Decoding Ashtanga Hridayam: Chapter 1- AYUSHKAMIYA

This is a very crude attempt from my end to read and interpret Ashtanga Hridayam, and explain it’s principles in treating diseases. I am a medical doctor training in Allopathy, and I am deeply passionate about human biology. Via a series of articles, I will be explaining Ashtanga Hridayam using layman’s language with a perspective of an allopathy practitioner. I intend to be thorough, yet simplistic. I would like to apologize right at the start if I make errors in this attempt.

In the last article I discussed briefly touched upon the Ayurvedic Concepts of Prakriti and Doshas. I discussed in detail how clinical trials are inaccurate instruments to confirm and validate any evidence for Ayurveda. I also explained how modern medical genetics provides authoritative evidence proving accuracy of Ayurveda.

In this article, I will discuss concepts from the first chapter of Ashtanga Hridayam. This chapter goes by the name- Ayushkamiya. I will combine translations from this chapter of Ashtanga Hridayam with my notes on those, based on my understanding of human biology.

Introduction

Ayushkamiya means “desire for long life”.

The text tells that any person desirous of long life should repose utmost faith in the teachings of Ayurveda. Life is viewed as a tool for achieving dharma (righteousness), artha (wealth) and sukha (happiness)  Sukha includes both kama (desire of sensual enjoyment) and moksa (salvation). Dharma, artha, kama and moksha are known as Purusharthas (pursuits of life) to be followed by every person. For achieving these, a long and healthy life is essential.

In this chapter, Vagabhata briefly recounts how the knowledge of Ayurveda evolved and passed on. The details are actually available in the first chapter of another Ayurvedic text- Charaka Samhita.

”Lord Brahma, recalling to his mind the science of life, taught it to Daksha (Prajapati). Prajapati taught it to Ashvin twins, who in their turn taught to Indra-the king of the gods. When diseases began to trouble the human beings, the great sages of the world assembled in the slopes of the Himalaya mountains. There these sages resolved to learn the science of Ayurveda from Indra and bring it to the world for the benefit of living beings. But who would undertake this difficult task of going to heaven and learn the science from Indra? Sage Bharadvaja, one of the participants of the assembly, volunteered for the task which was very gladly accepted. Bharadvaja went to Indra’s abode, learnt the science from him, came back to earth and propounded it to the assembly of sages. Krishna Atreya, also known as Punarvasu Atreya, who was son of sage Arti, taught this science to six of his disciples- Agnivesa, Bhela, Jatukarna, Parasara, Harita and Ksarapani. Each one of them wrote a treatise and placed them before their teacher Krishna Atreya and the assembly of the sages. The treatise of Agnivesa was adjudged as the best and was praised even by the gods. It became popular in the world.”

The teachings of Krishna Atreya deals mainly with: Kayachikitsa (internal medicine) which is one among the eight branches of Ayurveda. This school is popularly known as Atreya Sampradaya or Kayachikitsa. The original treatise written by Agnivesa is not available today. The one which is available is the revised version that was written by Sage Charaka. This version is what we know as Charaka Samhita. Charaka Samhita underwent a second revision later by Dradhabhala. Modern scholars assign Krishna Atreya and Agnivesa to 6th-5th century BC, Charaka to 2^nd century AD and Dradhabhala to 4^th century AD.

Ashtanga Ayurveda (eight branches of Ayurveda)

Vagabhata mentions that Kaya, Bala, Graha, Urdhvanga, Salya, Damstra, Jara and Varsa are the eight branches of Ayurveda.

Kayachikitsa branch deals with the treatment of diseases arising from disorders of digestive activity. In modern parlance Kayachikitsa can be seen as Internal Medicine. Bala chikitsa is treatment of diseases of children (paediatrics), Graha chikitsa means treatment of diseases arising from possession by evil spirits, pathogenic micro-organisms etc. and deals mainly with mental diseases (psychiatry). Urdhvanga chikitsa deals with treatment of diseases of the head inclusive of the eyes (ophthalmology), ears (otology), nose (rhinology), throat (laryngology) and teeth (dentistry). Salya chikitsa, also known as Shastra chikitsa, deals with treatment requiring the use of knife (surgery). Damstra chikitsa is treatment of diseases due to poison (toxicology). Jara cikitsa, also known as Rasayana chikitsa deals with treatment of diseases of old age (gerontology, geriatrics). Varsa chikitsa deals with treatment of diseases like impotence, sterility etc. and making man sexually strong by the use aphrodisiacs.

Tridoshas

Ashtanga Hridayam mentions that- Vata, Pitta and Kapha are the three doshas, in brief; they destroy and support the body when they are abnormal and normal respectively.”

The doshas are material substances that are always present in the body. In any individual, these doshas have their own definite pramana (quantity), guna (quality) and karma (functions). When they are normal (avikrita) they maintain different functions of the body. But they have the tendency to become abnormal (vikrita). Each can undergo increase (vriddhi) or decrease (kshaya) in their quantity, one or more of their qualities and functions. When they become abnormal, they spoil and harm their places of dwelling- the dhatus (tissues). Because of this tendency to spoil or harm, they are called doshas. These three doshas-Vita, Pitta and Kapha-are more intimately concerned with the physical body. Hence they are specifically called as shariraka doshas. Similar to them are two doshas of mind (manasa doshas)- the Rajas and the Tamas. Rajas and Tamas are concerned with the mind. Some ancient texts consider Rakta (blood) as the fourth sharirika dosha. But, Ashtanga Hridayam specifically sticks to the framework of three doshas and does not recognize Rakta as a dosha.

Doshas are present in every cell of the body attending to its different functions. But each dosha has a preference in terms of location- Vata preferentially rests below the umbilicus, Pitta in the area between the heart and the umbilicus, and Kapha in the area above the heart.

Doshas are also influenced by age of an individual, stage of digestion and time of the day. Vata is predominant in old age (after 60 years of age), in the afternoon (between 3 pm and 7 pm), late night (between 2 am and 6 am) and at the end of digestion of food. Pitta is predominant in the middle age (between 20 and 60 years), midday (between 11 am and 4 pm), midnight (between 12 am and 2 am) and during middle period of digestion. Kapha is predominant in early age ( from birth upto 16 years of age ), in the morning ( between 6 am and 10 am), in the early part of the night (between 7 pm and 11 pm ) and the early period of digestion.

Doshas	Preferred Location	Preferred time	Preferred stage of digestion	Preferred age
Kapha	Above heart	6 am to 10 am 7 pm to 11 pm	Start of digestion	Birth till 16 years
Pitta	Between heart and umbilicus	11 am to 4 pm 12 am to 2 am	Middle of digestion	20- 60 years
Vata	Below umbilicus	3 pm to 7 pm 2 am to 6 am	End of digestion	>60 years

This is quite interesting. It simply emphasizes the importance to ensuring meal and sleep timings to keep a healthy equilibrium.

Agnibheda (Kinds of digestion)

Agni refers to the fire-like activity in the alimentary canal, responsible for digestion of food. This activity is influenced by the condition of the doshas. Ashtanga Hridayam says that when all the three doshas are in equilibrium, the digestion of food will be perfect in all respects. This is known as Samagni-normal digestion. But when the doshas increase, they bring about their own characteristic changes in the digestive activity. When Vata goes up, the digestion becomes irregular and erratic and is accompanied with flatulance etc. A Vata dominated digestive activity is known as Visamagni. When Pitta is high, the digestive activity is very intense. Even large quantities of food get digested very quickly. Such situation leads to burning sensation, thirst, etc. during digestion. This Pitta dominated digestion is known as Tiksagni. When Kapha is aggravated the digestive activity is very dull, poor and inadequate. Even small quantities of food get digested after a long time and there is heaviness of the abdomen, lethargy, etc. during digestion. Such Kapha predominant digestion is known as Mandagni. All these three types of abnormal digestion (Visamagni, Tiksagni and Mandagni) give rise to many diseases corresponding to the causative doshas.

Koshtabheda (Kinds of bowel activtities)

Vata predominance makes the bowel movement hard (hard rough feces being eliminated with difficulty and not regularly every day). High Pitta makes the bowel soft (semi-solid or liquid feces, eliminated more than once a day- even drinking of milk produces loose motions). Kapha dominant bowel is moderate (feces neither hard solid nor liquid, is eliminated without difficult once a day, regularly). When all the doshas are in equilibrium, again the bowel is moderate. This state of equilibrium does not give rise to any disease. You can see that the state of equilibrium for bowel mimics a Kapha predominant bowel.

Dosha status	Type of digestion	Characteristics of digestion	Characteristics of feces
Doshas in equilibrium	Samagni	Normal	Neither hard solid nor liquid, is eliminated without difficult once a day, regularly
High Vata	Visamagni	Erratic digestion, flatulence	Hard rough feces being eliminated with difficulty and not regularly every day
High Pitta	Tiksagni	Intense digestion, quick digestion of large amount of food	Soft, semi-solid or liquid feces, eliminated more than once a day and can lead to diarrhoea
High Kapha	Mandagni	Dull digestion, takes a long time to digest small amount of food	Moderate, neither hard solid nor liquid, is eliminated without difficult once a day, regularly

Dehaprakrti (Body constitution)

Ashtanga Hridayam talks about sukranu and andanu during genesis of life. The male seed is called sukranu  (spermatazoa), while the female seed is called andanu (ovum). Both these unite together (fertilization) and form the embryo. This is how life starts. The male and the female seeds produced in the body of the man and the woman, contain the tridoshas. At the time of the union of the two seeds the doshas undergo change in their proportion. There are three possibilities here. Either all of them might remain in equal proportion, or any two together might become predominant or any one dosha only might become predominant. These conditions greatly influence the nature of the embryo which ultimately defines the Prakriti of a person (natural constitution unique to that person). Thus there are seven kinds of prakritis possible, three ekadosaja (predominance of one dosha) , three dvandvaja or samsargaja (predominance of a combination of any two doshas) and one from sammisra or sannipata ( from the combination of all the three together in equal proportion ) . Among these, ekadosaja are hina (poor), the samsargaja (dvandvaja) are madhya {moderate) and sammisra is uttama (best, ideal). Further, even among the ekadosaja, vitaja is hina (poor), Pittaja is madhya (moderate), and Kaphaja is uttama (best).

Type of spermatozoa/ovum	Constitution	Rating
Sammisara/ Sannipata	All 3 doshas in equal proportion	Best
Dvandvaja/ Samsargaja	Combination of any two doshas	Average
Ekadosaja- Kaphaja	Consists of only Kapha	Bad
Ekadosaja- Pittaja	Consists of only Pitta	Worse
Ekadosaja- Vataja	Consists of only Vata	Worst

It’s pleasantly surprising to note here how the ancient seers were deeply aware of the concept of meiosis and fertilization at cellular level, and how genetic mixing happens during fertilization.

If somehow western medicine can measure levels of each doshas in spermatozoa and ovum, it can potentially revolutionize the science artificial insemination and test tube baby industry!

Ashtanga Hridayam compares doshas to poisonous worms. Doshas, on their own, are harmful. However, they together achieve balance and this balance is essential for creation and sustenance of a healthy life. It is important to note that each person has his/her own unique proportion of doshas that is perfect for him/her.

Tridoshalakshana (Properties of Tridoshas)

• Properties of Vata: Ruksha (dryness), laghu (light in weight), shita (coldness), khara (roughness), shukshma (subtleness) and chala ( movement) are the properties of Anila (Vata Dosha). Imagine cold dry gust of air.
• Properties of Pitta: Sasneha (slight greasiness), tikshna  (penetrating deep), ushna (hot, heat producing), laghu (light in weight), vishra (bad smell), sara (free flowing) and drava (liquidity) are the properties of Pitta Dosha. Imagine bile.
• Properties of Kapha: Snigdha (greasiness), shita (cold, producing coldness), guru (heavy), manda (slow in action), shlakshna (smooth), martsna (slimy) and sthira (stable/static) are the properties of Kapha Dosha. Imagine thick mucous.

Both in their decreased and increased states, the combination of any two doshas is known as samsarga and of all three, as sannipata.

Dhatu and mala-(basic tissues and wastes)

Rasa (plasma), asarka (blood), mamsa (muscles), medas (fat), asthi (bone), majja (bone marrow) and sukra (semen) are the seven dhatus (basic tissues) and are also known is dushya (those that get spoit by the doshas), as per Ashtanga Hridayam.

Malas (waste products) are the mutra (urine), sakarta (feces), sweda (sweat) etc.

Vriddhi (increase) of all of them (doshas, dhatus and malas) is caused by the use of samana (similars) , They decrease by use of viparita ( dissimilars ).

In any individual, each of the doshas, dhatus, and malas has its own pramana (quantity), gunas (specific qualities) and karmas (functions). When they are in the state of normaly (samya ), they are conducive to health. They sometimes undergo vriddhi ( increase ) and kshaya ( decrease) in their quantity, one or more of their qualities and functions (which are both known as vaisamya (abnormalcy)). This leads to disease. Association with substances, qualities and activities which are similar with the material, qualities and functions of the doshas, dhatus and malas bring about their increase, whereas association with substances, qualities and activities which are viparita (dissimilar, opposite) bring about their decrease.

Sadarasa-(six tastes)

Swadu/madhura (sweet), amla (sour), lavana (salt), tikta (bitter), ushana (pungent) and kasaya (astringent) are the six rasas (tastes). Each one is more strengthening to the body in their order of precedence.

Taste is also a guna (quality) of every substance. Each substance may have one or more taste, which becomes known when the substance is put on the tongue. The first immediately recognizable taste is known as Pradhana rasa (primary taste) and the remaining tastes which are recognized later and mildly are known as anurasa (secondary taste). In respect of giving strength to the body, kasaya (astringent) provides the minimum, and swadu or madhura (sweet) providing the maximum.

6 Tastes	Doshas Increased	Doshas Decreased
Sweet	Kapha	Vata, Pitta
Sour	Kapha, Pitta	Vata
Salt	Kapha, Pitta	Vata
Bitter	Vata	Kapha, Pitta
Pungent	Vata, Pitta	Kapha
Astringent	Vata	Kapha, Pitta

It is logically to assume that if one has to lose weight, one must stick to those food which are astringent or pungent or bitter in taste.

Modification of doshas by tastes

Swadu, amla and lavana decrease Vata; tikta, usana and kasaya alleviate Kapha; kasaya, tikta and madhura alleviate Pitta.

Tikta, ushana and kasaya cause increase of Vata; amla, lavana and ushana cause increase of Pitta; swadu, amla and Iavana cause increase of Kapha-properties

Dravyabhedah (kinds of substances)

Dravyas (substances used as food, drugs, etc.) are of three kinds- samana (those which decrease the doshas), kopana (those which aggravate the doshas) and swasthahita (those which help maintain health).

Virya (Potency)

Ushna (heat) and shita (cold) are the two powerful qualities of any substance. Virya (potency of the substances) denotes the magnitude of these qualities from each such substance.

Vipaka ( nature of end product of digestion)

Vipaka can be of three types: swadu (sweet), amla (sour) and katu (pungent).

Twenty gunas (qualities) of any substance

Guru (heavy), laghu (light in weight), manda (slow), tikshna (quick, fast), hima (cold), ushna (hot), snighda (greasy), ruksha (dry), slakshna (smooth), khara (rough), shandra (solid), drava (liquid) mridu (soft), kathilna (hard), sthira (stable), chala (moving, unstable), sukshma (subtle, small), sthula (big, gross), vishada (non-slimy) and picchila (slimy): as per Ashtanga Hridayam these are the twenty qualities any substance can posses.

Roga-arogya karana (cause of disease and health)

Hina (inadequate, poor), mithya (improper, perverse) and ati (excess), yoga (association, contact, union) of kala (time, season, frequency and duration), artha (objects of senses) and karma ( activities, functions) are the chief causes of diseases; whereas their samyak yoga (proper contact, association) is the chief cause of health, as per Ashtanga Hridayam. In a particular individual each dosha possesses its own specific quantity, qualities and functions- when these are normal it is known as samya (equilibrium). Increase (vrddhi) and decrease (kshaya) in its quantity, one or more of its qualities and functions are known as its vaisamya (disequilibrium).

Deficiency or excess or improper engagement of any activity or substance leads to imbalance between the doshas. Roga (disease) results from disequilibrium of the doshas – while health is the result of the equilibrium of the doshas.

Roga (disease) is said to be of two kinds- nija (organic, arising from the body itself) and agantu (traumatic, arising from external causes). The adhisthana (seat, residence) of disease can be at two sites: kaya (the body) and manas (the mind).

Manasika doshah (doshas of the mind)

Ashtanga Hridayam enumerates Rajas and Tamas as the two doshas of the manas (mind). Satva, Rajas and Tamas are known as the three mahagunas. These mahagunas are primary qualities responsible for creation of all the substances of the world and said to be present in every particle. Out of them, Satva is considered to be pure and does not having any bad effect, whereas Rajas and Tamas have bad effects. Hence Rajas and Tamas are considered as the doshas of the mind, when they increase above the specific limit.

Rogi-roga pariksha- (examination of the patient)

Ashtanga Hridayam mentions that the rogi (patient) should be examined by darshana (inspection), spadana (palpation) and prashna (interrogation). Roga (disease) should be examined by its nidana (causes), pragrupa (starting symptoms), lakshana (specific signs and symptoms, clinical features), upasaya (diagnostic tests) and apti (pathogenesis).

This process is very similar to what is taught in western medicine as well.

Deshabhedah- (kinds of habitat)

Desha (habitat) is said to be of two kinds- bhumi desha (region of residence) and deha desha (the body). Bhumi desha (region of residence) is of three kinds- jangala, anupa and sadharana. Jangala is predominant of Vata, anupa is predominant of Kapha and sadharana a which has all the three doshas in normal condition.

Jangala region is arid or desert-like land with no mountains or hills, has less vegetation, poor water resources and is more breezy. Anupa is marshy land with more water, more vegetation, very less of sunlight and heat. Sadharana is the moderate type with few mountains, hills, moderate water., vegetation and sunlight.

Type of land	Description	Predominant Dosha
Jangala	Arid or desert-like land with no mountains or hills, has less vegetation, poor water resources and is more breezy.	Vata
Anupa	Marshy land with more water, more vegetation, very less of sunlight and heat.	Kapha
Sadharana	Moderate type of land with few mountains, hills, moderate water., vegetation and sunlight.	Vata, Kapha, Pitta

Kalabhedah (kinds of time)

Ashtanga Hridayam refers to kala (time) which is relevant to the administration and selection of drugs/therapies. Kala is of two kinds- the time commencing with kshana (moment) etc  and that of the stages of the disease.

Kshana is the minimum unit of time measurement and is equivalent to the time required for winking of the eyelid once or uttering of one letter of the alphabet. Kastha, kala, nadika, muhurata, yama, ahoratra, paksha, masa, ritu, ayana and samvatsara-are the successive units of time. Knowledge of this external time is essential for collection of drugs at appropriate period, preparation of medicine recipes, administration of therapies to the patient etc. Any disease never develops all of a sudden- it develops in different successive stages. Each stage has its own characteristic signs and symptoms. Recognition of each stage helps the physician to assess the strength of the disease and decide the appropriate drug and therapy required for that stage. This explains the necessity of two kinds of time.

Aushadha bhedah (kinds of therapies)

As per Ashtanga Hridayam, Aushadha (medicines/therapies) are of two types: shodhana (purifying) and samana (palliative). Shodhana is the method of eliminating the aggravated doshas from the body forcibly, thus purifying it. Samana, on the other hand, is to rebalance the aggravated doshas within the body itself.

For eliminating the doshas of the body, basti (enemata), vireka (purgations) and vamana (emesis) are the best therapies. Similarly taila (oil), ghrata (ghee, butterfat) and madhu (honey) are ideal for mitigating doshas. Administration of different kinds of medicinal enemas is best for mitigating Vata, inducing purgations helps eliminate Pitta and vomiting woks best to eliminate Kapha. Use of medicated oils (both internally and externally) is ideal for mitigating Vata, ghee for mitigating Pitta and honey for lowering Kapha.

	Vata	Kapha	Pitta
Elimination	Enemas	Vomiting	Purgation
Lowering	Medicated oils	Honey	Ghee (clarified butter)

Dhi (discrimination), dhairya (courage, strong will) and atmadi vijnana (knowledge of the self/soul) are the ideal therapies for the mind. Dhi is the ability of the person to differentiate between good and bad. Dhairya is ability to adhere to the good, avoid the bad, and withstand difficulties with strong will. Atmadi vijnana is obtaining correct philosophical view of human life, self and soul.

Chikitsa padah (four limbs of treatment)

Vagabhata mentions that the physician, the attendant (nurse), the drug and the patient are the four limbs of treatment; each one has four (good) qualities.

The physician must be efficient, having learnt the science in all its meanings (implications) from a preceptor, must have witnessed the therapies (gained practical experience) and be pure/clean in body, mind and speech.

The drug should be suitable for preparing many recipes, must possess many good qualities (taste and other properties), should be endowed with virtues (genuine, not defective) and must be suitable to be used in different condition of the doshas, in different diseases and different types of persons.

The attendant (nurse) should be attached (affectionate, faithful to the patient), clean (in body, mind and speech), efficient in work and intelligent.

The patient should be wealthy, obedient to the physician, having good memory (capable of remembering and explaining events connected with probable causes, symptoms, etc.) and of strong will (capable of withstanding strain of therapies).

Rogabhedah (kinds of diseases)

Disease is of two kinds-sadhya (curable) and asadhya (incurable). Sadhya (curable) diseases are on two kinds -susadhya ( easily curable) and kricchra sadhya (curable with difficulty). Asadhya (incurable) disease are also of two types- yapya (controllable) and anupakrama (does not respond to any therapy, fatal).

Sadhya Asadhya Lakshana (features of curability and incurability)

Ashtanga Hridayam describes features of diseases in terms of ease of treatment.

Susadhya diseases (easily curable) posses following features:

• Patient is capable of withstanding all kinds of therapies
• Patient is an adult
• Patient is a male
• Patient has good self-control
• The disease is not affecting vital organs,
• The disease has few/mild causes, premonitory symptoms and specific features which are uncomplicated (having no secondary diseases or very troublesome symptoms etc.) which are dissimilar in respect of doshas, dushyas (tissues), desha (habitat), ritu (season) and prakriti (body constitution)
• All the four limbs of treatment in excellent condition
• Planetary influence is favourable
• Disease has arisen from any one dosha
• Disease can be seen manifesting in one disease pathway
• Disease is of recent onset

Diseases which require the use of sharp instruments etc. in treatment and also those which have mixture of factors (enumerated above) are kricchra sadhya (curable with difficulty).

Diseases which persist till the remainder of life, but can be controlled with continuous good regimen (of drugs, food, activities etc.) and which possess qualities of the easily curable diseases are yapya (controllable).

Diseases which have features entirely opposite of curable diseases, which have stayed long, have involved all the important tissues and vital organs, which have produced anxiety (fear of death), delusion and restlessness, which are presenting fatal signs and which cause loss of sense organs (sensory functions) are anupakrama (which can’t be cured and death is certain).

Vagabhata is clear about which patient must be accepted by a doctor for treatment. As per Vagabhata, the physician should refuse to treatment a patient who is hated by the physician and the king (or government) and who hates them; who hates himself (dejected in life), who does not have the necessary facilities/tools required for treatment, who is busy with his/her own activities (not having the required attention/time towards the treatment), who is disobedient (to the physician), whose life is coming to an end, who is of evil mind, 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).

Chapter 1 ends by enumerating the names of chapters and topics that constitute Ashtanga Hridayam

I hope I was able to do justice in decoding Chapter 1 of Ashtanga Hridayam. In the next article, I will commence dissecting Chapter 2.