Chapter 12: Doshabhediya Dosha Types,

Imbalance Symptoms 12th chapter of Ashtanga Hrudaya Sutrasthana describes about location of Tridosha in the body, classification and functions of each type of Tridosha, causes for its increase or decrease etc. It is called as Doshabhediya Adhyaya.

Place of Tridosha – Doshasthana Place of Vata Dosha प वाशयकट सि थ ो ाि थ पशनेि

यम ्

थानं वात य त ा प प वाधानं वशेषतः Pakavasaya – large intestine, Kati – waist Sakthi – hip Shrotra – ear Asthi – bones Sparshanendriya – skin Special space – large intestine 1 Place of Pitta Dosha ना भरामाशयः वेदो लसीका पशनं च प त य ना भर

धरं रसः वशेषतः

Nadhi – Umbilicus, Amashaya- stomach and small intestine, Sweda – sweat, Lasika- lymph, Rudhira – blood, Rasa- plasma, Druk – eye, and Sparshanam – skin, Special seat – Nabhi- region around the Umbilicus. 2 Place of Kapha उरः क ठ शरः

लोमपवा ण आमशयो रसः

मेदो ाणं च िज वा च कफ य, सुतरामुरः Ura – Chest , Kantha – throat ,

Shira – head, Kloma – Pancreas?, Parvani – bone joints, Amashaya,- Stomach and small intestine, Rasa –plasma, Meda – fat Ghrana – nose and Jihva – tongue are the seats of Kapha, Special seat – Ura – chest. 3

5 types of Vata ाणा दभे दा प चा मा वायुः Vata is of 5 types. Prana Vata, Udana Vata, Vyana Vata, Samana Vata and Apana Vata,

Prana Vata – ाणो अ

मूधगः

उरः क ठचरो बु

दये ि

ठ वन वथू गार नः

य च तध ृक्

वासा न वेश कृत ्

Prana is located in the head and moves in the chest, throat. It regulates will, heart, sense organs, intellect and vision. It is the cause for expectoration, sneezing, belching, inspiration and swallowing of food. 4

Udana Vata – उरः वा

थानमद ु ान य नासाना भगलां चरे त ्

व ृि त य नोजाबलवण म ृ त

यः

The chest is the seat of Udana, it moves in the nose, umbilicus and throat; its functions are initiation of speech (vak), effort (Prayatna), enthusiasm (Urja), strength (bala) , color, complexion (varna) and memory (smruti) 5

Vyana Vata – यानो

दि थतः कृ

नदे हचार महाजवः

ग यप ेपणो

ेप नमेषो मे णा दकाः

ायः सवाः

या ति मन ्

तब ाः शर रणाम ्

Vyana is located in the heart, moves all over the body in great speed, It attends to functions such as flexion and extension (locomotor action) opening and closing of the eyelids etc. Generally all the body activities are regulated by Vyana Vata. 6-7

Samana Vata – समानो अि नसमीप थः को ठे चर त सवतः अ नं ग ृ ना त पच त ववेचय त मु च त Samana Vata is located near the digestive fire. It moves in the Kostha – alimentary tract, It receives the food into stomach, aids in digestion, helps in dividing the food into useful part and waste part, and moves these parts in their normal paths. 8

Apana Vata – अपानो अपानगः

ो णवि तमे ो गोचरः

शु ातवशकृ मू गभ न

मण

यः

Apana Vata is located in the Apana – large intestine, moves in the waist, bladder, genitals. It attends to the functions such as ejaculation, menstruation, defecation, urination and child birth. 9

Five types of Pittaप तं प चा मकं Pitta is of 5 types. Pachaka Pitta Ranjaka Pitta Sadhaka Pitta Alochaka Pitta Bhrajaka Pitta

Pachaka Pitta – त

प वमाशयम यगम ्

प चभत ू ा मक वे अ प य तैजसगन ु ोदयात ् य त

व वं पाका दकमणा अनलशाि दतम ्

पच य नं वभजते सार क ौ पथ ृ क् तथा

त

थमेव प तानां शेषाणाम यनु हम ्

करो त बलदानेन पाचकं नाम त

मृतम ्

It is located between large intestine and stomach. (between Amashaya and pakvashaya) It is composed of all the five basic elements (Panchamaha Bhuta), it is predominant with fire element and devoid of water element. It is called by the term Anala- fire because of its function of Paka – digestion and transformation of food materials. It cooks the food, divides it into essence and waste, It bestows grace and influence on other types of Pitta. Hence, among all the types of Pitta, Pachaka pitta is the dominant one.

Ranjaka Pitta – आमाशया यं प तं र जकं रसर जनात ् The pitta located in the Amasaya- stomach is known as Ranjaka. It converts the useful part of the digestion into blood. Hence it converts Rasa Dhatu into Rakta Dhatu. 12 ½

Sadhaka Pitta – बु मेधा भमान यैः अ भ े ताथसाधनात ्

साधकं

गतं प तं

The pitta located in the Hrudaya –heart is known as Sadhaka. It attends to mental functions such as knowledge, intelligence, self- consciousness, etc, thereby helping the purpose – aims of life. 13 1/3

Alochaka Pitta – पालोचनतः

मत ृ म्

थमालोचकं

It is located in the eyes. It helps in vision.

Bhrajaka Pitta – व

थं

ाजकं

ाजना वचः

It resides in skin and helps exhibition of color and complexions. 14

Types of Kapha ले मा त ु प चधा Kapha also is of five types;

Avalambaka Kapha – उरः

थः स

क य

ववीयतः

दय या नवीया च त

थ एवा बक ु मणा

कफधा नां च शेषाणां य करो यवल बनम ् अतो अवल बकः

ले मा

It is located in the chest and Trika pradesha – the meeting place of shoulder, neck and back;. By its innate strength and by the power of essence of food, it does lubrication, nourishing etc functions that are attributed to water element. It also influences the functioning of other types of Kapha. 15

Kledaka Kapha य

वामाशय संि थतः

लेदकः सो अ नस घात लेदकात ् Located in the Amasaya – stomach. It moistens the hard food mass and helps in digestion.

Bodhaka Kapha – रसबोधनात ् बोधको रसना थायी It is located in the tongue. It helps in taste perception.

Tarpaka Kapha शरः सं थो अ तपणात ्

तपकः

It is ocated in the head. It nourishes sense organs.

Shleshaka Kapha – सं धसं लेषा लेषकः सि धषु ि थतः It is located in the bone joints. It lubricates and strengthens the joint. इत

ाये ण दोषाणां

थाना य वकृता मनाम ्

या पनाम प जानीया कमा ण च प ृथ प ृथक्

Though Tridosha is present all over the body, they are more dominant in specific areas of the body, as explained above.

Qualities that influence increase and decrease of Tridosha – Note: In the description given below, Chaya means – first level increase of Dosha in their own place. Kopa / Prakopa - means increase and overflow of Doshas from its own place to other place. It has the potential to cause the disease. Shama / Prashama - means decrease of increased Dosha and restoration of health.

Qualities that cause Chaya, Kopa and Shama of Vata – उ णेन यु ता

ा या वायोः कु वि त स चयम ्

शीतेन कोपमु णेन शमं ि न धा यो गुणाः

Hot along with dryness, movement, etc causes Vata Chaya. Coldness along with dryness causes Kopa. Snigdha (oilyness, unctuousness) and other qualities- Guru (heavy), Usna (hot) , pichila (stickiness), sthira (stability) etc. associated with hotness bring about its Shamana of Vata. 19

Qualities that cause Chaya, Kopa and Shama of Pitta शीतेन यु ताः ती णा याः चयं प त य कुवते

उ णेन कोपं, म द याः शमं शीतोपसं हताः

Teekshna (piercing, strong) and other qualities- dryness, lightness, etc associated with cold cause Chaya- mild increase of Pitta, The above qualities associated with hot, cause Kopa – profound increase of Pitta. Manda (viscous, mild) and other qualities like stickyness, stability etc, associated with cold bring about Pitta Shama- reduction back to normal. 20

Qualities that cause Chaya, Kopa and Shama of Pitta शीतेन यु ताः ि न ध याः कुवते ले मण चयम ् उ णेन कोपं, तेनैव गण ु ा

ादयः शमम ्

Snigdha –(unctuous, oily) and others –heaviness, stickiness, mild, etc along with cold quality causes Kapha chaya. (mild increase) Same Snigdha – unctuous, oily etc qualities associated with Usna – hot cause Kapha Kopa Manda- dull and others- rough, dry, clarity, movement, lightness associated with cold quality bring about Kapha Shama- reduction to normal. 21

Overall, Vata Dosha Ushna (hot) + Ruksha (dryness) and associated qualities cause Vata Chaya Sheeta (cold) + Ruksha (dryness) and associated qualities cause Vata Kopa Ushna (hot) + Snigdha (unctuous, oily) and associated qualities cause Vata shama. Pitta Dosha Sheeta (cold) + Teekshna (piercing, strong) etc qualities cause Pitta Chaya Ushna (hot) + Teekshna (piercing, strong) etc qualities cause Pitta Kopa Sheeta (cold) + Manda (mild, dull) cause Pitta Shama. Kapha Dosha Sheeta (Cold) + Snigdha (unctuous, oily) cause Kapha Chaya Ushna (hot) + Snigdha (unctuous, oily) cause Kapha Kopa Ushna (hot) + Rooksha (dryness) cause Kapha Shama

Levels of Dosha Increase and Decrease Chaya चयो व ृ ः

वधा

ये व

वपर त गुणे छा च

वेषो व ृ हे तष ु ु २२

Chaya means slight increase of Dosha in its own place. It produces dislike against the things that would cause further increase of particular Dosha. It is a self defense mechanism of the body to avoid further increase of Dosha, which may lead to disease. 22

Kopa कोप तु उ मागगा मता ल गानां दशनं

वेषाम वा

यं रोगस भवः

Kopa – suggests further increase of Dosha and overflow of increased Dosha into other body channels. It causes appearance of symptoms of increased Dosha, leading to onset of disease process. The premonitory symptoms of the disease can be observed at this stage.

Sama व थान थ य समता वकारास भवः शमः Sama means normalcy. Restoration / decrease of increased Dosha to its normal levels.

Fluctuation of Dosha in different seasons – चय कोप शमा वायो

मा दषु

षु

वषा दषु तु प त य, ले मणः श शरा दषु Dosha Vata Pitta Kapha

Chaya Grisma (summer) Varsha (rainy) Shishira (winter)

चीयते लघु

Prakopa Varsha (rainy) Sharat (Autumn) Vasanta (spring)

Prasama Sharat (Autumn) Hemanta (early winter) Grishma (summer)

ा भरौषधी भः समीरणः

त वध त वधं दे हे काल यौ या न कु य त

अ

र ल वपाका भरोषधी भ च ता ृशम ्

प तं या त चयं कोपं न तु काल य शै यतः

चीयतेि न धशीता भ दकौष ध भः कफः तु ये अ प काले दे हे च

क न वा न

कु य त

Vata undergoes chaya (mild increase) during summer by the use of Plants possessing such as lightness, dryness etc. It is especially so, in the bodies of persons possessing such qualities. But during summer, Vata does not undergo profound increase due to the heat of the summer. (Remember, cold is a quality of vata). Hot is opposite to Vata, hence there is no increase by a large extent. Similarly, Pitta undergoes chaya in rainy season, because of production of Amla viplaka (sour taste at the end of digestion) of water and foods. But it does not undergo further increase in rainy season, because of coldness. (Remember, hot is the quality of Pitta) Coldness checks further increase of Pitta in rainy season.

Kapha undergoes Chaya in winter by the use of foods with cold and oily qualiies. But it does not undergo prakopa because Kapha becomes solidified due to severe cold of the winter 25-27 इ त काल वभावो अयमाहार दवशा पुनः

चयाद न ् याि त स यो अ प दोषाः काले अ प वा न तु So, activities and food habits can cause increase or decrease of Dosha. At the same time, seasonal effect also may cause Dosha increase or decrease. 28

Action of increased Dhosha – या नो त सहसा दे हामापादतलम तकम ्

नव तते तु कु पतो मलो अ पा पं जलौधवत ् When there is a flood, the water gushes into the cities very fast, but the reversal process is very slow. Similarly, the increased Doshas spread throughout body from foot to head to produce diseases but the decrease of Dosha and restoration of normalcy takes a very long time. 29

Dosha is the main cause for disease – दोषा एव ह सवषां रोगाणामेककारणम ्

यथा प

प रपतन ् सवतः सवम यहः

छायाम ये त ना मीयां यथां वा कृ वकारजातं व वधं

तथा

नम यदः

ीन ् गुणा ना तवतते

वधातव ु ष य न म तम प सवदा

वकारजातं

ी दोषान ्

Like a bird flying high in the sky cannot escape from its shadow, the root cause for disease lies in Tridosha. Even the mental qualities such as Satva, Raja and Tama are influenced by Tridosha. Dosha get vitiated, then cause vitiation of body tissues (Dhatu) and waste products (Mala) to cause disease. 32-34 ¼ Three kinds of causes for Dosha increase तेषां कोपे त ु कारणम ्

अथः असा

यैः संयोगः कालः कमः च द ु कृतम ्

ह ना त म यायोगेन भ यते त पुनि

धा

The causes of Dosha increase can be categorized as Less involvement (heena yoga), Wrong involvement (Mithya yoga) Over involvement (Atiyoga)

Of Artha – sense organs Kala – season Karma – action . So, less, wrongful or more involvement of sense organs / seasons / action leads to Dosha imbalance. It is explained further.

Artha – Senses and their correlation:ह नो अथन इि

य य अ पः संयोगः

वेन नैव वा

अ तयोगो अ तसंस गः सू म भासरु भैरवम ्

अ यास न अ तद ूर थं व यं वकृता द च

य

णावी यते

पं म यायोगः स दा णः

एवाम यु च प याद नि

याथान ् यथायथम ्

व यात ्

Hinayoga – Poor association of sense organs – insufficient, inadequate, contact or non- contact with the objects of senses- sound, touch, sight, taste and smell with their respective sense organs. For example, not at all hearing to sounds, or living in a low lit area etc Atiyoga is over indulgence. Seeing objects which are very minute, bright etc, gazing for a very long time, hearing to loud music etc. Mithya Yoga – wrong indulgence with sense organs – seeing / hearing frightening, very close, very far, disliked and abnormal objects etc. 36-38 ½

Kala – seasons:काल तु शीतो णवषाभेदि

धा मतः

स ह नो ह नशीता दः अ तयोगो अ तल णः म यायोग तु न द टो वपर त वल णः Kala is of three kinds, cold, hot and rainy. Hinayoga of the Kala is – less cold in winter, less temperature in summer and less rain in rainy season. Atiyoga is – more rain in rainy season, more temperature in summer etc. Mithyayoga is manifestation of qualities opposites of the natural ones of the season. Example – rain during summer, cold weather during summer etc. 38 ½ 39

Karma: Activities:कायवाि च तभेदेन कमा प वभजेि काया दकमणां ह ना

धा

विृ तह नसं कः

अ तयोगो अ तव ृि त तु वेगोद रणधारणम ् वषमा ग

यार भपतन खलना दकम ्

भाषणं सा मभु त य राग वेषभया द च

कम

ाण दपाता द दशधा य च नि दतम ्

म यायोगः सम तो असा वह वा अमु

वा कृतम ्

Three types of actions pertaining to mind, body and speech lead to Dosha imbalance. Heenayoga – very less speaking, very little physical activity, very less thought process. Atiyoga – excessive speaking, excess physical activity and excessive thinking. Mithyayoga – wrong speaking, wrong physical activities and wrong, evil thinking, suppression of natural urges, improper postures, abrupt jumping and falling, speaking – too much immediately after meals , harboring of desires- attachment, passion, hatred, fear etc. 40-42 ½ नदानमेत ोषाणां, कु पता तेन नैकधा

कुवि त व वधान ् याधीन ् शाखा

को ठाि थसि धषु

These are the causes for increase of Doshas, thus increased they produce many kinds of diseases, involving the mind, tissues, viscera, bones and joints. 43-44

Pathways of diseases - Rogamargas:The body is divided into three sections to explain different diseases. Antarogamarga – internal path – refers to gastro intestinal tract. Bahi roga marga – external path – refers to Rakta, Mamsa etc Dhatu (tissues) and skin. Madhyama rogamarga – it includes vital organs such as brain, heart, blood vessels, joints, nerves etc. This concept is explained below in detail.

Bahi Koshta / Bahi roga marga – External pathway शाखा र तादयः वक् च बा यरोगायनं ह तत ् ४४ तदा या मष य गग डाल यबुदादयः

ब हभागा च द ुन ामगु मशोफादयो गदाः ४५

Raktha- blood and others tissues (Blood, muscles, bone, fat, bone marrow and sex related secretions) and skin continue the Bahya Rogamarga – external pathway of disease. It is related with diseases such as moles, discolored patches on face, Gandalaji- goiter, glandular ulcer on the face, malignant tumors, hemorrhoids, abdominal tumor, swelling and other external diseases. 44 ½ -45

Anta Koshta / Anta Rogamarga – Internal path – अ तः को ठो महा ोत आमप वाशया यः तत ् थानाः

छ यतीसारकास वासोदर वराः

अ तभागं च शोफाश गु मवीसप व ध Amashaya – stomach and small intestine, Pakwashaya – large intestine The above two, along with the entire gastro intestinal tract is called as Mahasrota. (The big channel). This constitutes the Anta Koshta. Diseases which affect this path are – vomiting, diarrhea, cough, dyspnoea, enlargement of the abdomen, fever, dropsy, hemorrhoids, abdominal tumors, Visarpa (herpes), abscess etc. 46

Madhyama Koshta / Madhyama Rogamarga – The middle path शरो दयब

या दममा य

नां च स धयः

ति नब ाः शरा नायुक डरा या च म यमः रोगमागः ि थता त मूधा दरोगाः स

य मप वधा दताः

यि थ कशूल हादयः

The head, heart, urinary bladder and such other vital organs, joints of bones, blood vessels, tendons, ligaments, nerves constitute the madhyama rogamarga. From it arise, consumption , hemiplegia, facial paralysis, diseases of the head and other organs, pain, stiffness- loss of movement of the joints, bones, waist etc. 47-48

Different symptoms produced by increased Dosha -

Symptoms of Vata increase: ंस यास यध वापसाद

तोदभेदनम ् ४९

स गा गभ गस कोचवतहषणतषणम ् क पपा

यसौ षयशोष प दनवे टनम ् ५०

त भः कषायरसता वणः यावो अ णो अ प वा कमा ण वायोः

Sramsa – Ptosis- drooping down Vyasa – dilation Vyadha – cutting pain Swapa – loss of sensation Sada – weakness, loss of function Ruk – pain Toda – continuous pain Bhedanam – splitting pain Sanga – Constriction, Angabhanga – bodyache, Sankocha – shrinking of the organ, reduction in size Varta – twisting, Harshana – tingling sensation Tarshana – thirst Kampa – tremors Parushya – roughness Saushirya – feeling of empty Shosha – dryness Spandana – pulsating Veshtana – rigidity, as if tied Sthambha – stiffness Kashaya rasata – astringent taste in mouth Aruna, Shyava Varna - appearance of blue or crimson discoloration - these are the abnormal signs and symptoms of increased Vayu –Vata. 49-50

Symptoms of Pitta increase – प त य दाहरागो मपा कताः वेदः

लेदः स ृ तः कोथः सदनं मू छनं मदः

कटुका लौ रसौ वणः पा डुर णविजतः

Daha – burning sensation Raga – reddish discoloration Ushmapakita – heat, increase in temperature, formation of pus, ulcers Sveda – sweating Kleda – inflammation with wetness, moistness Sruti – inflammation with pus / oozing / secretions, exudation Kotha – putrefaction- decomposition Sadana – debility Murchana – fainting Mada – toxicity Katuka Amla Rasa - bitter and sour taste in the mouth Pandu Aruna Varjitaha - appearance of color other than yellowish white and crimson. 51- 52 ½

Symptoms of Kapha increase – ले मणः

नेहका ठ यक डूशीत वगौरवम ्

ब धोपलेप तै म यशोफाप वणः वे तो रसौ

य त न ताः

वाद ुलवणौ चरका रता

Sneha – unctuousness, oilyness Kathinya – hardness Kandu – itching Sheetatva – coldness Gaurava – heavyness Bandha – obstruction, Upalepa – coating, as if tied with a wet cloth Staimitya – stiffness, loss of movement Shopha – inflammation Apakti – indigestion, Atinidrata – excessive sleep Shveta varna – white discolouration Svadu lavana rasa – sweet, salt taste in mouth Chirakarita – delay in all activities. 52 ½ -53. इ यशेषामय या प यद ु तं दोषल णम ् दशना यैरव हत त स यगुपल ये त ् या यव था वभाग ः प य नातान ्

त णम ्

Thus are enumerated, the features, which appear in diseases, are to be recognized by the physician through inspection and others – methods of examination of patient. 54

Importance of patient observation: To gain the knowledge of the different stages of disease the physician should observe the patient every minute.55 अ यासा

ा यते

र ना दसदस

ि टः कम स

ानं न शा

का शनी

ादे व जायते

Knowledge of successful treatment is obtained from constant practice just as knowledge of determining the quality of gems is obtained only from- knowing the science. 56

Three kinds of diseases based on cause – Trividha rogaटापचारजः कि च कि च पूवापराधजः

त स करा

य यो या धरे वं

धा

म ृतः

Diseases are of three kinds viz, Karmaja Vyadhi – Includes Diseases that originate due to bad deeds of the past lives, or of present life or of both past and present lives. Usually the cause for such disease is not clearly known. 57 Doshaja Vyadhi – यथा नदानं दोषो थः कमजो हे तभ ु वना

महार भो अ पके हे तावात को दोषकमजः Diseases which arise from the specific causes, which lead to Dosha increase and then to disease manifestation. Doshakarmaja – combination of bad deeds and indulgence in causes of disease result in disease. Usually the symptoms are profound in this case. 58

Treatment for such diseases: वप शीलना पूवः कमजः कमस

ग छ युभयज मा तु दोषकम या

यात ्

यम ्

The Doshaja diseases get cured from indulgence in food, activities and medicine that have opposite qualities to the cause. Karmaja diseases get cured after the termination of the effects of such acts of previous / current lives. Dosha-Karmaja diseases get cured after the mitigation of Dosha and nullifying of effects of past deeds. 59

Two kinds of diseases – based on cause – Dvividha roga— वधा

वपरत

वा याधयोअ याः पुन वधा

पूवजाः पूव पा या, जाताः प चाद ुप वाः 1. Svatantra Roga यथा वज मोपशयाः

वत

ाः

प टल णाः

वपर ता ततो अ ये त ु Svatantra Roga – independent/ primary – have their own specific causes, comforting methods and clearly manifest features.

2. Paratantra Roga – secondary diseases, associated diseases. Those which do not have their own specific cause. It is further of two types. Purvaja – premonitory symptoms – the symptoms that are seen at the initial stage of a disease Upadrava – complications of diseases. 60- 61 व यादे वं मलान प तां ल येदव हतो वकुवाणान ्

तेषां

धान शमे

त वरम ्

शमो अशा यत तथा

प चाि च क स तूण वा बलव तमुप वम ् या धि ल टशर र य पीडाकरतरो ह सः

The secondary disease (Paratantra Roga) usually subsides when the primary diseases is treated. If they do not get subsided then, treatment has to be given- for the secondary diseases as well. If powerful, secondary affections should be treated soon because these- complication cause more troublers to the body which is already debilitated by the primary disease. 62-63 वकार नाम अकुशलो न ह िज यात ् कदाचन ।

न ह सव वकाराणां नामतो अि त

ुवा ि थ त: ॥६४॥

The physician should never feel shy for not knowing the nomenclature of the disease, for there is no rule/ custom/ state, that every disease has a name. 64 स एव कु पतो दोषः समु थान वशेषतः थाना तरा ण च

ा य वकारान ् कु ते बहून ्

त मा वकार कृ तर ध ठाना तरा ण च बु

वा हे तु वशेषां च शी ंकुयाद ुप मम ्

The very same Doshas, depending upon the nature of the causative factors, travels to many parts of the body and produces many disease, hence treatment of the disease, its abode- site should be judged very quickly with the help of knowledge of the disease. 65-66

Factors to observe in patient द ू यं दे शं बलं कालं अनलं स वं सा

कृ त ं वयः

यं तथा आहारं अव था च प ृथि वधाः ६७

सू म सू माः समी यैषां दोष औषध न पणे यो वतते च क सायां न स

खल त जातु चत ् ६८

The physician should minutely examine and determine, Dushya – the Dhatus and Malas involved in a diseases Desha – the area of the body where disease is manifested, the living place of the patient Bala – strength of the patient Kala- season, how old is the disease, age of the person etc. Anala- digestive power of the patient Prakriti- Body constitution, Vayas- age of the patient and disease, Satva- mind, tolerance capacity of the patient Satmya- The food and activities to which the patient is accustomed to. Ahara- food habits and Avastha- stages of the diseases The physician should watch for above factors to decide and then only, the physician should decide on the aggravated Dosha and its appropriate treatment. Such a doctor will never commit mistakes in treatment. 67-68 गुव प या धसं थानं स वदे हबलाबलात ्

यते अ य यथाकारं ति म नव हतो भवे त ्

The symptoms may be affected by the disease and also by the mental status of the patient. The strength of the disease varies based on strength and weakness of the mind and body of the patient. Hence the physician should be very attentive. 69. गु ं लघु म त या ध ं क पये तु भष अ पदोषाकलनया प ये व तप यते

ुवः

The unintelligent physician, who determines a grievous disease as a mild one, goes wrong in treatment because of under estimating the condition the Dosha. 70 ततो अ पम पवीय वा गु याधौ

योिजतम ्

उद रये तरां रोगान ् संशोधनमयोगतः शोधनं व तयोगेन वपर तं वपयये

ण ुया न मलानेव के वलं वपुर य त He will administer drugs/ therapies in small doses. Such mild treatment causes worsening of the disease because of ineffective treatment. On the other hand, if the person over estimates the strength of the disease and over treats with Panchakarma and oral medicines, it will also trouble the health of the patient to a very great extent. 71- 72 अतो अ भयु तः सततं सवमालो य सवथा तथा यु जीत भेष यमारो याय यथा

ुवम ्

Hence the physician should constantly study the science, determine the exact condition of all factors, all the time and then administer appropriate medicines and treatments. 73

Number of combination of Dosha – Dosha Samyoga samkhya – व य ते अतः परं दोषा व ृ पथ ृ क्

ीन ् व ृ

ीनेव संया व ृ

संसगि

य वभेदतः धा, त

तु ता नव

या, षडेक या तशायने

योदश सम तेषु ष

एकं त ु या धकै ः ष

वये का तशयेन तु

च तारत य वक पनात ्

प च वंश त म येवं व ृ ैः

ीणै च तावतः

The number of combinations of Dosha increase and decrease are 62. In their vriddhi they are - 3 individually, in the combination of two doshas they are 3, and 9 in total- 3 in equal proportion of increase, 6 with preponderance of one dosha; they are 13 in combination of all three together - 6 with preponderance of any one dosha, 1 with equal preponderance of all the three, 6 by disproportionate subdivisions; Thus in respect of vriddhi they are 25; Similarly in respect of kshaya they are 25. एकैकव ृ समता यैः ष एक य व

ते पुन च ष

वव ृ या स वपयया अ प ते

In the combination of increase, normal and decrease of one dosha each will make up for 6 numbers Again they are 6 in the combination of decrease of 1 dosha and increase of 2 doshas भेदा

वषि ट न द टाः

ष टः

वा

यकारणम ्

The number of combinations of Dosha increase and decrease are 62. The 63rd is the condition, where all the Doshas are in equilibrium, which is called as the state of health. 78 संसगा स धरा द भ तथैषां दोषां तु

यसमता वव ृ भेदैः

आन यं तरतभयोगत च यातान ् जानीयादव हतमानसो यथा वम ् With the association of Rasa, Rakta etc and the level of increase or decrease of Doshas, there can be innumerable permutations and combinations. The physician should understand them by their features – signs and symptoms with an attentive mind.79

Thus ends the chapter known as Dosabhediya Adhyaya. 12th of Sutrasthana of Ashtanga Hridayam.