AH-Su-Chapter 1: Ayushkameeya Adhyaya / Desire for long life

Salutations: 

Salutation to The Unique and Rare Physician, who has destroyed, without any residue all the diseases like Raga (lust, anger, greed, arrogance, jealousy, selfishness, ego), which are constantly associated with the body, which is spread all over the body, giving rise to disease, delusion and restlessness. This salutation is done to Lord Dhanwantari. 1

Purpose of life: Essential quality to learn Ayurveda:

To achieve the purpose of life, that is

1.        Dharma – following the path of righteousness

2.        Artha – earning money in a legal way

3.        Kama – fulfilling our desire

4.        Moksha – achieving Salvation,

To achieve this purpose of life, one should concentrate on having a long life. To learn the science of Ayurveda, which explains how to achieve this purpose, ‘obedience’ (Vidheya) is the most important quality. 2

Origin of Ayurveda:

Lord Brahma, remembering Ayurveda, taught  it to Prajapathi, he  in turn taught it to Ashwini Kumaras (twins), they taught it to Sahasraksa (Lord Indra), he taught it to Atri’s son (Atreya  Punarvasu) and other sages, they taught it to Agnivesa and others and they (Agnivesha and other disciples ) composed treatises, each one separately. 3

Ashtanga Hrudayam: 

From those Ayurvedic text books, which are too elaborate and hence very difficult to study, only the essence is collected and presented in Ashtanga Hridaya, which is neither too short nor too elaborate.

Branches of Ayurveda:

1.        Kaya Chikitsa – General medicine

2.        Bala Chikitsa – Paediatrics

3.        Graha Chikitsa – Psychiatry

4.        Urdhvanga Chikitsa – Diseases and treatment of Ear, Nose, Throat, Eyes and Head (neck and above region)

5.        Shalya Chikitsa – Surgery

6.        Damshrta Chikitsa – Toxicology

7.        Jara Chikitsa – Geriatrics

8.        Vrushya Chikitsa – Aphrodisiac therapy

These are the eight branches of Ayurveda. 4-5

Tridosha:

Vayu – Vata, Pitta and kapha are the three Doshas of the body. Perfect balance of three Doshas leads to health, imbalance in Tridosha leads to diseases. 5-6

How Thridosha are spread in body and in a day? 

The Tridosha are present all over the body, but their presence is especially seen in particular parts. If you divide the body into three parts, the top part upto chest is dominated by Kapha Dosha, between chest and umbilicus is dominated by Pitta, below umbilicus part is dominated by Vata.

Similarly, in a person’s life, day and in night (separately), the first part is dominated by Kapha, second part is dominated by Pitta and third part is dominated by Vata. While eating and during digestion, the first, second and third part are dominated by Kapha, Pitta and Vata respectively. 6-7

Types of digestive fires:

There are four types of Digestive fires (Agni)

1.        Vishama Agni – Influenced by Vata. A person with Vishama Agni will sometimes have high appetite, and sometimes, low appetite.

2.        Teekshna Agni - Influenced by Pitta. A person with Teeksna Agni will have high digestion power and appetite.

3.        Manda Agni - Influenced by Kapha. A person with Manda Agni will have low digestion power and appetite.

4.        Sama Agni - Influenced by perfect balance of Tridosha – Where person will have proper appetite and digestion power. Digestion occurs at appropriate time. 7-8

Types of digestive tracts / nature of bowels:

There are three types of digestive tracts (Koshta):

1.        Kroora Koshta – wherein the person will take long time for digestion. The bowel evacuation will be irregular. It is influenced by Vata.

2.        Mrudu Koshta – Sensitive stomach, has a very short digestion period. Even administration of milk will cause bowel evacuation.

3.        Madhya Koshta – Proper digestive tract, bowel evacuation at appropriate times. It is influenced by Tridosha balance.

Types of Prakruti – Body Types:

Like the poison is natural and inherent to poisonous insects, similarly, the Prakruti (body type) is inherent to humans. The body type is decided during conception, based on qualities of sperm and ovum.

Vata prakruti – Vata body type is considered as low quality

Pitta Prakruti – Pitta body type is considered as moderate quality

Kapha Prakruti – Kapha body type is considered good quality.

Tridosha body type – influenced equally by Vata, Pitta and Kapha is considered the best quality.

Dual body types, Like Vata-Pitta, Pitta-Kapha, Vata-Kapha body types are considered as not good. 9-10

Qualities of Vata:

Rooksha – dryness, Laghu – Lightness, Sheeta – coldness, Khara – roughness, Sookshma – minuteness, Chala – movement These are the qualities of Vata. 10

Qualities of Pitta:

Sasneha – slightly oily, unctuous, Teekshna – piercing, entering into deep tissues, Ushna – hotness, Laghu – lightness, Visram – bad smell, sara – having fluidity, movement, drava – liquidity are the qualities of Pitta. 11

Qualities of Kapha:

Snigdhna – oily, unctuous, Sheeta – cold, Guru – heavy, Manda – mild, viscous, shlakshna – smooth, clear, Mrutsna – slimy, jely, sthira – stability, immobility are the qualities of Kapha.

The increase, decrease of individual Doshas, or imbalance of couple of these Doshas is called as Samsarga. And imbalance of all the three Doshas together is called as Sannipata. 12

Body tissues and waste products:

Body tissues and waste products are called as Dushyas. Means, there are influenced, and affected by Doshas. Body tissues are -

1.        Rasa - the first product of digestion, Soon after digestion of food, the digested food turns into Rasa. It is grossly compared to lymph or plasma. But it is not a complete comparison.

2.        Rakta – Also called as Asruk. – Blood

3.        Mamsa – Muscle

4.        Meda - Fat tissue

5.        Asthi - Bones and cartilages

6.        Majja - Bone marrow

7.        Shukra – Semen / Ovum or entire male and female genital tract and its secretions are grossly covered under this heading.

Mala – waste products:
Shakrut / Pureesha – (faeces), Sweda (sweat) and Mootra (urine) are the three waste products of the body.

Nature of increase and decrease:

Equal qualities lead to increase, and opposing qualities lead to decrease. For example, dryness is the quality of Vata. If a Vata body type person exposes himself to dry cold weather, his dryness and in turn Vata will increase, leading to dry skin. In the same way, oiliness is opposite quality of dryness. If he applies oil to the skin, then the dryness and related Vata is decreased.

Six tastes:

Svadu – Madhura – sweet, Amla – Sour, Lavana – Salt, Tikta – Bitter, Ushna – Katu – Pungent, Kashaya – Astringent are the six types of Rasa.

They are successively lower in energy. That means, Sweet taste imparts maximum energy to body and the astringent, the least. 13

Effect of tastes on Tridosha:

In the list of tastes, the first three, i.e. Sweet, sour and salt mitigates Vata and increases Kapha. The last three, i.e. bitter, pungent and astringent tastes mitigates Kapha and increases Vata Astringent, bitter and sweet taste mitigates Pitta. Sour, salt and pungent tastes increase Pitta.

Types 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):

Ushna veerya (Hot potency) -Some food items are hot in nature. For example pepper

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.

Three types of Vipaka:

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

·          Madhura Vipaka (sweet) – Generally, Sweet, and salt tastes undergo this Vipaka.

·          Amla Vipaka (Sour) – Sour taste undergoes this Vipaka

·          Katu Vipaka – rest of the tastes – Bitter, astringent and pungent tastes undergo this Vipaka.

Twenty types of qualities:

Guru(heavy) X laghu (light in weight)
Manda(slow) X tiksna(quick,fast)
Hima (cold) X ushna (hot)
Snighda (unctuous) X ruksa (dry)
Slaksna (smooth) X khara (rough)
Sandra (solid) X drava (liquid)
Mrdu (soft) X kathina (hard)
Sthira (stable) X cala (moving, unstable)
Suksma (stable, small) X sthula (big,gross)
Vishada (non slimy) X picchila (slimy). 18

Cause for health and disease:

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.  (Explained detail in further chapters). 19

Definition of health and disease:

Imbalance in Tridosha is disease. Perfect balance is health.

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 body and mind.

Types of mental Doshas – 

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

How to test patient? 

Darshana – by means of inspection, observation.
Sparshana - by means of touching
Prashna – by means of asking. 22

Examination of disease: 

Disease should be examined by its

Nidana -causes, aetiology,

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

Types of Habitat  (Desha) :

In this science, is said  to  be  of  two kinds -  Bhumi desha – region of  land and Dehadesha – the body. Bhumi desa  -  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 resourses and is more breezy.
Anupa -   which  is  predominant  of  kapha - marshy land with more of water, more vegetation , very less of sunlight and heat.
Sadharana  which  has all Tridosha in balance - moderate type with few mountains , hills, moderate water, vegetation  and sunlight.

Kinds of time: 

Two kinds are considered- one is normal time, another – stages of diseases.

Types of medicines: 

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:
For Vata – Basti (suppositories) is the Shodhana treatment, and oil is Shamana treatment.
For pitta – Virechana (Purgation) is Shodhana and Ghee is Shamana.
For Kapha – Vamana (emesis) is Shodhana and Honey is Shamana. 25-26

Treatment for mental imbalance:

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

16 factors of treatment. –

Chikitsa Chatushpada

-  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
Shastra – Having detailed knowledge about diseases and treatment.
Drushtakarma – Having practical experience
Shuchi – Cleanliness

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
Shuchi – Cleanliness
Daksha – Alert, active
Buddhiman – Intelligence

Qualities of patient:

Adya - Rich 
Bhishagvashya – 100 % obedience towards doctor
Jnapaka – Good memory
Satvavaan – Having good strength to tolerate disease and treatment.

Types of diseases:

Two main types, which are further divided into two types.
Sadhya - Which can be cured. It is of two types – Easy to cure (Sukha Sadhya), Difficult to cure (Krichra Sadhya)

Asadhya - Which can not be cured. It is of two types – Yapya (medicine is required for as long as patient is alive), Anupakrama (nothing can be done. )

Qualities of diseases which can be cured easily: 

Sarvaushadha kshame dehe – The body of 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 brain, heart, kidney
Alpahetu – If the cause for 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.

Qualities of difficult-to-treat diseases:

Disease which require the use of sharp instruments etc. in treatment . and also those which have mixture of factors enumerated in  previous verses are krcchra sadhya (curable with difficulty ). Diseases which have features  entirely opposite  of curable  diseases, which have stayed for long period of time, 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 causes loss of sense organs are impossible to cure. (Anupakrama ), which require no therapy, fit to be rejected, sure to cause death. 32

Patient worth rejection: 

The physician should reject the patient, who is hated by physician and the king and who hates them; who hates himself (dejected in life), who is not having the equipments 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). 33

List of other chapters:

I.  SUTRASTHANA:
1. Ayuskamiya adhyaya (desire for long life).
2. Dinacarya adhyaya (daily regimen).
3. Rtucarya adhyaya (seasonal regimen).
4. Roganutpadaniya adhyaya (prevention of diseases).
5. Dravadravya vijnaniya adhyaya (knowledge of liquid materials).
6. Annasvarupa vijnaniya adhyaya (nature of food materials).
7. Annaraksadhyaya (Protection of foods).
8.  Matrasitiyadhyaya (Proper quantity of food).
9. Dravyadi vijnaniya adhyaya (Knowledge of substances etc.).
10. Rasabhediya adhyaya (classification of tastes).
11. Dosadi vijnaniya adhyaya (Knowledge of dosas etc.).
12. Dosabhediya adhyaya (classification of dosas).
13. Dosopakramaniya adhyaya (treatment of the dosas).
14. Dvividhopakramaniya adhyaya (two kinds of treatments).
15. Sodhanadigana sangraha adhyaya (groups of drugs for purificatory therapies etc.).
16. Sneha vidhi adhyaya (oleation therapy).
17. Svedavidhi adhyaya (sudation therapy).
18. Vamana virecana vidhi adhyaya (emesis and purgation therapies).
19. Basti vidhi adhyaya (enema therapy).
20. Nasya vidhi adhyaya (nasal medication).
21. Dhumapana vidhi adhyaya (inhalation of smoke therapy).
22. Gandusadi vidhi adhyaya (mouth gargles and other therapies).
23. Ascyotana-anjana vidhi adhyaya (eye drops, collyrium therapies).
24. Tarpana-putapaka vidhi adhyaya (satiating the eye and other therapies).
25. Yantra vidhi adhyaya (use of blunt instruments).
26. Sastra vidhi adhyaya (use of sharp instruments).
27. Siravyadha vidhi adhyaya (venesection).
28. Salyaharana vidhi adhyaya (removal of foreign bodies).
29. Sastrakarma vidhi adhyaya (surgical operation).
30. Ksaragnikarma vidhi adhyaya (alkaline and thermal cautery).

II. SARIRA STHANA (SECTION ON ANATOMY, PHYSIOLOGY ETC):

1. Garbhavakranti sarira (embryology).

2. Garbhavyapad sarira (disorders of pregnancy). 

3. Anga vibhaga sarira (different parts of the body).

4. Marma vibhaga sarira (classification of vital spots).

5. Vikrti vijnaniya sarira (knowledge of bad prognosis). 

6. Dutadi vijnaniya sarira (knowledge of messenger etc.).

III.   NIDANA STHANA (DIAGNOSIS OF DISEASES):

1. Sarvroga nidanam (diagnosis of diseases in general).

2. Jvara nidanam (diagnosis of fever).

3. Raktapitta, Kasa nidanam (disease and cough).

4. Svasa-Hidhma nidanam (diagnosis of bleeding disease and cough).

5. Rajayaksmadi nidanam (diagnosis of pulmonary tuberculosis etc.).

6. Madatyaya nidanam (diagnosis of alcoholic intoxication).

7. Arsas nidanam (diagnosis of haemorrhoids).

8. Atisara-Grahani nidanam (diagnosis of diarrhoea and duodenal disorders).

9. Mutraghata nidanam (diagnosis of retention of urine).

10. Prameha nidanam (diagnosis of diabetes).

11. Vidradhi-Vrddhi-Gulma nidanam (diagnosis of abscess, enlargement of the scrotum and abdominal tumour).

12. Udara nidanam (diagnosis of enlargement of the abdomen).

13. Panduroga-sopha-visarpa nidanam (diagnosis of anaemia, dropsy and herpes).

14. Kustha-svitra-krimi nidanam (diagnosis of leprosy, leucoderma and parasites).

15. Vata vyadhi nidanam (diagnosis of diseases of the nervous system).

16. Vatasonita nidanam (diagnosis of gout).

IV. CIKITSITA STHANA (THERAPEUTICS):

1. Jvara cikitsita (treatment of fevers).

2. Raktapitta cikitsita (treatment of bleeding disease).3. Kasa cikitsita (treatment of cough).

4. Svasa-Hidhma cikitsita (treatment of dyspnoea and hiccup).

5. Rajayaksmadi cikitsita (treatment of pul. tuberculosis, etc.). 

6. Chardi-Hrdroga-Trsna cikitsita (treatment of vomiting, heart disease and thirst).

7. Madatyaya cikitsita (treatment of alcoholic intoxication).

8. Arsas cikitsita (treatment of haemorrhoids).

9. Atisara cikitsita (treatment of diarrhoea).

10. Grahani dosa cikitsita (treatment of duodenal disorder).

11. Mutraghata cikitsita (treatment of retention of urine).

12. Prameha cikitsita (treatment of diabetes). 

13. Vidradhi-vrddhi cikitsita (treatment of abscess, enlargement of the scrotum). 

14. Gulma cikitsita (treatment of abdominal tumour). 

15. Udara cikitsita (treatment of enlargement of the abdomen). 

16. Pandu roga cikitsita (treatment of anaemia). 

17. Svayathu (sopha) cikitsita (treatment of dropsy). 

18. Visarpa cikitsita (treatment of herpes).

19. Kustha cikitsita (treatment of leprosy).

20. Svitra-krimi cikitsita (treatment of leucoderma and parasites).

21. Vata vyadhi cikitsita (treatment of diseases of the nervous system).

22. Vatasonita cikitsita (treatment of gout).

V. KALPASIDDHI STHANA (PURIFICATORY RECIPES, PHARMACEUTICS):

1. Vamana kalpa (emetic recipes).

2. Virecana kalpa (purgative recipes).

3. Vamana virecana vyapat siddhi (management of complications of emesis and purgation therapies). 

4. Basti kalpa (enema recipes).

5. Basti vyapat siddhi (management of complications of enema therapy).

6. Dravya-kalpa (pharmaceutics). 

VI. UTTARASTHANA:

1. Balopacaraniya adhyaya (care of the new born baby).

2. Balamaya pratisedha (treatment of diseases of children).

3. Balagraha pratisedha (treatment of evil spirits).

4. Bhuta vijnaniya (knowledge of demons).

5. Bhuta pratisedha (treatment of demons).

6. Unmada pratisedha (treatment of insanity).

7. Apasmara pratisedha (treatment of epilepsy).

8. Vartma roga vijnaniya (knowledge of diseases of eyelids).

9. Vartma roga pratsedha (treatment of diseases of eyelids).

10. Sandhisitasita roga vijnaniya (knowledge of diseases of fornices, sclera and cornea).

11. Sandhisitasita roga pratisedha (treatment of diseases of fornices, sclera and cornea). 

12. Drsti roga vijnaniya (knowledge of diseases of vision). 

13. Timira pratisedha (treatment of blindness).

14. Linganasa pratisedha (treatment of blindness).

15. Sarvaksi roga vijnaniya (knowledge of diseases of the whole eye).

16. Sarvaksi roga pratisedha (treatment of diseases of the whole eye).

17. Karna roga vijnaniya (knowledge of diseases of the ear). 

18. Karna roga pratisedha (treatment of diseases of the ear). 

19. Nasa roga vijnaniya (knowledge of the diseases of the nose). 

20. Nasa roga pratisedha (treatment of diseases of the nose).

21. Mukha roga vijnaniya (knowledge of the diseases of the mouth).

22. Mukha roga pratisedha (treatment of diseases of the mouth).

23. Siro roga vijnaniya (knowledge of the diseases of head).

24. Siro roga pratisedha (treatment of diseases of the head).

25. Vrana pratisedha (treatment of ulcers).

26. Sadyo vrana pratisedha (treatment of traumatic wounds).

27. Bhanga pratisedha (treatment of fractures). 

28. Bhagandara pratisedha (treatment of rectal fistula)

29. Granthi-arbuda-slipada-apaci-nadi vijnaniya (knowledge of tumours, cancers, filariasis, scrofula and sinus ulcer).

30. Granthyadi pratisedha (treatment of tumours etc.).

31. Ksudra roga vijnaniya (knowledge of minor diseases).

32. Ksudra roga pratisedha (treatment of minor diseases).

33. Guhya roga vijnaniya (knowledge of diseases of genital organs).

34. Guhya roga pratisedha (treatment of diseases of genital organs).

35. Visa pratisedha (treatment of poisoning).

36. Sarpa visa pratisedha (treatment of snake bite poison).

37. Kitalutadi visa pratisedha (treatment of poison of insects, spiders etc.).

38. Musika-alarka visa pratisedha (treatment of poison of mouse, rabid, dog etc.).

39. Rasayana vidhi (rejuvination therapy).

40. Vajikarana vidhi (virilification therapy).

Thus ends the first chapter called Aayuskameeya in sutrasthana of Astanga hrudaya composed by Srimad Vaghata, son of Sri Vaidyapati Simhagupta.