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

In Ayurveda, treatment has been classified into many types by many Acharyas. A twofold classification of treatments into Brimhana and Langhana is very popular amongst the physicians.
Acharya Vagbhata, in Ashtanga Hridaya Chapter 14 makes an important statement. He states that Brimhana and Langhana are the only two important treatment forms in Ayurveda. This article is to throw more light on this opinion of Master Vagbhata, which many physicians of Ayurveda agree with.
Ref – A.Hr.14/37

Brimhana and Langhana: Two best treatment forms

दोषगत्याऽतिरिच्यन्ते ग्राहिभेध्यादिभेदतः।
उपक्रमा न ते द्वित्वाद्भिन्ना अपि गदा इव॥३७॥
Acharya Vagbhata emphasizes that in spite of there being so many treatment varieties and forms, brimhana and langhana are the two best treatment forms from the lot.
Further, Acharya says,
There are innumerable states of doshas. Therefore, the types of treatments are also innumerable, like grahi – withholding or constipating treatments, bhedi – purgatives etc. In spite of this, the treatments do not surpass these two kinds of treatment i.e. brimhana – stoutening therapies and langhana – thinning therapies. Just like the diseases, though are innumerable, fall under two categories i.e. sama – associated with ama and nirama – not being associated with ama.

Analyzing this explanation
Brimhana means – nourishing, strengthening, building or increasing bulk. In short, brimhana is adding something to the system and trying to compensate for what has been lost.

Langhana – means lightening therapies i.e. those that remove certain unnecessary things from the body like morbid doshas, malas etc and bring about lightness in the body, a type of depletion therapy.

The simple logic of bringing all treatments under the wing of Brimhana or Langhana is the aim of all treatments will be either to add things which the body has lost or deplete things which the body has unnecessarily gained.

In this context, we need to see that Acharya Vagbhata has used the word ‘Upakrama’. The prefix Upa – means sub or associate. Upakrama, while grossly means treatments or interventions for a disease or medical condition, it specifically refers to supportive or accessory therapy. So, an upakrama may be a preparatory procedure for a Panchakarma therapy – like snehana, swedana etc. It can also be an individual therapy like Shidodhara, Pindasweda etc.

So, are the bigger therapies included in Panchakarma included amongst these two therapies or treatments other than Panchakarma should be considered?

Panchakarma therapies too are included under Langhana treatment form itself since they bring about lightness in the body.

Acharya Vagbhata further says, in the same chapter that the four important therapies i.e. snehana – oleation / lubrication, rukshana – imparting dryness, swedana – sudation and sthambana – constipating – are also included under brimhana and langhana itself. Snehana and Stambhana are types of Brihmhana while Rukshana and Swedana are types of Langhana.

Along with Brimhana and Langhana, they are called as Shad Vidha Upakrama i.e. six types of treatment.

The six Upakramas are –

1. Brimhana
2. Langhana
3. Snehana
4. Swedana
5. Stambhana
6. Rukshana

Acharya Sushruta has explained a set of 60 treatments and has named them Shashti Upakrama. This set also includes all surgical procedures and Panchakarma Therapies. So, undoubtedly the term Upakrama also means ‘treatment’ in general and shall be understood contextually.