The difference between Kleda and Aama Part 2
Aama gets generated and is a reason for disease formation. The main focus on pathogenesis is vitiation of doshas and weakness of srotas. For doshas to increase there has to be disturbed agni. If agni is balanced and strong, it won’t let doshas increase. Depletion of agni, formation of aama and THEN doshas increase and from there disease begins.
Few factors responsible for creating different stages of disease
Normally when we see different kinds of diseases we talk about chronic and acute stages of disease as well as severe mild and other different stages. The following is the stages and how they are formed.
Five factors that have potential to create different stages in the disease.
- Kala – time. Even if you are treating any disease, there are specific patterns to it and the stage will change. Certain things change symptom and pathogenesis wise. Ex.: First 8 days of a fever are considered navajwara – new fever, not old. Then after 8, that same fever considered jeerna jwara – old fever. First 8 days the body is struggling to reduce the fever. The body has enough strength in the dhatus. But after 8 days, not enough unctuousness in the dhatus, the body becomes slightly weak and we need to treat in a different manner. In the first 8 days the main focus is on bitter things to reduce aama and NO ghee to increase aam. Ghee has potential to increase kleda and aama. Can cause manda agni. That is why it is absolutely contraindicated in first stage of fever. Pruthvi + aap. If astringent decoctions are administered in Taruna (first stage of) Jwara, before the 6th day, then, the Doshas get adhered because of stickiness, and do not undergo Paka (digestion or coming to ripeness). This leads to the onset of Vishama Jwara – fever (irregular fever) which is not a complication of the original disease.
After 8 days agni is slightly better if one has fasted (langhan) and/or followed proper pathya but dhatus maybe somewhat depleted so it is the right time to add medicated ghee or even regular ghee as anupan with herbs depending upon the type of fever that it is.
After those 8 days, Ghee is administered when there is less Kapha aggravation with dominant Vata and Pitta Doshas. Ghee should only be administered after fever has crossed pachyamana stage. Ghee should not be administered if the patient has Kapha dominance and if the langhana (fasting) treatment is not appreciated even after 10th day of fever. To such patient, Kashaya (a decoction) is given till the body becomes light. The food in such cases is Mamsa Rasa (meat soup) because it promotes strength, which is capable of inhibiting the Doshas.
The body needs to replenish that unctuousness. Because of lack of nutrition for 8 days, dhatus are somewhat depleted and need nourishment. Doesn’t mean absolutely bedridden situation, but can be a comes and goes pattern. Vishamajwara – variable.
Another condition is a low-grade fever that you don’t see on the thermometer, but after 21 days becomes chronic. You know about it from the symptoms. I’m feeling feverish – tired, malaise, no energy, even hot. Similar signs to purvarupa of fever but not absolutely fever, but is a kind of fever that is disturbing the body. In the evening feeling tired or fever. Feel warm and heat inside the body.
Ex.2 rheumatoid arthritis – situation is same, lifestyle, herbs etc. are the same, but because of climate and weather changes the symptoms have changed. That is due to kala.
Ex.3 cold moving from nose to throat to chest – takes time to progress through the disease. Ex. 4 asthma attacks at nighttime. Specifically related to time.
Ex. 5 heart attacks at Vata time.
In same manner, time can be helpful. Abscess is present, red, hot and painful. At that time its problematic to treat, you don’t want to cut it open then. But if we apply herbs and allow time to pass and stages to change to final stage of puss formation and at that point it is painless and by applying herbs can open on own.
Fibroids – specifically pre ultrasounds, there were clinical tests to understand – pulse exam etc. but if every other examination that tells us whether fetus or fibroid forming. Time will help us to diagnose. Time will reveal what is happening. In the same manner, time is applicable to almost everything. Both complex and simple diseases.
Shingles/chicken pox – sharadrutu – summer shows these pitta related issues. According to time changes occur in particular dosha. And according to kala, we treat certain conditions too – vamana we treat in the morning not in the afternoon or evening. According to time certain things change in doshas and stage of disease and accordingly we can treat the system.
- Agni – very crucial factor in any disease. All diseases are caused by agni. That causes certain other conditions. If we improve the quality of agni, nurture the agni, we can improve the condition so naturally the stage of the disease changes. Applies to Aama as well. Aama atisaar is treated with grahi herbs that treat agni and reduce aama. When digestion is better, the treatment changes as well. Agni affects the stages and affects how it is treated. When agni is increased, its improved and helps to channelize vayu, open srotas, doshas keep reducing and stage of disease changes. That is what is wanted to be emphasized. We improve the quality of agni and slowly certain things fall into their places. The best thing to increase agni is before any kind of intake of herbs or hot water, do langhan. Go on fast and increase agni, digest aama and the doshas. That is why agni has potential to create different stages. How do we determine length of langhana? Seasonally – if a person is not strongly built and weak and emaciated and goes on long langhana, agni will increase agni. Aama if present is digested, but if not there, doshas digested, if not there, dhatus get digested. So if we go on a fast for a long time, the fire will burn anything that comes in front of it. If there is nothing there but dhatus, they will get disturbed and depleted. Langhan in always done in a precise manner. There are symptoms and signs – when it feels digested and light that is good, but if one goes beyond they will feel tired, depleted etc. In situation where a kapha person with aama, go on specific langhana they need to with hot water and very light food, small amounts of food and that will help decrease aama, increase agni. End result is that the food then taken in will be more nourishing. Aama may not manifest as absolute lack of hunger, but the appetite is disturbed or low. Agni mandya. Person can become adapted to the disease and it doesn’t bother him, but when aama is digested it will improve hunger. Medorogha – aamais present in medovaha srotas. Agni can become hyperactive with aama. Srotas gets blocked, aama gets trapped in srotas that kindles agni and always active because of the trapping of samana vayu. Gross level digestion takes place, but subtle level digestion is disturbed. Meda dhatu is replenished in an unhealthy way but excessive kleda and vitiated kapha dosha. More blocking causes more trapping of samana vayu and more hunger and more agni. In that case, vata is most important to be treated. Reduce the vayu and agni is proper and food that is consumed is in proper amount and everything starts working better. What one eats is very important too.
- Vyadhikshamatva – disease + prevention ~ immunity. Synonymous to the quality of Oja, but not the drops of oja in the body. The capacity of your body to prevent diseases. Related to the general strength of dhatus. The first thing is the generation of the disease won’t take place, will be prevented. 2nd if disease does form the progression of the disease will be slow or the response of treatment is faster. It is measured by the dhatu sara, the excellence of a particular dhatu. All 7 dhatus, by taking care of them it improves the quality and quantity of the dhatu, one or all. By birth/nature, one can have a good quality of certain dhatus and that is called dhatusara. If rakta dhatu is of good quality, that is raktasara. In that manner, that person becomes less susceptible to diseases and disorders of that particular dhatu. This can be by birth or acquired as well. Even if by birth the dhatus can be depleted. Overindulgence of the causative factors of the dhatu depletion can cause it. In every srotas, there are certain causative factors which vitiate that srotas. Mansavaha srotas – alcohol plus lack of exercise can vitiate, so with proper exercise and proper intake of mamsa improving foods can heal and the chance of getting a disease of the mansa dhatu is lessened. People that smoke their whole lives and DON’T get ill is because of the strength of the dhatus. The simplest thing is generally when there is acne and pimples regularly in particular stage of life, but not everyone gets it, it can be rakta dushti. Some people get no affliction related to rakta dhatu because of good quality so it doesn’t allow any doshas to get lodged in them. If there is no weakness and everything is strong, nothing can happen. Not keeping any room for weakness. Even if doshas are increasing won’t cause any disease. This is what a healthy dhatu does. If dhatus are good, ojas would be in good quality and in abundance. The amount of ojas will be less if the dhatus are not good. In some diseases the quality of the ojas will be of bad quality. If person has strong ojas, they may respond more quickly to treatment as well. Lifestyle is very important, but two people can have exact same regimen, example of acne – if one is raktasara and one is having rakta asara/bad qualities, the same treatment will work immediately on the rakta sara, while the other person will take a long time requiring more potent/strong herbs. According to the strength, the treatment varies. If acne vulgaris, rakta and rasa and even mamsa can be involved, scarring, thick skin, burning, itching. But treat the rakta sara. Same with asthi dhatu strength. One with good strength can survive impacts better and are less prone to break bones. Vitiation of vata interfering with replenishment of asthi dhatu could be a causative factor in broken bones, but ultimately asthi dhatu is weak, as well as majja dhatu filling empty spaces (strengthening asthi dhatu) and then mamsa dhatu covering the asthi as well. So strong dhatus is helpful to prevent diseases and easily cure diseases. Low vyadhikshamatva also means that the person may quickly get worse, more intense diseases. Ex. Pranavaha srotas that are weak, the immunity of that srotas is not good. Rather than treating pneumonia all the time, treat the body all the time with maybe Chyavanprasha or Dashmoola Haritaki to heal pranavaha srotas to increase immunity and strength of organ so that illness doesn’t settle into it.
Oja is the quality of the health of all 7 dhatus, if dhatus are of good quality the body will not get diseased. Vyadhikshamatva is particular to each dhatu, but oja is when ALL of the dhatus are strong. Rasayana Chikitsa refers to improving the Vyadhikshamatva of the dhatu. Usually is the last treatment to improve the dhatu after treating other things because someone needs to be healthy first. Rasayana are usually later stage after healing condition, treating disease and THEN strengthening the weakness. But sometimes we can use as a treatment and also as a rasayana. Goat is a rasayana for TB because dhatus and immunity of goat are in good quality and that is why when we eat goat meat we replenish dhatus in a proper manner and it helps us. You can still get sick with vyadhikshamatva, but will heal quickly.
- Chikitsa – Treatment with a specific regimen involved in it. Treatment and proper dietary and behavioral regimen. Specifically this point referring to different stages. Don’t treat the disease and it will get more severe. Patya diet can worsen the condition. Very superficial example, Udara (when the external abdominal wall becomes distended) – milk can be recommended rather than any other water or fluid with the medicines. This will help to cure the disease. But if the person totally ignores the treatment and takes in water can aggravate the condition and make much worse, can cause cardiac issues. So the diet chikitsa is very important for the stages of the disease. Milk because of its downward direction nourishes the body without going into the wall of the stomach – slightly laxative effect and purgative effect. Specific qualities of milk help to cure this condition.
In same manner, if we just don’t treat a disease it will gain in severity.
- Hetu-bala – Causative factor + Strong = Strength of Causative Factors. Every causative factor has some strength. According to its potential it will create a disease. For example, drinking room temperature water at night is again a shita guna, cold water which increases shita guna in the body and THAT shita guna doesn’t have enough potential to cause cold or sneezing. But if you have ice cream at night, that amount of shita guna DOES have potential to cause pratishaya (cold or sneezing). The amount of the potential of the causative factor. Not the strength of the disease factor (a cold or whatever) but one needs to understand whether the causative factor is really potent enough to cause that or not. How far open is the door of lack of immunity? So in diagnosing the case, two different causative factors will show two different symptoms. Ice water is one thing, ice cream another. Ice cream vs. cold smoothie/yogurt + fruit have different actions. Frozen yogurt has more potential to cause cold than ice cream. Ice cream more potential for sneezing. Yogurt person will have cold symptoms for whole day maybe, ice cream for a few hours. Add the fruit to it and you have something now that is toxic so the stages and severities are different.
If pathogens are stronger than the immunity, it will be the stronger causative factor. But if the immunity is stronger for that particular thing . If dhatusara is there, it will prevent certain diseases but not all diseases. If this person has asthisara, it will still break the bone if you were to hit it with a hammer.