Chapter 14: Dvividha Upakramaneeya

व वधोप मणीय – Two Kinds of Treatment We are discussing two main kinds of Ayurveda treatments. Any treatment can be broadly classified either as stoutening / nourishing OR as emaciating. The 14th chapter of Ashtanga Hrudaya Sutrasthana is called as Dvividha Upakramaneeya Adhyaya. Dvividha means 2 types. Upakrama means treatment. Let us explore further.

Dvividha Upakarma- two kinds of therapy :उप

य य ह

व वा

एकः संतपण त

वधैषोप मो मतः

वतीया चापतपणाः १

बं ृहणो ल घन चे त त पयायावुदा तौ

बंहृ णं य बह ृ वाय ल घनं लाघवाय यत ् २

दे ह य

Because, that to be treated, the human body is of two types – Obese and lean, the treatment is also of two kinds. 1. Santarpana- nourishing, enriching. It is also called as Brihmana (Stoutening, increasing weight, imparting heaviness) 2. Apartarpana –depleting, cleansing. It is also called as Langhana (fasting, losing weight, imparting lightness etc). 1-2 भवतः

ायो भौमाप मतर च ते

Generally, Brihmana treatment is dominant with Prithvi (Earth element) and ap (water element). Langhana is dominant with the rest three elements (Fire, air and ether). नेहनं

णं कम

भूतानां तद प

वे दनं

त भनं च यत ्

वै या वतयं ना तवतते

Functions such as Snehana (oleation/ lubrication) and Rukshana – (imparting dryness), Swedana- (sweating therapy, sudation, diaphoresis), Sthambhana- (withholding, obstructing) are also of these two kinds- Brihmana and Langhana. Snehana and Sthambhana can be categorized as Brihmana and Rukshana and Swedana can be categorized as Langhana Thus all functions are not apart from two .3-3 ½ Langhana therapy imparts lightness to the body. It makes the body thin and light. It is of two types.

शोधनं शमनं चे त

वधा त ा प ल घनं

Shodhana – Purification procedures (Panchakarma) and Shamana- palliative treatment. 4 यद रये ब हद षान ् प चधा शोधनं च यत ् न हो वमनं काय शरोरे को अ

व ु तः

Shodhana treatment expels imbalanced Doshas out of the body forcibly. It is of five kinds, viz Niruha- decoction enema, Vamana- emesis, vomiting therapy Kaya reka- Virechana – purgation for the body Shio reka – Shiro Virechana – nasya – purgation for the head, nasal instillation of medicines. Asra-visruti – Raktamokshana – blood letting .5 न शोधय त य ेषान ् समानोद रय या प समीकरो त वषमान ् शमनं त च स तधा पाचनं द पनं

ु त ृ यायामातपमा ताः

Shamana – palliative treatment is that which does not expel the increased Doshas out of the body, it does not increase the normal Dosha, but makes the abnormal- Doshas normal. In short, Shamana treatment brings imbalanced Dosha to normalcy.

Shamana 7 types – Pachana – digestive, carminatives, Deepana – hunger producing, stomachic, Kshut – withstanding hunger, avoidance of food, fasting Trut – withstanding thirst/avoidance of water drinking, avoiding liquid food intake Vyayama- physical activity, Aatapa- exposure to sunlight and Maruta- exposure of breeze. 6-6 ½ बं ृहणं शमनं वेव वायोः प ता नल य च Brimhana- stoutening therapy also is Shamana only because it alleviates/ mitigates both Vata and Vata Pitta- combination. 7

Treatment

Santarpana/Brihmana (Nourishning)

Apatarpana/Langhana (Thinning)

Sodhana (Expel out Dosha) (Purification, Panchakarma)

Shamana (Palliative, Dosha Balance)

1. 2. 3. 4. 5.

Vamana (Therapeutic Vomiting, Emesis) Virechana (purgation therapy) Niruha (decoction enema) Nasya (Nasal administration) Raktamokshana (Blood letting)

1. 2. 3. 4. 5. 6. 7.

Pachana (Digstive) Deepana (Hunger Producing) Kshut (Hunger tolerance) Trut (Thirst tolerance) Vyayama (exercise) Aatapa (Sun exposure) Maruta (Breeze exposure)

Persons requiring stoutening therapy - Brimhaneeya बं ृहये

या धभैष यम य

भारो वारः

त ीण

ग भणीसू तकाबालव ृ ा

ीशोकक शतान ्

द ुबलवातलान ्

ी मेअपरान प

मांस ीर सतास पमधुरि न धबि त भः

व नश यासख ु ा य ग नान नव ृ तहषणैः

Brimhana- stoutening therapy should be given to persons who are Vyadhi karshita – emaciated by diseases, Bhaishajya Karshita – emaciated by medicines- therapies, Madya Karshita – emaciated by alcohol Stri Karshita – Emaciated by excess sexual activity Shoka karshita – Emaciated by grief, Bhara – who carries heavy loads frequently Adhva – who has walked / travelled a long distance Urakshata – person with chest injury KShatakseena – who is debilitated due to injury Ruksha – who has excess dryness Durbala – debilitated

Vatala – Person with Vata body type. Garbhini – pregnant Sutika –the women who has delivered, Bala – children, Vruddha – the aged and Greeshme – in the month of summer, even the other people, who are not indicated above should be given Nourishing therapy.

Method of Brihmana - ; by the use of meat, milk, sugar, ghee, enema prepared sweet substances and fats(oil, ghee), sleep, comfortable bed, oil- massage, bath, comforts, rest and happiness of the mind. 8-9 ½

Persons requiring thinning therapy – Langhaneeya – मेहामदोषअ ति न ध वर उ वसप व ध ल ह शरक ठा

त भकुि ठनः १०

रो गणः

थूलां च ल घयेि न यं श शरे त ु अपरान प ११ Langana- thinning, slimming therapy should be doneto Meha – diabetics Amadosha – persons suffering from Ama Atisnigdha –who has undergone excess oleation treatment Jvara – fever Urustambha – stiffness of the thighs, Kushta – skin diseases Visarpa – herpes, Vidhradi – abscess, Pleeha – diseases of spleen, Shira, Kanta Akshi roga – head, throat, and eyes; Sthula – Those are obese Even to others during Shishira – winter, Langhana treatment should be done. 10-11

Indication for Langhana therapy by means of Shodhana (Panchakarma) – त

संशोधनैः

थौ यबल प तकफा धकान ्

आमदोष वर छ रतीसार दामयैः वब धगौरवो गार

लासा द भरातुरान ्

म य थौ या दकान ् ायः पूव पाचनद पनैः

ए भरे वामयैरातान ् ह न थौ यबला दकान ् ु त ृ णा न हैद षै

वातान ् म यबलै ढान ्

समीरणातपायासैः कमुता पबलैन रान ्

Patients with these diseases should be given Panchakarma treatment as the means for Langhana therapy. - Those who are very obese, strong and having predominance of Pitta and Kapha, those suffering from Amadosha, fever, vomiting, Diarrhoea , hearts diseases, constipation, feeling of heaviness, excess of belching, nausea, etc.

Indication for Deepana, Pachana and then Shodhana (Panchakarma) Those who are moderately obese, medium in strength of the body and also of the diseases mentioned, first by administration of digestives and hunger producing substances generally, later with other purification therapies;

Indication for Shamana type of Langhana – Those who are troubled by increased Doshas, who are of medium strength, with medium strength disease, who are capable of withstanding strain by the control of hunger and thirst; those again of poor strength- of the body and of disease by exposing them to breeze, sunlight and exercise. 1214 ½ न बं ृहयेत ् ल घनीयान ् बं ृहयां तु म ृद ु ल घयेत ् १५ यु

या वा दे श काला दबलत तान ् उपाचरे त ्

Those who are to be given Langhana- thinning therapy, should not be given Brimhanastoutening; those who are to be given Brimhana should be given mild Langhana, or both Langhana and Brimhana together, simultaneously may be given depending upon the nature of habitat, season, strength etc. 15

Benefits of Bruhmana therapy – बं ृ हते

या बलं पुि ट तत ् सा यामयस यः

Brimhana therapy makes for strength, nourishment of the body, and cure of such diseases which are curable by that therapy. 16

Benefits of Langhana Therapy वमलेि

यता सग मलानां लाघवं

ु त ृ सहोदयः शु

चः

दयो गारक ठता

या धमादवमु साह त

ानाश च ल घते

Keenness and clarity of sense organs, Expulsion of Malas- Doshas and wastes, Feeling of lightness of the body, Good taste perception, Appearance of hunger and thirst together,

Feeling of purity in the chest region (heart), Clear belching and clear throat, softening of the diseases- decreased severity, increase of enthusiasm and loss of stupor- laziness 16-17 अनपे

तमा ा दसे वते कु त तु ते

अ त थौ या दका याद न ्, व य ते ते च सौषधाः These- therapies indulged into in great measure than required, lead on to profound obesity and emaciation etc, which will be enumerated now, along with their treatment.18 पं तैरेव च

ेयमा तबं ृ हतल घते

Ati Brimhana- excess of stoutening therapy :अ त थौ यापचीमेह वरोदरभग दरान ् कासस

यासकृ

ामकु ठाद न तदा णान ्

Excess of Brimhana therapy produces Atisthaulya – profound obesity Apachi – scrofula, Meha – Diabetes, UTI Jvara – fever Udara – enlargement of abdomen, Bhagandara – fistula-in-ano, Kasa – cough, Sanyasa – loss of consciousness, Mutrakruchra – Dysuria, Ama- disorders of poor digestive activities, Kushta -skin diseases which are very dreadful. 20 Treatment for over nourishing त

मेदो नल ले मनाशनं सव म यते

कुला थजूण यामाकयवमु गमधूदकम ्

म त ुद डाहता र ट च ताशोधनजागरम ्

मधुना

फलां ल या गुडूचीमभयां घनम ्

रसा जन य महतः प चमल ू य ग ु गल ु ोः शलाजतु] योग च साि नम थरसो हतः

वड गं नागरं

ारः काललोहरजो मधु

यवामलक चूण च योगो अ त थौ यदोशिजत ्

Treatments which reduce Medas- fat, Anila- Vata and Kapha are desirable; Use of Kulattha – horse gram – Dolichos Biflorus, Jurna, Shyamaka, Yava – Barley – Hordeum Vulgare, Mudga – green gram – Averrhoa Carambola, and Honey water; Indulgence in worry, stressful activities Purification therapies, avoidance of sleep, either Triphala, Guduci, Abhaya –(Chebulic Myrobalan fruit rind – Terminalia chebula) and Musta (Cyperus rotundus), should be licked with honey daily; Either Rasanjana (Aqueous extract of Berberis aristata), Brihat Pancamula (Agnimantha, Shyonaka, Gambhari, Patala, Bilva), Guggulu – along with the fresh juice of Agnimnatha is suitable; Powder of Vidanga (False black pepper – Embelia ribes), Nagara – (Ginger), KsharaYavakshara and iron filing or powder of Yava (Barley – Hordeum vulgare) and Amla along with honey – should be licked daily. 21-24 योषकटवीवरा श ु वड गा त वषाि थराः

ह गुस ौवचलाजाजीयवानीधा य च काः

नशी ब ृह यौ हपुषा पाठामूलं च के बुकात ्

एषां चूण मधु घ ृतं तैलं च सदशांशकम ्

स तु भः षोडशगुणैयु तं पीतं नहि त तत ्

अ त थौ या दकान ् सवा ोगान यां च त वधान ् ोगकामलाि व

वासकासगल हान ्

बु मेधा म ृ तकरं स न या ने च द पनम ् Powder of Vyosha- (Trikatu – pepper, long pepper and ginger), Katvi, Vara (Triphala), Shigru (drum stick), Vidanga (False black pepper – Embelia ribes), Ativisha, Sthira (Desmodium gangeticum), Hingu – (Asa foetida), Sauvarcala, Ajaji – (Cuminum cyminum), Yavani – (Trachyspermum ammi), Dhanya, Chitraka, the two Nisa (turmeric and tree turmeric), the two Brihati(brihati and kantakari), Hapusa, root of Patha (Cyclea peltata) and of Kebuka, should be mixed with honey, ghee and oil in equal proportion and sixteen parts of saktu (corn flour), this mixture diseases- mentioned earlier and even others of similar nature such as heart diseases, Jaundice, Leucoderma, Dyspnoea, cough, obstruction in the throat- hoarseness of voice etc. improves powder of thinking, intelligence, memory and kindles the weakened fire- digestive activity. 25-28

Atilanghana- excess of thinning therapy:अ तका य

मः कास त ृ णा ध यमरोचकः

नेहाि न न ा बि त

मूधज घो

ो शु ौजः

ु

कपा व जा

वर यः वरः

लापो वा नल ला न छ पवाि थभेदनम ्

वच मू

हा या च जाय ते अ त वल घनात ्

Profound emaciation, Bhrama – Delusion, Dizziness, Kasa – cough, Trushna – severe thirst, Aruchi – anorexia, loss- decrease of moistness, and digestive power, of sleep, vision, hearing, semen, Ojas, hunger and voice; Pain in the urinary bladder, heart, head, calves, thighs, upper shoulders and flanks; fever, delirium- excess of talk, belching, exhaustion, vomiting, cutting pain in the joints and bones; non-elimination of faeces, urine etc., arise from excess of Langhana 29-30 काशमेव वरं

थौ यात ् न ह

थूल य भेषजम ् ॥३१॥ बं ृहणं ल घनं वाऽलि तमेदोि नवातिजत ् ।

Emaciation is better than obesity, there is no treatment for the obese, for, neither Brimhana nor Langhana are capable of vanquishing excess of fat, digestive activity and vata. 31 मधुर ि न ध सा ह यैय सौ येन च न य त शमा

थ वमाअ य त वपर त नषेव णैः

योजये बंहृ णं त

सव पाना नभेषजम ्

Emaciation gets cured by use of sweet and unctous- fatty foods and comfortable living, whereas obesity gets cured by the use of the foods etc, of the opposites- qualities to the above that too when used in maximum quantity. There, liquids, foods and drugs which are Brimhana should be adopted 32-33

अ च या हषणेन

ुवं संतपणेन च

व न स गाच कृशोवराह इव पु य त The emaciated person becomes stout like a boar by absence of worry, by happiness, more use of nutritious food and more of sleep. 34 न ह मांससमं कि चद यदे हब ृह वकृत ्

मांसादमांसं मांसेन स भ ृत वात ् वशेषतः ३५

There is nothing other than meat to stouten the body, especially so the meat of carnivorous animals, for they feed on meat itself. 35 गु

चातपणं

थूले वपर तं हतं कृशो

यवगोधूममुभयो त यो या हतक पनम ्

Foods which are heavy and non- nutrition are ideal for the obese whereas the opposites- are ideal for the emaciated; Yava – Barley – Hordeum vulgare- barley is heavy and non nutritious, ideal for obese and Godhuma- wheat is light to digest and nutritious, Hence good for emaciated. 36 दोषग या अ त र य ते

ा हमे या दभे दतः

उप मा न ते

ना अ प गदा इव

व वा

Though the states of Doshas are innumerable and innumerable are the kinds of treatments such as Grahi – withholding etc, still they do not surpass these two kinds- Brimhana and Langhana, just as the diseases- though innumerable fall into two kinds only, viz Sama and Nirama. (with and without Ama)

Thus ends the chapter named Dvividhopakrmaniya- the fourteenth of Sutrasthana of Astanga Hrudaya