AH-Su-Chapter 12: Doshabhediya दोषभेदीयं / Dosha Types, Imbalance Symptoms

Place of Tridosha – Doshasthana

Place of Vata Dosha -

पक्वाशयकटीसक्थिश्रोत्रास्थिस्पर्शनेन्द्रियम्
स्थानं वातस्य तत्रापि पक्वाधानं विशेषतः

Pakavasaya – large intestine,
Kati – waist
Sakthi – hip
Shrotra – ear
Asthi – bones
Sparshanendriya – skin
Special space – large intestine 1

Place of Pitta Dosha -

नाभिरामाशयःस्वेदो लसीका रुधिरं रसः
दृक्स्पर्शनं च पित्तस्य नाभिरत्र विशेषतः

Nadhi – Umbilicus,
Amashaya- stomach and small intestine,
Sweda – sweat,
Lasika- lymph,
Rudhira – blood,
Rasa- plasma,
Druk – eye, and
Sparshanam – skin,
Special seat – Nabhi- region around the Umbilicus. 2

Place of Kapha -

उरः कण्ठशिरः क्लोमपर्वाणि आमशयो रसः
मेदोघ्राणं च जिह्वा च कफस्य, सुतरामुरः

Ura – Chest ,
Kantha – throat ,
Shira – head,
Kloma – Pancreas?,
Parvani – bone joints,
Amashaya,- Stomach and small intestine,
Rasa –plasma,
Meda – fat
Ghrana – nose and
Jihva – tongue are the seats of Kapha,
Special seat – Ura – chest. 3

5 types of Vata -

प्राणादिभेदात्पञ्चात्मा वायुः

Vata is of 5 types.

Prana Vata,
Udana Vata,

Vyana Vata,
Samana Vata and
Apana Vata,

Prana Vata –  

प्राणो अत्र मूर्धगः
उरः कण्ठचरो बुद्धिहृदयेन्द्रियचित्तधृक्
ष्ठीवनक्षवथूद्गारनिः श्वासान्नप्रवेशकृत्

Prana is located in the head and moves in the chest, throat. It regulates will, heart, sense organs, intellect and vision.
It is the cause for expectoration, sneezing, belching, inspiration and swallowing of food. 4

Udana Vata – 

उरः स्थानमुदानस्य नासानाभिगलांश्चरेत्
वाक्प्रवृत्तिप्रयत्नोर्जाबलवर्णस्मृतिक्रियः

The chest is the seat of Udana, it moves in the nose, umbilicus and throat; its functions are initiation of speech (vak), effort (Prayatna), enthusiasm (Urja), strength (bala) , color, complexion (varna) and memory (smruti) 5

Vyana Vata – 

व्यानो हृदिस्थितः कृत्स्नदेहचारी महाजवः
गत्यपक्षेपणोत्क्षेपनिमेषोन्मेष्णादिकाः
प्रायः सर्वाः क्रियास्तस्मिन् प्रतिबद्धाः शरीरिणाम्

Vyana is located in the heart, moves all over the body in great speed,
It attends to functions such as flexion and extension (locomotor action) opening  and closing of the eyelids etc.
Generally all the body activities are regulated by Vyana Vata. 6-7

Samana Vata –

समानो अग्निसमीपस्थः कोष्ठे चरति सर्वतः
अन्नं गृह्नाति पचति विवेचयति मुञ्चति

Samana Vata is located near the digestive fire.
It moves in the Kostha – alimentary tract,
It receives the food into stomach, aids in digestion, helps in dividing the food into useful part and waste part, and moves these parts in their normal paths. 8

Apana Vata –

अपानो अपानगः श्रोणिवस्तिमेढ्रोरुगोचरः
शुक्रार्तवशकृन्मूत्रगर्भनिष्क्रमणक्रियः

Apana Vata is located in the Apana – large intestine, moves in the waist, bladder, genitals. It attends to the functions such as ejaculation, menstruation, defecation, urination and child birth. 9

  

Five types of Pitta-

पित्तं पञ्चात्मकं

Pitta is of 5 types.
Pachaka Pitta
Ranjaka Pitta
Sadhaka Pitta
Alochaka Pitta
Bhrajaka Pitta

Pachaka Pitta –

तत्र पक्वमाशयमध्यगम्
पञ्चभूतात्मकत्वे अपि यत्तैजसगुनोदयात्
त्यक्त द्रवत्वं पाकादिकर्मणा अनलशाब्दितम्
पचत्यन्नं विभजते सारकिट्टौ पृथक् तथा
तत्रस्थमेव पित्तानां शेषाणामप्यनुग्रहम्
करोति बलदानेन पाचकं नाम तत्स्मृतम्

It is located between large intestine and stomach.  (between Amashaya and pakvashaya)
It is composed of all the five basic elements (Panchamaha Bhuta), it is predominant with fire element and devoid of water element.
It is called by the term Anala- fire because of its function of Paka – digestion and transformation of food materials.
It cooks the food, divides it into essence and waste,
It bestows grace and influence on other types of Pitta.
Hence, among all the types of Pitta, Pachaka pitta is the dominant one.

Ranjaka Pitta –

आमाशयाश्रयं पित्तं रञ्जकं रसरञ्जनात्

The pitta located in the Amasaya- stomach is known as Ranjaka. It converts the useful part of the digestion into blood. Hence it converts Rasa Dhatu into Rakta Dhatu. 12 ½

Sadhaka Pitta – 

बुद्धिमेधाभिमानद्यैः अभिप्रेतार्थसाधनात्
साधकं हृद्गतं पित्तं

The pitta located in the Hrudaya –heart is known as Sadhaka.
It attends to mental functions such as knowledge, intelligence, self- consciousness, etc, thereby helping the purpose – aims of life. 13 1/3

Alochaka Pitta – 

रूपालोचनतः स्मृतम्
दृक्स्थमालोचकं

It is located in the eyes. It helps in vision.

Bhrajaka Pitta – 

त्वक्स्थं
भ्राजकं भ्राजनात्त्वचः

It resides in skin and helps exhibition of color and complexions. 14

Types of Kapha - 

श्लेष्मा तु पञ्चधा

Kapha also is of five types;

Avalambaka Kapha –

उरः स्थः स त्रिकस्य स्ववीर्यतः
हृदयस्यान्नवीर्याच्च तत्स्थ एवाम्बुकर्मणा
कफधाम्नां च शेषाणां यत्करोत्यवलम्बनम्
अतो अवलम्बकः श्लेष्मा

It is located in the chest and Trika pradesha – the meeting place of shoulder, neck and back;. By its innate strength and by the power of essence of food, it does lubrication, nourishing etc functions that are attributed to water element. It also influences the functioning of other types of Kapha. 15

Kledaka Kapha -

यस्त्वामाशय संस्थितः
क्लेदकः सो अन्नसङ्घातक्लेदकात्

Located in the Amasaya – stomach. It moistens the hard food mass and helps in digestion.

Bodhaka Kapha –

रसबोधनात्
बोधको रसनास्थायी

It is located in the tongue. It helps in taste perception.

Tarpaka Kapha -

शिरः संस्थो अक्षतर्पणात्
तर्पकः

It is ocated in the head. It nourishes sense organs.

Shleshaka Kapha –

संधिसंश्लेषाच्छ्लेषकः सन्धिषु स्थितः

It is located in the bone joints. It lubricates and strengthens the joint.

इति प्रायेण दोषाणां स्थानान्यविकृतात्मनाम्
व्यापिनामपि जानीयात्कर्माणि च पृथक्पृथक्

Though Tridosha is present all over the body, they are more dominant in specific areas of the body, as explained above.

Qualities that influence increase and decrease of Tridosha – 

Note: In the description given below,

Chaya means – first level increase of Dosha in their own place.
Kopa / Prakopa -  means increase and overflow of Doshas from its own place to other place. It has the potential to cause the disease.
Shama / Prashama - means decrease of increased Dosha and restoration of health.

Qualities that cause Chaya, Kopa and Shama of Vata – 

उष्णेन युक्ता रूक्षाद्या वायोः कुर्वन्ति सञ्चयम्
शीतेन कोपमुष्णेन शमं स्निग्धाद्यो गुणाः

Hot along with dryness, movement, etc causes Vata Chaya.
Coldness along with dryness causes Kopa.
Snigdha (oilyness, unctuousness) and other qualities- Guru (heavy), Usna (hot) , pichila (stickiness),  sthira (stability)  etc. associated with hotness bring about its Shamana of Vata. 19

Qualities that cause Chaya, Kopa and Shama of Pitta -

शीतेन युक्ताः तीक्ष्णाद्याः चयं पित्तस्य कुर्वते
उष्णेन कोपं, मन्दद्याः शमं शीतोपसंहिताः

Teekshna (piercing, strong)  and other qualities- dryness, lightness, etc associated with cold cause Chaya- mild increase of Pitta,
The above qualities associated with hot, cause Kopa – profound increase of Pitta.
Manda (viscous, mild) and other qualities like stickyness, stability etc, associated with cold bring about Pitta Shama- reduction back to normal. 20

Qualities that cause Chaya, Kopa and Shama of Pitta -

शीतेन युक्ताः स्निग्धद्याः कुर्वते श्लेष्मणश्चयम्
उष्णेन कोपं, तेनैव गुणा रूक्षादयः शमम्

Snigdha –(unctuous, oily) and others –heaviness, stickiness, mild, etc along with cold quality causes Kapha chaya. (mild increase)
Same Snigdha – unctuous, oily etc qualities associated with Usna – hot cause Kapha Kopa
Manda- dull and others- rough, dry, clarity, movement, lightness associated with cold quality bring about Kapha Shama- reduction to normal. 21

Overall,

Vata Dosha -
Ushna (hot) + Ruksha (dryness) and associated qualities  cause Vata Chaya
Sheeta (cold) + Ruksha (dryness) and associated qualities cause Vata Kopa
Ushna (hot) + Snigdha (unctuous, oily) and associated qualities cause Vata shama.

Pitta Dosha
Sheeta (cold) + Teekshna (piercing, strong) etc qualities cause Pitta Chaya
Ushna (hot) +  Teekshna (piercing, strong) etc qualities cause Pitta Kopa
Sheeta (cold) + Manda (mild, dull) cause Pitta Shama.

Kapha Dosha -
Sheeta (Cold) + Snigdha (unctuous, oily) cause Kapha Chaya
Ushna (hot) + Snigdha (unctuous, oily) cause Kapha Kopa
Ushna (hot) + Rooksha (dryness) cause Kapha Shama

Levels of Dosha Increase and Decrease

Chaya

चयो वृद्धिः स्वधाम्न्येव प्रद्वेषो वृद्धिहेतुषु २२
विपरीत गुणेच्छा च

Chaya means slight increase of Dosha in its own place.  It produces dislike against the things that would cause further increase of particular Dosha.  It is a self defense mechanism of the body to avoid further increase of Dosha, which may lead to disease. 22

Kopa

कोपस्तु उन्मार्गगामिता
लिङ्गानां दर्शनं  स्वेषामस्वास्थ्यं रोगसम्भवः

Kopa – suggests further increase of Dosha and overflow of increased Dosha into other body channels. It causes appearance of symptoms of increased Dosha, leading to onset of disease process. The premonitory symptoms of the disease can be observed at this stage.

Sama

स्वस्थानस्थस्य समता विकारासम्भवः शमः

Sama means normalcy. Restoration / decrease of increased Dosha to its normal levels.

Fluctuation of Dosha in different seasons –

चयप्रकोपप्रशमा वायोर्ग्रीष्मादिषु त्रिषु
वर्षादिषु तु पित्तस्य, श्लेष्मणः शिशिरादिषु

Dosha	Chaya	Prakopa	Prasama
Vata	Grisma (summer)	Varsha (rainy)	Sharat (Autumn)
Pitta	Varsha (rainy)	Sharat (Autumn)	Hemanta (early winter)
Kapha	Shishira (winter)	Vasanta (spring)	Grishma (summer)

चीयते लघुरूक्षाभिरौषधीभिः समीरणः
तद्विधस्तद्विधं देहे कालस्यौष्ण्यान्न कुप्यति
अद्भिरम्लविपाकाभिरोषधीभिश्च ताद्दृशम्
पित्तं याति चयं कोपं न तु कालस्य शैत्यतः
चीयतेस्निग्धशीताभिरुदकौषधिभिः कफः
तुल्ये अपि काले देहे च स्कन्नत्वान्न प्रकुप्यति

Vata undergoes chaya (mild increase) during summer by the use of Plants possessing such as lightness, dryness etc. It is especially so, in the bodies of persons possessing such qualities. But during summer, Vata does not undergo profound increase due to the heat of the summer. (Remember, cold is a quality of vata). Hot is opposite to Vata, hence there is no increase by a large extent.

Similarly, Pitta undergoes chaya in rainy season, because of production of Amla viplaka (sour taste at the end of digestion) of water and foods. But it does not undergo further increase in rainy season, because of coldness. (Remember, hot is the quality of Pitta) Coldness checks further increase of Pitta in rainy season.

Kapha undergoes Chaya in winter by the use of foods with cold and oily qualiies. But it does not undergo prakopa because Kapha becomes solidified due to severe cold of the winter 25-27

इति कालस्वभावो अयमाहारदिवशात्पुनः
चयादीन् यान्ति सद्यो अपि दोषाः काले अपि वा न तु

So, activities and food habits can cause increase or decrease of Dosha. At the same time, seasonal effect also may cause Dosha increase or decrease.  28

Action of increased Dhosha –

व्याप्नोति सहसा देहामापादतलमस्तकम्
निवर्तिते तु कुपितो मलो अल्पाल्पं जलौधवत्

When there is a flood, the water gushes into the cities very fast, but the reversal process is very slow. Similarly, the increased Doshas spread throughout body from foot to head to produce diseases but the decrease of Dosha and restoration of normalcy takes a very long time. 29

Dosha is the main cause for disease –

दोषा एव हि सर्वेषां रोगाणामेककारणम्
यथा पक्षि परिपतन् सर्वतः सर्वमप्यहः
छायामत्येति नात्मीयां यथां वा कृत्स्नमप्यदः
विकारजातं विविधं त्रीन् गुणान्नातिवर्तते
तथा स्वधातुर्वैषम्यनिमित्तमपि सर्वदा
विकारजातं त्रीन्दोषान्

Like a bird flying high in the sky cannot escape from its shadow, the root cause for disease lies in Tridosha. Even the mental qualities such as Satva, Raja and Tama are influenced by Tridosha. Dosha get vitiated, then cause vitiation of body tissues (Dhatu) and waste products (Mala) to cause disease.  32-34 ¼

Three kinds of causes for Dosha increase -

तेषां कोपे तु कारणम्
अर्थैः असात्म्यैः संयोगः कालः कर्मः च दुष्कृतम्
हीनातिमिथ्यायोगेन भिद्यते तत्पुनस्त्रिधा

The causes of Dosha increase can be categorized as
-         Less involvement (heena yoga),
-         Wrong involvement (Mithya yoga)
-         Over involvement (Atiyoga)
Of
Artha – sense organs
Kala – season
Karma – action .

So, less, wrongful or more involvement of sense organs / seasons / action leads to Dosha imbalance. It is explained further.

Artha – Senses and their correlation:-

हीनो अर्थेन इन्द्रियस्य अल्पः संयोगः स्वेन नैव वा
अतियोगो अतिसंसर्गः सूक्ष्म भासुरभैरवम्
अत्यासन्न अतिदूरस्थं विप्रियं विकृतादि च
यद्क्षणावीक्ष्यते रूपं मिथ्यायोगः स दारुणः
एवामत्युच्च पत्यादीनिन्द्रियार्थान् यथायथम्
विद्यात्

Hinayoga – Poor association of sense organs – insufficient, inadequate, contact or non- contact with the objects of senses- sound, touch, sight, taste and smell with their respective sense organs. For example, not at all hearing to sounds, or living in a low lit area etc

Atiyoga is over indulgence. Seeing objects which are very minute, bright etc, gazing for a very long time, hearing to loud music etc.

Mithya Yoga – wrong indulgence with sense organs – seeing / hearing frightening, very close, very far, disliked and abnormal objects etc. 36-38 ½

Kala – seasons:-

कालस्तु शीतोष्णवर्षाभेदस्त्रिधा मतः
स हीनो हीनशीतादिः अतियोगो अतिलक्षणः
मिथ्यायोगस्तु निर्दिष्टो विपरीतस्वलक्षणः

Kala is of three kinds, cold, hot and rainy.

Hinayoga of the Kala is – less cold in winter, less temperature in summer and less rain in rainy season.

Atiyoga is – more rain in rainy season, more temperature in summer etc.

Mithyayoga is manifestation of qualities opposites of the natural ones of the season. Example – rain during summer, cold weather during summer etc. 38 ½ 39

Karma: Activities:-

कायवाक्चित्तभेदेन कर्मापि विभजेत्त्रिधा
कायादिकर्मणां हीना प्रवृत्तिर्हीनसंज्ञकः
अतियोगो अतिवृत्तिस्तु वेगोदीरणधारणम्
विषमाङ्गक्रियारम्भपतनस्खलनादिकम्
भाषणं सामिभुक्तस्य रागद्वेषभयादि च
कर्म प्राणदिपातादि दशधा यच्च निन्दितम्
मिथ्यायोगः समस्तो असाविह वा अमुत्र वा कृतम्

Three types of actions pertaining to mind, body and speech lead to Dosha imbalance.

Heenayoga – very less speaking, very little physical activity, very less thought process.

Atiyoga – excessive speaking, excess physical activity and excessive thinking.

Mithyayoga – wrong speaking, wrong physical activities and wrong, evil thinking, suppression of natural urges, improper postures, abrupt jumping and falling, speaking – too much immediately after meals , harboring of desires- attachment, passion, hatred, fear etc. 40-42 ½

निदानमेतद्दोषाणां, कुपितास्तेन नैकधा
कुर्वन्ति विविधान् व्याधीन् शाखा
कोष्ठास्थिसन्धिषु

These are the causes for increase of Doshas, thus increased they produce many kinds of diseases, involving the mind, tissues, viscera, bones and joints. 43-44

Pathways of diseases - Rogamargas:-

The body is divided into three sections to explain different diseases.
Antarogamarga – internal path – refers to gastro intestinal tract.
Bahi roga marga – external path – refers to Rakta, Mamsa etc Dhatu (tissues) and skin.
Madhyama rogamarga – it includes vital organs such as brain, heart, blood vessels, joints, nerves etc.

This concept is explained below in detail.

Bahi Koshta / Bahi roga marga – External pathway  -

शाखा रक्तादयः त्वक् च बाह्यरोगायनं हि तत् ४४
तदाश्रया मषव्यङ्गगण्डालज्यर्बुदादयः
बहिर्भागाश्च दुर्नामगुल्मशोफादयो गदाः ४५
Raktha- blood and others tissues (Blood, muscles, bone, fat, bone marrow and sex related secretions) and skin continue the Bahya Rogamarga – external pathway of disease.

It is related with diseases such as moles, discolored patches on face, Gandalaji- goiter, glandular ulcer on the face, malignant tumors, hemorrhoids, abdominal tumor, swelling and other external diseases. 44 ½ -45

Anta Koshta / Anta Rogamarga – Internal path –

अन्तः कोष्ठो महास्रोत आमपक्वाशयाश्रयः
तत् स्थानाः च्छर्द्दयतीसारकासश्वासोदरज्वराः
अन्तर्भागं च शोफार्शोगुल्मवीसर्पविद्रधि

Amashaya – stomach and small intestine,
Pakwashaya – large intestine
The above two, along with the entire gastro intestinal tract is called as Mahasrota. (The big channel). This constitutes the Anta Koshta.

Diseases which affect this path are – vomiting, diarrhea, cough, dyspnoea, enlargement of the abdomen, fever, dropsy, hemorrhoids, abdominal tumors, Visarpa (herpes), abscess etc. 46

Madhyama Koshta / Madhyama Rogamarga – The middle path

शिरोहृदयबस्त्यादिमर्माण्यस्थ्नां च सन्धयः
तन्निबद्धाः शिरास्नायुकण्डराद्याश्च मध्यमः
रोगमार्गः स्थितास्तत्र यक्ष्मपक्षवधार्दिताः
मूर्धादिरोगाः सन्ध्यस्थित्रिकशूलग्रहादयः

The head, heart, urinary bladder and such other vital organs, joints of bones, blood vessels, tendons, ligaments, nerves constitute the madhyama rogamarga. From it arise, consumption , hemiplegia, facial paralysis, diseases of the head and other organs, pain, stiffness- loss of movement of the joints, bones, waist etc. 47-48

Different symptoms produced by increased Dosha - 

Symptoms of Vata increase:

स्रंसव्यासव्यधस्वापसादरुक्तोदभेदनम् ४९
सङ्गाङ्गभङ्गसङ्कोचवर्तहर्षणतर्षणम्
कम्पपारुष्यसौषिर्यशोषस्पन्दनवेष्टनम् ५०
स्तम्भः कषायरसता वर्णः श्यावो अरुणो अपि वा
कर्माणि वायोः

Sramsa – Ptosis- drooping down
Vyasa – dilation
Vyadha – cutting pain
Swapa – loss of sensation
Sada – weakness, loss of function
Ruk – pain
Toda – continuous pain
Bhedanam – splitting pain
Sanga – Constriction,
Angabhanga – bodyache,
Sankocha – shrinking of the organ, reduction in size
Varta – twisting,
Harshana – tingling sensation
Tarshana – thirst
Kampa – tremors
Parushya – roughness
Saushirya – feeling of empty
Shosha – dryness
Spandana – pulsating
Veshtana – rigidity, as if tied
Sthambha – stiffness
Kashaya rasata – astringent taste in mouth
Aruna, Shyava Varna  - appearance of blue or crimson discoloration
- these are the abnormal signs and symptoms of increased Vayu –Vata. 49-50

Symptoms of Pitta increase –

पित्तस्य दाहरागोष्मपाकिताः
स्वेदः क्लेदः सृतिः कोथः सदनं मूर्च्छनं मदः
कटुकाम्लौ रसौ वर्णः पाण्डुररुणवर्जितः

Daha – burning sensation
Raga – reddish discoloration
Ushmapakita – heat, increase in temperature, formation of pus, ulcers
Sveda – sweating
Kleda – inflammation with wetness, moistness
Sruti – inflammation with pus / oozing / secretions, exudation
Kotha – putrefaction- decomposition
Sadana – debility
Murchana – fainting
Mada – toxicity
Katuka Amla Rasa -  bitter and sour taste in the mouth
Pandu Aruna Varjitaha -  appearance of color other than yellowish white and crimson. 51- 52 ½

Symptoms of Kapha increase – 

श्लेष्मणः स्नेहकाठिन्यकण्डूशीतत्वगौरवम्
बन्धोपलेपस्तैमित्यशोफापक्त्यतिनिद्रताः
वर्णः श्वेतो रसौ स्वादुलवणौ चिरकारिता

Sneha – unctuousness, oilyness
Kathinya – hardness
Kandu – itching
Sheetatva – coldness
Gaurava – heavyness
Bandha – obstruction,
Upalepa – coating, as if tied with a wet cloth
Staimitya – stiffness, loss of movement
Shopha – inflammation
Apakti – indigestion,
Atinidrata – excessive sleep
Shveta varna – white discolouration
Svadu lavana rasa – sweet, salt taste in mouth
Chirakarita – delay in all activities. 52 ½ -53.

इत्यशेषामयव्यापि यदुक्तं दोषलक्षणम्
दर्शनाध्यैरवहितस्तत्सम्यगुपलक्षयेत्
व्याध्यवस्थाविभागज्ञः पश्यन्नार्तान् प्रतिक्षणम्

Thus are enumerated, the features, which appear in diseases, are to be recognized by the physician through inspection and others – methods of examination of patient. 54

Importance of patient observation: To gain the knowledge of the different stages of disease the physician should observe the patient every minute.55

अभ्यासात्प्राप्यते दृष्टिः कर्मसिद्धिप्रकाशिनी
रत्नादिसदसज्ज्ञानं न शास्त्रादेव जायते 

Knowledge of successful treatment is obtained from constant practice just as knowledge of determining the quality of gems is obtained only from- knowing the science. 56

Three kinds of diseases based on cause – Trividha roga-

दृष्टापचारजः कश्चित्कश्चित्पूर्वापराधजः
तत्सङ्कराद्भत्यन्यो व्याधिरेवं त्रिधा स्मृतः

Diseases are of three kinds viz,

Karmaja Vyadhi – Includes Diseases that originate due to bad deeds of the past lives, or of present life or of both past and present lives. Usually the cause for such disease is not clearly known. 57

Doshaja Vyadhi – 

यथानिदानं दोषोत्थः कर्मजो हेतुर्भविना
महारम्भो अल्पके हेतावातङ्को दोषकर्मजः

Diseases which arise from the specific causes, which lead to Dosha increase and then to disease manifestation.

Doshakarmaja – combination of bad deeds and indulgence in causes of disease result in disease.  Usually the symptoms are profound in this case. 58

Treatment for such diseases: 

विपक्षशीलनात्पूर्वः कर्मजः कर्मसङ्ख्यात्
गच्छत्युभयजन्मा तु दोषकर्मक्षयात्क्षयम्

The Doshaja diseases get cured from indulgence in food, activities and medicine that have opposite qualities to the cause.

Karmaja diseases get cured after the termination of the effects of such acts of previous / current lives.

Dosha-Karmaja diseases get cured after the mitigation of Dosha and nullifying of effects of past deeds. 59

Two kinds of diseases – based on cause – Dvividha roga—

द्विधा स्वपरतन्त्रत्वाद्याधयोअन्त्याः पुनर्द्विधा
पूर्वजाः पूर्वरूपाख्या, जाताः पश्चादुपद्रवाः

1. Svatantra Roga 

यथास्वजन्मोपशयाः स्वतन्त्राः स्पष्टलक्षणाः
विपरीतास्ततो अन्ये तु

Svatantra Roga – independent/ primary – have their own specific causes, comforting methods and clearly manifest features.

2. Paratantra Roga – secondary diseases, associated diseases. Those which do not have their own specific cause.
It is further of two types.

Purvaja – premonitory symptoms – the symptoms that are seen at the initial stage of a disease

Upadrava – complications of diseases. 60- 61

विद्यादेवं मलानपि
तांल्लक्षयेदवहितो विकुर्वाणान् प्रतिज्वरम्
तेषां प्रधानप्रशमे प्रशमो अशाम्यतस्तथा
पश्चाच्चिकित्सत्तूर्णं वा बलवन्तमुपद्रवम्
व्याधिक्लिष्टशरीरस्य पीडाकरतरो हि सः

The secondary disease (Paratantra Roga) usually subsides when the primary diseases is treated.
If they do not get subsided then, treatment has to be given- for the secondary diseases as well.
If powerful, secondary affections should be treated soon because these- complication cause more troublers to the body which is already debilitated by the primary disease. 62-63

विकार नाम अकुशलो न हि जिह्रीयात् कदाचन ।

नहि सर्वविकाराणां नामतो अस्ति ध्रुवा स्थिति: ॥६४॥

The physician should never feel shy for not knowing the nomenclature of the disease, for there is no rule/ custom/ state, that every disease has a name. 64

स एव कुपितो दोषः समुत्थानविशेषतः
स्थानान्तराणि च प्राप्य विकारान् कुरुते बहून्
तस्माद्विकारप्रकृतिरधिष्ठानान्तराणि च
बुद्ध्वा हेतुविशेषांश्च शीघ्रंकुर्यादुपक्रमम्

The very same Doshas, depending upon the nature of the causative factors, travels to many parts of the body and produces many disease, hence treatment of the disease, its abode- site should be judged very quickly with the help of knowledge of the disease. 65-66

Factors to observe in patient -

दूष्यं देशं बलं कालं अनलं प्रकृतिं वयः
सत्त्वं सात्म्यं तथा आहारं अवस्थाश्च पृथग्विधाः ६७
सूक्ष्म सूक्ष्माः समीक्ष्यैषां दोष औषध निरूपणे
यो वर्तते चिकित्सायां न स स्खलति जातुचित् ६८

The physician should minutely examine and determine,
Dushya – the Dhatus and Malas involved in a diseases
Desha – the area of the body where disease is manifested, the living place of the patient
Bala – strength of the patient
Kala- season, how old is the disease, age of the person etc.
Anala- digestive power of the patient
Prakriti- Body constitution,
Vayas- age of the patient and disease,
Satva- mind, tolerance capacity of the patient
Satmya- The food and activities to which the patient is accustomed to.
Ahara- food habits and
Avastha- stages of the diseases

The physician should watch for above factors to decide and then only, the physician should decide on the aggravated Dosha and its appropriate treatment. Such a doctor will never commit mistakes in treatment. 67-68

गुर्वल्पव्याधिसंस्थानं सत्त्वदेहबलाबलात्
दृश्यते अप्यन्यथाकारं तस्मिन्नवहितो भवेत्

The symptoms may be affected by the disease and also by the mental status of the patient. The strength of the disease varies based on strength and weakness of the mind and body of the patient. Hence the physician should be very attentive. 69.

गुरुं लघुमिति व्याधिं कल्पयेस्तु भिषग्ब्रुवः
अल्पदोषाकलनया पथ्ये विप्रतिपद्यते

The unintelligent physician, who determines a grievous disease as a mild one, goes wrong in treatment because of under estimating the condition the Dosha. 70

ततो अल्पमल्पवीर्यं वा गुरुव्याधौ प्रयोजितम्
उदीरयेत्तरां रोगान् संशोधनमयोगतः
शोधनं त्वतियोगेन विपरीतं विपर्यये
क्षिणुयान्न मलानेव केवलं वपुरस्यति

He will administer drugs/ therapies in small doses. Such mild treatment causes worsening of the disease because of ineffective treatment.

On the other hand, if the person over estimates the strength of the disease and over treats with Panchakarma and oral medicines, it will also trouble the health of the patient to a very great extent. 71- 72

अतो अभियुक्तः सततं सर्वमालोच्य सर्वथा
तथा युञ्जीत भेषज्यमारोग्याय यथा ध्रुवम्

Hence the physician should constantly study the science, determine the exact condition of all factors, all the time and then administer appropriate medicines and treatments. 73

Number of combination of Dosha – Dosha Samyoga samkhya –

वक्ष्यन्ते अतः परं दोषा वृद्धिक्षयविभेदतः
पृथक् त्रीन् वृद्धि संसर्गस्त्रिधा, तत्र तु तान्नव
त्रीनेव संया वृद्ध्या, षडेकस्यातिशायने
त्रयोदश समस्तेषु षड् द्वयेकातिशयेन तु
एकं तुल्याधिकैः षट् च तारतम्यविकल्पनात्
पञ्चविंशतिमित्येवं वृद्धैः क्षीणैश्च तावतः

The number of combinations of Dosha increase and decrease are 62.

In their vriddhi they are - 3 individually, in the combination of two doshas they are 3, and 9 in total- 3 in equal proportion of increase, 6 with preponderance of one dosha; they are 13 in combination of all three together - 6 with preponderance of any one dosha, 1 with equal preponderance of all the three, 6 by disproportionate subdivisions; Thus in respect of vriddhi they are 25; Similarly in respect of kshaya they are 25.

एकैकवृद्धिसमताक्षयैः षट् ते पुनश्च षट्
एकक्षयद्वन्द्ववृद्धया सविपर्यया अपि ते

In the combination of increase, normal and decrease of one dosha each will make up for 6 numbers

Again they are 6 in the combination of decrease of 1 dosha  and increase of 2 doshas

भेदा द्विषष्टिनिर्दिष्टाः त्रिषष्टः स्वास्थ्यकारणम्

The number of combinations of Dosha increase and decrease are 62.

The 63^rd is the condition, where all the Doshas are in equilibrium, which is called as the state of health. 78

संसर्गाद्रसरुधिरादिभिस्तथैषां दोषांस्तु क्षयसमताविवृद्धिभेदैः
आनन्त्यं तरतभयोगतश्च यातान् जानीयादवहितमानसो यथास्वम्

With the association of Rasa, Rakta etc and the level of increase or decrease of Doshas, there can be innumerable permutations and combinations. The physician should understand them by their features – signs and symptoms with an attentive mind.79

Thus ends the twelvth chapter called Dosabhediya Adhyaya in sutrasthana of Astanga hrudaya composed by Vaghata.