Adhyäya : 223

13

* Both sagräsa and gräsäntara are indicated in the disorders ofpräpa väta.
* Sagräsa drugs are in the form of powders and pastes.
* Useful to increase the power of digestion.
* Aphroidisicas should be given with the morsel of food.
* Drugs, which cure the diseases of the heart.
* Which are useful for emesis.
* Useful for the inhalation of smoke. Should be administered in between the two
morsels.
I l . Niéi (Bed time):

* Administration of drugs in the bedtime is known as ni'i.

* Indicated in the disorders of upper parts of the body above the shoulders i.e. E. N. T.
and ophthalmic disorders.

Thus ends the thirteenth chapter entitled Dosopakramapiya Adhyäya of

Sutra Sthäna in Hrdaya Sarilhitä, which was composed by Äcärya
Vägbha!a son of Sri Vaidyapati Simhagupta.
In this chapter Äcärya Vägbha!a explained the general line of treatment for tridosas,
individually and also given the suggestion to manage the samsargaja and sannipätaja
dosas.
Äcärya Vägbha!a expressed that these dosas gets vitiated not only due to the irregular
diet, dietics etc. but also due to the variations of the seasons also. Hence the relationship
between the dosas and seasons has been mentioned. Next, definition of äma, features of
säma and niräma dosas and also the line of treatment for äma dosas are explained.
Vitiated cloys and their movement in the body, line of treatment, suitable time for
godhana therapy and time of administration of medicine etc. have been discussed.
After 'Doyopakramapiya Adhyäya' Äcärya Vägbha!a expounded the chapter
'Dvividhopakramapiya ' (Two Kinds of Therapies), thus said Lord Ätreya and other great
sages.
In the present chapter Äcärya Vägbha!a deals with the two types of treatment viz.
nourishing therapy and reduction therapy, their advantages, complications and the
treatment also have been discussed.
Two kinds of treatment:

Il l I l
Two kinds of treatment have been mentioned namely santarparpa (nourishing therapy)
and apatarpapa (reduction therapy); brmharpa and lahghana are the synonmys for the
above therapeutic procedures respectively.
Whatever adds to the corpulence of the body is brmhapa or nourishing therapy.
Lafighana: Whatever is capable to reduce the body is known as lahghana or reducing
therapy.
Dominancy of mahäbhüta:

Generally the body gets nourished by the use of substances having the dominancy of
prthivi and ap mahäbhütas, while it is reducing due to the substances having the agni,
väyu and äkäSa mahäbhütas.

113 I l
Similarly snehana, rükyam, svedana and stambhana therapies are also showing their
effects due to the dominancy of the basic elements only.
 Dvividhopakramapiya Adhyäya : 14 225
Even though 6 types of treatments have been mentioned, all the six types can be
incorporated in the above-mentioned two kinds of treatments i.e. b!Ti1hapa and lahghana
only.
Notes:
Sadupakrama:
l. B!7i1hava (nourishing therapy), 2. lahghana (reduction therapy), 3. snehana (oleation
therapy), 4. svedana (sudation therapy), 5. stambhana (astringent therapy) and 6. rüksava
(drying therapy).
Snehana and stambhana can be included in b!7i1hava therapy while svedana and rüksapa
comes under lahghana therapy, basing on the bhüta predominance and their similar actions.
The drugs having the qualities of heavy, cold, soft, unctuous, thick, bulky, slimy,
sluggish, stable and smooth will be known as nourishing drugs and which causes
nourishment to the body.
Types of lafighana:

Lahghana is of again 2 types— Sodhana and 'amana.

Sodhana (Elimination therapy):
115 I l

Sodhana which expels the vitiated dosas from the body and maintain the equilibrium state in
the body is known as Sodhana therapy. It is of 5 types viz.
l. Nirüha (medicated enemata with decoctions), 2. vamana (emesis), 3. käya-vireka
(purgation), 4. Siro-vireka (nasal administration) and 5. asra visruti (blood letting).
Samana (Palliative measures):

116 I l
Samana is that, which neither expels nor excites the dosas but mitigated the increased dosas
and maintains the normalcy of the dosas within the body. It is of 7 types.
I . Päcana (increased digestion), 2. dipana (carmination), 3. kyut(suppressing appetite), 4.
try.lä (suppressing thirst), 5. vyäyäma (exercises), 7. ätapa (exposing to the sun) and 6.
märuta (exposing to open air).
In Caraka Samhitä, it is clearly stated that one who is having the knowledge pertaining to
all the 6 types of therapies is only the real physician. That indicates the importance of
sadüpakramas.
$adüpakrama
B17i1hana Langhana Sne ana Svedana Stam hana Rüksana
(Nourishing (Reduction (Oleation) (Sudation) (Astringent) (Drying therapy) therapy) therapy)

Sodhana Samana
 Dvividhopakramapiya Adhyäya : 14 227
117 I l
Brlfihapa also can be considered as Samana therapy as it mitigates väta and also väta-pitta
dosa.
Persons eligible for nourishing therapy:

118 u 119 I l

* During convalescence period.

* Become weak due to the treatments.
* Alcohol consumption, excessive copulation, grief etc.
* Carrying heavy loads, long walks, injury to chest.
* Thin and debilitated.
* Suffering with vätadisorders.
* Pregnant, postnatal period, children, aged and everybody during summer.
* Daily use of mutton, milk, sugar, ghee, enema with unctuous substances, comfortable
sleeping and sitting, massage, bath, inducing happiness etc. gives nourishment to the
body.
Persons eligible for reducing therapy:

Ill 1 I l
Reducing therapy is indicated for the persons suffering from diabetes, äma dosa, excessive
unctuousness in the body, fever, stiffness of the thighs, skin disorders, herpes, abscess,
enlargement of the spleen, diseases of head, neck and eyes, obesity and also other persons
during winter.
Different types of lafighana therapies indicated in various conditions:

Type of lafighana therapy Indications

228 H!dayam : Sütra-sthäna
1. Sodhana therapies like vamana, Obesity, strong, pitta & kapha dominancy, ama dosa, fever,
virecana. vomiting, diarrhoea, heart complaint, constipation, heaviness in
the body, excessive eructation, nausea etc.
Moderate obesity, moderately strong, moderate vitiation of pitta
2. Dipana, päcana followed by
& kapha and the above conditions like äma dosa etc.
suitable Sodhana therapies.
Slightly obese, weak, slight vitiation of pitta and kapha and also
3. Ksudhä & trypä nigrahapa in the above conditions.
(control ofhunger and thirst) Moderately vitiated dosas, along with above condition.
4. Ätapa (exposing to the sun),
vyäyäma (exercises) Those having poor strength and suffering from äma dosa and
5. Märuta-sevana other conditions.
(exposings to open air)
* Purificatory therapies like emesis, purgation are indicated for the persons, who are very
obese, strong and increased kapha and pitta.
* Digestive drugs and carminatives are indicated in fever, vomiting, diarrhoea,
constipation, heaviness and slightly obese.
* Suppressing the thirst and hunger is indicated in moderately strong and stout. *
Exposing to open air and sun are useful for persons of a poor strength.

* Never conduct nourishing therapy to the obese persons but at times mild reducing
therapy can be conducted to the lean persons.
* Both the therapies can be conducted to the lean persons depending upon the nature of
habitat, season, strength etc.
Advantages of nourishing therapy:
Ill 6 I l
* Increases the strength.
* Development of the body takes place.
* Those diseases will be cured which requires such therapy i.e. disappearance of the
defects of emaciation.
Advantages of reducing therapy:

Il l 7 I l
* Sense organs becomes clear.
* Proper excretion of flatus, urine and faeces.
* Lightness of the body.
* Increases the perception of the taste.
 Dvividhopakramapiya Adhyäya : 14 229
* Excessive hunger and thirst and contentment.
* Feeling of purity in heart, eructation and throat.
* Decreasing the signs and symptoms of the disease. * Exertion and disappearance of
lassitude.

Il l 9 I l
Both these therapies should be conducted systematically (considering various aspects like
mäträetc.) otherwise they will produce too much of stoutness or emaciation respectively.
They are being mentioned with their treatment.
Signs and symptoms of obesity and emaciation are enumerated here, as under, which
facilitates to find out the features of excessive nourishing and reducing therapies.
Notes:
Obesity and its causes:
Due to the excessive ingestion of heavy foods leads to indigestion and which in turn causes
for the production of äma.
Äma gets mixed with kapha at the tissue level and make them weak and causes increase of
fatty tissue.
Simultaneously the channels will be blocked, and the väta moving into gastro-intestinal
tract, causes increase of digestive power, which results in excessive hunger, which in turn
leads excessive intake of food and results in obesity.
Signs and symptoms of obesity:
* Excessive thirst, hunger and sweating.
* Dyspnoea on exertion.
* Excessive sleep.
* Unable to do minimum physical exercises.
* Lassitude-decreased life-span, strength and vigor.
* Foul smell of the body.
* Hoarseness of voice.
* Increase of fatty tissue.
* Accumulation of fat in the regions of abdomen, buttocks and thighs etc.
Atibrrilhapa (Features of excessive nourishing therapy):
112 0 I l
Atisthoulya (profound obesity), apaci (scrofula), meha (diabetes), jwara (fever), udara
(diseases of the abdomen), bhagandara (fistula), käsa (cough), sanyäsa (loss of
230 H!dayam : Sütra-sthäna
consciousness), mütralgcchra (dysurea), äma (disorders of poor digestive activities) and
kus!ha (skin disorders).
Treatment for obesity:

1Il
112 2 I l
112 3 I l
112 4 I l

* Foods which mitigate väta, kapha and medas such as hoarse gram, small variety of
barley, barley,jower, black millets, green gram etc.
* Drinks such as aristas, honey plus water, whey and buttermilk.
* Drugs, which are sharp, hot, dry and scarifying.
* Too much worry, excessive sexual inter course, excessive exercises, purificatory
therapies, avoidance of sleep and powder massage etc.
* Powders of triphalä, gudüci, haritakiand mustäare to be taken with honey.
* Rasäfijana, bchatpaficamüla, guggulu and Siläjita should be taken along with
agnimantha svarasa.
* Equal parts of vidahga, Sup!hi, yavaksära, lohabhasma, ämalaki and barley if taken
with honey cure the complications of obesity.
VY0}ädi yoga:
5I

l
112 7 I l

1. Sunthi 9. Vidapga 17. Citraka

2. Marica 10. Ativisä 18. Haridrä
3. Pippali 11. Sthlra 19. Däruharidrä
4. Katuki 12. Hiligu 20. Brhati
5. Haritaki 13. Sou varcala la vana 21. Kantakäri
6. Ämalaki 14. Ajäji 22. Hapuyä
7. Vibhitaki 15. Yaväni 23. Päthämüla
8. Slgru 16. Dhänyaka 24. Kembukamü/a
Take the above 24 drugs in equal quantity and then add equal quantity of madhu, ghrta and
taila separately and then mix 16 parts of saktu (corn flour) and to be taken regularly.
 Dvividhopakramapiya Adhyäya : 14 231
Regular use of above formula will be useful in curing obesity and other complications,
heart diseases, jaundice, leucoderma, dyspnoea, cough, hoarseness of voice. It will be
useful to improve thinking, intelligence and memory power. It also increases the power of
digestion.
Ati-lafighana (Features of excessive reducing therapy):

112 9 I l
Due to the excessive treatment of reducing therapy the following complications may be
developed.
* Profound emaciation, giddiness, cough, thirst, anorexia.
* Decreased unctuousness, digestive power, sleep, vision and hearing, semen, ojas,
hunger and voice.
* Pain in the bladder, heart, head, calves, thighs, hip and flanks etc.
* Fever, irrelevant and excessive talks, eructation, tiredness, vomiting, severe pain in the
phalanges and bones, non-elimination of faeces and urine etc.
Käréya is better than sthoulya and its reasons:

1Il
* Emaciation is better than obesity because there is no effective treatment for the obese.
* Neither nourishing nor reducing therapies are suitable to reduce excess fat, digestive
activities and väta.
Treatment for emaciation:

113 3 It

* Sweet and unctuous foods and other comforts cure emaciation easily.
* The use of opposite substances like tikta, kagu and kasäya rasa dravyascures obesity. *
All the drinks, foods and drugs useful for nourishing therapy are advised for emaciated.
* Aphrodisiacs like agvagandhä, vidärietc are good.
113 4 I l

* By the absence of worry, feeling of happiness, nourishing food and drinks, excessive
sleep causes the emaciated become stout like a pig.
113 5 I l

* No other substances will make the body stout except meat, that too the meat of
carnivorous animals. Notes:
232 H!dayam : Sütra-sthäna
* Take equal parts of pippali, sugar candy, gingili oil, honey and ghee and add corn flour
mixed with (mantha) will be useful.
* Similarly sugar candy + honey + madirä (wine) + corn flour also useful for the
treatment of emaciation.
* Mantha prepared from kharjüra, dräk9ä, vrkyämla, amlikä, dädima bija, parüsaka,
ämalaka cures thirst and other disorders instantaneously. Suitable diet for sthüla &
kréa:
113 6 I l
Food substances, which are having guru gurpa along with non-nutritious ones, are ideal for
the management of obesity.
Ex. honey andjätiphala. As they are having rükya and guru gum they will be useful in
reducing fat as well as takes time to digest.
Where as opposites are useful for emaciated.
Yava and godhüma are good for both types of conditions.
All the therapies can be included under lafighana & brlilhapa:
113 7 I l
Though the states of dosas and treatments (such as grähi, bhedya) are innumerable all of
them can be incorporated into two only as säma and niräma dosa and lahghana and
b17i1hapa cikitsä respectively.

Thus ends the fourteenth chapter entitled Dwividhopakramapiya Adhyäya

of Sutra Sthäna in As!äfiga H!daya Sari1hitä, which was composed by
Äcärya Vägbhata son of Sri Vaidyapati Sirilhagupta.
In this chapter Äcärya Vägbha!a expounded the two types of treatment i.e. bchlfiarpa and
lahghana. Langhana has been again divided into 2 types such as godhana and Samana.
Next persons eligible for nourishing therapy and reducing therapy, advantages of both the
therapies. Causes for obesity—signs and symptoms, complications and their treatment.
Signs and symptoms of emaciation, complications and treatment also discussed.