Doshopakramaniyam AH Su.13 Notes: Dosha Chikitsa, Ama, and Aushadha Sevana Kala Explained

Introduction: Doshopakramaniyam

Doshopakramaniyam is the chapter where Ayurveda shifts from understanding the doshas to mastering how to correct dosha. While earlier chapters explain what Vata, Pitta, and Kapha are, this chapter reveals the fundamental therapeutic approaches used to restore balance when a dosha rises, weakens, or behaves abnormally and aushadha sevana kala.

Acharya Vagbhata presents these principles not as rigid rules but as dynamic tools that adapt to the patient’s condition, strength, season, digestion, and disease pathway. Whether a dosha needs to be calmed, expelled, nourished, dried, or stimulated, the physician chooses from these upakramas with precision and timing.

Doshopakramaniyam also highlights how treatment is never isolated. Each upakrama interacts with Agni, dhatus, srotas, and the rogamarga to create a complete therapeutic effect. This chapter teaches the art of selecting the right intervention at the right moment — the essence of Ayurvedic clinical intelligence.

Treatment of Vata Imbalance in Doshopakramaniyam

Vata imbalance is treated through warmth, oiliness, stability, and nourishment. The focus is on calming Vata’s cold, dry, light, and mobile qualities.

Remove Vata‑Aggravating Causes

• cold, dry foods
• irregular routine
• excessive movement
• stress and lack of sleep
• fasting or skipping meals

Warm, Oily, Soft Diet

• ghee, sesame oil
• warm soups, stews, khichdi
• cooked grains and vegetables
• avoid raw, cold, dry foods

Grounding Lifestyle

• regular routine
• adequate rest
• gentle yoga and slow breathing
• staying warm and avoiding wind

Shamana (Pacification)

• oil massage (abhyanga)
• steam therapy
• warm baths
• medicated ghee/oils

Shodhana (Cleansing)

If the patient is strong:

• Basti is the main therapy for Vata disorders.

Gentle Agni Support

• Mild spices (ginger, cumin)
• Warm water
• Regular meals

Rasayana (Rejuvenation)

• Ashwagandha
• Ghee
• Nourishing tonics

Treatment of Pitta Imbalance in Doshopakramaniyam

Pitta imbalance shows as heat, acidity, inflammation, irritability, and burning sensations. Treatment focuses on cooling, soothing, cleansing, and calming the body and mind.

Remove Heat‑Increasing Causes
Reduce spicy, sour, salty foods, alcohol, fermented foods, sun exposure, overwork, and emotional intensity.

Cooling Diet
Prefer sweet, bitter, and astringent foods: ghee, milk, coconut water, cucumber, leafy greens, rice, mung dal, coriander, fennel, sweet fruits. Avoid hot, oily, fried, and fermented foods.

Cooling Lifestyle
Stay cool, avoid midday sun, practice gentle yoga, meditation, sheetali/sheetkari pranayama, maintain emotional calm.

Shamana (Pacification)
Use cooling herbs and practices: ghee, amalaki, guduchi, coriander, rose water, coconut oil massage, cool baths.

Shodhana (Elimination)
When Pitta is high and the patient is strong: Virechana is the main therapy; Raktamokshana is used traditionally for Pitta‑Rakta issues.

Strengthen Agni Gently
Use cumin‑coriander‑fennel tea, small amounts of ghee, regular meals, and avoid overeating.

Rasayana (Rejuvenation)
After Pitta calms: Amla, Shatavari, and cooling ghee‑based tonics rebuild tissues without increasing heat.

Treatment of Kapha Imbalance in Doshopakramaniyam

Kapha imbalance is treated through lightness, warmth, stimulation, and movement. The goal is to counter Kapha’s heavy, cold, slow, and oily qualities.

Remove Kapha‑Aggravating Causes

• Heavy, oily, sweet foods
• Cold drinks
• Overeating
• Oversleeping
• Lack of movement

Light, Warm, Spicy Diet

• Ginger, black pepper, trikatu
• Warm soups, steamed vegetables
• Barley, millet, mung soup
• Avoid sweets, dairy excess, fried foods

Activating Lifestyle

• Brisk walking, yoga, regular exercise
• Avoid daytime sleep
• Stay warm and active
• Reduce lethargy and stagnation

Shamana (Pacification)

• Dry massage (udvartana)
• Steam therapy
• Honey‑based formulations
• Warming herbs

Shodhana (Cleansing)

If strong enough:

• Vamana is the main cleansing therapy for Kapha.

Agni Support

• Trikatu
• Ginger tea
• Warm water
• Deepana‑pachana herbs

Rasayana (Rejuvenation)

• Pippali
• Tulsi
• Light, warming tonics

Treatment of All Three Doshas in Doshopakramaniyam

Dosha Movement Concept

Origin: All doshas (Vata, Pitta, Kapha) originate and accumulate in the digestive tract (Koshtha).

Spread: When aggravated, they move outward through channels (Srotas) into tissues (Dhatus) — this is called Shakha Gata Dosha.

Return: During healing, the doshas are drawn back from tissues to the digestive tract — Koshtha Gata Dosha — where they can be expelled through Shodhana (cleansing) therapies.

Mechanism of Movement

Stage	Description	Ayurvedic Term
Accumulation	Dosha builds up in its site (e.g., Vata in colon, Pitta in small intestine, Kapha in stomach).	Sanchaya
Aggravation	Dosha becomes excessive and unstable.	Prakopa
Spread	Moves from Koshtha to Shakha via Srotas.	Prasara
Localization	Settles in weak tissues, causing disease.	Sthanasamsraya
Manifestation	Symptoms appear.	Vyakti
Complication / Return	With treatment, dosha moves back to Koshtha for elimination.	Bheda / Shamana

Sthayi & Agantu Doshas in Dosha Movement

Sthayi Dosha — The “Resident” Doshas

These are the stable, inherent doshas that reside within each tissue (dhatu) and maintain its normal function.

• Present inside the tissues (Shakha)
• Support structure, metabolism, lubrication, immunity
• Do not cause disease unless disturbed by external or internal factors
• Become problematic only when Agantu Dosha or aggravated Koshtha dosha interacts with them

Example: Sthayi Pitta in the blood maintains warmth and color. When aggravated Pitta from the gut reaches the blood, it disturbs Sthayi Pitta → rashes, burning, inflammation.

Agantu Dosha — The “Invading” Doshas

These are external or invading doshas that enter the body or tissues due to:

• Trauma
• Infection
• Emotional shock
• Environmental exposure
• Sudden dietary or lifestyle triggers

Agantu doshas disturb the Sthayi doshas, creating pathology.

Example: An external heat exposure (Agantu Pitta) disturbs Sthayi Pitta → sunburn, heat rash.

Integrated Summary Table

Concept	Meaning	Location	Role
Koshtha Dosha	Gut dosha	Digestive tract	Source of internal imbalance
Shakha Gata Dosha	Dosha in tissues	Dhatus	Causes localized disease
Sthayi Dosha	Resident tissue dosha	Dhatus	Gets disturbed → early disease
Agantu Dosha	External/invading dosha	Outside → tissues	Triggers or worsens imbalance

Sama Dosha Lakshana — Effects of Doshas Associated with Ama

When Ama combines with any dosha, the result is Sama Vata, Sama Pitta, or Sama Kapha. These are heavier, stickier, more obstructive versions of the doshas.

Ama makes the dosha:

• sluggish
• sticky
• cold
• obstructive
• prone to block channels (srotas)

This leads to systemic symptoms and tissue-level pathology.

General Signs of Sama Dosha

These apply to all three doshas when mixed with Ama.

• Loss of appetite
• Heaviness in body
• Coated tongue
• Fatigue and dullness
• Sticky stools
• Foul smell from body or stools
• Indigestion, bloating
• Blocked channels → pain, stiffness

Ama: What It Is

Ama is the toxic, sticky, heavy, undigested metabolic waste produced when digestion or tissue metabolism is impaired.

It is:

• Cold
• Heavy
• Sticky
• Foul-smelling
• Channel-blocking (Srotorodhaka)

It mixes with doshas → Sama Vata, Sama Pitta, Sama Kapha.

Ama forms when Agni (digestive fire) is weak, irregular, or obstructed.

Origin of Ama- Amotpatti

Stage	Mechanism	Result
Weak Agni	Poor digestion	Ama formation
Blocked Srotas	Stagnation	Ama accumulation
Dosha involvement	Ama + Dosha	Sama Dosha
Tissue involvement	Ama + Dhatu	Dhatu Ama
Disease formation	Ama + Sthayi Dosha	Sthana Samsraya

Sama Dosha Chikitsa — Treatment of Doshas Associated With Ama

Stage	Purpose	Guided Link
Langhana	Lighten Ama	Langhana
Pachana	Digest Ama	Pachana
Deepana	Strengthen Agni	Deepana
Srotoshodhana	Clear channels	Srotoshodhana
Shodhana	Remove dosha‑Ama	Shodhana
Shamana	Pacify dosha (after Ama clears)	Shamana

Aushadha sevana kala – Chart

Kāla	Meaning	Therapeutic Use
Abhakta	Empty stomach	Strong action on Vāta; rapid absorption
Prāgbhakta	Before food	Kapha disorders; diseases above clavicle
Madhyabhakta	Mid‑meal	Pitta disorders; gastric irritation
Adhobhakta	After food	Lower‑GI Vāta; colic, distension
Sahabhakta	With food	Weak patients; strong medicines
Antarabhakta	Between meals	Digestive/metabolic disorders
Samudga	Before & after food	Diseases involving both upper & lower GI
Grahana	During food	Assimilation disorders
Nishi Kāla	Night time	Vāta disorders; insomnia
Rātribhakta	Night after meals	Pakvāśaya (colon) disorders; constipation

“Empty stomach for Vāta, before food for Kapha, mid‑meal for Pitta, after food for lower‑GI Vāta.”

This completes the summary of Doshopakramaniyam Ashtanga Hridayam sutrasthana chapter 13 by Acharya Vagbhatt.

Shaloka from the text book with meaning of Doshopakramaniyam

Treatment of Dosha Imbalance and AAma

In this chapter we are learning the treatment options for Dosha imbalance, how Tridosha reach with Ama and produce symptoms, what is the line of treatment for this condition. We also learn about time of administration of medicines based on disease. It is the 13th chapter of Sutrasthana of Ashtanga Hrudaya, called as Doshopakramaniyam Adhyaya.

Treatment for Vata imbalance (increase) – Vriddha Vata chikitsa in Doshopakramaniyam

वातस्योपक्रमः स्नेहः स्वेदः संशोधनं मृदु ।
स्वाद्व्-अम्ल-लवणोष्णानि भोज्यान्य् अभ्यङ्ग-मर्दनम् ॥ 1 ॥
वेष्टनं त्रासनं सेको मद्यं पैष्टिक-गौडिकम् ।
स्निग्धोष्णा वस्तयो वस्ति-नियमः सुख-शील-ता ॥ 2 ॥
दीपनैः पाचनैः स्निग्धाः स्नेहाश् चानेक-योनयः ।
विशेषान् मेद्य-पिशित-रस-तैलानुवासनम् ॥ 3 ॥

Treatment options for increased Vata Dosha are-

• Sneha – oleation-oral administration of oil / ghee / fat and external oil massage
• Sveda – Sudation – diaphoresis, sweating therapy
• Mrudu Samshodhana – Mild purification procedure, Mild Panchakarma (Vamana and Virechana). Excess of Panchakarma might lead to Vata increase.
• Svadu Amla Lavana Ushna Bhojya – foods which are of sweet, sour and salt taste;
• Abhyanga – Oil massage
• Mardana – simple massage
• Veshtana – wrapping / covering the body/ organ with cloth
• Trasana – Threatening, frightening
• Seka – pouring of herbal decoctions / oils on the affected part
• Paishtika Goudika Madya – wine prepared from corn flour and jaggery- molasses
• Snigdha Ushna Basti – enema therapy with fat-oil, enema with drugs of hot potency
• Sukhasheelata – comforting the patient
• Deepana Pachana Siddha Sneha – medicated fats of different kinds- sources prepared with drugs causing increase of hunger and improving digestion;
• Medya Pishita Taila Anuvasana – oleation enema prepared from juice of fatty meat and oil- 1-3

Treatment for Pitta imbalance (increase) – Vriddha Pitta Chikitsa in Doshopakramaniyam

पित्तस्य सर्पिषः पानं स्वादु-शीतैर् विरेचनम् ।
स्वादु-तिक्त-कषायाणि भोजनान्य् औषधानि च ॥ 4 ॥
सु-गन्धि-शीत-हृद्यानां गन्धानाम् उपसेवनम् ।
कण्ठे-गुणानां हाराणां मणीनाम् उरसा धृतिः ॥ 5 ॥
कर्पूर-चन्दनोशीरैर् अनुलेपः क्षणे क्षणे ।
प्रदोषश् चन्द्रमाः सौधं हारि गीतं हिमो ऽनिलः ॥ 6 ॥
अ-यन्त्रण-सुखं मित्रं पुत्रः संदिग्ध-मुग्ध-वाक् ।
छन्दानुवर्तिनो दाराः प्रियाः शील-विभूषिताः ॥ 7 ॥
शीताम्बु-धारा-गर्भाणि गृहाण्य् उद्यान-दीर्घिकाः ।
सु-तीर्थ-विपुल-स्वच्छ-सलिलाशय-सैकते ॥ 8 ॥
साम्भो-ज-जल-तीरान्ते कायमाने द्रुमाकुले ।
सौम्या भावाः पयः सर्पिर् विरेकश् च विशेषतः ॥ 9 ॥ 

Treatment options for increased Pitta Dosha are –

• Sarpi paana – drinking of Ghrita (clarified Butter). It can be plain or medicated, based on physician’s advice.
• Svadu, sheeta Virechana – purgation therapy with drugs of sweet taste and cold potency,
• Intake of foods and drugs having sweet, bitter and astringent tastes.
• Inhaling of fumes from herbs that are coolant, pleasant and cordial
• Anointing the body with camphor, sandalwood paste, Vetiver paste, very frequently.
• Residing on terraces lit by moonlight in the evenings, enjoying pleasant music and soft cold breeze, company of friends who do not restrain him, of sons who speak cordially and with innocence.
• Spending time with wife, who is obedient, pleasing and virtuous;
• Residing in houses equipped with fountains emitting cooled water, parks and ponds,
• Spending time in houses near water reservoirs having clean water, sand, lotus, flowers, and trees, with a calm mind;
• Consuming milk, ghee and Purgation therapy (Virechana)

Treatment for Kapha imbalance (increase) – Vriddha Kapha Chikitsa in Doshopakramaniyam

श्लेष्मणो विधिना युक्तं तीक्ष्णं वमन-रेचनम् ।
अन्नं रूक्षाल्प-तीक्ष्णोष्णं कटु-तिक्त-कषायकम् ॥ 10 ॥
दीर्घ-काल-स्थितं मद्यं रति-प्रीतिः प्रजागरः ।
अनेक-रूपो व्यायामश् चिन्ता रूक्षं विमर्दनम् ॥ 11 ॥
विशेषाद् वमनं यूषः क्षौद्रं मेदो-घ्नम् औषधम् ।
धूमोपवास-गण्डूषा निः-सुख-त्वं सुखाय च ॥ 12 ॥ 

• Vidhiyukta Teekshna Vamana Virechana – Strong emesis and purgation in accordance with prescribed procedure,
• Consuming food which are dry,
• Consuming food in limited quantity
• Consuming food that have Teekshna (strong, piercive), Ushna (hot), pungent, bitter and astringent taste,
• Old wine
• Sexual activity
• keeping awake at night,
• Exercises of different kinds,
• Worry,
• Dry massage of the body;
• Vamana – emesis therapy,
• drinking of soups- of grains
• Use of honey,
• Therapies and medicines that reduce fat,
• Inhalation of medicinal smoke,
• Fasting,
• Gargling
• Facing difficulties 10-12

Treatment of combination of dosha in Doshopakramaniyam

उपक्रमः पृथग् दोषान् यो ऽयम् उद्दिश्य कीर्तितः ।
संसर्ग-संनिपातेषु तं यथा-स्वं विकल्पयेत् ॥ 13 ॥
The different treatment prescribed for each Dosha individually, may be combined appropriately in conditions of combinations of two or three Doshas. 13

ग्रैष्मः प्रायो मरुत्-पित्ते वासन्तः कफ-मारुते ।
मरुतो योग-वाहि-त्वात् कफ-पित्ते तु शारदः ॥ 14 ॥ 
Generally the treatment for the combination of Vata and Pitta is similar to the regimen of summer– described in Chapter 3.

For Kapha and Vata combination treatment, it is similar to the regimen of Vasanta- spring because Maruta- Vata is Yogavahi; Yogavahi means, Vata, when associated with Pitta, boosts Pitta Dosha, when it is associated with Kapha, it boosts Kapha Dosha. For the combination of Kapha and Pitta the treatment shall be similar to the regimen of Sarad- Autumn .14

चय एव जयेद् दोषं कुपितं त्व् अ-विरोधयन् ।
सर्व-कोपे बलीयांसं शेष-दोषा-विरोधतः ॥ 15 ॥
The Doshas should be treated properly when there are in Chaya stage (mild increase) only.
In their stage of Kopa (Dosha enhanced imbalance), they should be vanquished without opposing m/ interfering with one another Dosha. When there is simultaneous enhanced increase (Kopa) of all the three Doshas, the most powerful / most aggravated Dosha should controlled first, without opposing the remaining Doshas. 15
प्रयोगः शमयेद् व्याधिम् एकं यो ऽन्यम् उदीरयेत् ।
नासौ विशुद्धः शुद्धस् तु शमयेद् यो न कोपयेत् ॥ 16 ॥ 
That treatment which cures one disease and gives rise to another disease- sooner or later, is not Shuddha- pure/ good/appropriate; A pure treatment is that which cures one – diseases and does not give rise to another. 16

Movement of Dosha from Digestive Tract to Body Tissues and vice versa –

व्यायामाद् ऊष्मणस् तैक्ष्ण्याद् अ-हिताचरणाद् अपि ।
कोष्ठाच् छाखास्थि-मर्माणि द्रुत-त्वान् मारुतस्य च ॥ 17 ॥
Movement from Koshta to Shakha – By the effect of exercise, increase of heat, unsuitable/unhealthy activities and due to quick movement of Vata, the increased Doshas move out of the Kostha (gastrointestinal tract) to the Shakhas- tissues, Asthi – bones and Marmas- vital organs and vulnerable points.
दोषा यान्ति तथा तेभ्यः स्रोतो-मुख-विशोधनात् ।
वृद्ध्याभिष्यन्दनात् पाकात् कोष्ठं वायोश् च निग्रहात् ॥ 18 ॥
तत्र-स्थाश् च विलम्बेरन् भूयो हेतु-प्रतीक्षिणः ।
ते कालादि-बलं लब्ध्वा कुप्यन्त्य् अन्याश्रयेष्व् अपि ॥ 19 ॥

Movement from Shakha to Koshta –

Doshas move from body channels and tissues to the gastro intestinal tract,

• By the effect of purification, clearing and widening of the minute body channels.
• By further increase of Doshas,
• By liquefaction,
• By maturity,
• By Balancing and controlling Vata.
  When Doshas move from one place to other, they remain there for some time, waiting for an exciting factor. After deriving strength by season, time etc, they get further aggravated and move to other places as well. 17-19

Native and foreign Doshas:- Sthayi- and Agantu Doshas in Doshopakramaniyam

तत्रान्य-स्थान-संस्थेषु तदीयाम् अ-बलेषु तु ।
कुर्याच् चिकित्सां स्वाम् एव बलेनान्याभिभाविषु ॥ 20 ॥ 
Treatment should be done- especially on priority to that Dosha which has travelled into the seats of other Doshas and which is weak, Priority should also be given to that Dosha which, by its own strength overcomes other Doshas.

Agantu Dosha –

आगन्तुं शमयेद् दोषं स्थानिनं प्रतिकृत्य वा । 
Foreign Dosha, should be treated either after treating the Sthanika (native Dosha) or even otherwise. The choice of Dosha, to be treated first depends on the level of aggravation and strength of Doshas. 20

Triyak gata Dosha –

प्रायस् तिर्यग्-गता दोषाः क्लेशयन्त्य् आतुरांश् चिरम् ॥ 21 ॥
कुर्यान् न तेषु त्वरया देहाग्नि-बल-वित् क्रियाम् ।
शमयेत् तान् प्रयोगेण सुखं वा कोष्ठम् आनयेत् ॥ 22 ॥
ज्ञात्वा कोष्ठ-प्रपन्नांश् च यथासन्नं विनिर्हरेत् । 
Usually, the Triyaggata Doshas – which are not localized in the gastrointestinal tract but localized in the tissues, cause troubles to the patient for a long time; they should not be treated in haste. They should be carefully treated only afterdetermining the strength of the body and digestive activity. They should be mitigated with stipulated palliative treatment or they should be brought into the alimentary tract and then they should be expelled out by the nearby route (either by mouth – by emeisis – Vamana or by anal route, by purgation – Virechana). 21-22

Effects of Doshas associated with Ama – SamaDosha Lakshana –

स्रोतो-रोध-बल-भ्रंश-गौरवानिल-मूढ-ताः ॥ 23 ॥
आलस्या-पक्ति-निष्ठीव-मल-सङ्गा-रुचि-क्लमाः ।
लिङ्गं मलानां सामानां निर्-आमाणां विपर्ययः ॥ 24 ॥ 
When imbalanced Doshas get associated with Ama (a factor of indigestion / false metabolism), it is called as Saama Dosha. (Sa aama Dosha, Sa means ‘with’).

The features that are seen due to Sama Dosha are –

• Srotorodha – Obstruction of the channels, pores
• Balabhramsha – loss of strength,
• Gaurava – feeling of heaviness of the body,
• Anila Moodata – inactivity of Anila-vata,
• Alasya – laziness, lassitude,
• Apakti – loss of digestive power,
• Nishteeva – Person spits saliva frequently, more of expectoration,
• Malasanga – constipation or low frequency of urination leading to accumulation of wastes
• Aruchi – anorexia,
• Klama – exhaustion

The opposites of the above symptoms are of the Nirama Doshas –Doshas not mixed up with the Ama. (undigested materials) 23-24

Origin of Ama – Amotpatti-

ऊष्मणो ऽल्प-बल-त्वेन धातुम् आद्यम् अ-पाचितम् ।
दुष्टम् आमाशय-गतं रसम् आमं प्रचक्षते ॥ 25 ॥
Soon after digestion process, the useful part gets separated from the waste. The useful, nutrition rich part is called as Rasa dhatu
Due to lack of digestion strength, The Rasa Dhatu does not form well, it remains in raw, weak form. It gets vitiated, it stays in the Amashaya (stomach and intestines) itself, and becomes ‘Ama’. 25

अन्ये दोषेभ्य एवाति-दुष्टेभ्यो ऽन्यो-ऽन्य-मूर्छनात् ।
कोद्रवेभ्यो विषस्येव वदन्त्य् आमस्य संभवम् ॥ 26 ॥
Other authors opine that Ama gets formed from intimate mixing with one another of greatly increased Doshas. 26

आमेन तेन संपृक्ता दोषा दूष्याश् च दूषिताः ।
सामा इत्य् उपदिश्यन्ते ये च रोगास् तद्-उद्भवाः ॥ 27 ॥
The Doshas and Dusyas (the Dhatus and Malas) which get mixed with this Ama are designated as Sama – mixed with Ama; The diseases originating from this Saama dosha are called as Saama Vyadhi. 27

Saama Dosha chikitsa—treatment of Sama Doshas :-

सर्व-देह-प्रविसृतान् सामान् दोषान् न निर्हरेत् ।
लीनान् धातुष्व् अन्-उत्क्लिष्टान् फलाद् आमाद् रसान् इव ॥ 28 ॥
आश्रयस्य हि नाशाय ते स्युर् दुर्-निर्हर-त्वतः । 
The Sama Doshas which are spread all over the body, which are lurking in the Dhatus and which are not moving out of their places of accumulation, should not be forced out by purification Panchakarma therapies like emesis, purgations etc. Just as attempts of extracting juice from an unripe fruit leads to destruction, the dwelling place itself will get destroyed if Doshas are tried to expel out along with Ama. 28

Right approach in Sama Dosha treatment – Sama Doshas should be treated

पाचनैर् दीपनैः स्नेहैस् तान् स्वेदैश् च परिष्कृतान् ॥ 29 ॥
शोधयेच् छोधनैः काले यथासन्नं यथा-बलम् । 

• First with drugs which are digestive and which increase hunger;
• Next with oleation and sudation therapies (Snehana, Svedana) and
• Finally they should be expelled out with Shodhana therapies- emesis, purgation at the proper time, and in accordance with the strength of the patient. 29

हन्त्य् आशु युक्तं वक्त्रेण द्रव्यम् आमाशयान् मलान् ॥ 30 ॥
घ्राणेन चोर्ध्व-जत्रूत्थान् पक्वाधानाद् गुदेन च । 
Drugs administered through the mouth, bring out the Malas- Doshas from the Amasaya- stomach and small intestines; Drugs administered through the nose bring out the Doshas from the parts above the shoulders and Drugs administered through the rectum bring out the Doshas from the Pakvasaya – large intestine. 30

उत्क्लिष्टान् अध ऊर्ध्वं वा न चामान् वहतः स्वयम् ॥ 31 ॥
धारयेद् औषधैर् दोषान् विधृतास् ते हि रोग-दाः । 
Saama Doshas which are greatly increased and going out of the body on their own accord, either in the upward or downward routes- vomiting and purging respectively should not be stopped by medicines, for they produce diseases, if they are stopped. 31

प्रवृत्तान् प्राग् अतो दोषान् उपेक्षेत हिताशिनः ॥ 32 ॥
विबद्धान् पाचनैस् तैस् तैः पाचयेन् निर्हरेत वा । Such Doshas which are going out should be ignored in the early stage and the patient should be given suitable foods- light food; Next in the second stage they should be cooked with digestive drugs or removed out by purification (Panchakarma) therapies. 32

Time for eliminating Dosha out of the body –

श्रावणे कार्त्तिके चैत्रे मासि साधारणे क्रमात् ॥ 33 ॥
ग्रीष्म-वर्षा-हिम-चितान् वाय्व्-आदीन् आशु निर्हरेत् । 
Vata which undergoes mild increase (Chaya) in Greeshma (summer) should be removed from the body (by basti- enema) in Shravana masa (August). Pitta which undergoes mild increase in Varsha (rainy season), should be expelled out of the body in kartika Month (by Virechana – purgation). Kapha which undergoes mild increase in Shishira (winter) should be expelled out in Chaitra month (April) by Vamana. 33

अत्य्-उष्ण-वर्ष-शीता हि ग्रीष्म-वर्षा-हिमागमाः ॥ 34 ॥
संधौ साधारणे तेषां दुष्टान् दोषान् विशोधयेत् । 
Greeshma, Varsa and Hemanta [summer, rainy season and winter]- have too much of heat, rain and cold respectively; in the period in between these, known as Sadharana Kala; the Doshas should be cleared out. 34

स्वस्थ-वृत्तम् अभिप्रेत्य व्याधौ व्याधि-वशेन तु ॥ 35 ॥
कृत्वा शीतोष्ण-वृष्टीनां प्रतीकारं यथा-यथम् ।
प्रयोजयेत् क्रियां प्राप्तां क्रिया-कालं न हापयेत् ॥ 36 ॥ 
After having overcome the effects of cold, hot and rainy seasons suitably- by adopting appropriate protective methods necessary treatment – therapies should be administered; The Kriyakala- period of abnormal activity, stages of disease evolution should not be allowed to progress- further. 36

Aushadha Sevana Kala – time of administration of medicines in Doshopakramaniyam

युञ्ज्याद् अन्-अन्नम् अन्नादौ मध्ये ऽन्ते कवडान्तरे ।
ग्रासे ग्रासे मुहुः सान्नं सामुद्गं निशि चौषधम् ॥ 37 ॥

Medicines should be administered,

• Ananna – on empty / when there is no food- in the stomach ;
• Annadau – just before food or at the beginning of food intake,
• Anna madhye – during / in between food intake
• Anna ante – at the end of food intake.
• Kavalantare – in between morsels
• Grase grase – with each morsel
• Muhu: – repeatedly, many a times a day
• Sa annam – mixed with food
• Samudgam – before and after food
• Nishi – at night, bed time

कफोद्रेके गदे ऽन्-अन्नं बलिनो रोग-रोगिणोः ।
अन्नादौ वि-गुणे ऽपाने समाने मध्य इष्यते ॥ 38 ॥
व्याने ऽन्ते प्रातर्-आशस्य सायम्-आशस्य तूत्तरे ।
ग्रास-ग्रासान्तयोः प्राणे प्रदुष्टे मातरिश्वनि ॥ 39 ॥
मुहुर् मुहुर् विष-च्छर्दि-हिध्मा-तृट्-श्वास-कासिषु ।
योज्यं स-भोज्यं भैषज्यं भोज्यैश् चित्रैर् अ-रोचके ॥ 40 ॥
कम्पाक्षेपक-हिध्मासु सामुद्गं लघु-भोजिनाम् ।
ऊर्ध्व-जत्रु-विकारेषु स्वप्न-काले प्रशस्यते ॥ 41 ॥ 

Medicines should be administered,

• Ananna – on empty stomach – For diseases arising from increase of Kapha, which are severe and for persons who are strong, the time of administration of medicine shall be when there is no food- in the stomach ;
• Annadau – just before food or at the beginning of food intake – in disorders of Apanavata,
• Anna Madhye – During / in between food intake – in disorders of Samana vata
• Anna ante – at the end of food intake – in disorders of Vyana vata at the end of the morning meal, in disorders of Udana vata at the end of evening meal.
• Kavalantare – in between morsels – in disorders of Prana- vata
• Grase Grase – With each morsel – in anorexia, loss of taste it shall be mixed with different kinds of tasty foods
• Muhu: – Repeatedly, many a times a day – in diseases produced by poison, vomiting, hiccup, thirst, dysponea and cough
• Sa annam – Mixed with food – in anorexia
• Samudgam – before and after food – in tremors, Akshepaka (convulsions), Hiccup,
• Nishi – at night, bed time – for diseases affecting head and neck. 37

Thus ends 13th chapter.