Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

The states of doshas are many. Two most important states from a treatment perspective are – Sama Doshas and Nirama Doshas.

Sama doshas – This is a state wherein the doshas are associated with ama. Aggravated doshas are as such harmful for the body but when these doshas get associated with ama, they form a dangerous combination. Sama doshas are a state wherein the ama coats the dosha. Ama is a sticky substance and doshas after their association with ama too become sticky, like doshas having an outer coating of glue. In this state, the doshas would adhere to the tissues and refuse to move away from there.

Ama is a substance formed in the amashaya – stomach. This is caused when weak digestive fire acts on food and improperly digests it. Then, there is formation of uncooked (unprocessed), foul smelling and severely sticky in nature. It can stick with anything, like a glue, with dosha, dhatu, mala, inside srotas and everywhere. By adhering, it can cause blocks in the channels of the body and this deprives nutrition to the parts of the body. Doshas associated with ama are called sama dosha. Similarly sama dhatu, sama mala etc are formed.

As a rule, sama doshas cannot be expelled from the body, actually should not be expelled. It is not easy to do it since doshas are adhered to the tissues and pulling them forcibly to expel them would damage the tissues and also the body in the long run.

So, a wise physician should know how to handle the sama-dosha situation. First principle will be to digest the ama associated with the dosha and separate it. When the doshas become nirama, i.e. devoid of association with ama, they can be eliminated out of the body by administration of shodhana therapies.

Let us see what Master Vagbhata has to say about this.

A.Hr.Su.13/29, 30

Principles of Treating Sama Doshas

पाचनैर्दीपनैः स्नेहैस्तान् स्वेदैश्च परिष्कृतान्॥२९॥
शोधयेच्छोधनैः काले यथासन्नं यथाबलम्।

This is the complete explanation of how sama doshas should be treated in a methodical way.

The first step would be to prepare and process the sama doshas and make them ready to get expelled from the body.

This preparation involves administering the below mentioned –

–        Pachana – medicines to digest the ama should be administered. These medicines also help in detaching the doshas from their association with ama. The doshas would become nirama, devoid of ama. Now, they can be expelled from the body by administration of shodhana.
–        Dipana – involves administration of herbs and medicines which would enhance and balance the digestive fire in the stomach. This fire would digest the food properly and make sure that no more ama is formed. Through a feedback mechanism, the fire kindled in the gut would also kindle the fire in the tissues.
–        Snehana – oleation is administered to swell up the ama i.e. sama doshas in the tissues. This is because medicated fats have similar quality as that of ama. Sneha, on reaching the tissues, would provoke the sama dosha to swell up. The swollen sama dosha is ready to exit the tissues now or we can tell that the tissues now undergo pressure of swollen sama dosha and would get ready to push them out.
–        Swedana – Sudation administered after oleation, would melt the swollen sama doshas in the tissues and make them ready to flow out of the tissues, towards the gut.

All these steps are included in the preparation of sama doshas (digesting the ama associated with dosha, to separate the ama from dosha, to destroy ama and make the dosha nirama) to get expelled.

Shodhana

The sama doshas are brought to maturity by the above-mentioned therapies. The doshas are devoid of ama. These doshas now flow towards the stomach / gut. The morbid doshas should now be expelled out by administration of shodhana therapies, mainly emesis and purgation, at proper time, from the nearest routes. Morbid Kapha should be removed from the route nearest to the stomach (which is the seat of kapha) i.e. through mouth, by administration of vamana – emesis. Likewise, morbid pitta should be removed from the route nearest to the small intestine (seat of pitta) i.e. through anal route, by administering virechana – purgation. These therapies should be planned in accordance with the strength of the patient.

So, this is the method of dealing with sama doshas. To sum up, the measures to be administered are in this chronology – Pachana, Deepana, Snehana, Swedana and Shodhana (emesis or purgation).