara and dhānyaka are taken each in 12 gm and decoction is prepared in one 768 ml of water and reduced to one fourth. This decoction is administered as a pānīya (drink) or yavāgū (gruel) prepared using this decoction (142-143). शुष्कमूलकयूषेण कौलत्थेनाथवा पुनः| कट्वम्लक्षारपटुना लघून्यन्नानि भोजयेत्||१४४|| अम्लं चानु पिबेत्तक्रं तक्रारिष्टमथापि वा| मदिरां मध्वरिष्टं वा निगदं सीधुमेव वा||१४५|| śuṣkamūlakayūṣēṇa kaulatthēnāthavā punaḥ| kaṭvamlakṣārapaṭunā laghūnyannāni bhōjayēt||144|| amlaṁ cānu pibēttakraṁ takrāriṣṭāmathāpi vā| madirāṁ madhvariṣṭaṁ vā nigadaṁ sīdhumēva vā||145|| shuShkamUlakayUSheNa kaulatthenAthavA punaH| kaTvamlakShArapaTunA laghUnyannAni bhojayet||144|| amlaM cAnu pibettakraM takrAriShTamathApi vA| madirAM madhvariShTaM vA nigadaM sIdhumeva vA||145|| Soup of dried raddish or kulatha is to be given regularly and repeatedly. Food which is easy to digest should be fortified with katu, amla, kṣāra and lavana rasa. Patient should take such foods which are easy to digest, along with buttermilk slightly sour or takrāriṣṭa, madirā (medicated alcoholic preparation), madhvariṣṭa or well prepared sīdhu (144-145). Madhūkāsava: द्रोणं मधूकपुष्पाणां विडङ्गानां ततोऽर्धतः| चित्रकस्य ततोऽर्धं स्यात्तथा भल्लातकाढकम्||१४६|| मञ्जिष्ठाष्टपलं [३२] चैव त्रिद्रोणेऽपां विपाचयेत्| द्रोणशेषं तु तच्छीतं मध्वर्धाढकसंयुतम्||१४७|| एलामृणालागुरुभिश्चन्दनेन च रूषिते| कुम्भे मासस्थितं जातमासवं तं प्रयोजयेत्||१४८|| ग्रहणीं दीपयत्येव बृंहणः [३३] कफपित्तजित्| शोथं कुष्ठं किलासं च प्रमेहांश्च प्रणाशयेत्||१४९|| इति मधूकासवः drōṇaṁ madhūkapuṣpāṇāṁ viḍaṅgānāṁ tatō'rdhataḥ| citrakasya tatō'rdhaṁ syāttathā bhallātakāḍhakam||146|| mañjiṣṭhāṣṭapalaṁ [32] caiva tridrōṇē'pāṁ vipācayēt| drōṇaśēṣaṁ tu tacchītaṁ madhvardhāḍhakasaṁyutam||147|| ēlāmr̥ṇālāgurubhiścandanēna ca rūṣitē| kumbhē māsasthitaṁ jātamāsavaṁ taṁ prayōjayēt||148|| Grahaṇī ṁ dīpayatyēva br̥ṁhaṇaḥ [33] kaphaPittajit| śōthaṁ kuṣṭhaṁ kilāsaṁ ca pramēhāṁśca praṇāśayēt||149|| iti madhūkāsavaḥ droNaM madhUkapuShpANAM viDa~ggAnAM tato~ardhataH| citrakasya tato~ardhaM syAttathA bhallAtakADhakam||146|| ma~jjiShThAShTapalaM [32] caiva tridroNe~apAM vipAcayet| droNasheShaM tu tacchItaM madhvardhADhakasaMyutam||147|| elAmRuNAlAgurubhishcandanena ca rUShite| kumbhe mAsasthitaM jAtamAsavaM taM prayojayet||148|| grahaNIM dIpayatyeva bRuMhaNaH [33] kaphapittajit| shothaM kuShThaM kilAsaM ca pramehAMshca praNAshayet||149|| iti madhUkAsavaH Take one drōṇa (12.22 kg/l) flowers of madhūka, half drōṇa (6.11 kg/l) of viḍaṅga, chitraka half of viḍaṅga i.e. 1/4th drōṇa (3.05 kg/l), bhallātaka one aḍhaka (3.073 kg) and eight pala (384 gm) of mañjiṣṭha and mix with three drōṇa (36.66 kg/l) of water and reduce to one drōṇa (12.22 L) and after the decoction comes to room temperature add half aḍhaka (1.53 kg) of honey. Keep this preparation in a pot lined with paste of elā, mrunala, agaru and chandana and store for period of one month till asava siddhi occurs. This preparation is called madhūkāsava and is useful in grahaṇī, helps empowering of agni, promotes nutrition and normalizes kapha and pitta. It is indicated in sōtha, kuṣṭha, kilāsa and pramēha (146-149). मधूकपुष्पस्वरसं शृतमर्धक्षयीकृतम्| क्षौद्रपादयुतं शीतं पूर्ववत् सन्निधापयेत्||१५०|| तं पिबन् ग्रहणीदोषाञ्जयेत् सर्वान् हिताशनः| तद्वद्द्राक्षेक्षुखर्जूरस्वरसानासुतान् [३४] पिबेत्||१५१|| madhūkapuṣpasvarasaṁ śr̥tāmardhakṣayīkr̥tam| kṣaudrapādayutaṁ śītaṁ pūrvavat sannidhāpayēt||150|| taṁ piban Grahaṇī dōṣāñjayēt sarvān hitāśanaḥ| tadvaddrākṣēkṣukharjūrasvarasānāsutān [34] pibēt||151|| madhUkapuShpasvarasaM shRutamardhakShayIkRutam| kShaudrapAdayutaM shItaM pUrvavat sannidhApayet||150|| taM piban grahaNIdoShA~jjayet sarvAn hitAshanaH| tadvaddrAkShekShukharjUrasvarasAnAsutAn [34] pibet||151|| Boil svarasa of flowers of madhūkā till reduced to half the quantity. When cooled one fourth of honey is added and kept for fermentation as mentioned above. This preparation relieves all types of grahaṇīdōṣhā provided patient takes pathya aahāra. In the same manner fermentation of svarasa of drākṣa (grapes), sugarcane and date palm is helpful for the patient (150-151). Durālabhāsava: प्रस्थौ दुरालभाया द्वौ पस्थमामलकस्य च| दन्तीचित्रकमुष्टी [३५] द्वे प्रत्यग्रं चाभयाशतम्||१५२|| चतुर्द्रोणेऽम्भसः पक्त्वा शीतं द्रोणावशेषितम्| सगुडद्विशतं पूतं मधुनः कुडवायुतम्||१५३|| तद्वत् प्रियङ्गोः पिप्पल्या विडङ्गानां च चूर्णितैः| कुडवैर्घृतकुम्भस्थं पक्षाज्जातं ततः पिबेत्||१५४|| ग्रहणीपाण्डुरोगार्शःकुष्ठवीसर्पमेहनुत्| स्वरवर्णकरश्चैष रक्तपित्तकफापहः||१५५|| इति दुरालभासवः prasthau durālabhāyā dvau prasthamāmalakasya ca| dantīcitrakamuṣṭī [35] dvē pratyagraṁ cābhayāśatam||152|| caturdrōṇē'mbhasaḥ paktvā śītaṁ drōṇāvaśēṣitam| saguḍadviśataṁ pūtaṁ madhunaḥ kuḍaVātatam||153|| tadvat priyaṅgōḥ pippalyā viḍaṅgānāṁ ca cūrṇitaiḥ| kuḍavairghr̥takumbhasthaṁ pakṣājjātaṁ tataḥ pibēt||154|| Grahaṇī pāṇḍurōgārśaḥkuṣṭhavīsarpamēhanut| svaravarṇakaraścaiṣa raktaPittakaphāpahaḥ||155|| iti durālabhāsavaḥ prasthau durAlabhAyA dvau pasthamAmalakasya ca| dantIcitrakamuShTI [35] dve pratyagraM cAbhayAshatam||152|| caturdroNe~ambhasaH paktvA shItaM droNAvasheShitam| saguDadvishataM pUtaM madhunaH kuDavAyutam||153|| tadvat priya~ggoH pippalyA viDa~ggAnAM ca cUrNitaiH| kuDavairghRutakumbhasthaM pakShAjjAtaM tataH pibet||154|| grahaNIpANDurogArshaHkuShThavIsarpamehanut| svaravarNakarashcaiSha raktapittakaphApahaH||155|| iti durAlabhAsavaH Boil two prastha (1.53 kg) each of durālabhā and amalaki, one muṣṭi each of danti and chitraka and two hundred matured fruits of haritaki in four drōṇa (48.88 kg/l) of water and reduce to one drōṇa (12.228 kg/l). When it comes to room temperature add two hundred pala (9600 gm) of jaggery and one kudava (192 gm) of honey as well as powder of priyaṅgu, pippalī and viḍaṅga each in one kudava (192 gm) and keep in jar pasted with ghee on the inner wall for period of fifteen days. This preparation is known as durālabhāsava and is indicated in grahaṇī, pāṇḍu, arśa, kuṣṭha, vīsarpa and pramēha. It promotes voice and complexion and cures raktapitta and other kaphaja disorders (152-155). Mūlāsava: हरिद्रा पञ्चमूले द्वे वीरर्षभकजीवकम्| एषां [३६] पञ्चपलान् भागांश्चतुर्द्रोणेऽम्भसः पचेत्||१५६|| द्रोणशेषे रसे पूते गुडस्य द्विशतं भिषक्| चूर्णितान् कुडवार्धांशान् प्रक्षिपेच्च समाक्षिकान्||१५७|| प्रियङ्गुमुस्तमञ्जिष्ठाविडङ्गमधुकप्लवान्| लोध्रं शाबरकं चैव मासार्धस्थं पिबेत्तु तम्||१५८|| एष मूलासवः सिद्धो दीपनो रक्तपित्तजित्| आनाहकफहृद्रोगपाण्डुरोगाङ्गसादनुत्||१५९|| इति मूलासवः haridrā pañcamūlē dvē vīrarṣabhakajīvakam| ēṣāṁ [36] pañcapalān bhāgāṁścaturdrōṇē'mbhasaḥ pacēt||156|| drōṇaśēṣē rasē pūtē guḍasya dviśataṁ bhiṣak| cūrṇitān kuḍavārdhāṁśān prakṣipēcca samākṣikān||157|| priyaṅgumustāmañjiṣṭhāviḍaṅgāmadhukaplavān| lōdhraṁ śābarakaṁ caiva māsārdhasthaṁ pibēttu tam||158|| ēṣa mūlāsavaḥ siddhō dīpanō raktaPitta jit| ānāhakaphahr̥drōgapāṇḍurōgāṅgasādanut||159|| iti mūlāsavaḥ haridrA pa~jcamUle dve vIrarShabhakajIvakam| eShAM [36] pa~jcapalAn bhAgAMshcaturdroNe~ambhasaH pacet||156|| droNasheShe rase pUte guDasya dvishataM bhiShak| cUrNitAn kuDavArdhAMshAn prakShipecca samAkShikAn||157|| priya~ggumustama~jjiShThAviDa~ggamadhukaplavAn| lodhraM shAbarakaM caiva mAsArdhasthaM pibettu tam||158|| eSha mUlAsavaH siddho dIpano raktapittajit| AnAhakaphahRudrogapANDurogA~ggasAdanut||159|| iti mUlAsavaH Boil five pala (240 gm) each of haridrā, two types of pañchamūla i.e. brihat and laghu pañchamūla, vīra (shatvari), rṣabhaka, jīvaka in four drōṇa (48.88 kg/l) of water and reduce to one drōṇa (12.22 kg/l); to this add two hundred pala (9600 gm) of jaggery and half kudava (96 gm) of honey as well as powders of priyaṅgu, musta, mañjiṣṭhā, viḍaṅga, madhuka, plavā, and sābaraka lōdhra and fermented for a fortnight. This mūlāsava does dīpana and is effective in raktapitta, anāha, kaphaja vikāra, hridroga, pāṇḍu and aṅgasāda (156-159). Piṇḍāsava: प्रास्थिकं [३७] पिप्पलीं पिष्ट्वा गुडं मध्यं बिभीतकात्| उदकप्रस्थसंयुक्तं यवपल्ले निधापयेत्||१६०|| तस्मात् पलं सुजातात्तु सलिलाञ्जलिसंयुतम्| पिबेत्पिण्डासवो ह्येष रोगानीकविनाशनः||१६१|| स्वस्थोऽप्येनं पिबेन्मासं नरः स्निग्धरसाशनः [३८] | इच्छंस्तेषामनुत्पत्तिं रोगाणां येऽत्र कीर्तिताः||१६२|| इति पिण्डासवः prāsthikaṁ [37] pippalīṁ piṣṭvā guḍaṁ madhyaṁ bibhītakāt| udakaprasthasaṁyuktaṁ yavapallē nidhāpayēt||160|| tasmāt palaṁ sujātāttu salilāñjalisaṁyutam| pibētpiṇḍāsavō hyēṣa rōgānīkavināśanaḥ||161|| svasthō'pyēnaṁ pibēnmāsaṁ naraḥ snigdharasāśanaḥ [38] | icchaṁstēṣāmanutpattiṁ rōgāṇāṁ yē'tra kīrtitāḥ||162|| iti piṇḍāsavaḥ prAsthikaM [37] pippalIM piShTvA guDaM madhyaM bibhItakAt| udakaprasthasaMyuktaM yavapalle nidhApayet||160|| tasmAt palaM sujAtAttu salilA~jjalisaMyutam| pibetpiNDAsavo hyeSha rogAnIkavinAshanaH||161|| svastho~apyenaM pibenmAsaM naraH snigdharasAshanaH [38] | icchaMsteShAmanutpattiM rogANAM ye~atra kIrtitAH||162|| iti piNDAsavaH One prastha of pippalī is mixed with jaggery and seed pulp of bibhītaki and to it one prāstha of water is added and kept in a vessel covered with yava (barley) for fermentation; this is called as piṇḍāsava. One pala (48 gm) of piṇḍāsava is mixed with one añjali (192 gm) of water and is given to patient. It is helpful in earlier mentioned disorders. Even a healthy person may take this preparation for period of one month and take unctuous and liquid diet (mainly soups). It helps in prevention of genesis of disease (160-162). Madhvariṣṭa: नवे पिप्पलिमध्वाक्ते कलसेऽगुरुधूपिते| मध्वाढकं जलसमं चूर्णानीमानि दापयेत्||१६३|| कुडवार्धं विडङ्गानां पिप्पल्याः कुडवं तथा| चतुर्थिकांशां त्वक्क्षीरीं केशरं मरिचानि च||१६४|| त्वगेलापत्रकशटीक्रमुकातिविषाघनान्| हरेण्वेल्वालुतेजोह्वापिप्पलीमूलचित्रकान्||१६५|| कार्षिकांस्तत् स्थितं मासमत ऊर्ध्वं प्रयोजयेत्| मन्दं सन्दपयत्यग्निं करोति विषमं समम्||१६६|| हृत्पाण्डुग्रहणीरोगकुष्ठार्शःश्वयथुज्वरान्| वातश्लेष्मामयांश्चान्यान्मध्वरिष्टो व्यपोहति||१६७|| इति मध्वरिष्टः navē pippalīmadhvāktē kalasē'gurudhūpitē| madhvāḍhakaṁ jalasāmaṁ cūrṇānīmāni dāpayēt||163|| kuḍavārdhaṁ viḍaṅgānāṁ pippalyāḥ kuḍavaṁ tathā| caturthikāṁśāṁ tvakkṣīrīṁ kēśaraṁ maricāni ca||164|| tvagēlāpatrakaśaṭīkramukātiviṣāghanān| harēṇvēlvālutējōhvāpippalīmūlacitrakān||165|| kārṣikāṁstat sthitaṁ māsāmata ūrdhvaṁ prayōjayēt| mandaṁ sandapayatyāgniṁ karōti viṣāmaṁ sāmam||166|| hr̥tpāṇḍuGrahaṇī rōgakuṣṭhārśaḥśvayathujvarān| Vātaślēṣmāmayāṁścānyānmadhvariṣṭō vyapōhati||167|| iti madhvariṣṭaḥ nave pippalimadhvAkte kalase~agurudhUpite| madhvADhakaM jalasamaM cUrNAnImAni dApayet||163|| kuDavArdhaM viDa~ggAnAM pippalyAH kuDavaM tathA| caturthikAMshAM tvakkShIrIM kesharaM maricAni ca||164|| tvagelApatrakashaTIkramukAtiviShAghanAn| hareNvelvAlutejohvApippalImUlacitrakAn||165|| kArShikAMstat sthitaM mAsamata UrdhvaM prayojayet| mandaM sandapayatyagniM karoti viShamaM samam||166|| hRutpANDugrahaNIrogakuShThArshaHshvayathujvarAn| vAtashleShmAmayAMshcAnyAnmadhvariShTo vyapohati||167|| iti madhvariShTaH New earthen pot should be pasted internally by pippalī and honey and fumigated with aguru. One aḍhaka (3.073 kg) of honey and equal quantity of water should be added. To this add half kudava (1.53 kg) of powder of viḍaṅga and one kudava (192 gm) of pippalī, one fourth kudava (48 gm) of vāṁśa and one karsa (12 gm) each of tvak, elā, kēśar, maricha, patra, saṭī, kramukā, ativiṣā, ghanā (chandana), harēṇu, elvāluka, tējōhvā, pippalīmula and chitraka and fermented for period of one month and later on administered. It stimulates the power of digestion and regularizes the viṣāma agni. It is useful in hrdroga, pāṇḍu, grahaṇī, kuṣṭha, arśa, svayathu, jwara and other disorders caused by vata kapha dōṣha. Thus, completes description of madhvariṣṭa (163-167). समूलां पिप्पलीं क्षारौ द्वौ पञ्च लवणानि च| मातुलुङ्गाभयारास्नाशटीमरिचनागरम्||१६८|| कृत्वा समांशं तच्चूर्णं पिबेत् प्रातः सुखाम्बुना| श्लेष्मिके ग्रहणीदोषे बलवर्णाग्निवर्धनम्||१६९|| एतैरेवौषधैः सिद्धं सर्पिः पेयं समारुते| samūlāṁ pippalīṁ kṣārau dvau pañca lavaṇāni ca| mātuluṅgābhayārāsnāśaṭīmaricanāgaram||168|| kr̥tvā samāṁśaṁ taccūrṇaṁ pibēt prātaḥ sukhāmbunā| ślēṣmikē Grahaṇī dōṣē balavarṇāgnivardhanam||169|| samUlAM pippalIM kShArau dvau pa~jca lavaNAni ca| mAtulu~ggAbhayArAsnAshaTImaricanAgaram||168|| kRutvA samAMshaM taccUrNaM pibet prAtaH sukhAmbunA| shleShmike grahaNIdoShe balavarNAgnivardhanam||169|| etairevauShadhaiH siddhaM sarpiH peyaM samArute| Pippalī, pippalīmula, two types of kṣāra (yavakṣāra, Svarjikakṣāra), five types of lavana, mātuluṅgā, haritaki, rāsnā, saṭī, maricha and nāgara are taken in equal quantity and powdered and administered with warm water early in the morning. It cures kaphaja grahaṇī dōṣha and improves bala, complexion and agni. Ghr̥ita fortified with above medicines is useful in kapha associated with vātaj grahaṇīdōṣha (168-169). गौल्मिके षट्पलं प्रोक्तं भल्लातकघृतं च यत्||१७०|| gaulmikē ṣaṭpalaṁ prōktaṁ bhallātakaghr̥taṁ ca yat||170||

gaulmike ShaTpalaM proktaM bhallAtakaghRutaM ca yat||170|| Saṭpala ghr̥ita (Ca.Ci. 5/147-148) and bhallātaka ghr̥ita (Ca.Ci.5/143-146) as explained in gulma adhyaya may also be administered (170). kṣāraghr̥ita: बिडं कालोत्थलवणं सर्जिकायवशूकजम्| सप्तलां कण्टकारीं च चित्रकं चेति दाहयेत्||१७१|| सप्तकृत्वः स्रुतस्यास्य क्षारस्य [३९] द्व्याढकेन तु| आढकं सर्पिषः पक्त्वा पिबेदग्निविवर्धनम्||१७२|| इति क्षारघृत biḍaṁ kālōtthalavaṇaṁ sarjikāyavaśūkajam| saptalāṁ kaṇṭakārīṁ ca citrakaṁ cēti dāhayēt||171|| saptakr̥tvaḥ srutasyāsya kṣārasya [39] dvyāḍhakēna tu| āḍhakaṁ sarpiṣaḥ paktvā pibēdAgnivivardhanam||172|| iti kṣāraghr̥tam biDaM kAlotthalavaNaM sarjikAyavashUkajam| saptalAM kaNTakArIM ca citrakaM ceti dAhayet||171|| saptakRutvaH srutasyAsya kShArasya [39] dvyADhakena tu| ADhakaM sarpiShaH paktvA pibedagnivivardhanam||172|| iti kShAraghRutam Bida lavana, kālōttha lavana, sarjikakṣāra, yavakṣāra, saptalā, kaṇṭakārī and chitraka are burned together and later on mixed in water and filtered seven times. One aḍhaka (3.073 kg) of this kṣāra is added to one aḍhaka (3.073 kg) of ghr̥ita and sneha siddhi is done. This kṣāraghir̥ta is indicated for increasing the digestive power (171-172). समूलां पिप्पलीं पाठां चव्येन्द्रयवनागरम्| चित्रकातिविषे हिङ्गु श्वदंष्ट्रां कटुरोहिणीम्||१७३|| वचां च कार्षिकं पञ्चलवणानां पलानि च| दध्नः प्रस्थद्वये तैलसर्पिषोः कुडवद्वये||१७४|| खण्डीकृतानि निष्क्वाथ्य शनैरन्तर्गते रसे| अन्तर्धूमं ततो दग्धवा चूर्णं कृत्वा घृताप्लुतम्||१७५|| पिबेत् पाणितलं तस्मिञ्जीर्णे स्यान्मधुराशनः| वातश्लेष्मामयान्सर्वान्हन्याद्विषगरांश्च सः||१७६|| samūlāṁ pippalīṁ pāṭhāṁ cavyēndrayavanāgaram| citrakātiviṣē hiṅgu śvadaṁṣṭrāṁ kaṭurōhiṇīm||173|| vacāṁ ca kārṣikaṁ pañcalavaṇānāṁ palāni ca| dadhnaḥ prasthadvayē tailasarpiṣōḥ kuḍavadvayē||174|| khaṇḍīkr̥tāni niṣkvāthya śanairantargatē rasē| antardhūmaṁ tatō dagdhavā cūrṇaṁ kr̥tvā ghr̥tāplutam||175|| pibēt pāṇitalaṁ tasmiñjīrṇē syānmadhurāśanaḥ| Vātaślēṣmāmayānsarvānhanyādviṣagarāṁśca saḥ||176|| samUlAM pippalIM pAThAM cavyendrayavanAgaram| citrakAtiviShe hi~ggu shvadaMShTrAM kaTurohiNIm||173|| vacAM ca kArShikaM pa~jcalavaNAnAM palAni ca| dadhnaH prasthadvaye tailasarpiShoH kuDavadvaye||174|| khaNDIkRutAni niShkvAthya shanairantargate rase| antardhUmaM tato dagdhavA cUrNaM kRutvA ghRutAplutam||175|| pibet pANitalaM tasmi~jjIrNe syAnmadhurAshanaH| vAtashleShmAmayAnsarvAnhanyAdviShagarAMshca saH||176|| Pippalī, pippalīmula, pāṭhā, chavya, indrayava, nāgara, chitraka, ativisha, hiṅgu, svadaṁṣṭrā (goksura), kaṭurōhiṇī and vacā are taken in one karṣa (12 gm) quantity each. To this one pala (12 gm) of pañcalavaṇa is added alongwith two prastha of curds and two kudava (384 gm) of taila and ghr̥ita. The combination is boiled till water is completely evaporated. It is again burned by antardhūma method and the end product is powdered and mixed with ghee its dosage is one pāṇitala and when medicine gets digested patient is advised to take sweet diet. It is indicated in vāta kaphaja disorders and in viṣha and gara viṣha (173-176). Kshāra preparations: भल्लातकं त्रिकटुकं त्रिफलां लवणत्रयम्| अन्तर्धूमं द्विपलिकं गोपुरीषाग्निना दहेत्||१७७|| स क्षारः सर्पिषा पीतो भोज्ये वाऽप्यवचूर्णितः| हृत्पाण्डुग्रहणीदोषगुल्मोदावर्तशूलनुत्||१७८|| bhallātakaṁ trikaṭukaṁ triphalāṁ lavaṇatrayam| antardhūmaṁ dvipalikaṁ gōpurīṣāgninā dahēt||177|| sa kṣāraḥ sarpiṣā pītō bhōjyē vā'pyavacūrṇitaḥ| hr̥tpāṇḍuGrahaṇī dōṣagulmōdāvartaśūlanut||178|| bhallAtakaM trikaTukaM triphalAM lavaNatrayam| antardhUmaM dvipalikaM gopurIShAgninA dahet||177|| sa kShAraH sarpiShA pIto bhojye vA~apyavacUrNitaH| hRutpANDugrahaNIdoShagulmodAvartashUlanut||178||

Bhallātaka, trikaṭu, triphalā, three types of lavana (saindhva, sauvarchala and bida) should be burned by antardhūma method with help of cow dung cakes. This kṣāra should be administered with ghee or by sprinkling over prepared food. It is indicated in hridroga, pāṇḍu, grahaṇīdōṣha, gulma, udāvarta and pain (especially spasmodic pain)(177-178). दुरालभां करञ्जौ द्वौ सप्तपर्णं सवत्सकम्| षड्ग्रन्थां मदनं मूर्वां पाठामारग्वधं तथा||१७९|| गोमूत्रेण समांशानि कृत्वा चूर्णानि दाहयेत्| दग्ध्वा च तं पिबेत् क्षारं ग्रहणीबलवर्धनम्||१८०|| durālabhāṁ karañjau dvau saptaparṇaṁ savatsakam| ṣaḍgranthāṁ madanaṁ mūrvāṁ pāṭhāmāragvadhaṁ tathā||179|| gōmūtrēṇa samāṁśāni kr̥tvā cūrṇāni dāhayēt| dagdhvā ca taṁ pibēt kṣāraṁ Grahaṇī balavardhanam||180|| durAlabhAM kara~jjau dvau saptaparNaM savatsakam| ShaDgranthAM madanaM mUrvAM pAThAmAragvadhaM tathA||179|| gomUtreNa samAMshAni kRutvA cUrNAni dAhayet| dagdhvA ca taM pibet kShAraM grahaNIbalavardhanam||180|| Durālabhā, two types of karañja [karañja, latā karañja], saptaparna, vatsaka, sadgrantha (vacha), madanaphala, mūrvā, pāṭhā and aragvadha should be mixed with equal quantity of gomutra and boiled and prepared as per kṣāra kalpanā. This kṣāra increases bala of grahaṇī i.e. of agni (179-180) भूनिम्बं रोहिणीं तिक्तां पटोलं निम्बपर्पटम्| दहेन्माहिषमूत्रेण क्षार एषोऽग्निवर्धनः||१८१|| bhūnimbaṁ rōhiṇīṁ tiktāṁ paṭōlaṁ nimbaparpaṭam| dahēnmāhiṣamūtrēṇa kṣāra ēṣō'gnivardhanaḥ||181|| bhUnimbaM rohiNIM tiktAM paTolaM nimbaparpaTam| dahenmAhiShamUtreNa kShAra eSho~agnivardhanaH||181|| Bhūnimba, kutaki, tikta, paṭōla, nimba and parpatak are burned with buffalo urine and prepared as per kṣāra kalpana. Such kṣāra promotes agnibala (181). द्वे हरिद्रे वचा कुष्ठं चित्रकः कटुरोहिणी| मुस्तं च बस्तमूत्रेण दहेत् क्षारोऽग्निवर्धनः||१८२|| dvē haridrē vacā kuṣṭhaṁ citrakaḥ kaṭurōhiṇī| mustaṁ ca bastamūtrēṇa dahēt kṣārō'gnivardhanaḥ||182|| dve haridre vacA kuShThaM citrakaH kaTurohiNI| mustaM ca bastamUtreNa dahet kShAro~agnivardhanaH||182|| Two types of haridra (haridra and daruharidra), vacā, kuṣṭha, chitraka, kutaki and musta after mixing in goats urine are burned and kṣāra is prepared as per kṣāra kalpana. It helps in increasing the agni bala (182). kṣāraguḍikā: चतुष्पलं सुधाकाण्डात्त्रिपलं लवणत्रयात्| वार्ताकीकुडवं चार्कादष्टौ द्वे चित्रकात् पले||१८३|| दग्धानि वार्ताकुरसे गुटिका भोजनोत्तराः| भुक्तं भुक्तं पचन्त्याशु कासश्वासार्शसां हिताः||१८४|| विसूचिकाप्रतिश्यायहृद्रोगशमनाश्च ताः| इत्येषा क्षारगुटिका कृष्णात्रेयेण कीर्तिता||१८५|| इति क्षारगुडिका catuṣpalaṁ sudhākāṇḍāttripalaṁ lavaṇatrayāt| vārtākīkuḍavaṁ cārkādaṣṭau dvē citrakāt palē||183|| dagdhāni vārtākurasē guṭikā bhōjanōttarāḥ| bhuktaṁ bhuktaṁ pacantyāśu kāsaśvāsārśasāṁ hitāḥ||184|| visūcikāpratiśyāyahr̥drōgaśāmanāśca tāḥ| ityēṣā kṣāraguṭikā kr̥ṣṇātrēyēṇa kīrtitā||185|| iti kṣāraguḍikā catuShpalaM sudhAkANDAttripalaM lavaNatrayAt| vArtAkIkuDavaM cArkAdaShTau dve citrakAt pale||183|| dagdhAni vArtAkurase guTikA bhojanottarAH| bhuktaM bhuktaM pacantyAshu kAsashvAsArshasAM hitAH||184|| visUcikApratishyAyahRudrogashamanAshca tAH| ityeShA kShAraguTikA kRuShNAtreyeNa kIrtitA||185|| iti kShAraguDikA Four pala (192 gm) of stems of sudhā three pala (144 gm) of three types of lavana i.e. one pala (48 gm) each of saindhava, sauvarcala and bida, one kudava (192 gm) of vārtākī, eight pala (388 gm) of arka and two pala (96 gm) of chitraka are burned and the kṣāra thus prepared is triturated with svarasa of vārtāku and pills are prepared. Its administeration after food helps in quick digestion and useful in kāsa, svāsa, arśa, visūchikā, pratiśyāya and hr̥drōga. This preparation is called kṣāraguḍikā and is propounded by kr̥ṣṇātre (183-185) Chaturtha-kṣāra: वत्सकातिविषे पाठां दुःस्पर्शां हिङ्गु चित्रकम्| चूर्णीकृत्य पलाशाग्रक्षारे मूत्रस्रुते पचेत्||१८६|| आयसे भाजने सान्द्रात्तस्मात् [४०] कोलं सुखाम्बुना| मद्यैर्वा ग्रहणीदोषशोथार्शःपाण्डुमान् पिबेत्||१८७|| इति चतुर्थक्षारः vatsakātiviṣē pāṭhāṁ duḥsparśāṁ hiṅgu citrakam| cūrṇīkr̥tya palāśāgrakṣārē mūtrasrutē pacēt||186|| āyasē bhājanē sāndrāttasmāt [40] kōlaṁ sukhāmbunā| madyairvā Grahaṇī dōṣaśōthārśaḥpāṇḍumān pibēt||187|| iti caturthakṣāraḥ vatsakAtiviShe pAThAM duHsparshAM hi~ggu citrakam| cUrNIkRutya palAshAgrakShAre mUtrasrute pacet||186|| Ayase bhAjane sAndrAttasmAt [40] kolaM sukhAmbunA| madyairvA grahaNIdoShashothArshaHpANDumAn pibet||187|| iti caturthakShAraH Vatsaka, ativisā, pāṭhā, duḥsparśā, hiṅgu and chitraka should be powdered together and mixed with palāśāgrakṣāra. It is cooked in cow’s urine in an iron pan till it becomes semi solid. Its dosage is one kōla (6 gm) to be taken with lukewarm water or with madya (medicated alcohol). It is indicated in grahaṇīdōṣha, sōthā, arśa and pāṇḍu. The prepatation is known as chaturtha kṣāra (186-187). Pañchāmakṣāra: त्रिफलां कटभीं चव्यं बिल्वमध्यमयोरजः| रोहिणीं कटुकां मुस्तं कुष्ठं पाठां च हिङ्गु च||१८८|| मधुकं मुष्ककयवक्षारौ त्रिकटुकं वचाम्| विडङ्गं पिप्पलीमूलं स्वर्जिकां निम्बचित्रकौ||१८९|| मूर्वाजमोदेन्द्रयवान् गुडूचीं देवदारु च| कार्षिकं लवणानां च पञ्चानां पलिकान्पृथक्||१९०|| भागान् दध्नि त्रिकुडवे घृततैलेन मूर्च्छितम्| अन्तर्धूमं शनैर्दग्ध्वा तस्मात् पाणितलं पिबेत्||१९१|| सर्पिषा कफवातार्शोग्रहणीपाण्डुरोगवान्| प्लीहमूत्रग्रहश्वासहिक्काकासक्रिमिज्वरान्||१९२|| शोषातिसारौ श्वयथुं प्रमेहानाहहृद्ग्रहान्| हन्यात् सर्वविषं [४१] चैव क्षारोऽग्निजननो वरः||१९३|| जीर्णे रसैर्वा मधुरैरश्नीयात् पयसाऽपि वाइति पञ्चमक्षारः triphalāṁ kaṭabhīṁ cavyaṁ bilvāmadhyāmayōrajaḥ| rōhiṇīṁ kaṭukāṁ mustaṁ kuṣṭhaṁ pāṭhāṁ ca hiṅgu ca||188|| madhukaṁ muṣkakayavakṣārau trikaṭukaṁ vacām| viḍaṅgaṁ pippalīmūlaṁ svarjikāṁ nimbacitrakau||189|| mūrvājamōdēndrayavān guḍūcīṁ dēvadāru ca| kārṣikaṁ lavaṇānāṁ ca pañcānāṁ palikānpr̥thak||190|| bhāgān dadhni trikuḍavē ghr̥tatailēna mūrcchitam| antardhūmaṁ śanairdagdhvā tasmāt pāṇitalaṁ pibēt||191|| sarpiṣā kaphavātārśōGrahaṇī pāṇḍurōgavān| plīhamūtragrahaśvāsahikkākāsakrimijvarān||192|| śōṣātisārau śvayathuṁ pramēhānāhahr̥dgrahān| hanyāt sarvaviṣaṁ [41] caiva kṣārō'gnijananō varaḥ||193|| jīrṇē rasairvā madhurairaśnīyāt payasā'pi vāiti pañcāmakṣāraḥ triphalAM kaTabhIM cavyaM bilvamadhyamayorajaH| rohiNIM kaTukAM mustaM kuShThaM pAThAM ca hi~ggu ca||188|| madhukaM muShkakayavakShArau trikaTukaM vacAm| viDa~ggaM pippalImUlaM svarjikAM nimbacitrakau||189|| mUrvAjamodendrayavAn guDUcIM devadAru ca| kArShikaM lavaNAnAM ca pa~jcAnAM palikAnpRuthak||190|| bhAgAn dadhni trikuDave ghRutatailena mUrcchitam| antardhUmaM shanairdagdhvA tasmAt pANitalaM pibet||191|| sarpiShA kaphavAtArshograhaNIpANDurogavAn| plIhamUtragrahashvAsahikkAkAsakrimijvarAn||192|| shoShAtisArau shvayathuM pramehAnAhahRudgrahAn| hanyAt sarvaviShaM [41] caiva kShAro~agnijanano varaH||193|| jIrNe rasairvA madhurairashnIyAt payasA~api vAiti pa~jcamakShAraH

Triphalā, kaṭabhī, chavya, pulp of bilva, powder of ayōraja (mandur), katutki, musta, kuṣṭha, pāṭhā, hiṅgu, madhuka, kṣāra of muskaka and yavakṣāra, trikatu, vacā, viḍaṅga, pippalīmula, svarjikākṣāra, nimba, chitraka, mūrva, ajamoda, indrayava, guḍūchī and dēvadāru are taken in one karṣa (12 gm) quantity and one pala each of five salts are taken. All are mixed with three kudavas (576 gm) of dadhi, ghr̥ita and taila. The mixture is burned by antardhūma method. One panitala is the dose which is given with ghee. It is indicated in kapha and vātaja arśa, grahaṇī, pāṇḍu, plīha, mūtragraha, svāsa, hikkā, kāsa, krimi, jwara, sōṣa, atisāra, sōthā, pramēha, anāha, hr̥dgrahā and in all types of toxicity. It is one among the best stimulators of agni. Once the medicine is digested mamsarasa or sweet diet or milk should be administered. This ends the explanation of the pañchāmakṣāra (188-193). Treatment of tridōṣaja grahaṇī: त्रिदोषे विधिविद्वैद्यः पञ्च कर्माणि कारयेत्||१९४|| घृतक्षारासवारिष्टान् दद्याच्चाग्निविवर्धनान्| क्रिया या चानिलादीनां निर्दिष्टा ग्रहणीं प्रति||१९५|| व्यत्यासात्तां समस्तां वा कुर्याद्दोषविशेषवित्| tridōṣē vidhividvaidyaḥ pañca karmāṇi kārayēt||194|| ghr̥takṣārāsavāriṣṭān dadyāccāgnivivardhanān| kriyā yā cānilādīnāṁ nirdiṣṭā Grahaṇī ṁ prati||195|| vyatyāsāttāṁ sāmastāṁ vā kuryāddōṣaviśēṣavit| tridoShe vidhividvaidyaH pa~jca karmANi kArayet||194|| ghRutakShArAsavAriShTAn dadyAccAgnivivardhanAn| kriyA yA cAnilAdInAM nirdiShTA grahaNIM prati||195|| vyatyAsAttAM samastAM vA kuryAddoShavisheShavit| In tridōṣaja grahaṇī, panchakarma should be carried out as per predominancy of doṣha. Various ghee, kṣāra, asava and ariṣṭa preparation useful in stimulation of agni should be administered. Previously described line of treatment for vātaja etc grahaṇī should be accordingly followed. This line of treatment should be done either separately or jointly after finding the predominancy of doṣha (194-195). स्नेहनं स्वेदनं शुद्धिर्लङ्घनं दीपनं च यत्||१९६|| चूर्णानि लवणक्षारमध्वरिष्टसुरासवाः| विविधास्तक्रयोगाश्च दीपनानां च सर्पिषाम्||१९७|| ग्रहणीरोगिभिः सेव्याः snēhanaṁ svēdanaṁ śuddhirlaṅghanaṁ dīpanaṁ ca yat||196|| cūrṇāni lavaṇakṣārāmadhvariṣṭasurāsavāḥ| vividhāstakrayōgāśca dīpanānāṁ ca sarpiṣām||197|| Grahaṇī rōgibhiḥ sēvyāḥ snehanaM svedanaM shuddhirla~gghanaM dIpanaM ca yat||196|| cUrNAni lavaNakShAramadhvariShTasurAsavAH| vividhAstakrayogAshca dIpanAnAM ca sarpiShAm||197|| grahaNIrogibhiH sevyAH, Snehana, swedana, shodhana, langhana, dīpana, various powder preparation of lavana, kṣāra, madhvariṣṭa, surāsavā, various takra preparation, dīpaniya ghr̥ita are to be prescribed to the grahaṇīdoṣha patient (196-197). Treatment of various states of disease and dosha aggravation: क्रियां चावस्थिकीं शृणु| ष्ठीवनं श्लैष्मिके रूक्षं दीपनं तिक्तसंयुतम्||१९८|| kriyāṁ cāvasthikīṁ śr̥ṇu| ṣṭhīvanaṁ ślaiṣmikē rūkṣaṁ dīpanaṁ tiktasaṁyutam||198|| kriyAM cAvasthikIM shRuNu| ShThIvanaM shlaiShmike rUkShaM dIpanaM tiktasaMyutam||198|| Henceforth treatment as per condition is being mentioned. In kaphaja grahaṇī if there is excess sputum, then rūkṣa (ununctuous) and dīpana drugs having bitter taste should be administered (198). सकृद्रूक्षं सकृत्स्निग्धं कृशे बहुकफे हितम्| परीक्ष्यामं शरीरस्य दीपनं स्नेहसंयुतम्||१९९|| sakr̥drūkṣaṁ sakr̥tsnigdhaṁ kr̥śē bahukaphē hitam| parīkṣyāmaṁ śarīrasya dīpanaṁ snēhasaṁyutam||199|| sakRudrUkShaM sakRutsnigdhaM kRushe bahukaphe hitam| parIkShyAmaM sharIrasya dIpanaM snehasaMyutam||199|| If patient is weak, but kapha is excessive then alternately un-unctous and unctuous therapies should be administered repeatedly. After complete examination; if pāchana of ama has taken place than administer ghee fortified by dīpaniya medicines (199) दीपनं बहुपित्तस्य तिक्तं मधुरसंयुतम्| बहुवातस्य तु स्नेहलवणाम्लयुतं हितम्||२००|| dīpanaṁ bahuPittasya tiktaṁ madhurasaṁyutam| bahuVātasya tu snēhalavaṇāmlayutaṁ hitam||200|| dIpanaM bahupittasya tiktaM madhurasaMyutam| bahuvAtasya tu snehalavaNAmlayutaM hitam||200|| If pitta is aggravated then dīpana drugs having bitter taste along with medicines having sweet taste should be administered whereas if vāta is aggravated then dīpaniya drugs alongwith snēha, lavana and amla dominated drugs should be administered (200). सन्धुक्षति तथा वह्निरेषां विधिवदिन्धनैः| स्नेहमेव परं विद्याद्दुर्बलानलदीपनम्||२०१|| sandhukṣati tathā vahnirēṣāṁ vidhivadindhanaiḥ| snēhamēva paraṁ vidyāddurbalānaladīpanam||201|| sandhukShati tathA vahnireShAM vidhivadindhanaiH| snehameva paraM vidyAddurbalAnaladIpanam||201||

Proper management as mentioned in earlier verses stimulates the agni (digestive power). Sneha is the best among the dipana dravya which helps in stimulating the inefficient agni (201). नालं स्नेहसमिद्धस्य शमायान्नं सुगुर्वपि| मन्दाग्निरविपक्वं तु पुरीषं योऽतिसार्यते||२०२|| दीपनीयौषधैर्युक्तां घृतमात्रां पिबेत्तु सः| तया समानः पवनः प्रसन्नो [४२] मार्गमास्थितः||२०३|| अग्नेः समीपचारित्वादाशु प्रकुरुते बलम्| nālaṁ snēhasamiddhasya śamāyānnaṁ sugurvapi| mandāgniravipakvaṁ tu purīṣaṁ yō'tisāryatē||202|| dīpanīyauṣadhairyuktāṁ ghr̥tamātrāṁ pibēttu saḥ| tayā samānaḥ pavanaḥ prasannō [42] mārgamāsthitaḥ||203|| agnēḥ samīpacāritvādāśu prakurutē balam|

nAlaM snehasamiddhasya shamAyAnnaM sugurvapi| mandAgniravipakvaM tu purIShaM yo~atisAryate||202|| dIpanIyauShadhairyuktAM ghRutamAtrAM pibettu saH| tayA samAnaH pavanaH prasanno [42] mArgamAsthitaH||203|| agneH samIpacAritvAdAshu prakurute balam|

If the patient has inefficient digestive power and voids undigested food in excess in stools or frequency of motions is more, then appropriate quantity of ghr̥ita fortified by dīpana medicines should again be given. Thus, samāna vāta is regularized and moves in its normal tract. As samāna vāta is associated with agni it instantaneously promotes the strength of agni. Digestive power thus stimulated by ghr̥ita cannot be suppressed even by heavy meals (202-203). काठिन्याद्यः पुरीषं तु कृच्छ्रान्मुञ्चति मानवः||२०४|| सघृतं लवणैर्युक्तं नरोऽन्नावग्रहं पिबेत्| kāṭhinyādyaḥ purīṣaṁ tu kr̥cchrānmuñcati mānavaḥ||204|| saghr̥taṁ lavaṇairyuktaṁ narō'nnāvagrahaṁ pibēt| kAThinyAdyaH purIShaM tu kRucchrAnmu~jcati mAnavaH||204|| saghRutaM lavaNairyuktaM naro~annAvagrahaM pibet|

If patient finds difficulty in evacuation of stools due to hardness in stools then salt mixed ghr̥ita should be administered in between the food. (Note:Lavana rasa has vāta anuloman action and also increases secretions, therefore hardness of stool is reduced and stools are easily evacuated) (204). रौक्ष्यान्मन्दे पिबेत्सर्पिस्तैलं वा दीपनैर्युतम्||२०५|| raukṣyānmandē pibētsarpistailaṁ vā dīpanairyutam||205|| raukShyAnmande pibetsarpistailaM vA dIpanairyutam||205|| If agni is suppressed due to rūkṣa guna then either ghr̥ita or taila fortified with dīpaniya drugs should be administered (205). अतिस्नेहात्तु मन्देऽग्नौ चूर्णारिष्टासवा हिताः| भिन्ने गुदोपलेपात्तु मले तैलसुरासवाः||२०६|| atisnēhāttu mandē'gnau cūrṇāriṣṭāsavā hitāḥ| bhinnē gudōpalēpāttu malē tailasurāsavāḥ||206||

atisnehAttu mande~agnau cUrNAriShTAsavA hitAH| bhinne gudopalepAttu male tailasurAsavAH||206||

If excessive intake of snēha is cause for agnimāndya then powder preparation, ariṣṭa asava as mentioned earlier are beneficial; whereas if anal area gets adhered by unformed stools then taila, surā and asavā preparation should be administered (206). उदावर्तात्तु मन्देऽग्नौ निरूहाः स्नेहबस्तयः| दोषवृद्ध्या तु मन्देऽग्नौ शुद्धो दोषविधिं चरेत्||२०७|| udāvartāttu mandē'gnau nirūhāḥ snēhabastayaḥ| dōṣavr̥ddhyā tu mandē'gnau śuddhō dōṣavidhiṁ carēt||207|| udAvartAttu mande~agnau nirUhAH snehabastayaH| doShavRuddhyA tu mande~agnau shuddho doShavidhiM caret||207||

If udavarta (mis-peristalsis) is responsible for suppression of agni then nirūha and snēha basti should be administered; whereas if dōṣha vr̥iddhi is the cause for suppression of agni then shodhana as per dōṣha is indicated (207). व्याधियुक्तस्य मन्दे तु सर्पिरेवाग्निदीपनम्| उपवासाच्च मन्देऽग्नौ यवागूभिः पिबेद्घृतम्||२०८|| अन्नावपीडितं बल्यं दीपनं बृंहणं च तत्| vyādhiyuktasya mandē tu sarpirēvāgnidīpanam| upavāsācca mandē'gnau yavāgūbhiḥ pibēdghr̥tam||208|| annāvapīḍitaṁ balyaṁ dīpanaṁ br̥ṁhaṇaṁ ca tat| vyAdhiyuktasya mande tu sarpirevAgnidIpanam| upavAsAcca mande~agnau yavAgUbhiH pibedghRutam||208||

If suppression of agni has taken place due to diseases than ghr̥ita is best for agni dīpana but if fasting is the causes of agni suppression than yavāgū (gruel) along with ghr̥ita should be taken. Ghr̥ita when taken in between the meal, it increases the strength, stimulates the digestion and nourishes the body (208). दीर्घकालप्रसङ्गात्तु क्षामक्षीणकृशान्नरान्||२०९|| प्रसहानां रसैः साम्लैर्भोजयेत् पिशिताशिनाम्| लघु, तीक्ष्णोष्णशोधित्वाद्दीपयन्त्याशु तेऽनलम्||२१०|| मांसोपचितमांसत्वात्तथाऽऽशुतरबृंहणाः| dīrghakālaprasaṅgāttu kṣāmakṣīṇakr̥śānnarān||209|| prasahānāṁ rasaiḥ sāmlairbhōjayēt piśitāśinām| laghu, tīkṣṇōṣṇaśōdhitvāddīpayantyāśu tē'nalam||210|| māṁsōpacitamāṁsatvāttathāśutarabr̥ṁhaṇāḥ| annAvapIDitaM balyaM dIpanaM bRuMhaNaM ca tat| dIrghakAlaprasa~ggAttu kShAmakShINakRushAnnarAn||209|| prasahAnAM rasaiH sAmlairbhojayet pishitAshinAm| laghu, tIkShNoShNashodhitvAddIpayantyAshu te~analam||210|| mAMsopacitamAMsatvAttathA~a~ashutarabRuMhaNAH| If agnimāndya has been chronic and patient has become indolent, weak and emaciated then soup of prasahā group of animals (animals who snatch their food) fortified with amla drugs is advised. As this meat soups are light for digestion having penetrating, hot, purifying qualities stimulates the agni. Further as the animals feed on other animals their meat māṁsa is well nourished and compact therefore causes quick nourishment (209-210). Factors affecting status of agni: नाभोजनेन कायाग्निर्दीप्यते नातिभोजनात्||२११|| यथा निरिन्धनो वह्निरल्पो वाऽतीन्धनावृतः| nābhōjanēna kāyāgnirdīpyatē nātibhōjanāt||211|| yathā nirindhanō vahniralpō vā'tīndhanāvr̥taḥ| nAbhojanena kAyAgnirdIpyate nAtibhojanAt||211|| yathA nirindhano vahniralpo vA~atIndhanAvRutaH|

Fasting or over eating doesn’t stimulate agni, as like fire in environment is extinguished if there is no fuel supply or if excessive fuel covers the agni. (211). स्नेहान्नविधिभिश्चित्रैश्चूर्णारिष्टसुरासवैः ||२१२|| सम्यक्प्रयुक्तैर्भिषजा बलमग्नेः प्रवर्धते| यथा हि सारदार्वग्निः स्थिरः सन्तिष्ठते चिरम्||२१३|| snēhānnavidhibhiścitraiścūrṇāriṣṭasurāsavaiḥ [44] ||212|| samyakprayuktairbhiṣajā balāmagnēḥ pravardhatē| yathā hi sāradārvAgniḥ sthiraḥ santiṣṭhatē ciram||213|| snehAnnavidhibhishcitraishcUrNAriShTasurAsavaiH [44] ||212|| samyakprayuktairbhiShajA balamagneH pravardhate| yathA hi sAradArvagniH sthiraH santiShThate ciram||213|| Proper intake of snēha, followed by eating proper food preparations as well as appropriate use of various chūrṇa, ariṣṭa, surā and asava alongwith proper medication as per condition, enhances the power of agni similar to the environmental fire which remains stable for long duration when good hard wood catches fire (212-213).

स्नेहान्नविधिभिस्तद्वदन्तरग्निर्भवेत् स्थिरः| हितं जीर्णे मितं चाश्नंश्चिरमारोग्यमश्नुते||२१४|| अवैषम्येण धातूनामग्निवृद्धौ यतेत ना| समैर्दोषैः समो मध्ये देहस्योष्माऽग्निसंस्थितः||२१५|| पचत्यन्नं तदारोग्यपुष्ट्यायुर्बलवृद्धये| दोषैर्मन्दोऽतिवृद्धो वा विषमैर्जनयेद्गदान्||२१६|| वाच्यं मन्दस्य तत्रोक्तमतिवृद्धस्य वक्ष्यते| snēhānnavidhibhistadvadantarAgnirbhavēt sthiraḥ| hitaṁ jīrṇē mitaṁ cāśnaṁściramārōgyāmaśnutē||214|| avaiṣamyēṇa dhātūnāmAgnivr̥ddhau yatēta nā| sāmairdōṣaiḥ samō madhyē dēhasyōṣmā'gnisaṁsthitaḥ||215|| pacatyannaṁ tadārōgyapuṣṭyāyurbalavr̥ddhayē| dōṣairmandō'tivr̥ddhō vā viṣāmairjanayēdgadān||216|| vācyaṁ mandasya tatrōktam ativr̥ddhasya vakṣyatē| snehAnnavidhibhistadvadantaragnirbhavet sthiraH| hitaM jIrNe mitaM cAshnaMshciramArogyamashnute||214|| avaiShamyeNa dhAtUnAmagnivRuddhau yateta nA| samairdoShaiH samo madhye dehasyoShmA~agnisaMsthitaH||215|| pacatyannaM tadArogyapuShTyAyurbalavRuddhaye| doShairmando~ativRuddho vA viShamairjanayedgadAn||216|| vAcyaM mandasya tatroktamativRuddhasya vakShyate| Intake of food mixed with snēha and as per dietetic rules and regulation stabilizes the digestive power. Eating wholesome diet in appropriate quantity after previously eaten food is digested helps in maintaining good health for long duration. A person should workout so that agni vr̥iddhi takes place without disturbing the balance of dhātus. Such agni digests the food, maintains health and nourishment, promotes longevity and increases strength. The same doṣha when vitiated causes mandāgni, tikshnāgni and vishamāgni and such a vitiated agni gives rise to various diseases. Management of mandāgni has been explained previously henceforth management of ativr̥ddha agni will be explained (214-216). Samprapti of atyagni: नरे क्षीणकफे पित्तं कुपितं मारुतानुगम्||२१७|| स्वोष्मणा पावकस्थाने बलमग्नेः प्रयच्छति| तदा लब्धबलो देहे विरूक्षे सानिलोऽनलः||२१८|| परिभूय पचत्यन्नं तैक्ष्ण्यादाशु मुहुर्मुहुः| पक्त्वाऽन्नं स ततो धातूञ्छोणितादीन् पचत्यपि||२१९|| narē kṣīṇakaphē Pittaṁ kupitaṁ mārutānugam||217|| svōṣmaṇā pāvakasthānē balāmagnēḥ prayacchati| tadā labdhabalō dēhē virūkṣē sānilō'nalaḥ||218|| paribhūya pacatyannaṁ taikṣṇyādāśu muhurmuhuḥ| paktvā'nnaṁ sa tatō dhātūñchōṇitādīn pacatyapi||219|| nare kShINakaphe pittaM kupitaM mArutAnugam||217|| svoShmaNA pAvakasthAne balamagneH prayacchati| tadA labdhabalo dehe virUkShe sAnilo~analaH||218|| paribhUya pacatyannaM taikShNyAdAshu muhurmuhuH| paktvA~annaM sa tato dhAtU~jchoNitAdIn pacatyapi||219|| Person having diminished kapha, aggravated pitta and associated vāta leads to increase in the ushma of agni resulting in enhancing the capacity and power of agni. In such patient if the body is already undernourished, vāta increases which further strengths the agni wherein both, together with help of tikshna guna digests the food even if taken frequently. After digestion of food, the increased agni starts digesting rakta etc dhātus also (217-219). ततो दौर्बल्यमातङ्कान्मृत्युं चोपनयेन्नरम्| भुक्तेऽन्ने लभते शान्तिं जीर्णमात्रे प्रताम्यति||२२०|| तृट्श्वासदाहमूर्च्छाद्या व्याधयोऽत्यग्निसम्भवाः| तमत्यग्निं गुरुस्निग्धशीतैर्मधुरविज्जलैः||२२१|| अन्नपानैर्नयेच्छान्तिं दीप्तमग्निमिवाम्बुभिः| मुहुर्मुहुरजीर्णेऽपि भोज्यान्यस्योपहारयेत्||२२२|| निरिन्धनोऽन्तरं लब्ध्वा यथैनं न विपादयेत्| tatō daurbalyamātaṅkānmr̥tyuṁ cōpanayēnnaram| bhuktē'nnē labhatē śāntiṁ jīrṇamātrē pratāmyati||220|| tr̥ṭśvāsadāhamūrcchādyā vyādhayō'tyAgnisambhavāḥ| tāmatyāgniṁ gurusnigdhaśītairmadhuravijjalaiḥ||221|| annapānairnayēcchāntiṁ dīptāmAgnimivāmbubhiḥ| muhurmuhurajīrṇē'pi bhōjyānyasyōpahārayēt||222|| nirindhanō'ntaraṁ labdhvā yathainaṁ na vipādayēt| tato daurbalyamAta~gkAnmRutyuM copanayennaram| bhukte~anne labhate shAntiM jIrNamAtre pratAmyati||220|| tRuTshvAsadAhamUrcchAdyA vyAdhayo~atyagnisambhavAH| tamatyagniM gurusnigdhashItairmadhuravijjalaiH||221|| annapAnairnayecchAntiM dIptamagnimivAmbubhiH| muhurmuhurajIrNe~api bhojyAnyasyopahArayet||222|| nirindhano~antaraM labdhvA yathainaM na vipAdayet|

Consequently, the patient becomes weak and death may occur due to disease. The patient feels better on consuming the food but feels worn out alongwith blackouts when food is digested. Morbid thirst, dyspnoea, burning sensation, fainting etc are observed in disease caused due to atyāgni. Digestive power can be pacified by taking foods and drinks which are heavy to digest, unctuous, cold, sweet and liquid same way as fire is extinguishes by water in nature. The patient should be administered food at regular interval although previously eaten meal is undigested so that atyāgni due to lack of fuel does not digest the tissues (220-222). Management of atyagni: पायसं कृशरां स्निग्धं पैष्टिकं गुडवैकृतम्||२२३|| अद्यात्तथौदकानूपपिशितानि भृतानि च| मत्स्यान्विशेषतः श्लक्ष्णान्स्थिरतोयचरांस्तथा||२२४|| आविकं च भृतं मांसमद्यादत्यग्निनाशनम् [४६] | pāyasaṁ kr̥śarāṁ snigdhaṁ paiṣṭikaṁ guḍavaikr̥tam||223|| adyāttathaudakānūpapiśitāni bhr̥tāni ca| matsyānviśēṣataḥ ślakṣṇānsthiratōyacarāṁstathā||224|| āvikaṁ ca bhr̥taṁ māṁsāmadyādatyāgnināśanam [46] | pAyasaM kRusharAM snigdhaM paiShTikaM guDavaikRutam||223|| adyAttathaudakAnUpapishitAni bhRutAni ca| matsyAnvisheShataH shlakShNAnsthiratoyacarAMstathA||224|| AvikaM ca bhRutaM mAMsamadyAdatyagninAshanam [46] | Pāyasa (milk pudding), kr̥śarā (thick gruel prepared of rice and lentils), snigdha (unctuous), paiṣṭika (resembling flour paste), various jaggery products, meat of aquatic animals or marshy area especially fish which is mainly in smooth (not salty) and stable water and roasted meat of sheep may be given to pacify the atyāgni (223-224). यवागूं समधूच्छिष्टां घृतं वा क्षुधितः पिबेत्||२२५|| गोधूमचूर्णमन्थं वा व्यधयित्वा सिरां पिबेत्| पयो वा शर्करासर्पिर्जीवनीयौषधैः शृतम्||२२६|| yavāgūṁ sāmadhūcchiṣṭāṁ ghr̥taṁ vā kṣudhitaḥ pibēt||225|| gōdhūmacūrṇāmanthaṁ vā vyadhayitvā sirāṁ pibēt| payō vā śarkarāsarpirjīvanīyauṣadhaiḥ śr̥tam||226|| yavAgUM samadhUcchiShTAM ghRutaM vA kShudhitaH pibet||225|| godhUmacUrNamanthaM vA vyadhayitvA sirAM pibet| payo vA sharkarAsarpirjIvanIyauShadhaiH shRutam||226||

Yavāgū (thick gruel) mixed with bee wax or ghr̥ita should be given whenever patient feels hungry. Mantha prepared from wheat flour or venesection may be advised. Milk medicated with jīvanīya group of drugs alongwith sugar and ghr̥ita may be given (225-226). फलानां तैलयोनीनामुत्क्रुञ्चाश्च [४७] सशर्कराः| मार्दवं जनयन्त्यग्नेः स्निग्धा मांसरसास्तथा||२२७|| phalānāṁ tailayōnīnāmutkruñcāśca [47] saśarkarāḥ| mārdavaṁ janayantyagnēḥ snigdhā māṁsarasāstathā||227|| phalAnAM tailayonInAmutkru~jcAshca [47] sasharkarAH| mArdavaM janayantyagneH snigdhA mAMsarasAstathA||227||

Paste of fruits, substances containing oil like tila (sesame seeds) with sugar and meat soup with ghee pacifies the agni (227). पिबेच्छीताम्बुना सर्पिर्मधूच्छिष्टेन संयुतम्| गोधूमचूर्णं पयसा ससर्पिष्कं पिबेन्नरः||२२८|| आनूपरससिद्धान् वा त्रीन् स्नेहांस्तैलवर्जितान्| पयसा सम्मितं [४८] चापि घनं त्रिस्नेहसंयुतम्||२२९|| नारिस्तन्येन संयुक्तां पिबेदौदुम्बरीं त्वचम्| ताभ्यां वा पायसं सिद्धमद्यादत्यग्निशान्तये||२३०|| pibēcchītāmbunā sarpirmadhūcchiṣṭēna saṁyutam| gōdhūmacūrṇaṁ payasā sasarpiṣkaṁ pibēnnaraḥ||228|| ānūparasasiddhān vā trīn snēhāṁstailavarjitān| payasā sammitaṁ [48] cāpi ghanaṁ trisnēhasaṁyutam||229|| nāristanyēna saṁyuktāṁ pibēdaudumbarīṁ tvacam| tābhyāṁ vā pāyasaṁ siddhāmadyādatyāgniśāntayē||230|| pibecchItAmbunA sarpirmadhUcchiShTena saMyutam| godhUmacUrNaM payasA sasarpiShkaM pibennaraH||228|| AnUparasasiddhAn vA trIn snehAMstailavarjitAn| payasA sammitaM [48] cApi ghanaM trisnehasaMyutam||229|| nAristanyena saMyuktAM pibedaudumbarIM tvacam| tAbhyAM vA pAyasaM siddhamadyAdatyagnishAntaye||230||

The patient should take ghr̥ita with beeswax alongwith cold water as anupana. Patient may take wheat flour with milk and ghee. Patient may be advised to take three sneha i.e. ghee, abinal fat, bonemarrow fortified with meat soup of animals residing in marshy areas. Milk mixed with wheat flour and curd alongwith three snēha (ghr̥ita, vasa, majja) may be given. Bark of udumbara mixed with human milk and milk pudding prepared from udumbara and human milk helps in pacifying the atyāgni (228-230). श्यामात्रिवृद्विपक्वं वा पयो दद्याद्विरेचनम्| असकृत् पित्तशान्त्यर्थं पायसप्रतिभोजनम्||२३१|| प्रसमीक्ष्य भिषक् प्राज्ञस्तस्मै दद्याद्विधानवित्| śyāmātrivr̥dvipakvaṁ vā payō dadyādvirēcanam| asakr̥t Pitta śāntyarthaṁ pāyasapratibhōjanam||231|| prasamīkṣya bhiṣak prājñastasmai dadyādvidhānavit|

shyAmAtrivRudvipakvaM vA payo dadyAdvirecanam| asakRut pittashAntyarthaM pAyasapratibhojanam||231|| prasamIkShya bhiShak prAj~jastasmai dadyAdvidhAnavit|

Milk medicated with syāmā and trivr̥ta may be advised for virechana for alleviating the pitta followed by diet of milk pudding. Expert physician should follow the line of treatment after proper examination of patient (231). यत्किञ्चिन्मधुरं मेद्यं श्लेष्मलं गुरुभोजनम्||२३२|| सर्वं तदत्यग्निहितं भुक्त्वा प्रस्वपनं दिवा| मेद्यान्यन्नानि योऽत्यग्नावप्रतान्तः [४९] समश्नुते||२३३|| न तन्निमित्तं व्यसनं लभते पुष्टिमेव च| कफे वृद्धे जिते पित्ते मारुते चानलः समः||२३४|| yatkiñcinmadhuraṁ mēdyaṁ ślēṣmalaṁ gurubhōjanam||232|| sarvaṁ tadatyāgnihitaṁ bhuktvā prasvapanaṁ divā| mēdyānyannāni yō'tyagnāvapratāntaḥ [49] sāmaśnutē||233|| na tannimittaṁ vyasanaṁ labhatē puṣṭimēva ca| kaphē vr̥ddhē jitē pittē mārutē cānalaḥ sāmaḥ||234|| sāmadhātōḥ pacatyannaṁ puṣṭyāyurbalavr̥ddhayē| yatki~jcinmadhuraM medyaM shleShmalaM gurubhojanam||232|| sarvaM tadatyagnihitaM bhuktvA prasvapanaM divA| medyAnyannAni yo~atyagnAvapratAntaH [49] samashnute||233|| na tannimittaM vyasanaM labhate puShTimeva ca| kaphe vRuddhe jite pitte mArute cAnalaH samaH||234|| samadhAtoH pacatyannaM puShTyAyurbalavRuddhaye| Foods which are sweet in taste, fatty, increases kapha and heavy to digest should be given. All food items are good for atyāgni and sleeping after meals during day time is beneficial in atyāgni. Patient who takes fatty diet even though he is not hungry does not succumb to death. If he is suffering from atyāgni on the other hand such diet pattern is nutritional. Whenever due to medication and diet, kapha is increased; it subdues pitta and vāta and normalizes the agni. When dhātus are in equilibrium anna gets digested resulting in increase in nutrition, longevity and strength (232-234). Improper dietary habits: भवन्ति चात्र- पथ्यापथ्यमिहैकत्र भुक्तं समशनं मतम्||२३५|| विषमं बहु वाऽल्पं वाऽप्यप्राप्तातीतकालयोः| भुक्तं पूर्वान्नशेषे तु पुनरध्यशनं मतम्||२३६|| त्रीण्यप्येतानि मृत्युं वा घोरान् व्याधीन्सृजन्ति वा| bhavanti cātra- pathyāpathyamihaikatra bhuktaṁ sāmaśanaṁ matam||235|| viṣāmaṁ bahu vā'lpaṁ vā'pyaprāptātītakālayōḥ| bhuktaṁ pūrvānnaśēṣē tu punaradhyaśanaṁ matam||236|| trīṇyapyētāni mr̥tyuṁ vā ghōrān vyādhīnsr̥janti vā| bhavanti cAtra- pathyApathyamihaikatra bhuktaM samashanaM matam||235|| viShamaM bahu vA~alpaM vA~apyaprAptAtItakAlayoH| bhuktaM pUrvAnnasheShe tu punaradhyashanaM matam||236|| trINyapyetAni mRutyuM vA ghorAn vyAdhInsRujanti vA|

Taking of wholesome and unwholesome foods together in diet is known as samaśana. Viṣamaśana is defined as taking food either in excess quantity or very little quantity and also if taken before or after appropriate time. Adhyaśana is having food even though previously eaten food is not yet digested. All the above three are causes for death or give rise to serious disorders (235-236). Variation in digestion as per day-night cycle: प्रातराशे त्वजीर्णेऽपि सायमाशो न दुष्यति||२३७|| दिवा प्रबुध्यतेऽर्केण हृदयं पुण्डरीकवत्| तस्मिन्विबुद्धे स्रोतांसि स्फुटत्वं यान्ति सर्वशः||२३८|| व्यायामाच्च विहाराच्च विक्षिप्तत्वाच्च चेतसः| न क्लेदमुपगच्छन्ति दिवा तेनास्य धातवः||२३९|| prātarāśē tvajīrṇē'pi sāyamāśō na duṣyati||237|| divā prabudhyatē'rkēṇa hr̥dayaṁ puṇḍarīkavat| tasminvibuddhē srōtāṁsi sphuṭatvaṁ yānti sarvaśaḥ||238|| vyāyāmācca vihārācca vikṣiptatvācca cētasaḥ| na klēdamupagacchanti divā tēnāsya dhātavaḥ||239|| prAtarAshe tvajIrNe~api sAyamAsho na duShyati||237|| divA prabudhyate~arkeNa hRudayaM puNDarIkavat| tasminvibuddhe srotAMsi sphuTatvaM yAnti sarvashaH||238|| vyAyAmAcca vihArAcca vikShiptatvAcca cetasaH| na kledamupagacchanti divA tenAsya dhAtavaH||239||

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

अक्लिन्नेष्वन्नमासिक्तमन्यत्तेषु न दुष्यति| अविदग्ध इव क्षीरे क्षीरमन्यद्विमिश्रितम्||२४०|| नैव दूष्यति तेनैव समं सम्पद्यते यथा| aklinnēṣvannamāsiktāmanyattēṣu na duṣyati| avidagdha iva kṣīrē kṣīrāmanyadvimiśritam||240|| naiva dūṣyati tēnaiva sāmaṁ sampadyatē yathā| aklinneShvannamAsiktamanyatteShu na duShyati| avidagdha iva kShIre kShIramanyadvimishritam||240|| naiva dUShyati tenaiva samaM sampadyate yathA|

As unspoiled milk when mixed with fresh milk, the mixture does not get spoiled and will get uniformly mixed, so is the condition when in daytime previously eaten food although not digested still a person can digest another meal (240). रात्रौ तु हृदये म्लाने संवृतेष्वयनेषु च| यान्ति कोष्ठे परिक्लेदं संवृते देहधातवः||२४१|| क्लिन्नेष्वन्यदपक्वेषु तेष्वासिक्तं प्रदुष्यति| विदग्धेषु पयःस्वन्यत् पयस्तप्तमिवार्पितम्||२४२|| नैशेष्वाहारजातेषु नाविपक्वेषु बुद्धिमान्| तस्मादन्यत्समश्नीयात्पालयिष्यन्बलायुषी||२४३|| rātrau tu hr̥dayē mlānē saṁvr̥tēṣvayanēṣu ca| yānti kōṣṭhē pariklēdaṁ saṁvr̥tē dēhadhātavaḥ||241|| klinnēṣvanyadapakvēṣu tēṣvāsiktaṁ praduṣyati| vidagdhēṣu payaḥsvanyat payastaptamivārpitam||242|| naiśēṣvāhārajātēṣu nāvipakvēṣu buddhimān| tasmādanyatsāmaśnīyātpālayiṣyanbalāyuṣī||243|| rAtrau tu hRudaye mlAne saMvRuteShvayaneShu ca| yAnti koShThe parikledaM saMvRute dehadhAtavaH||241|| klinneShvanyadapakveShu teShvAsiktaM praduShyati| vidagdheShu payaHsvanyat payastaptamivArpitam||242|| naisheShvAhArajAteShu nAvipakveShu buddhimAn| tasmAdanyatsamashnIyAtpAlayiShyanbalAyuShI||243|| In the night, the channels are closed, so is the heart which functions at slow rate as demand is less, the apakva ahāra rasa increases in viscosity; thus ama adheres to the dhātus and if another food is taken the indigestion causes more apakva ahāra rasa causing disease. The condition resembles, wherein uncooked milk mixed with warm milk gets spoiled. Therefore, a wise person should not take meals if food taken at night is not digested; this will surely effect strength and life of a person (241-243). Summary: तत्र श्लोकाः- अन्तरग्निगुणा देहं यथा धारयते च सः| यथाऽन्नं पच्यते यांश्च यथाऽऽहारः करोत्यपि||२४४|| येऽग्नयो यांश्च पुष्यन्ति यावन्तो ये पचन्ति यान्| रसादीनां क्रमोत्पत्तिर्मलानां तेभ्य एव च||२४५|| वृष्याणामाशुकृद्धेतुर्धातुकालोद्भवक्रमः| रोगैकदेशकृद्धेतुरन्तरग्निर्यथाऽधिकः||२४६|| प्रदुष्यति यथा दुष्टो यान् रोगाञ्जनयत्यपि| ग्रहणी या यथा [५३] यच्च ग्रहणीदोषलक्षणम्||२४७|| पूर्वरूपं पृथक् चैव व्यञ्जनं सचिकित्सितम्| चतुर्विधस्य निर्दिष्टं तथा चावस्थिकी क्रिया||२४८|| जायते च यथाऽत्यग्निर्यच्च तस्य चिकित्सितम्| उक्तवानिह तत् सर्वं ग्रहणीदोषके मुनिः||२४९|| tatra ślōkāḥ- antarAgniguṇā dēhaṁ yathā dhārayatē ca saḥ| yathā'nnaṁ pacyatē yāṁśca yathāhāraḥ karōtyapi||244|| yē'gnayō yāṁśca puṣyanti yāvantō yē pacanti yān| rasādīnāṁ kramōtpattirmalānāṁ tēbhya ēva ca||245|| vr̥ṣyāṇāmāśukr̥ddhēturdhātukālōdbhavakrāmaḥ| rōgaikadēśakr̥ddhēturantarAgniryathā'dhikaḥ||246|| praduṣyati yathā duṣṭō yān rōgāñjanayatyapi| Grahaṇī yā yathā [53] yacca Grahaṇī dōṣalakṣaṇam||247|| pūrvarūpaṁ pr̥thak caiva vyañjanaṁ sacikitsitam| caturvidhasya nirdiṣṭaṁ tathā cāvasthikī kriyā||248|| jāyatē ca yathā'tyAgniryacca tasya cikitsitam| uktavāniha tat sarvaṁ Grahaṇī dōṣakē muniḥ||249|| tatra shlokAH- antaragniguNA dehaM yathA dhArayate ca saH| yathA~annaM pacyate yAMshca yathA~a~ahAraH karotyapi||244|| ye~agnayo yAMshca puShyanti yAvanto ye pacanti yAn| rasAdInAM kramotpattirmalAnAM tebhya eva ca||245|| vRuShyANAmAshukRuddheturdhAtukAlodbhavakramaH| rogaikadeshakRuddheturantaragniryathA~adhikaH||246|| praduShyati yathA duShTo yAn rogA~jjanayatyapi| grahaNI yA yathA [53] yacca grahaNIdoShalakShaNam||247|| pUrvarUpaM pRuthak caiva vya~jjanaM sacikitsitam| caturvidhasya nirdiShTaM tathA cAvasthikI kriyA||248|| jAyate ca yathA~atyagniryacca tasya cikitsitam| uktavAniha tat sarvaM grahaNIdoShake muniH||249|| To conclude; the grahaṇī dōṣha, adhyaya has discussed following points. a) Qualities of antaragni, b) Manner in which agni does dhāran (sustenance) of the body, c) Manner in which food is digested, d) How digested food functions? e) How different types of agni does nutrition after digesting the fuel? f) Development of rasādi dhātus and their associated waste products after digestions at dhātu level (tissue level), g) How aphrodisiacs act instantly and time taken for the dhātu formation and order of development? h) Reason why diseases are located in one part of the body and role of antarāgni in disease formation, i) Diseases caused by abnormal agni, j) Definition of grahaṇī and sign and symptoms of grahaṇī dōṣha, k) Premonitory symptoms along with four types of grahaṇī dōṣha their signs and symptoms with treatment as per various condition, l) How condition of atyāgni is generated and its treatment. (244-249).

इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने ग्रहणीचिकित्सितं नाम पञ्चदशोऽध्यायः||१५|| ityAgnivēśakr̥tē tantrē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē Grahaṇī cikitsitaṁ nāma pañcadaśō'dhyāyaḥ||15|| ityagniveshakRute tantre~aprApte dRuDhabalasampUrite cikitsAsthAne grahaNIcikitsitaM nAma pa~jcadasho~adhyAyaH||15||

Herewith, fifteenth chapter related to Grahaṇī Chikitsā which was unavailable as part of Chikitsā Sthāna of Agnivesha Tantra supplemented by Dr̥ḍhabala has been completed (15).

Tatva Vimarsha

• Dehāgni (all the entities in the body that are responsible for digestion and metabolism) is the fundamental causative agent for longevity, normal complexion, normal strength, good health, motivation, normal growth, normal luster, normal ojas, normal body temperature and various other forms of agni. Even the existence of an individual is said to be because of dehāgni (3). • When the agni stops functioning, the individual dies; if the agni functions normally, the individual can lead a healthy and long life. . Similarly, if the agni becomes abnormal, the individual suffers from various diseases; and hence, the agni is said to be the root cause of health and longevity (4). • Normal functioning of agni is essential to make the consumed food capable of nourishing the body tissues and of promoting the ojas (vital essence), strength, complexion etc. In the absence of normal digestion (and metabolism), the normal body tissues such as rasa cannot be formed nor nourished (5). • Vata dosha, specifically prana vata and samana vata play significant role in process of digestion and metabolism. • Three doshas are produced in three consequent stages of digestion after consumption of food. Kapha is produced in first stage of madhura avasthapaka; pitta in second stage of amla avasthapaka and vata is produced in third stage of katu avasthapaka. The site of production and time of production of dosha is in sequence as the process of digestion proceeds. Increase or decrease in quantity of dosha depends upon similarity or dis-similarity of basic composition of food consumed. • The first phase of digestion is carried out by jatharagni, second phase by bhutagni and third phase by dhatvagni. These are different levels of action of agni where various digestive and metabolic processes take place. • During the processing by dhatvagni, Stanya (breast milk) and the menstrual blood are derived after rasa. Kaṇḍarā (tendon) and sirā(vein) are derived after rakta. Vasā(fat) and the six layers of tvachā (skin) are derived after māṃsa (muscle) and snāyu(ligament) are derived after medas (adipose tissue) (17). • The faeces and the urine are the kiṭṭa (non-nutrient portion/waste portion/byproduct) of ingested food. The kiṭṭa of rasa is mala-kapha (excretions). Mala-pitta (bile pigment) is the kiṭṭa of rakta. Kha-mala (the wastes accumulated in the hollow structures of the body such as external ears and nostrils) are the kiṭṭa of māṃsa. Sweda (sweat) is the mala of medas. Keśa (hairs on the head) and loma (body hair) are the mala of asthi. The mala of majjā is the oily excretion of the eye and the skin (sebum). Thus, the dhātus continuously undergo two kinds of transformation: prasāda (nutrient portion) and kiṭṭa (non-nutrient portion). This entire sequence of transformation and metabolism of dhātu is thus inter dependent (18-19½ ). • Disorders of various factors mentioned above shall be treated after considering the original dhatu from which the factor is derived. • Vyāna vāta forcefully propels the rasa dhātu out of the heart and spreads it all over the body simultaneously, continuously and for the entire life (36). • Disease is produced only at the site of abnormality of body systems. • Life and strength of an individual depends on agni hence one should take utmost care to maintain the agni by providing fuel in the form of food and drinks which should be taken as per the rules mentioned. (40) • If the rules of diet and dietary habits are not followed due to greed, then disease of grahani occurs. • The anna-visha (toxins) produced due to improper digestion and metabolism causes diseases at the sites of affliction. • The vishāmagni (improper agni) causes irregularity in digestion and therefore defective formation of dhātu takes place. Whereas, tīkṣṇāgni (excessive agni) when associated with little quantity of fuel (in the form of food) causes depletion of dhātu (tissue elements) (50). • The digestive disorder of grahani can lead to secondary disorders related with other body systems along with digestive system. • Grahaṇī disease is classified into four types viz vātaja, pittaja, kaphaja and sannipātaja depending upon the dominance of dosha and on the basis of the classification, etiological factors, symptoms and signs are varied. • When the dōṣhas are located in grahaṇī and are associated with incomplete digested food then vamana (emetic therapy) is advised. • If the ama is in pakvāśaya and in anutkliṣṭa (stuck, not ready to come out) condition, then stravan (increasing secretion) with dīpana dravyas should be administered. • If ama gets absorbed along with rasa dhātu and if it pervades throughout the body then laṅghana and pāchana should be advised. • Various purification procedures are advised as per the state of dosha aggravation and site of affliction in disease. Ghee processed with digestive stimulant drugs, sour media like buttermilk is advised. • Patient should be evaluated for amadōṣa whether sāmatā or nirāmtā is present or not and then appropriately treated with pāchana etc. treatment (95). • Buttermilk due to its dīpana, grāhi (substances which increases appetite and digestive power and absorb fluid from the stool) and easy to digest actions is very useful in grahaṇīdōṣha. • Vata dominant grahani shall be treated with basti, virechana and unctuous preparations. • If pitta is dominant in its own place then virechana or vāmana should be administered for removal of pitta (122). • In kaphaja grahaṇī, vamana and then drugs having katu, amla, lavana, kṣāra and tikta rasa shall be administered to increase agni (digestive power) (141). • In tridōṣaja grahaṇī, panchakarma should be carried out as per predominancy of doṣha. Various ghee, kṣāra, asava and ariṣṭa preparation useful in stimulation of agni should be administered. • Sneha is the best among the dipana dravya which helps in stimulating the inefficient agni (201) • Fasting or over eating doesn’t stimulate agni. Proper intake of snēha, followed by eating proper food preparations as well as appropriate use of various chūrṇa, ariṣṭa, surā and asava along with proper medication as per condition, enhances the power of agni. • Atygni is caused by diminished kapha, aggravated pitta and associated vāta. This leads to emaciation if proper food is not consumed. Excessively increased digestive power can be pacified by taking foods and drinks which are heavy to digest, unctuous, cold, sweet and liquid. • Samaśana is taking wholesome and unwholesome foods together in diet. Viṣamaśana is taking food either in excess quantity or very little quantity and also if taken before or after appropriate time. Adhyaśana is having food even though previously eaten food is not yet digested. All the above three are causes for death or give rise to serious disorders (235-236). • If morning eaten food is undigested and still if anyone takes evening food, it may not be more vitiative since in day time all the srotas (channels) are dilated and heart is active similar to the lotus which blossoms with sunrise. During daytime, exercise, other physical and mental activities (cause heart to pump blood properly to) prevent the genesis of kleda (excess moisture) in various dhātus. In the night, the channels are closed, so is the heart which functions at slow rate as demand is less, the apakva ahāra rasa increases in viscosity; thus ama adheres to the dhātus and if another food is taken in the morning the indigestion causes more apakva ahāra rasa causing disease.

Vidhi Vimarsha

Importance of agni: The functions of gut are vital for maintenance and preservation of health. Grahani is the seat of jatharagni, which is the initiator of digestive process and strengthens the other 12 agnis. Jatharagni transforms food into biological substance (ahar rasa) which is further trifurcated into madhur, amla and katu avastha pak which gets transformed into three biological energies kapha, pitta and vata respectively. From the physiological point of view, the Jaṭharāgni or the active form of pāchaka pitta is responsible for the digestion of all kinds of foods in the gut. Therefore, this should include all amylolytic, proteolytic and lipolytic enzymes secreted by various kinds of exocrine glands in the gut, which actually cause digestion, i.e., breaking down of different macromolecules into their constituent units. There are five bhūtāgnis and their function is to metabolize panchabhautic components of the food that are homologous to them in their composition. For instance, bhauma agni acts on the component that is bhauma or pārthiva in its composition. Bhūtāgnis act on the products of digestion (jaṭharāgni pāka), hence, must be acting after the absorption of the nutrients, but before the action of dhātvāgni. The major site where the absorbed nutrients undergo biochemical transformation is in the liver, which plays an important role in metabolism, wherein several processes such as trans-amination, de-amination, beta-oxidation of fatty acids, glycolysis etc. take place. Therefore, the overall intermediary metabolism (involving fats, carbohydrates and proteins) can be understood as the functioning of the bhūtāgni. Dhātvāgni acts at tissue-level (in fact, at cellular level) upon the products of bhūtāgni pāka and are responsible for the building of the respective dhātus. In other words, the bio-energetic processes of a cell seem to be under the regulation of dhātvāgni. For instance, the common product of intermediary metabolism (involving fats, carbohydrates and proteins) is Acetyl-Co-A, which enters into Kreb’s cycle in the mitochondria of a cell. This is followed by electron transfer and oxidative phosphorylation. [ ] It is interesting to note that the Kreb’s cycle is also known as the ‘final common pathway’ in the process of catabolism of carbohydrates, proteins and fats. However, for the entry of amino acids, glucose and fatty acids into the cell, certain other factors such as hormones too are needed. For instance, insulin promotes the transportation of glucose, amino acids and fatty acids into the cell. Therefore, all these hormones (such as insulin, growth hormone, thyroid hormones, testosterone etc.) that promote the transportation of various nutrients into the cells, along with the enzymes participating in the Kreb’s cycle are to be included under the term dhātvagni. Thus, the three major stages of the catabolism (involving fats, carbohydrates and proteins) i.e. digestion, intermediary metabolism and Kreb’s cycle - seem to represent the three sets of agnis, viz., jaṭharāgni, bhūtāgni and dhātvagni respectively.

Role of vata in digestion:

Samana vayu separates nutritive (prasad) and waste (kitt) part from ahaar rasa. Nutritive part is circulated to entire body after absorption through rsayinii (villi) by vyan vayu. Waste part is excreted as feces, urine and sweat through their excretory channels by apaan vata. Absorbed nutritive substances circulate all over the body through seven specific micro channels of each of the seven dhatus. Dhatvagni : Each dhatu has its own transforming agni and srotas. Srotus or micro channels have two functions of carrying and transforming the tissues with the help of their specific dhatu agni. Five bhutagnis, one for each mahbhuta, transform five bhautic elements into the body tissues and organs. Seven dhatuagni or tissue transformers, form the tissue elements of seven dhatus by their needed nutrients. After formation of dhatu, the microchannels permeates them into the organs for functioning. During this transformation process, updhatu or subtissues and dhatumal or waste products are formed. Updhatus of rasa dhatu is breast milk, menstrual blood is updhatu of rakta and tendons and six layers of skin is updhatu of maansa dhatu etc. Apart from digestion, the gut performs various other significant functions as well. The gut has its own protective mechanism in the form of gut-associated lymphoid tissue, which prevents the entry of pathogens into the bloodstream. The micro-biota in the gut serves vital functions related to various aspects of health. The enteric nervous system of the gut has its own functional significance and has been proven to be very closely associated with the central nervous system functions. The gut secretes several hormone-like substances that are helpful in regulating long-term energy balance. All the factors mentioned are either directly or indirectly dependant on these functional domains of the gut. [ ] [ ] Other forms of agni in this context are indicative of bhūtāgni and dhātvāgni, which in turn, are functionally dependent on jaṭharāgni. ‘Prānāḥ’ in this context may stand for all types of vāta as well. Three stages of digestion: There are three stages of digestion in the gut. The first stage (madhura) takes place in the upper gastro-intestinal tract, i.e., inside the eosophagus and stomach; the second stage (amla) takes place in the middle portion of the gut, i.e., in the small intestine; and the last stage (kaṭu) takes place in the colon. The froth-like kapha seems to be the thick mucus that covers the entire stomach, providing a protective coating that prevents the gastric mucosa being digested and damaged due to the acid-pepsin mixture. Accha pitta is ‘liquid’ in nature, released in the duodenum and can be correlated with bile. Pācaka pitta has the functional site between amāśhaya (stomach) and pakvāśaya (colon), which is indicative of small intestine. It is composed of five mahābhūtas but the agni mahābhūta is predominant; and hence, it becomes devoid of fluidity and therefore is also known as agni. It splits the food into sāra (nutritive) and kiṭṭa (non-nutritive) portions. (Ashtanga Hridaya, Sutra Sthana, 12/10-12). Sāra portion of the food is the minutest fraction (parama sūkṣma). This portion reaches the heart in the form of ‘ahara rasa’. From the heart, it then gets re-distributed into 24 pulsatile vessels to be carried into the whole body. (Sushruta Samhita, Sutra Sthana, 14/3) The portion that reaches the colon is the one that is designated as ‘kiṭṭa’. During the third stage of digestion, there occurs the solidification of fecal matter and formation of certain pungent gases such as ammonia, methane, hydrogen sulfide etc. The term ‘pakva’ in this context indicates pakva mala; not pakva ahāra (Verse 9-11). Formation of the seven dhātus: Rasa, rakta, māṃsa, meda, asthi, majjā and shukra are the seven fundamental entities that sustain the human body. These can be called ‘tissues’ for the sake of convenience, though some of them are not tissues in a strict sense. It will be pertinent to look into these individual entities at this stage to understand what they really are in terms of anatomy. [ ] Rasa: A colorless fluid that gets ejected out of the heart and nourishes the entire body. Rakta: The red colored fraction that is formed in liver and spleen after the action of rañjaka pitta on rasa. It is essential for life and its function is to supply the life principle (jīva). Rasa and rakta together form what is generally known as blood: rakta being the red fraction (red blood corpuscles) and rasa being the colorless fluid (plasma). Māṃsa: The correct translation of this term would be ‘flesh’. Flesh generally means all kinds of muscles and also the parenchyma of the different viscera such as thyroid, liver, spleen, kidneys etc. Medas: This generally stands for fatty tissue, however, it is to be noted that it is of two types: Baddha (bound, stable, fixed, stored) and abaddha (free, unbound). The baddha form, therefore, must include the stored fat in the form of adipose tissue; and the abaddha form must include the circulating lipids such as cholesterol, LDL, HDL etc. Asthi: Though the term asthi generally stands for bony tissue, it may in some contexts, include all such relatively hard structures that resist easy decaying, viz., teeth, nails and hair. Majjā: Generally, the substance that fills all the bony cavities is called majjā. However, the brain substance that fills the cranial cavity too, must be included in majjā. Therefore, majjā is of two types: asthigata (bony) and mastakagata (cranial). Shukra: The term ‘shukra’ has been described to be of two forms in Ayurveda textbooks: 1. The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis, 2. The one that is formed from majjā (the tissue that fills the bony cavities) which in turn circulates all over the body both in males and females. Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamo-pituitary-gonadal axis of hormones that circulate all over the body. The process of nourishment of dhātu: The process of nourishment of dhātus is explained by three analogies: Kṣīra-dadhi (milk curdling analogy), khalekapota (analogy of pigeons picking up the choicest grains) and kedārī-kulyā (irrigation analogy). Kṣīra-dadhi nyāya (milk curdling analogy): According to this analogy, the nourishment of a dhātu takes place according to the rule of conversion (of one substance into another). Just as the milk is converted into different forms (from milk to curd, curd to butter, butter to ghee) successively, the preceding dhātu too is converted into the next one. The sequence of this conversion is as follows: rasa - rakta - māṃsa – meda – asthi – majjā – and - shukra in the same order. The transformation of various substances that takes place due to various biochemical reactions could be one way of understanding this analogy. For instance, the process of glycolysis involves different enzymes acting on different substrates at different steps and converting them from one to another. The ability of one kind of stem cell derived from one tissue in giving rise to different forms of cell types of different tissues is known. The response of mesenchymal stem cells to certain stimuli such as hypoxia in the form of migration and tissue regeneration is also known, which can further support this analogy. Khalekapota nyāya (analogy of pigeons picking up the choicest grains): According to this analogy, the nourishment of different dhātus takes place according to the rule of selectivity. Just as the pigeons coming from far off places, picking up the grains of their choice from the granary (a storehouse for thrashed grain, khala) and flying back to their destination, the different dhātus too, pick up the required nourishment from the common nutrient pool known as rasa. The dhātu that is situated nearer to rasa is nourished first and the remaining later, just as the pigeon from a nearer place gets a chance to pick up grains quickly in the given analogy. In this analogy, the choice that the pigeons have in picking up the grain (selectivity) and the energy they spend in the process of obtaining grains (actively) are the vital features. The tissue metabolism can influence the extent of vasodilatation and thus its own perfusion. This is known as auto-regulation of blood supply. Similarly, the specific kind of tissue has affinity for specific nutrient and other substances. For example, the calcium gets deposited normally in bones, but not in the mucous membranes. Similarly, vitamin B-12 is stored in liver and not in other tissues. Kedārī-kulyā nyāya (analogy of irrigation): According to this analogy, the nourishment of dhātu takes place according to the rule of irrigation. Just as the kulyās (small canals / trenches / channels) receive water from the kedārikā (the bigger water reservoir) and then irrigate the nearest field first, the rasa too, nourishes the dhātus in a sequential fashion depending on the location of the dhātu. The anatomical location of a cell in the body can influence the amount of perfusion it receives. For instance, the apical regions of the lungs are less perfused than the other areas of the lung, and hence, are susceptible to be affected in some infectious conditions such as tuberculosis. Similarly, the hepatocytes that surround the central vein in a hepatic lobule are more susceptible to hypoxic injury than those situated in the periphery. Sub-endocardial region of the heart is, in the same manner, is more susceptible to ischemia than the epicardial region. Another important feature to be noted in this analogy is the passive flow of water from higher altitude to lower altitude, where no external energy is spent. This is in contrast to the pigeons expending their energy to pick up the grains of their choice actively. It is interesting to note the process of transportation of substances across the cell membrane, which has been divided into two major types: active transport and passive transport (Verse-16). Bilirubin is a metabolic byproduct of heme portion of the hemoglobin. This is secreted into bile juice in the liver which is in turn released during the process of digestion. Features of pitta vr̥ddhi therefore, are yellowish discoloration of sclera, skin, urine and feces. Mucous is rich in water that is derived from extracellular fluid while it is being formed. The cerumen, sebum, and other similar external secretions perform some functions such as providing a waxy protective layer. Sweat and urine share similarities in function as well as composition. Therefore, vr̥kka mentioned as the site of origin of medavaha srotas makes sense when one considers sweda as the mala of meda. Hair and bones share similarity when it comes to the power to resist easy biodegradation. They also grow weaker in old age. Therefore, hair are the mala of asthi (Verse 19). Circulating provoked dosha settles in a tissue whose channels are defective (kha-vaigunya) and perfuce the lesion. This pathogenesis has been compared with rain production. The obstruction to the moving rasa by the abnormality of srotas, results in causation of disease, just as the obstruction to the cloud laden monsoon winds by the tall mountains results in the causation of rainfall (Verse 37). Causes of grahani disorder: Abhōjana (starvation) leads to increase in vāta and in turn agnimāndya.(Ca.Vi/ 2/7) Starvation and protein malnutrition disrupts the normal indigenous gastro intestinal tract micro-flora and impairs host antibacterial defenses. Both starvation and protein malnutrition increases the cecal levels of gram negative enteric bacilli and decrease the level of lactobacillus and promote growth of anaerobes that inturn disturb the gut flora. Gut flora also known as gut microbiome has a unique role in digestion and absorption. Once the gut microbiome gets vitiated it leads to indigestion and malabsorption.

Atibhōjana (excessive intake) causes provocation of all the doṣha and thereby causing agnimāndya. Protein rich diet or fat laden diet or excessive diet takes longer time for emptying of stomach. Longer stay of food explains increase of acidic pH. Therefore, whenever such chyme enters the duodenum the liver and pancreas need to increase secretion of alkali pH. Repeated, such dietary habits lead to indigestion. Further increase of alkali pH causes reduced transit time in small intestine leading to the symptoms like diarrhea. Diet which is atiguru (heavy) and indulging viṣamāśana( irregular food habit) will have similar effect. Atirukṣa ahāra or diet has low protein value. Protein malnutrition leads to decrease of enzyme secretion as proteins are the building blocks of enzymes. Asātmya deśa, kāla, ritu only explain the dietary changes which dramatically alter the balance of bacteria in the gut on daily basis. Research shows that these fluctuations could lead to various digestive and absorptive problems. Duṣiṭa bhojana or contaminated food reacts directly with intestinal flora disturbing their quantitative and qualitative growth causing indigestion. Intake of unctuous substances in sāma pitta condition leads to grahaṇīdoṣha and various other disorders.( Ca. Su 13/76 ) Emaciation due to disease also has its own impact on digestion. Mandāgni is a causative factor for all diseases but if patient continuously indulges in apathya then complications may increase or the prognosis turns bad. Suppression of manifested natural urges may have impact on nervous system resulting in effect either on enzymatic secretion or on the hormonal secretion.These factors have role in digestion and absorption as may be understood in case of adhovāta (accumulation of vata in rectum and pelvic region) and puriṣa vegadhāran (suppression of urge of defecation), wherein regular urge suppression disturbs the intestinal pro-kinetic movement.( Ca. Su. 7/ 6,8,12) Disturbed pro-kinesia increases the transit time leading to the change in pH which further has its impact on electrolytes and enzymatic secretion leading to reduced digestive power (agnimāndya). Further kṣudhā vegadhārana (avoiding sense of hunger) effect will be similar to abhojana (not eating). It may also be noted that repeated kṣudhā vegadhārana leads to atrophy of the stomach which further weakens the perception of hunger which is controlled by the percentage of the stomach that remains empty similar to the explanation given by Charaka that excessive fasting leads to diminution in agni.(Ca.Su.22/37) Tr̥ṣṇā vegadhārana (avoiding thirst) leads to reduced fluid balance in the body. Nearly seven liters of water is secreted during various gastrointestinal secretions. Reduced water intake in long term will reduce gastrointestinal secretion leading to impaired digestion. Abnormal digestion is from faulty food habits and unwholesome diet, that causes jatharagni dushti or vitiation of digestive power. The improperly digested food turns into toxic substance called aamavisha, basic cause of most diseases. If aamavisha associates with any balanced dosha or healthy dhatu, they turn pathogenic. Grahanidosha is an important example of aamavisha and agnidushti. Grahinidosha is of four types. It starts with inflammation of elementary canal at different places and is called by different names e.g gastritis, duodenitis and colitis. In the second stage erosions and ulcers develop. In third stage mental symptoms like anxiety, illusions, fear, and IBS like symptoms. Fourth stage is sannipatic with clinical features resembling ulcerative colitis. Treatment of grahanidosha is to enhance jatharagni, bhutagni and dhatuagni which encompasses the whole digestive process. Food and drinks are also medicated depending upon the patient and the stage of disease, for extended period of time. Effect on immunity: Prayatna (effort), urjā (energy) and bala (strength) are the role played by vāta, pitta and kapha in building up of immunity. When the doṣha gets vitiated prayatna, urjā and bala are hampered leading to suppression of immunity. Exogenous and endogenous factors vitiate the doṣha which when associated with ama produce either local or systemic disorders. Tridoṣha play role in impairing immunity and depending on the dominance of a particular doṣha they are classified as vātaja, pittaka and kaphaja disorders.(Ca. Su. 28/7) Equilibrium of agni: Agni should be associated with balance of vāta, pitta and kapha or Samāgni. Digestive enzyme secretion is controlled by sympathetic and parasympathetic nerve supply. Samāgni may be compared with balanced state of sympathetic/ parasympathetic activity which explains the role of balanced or Samān vāta. It may also be noted that prāṇa vāta and apāna vāta also have impact on balancing the normal status of agni. Acidic and alkaline pH of digestive secretions explains the balanced pitta. Modern science explains specific range of pH of digestive secretions e.g. pancreatic juice has pH in range of 7.1 – 8.2 that buffers acidic gastric juice in chyme, stops the action of pepsin from the stomach and creates proper pH for action of digestive enzymes in small intestine. Specific pH of gastric juice is essential to convert pepsinogen into pepsin, an active form of proteolytic enzyme thus improper pH will cause variation in digestion. Mucosal resistance explains role of kapha in maintaining samāgni. Intact mucosal lining is present in stomach and small intestine. Breach in mucosal lining causes gastritis, burning sensation etc whereas increased size of mucosal cells alters the pH thereby a balanced kapha plays essential role in samāgni. Role of prostaglandins to maintain gastric mucosal resistance to prevent the action of HCl in gastric mucosa is to be considered as part of kledaka kapha as sodium bicarbonate and mucus is secreted by prostaglandins. Drugs which inhibit prostaglandins e.g. aspirin, impairs gastric mucosal barriers leading to gastritis, duodenitis and peptic ulcers. Clinical features: Ārōcaka (aversion to food), vairasya (distaste), prasēka (excessive salivation) are general gastro intestinal manifestations of indigestion. Tamaka or blackout occurs due to nutritional deficiency. Mal-absorption causes diarrhea which leads to decrease in circulating liquid, a cause of hypotension a reason for blackout. Impaired absorption of iron, folate, vit. B12 leads to anemia which may be the cause for blackout (tamakānvitaḥ). Resulting anemia and electrolyte depletion (particularly K+) leads to weakness. 1) Peripheral neuropathy due to Vit B12 and thiamine deficiency 2) Dermatitis due to deficiency of Vit. A, Zinc and essential fatty acid 3) Night Blindness/Xeropthalmia due to Vit A mal-absorption. 4) Bleeding due to Vit K malabsorption and hypo prothrombinemia 5) Anemia impaired absorption of iron, folate, and vitamin B12 6) Amenorrhea, decreased libido due to protein depletion decreased calories and secondary hypopituitarism. 7) Tetany, paresthesia due to calcium and magnesium mal-absorption 8) Glossitis, cheilosis, stomatitis due to deficiency of iron, Vit B12, folate and Vit A (Verse 52-54). Spices are basically a combination of acids. When too much of these acids are introduced in gastrointestinal tract which has its own acidic contents it starts damaging the mucosal lining of walls of gastrointestinal tract. It also reduces the pH thus activation of enzyme is hampered leading to indigestion. Etiological factors as mentioned in the text have impact mainly on the neural stimulation of digestive secretions affecting the flow of gastrointestinal secretions into the gastrointestinal tract thereby hampering the digestion. Hence it is explained that aggravated vāta encompasses the agni. Altered canalicular functions hampers digestion, easily understood in primary biliary cirrhosis wherein biliary secretion is restricted. Atrophy of gastric mucosa reduces HCl secretion causing indigestion. The gastric gland contains three types of exocrine gland cells that secrete their products into stomach lumen. ‘srotasām kharatvam’ (hardness in channels) quality of tikta rasa destroys the exocrine gland cell reducing their secretions. Gastric glands include a type of enteroendocrine cell, the G cell which is located mainly in the pyloric antrum and secretes the hormone gastrin into the blood stream which stimulates parietal cells to secrete HCl and chief cells to secrete pepsinogen, it also contracts the lower esophageal sphincter, increases motility of the stomach and relaxes pyloric sphincter. G cells when get destroyed the above action of kapha inturn agni is hampered so also contraction and relaxation karma of vāta is vitiated. Further kaṣāya rasa reduces peristaltic movements called as mixing waves which reduces the maceration and mixing of food with secretions of gastric glands, thus improper chyme is formed. Deficiency of gastrointestinal secretions due to damage to the glands or canaliculi or intestine may be mostly considered as having vātaja origin. Loss of pravartan karma is to be understood where the transport of secretions is hampered (except in obstructive pathology where kapha to be considered). Hartnup’s syndrome a defect in neutral amino acid transport and cystinuria a defect in dibasic amino acid transport explain the rare genetic disorders (Bija Dusti) involved in protein digestion absorption. Further due to vāta prakopa, intestinal activity is increased which is manifested as mal-absorption. For e.g. lactose intolerance is related to rate of gastric emptying. Symptoms are more likely when gastric emptying is rapid than when gastric emptying is slower. Therefore it is more likely that skim milk will be associated with symptoms of lactose intolerance than with whole milk as rate of gastric emptying is more rapid in skim milk. Milk proteins, particularly caseins have appropriate amino acids composition for growth and development of young. Caseins are highly digestible in intestine and high quality source of amino acids. Most of whey proteins are relatively less digestible in intestine, although all of them are digested to some degree. When substantial whey proteins are not digested fully, some of intact protein may stimulate a localized intestinal or systemic immune response this is due to beta lactoglobullin referred to milk protein allergy. Similarly, diarrhea observed following subtotal gastrectomy is often a result of lactose intolerance as gastric emptying is accelerated in patients with gastrojejunostomy, rapid small intestinal transit time develops symptoms of lactose intolerancy. Kaṇṭhāsya-Śōṣaḥ (dryness of mouth also known as xerostomia) occurs due to diminish salivary gland secretion. Primary cause being fluid loss through diarrhea secondarily it may be association of Sjogrens syndrome with autoimmune disease like primary biliary cirrhosis ~ a secondary Sjogrens syndrome. In this syndrome involvement of other exocrine glands occur leading to diminished secretion of exocrine glands of the gastrointestinal tract, leading to esophageal mucosal atrophy, atrophic gastritis and subclinical pancreatitis. Increased appetite (Kṣudhā) is seen because of a negative feedback due to mal-absorption or it may be understood under rasasheshājīrṇa. Tṛṣṇā is manifested due to increased Rukṣa Guna of vāta and decreased Jalādi Ansha due to diarrheas and low fluid intake. Timira (blurred vision) results from vitamin A mal-absorption and anemia. Tinnitus is a symptom also found in Pāndu (anemia)(Ca. Ci. 15/61), which is observed due to mal-absorption of essential elements like vitamin B12. Pain in flanks, thigh, pelvis, cervical area occurs due to calcium and Vitamin D mal-absorption. Pain is also contributed by protein deficiency due to low nutritional diet, osteoporosis, anemia and decrease lactic acid neutralization due to reduce peripheral circulation. Whipple’s disease is chronic multisystem disease associated with diarrhea, steatorrhea, weight loss, arthralgia and CNS and cardiac problems caused due to tropheryma whipple. Hr̥tpīḍā is chest discomfort or chest pain which may be resultant of anemia but most probably due to gastro esophageal reflux disease. Mal-absorption may be for single entity or for various minerals and vitamins and may lead to emaciation and weakness. Vairasyaṁ (distaste) is probably because of taste projections to the hypothalamus and limbic system, there is a strong link between the taste and pleasant and unpleasant emotions. Parikartikā (cutting pain) is due to Śuṣkā-mala Pravṛtti (pellet stools) which causes pressure and rupture of anal mucosal lining that may lead to cutting pain. Craving for all types of food (Gr̥ddhiḥ Sarvarasānāṁ) is seen due to mal-absorption of various elements, mineral and vitamins causing deficiency of the essential requirements of elements. The negative feedback system creates the craving for essential elements which is presented in the form of craving for all six rasa. rasa should be understood for food which will fulfill the requirements. Mood disorders are observed due to depletion of essential vitamins, mineral and other elements. Electrolyte difference creates confusion which may be the cause for Mano Avasāda. Bloating of abdomen is manifested while digestion is in process or after digestion is completed because of indigestion that causes abnormal growth of gut microbiome. Bacterial fermentation of unabsorbed carbohydrates leads to flatus. Carbohydrates metabolism occurs in small and large intestine therefore the symptom occurs during Jīrṇē Jīryati Cādhmānaṁ i.e. during and after the process of digestion. Once the patient takes food, circulation towards stomach is increased and digestive activity in the colon is reduced thus carbohydrate metabolism is depressed reducing the formation of flatus in rectum thereby reducing the bloating of abdomen. Patient doubts as if he may be suffering from following of the disorders like vātavikār, gulma, hridroga and pleeha. Due to formation of flatus and later on bloating of abdomen makes the patient feel he is suffering from vātika disorders related to gastrointestinal tract. Especially gulma since the patient feels the movement of flatus, so doubts about gulma. Ūṣnā and Tīkṣṇa Guna of pitta trigger inflammatory response by irritating the intestinal mucosa. Indigestion causes depletion of beneficial gut bacteria thus breakdown in the balance between the putative protective and harmful intestinal bacteria leads to chronic inflammation. Antigenic nature of endogenous factors can be understood when helpful bacteria and ūṣnā, tīkṣṇa Guna of kapha trigger inflammatory response leading to autoimmune pathogenesis. In case of hypersecretion of gastrin in gastrinoma [Zollingers – Ellison Syndrome] stimulate the parietal cells of the stomach to secrete acid to their maximal capacity and increase the parietal cell mass three to six fold. The acid output may be so great that it reaches the upper small intestine reducing the luminal pH to 2 or less. Pancreatic lipase is inactivated and bile acids are precipitated. It results in diarrhea and steatorrhea. Subtotal villous atrophy occurs due to hyper-secretion which may cause mal-absorption. Excessive gastrointestinal secretions cause derangements in fluid and electrolyte transport across the entero-colonic mucosa leading to diarrhea. They are characterized clinically by watery, large volume fecal outputs that are typically painless and persist with fasting because there is no mal-absorbed solute; stool osmolalirity is accounted for normal endogenous electrolytes with no fecal osmotic gap. Other than excessive secretion, condition like ileal dysfunction caused by either Crohn’s disease or surgical resection results in a decrease in bile acid re absorption in the ileum and an increase in the delivery of bile acids to the large intestine. The resultant is a diarrhea with or without steatorrhea. It becomes a cause for mal-absorption syndrome. Inflammatory Bowel Disease needs consideration in pittaja grahaṇī. Exogenous factors trigger inflammatory response that the mucosal immune system may fail to control. With mild inflammation the mucosa is erythematous and in severe condition the mucosa becomes hemorrhagic, edematous and ulcerated (Verse 65). Loose motions (Drava Mala Pravṛtti) are mainly due to excessive secretion of bile juice (Drava guna of pitta). Excessive secretion may be due excessive formation in liver or decrease absorption in the intestine. Bile acids are not present in the diet but are synthesized in the liver by a series of enzymatic steps that also include cholesterol catabolism. Bile acids are either primary or secondary. Primary bile acids are synthesized in the liver from cholesterol and secondary bile acids are synthesized from primary bile acids in the intestine by colonic bacterial enzymes. Bile acids are primarily absorbed by active, sodium dependent process that is located exclusively in the ileum; secondly bile acids can also be absorbed to a lesser extent by non carrier mediated transport processes in the jejunum, ileum and colon. Conjugated bile acids that enter the colon are deconjugated by colonic bacterial enzyme to unconjugated bile acids and are rapidly absorbed. Colonic bacterial enzymes also dehydroxylate bile acids to secondary bile acids, thus if exogenous factors like diet as discussed above disturb the colonic bacterial growth than bile acids are not absorbed. A decrease in the amount of bile acids returning to the liver from the intestine is associated with an increase in bile acids synthesis/cholesterol catabolism, which helps keep bile acid pool size relatively constant. Defects in any of the steps of the enterohepatic circulation of bile acids can result in decrease in duodenal concentration of conjugated bile acids as a result steatorrhea. Thus steatorrhea can be caused by abnormalities in bile acid synthesis and excretion, their physical state in the intestinal lumen and reabsorption. The bile gives the yellowish nature to the stools (Verse 66). Guru, snigdha and sītā ahara is dominated by prithvi and jala mahābhuta, these qualities help in reducing the impact of agni mahābhuta thus causing jatharāgni māndyatā resulting in indigestion leading to formation ama. Such ama is responsible for doṣha prakopa.(Madhukoshatika Ma. Ni. Jwara adhyaya/2) Klinna(moist), guru, piṣṭānna(malt), abhiṣyandi(which increases secretions) ahāra and adhyāśana(over eating) are source for extra calories. Fast foods are defined as any food that contributes little or no nutrient values to the diet, but instead provides excess calories and fat. Common foods include salted snack foods, gum, sweet desserts, fried fast foods, carbonated beverages and candy. Diets rich in trans-fatty acids like deep fried fast food, cake mixes, chips and packed cookies, all have inclusion in guru, piṣṭānna, vishtambi(causing obstruction) ahara. People consuming snigdha ahāra (fatty food) and have sedentary lifestule with very little energy expenditure, and most fat is stored. The above 2 concepts explain why agnimāndya and ajīrṇa have been mentioned after taking heavy food. Excessive heavy food (guru ahara) slows down emptying of stomach (samāna vāta karma is hampered) and enzymes are not secreted into lumen (pitta action hampered) causing agnimāndya. Substances of sīta vīrya causes constriction reducing the secretion (stambhana) of gastrointestinal juices thus hampering lipase activity therefore leading to steatorrhea. Further heavy meals increase the transit time causing functional stasis which may cause bacterial overgrowth syndrome. Sleeping just after meals may also lead to functional stasis (further study required). Peristalses are also reduced with heavy meals and sleeping after meals causes bacterial overgrowth. Bacteria deconjugate conjugated bile acids and as a result intraduodenal concentration of bile acids will be reduced resulting in steatorrhoea and macrocytic anemia. Bacterial overgrowth also occurs with stasis from a blind loop, small bowel diverticulum or dysmotility. Postmucosal lymphatic obstruction- The pathophysiology of this condition which is due to the rare congenital intestinal lymphangectasia or due to acquired lymphatic obstruction secondary to trauma, tumour or infections, leads to the unique constellation of fat malabsorption with enteric loss of protein (often causing edema) and lymphocytopenia. Carbohydrates and amino acid absorption are preserved (Verse 67). Nausea and vomiting are both caused by stimulation at one of the four sites: the gastrointestinal tract, the vestibular system, the chemoreceptor trigger zone and the cerebral cortex. Nausea and vomiting occurs due to disturbed gastric motility caused by heavy meal and delayed gastric emptying. The same is the cause for heavy abdomen and eructation with foul smell and sweet taste. As the food stays for long time in gastrointestinal tract blood flow increases centrally and reduces the enthusiasm and decrease in libido. The sluggish activity of gastrointestinal tract causes symptoms such as absence of movement in the abdomen (udaraṁ stimitaṁ guru). The heavy abdomen puts pressure on the diaphragm causing symptoms of heaviness in chest (hr̥dayaṁ manyatē styānam). Bacterial overgrowth due to undigested guru, klinna, snigdha and abhiṣyandi ahāra causes increased mucoid secretion, thus formed stool is not observed instead bhinnāmaślēṣma-saṁsr̥ṣṭa varcā(loose stools with ama and kapha) is seen; which is also cause for heaviness of stools (guru-varcaḥ-pravartanam) Due to diet pattern and sedentary lifestyle there is accumulation of fat (obesity) but due to decrease protein absorption and malabsorption of essential elements patient feels weakness and laziness without weight loss (Verse 68-70). Normalcy of vāta pitta and kapha keeps the agni in balanced condition, it means that a specific pH is maintained (pitta); secretion, transportation and villi movement are normal (vāta) and mucosal bed secretes normal mucus and is healthy (kapha), thus maintains samāgni or a normal digestive process (Verse 71). Protein losing enteropathy is increased protein loss into the gastrointestinal tract which is classified into three groups. a) Mucosal ulceration; there is protein loss by exudation across damaged mucosa e.g. Ulcerative colitis, peptic ulcer, gastro intestinal carcinoma. In such cases dominance of pitta doṣha needs to be considered. b) Non ulcerated mucosa but evidence of mucosal damage; Protein loss primarily represents loss across epithelia with altered permeability e.g. celiac sprue and menetrier’s disease in small intestine and stomach respectively, vāta doṣha and/or kapha doṣha dominancy should be considered. c) Lymphatic dysfunction, represents either primary lymphatic disease or secondary to partial lymphatic obstruction that may occur as a result of enlarged lymph nodes or cardiac disease. Patient with increased protein loss into gastrointestinal tract due to lymphatic obstruction often have steatorrhea and diarrhea. The steatorrhea is a result of altered lymphatic flow as lipid containing chylomicrons exit from intestinal epithelial cells via intestinal lymphatic’s which may be compared with flow of ahar rasa and/ or presence of vata and kapha. Genetic factors (bija dushti) almost all patients with celiac sprue express the HLA-DQ2 allele. Environmental factor, gliadin a component of gluten that is present in wheat, barley and rye contributes to the disease. Immunologic component (prayatna, bala and urja of vāta, kapha and pitta respectively), serum antibodies – IgA antigliadin, IgA antiendomyasial and IgA antibodies and IgG antibodies are present. In addition, gliadin peptides may interact with gliadin specific T cells that may either mediate tissue injury or induce the release of one or more cytokines that cause tissue injury (Verse 72). Further research shows that incase of uncontrolled growth of gut microbiome, flushing of gut reduces both psycho-somatic symptoms. Shodhana therapy not only flushes the vitiated gut microbiome but also flushes out the substrata due to which growth of microbiome is controlled (Verse 73-74). Kṣāra has been advised along with tilvaka sneha; kṣāra has alkaline pH. In duodenum and small intestine, enzymes with alkaline pH are secreted. uṣṇa, Tīkṣṇa and Laghu guna helps in digestion. ‘Kledayati ādo Paschata Visoshayati’(Ca. Vi. 1/17 ) i.e. secretion are first increased and later on absorbed is very essential in grahaṇī Doṣa. Both these actions help in secretion of digestive enzymes thereby increasing agni and by absorption correct the malabsorption. Therefore use of kṣāra is more in grahaṇī doṣha and gulma (Verse 79). Āranāla(a fermented preparation), dadhimanda(thin part of curd) or sauvīraka are all fermented liquids. Fermented liquids contain probiotic organisms. Probiotic foods are produced by chemical action of lactic acid, bacteria, yeast or combination of both. These useful microorganisms help in breaking down carbohydrates, sugars making them easily digestible. Probiotics improves absorption of nutrients; improve synthesis of vitamins, essential fatty acids and enhance nutritional qualities of food grains. Fermented foods increase the absorption of vital minerals from gastrointestinal tract thus preventing mineral deficiencies and also treat the diarrhea. It explains the role of helpful gut microbiome (Verse 82-86). Use of fermented products explains the concept of gut microbiome and use of kṣāra and amla drug for maintaining pH (Verse 88-93). Vamana (medicated emesis) reduces gastro-paresis by emptying the gastrointestinal contents (Verse 101-102). Fermented liquids are rich source of gut microbiome which will help to replace the unhealthy microbiome. These fermented liquids also help to balance the pH of the gastrointestinal tract. Further study is required to decide impact of above mentioned liquid diet on pH and specific enzymes (Verse 115-116). One cup of buttermilk contains 152 calories and 8.11 grams of fat, of which 4.65 grams are saturated, 282 milligrams of calcium and 127 international units of vitamin D. The vitamin also helps to maintain normal phosphorus levels. Phosphorus is another nutrient that contributes to bone health (Verse 117-119) Samāna vāta regularizes the secretion of pancreatic and intestinal enzymes. Initially the enzymes are in zymogens (inactive form). Samān vāta helps in conversion of zymogens into active enzymes so all the factors which help in stimulating exocytosis can be considered as functional components of Samān vāta. Once Sāmana vāta is stimulated efficiently the digestive process becomes intact to digest all types of nutrients (Verse 202-203 -1/2). Hyperthyroidism is one of the causes for hypermetabolic disorders but extra thyroidal causes are also important. Hypermetabolism typically occurs after significant injury to the body. Infections, sepsis, burns, multiple traumas, fever, long bone fractures, prolonged steroid therapy, pheocromocytoma, surgery and bone marrow transplants. Hypermetabolism may occur particularly in the brain after traumatic brain injury (Verse 217-219). Hypermetabolism is accompanied by a variety of internal and external symptoms most notably extreme weight loss. External symptoms of hypermetabolism may include anemia, fatigue, elevated heart rate, irregular heartbeat, insomnia, shortness of breath, dysautonomia, muscle weakness, excessive sweating while internal symptoms include peripheral insulin resistance, elevated catabolism of proteins, carbohydrates triglycerides and negative nitrogen in the body. In this context there is increased function due to excess secretion of thyroid hormones. Thyroid hormones act as catabolic hormones and promote calorigenesis and develops hypermetabolic state which may result in gluconeogenesis, lipolysis and glycogenolysis causing decreased muscle mass and weight loss. Metabolic rate is enhanced, because of vitiated pitta and associated Vāta. This is the condition where increased appetite with weight loss is seen due to insufficient supply of nutrients in relation to agnibala. Thyroid storm/ thyroid-toxic crisis is rare and life threatening exacerbation of hyperthyroidism, accompanied by fever, delirium, seizures, vomiting, diarrhea and jaundice. Death may occur due to cardiac failure, arrhythmia and hyperthermia. Management requires intensive monitoring, supportive care, identification of the precipitating causes (stroke, infection, trauma, diabetic ketoacidosis, surgery and radio iodine treatment), and measures that reduce thyroid hormone synthesis (Verse 220-222½). Kleda can also be considered as inter-mediory product of metabolism like ketones, pyruvate, lactate which are well utilized in active/healthy persons as fuel and therefore does not cause inflammation/disease process (Verse 237-239). Current clinical practices: Sr.No. Name Dose Time of administration Anupana 1. Chitrakadi vati 250-500 mg Between meals Buttermilk or lukewarm water 2. Shankha vati 250-500 mg Between meals Buttermilk or lukewarm water 3. Lashunadi vati 250-500 mg Between meals Buttermilk or lukewarm water 4. Hingvadi vati 250-500 mg Between meals Buttermilk or lukewarm water 5. Shiva kshara pachana churna 1-5 grams Between meals Buttermilk or lukewarm water 6. Hingvashtaka churna 1-5 grams Between meals Buttermilk or lukewarm water 7. Bhunimbadi churna 1-5 grams Between meals Lukewarm water 8 Avipattikara churna 1-5 grams Between meals Lukewarm water 9 Lavana bhaskar churna 1-5 grams Between meals Buttermilk or lukewarm water 10 Swadishta virechana churna 1-5 grams Between meals Lukewarm water 11 Nagaradi churna 1-5 grams Between meals Buttermilk or lukewarm water 12 Dadimashtaka churna 1-5 grams Between meals Nimbu panaka or lukewarm water 13 Pippalyasava 10-40 ml Between meals Lukewarm water 14 Jeerakadyarishta 10-40 ml Between meals Lukewarm water 15 Abhayarishta 10-40 ml Before meals Lukewarm water 16 Takrarishta 10-40 ml Between meals Lukewarm water 17 Chitrakadi ghrita 5-40 ml Between meals Lukewarm water 18 Dadimadi ghrita 5-40 ml Between meals Lukewarm water 19 Kiratadi churna 1-5 grams Between meals Honey or Lukewarm water 20 Marichyadi churna 1-5 grams Between meals Buttermilk or lukewarm water

Areas of Further Research

• To study asava and arishta in relation with microbioma. • To understand concept of ama with relation to autoimmune diseases. References