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The word ‘brimhana’ means building, nourishing or strengthening.<ref>Brimhana [Internet] [Updated 2020 Oct 21; cited 2020 Nov 11]. Available from https://www.wisdomlib.org/definition/brimhana</ref> It is one among the six important treatment principles.[Cha.Sa.[[Sutra Sthana]] 22/4] The brimhana therapies are indicated in degenerative conditions or to nourish and replenish the depleted body components. The medicines or procedures increase bulk of body components by quantity or quality [Cha.Sa.[[Sutra Sthana]] 22/10]. Thus, this therapy makes body strong and firm.
{{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = [[Chikitsa]] / [[Brimhana]]
|label2 = Authors
|data2 =Aneesh E.G.<sup>1</sup>, Chaudhary Sujata <sup>2</sup>, Deole Yogesh S. <sup>1</sup>
|label3 = Reviewed and Edited by
|data3 = Basisht G.<sup>1</sup>
|label4 = Affiliations
|data4 = <sup>1</sup>[[Charak Samhita Research, Training and Development Centre]], I.T.R.A., Jamnagar, India, <sup>2</sup>Assistant professor, Shri Santpal Singh Ayurved Medical College and Hospital, Mirzapur, Shahjahanpur, Uttar Pradesh, India
|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com
|label6 = Date of first publication:
|data6 = April 24, 2021
|label7 = DOI
|data7 = Awaited
}}
<div style='text-align:justify;'>
==Etymology, definition and synonyms==
The term ‘Brimhana’ in Sanskrit is used as a noun and a verb. As a verb, it indicates ‘therapy’. While as a noun, it points out food articles/ medicines/ physical activities capable of performing the action of brimhana.
'''Definition:'''‘Brimhana’ is the procedure to nourish tissues and improve their quality to make body compact. [Dalhana on Su.Sa.Sutra Sthana 45/113]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>
'''Synonyms:''' Santarpana [A.Hr. Sutra Sthana 14/2]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
==Properties==
The nourishing (brimhana) substance possess properties like heavy (guru) leading to fullness, cold potency (sheeta), softness (mrudu), unctuousness (snigdha), thickness (bahala), gross (sthoola), sliminess (picchila), slowness (manda), stability (sthira) and smoothness (shlakshna). [Cha.Sa. [[Sutra Sthana]] 22/13]
The substances having these properties are high energy density, satiety index, heavy to digest, slow and long acting.[Cha.Sa.[[Sutra Sthana]] 22/13-14]
==Panchamahabhuta constitution==
The brimhana substance has [[Prithvi]] and [[jalamahabuhta]] predominance.[A.Hr. Sutra Sthana 14/02]<ref name=Hridaya/>
==[[Dosha]] specific action==
Pacify [[Vata]] and [[pitta]] [A.Hr. Sutra Sthana 14/7]<ref name=Hridaya/> and increase [[Kapha]][[dosha]]
==Indications==
*Persons with [[vata]] predominant constitution. [A.Hr. Sutra Sthana 14/8-9]<ref name=Hridaya/>
*Weak or emaciated persons, traumatized or injured persons [Cha.Sa.[[Sutra Sthana]] 22/26]
*Pregnant women, post-partum period [A.Hr. Sutra Sthana 14/8-9]<ref name=Hridaya/>
*Aged persons (above 60 years)
*Individuals who walk for long distances, those who indulge in excessive sexual intercourse, and those who take alcohol daily.
*In summer season (grishma), when the body strength is naturally low [Cha.Sa.[[Sutra Sthana]] 22/26]
*In winter season, when the digestive capacity is stronger [A.S. Sutra Sthana 4/9]<ref name= Sangraha> Vridha Vagbhata, Ashtanga Sangraha. Edited by Shivaprasad Sharma. 3rd ed. Varanasi: Chaukhamba sanskrit series office;2012.</ref>
*To regain strength after purification therapies [Cha.Sa.[[Sutra Sthana]]16/22]
==Contraindications==
*Those in whom fasting/reducing therapy ([[langhana]]) is recommended [A.Hr. Sutra Sthana 14/15]<ref name=Hridaya/>
*In case of excessive aggravation of fat/adipose tissue ([[meda]]) or [[kapha]][[dosha]]. [Cha.Sa.[[Chikitsa Sthana]] 29/156]
==Methods==
The nourishing therapies are done in the following methods:
#Diet
#Daily habits
#Psychological factors
#Therapeutic measures
===Diet===
'''Meat:''' The best nourishing diet is meat. [A.S.Sutra Sthana 13/2]<ref name=Sangraha/> Meat of adult (mature) animals, fish, and birds which are found roaming in their suitable natural surroundings, which are healthy, is considered to be ideal for nourishing therapy. [Cha.Sa.[[Sutra Sthana]] 22/25] Especially meat of goat, sheep [Cha.Sa.[[Sutra Sthana]] 27/62] and hog [Cha.Sa.[[Sutra Sthana]] 27/78] provides nourishment. River fish is more stoutening than that of marine. [Su.Sa.Sutra Sthana 46/121] The eggs of swan, rooster and peacock [Cha.Sa.[[Sutra Sthana]] 27/85] are also nourishing in nature.
'''Milk:''' Milk [Cha.Sa.[[Sutra Sthana]] 27/224] provides nourishment to body due to its unctuous and cold nature. [Cha.Sa.[[Sutra Sthana]] 1/107] Cow milk possess maximum qualities for nourishing therapy.[Cha.Sa.[[Sutra Sthana]] 27/217] The fat in goat milk is similar to cow milk fat. Lipid fractions of whole milk and cream, containing 97 to 99% free lipid (97% of which was in the form of triglycerides) and 1 to 3% bound lipid (containing neutral lipid, glycolipid, and phospholipid) are same in both types.<ref name=ClarkS>Clark S, Mora García MB. A 100-Year Review: Advances in goat milk research. J Dairy Sci. 2017 Dec;100(12):10026-10044. doi: 10.3168/jds.2017-13287. PMID: 29153153.</ref> However, goat's milk has no clear nutritional advantage over cow's milk.<ref>Turck D. Cow's milk and goat's milk. World Rev Nutr Diet. 2013;108:56-62. doi: 10.1159/000351485. Epub 2013 Sep 6. PMID: 24029787.</ref> Goat’s milk is easier to digest [Cha.Sa.[[Sutra Sthana]] 27/222] than cow’s milk. It can be preferred over cow’s milk to nourish those having low appetite, weak digestive capacity or any disease [fever/ tuberculosis/ diarrhea/ bleeding disorders [Ch.Sa.[[Sutra Sthana]] 27/222]. A research conducted on undernourished children also showed that goat’s milk can be considered as a substitute for cow’s milk.<ref>Razafindrakoto O, Ravelomanana N, Rasolofo A, Rakotoarimanana RD, Gourgue P, Coquin P, Briend A, Desjeux JF. Goat's milk as a substitute for cow's milk in undernourished children: a randomized double-blind clinical trial. Pediatrics. 1994 Jul;94(1):65-9. PMID: 8008540.</ref>
Camel milk is also a good source of nutrition; however, it is not suitable for weight gain therapy. Camel milk lipids contain lower saturated fatty acids, higher unsaturated fatty acids and low sugar and cholesterol value as compared to cow milk.<ref>Maqsood S, Al-Dowaila A, Mudgil P, Kamal H, Jobe B, Hassan HM. Comparative characterization of protein and lipid fractions from camel and cow milk, their functionality, antioxidant and antihypertensive properties upon simulated gastro-intestinal digestion. Food Chem. 2019 May 1;279:328-338. doi: 10.1016/j.foodchem.2018.12.011. Epub 2018 Dec 13. PMID: 30611498.</ref> Camel milk can lead to dryness (rukshata) in the body.[Cha.Sa [[Sutra Sthana]] 27/220] It is used for nourishment in disorders like ascites, where restriction of liquid intake is advised. [Cha.Sa.[[Chikitsa Sthana]] 13/183]
'''Other recipes:''' Ghee, relishing soups prepared with cereals [Cha.Sa.[[Sutra Sthana]]16/22], rice, blackgram, sugarcane, wheat and jaggery preparations[Chakrapani on Cha.Sa.[[Sutra Sthana]] 21/29-34], curd[Cha.Sa.[[Sutra Sthana]] 27/225], butter [Su.Sa.Sutra Sthana 45/92]<ref name=Susruta/> and oil [Su.Sa.Sutra Sthana 45/113]<ref name=Susruta/> are nourishing in nature.
'''Fruits:''' Dates, common figs, Indian hog plum, coconut, ripe peach[Cha.Sa.[[Sutra Sthana]] 27/127-129, 133], mango [Su.Sa.Sutra Sthana 46/153],wild lemon (madulunga)etc.[A.S.Sutra Sthana 7/176]<ref name=Sangraha/> have nourishing property.
Food items having sweet [Cha.Sa.[[Sutra Sthana]] 26/43] or sour taste [A.S.Sutra Sthana 18/6]<ref name=Sangraha/> generally possess nourishing property.
===Daily regimen===
Oil massage, bath [Cha.Sa.[[Sutra Sthana]]16/22][Chakrapani on Cha.Sa.[[Sutra Sthana]] 22/18], sleep and less physical activities [Chakrapani on Cha.Sa.[[Sutra Sthana]] 21/29-34] makes the body stout.
'''Sleep''' (swapna/ nidra): It is one of the three pillars of life. It produces coolness and sluggishness in the body and provides strength. It smoothens and softens body tissues after their repair. [Cha.Sa.[[Sutra Sthana]].21/36] During deep sleep, most of the body's systems are in an anabolic state. Thus, sleep helps to restore all the body systems including immune, nervous, skeletal, and muscular systems. Quality and amount of sleep is crucial in any nourishing regimen.
'''Bath''' (snana): Bathe is an important activity that has direct impact on body and mind. It soothes mind and relaxes the body. Thus, it provides sluggishness and strength to the body. [Ch.Sa.[[Sutra Sthana]] 5/94]
===Mental factors that promote nourishment===
Cheerfulness/happiness, contentment and avoiding mental worries has nourishing effect. [Chakrapani on Cha.Sa.[[Sutra Sthana]] 21/29-34][A.Hr. Sutra Sthana 14/9]<ref name=Hridaya/> Worries always increase energy expenditure. A recent study revealed a link between anxiety and hyper-metabolism. The researchers found that increased activation of anxiogenic circuits can reduce body weight via the promotion of adaptive thermogenesis and basal metabolism.<ref>Xie X, Yang H, An JJ, Houtz J, Tan JW, Xu H, Liao GY, Xu ZX, Xu B. Activation of Anxiogenic Circuits Instigates Resistance to Diet-Induced Obesity via Increased Energy Expenditure. Cell Metab. 2019 Apr 2;29(4):917-931.e4. doi: 10.1016/j.cmet.2018.12.018. Epub 2019 Jan 17. PMID: 30661931; PMCID: PMC6507421.</ref> Mental distress leads to poor nutrition and reduces weight. Hence, distress and worries shall be avoided during nourishment therapy. Blissful living with appropriate nourishment and desirable physical activities always helps in nourishment of the body.
===Therapeutic measures===
'''Medicines:'''
The group of 10 herbs that possess nourishing property [Cha.Sa.[[Sutra Sthana]] 4/8(2)] are as follows:
*Euphorbia prostrate (kshirini)
*Brasica juncea (rajakshavaka)
*Withania somnifera (ashwagandha)
*Fritillaria cirrhosa (kakoli)
*Lilium polyphyllum (kshirakakoli)
*Sida rhombifolia (vatyayani/shwetabala)
*Sida cordifolia (bhadraudani/pitabala)
*Bhardwaji/vanakarpasi
*Pueraria tuberose (payasya/vidarikanda)
*Abutilon indicum (rishyagandha)
Holostemma annulare (jeevanti) [A.S.Sutra Sthana 7/120]<ref name=Sangraha/>, skin and pulp of Semecarpus anacardium (bhallataka) [A.S.Sutra Sthana 7/177]<ref name=Sangraha/> etc. also possess nourishing property.
'''The time of administration:''' With food (sabhakta annakala) [A.S.Sutra Sthana 11/54]<ref name=Sangraha/>
'''Nourishing procedures:'''
*Low dose unctuous enema (matra[[basti]) [Cha.Sa.[[Siddhi Sthana]] 4/54]
*Oil massage (abhyanga)
*Fomentation with bolus of medicated rice (shashtika shali pinda sweda)
*Nourishing unction therapy (brimhana snehapana)
*Nourishing intranasal drug administration (brimhana nasya)
*Nourishing enema (brimhana [[basti]])
*Nourishing smoke inhalation (dhumapana)
*Rejuvenating therapy ([[rasayana]])
*Aphrodisiac therapy ([[vajikarana]])
==Assessment==
The assessment of effect of nourishing therapy is done on the basis of observation of clinical features. The weight of individual, body fat percentage, skin fold thickness, abdominal girth, waist circumference, hip circumference can be used as objective parameters for assessment.
===Features of optimal nourishing (brimhana) therapy===
*The person attains good strength and robustness
*Recovery from emaciation and related problems [Cha.Sa.[[Sutra Sthana]] 22/38]
*Clarity of senses and improved perceptions
*Proper elimination of waste products
*Feeling of lightness of body and improvement in taste [A.S.Sutra Sthana 24/15]<ref name=Sangraha/>
===Features of excessive nourishing (brimhana) therapy===
*Obesity[Cha.Sa.[[Sutra Sthana]] 22/38]
*Person may suffer from fever, scrofula, diabetes, abdominal enlargement, cough, accumulation of toxic metabolic waste ([[ama]]) and skin diseases (kushtha). [A.Hr. Sutra Sthana 14/20]<ref name=Hridaya/>
==Importance in preservation of health and prevention==
Proper nourishment is essential for preservation of health. The therapeutic measures like elimination of [[dosha]] at proper time, regular use of rejuvenating and aphrodisiac formulations nourishes the body. [Cha.Sa.[[Sutra Sthana]]21/33] Thus it improves health and prevents diseases. Nourishing therapy maintains quality of tissues and decreases the risk of disease complications. It builds up the immunity and defensive systems of body. Thus, helps to prevent occurrence and recurrence of diseases.
==Importance in the management of diseases==
Nourishing (brimhana) is the treatment of choice for all [[vata]] dominant disorders. [Cha.Sa.[[Chikitsa Sthana]] 28/106] Nourishing therapy (brimhana) itself acts as pacifying therapy (shamana) also. [A.Hr. Sutra Sthana 14/7]<ref name=Hridaya/> The diseases caused by the depletion of body constituents should be treated through nourishing therapy (brimhana) [Indu on A.S.Sutra Sthana 19/13]<ref name=Sangraha/>
For the management of leanness, nourishing therapy is advised. [Cha.Sa.[[Sutra Sthana]]21/29-34] Meat soup of carnivorous animals and birds are nourishing in nature especially to persons who became lean as a result of diseases like assimilation disorders (grahani), piles (arsa) etc. [Cha.Sa.[[Sutra Sthana]] 22/27]
Nourishing therapies are indicated in the following conditions:
*If body becomes weak by chronic stage of [[jwara]], to preserve strength of the person. [Cha.Sa.[[Chikitsa Sthana]] 3/292]
*In abdominal tumors caused by [[vata]] [Cha.Sa.[[Chikitsa Sthana]] 5/183]
*For lean diabetic patients [Cha.Sa.[[Chikitsa Sthana]] 6/15] and chronic stage of diabetes.
*In respiratory disorders (shwasa) and hiccups (hikka) [Cha.Sa.[[Chikitsa Sthana]] 17/150]
*In the initial stages of cough due to depletion of body tissues (kshayaja kasa) [Cha.Sa.[[Chikitsa Sthana]] 18/150]
*In poisoning leading to [[vata]] aggravation [Cha.Sa.[[Chikitsa Sthana]] 23/170]
*It is a process to remove foreign body from the fleshy body parts [A.S.Sutra Sthana 37/32]<ref name=Sangraha/> and for treating fractures [Su.Sa.Chikitsa Sthana 3/5]<ref name=Susruta/> also.
*During loss of hunger due to fasting, gruel mixed with ghee given in between meals (annavapeditam) makes the body nourish. [Cha.Sa.[[Chikitsa Sthana]] 15/209]
==Current researches==
In a study, 72 healthy students were divided into two groups. One group was provided with a nourishing compound having Pueraria tuberose (vidarikanda), Triticum aestivum (wheat), Hordeum vulgare (Barley), sugar and ghee as the ingredients; and the other group with placebo. The group administered with nourishing compound showed significant improvement in anthropometric parameters like body weight, chest, mid-arm and mid-thigh circumference. Significant improvement in muscular strength and endurance; and cardio-respiratory functions were also noted by administration of nourishing compound.<ref>Ingle NM, Ojha NK, Kumar A. Clinical study to evaluate the Brinhaniya effect of Vidarikandadi Yog to enhance the sport performance in children. J Ayurveda Integr Med 2013;4:171-5.</ref>
Pueraria tuberose possess growth hormone inducing, nootropic, anxiolytic, adaptogenic, immunomodulatory and antioxidant properties. The similar properties of nourishing (brimhana) drugs might be the cause for its bulk promoting, strength-enhancing and stress tolerating abilities.<ref name=ClarkS/>It can improve sports performance.
A case of Erb’s palsy treated with nourishing therapies like oil massage (abhyanga) and rice paste application (annalepa) associated with physiotherapy showed promising results. The power of the affected upper limb improved from zero to near normal. The disparity in length and mid-arm circumference of affected and normal upper limbs was also reduced after the treatment.<ref>Srilakshmi D, Chaganti S. A holistic approach to the management of Erb's palsy. J Ayurveda Integr Med 2013;4:237-40.</ref>
In another study conducted on 34 patients having low BMI, supplementation of nutritional compound with Phoenix dactylifera (dates) and cow ghee as ingredients, showed highly significant improvement in weight, BMI and fat percentage. Skin fold thickness of biceps, triceps and abdomen was also increased. Dates are having high nutritional value as it contains abundant macro and micronutrients.<ref>Dhoke SP, Dwivedi R, Vyas M. A placebo-controlled clinical evaluation of Kharjurapaka in Mamsakshaya. Ayu 2015;36:404-9.</ref>
A study showed that the neonatal weight gain in the infants with the oil massage was 21 g daily on average, whereas the increase in infant massage without oil was 7 g. This difference was statistically significant (P < 0.001).<ref>Jabraeile, M., Rasooly, A. S., Farshi, M. R., & Malakouti, J. (2016). Effect of olive oil massage on weight gain in preterm infants: A randomized controlled clinical trial. Nigerian medical journal: journal of the Nigeria Medical Association, 57(3), 160–163. https://doi.org/10.4103/0300-1652.184060.</ref> Another study conducted to test the role of Ashwagandha oil massage in the management of emaciation (Karshya) in adults also gave significant results.<ref>Asutkar, S., et al (2017). Role of Ashwagandha tail abhyanga in the management of Karshya. International Ayurvedic Medical Journal, 5(2), 375-381. Available from: http://www.iamj.in/posts/images/upload/375_381.pdf.</ref> When oil is applied all over the skin and massage is done, it pacifies [[vata]][[dosha]] and nourishes body tissues underneath the skin (mainly muscle mass and fat tissue). [Su.Sa. Chikitsa Sthana 24/30]<ref name=Susruta/> Oils processed with nourishing (brimhana) herbs may fulfill the purpose well.
==List of theses done==
#Nirali Doshi (2011). A clinical study on brumhan effect of prinan modaka and godhumadi modaka in the management of karshya in children. Department of Kaumarabrithya. IPGT&RA Jamnagar
#Shweta Patil (2013): A comparative study on the effect of vamana and virechana karma followed by brumhana snehapana (kantakari ghrita) in the management of tamaka shvasa w.s.r to Bronchial asthma. Department of Panchakarma, IPGT&RA Jamnagar
#Dobariya Nitinkumar Parsotambhai (2016): A study of Santarpaniya adhyaya of Charaka samhita in the context to principal of management for santarpan nimittaja vyadhi. Department of Basic Principles. IPGT&RA Jamnagar
==More information==
[[Langhanabrimhaniya Adhyaya]]
[[Ashtauninditiya Adhyaya]]
==Abbreviations==
Cha. = Charak, Su. = Sushruta, A. = Ashtanga, S. = Sangraha, Hr. = Hridayam, Sa. = Samhita.
==List of References==
The list of references for brimhana in Charak Samhita can be seen here
==References==
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