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

Acharya Vagbhata has mentioned three important routes of administering the medicines. In the same context he also speaks about the routes of expelling the doshas. Then he links both of them. In short, this principle is a basic guideline for the physicians regarding the route of administration of medicines and route of expulsion of doshas. It explains – ‘medicine should be administered in which route to eliminate morbid doshas in which route’? Basically, this reference speaks about the medicines given for shodhana – cleansing purpose.

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

Ref – A.Hr.Su.13/30-31

Routes of administration of medicines and Routes from which the morbid doshas need to be removed

हन्त्याशु युक्तं वक्त्रेण द्रव्यमामाशयान्मलान्॥३०॥
घ्राणेन चोर्ध्वजत्रूत्थान् पक्वाधानाद्गुदेन च।

1. Herbs or medicines which are administered through the mouth (oral route) would expel the doshas from the stomach and intestines. Here we speak about the vamana – emesis and virechana – purgation. The emetic and purgative medicines are administered through the mouth including medicines used for Deepana – medicines used to enhance digestive fire, Pachana – medicines used to digest and destroy ama and separate the morbid dosha and its association with ama and snehana – oleation, which are used as preparatory medicines before administration of vamana or virechana.

Master Vagbhata, in the same chapter tells that the doshas on reaching the koshta i.e. stomach / intestine should be removed from their nearest route. This means to say that, if the dosha flowing to the stomach from the tissues is kapha, it should be eliminated from the route nearer to stomach (seat of kapha), i.e. by oral route through administration of vamana – emesis. If the dosha flowing to the intestine from the tissues is pitta, it should be eliminated from the route nearer to the small intestine (seat of pitta), i.e. by anal route, through administration of virechana – purgation.

Thus, it is clear that the doshas in stomach and intestine (small intestine) should be removed by administering medicines through oral route, by means of vamana or virechana.

2. Herbs or medicines administered through the nose (nasal route), would expel the doshas from the parts above the shoulder i.e. from head and neck.

Here, we speak about the medicines administered through the nasal route i.e. nasya – nasal drops, nasal medicines or errhines.

Nasya medicines are administered through the nose and the doshas are also eliminated through the nose or mouth. Nose is considered as the gateway of the head. The medicines administered from this route pull the doshas from the head and neck and expel them.

3. Herbs or medicines administered through the anus (rectum) will expel the doshas from the large intestine (colon).

Here, we speak about the medicines administered through the anal route i.e. basti / vasti – medicinal enemas.

Enemas are administered through the anal route (and also urethral and vaginal) and the doshas are also eliminated through the anal route itself. The administered enema, be it in the form of medicinal decoction (asthapana vasti, niruha vasti) or medicated fats (anuvasana vasti) through the anal route, would pull down the doshas through the anal route and expel them.

To sum up

The routes of administration of shodhana medicines and routes of expulsion of the doshas –

Route of Administration of medicine (for shodhana)	Expels doshas from	Route from which the doshas are expelled	Therapy included
Oral route	StomachSmall intestine	MouthAnus	Vamana (from oral route)Virechana (from anal route)
Nasal route	HeadNeck	NoseMouth	Nasya – errhines, head purges
Anal route	Large Intestine (colon)	Anal route	Vasti / Basti – medicinal enemas

Shamana or Shodhana

The word ‘Hantyashu’ in the first line of the verse means ‘quickly destroys’. If it is taken as ‘quickly destroyed’ instead of ‘quickly expels’ the shamana type of treatment too shall be considered. These medicines too shall be administered by the same route.

The medicines administered by oral route, would quickly destroy the doshas in the stomach and intestine. That administered by nasal route would destroy the doshas in the head and neck. The medicines administered through the anal route would destroy the doshas in the colon. Here the medicines may just destroy the doshas without expelling them and the dosha aggravation may be minimal or moderate. But usually, we do not administer the medicines through anal route to pacify the doshas. This is a clue which clarifies that the verse means to explain ‘quick expulsion’ and not ‘quick destruction’.