AH-Su-Chapter 14: Dvividha Upakramaneeya / Two Kinds of Treatment

Dvividha Upakarma- two kinds of therapy :-

Because, that to be treated, the human body is of two types – Obese and lean, the treatment is also of two kinds.

1. Santarpana- nourishing, enriching. It is also called as Brihmana (Stoutening, increasing weight, imparting heaviness)

2. Apartarpana –depleting, cleansing. It is also called as Langhana (fasting, losing weight, imparting lightness etc). 1-2

Generally, Brihmana treatment is dominant with Prithvi (Earth element) and ap (water element).
Langhana is dominant with the rest three elements (Fire, air and ether).

Functions such as Snehana (oleation/ lubrication) and Rukshana – (imparting dryness),
Swedana- (sweating therapy, sudation, diaphoresis), Sthambhana- (withholding, obstructing)  are also of these two kinds- Brihmana and Langhana.
Snehana and Sthambhana can be categorized as Brihmana and
Rukshana and Swedana can be categorized as Langhana

Thus all functions are not apart from two .3-3 ½

Langhana therapy imparts lightness to the body. It makes the body thin and light. It is of two types.

Shodhana – Purification procedures (Panchakarma) and
Shamana- palliative treatment. 4

Shodhana treatment expels imbalanced Doshas out of the body forcibly.
It is of five kinds, viz
Niruha- decoction enema,
Vamana- emesis, vomiting therapy
Kaya reka- Virechana – purgation for the body
Shio reka – Shiro Virechana – nasya – purgation for the head, nasal instillation of medicines.
Asra-visruti – Raktamokshana – blood letting .5

Shamana – palliative treatment is that which does not expel the increased Doshas out of the body, it does not increase the normal Dosha, but makes the abnormal- Doshas normal.
In short, Shamana treatment brings imbalanced Dosha to normalcy.

Shamana 7 types – 

Pachana – digestive, carminatives,
Deepana – hunger producing, stomachic,
Kshut – withstanding hunger,  avoidance of food, fasting
Trut –  withstanding thirst/avoidance of water drinking, avoiding liquid food intake
Vyayama- physical activity,
Aatapa- exposure to sunlight and
Maruta- exposure of breeze. 6-6 ½

Brimhana- stoutening therapy also is Shamana only because it alleviates/ mitigates both Vata and Vata Pitta- combination. 7

Persons requiring stoutening therapy  - Brimhaneeya -

Brimhana- stoutening therapy should be given to persons who are

Vyadhi karshita – emaciated by diseases,
Bhaishajya Karshita – emaciated by medicines- therapies,
Madya Karshita – emaciated by alcohol
Stri Karshita – Emaciated by excess sexual activity
Shoka karshita – Emaciated by  grief,
Bhara – who carries heavy loads frequently
Adhva – who has walked / travelled a long distance
Urakshata – person with chest injury
KShatakseena – who is debilitated due to injury
Ruksha – who has excess dryness
Durbala – debilitated
Vatala – Person with Vata body type.
Garbhini – pregnant
Sutika –the women who has delivered,
Bala – children,
Vruddha – the aged and
Greeshme – in the month of summer, even the other people, who are not indicated above should be given Nourishing therapy.

Method of Brihmana - by the use of meat, milk, sugar, ghee, enema prepared sweet substances and fats(oil, ghee),  sleep, comfortable bed, oil- massage, bath, comforts, rest and happiness of the mind.
8-9 ½

Persons requiring thinning therapy – Langhaneeya –

Langana- thinning, slimming therapy  should be doneto
Meha – diabetics
Amadosha – persons suffering  from Ama
Atisnigdha –who has undergone excess oleation treatment
Jvara – fever
Urustambha – stiffness of the thighs,
Kushta – skin diseases
Visarpa – herpes,
Vidhradi – abscess,
Pleeha – diseases of spleen,
Shira, Kanta Akshi roga – head, throat, and eyes;
Sthula – Those are obese
Even to others during Shishira – winter, Langhana treatment should be done. 10-11

Indication for Langhana therapy by means of Shodhana (Panchakarma) –

Patients with these diseases should be given Panchakarma treatment as the means for Langhana therapy. -   Those who are very obese, strong and having predominance of Pitta and Kapha, those suffering  from Amadosha, fever, vomiting, Diarrhoea , hearts diseases, constipation, feeling of heaviness, excess of belching, nausea, etc.

Indication for Deepana, Pachana and then Shodhana (Panchakarma) -

Those who are moderately obese, medium in strength of the body and also of the diseases mentioned, first by administration of digestives and hunger producing substances generally, later with other purification therapies;

Indication for Shamana type of Langhana –

Those who are troubled by increased Doshas, who are of medium strength, with medium strength disease, who are capable of withstanding strain by the control of hunger and thirst; those again of poor strength- of the body and of disease by exposing them to breeze, sunlight and exercise. 12-14 ½

Those who are to be given Langhana- thinning therapy, should not be given Brimhana-stoutening; those who are to be given Brimhana should be given mild Langhana, or both Langhana and Brimhana together, simultaneously may be given depending upon the nature of habitat, season, strength etc. 15

Benefits of Bruhmana therapy – 

Brimhana therapy makes for strength, nourishment of the body, and cure of such diseases which are curable by that therapy. 16

Benefits of Langhana Therapy -

Keenness and clarity of sense organs,
Expulsion of Malas- Doshas and wastes,
Feeling of lightness of the body,
Good taste perception,
Appearance of hunger and thirst together,
Feeling of purity in the chest region (heart),
Clear belching and clear throat,
softening of the diseases- decreased severity,
increase of enthusiasm and
loss of stupor- laziness 16-17

These- therapies indulged into in great measure than required, lead on to profound obesity and emaciation etc, which will be enumerated now, along with their treatment.18

Ati Brimhana- excess of stoutening therapy :-

Excess of Brimhana therapy produces
Atisthaulya – profound obesity
Apachi – scrofula,
Meha – Diabetes, UTI
Jvara – fever
Udara – enlargement of abdomen,
Bhagandara – fistula-in-ano,
Kasa – cough,
Sanyasa – loss of consciousness,
Mutrakruchra – Dysuria,
Ama- disorders of poor digestive activities,
Kushta -skin diseases which are very dreadful. 20

Treatment for over nourishing  -

Treatments which reduce Medas- fat, Anila- Vata and Kapha are desirable;
Use of Kulattha – horse gram – Dolichos Biflorus,
Jurna, Shyamaka,
Yava – Barley – Hordeum Vulgare,
Mudga – green gram – Averrhoa Carambola, and Honey water;

Indulgence in worry, stressful activities
Purification therapies, avoidance of sleep,
either Triphala, Guduci, Abhaya –(Chebulic Myrobalan fruit rind – Terminalia chebula) and Musta (Cyperus rotundus), should be licked with honey daily;
Either Rasanjana (Aqueous extract of Berberis aristata), Brihat Pancamula (Agnimantha, Shyonaka, Gambhari, Patala, Bilva), Guggulu – along with the fresh juice of Agnimnatha is suitable;

Powder of Vidanga (False black pepper – Embelia ribes), Nagara – (Ginger), Kshara- Yavakshara and iron filing or powder of Yava (Barley – Hordeum vulgare) and Amla along with honey – should be licked  daily. 21-24

Powder of Vyosha- (Trikatu – pepper, long pepper and ginger), Katvi, Vara (Triphala), Shigru (drum stick), Vidanga (False black pepper – Embelia ribes), Ativisha, Sthira (Desmodium gangeticum), Hingu – (Asa foetida), Sauvarcala, Ajaji – (Cuminum cyminum), Yavani – (Trachyspermum ammi), Dhanya, Chitraka, the two Nisa (turmeric and tree turmeric), the two Brihati(brihati and kantakari), Hapusa, root of Patha (Cyclea peltata) and of Kebuka, should be mixed with honey, ghee and oil in equal proportion and sixteen parts of saktu (corn flour), this mixture diseases- mentioned earlier and even others of similar nature such as heart diseases, Jaundice, Leucoderma, Dyspnoea, cough, obstruction in the throat- hoarseness of  voice etc. improves powder of thinking, intelligence, memory and kindles the weakened fire- digestive activity. 25-28

Atilanghana- excess of thinning therapy:-

Profound emaciation,
Bhrama – Delusion, Dizziness,
Kasa – cough,
Trushna – severe thirst,
Aruchi – anorexia,
loss- decrease of moistness, and digestive power, of sleep, vision, hearing, semen, Ojas, hunger and voice;
Pain in the urinary bladder, heart, head, calves, thighs, upper shoulders and flanks;
fever, delirium- excess of talk, belching, exhaustion, vomiting, cutting pain in the joints and bones;
non-elimination of faeces, urine etc., arise from excess of Langhana 29-30

Emaciation is better than obesity, there is no treatment for the obese, for, neither Brimhana nor Langhana are capable of vanquishing excess of fat, digestive activity and vata. 31

Emaciation gets cured by use of sweet and unctous- fatty foods and comfortable living, whereas obesity gets cured by the use of the foods etc, of the opposites- qualities to the above that too when used in maximum quantity. There, liquids, foods and drugs which are Brimhana should be adopted 32-33

The emaciated person becomes stout like a boar by absence of worry, by happiness, more use of nutritious food and more of sleep. 34

There is nothing other than meat to stouten the body, especially so the meat of carnivorous animals, for they feed on meat itself. 35

Foods which are heavy and non- nutrition are ideal for the obese whereas the opposites- are ideal for the emaciated;

Yava – Barley – Hordeum vulgare- barley is heavy and non nutritious, ideal for obese and
Godhuma- wheat is light to digest and nutritious, Hence good for emaciated. 36

Though the states of Doshas are innumerable and innumerable are the kinds of treatments such as Grahi – withholding etc, still they do not surpass these two kinds- Brimhana and Langhana, just as the diseases- though innumerable fall into two kinds only, viz Sama and Nirama. (with and without Ama)

Thus ends the fourteenth chapter called Dvividhopakrmaniya in Suthrasthana of Ashtang Hridaya composed by Srimad Vaghata, son of Sri Vaidyapati Simhagupta.