By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
It is necessary to eliminate the disease causing aggravated doshas from the body, especially when they are severely exacerbated and are present in large quantity. This is essential and mandatory to cure the diseases caused by those doshas. But Ayurveda principles of treating diseases emphasize on not eliminating the unripe and immature doshas. If done, they may damage the body tissues and organs and also cause death in worst scenarios.
Read – Ayurvedic Panchakarma Treatment: Introduction, Benefits, Dosha Relation
Pathological events caused by aggravated doshas
The aggravated doshas are the prime causes for most diseases in the body. They do it by creating a series of pathological events in the body.
Doshas go through six stages of pathogenesis to cause disease and complications. These stages collectively called as Shat Kriya Kala.
Doshas accumulate and aggravate in their predominant seats in sanchaya and prakopa stages. In prasara stage they overflow and reach different tissues and organs. The onset of disease pathogenesis starts from stage 4 known as sthana samshraya. Here the aggravated doshas enter weak and susceptible tissues and get lodged therein. The disease process starts when these doshas damage the tissues and cause reaction as a result of which the premonitory symptoms of the disease are manifested. In the fifth stage i.e. vyakta stage the tissues are further damaged by the doshas, the disease manifests with its signs and symptoms. In the final stage i.e. bheda stage the complications of the disease are formed.
Read – Shat Kriya Kala – ‘Stage-Wise Disease Management’
Association of ama with the doshas
As a part of normal physiology, there is constant transit of doshas from gut to tissues and from tissues to the gut. The word gut is used only for easy understanding. The transit actually takes place between the tissues and hollow viscera. This process enables smooth functioning of tissues and organs.
In disease process, when the doshas are associated with ama, they acquire stickiness. In the fourth stage of pathogenesis the doshas not only get lodged in the tissues but also get adhered to the walls of tissues owing to the association with ama.
The doshas associated with ama are called as apakva doshas which means ‘immature or unripe’ doshas. This is because ama is an unripe / immature substance formed due to deficit strength of the digestive fire and subsequent improper digestion of food. Since the organs and channels of transportation are made up of these tissues, indirectly the ama is also located / lodged in the organs and also channels.
Read – Dhatu – 7 Body Tissues As Explained In Ayurveda
Why should immature / unripe doshas not be expelled from the tissues?
It is very difficult to expel these immature doshas from the tissues and organs because they are in a stage of linavastha. Linavastha means a stage wherein the doshas are adhering to the walls of the tissues and organs. If we try to expel these doshas forcibly, they tend to damage the tissues or organs where they are adhered or even cause death of the person. If these doshas are not eliminated from the tissues, they may still damage the tissues in an aggressive way. It is lose-lose situation.
Analogy to explain the concept of ‘non-elimination’ of doshas through purification measures in presence of unripe doshas
Juice extracted only from ripe fruit is obtained in optimum quantity. Trying to extract juice from unripe fruit will not yield any juice and it causes destruction of the fruit itself.
Similarly doshas should be removed from the body only when they are ripe. Only then we will be able to expel them completely. Ripe doshas are those which are not associated with ama. The doshas associated with ama are considered unripe and are sticky; hence stick to the walls of the tissues and organs. When we try to remove these unripe doshas they tend to damage the tissues and destroy them, may also cause destruction of the body (death)
| Meaning | Extraction | Effect of forcible extraction | What to do | |
| Apakva Phala | Unripe fruit | Forcibly trying to extract its juice | Juice cannot be extracted, Fruit is destroyed | Wait till the fruit gets ripened and then extract the juice |
| Apakva / Sama/ Lina Dosha | 1. Apakva – unripe dosha 2. Sama – dosha associated with ama 3. Lina – dosha stubbornly adhering to the walls of the tissues | Forcibly trying to expel the dosha by administering purifying therapies | 1. Doshas cannot be expelled, 2. The tissues, organs and channels where these doshas are adhered are destroyed, 3. Even death may be caused | 1. Wait till the doshas get mature or, 2. Induce ripening of doshas and then expel them using purification therapies |
Therefore the doshas should not be expelled in their unripe condition. This also means to tell that the purification therapies i.e. panchakarma treatments should not be administered during this state of doshas.
How to expel the unripe doshas from the body?
The unripe doshas should first be made ripened before expelling them. To ripen the dosha means to detach and separate ama from the dosha. Once ama has been separated, the ripe dosha can be excited in the tissues and pulled into the koshta i.e. stomach. From here, the doshas may be expelled using purification therapies.
Read – Vitiation Of Doshas According To Movement Of Doshas In The Body
Methods to ripen the doshas and expel
Ama pachana – Firstly diet and medicines to digest the ama should be administered. These medicines will enable effective separation of ama from the doshas. Doshas consequentially will get detached from the walls of the tissues and will show preparedness to get flushed from the tissues and move towards the stomach.
Agni Dipana – Medicines and foods which kindle the digestive fire in the gut should be administered. When the fire becomes strong, the food gets properly digested. As a consequence ama is not formed.
Langhana – Therapies which bring around lightness in the body, mainly upavasa i.e. fasting should be resorted to. Inducing thirst, exposure to sunlight and exercise will also serve this purpose.
Methods of bringing the doshas from tissues to the stomach
- Vriddhi – Temporary increase of doshas in tissues
- Vishyandana – dissolution of doshas in the tissues includes sudation therapy
- Paka – digestion of doshas, includes ama digesting measures
- Srotomukha Vishodana – opening up the mouths of the blocked channels to enable free flow of doshas from tissues to the stomach
- Vayu Nigraha – controlling the aggravated vata
The above said measures shall be done individually or collectively as per the condition of the disease and doshas. These measures will swell up the doshas in the tissues, liquefy them and enable them to freely flow towards the stomach from where they can be easily eliminated.
What to do once the ripe doshas reach the stomach?
If there are kapha predominant doshas, emesis should be administered. If there are pitta predominant doshas, purgation should be administered. The rule of bringing the doshas from tissues to the gut in a ripe form and then eliminating them is strictly applicable for administering emesis and purgation. For other panchakarma measures too i.e. for administering decoction enema, head purgation and bloodletting too the presence and association of ama shall be analyzed and dealt accordingly.
It is important to see the presence of below mentioned conditions as mandatory rules to expel the doshas –
- Absence of association of ama with the doshas
- Presence of nirama doshas i.e. doshas devoid of ama in the stomach / intestine
- Doshas should be in utklishta avastha i.e. a state of excitation i.e. should show the signs of preparedness to get expelled (mainly applies to kapha and kapha predominant doshas)
Even when the doshas are not properly excited, it means to tell that the doshas are still adhering to the tissues and have not completely come to the gut.
