Ashtanga Hridayam, Chapter-1 (Desire for long life), Sutrasthana, BAMS 1st year, Ayurveda.

In this post, we will learn about the remaining verses of chapter 1, desire for long life, of Ashtanga Hridayam, Sutrasthana under Bachelor of Ayurveda, Medicine and Surgery, 1st year.

Dravya bhedah-(Type of food substances)

Shamana – Food that brings down the increased Dosha to normalcy

Kopana – Food that increases the lowered Dosha to normalcy 

Swasthahita – Food that maintains the normalcy of Tridosha and health.

Types of Potency (Veerya)

1. Ushna veerya (Hot potency) -Some food items are hot in nature. For example pepper 
2. Sheeta veerya (cold potency) – Some food items are cold in nature. For example milk.

These are the two types of potencies. Generally, substances that have Astringent, bitter and sweet tastes are coolant in nature and Sour, salt and pungent tastes are hot in nature.

Vipaka

Vipaka refers to conversion of taste after the initial phase of digestion.

1. Madhura Vipaka (sweet) – Generally, Sweet and salt tastes undergo this Vipaka.
2. Amla Vipaka (Sour) – Sour taste undergoes this Vipaka
3. Katu Vipaka – rest of the tastes – Bitter, astringent and pungent tastes undergo this Vipaka.

Twenty types of qualities in Ayurveda

In total 41 gunas (qualities) have been enumerated in Ayurveda as under:

1. Artha(5) (indriyartha): Objects Of Sense Organs [sabda (sound), sparsa (touch), rupa (vision), rasa (taste) and gandha (smell)]
2. Gurvadi (20) : Dravyaguna or dwandwa guna
3. Atmagunas(6): Buddhi (intellect), sukha (happiness), duhkha (misery), iccha (desire), (hatred) and prayatna (efforts).
4. Paradiguna (10): Para (predominence), apara (subordination), yukti (propriety) sankhya (number), samyoga (combination), vibhaga (division), prthaktwa (separation), parimana (measurement), sarhskara (transformation) and abhyasa (repetition)

Gurvadi Guna in Ayurveda:

Guru (heavy), manda (slow), hima (cold), Snigdha (unctuous), slaksna (smooth), Sandra (solid), mrdu (soft), sthira (stable), suksma (minute, subtle), and vishada (non-slimy )-these ten along with their respective opposites-are the twenty gunas (qualities* properties of substances).

Cause of disease and health in Ayurveda

The present verse represents an exposition of causative factors responsible for the production of almost all diseases pertaining to the body and mind.

The 3-fold causes are:

• Insufficient utilization (hinayoga),
• Wrong utilization (mithyayoga) and
• Excessive utilization (atiyoga),

of time (kala), objects of the sense organs (indriyarthas) and the activities of the body, mind and speech (karma), whereas the proper utilisation (samyak yoga) of the above factors results in a healthy state.

Notes:
Triskandhas:
Ayurveda is based on triskandhas viz.,

1. Hetu skandha (causative factors/etiology)
2. Linga skandha (signs and symptoms/symptomatology)
3. Aushadha skandha (drugs/treatment/knowledge of therapeutics).

Hetu skandha: 

1. Kala (time): Parinama
2. Artha: Asatmyendriyartha samyoga
3. Karma: Prajnaparadha.

Due to the above causative factors doshas gets vitiated and various signs and symptoms will be formed as shown in linga skandha. By selecting the appropriate drugs from ausadha skandha, which brings the vitiated doshas to normalcy, is one of the aims and objectives of Ayurveda.

Kala (Time):

Hinayoga : Heat in summer, cold in winter is decreased than the normal condition. 

Mithyayoga : Cold in summer, and heat in winter.

Atiyoga : More heat in summer and more cold in winter than the normal climaticcondition.

Artha/Indriyartha (Objects of sense organs):

• Hinayoga:
  • Insufficient utilization of sense organs.
  • Sabda—hearing very low sound/not hearing any sound.
  • Sparsa—not touching anything.
  • Rupa—seeing objects in dim light.
  • Rasa—not tasting.Gandha—not smelling.

• Mithyayoga:
  • Seeing unnatural objects.
  • Hearing harsh, unpleasant sounds.
  • Smelling unpleasant, putrefying smells.
  • Tasting undesirable. Contact of hard, dirty, and harmful things.

• Atiyoga:
  • Seeing very bright objects.
  • Hearing very loud sounds.
  • Smelling powerful pungent smells.
  • Eating large quantities of substances.
  • Touching too many cold and hot substances.

Karma (Activities of body, mind and speech):

• Hinayoga: Not doing any activity or doing very little of it physically, mentally, or vocally.
• Mithyayoga: Doing unusual activities like suppression of natural urges, falling from a great height, etc.
• Atiyoga: Indulging in activities more than usual like excessive exercises, coitus, riding, talking, thinking, etc. 

Notes:-Less, more or wrong unison of time, senses and functions is the reason for disease and the right unison of these three factors is the reason for health. This will be described in detail in chapter 12.

Roga (disease) in Ayurveda

Roga (disease) is (the effect of) disequilibrium of the Doshas while health is ( the result of) the equilibrium of the Doshas. 

Notes :—Each of the Doshas  possessing its specific quantity, qualities and functions is known as its samya (equilibrium) whereas increase (vrddhi) and decrease (ksaya) in its quantity, one or more of its qualities and functions are known as its vaisamya (disequilibrium).

Types of disease:

Nija roga – Disease caused due to imbalance in internal factors. For example, eating excessive hot substances, leading to gastritis.

Agantu Roga – Disease caused due to external factors. Such as injuries. Both these types of disease can occur to the body and mind.

Manasika Doshas (Doshas of the mind)

Rajas – quality of mind, that drives us to take actions, Tamas – that leads to inaction and lethargy. 

Notes:—Satva, rajas and tamas are known as the three mahagunas, they are primary or natural qualities responsible for creation of all the substances of the world and said to be present in every one of them and concerned with intelligence stuff. Out of them, satva is considered to be pure and not having any bad effect, whereas the other two are bad and having bad effects. Hence rajas and tamas are considered as the dosas of the mind, when they become increased above the specific limit.

How to test patients?

• Darshana – by means of inspection, observation. 
• Sparshana – by means of touching
• Prashna – by means of asking

Examination of disease:

Disease should be examined by its 

• Nidana -causes, etiology,
• Pragrupa – Purvarupa – prodromal symptoms, premonitory symptoms 
• Lakshana – Specific signs and symptoms, clinical features 
• Upashayaa – diagnostic tests
• Apti – Samprapti – Pathogenesis.

Types of Habitat (Desha) in Ayurveda

In this science, it is said to be of two kinds – Bhumi desha – region of land and Dehadesha – the body. 

• Bhumi Desa – the land region is of three kinds of viz,
  • Jangala -which is predominant of Vata – arid or desert-like land with no mountains or hills, has less vegetation, poor water resources, and is more breezy.
  • Anupa – which is predominant of Kapha – marshy land with more water, more vegetation, very little sunlight, and heat.
  • Sadharana has all Tridosha in balance – moderate type with few mountains, hills, moderate water, vegetation, and sunlight.

Notes:  Jangala region is arid or desert-like land with no mountains or hills, has less vegetation, poor water resources and is more Breezy. Anupa is marshy land with more of water, more vegetation, very less of sunlight and heat. Sadharana is the moderate type with few mountains, hills, moderate water, vegetation and sunlight.

Kala Bhedh-(kinds of time)

Kala (time) which is relevant to the (administration and selection of) drug (or therapies) is of two kinds-viz. that (time) commencing with ksana (moment) etc., and that of the stages of the disease. 

Notes:—Ksana is the minimum unit of time measurement and is equivalent to the time required for winking of the eyelid once or uttering of one letter of the alphabet; kastha, kala, nadika, muhurta, yama, ahoratra, paksa, masa, rtu, ayana and samvatsara-are the successive units, knowledge of this external time is essential for collection of drugs at appropriate period, preparation of recipes, administration to the patient etc.

The disease develops in the body in different successive stages and not all of a sudden; each stage has its own characteristic signs and symptoms, recognition of each stage helps the physician to assess the strength of the disease and decide the appropriate drug and therapy required for that stage, hence the necessity of two kinds of time.

Types of therapies (Ausudha Bhedh) in Ayurveda 

There are two types of medicines.

1. Shamana – Palliative treatment – which brings the Dosha to normalcy, useful in initial stages of diseases

2. Shodhana – Purification treatment – which expels imbalanced Dosha out of body. – Useful in aggravated stages of diseases.

Examples:

• Vata – Basti (suppositories) is the Shodhana treatment, and oil is Shamana treatment. 
• Pitta – Virechana (Purgation) is Shodhana and Ghee is Shamana.
• Kapha – Vamana (emesis) is Shodhana and Honey is Shamana.

For the doshas of the Body, Basti (enemata), vireka (purgation) and vamana (emesis) are the Best therapies respectively; likewise are taila {oil), ghrta (ghee, Butter fat) and madhu (honey).

Notes: Administration of different kinds of medicinal enemas is Best for mitigating vata, producing purgation is for pitta and vomiting is for kapha; use of medicated oils (Both internally and externally) is ideal for mitigating vata, ghee for mitigating pitta and honey for kapha.

• Dhee – improving intelligence
• Dhairya – improving courage
• Atmavijnana – Self realization are the means to treat mental imbalance.

Notes:—Dhi is the ability of the person to decide good and bad, dhairya is ability to adhere to the good, avoid the bad, and withstand difficulties with strong will; atmadi vijnana is possessing or obtaining correct knowledge of the soul, of the aims and pursuits of the present life as well as of future life etc., in other words, a philosophical view of human life. These are especially of great value in the treatment of mental disorders.

Cikitsa padah-(four limbs of treatment) in Ayurveda

– Bhishag (Doctor), Dravya (medicine), Upastha (Nurse) and Rogi (patient) are the four factors in treatment. Each of these four have further four qualities.

Qualities of doctor

• Daksha – Alert, disciplined, efficient 
• Shastra – Having detailed knowledge about diseases and treatment.
• Drushtakarma – Having practical experience
• Shuchi – Cleanliness (in Body, mind, and speech).

Qualities of medicine:

• Bahukalpa – Ability to formulate in different dosage forms, like decoction, powder, herbal oil etc
• Bahuguna – Having enormous qualities
• Sampanna – Endowed with virtues
• Yogya – suitable and appropriate for specific diseases.

Qualities of nurse:

• Anurakta – Compassion towards patients  (affectionate, faithful to the patient)
• Shuchi – Cleanliness
• Daksha – Alert, active
• Buddhiman – Intelligence

Qualities of patient

• Adya – Rich
• Bhishagvashya – 100 % obedience towards the doctor
• Jnapaka – Good memory  (capable of remembering and explaining events connected with probable causes, symptoms, etc.)
• Satvavaan – Having good strength to tolerate disease and treatment.

Roga Bhedh-(kinds of diseases) in Ayurveda

Two main types, which are further divided into two types.

• Sadhya(curable) – Which can be cured. It is of two types – Easy to cure (Sukha Sadhya), Difficult to cure (Krichra Sadhya). 
• Asadhya (incurable)- Which can not be cured. It is of two types – Yapya (medicine is required for as long as the patient is alive), Anupakrama (nothing can be done. )

• Sadhya asadhya laksana-(features of curability and incurability) –
  • Sarvaushadha kshame dehe – The body of the patient is able to tolerate all types of medicines 
  • Yunaha – Young patient
  • Jitatmanaha – Patient having good control over sense organs, who follows abstinence 
  • Amarmaga – If the disease is not affected sensitive areas like the brain, heart, kidney 
  • Alpahetu – If the cause for the disease is mild
  • Alparoopa – Mild symptoms
  • Anupadrava – no complications.
  • Atulya dushya Desha rutu prakruti – If the Dosha involved, Dhatu (body tissue) involved, Desha (place), Rutu (season), and Prakruti (body type) are not influenced by one particular Dosha, 
  • Pada sampadi – If all the sixteen qualities of Doctor, patient, etc explained above are present, 
  • Graha anuguna – If astrology is in favour of the patient
  • Eka Doshaja – Disease due to only one Dosha
  • Eka Marga – If only one body channel is affected
  • Nava – Disease of recent origin / onset -are susadhya (easily curaBle).

Qualities of difficult to treat diseases

• The diseases that require the use of sharp instruments etc. in treatment, and also those which have a mixture of factors (enumerated in the previous verses) are krchra sadhya (curaBle with difficulty).
• Diseases which persist till the remainder of life, But can Be controlled with continuous good regimen (of drugs, food, activities, etc.) and which possess qualities of those (easily curable) diseases are yapya (controllaBle)
• Diseases which have features entirely opposite (of curable diseases), which have stayed long (involving all the important tissues and vital organs), which have produced anxiety (fear of death), delusion, and restlessness; which are presenting fatal signs and which cause loss of sense organs (sensory functions) are anupakrama (which require no therapy, fit to Be rejected, sure to cause death).

Paitient worth rejection 

The physician should reject the patient (refuse treatment to) who is hated By the physician and the king (or government) and who hates them; who hates himself (dejected in life), who is not having the equipment and other facilities required for treatment, who is Busy with other activities (not having the required attention, leisure etc. towards the treatment), who is disoBedient (to the physician), whose life is coming to an end, who is of evil mind (violent, destructive), who is afflicted with great grief, who is full of fear, who is ungrateful and who thinks himself to Be a physician (in respect of deciding drug, therapies, food, activities etc.)

Adhydya sangraha (chapters of the treatise)

Further on, shall Be the enumeration of the names of chapters of this treatise;

Sutrasthana

• Ayuskamiya (desire for long life),
• Dinacarya (daily regimen),
• Ritucharya (seasonal regimen),
• Roganutpadaniya (prevention of diseases),
• Dravadravya vijnaniya (knowledge of liquid materials), 
• Annasvarupa vijnaniya (knowledge of nature of foods),
• Annaraksa (protection of food),
• Matrasitlya (determination of quantity of food),
• Dravyadi vijnaniya (knowledge of substances etc.),
• Rasa bhediya (classification of tastes), 
• Doshadi vijnaniya (knowledge of doshas etc.),
• Dosha Bhediya (classification of doshas etc.),
• Dosha pakramaniya (treatment of doshas), 
• Dvividohpakramantya (the two kinds of treatments) 
• Sodhanadi gana sangraha (collection of purificatory drugs etc.), 
• Sneha vidhi (oleation therapy),
• Sweda vidhi (sudation therapy),
• Vamanavirecana vidhi (emesis and purgation therapy),
• Basti vidhi (enema therapy), 
• Nasya vidhi (nasal medication therapy),
• Dhuma pana vidhi (inhalation of fume therapy),
• Gandushdi vidhi (mouth gargle and such other therapies),
• Ascyotana-anjana vidhi (eye-wash and such other therapies),
• Tar pana-putapaka vidhi (therapies for the eyes),
• Yantra vidhi (use of Blunt instruments and appliances), 
• Sastra vidhi (use of sharp instruments etc.),
• Siravyadha vidhi (venesection), 
• Saly&harana vidhi (removal of foreign Bodies),
• Sastrakarma vidhi (surgical procedures) and 
• Ksaragnikarma vidhi (caustic alkali and fire cautery therapies these thirty chapters form the Sutras Thana.)

Sarirasthana

• Garbhavakranti (formation of the embryo),
• Garbhavyapt (disorders of a pregnant woman and the new Born),
• Angavibhaga (human body and its parts),
• Marmvibhaglya (classification of vulnerable spots),
• Vikrti vijnaniya (knowledge of bad prognostic features),
• Dutadi vijnaniya (knowledge of the messenger etc.)- These six form the Sarirasthana.

Nidanasthana

• Sarvaroga nidana (causes and methods of diagnosis of all diseases, 
• Jwara nidana (diagnosis of fevers), 
• Rakta pitta, Kasa nidana (diagnosis of bleeding diseases and cough),
• Swasa, hidhma nidana (diagnosis of dyspnea and hiccup),
• Rajayaksmadi nidana (diagnosis of tuberculosis etc.),
• Madatyaya nidana (diagnosis of alcoholic intoxication), 
• Arso nidana (diagnosis of piles),
• 8. Atisara -grahaniroga nidana (diagnosis of diarrhea and duodenal disorders),
• Mutraghata nidana (diagnosis of suppression of urine), 
• Prameha nidana (diagnosis of diabetes),
• Vidradhi, (gulma), nidana (diagnosis of the abscess, hernia, and abdominal tumors),
• Udara nidana (diagnosis of enlargement of the abdomen),
• Panduroga (Sopha-visarpa) nidana (diagnosis of anemia, dropsy, and erysipelas),
• Kustha (svitra krmi) nidana (diagnosis of leprosy, leucoderma, and worms), These sixteen chapters from the Nidanasthana.

Chikitsa sthana.

• Jwara chikitsa (treatment of fevers),
• Rakta pitta chikitsa (treatment of bleeding disease),
• Kasa chikitsa (treatment of cough), 
• Swasa-hidhma chikitsa (treatment of dyspnea and hiccup),
• Rajayaksmadi chikitsa (treatment of tuberculosis etc.), 
• Chardi hydroga-tysija chikitsa (treatment of vomiting, heart diseases, and thirst),
• Madatyaya chikitsa (treatment of alcoholic intoxication etc.
• Arsas chikitsa (treatment of piles),
• Atisara chikitsa (treatment of diarrhea), 
• Grahaniroga chikitsa (treatment of disorders of the duodenum), 
• Mutraghata chikitsa (treatment of suppression of urine),
• Prameha chikitsa (treatment of diabetes),
• Vidradhi-vriddhi chikitsa (treatment of abscess and hernia), 
• Gulma chikitsa (treatment of abdominal tumor), 
• Udara chikitsa (treatment of enlargement of the abdomen), 
• Panduroga chikitsa (treatment of anemia),
• Swayathu chikitsa (treatment of dropsy), 
• Visarpa chikitsa (treatment of herpes),
• Kustha chikitsa (treatment of leprosy and other skin disorders),
• Svitrakrimi chikitsa (treatment of leucoderma and worms),
• Vatavyadhi chikitsa (treatment of diseases caused by Vata-nervous diseases),
• Vataionita chikitsa (treatment of gout)-these twenty-two chapters form the chikitsa sthana.

Kalpa siddhisthana 

• Vamanakalpa (recipes for emesis therapy), 
• Virecana kalpa (recipes for purgation therapy), 
• Vamana-vyapat siddhi (management of complications of emesis and purgation therapies,
• Basti kalpa (recipes for enema therapies), 
• Basti vyapat siddhi (management of complications of enema therapy),
• Dravya kalpa (nature of medicinal recipes etc.). These six chapters form the Kalpa siddhi sthana 

Uttarsthana 

• Balopacaraiiiya (care of children), 
• Balamaya pratisedha (prevention of diseases of children), 
• Balagraha pratisedha (prevention of seizures in children), 
• Bhuta vijnanlya (knowledge about evil spirits etc.), 
• Bhuta pratisedha (dispelling of evil spirits), 
• Unmade pratisedha (prevention of insanity), 
• Apasmara pratisedha (prevention of epilepsy),
• Vartmaroga vijnaniya (diagnosis of the diseases of the eyelids),
• Vartmaroga pratisedha (treatment of diseases of the eyelids), 
• Safidhisitasita roga vijnaniya (diagnosis of eye joints, sclera and cornea), 
• Safidhisitasita roga pratisedha (treatment of diseases of eye joints sclera and cornea),
• Dristi roga vijnaniya (diagnosis of diseases of vision), 
• timira pratisedha (treatment of blindness), 
• Linganasa pratisedha (treatment of disorders of lens), 
• Sarvaksi roga vijnaniya (diagnosis of diseases affecting the entire eye). 
• sarvaksi roga pratisedha (treatment of diseases affecting the entire eye.), 
• Karna roga vijnaniya (diagnosis of diseases of the ear), 
• Karna roga pratisedha (treatment of diseases of the ear), 
• Nasa roga vijnaniya (diagnosis of diseases of the nose),
• Nasa roga pratisedha (treatment of diseases of the nose),
• Mukha roga vijnaniya (diagnosis of diseases of the mouth), 
• Mukha roga pratisedha (treatment of diseases of the mouth),
• siro roga vijnaniya (diagnosis of the disease soft head),
• Siro roga pratisedha (treatment of diseases of the head.), 
• Vraijapratisedha (treatment of ulcers),
• Sadyovrana pratisedha (treatment of traumatic wounds), 
• Bhagna pratisedha (treatment of fractures), 
• Bhagandara pratisedha (treatment of fistula-in-ano),
• Granthi-arbuda-slipada apaci-nadi vijnaniya (diagnosis of tumors, cancer, filariasis, goiter and sinus ulcers),
• Granthi-arbuda-slipada-apaci-nadi pratisedha (treatment of tumors, cancer, filariasis, goitre and sinus ulcers), 
• Ksudra roga vijnaniya (diagnosis of minor diseases), 
• Ksudra roga pratisedha (treatment of minor diseases), 
• Guhya roga vijnaniya (diagnosis of veneral diseases), 
• Guhya roga pratisedha (treatment of veneral diseases), 
• Visa pratisedha (treatment of diseases due to poisons), 
• sarpa visa pratisedha (treatment of snakebite), 
• kita-lutadi visa pratisedha (treatment of Bites of insects, spiders etc.), 
• Musika-alarka visa pratisedha (treatment of Bites of mouse, rabid dog, etc,), 
• Rasayana vidhi (rejuvenator therapies) and 
• Bijaposana vidhi (nourishment of reproductive tissue or aphrodisiac therapy). These forty chapters form the Uttarsthana 

Thus there are, one hundred and twenty chapters, divided into six sections

Thus ends the chapter known as Ayuskamiya, Desire for long life, the first of sutrasthana in Ashtanga hridayam. 

With this we have finish, all the verses of Chapter-1 of Ashtanga Hridayam, Sutrasthana under course, Bachelor of Ayurveda, Medicine, and Surgery, first year.

You can read the previous post of the chapter-1,
Desire for long life, Ashtanga Hridayam, Sutrasthana, Chapter-1, verse 1.9-1.14, BAMS 1st year.
Ashtanga Hridayam (Sutrasthana), Chapter-1,(BAMS Ist Year), verse1.1-1.8.

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