Ayurveda, the ancient Indian science is distinct in its approach towards a disease & its treatment. Analysis of each condition & its management is individualistic. Ayurveda physician can decide the suitable medicines & treatment only after accessing all these variables like age, gender, prakruthi (body constitution / body nature) & detailed examination of the patient(to determine the dosha involved, dhatu affected, stage & severity of the disease etc). Even to the same disease the medicines given to 2 persons may not be similar as per the variables.

Basically Ayurveda provides guidelines for analyzing the stages of vyadhi in the form of 6 kriyakala / Samprapti (Stages of pathogenesis).

They are,

• Sanchaya
• Prakopa
• Prasara
• Sthanasamshraya
• Vyakta / Vyadhi
• Bheda / Upadrava

Specific signs & symptoms indicating each stage according to the dosha are given, which have to be identified in the patient. Based on the diagnosis as in which stage the disease is, vaidya has to plan the treatment. Depending upon the stage & severity of the disease the line of treatment & appropriate medicines are to be decided.

In classics like Charaka, Sushruta etc. we find that the disease management has been done stage by stage according to the condition of the disease. Even in traditional Kerala style also we same the same. Based on these guidelines generally, chikitsa can be planned under 5 broad headings,

• Ama pachana or Agni deepana
• Shodhana
• Shamana
• Brumhana
• Rasayana

Selection of formulations accordingly

1) Ama pachana or Agni deepana

Usually most of the conditions are associated with ama or agnimandya. Hence without treating ama & improving agni it is impossible to treat the actual disease.

In this stage usually kashaya, vati, churna or arishta may be selected based on the sthana (koshta / shaka), avastha (prabhuta, madhyama, alpa etc).

Ex :     Paneeya –

• Kapha – Shunti
• Kapha Vata – Panchakola
• Vata – Jeeraka + Dhanyaka
• Pitta – Musta, Guduchi (Tikta dravya pachana), Shadanga Paneeya (as a whole / individual ingredients can be used for paneeya)

Kashaya –

• Kapha Vata – Amrutottara kashaya
• Pitta – Drakshadi kashaya

Churna –

• Taleesadi churna (rochana & pachana)
• Hingvashtaka churna, Ajamodadi churna,
• Trikatu churna, Panchakola Churna, Hinguvachaadi churna etc.

Vati     –

• Agnitundi vati, Chitrakaadi vati, Sanjeevini vati, Laghumalini vasanta
• Vettumaran – can also be used as best amapachaka

Arishta –

• Amrutaarishta – the best
• Pippalyaasava
• Mahasudharshana kadha – in few cases

After ama pachana , it facilitates the entry of medicine so that we can proceed to next stage of treatment i.e., Shodhana /  Panchakarma / Purification / Detoxification.

2) Shodhana / Panchakarma

It includes 5 different treatment procedures – Vamana, Virechana, Basti, Nasya & Raktamokshana.

It may be done as –

1) Pradhana shodana  or

2) Mrudu shodana

Pradhana shodana

1. Vamana – is selected if doshas are in Amashaya (Kapha sthana) or if Kapha is more. Here our aim is to remove Kapha without disturbing vata.
2. Virechana – is selected if Pitta is dominant or doshas are in Pitta sthana.

Here selection of medicine starts from Snehapana stage itself & includes various criteria’s to be considered while selecting Vamana or Virechana dravyas.

Selection of medicines for Snehapana

According to the dosha involved Sneha can be selected. Here we can use the logic given in Pandu chikitsa as the selection criteria.

• Vata Pitta – Mahakalyanaka / Kalyanaka ghruta
• Pitta Kapha – Mahatiktaka ghruta / Tiktaka ghruta
• Kapha Vata – Panchagavya ghruta / Mahapanchagavya ghruta
• Koshta Vata – Indukantha / Guggulutiktaka ghruta

Other ghrutas may not be useful as Shodhananga sneha as they are more towards Shamana.

Selection of Virechaka / Virechanopoga drayas

Selecting specific drug of choice is very important to remove the doshas effectively through Virechana / purgation.

• Kapha – Manibadra guda
• Pitta – Avipattikara churna, Trivrut lehya
• Vata – Gandharvahasthadi taila (Snighda virechana)

Selection of suitable anupana

Anupana selection is also equally important in this regard,

• Pitta – Ksheera
• Kapha – Gomutra

If rogi & roga bala are more then we can select teekshna virechaka drugs & if madhyama bala accordingly.

If rogi bala is less, then we can opt for mrudu shodhana or nithya virechana.

Mrudu Shodana

It can be done in the ways such as – Nithya virechana.

Nitya Virechana can be done with the following drugs,

• Kashaya – Ghandharvahastaadi kashaya – Together it does pachana & anulomana / Triphala kashya
• Churna – Avipattikara churna / Trivrut churna
• Lehya – Trivrut lehya / Dashamoola hareethaki lehya
• Taila – Ghandharvahasthaadi taila

These are the preparations in general but according to the disease specific shodhana dravyas can be selected.

For example in Kasa,

• Nagavalli swarasa & palandu swarasa with madhu – removes Kapha by lekhana.
• Kanakasava – removes Kapha by chedhana & lekhana.
• Pippali, Karpuradhi churna & Tankana bhasma – does lekhana & shoshana.
• Sindhura preparations (Malla & Rasa Sindhoora).

In the same way even preparations for other Shodhana’s i.e., Basti, Nasya & Raktamokshana can to be selected.

3) Shamana

In Shamana stage, preparations like kashaya, taila, ghruta, lehya, vati, churna, bhasma, asava & arishta etc. are selected based on the dosha involved.

To understand how to select the drugs in shamana stage, let’s take the example of condition of shwasa & kasa.

Kashaya –

• In Kapha pradhana stage – Dashamoolakatutrayadi kashaya, Dashamoola kashaya, Indukanta kashaya.
• As shamana & brumhana-  Nayopayam kashaya especially in Vata pradhana alpa Kaphanubandha.
• Taila – In Vata pradhana – Mahanarayana taila
• Ghruta – Indukantha ghruta, Dadimadi ghruta, Rasnaadi ghruta

Lehya –

• Dashamoola hareetaki
• Vasavalehya
• Agastya hareetaki lehya

Vati –

• Shwasakutara rasa
• Laxmivilasa Rasa

Churna –

• In Vata pradhana – dry cough – Sitophaladi churna + Yasti
• In Kapha pradhana – with sputum – Talisadi churna
• In Pitta pradhana – Yasti churna

Asava & Arishta –

• In kapha – Pushkaramoolasava / Kanakasava / Somasava
• In pitta – Vasakaasava, Vasakaarishta, Drakshaasava, Drakshaarishta
• In vata pradhana Kaphaanubhanda – Dashamoolarishta

Rasa dravyas –

• Vata – Sameerapannaga
• Kapha – Rasa sindhoora

4) Brumhana

After the removal of the disease the body needs to regain its lost bala / strength. Hence brumhana is essential. Few opine that brumhana chikitsa is nothing but vata chikitsa. But it may not be true always. It is mainly meant for dhatu pushti (increasing the strength & vitality of the tissues).

Kashaya –

• Nayopayam kashaya
• Vata – Vidaryadi kashaya

Taila –

• Mahanarayana taila
• Mahamasha taila

Ghruta –

• Vidaryadi ghruta
• Rasnadi ghruta
• Amruta prasha ghruta

Bhasma –

• Abhraka bhasma
• Swarna bhasma

5) Rasayana

Rasayana chikitsa is vyadhi apunarbava chikitsa i.e., which prevents the recurrence of the disease. It also regains the lost bala (strength), varna (complexion), etc of the patient. Acharya Charaka in chikitsa sthana mentions many rasayana yogas.

Ex –

• Shilajithu rasayana
• Pippali rasayana
• Swarna bhasma
• Lehyas etc.

In this way, we can treat any disease effectively in these 5 steps.

To conclude,

It is very important to understand the particular samprapti occurring (pathogensis) & the present status of the patient approaching us. Then only we can decide the particular treatment suitable for that condition. Many a times a patient will come to us after initial treatment with other Ayurvedic doctors. If they have done the initial stages of treatment like amapachana or shodhana etc. then it is not necessary to go back & repeat the same, we can proceed to the next steps. By this we can even save the time & money of the patient.

In this way, after deciding which stage of treatment has to be adopted (whether shodhana / shamana / brumhana etc. ) the specific yogas needed have to be selected. The properties of individual drugs studied in Dravya guna prove to be useful in this regard. Based on the properties of individual drugs & knowledge of Bhaishajya kalpana & Rasa shastra, one can interpret the action of medicines. Thereby we can select the potent & most opt medicine for the condition.

Note: This article is an attempt to present the interpretations prevalent in general practice, based on the guidelines found in Ayurveda classical texts. Individual opinions & interpretations may vary.

Authors:

Dr. Shilpa S. N, Senior consultant, Sriranga Ayurveda Chikitsa Mandira

Dr. Prasanna Venkatesh, Chief Physician, Sriranga Ayurveda Chikitsa Mandira

Healthcare unit of Prakruthi Ayurveda Pratistana ®, Mysore – 23