Doshabhedeeya Adhyaya – Ashtanga Hrudaya Sutrasthana 12

The 12^th chapter of Sutrasthanam of Ashtanga Hridayam is named as Doshabhediya Adhyayam. This chapter explains about the dosha types and location of tridoshas in the body. The classification and functions of each type of tridosha, the causes for their increase or decrease etc are also dealt with in this chapter.

Pledge by the author(s)

अथातो दोषभेदीयाध्यायं व्याख्यास्यामः।
इति ह स्माहुरात्रेयादयो महर्षयः।(गद्यसूत्रे॥२॥)
athāto doṣabhedīyādhyāyaṃ vyākhyāsyāmaḥ|
iti ha smāhurātreyādayo maharṣayaḥ|(gadyasūtre||2||)

अथा अतो दोषभेदीय अध्यायं व्याख्यास्यामः – athā ato doṣabhedīya adhyāyaṃ vyākhyāsyāmaḥ – after having offered prayers to the God, henceforth we are going to explain the chapter pertaining to Dosha types, imbalance of doshas and symptoms of imbalance
इति ह स्माहु: आत्रेयादयो महर्षयः – iti ha smāhur ātreyādayo maharṣayaḥ – thus pledge Atreya and other sages.

Atreya and other sages pledge that after Doshadi vijnaneeyam  adhyayam (chapter pertaining to knowledge of doshas) they would henceforth be explaining the chapter called Dosha Bhediya Adhyayam which deals with explanation of doshas, their types, imbalance of doshas and the symptoms of their imbalance.

Place of Tridosha – Doshasthana

Shloka Recitation Video

Vata sthana 

AH Su 12.1

Places of Vata Dosha

पक्वाशयकटीसक्थिश्रोत्रास्थिस्पर्शनेन्द्रियम्।
स्थानं वातस्य, तत्रापि पक्वाधानं विशेषतः॥१॥
pakvāśayakaṭīsakthiśrotrāsthisparśanendriyam|
sthānaṃ vātasya, tatrāpi pakvādhānaṃ viśeṣataḥ||1||

पक्वाशय – pakvāśaya – large intestine,
कटी – kaṭī – waist,
सक्थि – sakthi – hip,
श्रोत्र – śrotra – ear,
अस्थि – asthi – bones,
स्पर्शनेन्द्रियम् – sparśanendriyam – skin,
स्थानं वातस्य – sthānaṃ vātasya – are the places of Vata,
तत्रापि – tatrāpi – even among the above said places,
पक्वाधानं विशेषतः – pakvādhānaṃ viśeṣataḥ – the large intestine is the special place of Vata

Pakavasaya – large intestine,
Kati – waist
Sakthi – hip
Shrotra – ear
Asthi – bones
Sparshanendriya – skin
Special space – large intestine

Pitta sthana

AH Su 12.2

Places of Pitta Dosha

नाभिरामाशयः स्वेदो लसीका रुधिरं रसः।
दृक् स्पर्शनं च पित्तस्य, नाभिरत्र विशेषतः॥२॥
nābhirāmāśayaḥ svedo lasīkā rudhiraṃ rasaḥ|
dṛk sparśanaṃ ca pittasya, nābhiratra viśeṣataḥ||2||

नाभि: – nābhir – umbilicus, navel
आमाशयः – āmāśayaḥ – stomach, small intestine,
स्वेदो – svedo – sweat,
लसीका – lasīkā – lymph,
रुधिरं – rudhiraṃ – blood,
रसः – rasaḥ – plasma,
दृक् – dṛk – eye
स्पर्शनं च – sparśanaṃ ca – and skin,
पित्तस्य – pittasya – are the places of pitta,
नाभिरत्र विशेषतः – nābhiratra viśeṣataḥ – among the above said places, navel region or umbilicus is the special seat of pitta

Nabhi – Umbilicus,
Amashaya- stomach and small intestine,
Sweda – sweat,
Lasika- lymph,
Rudhira – blood,
Rasa- plasma,
Druk – eye and
Sparshanam – skin,
Special seat – Nabhi- region around the Umbilicus. 2

Kapha sthana

AH Su 12.3

Places of Kapha Dosha

उरःकण्ठशिरःक्लोमपर्वाण्यामाशयो रसः।
मेदो घ्राणं च जिह्वा च कफस्य सुतरामुरः॥३॥
uraḥkaṇṭhaśiraḥklomaparvāṇyāmāśayo rasaḥ|
medo ghrāṇaṃ ca jihvā ca kaphasya sutarāmuraḥ||3||

उरः – uraḥ – chest,
कण्ठ – kaṇṭha – throat,
शिरः – śiraḥ – head,
क्लोम – kloma – pancreas, (trachea?)
पर्वाणि – parvāṇy – bone joints (small joints of the fingers)
आमाशयो – āmāśayo – stomach (small intestine),
रसः – rasaḥ – plasma,
मेदो – medo – fat,
घ्राणं च – ghrāṇaṃ ca – nose and
जिह्वा च – jihvā ca – tongue are the places
कफस्य – kaphasya – of kapha,
सुतराम् उरः – sutarām uraḥ – even among the above said places, chest is the special seat of Kapha

Ura – Chest,
Kantha – throat,
Shira – head,
Kloma – Pancreas,
Parvani – bone joints,
Amashaya – Stomach and small intestine,
Rasa –plasma,
Meda – fat
Ghrana – nose and
Jihva – tongue are the seats of Kapha,
Special seat – Ura – chest. 3

5 types of Vata

AH Su 12.4a ½

Five types of Vayu

प्राणादिभेदात्पञ्चात्मा वायुः
prāṇādibhedātpañcātmā vāyuḥ

वायुः पञ्चात्मा – vāyuḥ pañcātmā – vayu is of 5 types,
प्राणादि भेदात् – prāṇādi bhedāt – prana etc are its types

Vayu is of 5 types:

• Prana Vayu
• Udana Vayu
• Vyana Vayu
• Samana Vayu
• Apana Vayu

Prana Vata

AH Su 12.4a ½-5a

Prana Vata (vayu), its sites, functions

प्राणोऽत्र मूर्धगः।
उरःकण्ठचरो बुद्धिहृदयेन्द्रियचित्तधृक्॥४॥
ष्ठीवनक्षवथूद्गारनिःश्वासान्नप्रवेशकृत्।
prāṇo’tra mūrdhagaḥ|
uraḥkaṇṭhacaro buddhihṛdayendriyacittadhṛk||4||
ṣṭhīvanakṣavathūdgāraniḥśvāsānnapraveśakṛt|

अत्र प्राणो मूर्धगः – atra prāṇo mūrdhagaḥ – here (among them), prana vayu is located in the head and
उरःकण्ठ चरो – uraḥ kaṇṭha caro – moves in the chest and throat,
बुद्धि हृदय इन्द्रिय चित्त धृक् – buddhi hṛdaya indriya citta dhṛk – regulates intuition (intelligence, perception), heart, senses, mind (intelligence, thought) and vision,
ष्ठीवन क्षवथूद्गार निःश्वास अन्नप्रवेशकृत् – ṣṭhīvana kṣavathūdgāra niḥśvāsa annapraveśakṛt – causes expectoration, sneezing, belching, inspiration and swallowing of food

Prana Vata –  Prana is located in the head and moves in the chest, throat. It regulates will, heart, sense organs, intellect and vision.
It is the cause for expectoration, sneezing, belching, inspiration and swallowing of food.

Udana Vata

AH Su 12.5b-6a

Udana Vata (vayu), its sites, functions

उरःस्थानमुदानस्य नासानाभिगलांश्चरेत्॥५॥
वाक्प्रवृत्तिप्रयत्नोर्जाबलवर्णस्मृतिक्रियः।
uraḥsthānamudānasya nāsānābhigalāṃścaret||5||
vākpravṛttiprayatnorjābalavarṇasmṛtikriyaḥ|

स्थानम् उदानस्य उरः – sthānam udānasya uraḥ – the seat of udana vayu is chest,
नासा नाभि गलांश्चरेत् – nāsā nābhi galāṃścaret – it moves (circulates) in the nose, umbilicus (navel) and throat,
वाक्प्रवृत्ति – vākpravṛtti – its functions are initiation of speech
प्रयत्नोर्जा – prayatnorjā – effort,
बल वर्ण – bala varṇa – enthusiasm, strength,
स्मृतिक्रियः – smṛtikriyaḥ – color and memory

Udana Vata – The chest is the seat of Udana, it moves in the nose, umbilicus and throat; its functions are initiation of speech (vak), effort (Prayatna), enthusiasm (Urja), strength (bala) , color, complexion (varna) and memory (smruti).

Vyana Vata

AH Su 12.6b-7

Vyana Vata (vayu), its sites, functions

व्यानो हृदि स्थितः कृत्स्नदेहचारी महाजवः॥६॥
गत्यपक्षेपणोत्क्षेपनिमेषोन्मेषणादिकाः।
प्रायः सर्वाः क्रियास्तस्मिन् प्रतिबद्धाःशरीरिणाम्॥७॥
vyāno hṛdi sthitaḥ kṛtsnadehacārī mahājavaḥ||6||
gatyapakṣepaṇotkṣepanimeṣonmeṣaṇādikāḥ|
prāyaḥ sarvāḥ kriyāstasmin pratibaddhāḥśarīriṇām||7||

व्यानो स्थितः हृदि – vyāno sthitaḥ hṛdi – vyana vayu is located in the heart  
कृत्स्न देहचारी महाजवः – kṛtsna dehacārī mahājavaḥ – in the entire body it moves with great speed,
गति – gati – (it causes functions like) movement – locomotion, walking.
अपक्षेपणोत्क्षेप – apakṣepaṇotkṣepa – extension, flexion,
निमेषोन्मेषणादिकाः – nimeṣonmeṣaṇādikāḥ – closing and opening of the eyelids etc,
प्रायः सर्वाः क्रिया: – prāyaḥ sarvāḥ kriyās – mostly all the activities
शरीरिणाम् – śarīriṇām – of the human body
प्रतिबद्धाः – pratibaddhāḥ  – are controlled
तस्मिन् – tasmin – by vyana vayu.

Vyana Vata –
Vyana is located in the heart, moves all over the body in great speed,
It attends to functions such as flexion and extension (locomotor action) opening  and closing of the eyelids etc.
Generally all the body activities are regulated by Vyana Vata.

Samana Vata

AH Su 12.8

Samana Vata (vayu), its sites, functions

समानोऽग्निसमीपस्थः कोष्ठे चरति सर्वतः।
अन्नं गृह्णाति पचति विवेचयति मुञ्चति॥८॥
samāno’gnisamīpasthaḥ koṣṭhe carati sarvataḥ|
annaṃ gṛhṇāti pacati vivecayati muñcati||8||

समानो अग्नि समीपस्थः – samāno agni samīpasthaḥ – samana vayu is located near to the digestive fire,
चरति सर्वतः कोष्ठे – carati sarvataḥ koṣṭhe – moves everywhere in the alimentary tract,
अन्नं गृह्णाति – annaṃ gṛhṇāti  – receives the food,
पचति – pacati – digests the food (aids in digestion)
विवेचयति – vivecayati – divides the food into useful part and waste part
मुञ्चति – muñcati – excretes the waste part.

Samana Vata –
Samana Vata is located near the digestive fire.
It moves in the Kostha – alimentary tract,
It receives the food into stomach, aids in digestion, helps in dividing the food into useful part and waste part, and moves these parts in their normal paths.

Apana Vata

AH Su 12.9

Apana Vata (vayu), its sites, functions

अपानोऽपानगः श्रोणिबस्तिमेढ्रोरुगोचरः।
शुक्रार्तवशकृन्मूत्रगर्भनिष्क्रमणक्रियः॥९॥
apāno’pānagaḥ śroṇibastimeḍhrorugocaraḥ|
śukrārtavaśakṛnmūtragarbhaniṣkramaṇakriyaḥ||9||

अपानो अपानगः – apāno apānagaḥ – apana vayu is located in the apana – large intestine (colon), anal region
श्रोणि बस्ति मेढ्रोरुगोचरः – śroṇi basti meḍhr oru gocaraḥ – Itmoves in the waist, urinary bladder, genitals, urinary passages and thigh,
शुक्र निष्क्रमणक्रियः – śukra niṣkramaṇakriyaḥ –  useful in releasing of Shukra – sperm, semen, ovum
आर्तव निष्क्रमणक्रियः – ārtava niṣkramaṇakriyaḥ – menstruation,  
शकृत् निष्क्रमणक्रियः – śakṛn niṣkramaṇakriyaḥ – defecation,
मूत्र निष्क्रमणक्रियः – mūtra niṣkramaṇakriyaḥ – urination,
गर्भ निष्क्रमणक्रियः – garbha niṣkramaṇakriyaḥ – child birth

Apana Vata –
Apana Vata is located in the Apana – large intestine, moves in the waist, bladder, genitals. It attends to the functions such as ejaculation, menstruation, defecation, urination and child birth.

Five types of Pitta

AH Su 12.10a ½

Five types of Pitta

पित्तं पञ्चात्मकम्
pittaṃ pañcātmakam

Pitta is of five types

• Pachaka Pitta
• Ranjaka Pitta
• Sadhaka Pitta
• Alochaka Pitta
• Bhrajaka Pitta

Pachaka Pitta

AH Su 12.10a ½-12

Pachaka Pitta, its sites, functions

तत्र पक्वामाशयमध्यगम्।
पञ्चभूतात्मकत्वेऽपि यत्तैजसगुणोदयात्॥१०॥
त्यक्तद्रवत्वं पाकादिकर्मणाऽनलशब्दितम्।
पचत्यन्नं विभजते सारकिट्टौ पृथक् तथा॥११॥
तत्रस्थमेव पित्तानां शेषाणामप्यनुग्रहम्।
करोति बलदानेन पाचकं नाम तत्स्मृतम्॥१२॥
tatra pakvāmāśayamadhyagam|
pañcabhūtātmakatve’pi yattaijasaguṇodayāt||10||
tyaktadravatvaṃ pākādikarmaṇā’nalaśabditam|
pacatyannaṃ vibhajate sārakiṭṭau pṛthak tathā||11||
tatrasthameva pittānāṃ śeṣāṇāmapyanugraham|
karoti baladānena pācakaṃ nāma tatsmṛtam||12||

तत्र तत् – tatra tat – among the five types of pitta,
पक्व आमाशय मध्यगम् – pakva āmāśaya madhyagam – is located between large intestine and stomach,
पञ्चभूतात्मकत्वे अपि – pañcabhūtātmakatve api – in spite of being composed of all five basic elements of nature,
यत्तैजस गुणोदयात् – yattaijasa guṇodayāt –Pachaka Pittais predominant in the fire element,
त्यक्त द्रवत्वं – tyakta dravatvaṃ – devoid of water element,
शब्दितम् अनल पाकादिकर्मणा – pākādikarmaṇā anala śabditam – called by the name anala or fire owing to its functions of digestion and transformation of food materials etc,
पचत्यन्नं – pacatyannaṃ – digests the food,
विभजते सार किट्टौ पृथक् तथा – vibhajate sāra kiṭṭau pṛthak tathā – divides the food into sara (essence, useful part) and kitta (waste part),
तत्रस्थमेव – tatrasthameva – being located there itself (in its seat, i.e. in between large intestine and stomach)
करोति अनुग्रहम् – karoti anugraham – bestows grace and influence
शेषाणाम् पित्तानां अपि – śeṣāṇām pittānāṃ apy – on the other types of pitta also
बलदानेन – baladānena – by providing strength (support, functioning capacity, influence, grace) to them,
स्मृतम् पाचकं नाम – smṛtam pācakaṃ nāma – is called by the name Pachaka Pitta.

It is located between large intestine and stomach.  (between Amashaya and Pakvashaya)
It is composed of all the five basic elements (Panchamaha Bhuta), it is predominant with fire element and devoid of water element.
It is called by the term Anala- fire because of its function of Paka – digestion and transformation of food materials.
It cooks the food, divides it into essence and waste,
It bestows grace and influence on other types of Pitta.
Hence, among all the types of Pitta, Pachaka pitta is the dominant one.

Ranjaka Pitta

AH Su 12.13a

Ranjaka Pitta, its sites, functions

आमाशयाश्रयं पित्तं रञ्जकं रसरञ्जनात्।
āmāśayāśrayaṃ pittaṃ rañjakaṃ rasarañjanāt|

पित्तं आमाशय आश्रयं – pittaṃ āmāśaya āśrayaṃ – the pitta located in the amashaya – stomach
रञ्जकं – rañjakaṃ – is called Ranjaka Pitta
रस रञ्जनात् – rasa rañjanāt – since it imparts color (ranjana) to the rasa – the essence part of digestion (and converts it into rakta or blood)

Note: Ranjana means ‘to impart color’. Ranjaka Pitta helps in imparting red color to the rasa dhatu (essence of digestion, nutritive juice, lymph) and converts it into rakta dhatu (blood). Ranjaka Pitta is therefore that pitta which converts rasa dhatu into rakta dhatu.

The pitta located in the Amasaya- stomach is known as Ranjaka. It converts the useful part of the digestion into blood. Hence it converts Rasa Dhatu into Rakta Dhatu.

Sadhaka Pitta

AH Su 12.13b-14a ½

Sadhaka Pitta, its sites, functions

बुद्धिमेधाभिमानाद्यैरभिप्रेतार्थसाधनात्॥१३॥
साधकं हृद्गतं पित्तं
buddhimedhābhimānādyairabhipretārthasādhanāt||13||
sādhakaṃ hṛdgataṃ pittaṃ

पित्तं हृद्गतं साधकं – pittaṃ hṛdgataṃ sādhakaṃ – the pitta located in the heart is called sadhaka pitta
अभिप्रेतार्थ साधनात् – abhipretārtha sādhanāt – since it helps in achieving the desired things (purpose and aims of life) through
बुद्धि मेधा अभिमानाद्यै: – buddhi medhā abhimānādyair – proper use or integration of knowledge, intelligence, self-consciousness etc
The pitta located in the Hrudaya –heart is known as Sadhaka.
It attends to mental functions such as knowledge, intelligence, self- consciousness, etc, thereby helping the purpose – aims of life.

Alochaka Pitta  

AH Su 12.14a ½-14b ½   

Alochaka Pitta, its sites, functions

रूपालोचनतः स्मृतम्।
दृक्स्थमालोचकं
rūpālocanataḥ smṛtam|
dṛksthamālocakaṃ

दृक्स्थम् आलोचकं स्मृतम् – dṛkstham ālocakaṃ smṛtam – the pitta located in the eyes is called alochaka,
रूपालोचनतः – rūpālocanataḥ – since it helps in vision (perception of objects through eyes, being located deep in the eyes), it is called Alochaka Pitta. (Lochana means eyes, vision)

It is located in the eyes. It helps in vision.

Bhrajaka Pitta

AH Su 12.14b

Bhrajaka Pitta, its sites, functions

त्वक्स्थं भ्राजकं भ्राजनात्त्वचः॥१४॥
tvaksthaṃ bhrājakaṃ bhrājanāttvacaḥ||14||

त्वक्स्थं भ्राजकं – tvaksthaṃ bhrājakaṃ – the pitta located in the skin is called bhrajaka pitta, भ्राजनात्त्वचः – bhrājanāttvacaḥ – It is named sobecause it brings about bhrajana or exhibition of color and complexion

It resides in skin and helps exhibition of color and complexions.

5 Types of Kapha

AH Su 12.15a ½

Five Types of Kapha

श्लेष्मा तु पञ्चधा – śleṣmā tu pañcadhā –
shleshma or kapha is of five types.

• Avalambaka Shleshma (Kapha)
• Kledaka Shleshma (Kapha)
• Bodhaka Shleshma (Kapha)
• Tarpaka Shleshma (Kapha)
• Shleshaka Shleshma (Kapha)

Avalambaka Kapha –

AH Su 12.15a ½-16b ½

Avalambaka Shleshma (Kapha), its sites, functions

उरःस्थः स त्रिकस्य स्ववीर्यतः।
हृदयस्यान्न वीर्याच्च तत्स्थ एवाम्बुकर्मणा॥१५॥
कफधाम्नां च शेषाणां यत्करोत्यवलम्बनम्।
अतोऽवलम्बकः श्लेष्मा
uraḥsthaḥ sa trikasya svavīryataḥ|
hṛdayasyānnavīryācca tatstha evāmbukarmaṇā||15||
kaphadhāmnāṃ ca śeṣāṇāṃ yatkarotyavalambanam|
ato’valambakaḥ śleṣmā

यत् उरःस्थः – yat uraḥsthaḥ – that kapha which is located in the chest
स्ववीर्यतः त्रिकस्य अवलम्बनम् करोति – svavīryataḥ trikasya avalambanam karoti – by its innate strength,
supports (lubricates, nourishes) the trika (lower portion of the back, sacral region or the meeting place of shoulder, neck and back according to other references)
स्ववीर्यतः अन्न वीर्याच्च हृदयस्य अवलम्बनम् करोति – svavīryataḥ ānnavīryācca hṛdayasya avalambanam karoti– supports (lubricates, nourishes) the hridaya (heart) by its innate nature and also by the power of the essence of food,
स अवलम्बकः श्लेष्मा – sa ato’valambakaḥ śleṣmā – is called avalambaka shleshma
तत्स्थ एव – tatstha eva – being seated there, in the chest,
अम्बुकर्मणा – ambukarmaṇā – and by the virtue of its functions similar to those of water (like lubrication, nourishment etc),
शेषाणां कफधाम्नां च स अवलम्बनम् करोति – śeṣāṇāṃ kaphadhāmnāṃ ca sa avalambanam karoti – Avalambaka kapha supports the other sites of kapha,  
अतो अवलम्बकः श्लेष्मा – ato avalambakaḥ śleṣmā – and hence called avalambaka shleshma.
Word meaning of Avalamba is dependant. Other Kaphas are dependant on Avalambaka Kapha.

It is located in the chest and Trika pradesha – the meeting place of shoulder, neck and back;. By its innate strength and by the power of essence of food, it does lubrication, nourishing etc functions that are attributed to water element. It also influences the functioning of other types of Kapha.

Kledaka Kapha

AH Su 12.16.b-17.a ½

Kledaka Kapha, sites, functions

यस्त्वामाशयसंस्थितः॥१६॥
क्लेदकः सोऽन्नसङ्घातक्लेदनात्
yastvāmāśayasaṃsthitaḥ||16||
kledakaḥ so’nnasaṅghātakledanāt

यस्तु आमाशय संस्थितः – yastu āmāśaya saṃsthitaḥ – that kapha which is located in the stomach is called
क्लेदकः – kledakaḥ – kledaka kapha
सो अन्नसङ्घात क्लेदनात् – so annasaṅghāta kledanāt – since it moistens (kledana) the hard food mass (anna sanghata)

Note: The food mass which we consume is made moist by the kledaka kapha this enables proper digestion of consumed food.

Located in the Amashaya – stomach. It moistens the hard food mass and helps in digestion.

Bodhaka Kapha –

AH Su 12.17a ½-17b ½

Bodhaka Shleshma (Kapha), its sites, functions

रसबोधनात्।
बोधको रसनास्थायी
rasabodhanāt|
bodhako rasanāsthāyī

बोधको रसना स्थायी – bodhako rasanā sthāyī – bodhaka Kapha is located in the rasana (tongue), it is called so because
रस बोधनात् – rasa bodhanāt – it helps in perception of tastes

It is located in the tongue. It helps in taste perception.

Tarpaka Kapha

AH Su 12.17b

Tarpaka Shleshma (Kapha), its sites, functions

शिरःसंस्थोऽक्षतर्पणात्॥१७॥
तर्पकः
śiraḥsaṃstho’kṣatarpaṇāt||17||
tarpakaḥ

शिरःसंस्थोऽ तर्पकः – śiraḥsaṃstho tarpakaḥ – the kapha located in the head is called tarpaka (shleshma or kapha)
अक्षतर्पणात् – akṣatarpaṇāt – because it nourishes (tarpana) the sense organs (aksha)

It is located in the head. It nourishes sense organs.

Shleshaka Kapha

AH Su 12.18a

Shleshma (Kapha), its sites, functions

सन्धिसंश्लेषाच्छ्लेषकः सन्धिषु स्थितः।
sandhisaṃśleṣācchleṣakaḥ sandhiṣu sthitaḥ|

श्लेषकः सन्धिषु स्थितः – shleṣakaḥ sandhiṣu sthitaḥ – shleshaka shleshma (kapha) is located in the bone joints (and is called as shleshaka because)
सन्धि संश्लेषात् – sandhi saṃśleṣāt – it lubricates and strengthens (samslesat) the joints (sandhi)

It is located in the bone joints. It lubricates and strengthens the joint.

Though Tridosha is present all over the body, they are more dominant in specific areas of the body, as explained above.

Qualities that influence increase and decrease of Tridosha

AH Su 12.18b-19a

Specific seats of dosha predominance

इति प्रायेण दोषाणां स्थानान्यविकृतात्मनाम्॥१८॥
व्यापिनामपि जानीयात्कर्माणि च पृथक्पृथक्।
iti prāyeṇa doṣāṇāṃ sthānānyavikṛtātmanām||18||
vyāpināmapi jānīyātkarmāṇi ca pṛthakpṛthak|

प्रायेण – prāyeṇa – in general terms
अविकृतात्मनाम् दोषाणां व्यापिनाम् अपि – avikṛtātmanām doṣāṇāṃ vyāpinām api – though the non-vitiated doshas are spread out all over the body,
इति स्थानानि जानीयात् – iti sthānāny jānīyāt – the above mentioned seats should be considered by the physician as the specific seats in which they are predominant (the doshas get different names depending on the different seats)
कर्माणि च पृथक्पृथक् इति – karmāṇi ca pṛthakpṛthak – the functions of these doshas also should be understood separately (depending on their site)

Chaya, Prakopa and Prashama of the doshas

In the next few verses the terms chaya, prakopa (kopa) and prashama (shama) will be used.

Chaya (mild increase or accumulation) – means increase of dosha in its own place or seat

Kopa / Prakopa (profound increase or aggravation) – means increase and (tendency) to overflow of doshas from its own place (to the other places)

Shama / Prashama (reduction) – means decrease (natural) of increased dosha and restoration of normalcy (and health)

Note: In the description given below,
Chaya means – first level increase of Dosha in their own place.
Kopa / Prakopa means increase and overflow of Doshas from its own place to other places. It has the potential to cause disease.
Shama / Prashama means decrease of increased Dosha and restoration of health.

Qualities that cause Chaya, Kopa and Shama of Vata

AH Su 12.19b-20a

Qualities that cause chaya, kopa and shamana of vata

उष्णेन युक्ता रूक्षाद्या वायोः कुर्वन्ति सञ्चयम्॥१९॥
शीतेन कोपमुष्णेन शमं स्निग्धादयो गुणाः।
uṣṇena yuktā rūkṣādyā vāyoḥ kurvanti sañcayam||19||
śītena kopamuṣṇena śamaṃ snigdhādayo guṇāḥ|

उष्णेन युक्ता रूक्षाद्या गुणाः – uṣṇena yuktā rūkṣādyā guṇāḥ – hotness associated with dryness, movement etc qualities of Vata
कुर्वन्ति सञ्चयम् वायोः – kurvanti sañcayam vāyoḥ – causes sanchaya or chaya of vata
शीतेन (युक्ता रूक्षाद्या गुणाः) – śītena (yuktā rūkṣādyā guṇāḥ) – cold associated with dryness, movement etc qualities of Vata
(कुर्वन्ति) कोपं (वायोः) – (kurvanti) kopaṃ (vāyoḥ) – causes kopa of vata
उष्णेन युक्ता स्निग्धादयो गुणाः – uṣṇena yuktā snigdhādayo guṇāḥ – hot (heat) associated with unctuousness, stability etc qualities (opposite to those of vata)
(कुर्वन्ति) शमं (वायोः) – (kurvanti) śamaṃ (vāyoḥ) – causes shamana of vata

Hot  along with dryness, movement, etc causes Vata Chaya.
Coldness along with dryness causes Kopa.
Snigdha (oiliness, unctuousness)  and other qualities- Guru (heavy), Usna (hot) , pichila (stickiness),  sthira (stability)  etc. associated with hotness bring about Shamana of Vata.

Qualities that cause Chaya, Kopa and Shama of Pitta

AH Su 12.20b-21a

Qualities that cause chaya, kopa and shamana of pitta

शीतेन युक्तास्तीक्ष्णाद्याश्रयं पित्तस्य कुर्वते॥२०॥
उष्णेन कोपं, मन्दाद्या: शमं शीतोपसंहिताः।
śītena yuktāstīkṣṇādyāśrayaṃ pittasya kurvate||20||
uṣṇena kopaṃ, mandādyā: śamaṃ śītopasaṃhitāḥ|

तीक्ष्णाद्याः युक्ता: शीतेन – tīkṣṇādyāś yuktās śītena – piercing (strong) and other qualities of pitta (like heat, lightness etc) when associated with cold,
कुर्वते चयम् पित्तस्य – kurvate cayam pittasya – will cause chaya of pitta,
(तीक्ष्णाद्याः युक्ता:) उष्णेन – (tīkṣṇādyāś yuktās) uṣṇena – piercing (strong) and other qualities of pitta (like heat, dryness, lightness etc) when associated with hotness,
(कुर्वते) कोपं (पित्तस्य) – (kurvate) kopaṃ (pittasya) – will cause kopa of pitta
मन्दाद्या: शीतोपसंहिताः – mandādyā: śītopasaṃhitāḥ – viscous (mild) and other qualities opposite to that of pitta (like stickiness, stability etc) when associated with cold
(कुर्वते) शमं (पित्तस्य) – (kurvate) śamaṃ (pittasya) – will bring about pitta shamana

Teekshna (piercing, strong)  and other qualities- dryness, lightness, etc associated with cold cause Chaya- mild increase of Pitta,
The above qualities associated with hot, cause Kopa – profound increase of Pitta.
Manda (viscous, mild) and other qualities like stickiness, stability etc, associated with cold bring about Pitta Shama- reduction back to normal. 20

Qualities that cause Chaya, Kopa and Shama of Kapha

AH Su 12.21b-22a

Qualities that cause chaya, kopa and shamana of pitta

शीतेन युक्ताः स्निग्धाद्या: कुर्वते श्लेष्मणश्चयम्॥२१॥
उष्णेन कोपं, तेनैव गुणा रूक्षादयः शमम्।
śītena yuktāḥ snigdhādyā: kurvate śleṣmaṇaścayam||21||
uṣṇena kopaṃ, tenaiva guṇā rūkṣādayaḥ śamam|

स्निग्धाद्या: युक्ताः शीतेन – snigdhādyā: yuktāḥ śītena – unctuousness and other Kapha qualities (like heaviness, stickiness, mild etc) when associated with cold,
कुर्वते चयम् श्लेष्मण: – kurvate cayam śleṣmaṇaś – causes chaya of shleshma 
(स्निग्धाद्या: युक्ताः) उष्णेन – (snigdhādyā: yuktāḥ) uṣṇena –  unctuousness and other qualities similar to the qualities of kapha (like heaviness, stickiness, mild etc) when associated with hot,
(कुर्वते) कोपं (श्लेष्मण:) – (kurvate) kopaṃ (śleṣmaṇaś) – causes kopa of shleshma
तेनैव गुणा रूक्षादयः tenaiva guṇā rūkṣādayaḥ – the same qualities (unctuous etc) when associated with dryness, rough, lightness, movement, clarity etc qualities (opposite to those of kapha),
(कुर्वते) शमम् (श्लेष्मण:) – (kurvate) śamam (śleṣmaṇaś) – decreases Kapha Dosha.

Snigdha –(unctuous, oily) and others –heaviness, stickiness, mild, etc along with cold quality causes Kapha chaya. (mild increase)
Same Snigdha – unctuous, oily etc qualities associated with Usna – hot cause Kapha Kopa
Manda- dull and others- rough, dry, clarity, movement, lightness associated with cold quality bring about Kapha Shama- reduction to normal.

Overall,
Vata Dosha –
Ushna (hot) + Ruksha (dryness) and associated qualities  cause Vata Chaya
Sheeta (cold) + Ruksha (dryness) and associated qualities cause Vata Kopa
Ushna (hot) + Snigdha (unctuous, oily) and associated qualities cause Vata shama.

Pitta Dosha
Sheeta (cold) + Teekshna (piercing, strong) etc qualities cause Pitta Chaya
Ushna (hot) +  Teekshna (piercing, strong) etc qualities cause Pitta Kopa
Sheeta (cold) + Manda (mild, dull) cause Pitta Shama.

Kapha Dosha –
Sheeta (Cold) + Snigdha (unctuous, oily) cause Kapha Chaya
Ushna (hot) + Snigdha (unctuous, oily) cause Kapha Kopa
Ushna (hot) + Rooksha (dryness) cause Kapha Shama

Levels of Dosha Increase and Decrease

AH Su 12.22b-23a ½

Chaya of Doshas

चयो वृद्धिः स्वधाम्न्येव प्रद्वेषो वृद्धिहेतुषु॥२२॥
विपरीतगुणेच्छा च
cayo vṛddhiḥ svadhāmnyeva pradveṣo vṛddhihetuṣu||22||
viparītaguṇecchā ca

चयो वृद्धिः स्व धाम्न्येव – cayo vṛddhiḥ sva dhāmnyeva – chaya means slight increase of dosha in its own place (seat),
प्रद्वेषो वृद्धि हेतुषु – pradveṣo vṛddhi hetuṣu – chaya would produce dislike against its aggravating factors (the things that would cause further increase of that particular dosha)
विपरीत गुणेच्छा च – viparītaguṇecchā ca – and liking towards opposite factors (which would not allow the dosha to aggravate further)

Chaya means slight increase of Dosha in its own place.  It produces dislike against the things that would cause further increase of particular Dosha.  It is a self defense mechanism of the body to avoid further increase of Dosha, which may lead to disease.

AH Su 12.23a ½-23b

Kopa of Doshas

कोपस्तून्मार्गगामिता।
लिङ्गानां दर्शनं स्वेषामस्वास्थ्यं रोगसम्भवः॥२३॥
kopastūnmārgagāmitā|
liṅgānāṃ darśanaṃ sveṣāmasvāsthyaṃ rogasambhavaḥ||23||

कोप: तु उन्मार्गगामिता – kopa: tu unmārgagāmitā – kopa is a stage in which the doshas increase further and overflow, leave their seats and move into the other places
दर्शनं लिङ्गानां स्वेषाम् –darśanaṃ liṅgānāṃ sveṣām – it (kopa) causes appearance of symptoms of increased dosha leading to
अस्वास्थ्यं – asvāsthyaṃ – feeling of ill-health,  
रोग – roga – manifestation of the disease and
सम्भवः – sambhavaḥ – long term association with disease and complications.

Kopa – suggests further increase of Dosha and overflow of increased Dosha into other body channels. It causes appearance of symptoms of increased Dosha, leading to onset of disease process. The premonitory symptoms of the disease can be observed at this stage.

AH Su 12.24a

Sama (Shamana, shama) of Doshas

स्वस्थानस्थस्य समता विकारासम्भवः शमः।
svasthānasthasya samatā vikārāsambhavaḥ śamaḥ|

स्वस्थानस्थस्य – svasthānasthasya  – doshas are located in their own sites
समता – samatā – in normal proportions
विकारासम्भवः – vikārāsambhavaḥ –  and not causing the disease is called
शमः– śamaḥ – shama

Shama means normalcy. Restoration / decrease of increased Dosha to its normal levels.

Fluctuation of Dosha in different seasons

AH Su 12.24b-25a

Fluctuations of dosha in different seasons

चयप्रकोपप्रशमा वायोर्ग्रीष्मादिषु त्रिषु॥२४॥
वर्षादिषु तु पित्तस्य, श्लेष्मणः शिशिरादिषु।
cayaprakopapraśamā vāyorgrīṣmādiṣu triṣu||24||
varṣādiṣu tu pittasya, śleṣmaṇaḥ śiśirādiṣu|

चय प्रकोप प्रशमा वायोर्ग्रीष्मादिषु त्रिषु – caya prakopa praśamā vāyorgrīṣmādiṣu triṣu – chaya, prakopa and prashama of Vata takes place in grishma (summer), varsha (raining season) and sharat (autumn) respectively
चय प्रकोप प्रशमा तु पित्तस्य वर्षादिषु – caya prakopa praśamā tu pittasya varṣādiṣu – chaya, prakopa and prashama of pitta takes place in varsha (rainy season), sharat (autumn) and hemanta (early winter) respectively
चय प्रकोप प्रशमा श्लेष्मणः शिशिरादिषु – caya prakopa praśamā śleṣmaṇaḥ śiśirādiṣu – chaya, prakopa and prashama of kapha (shleshma) takes place in shishira (winter), vasanta (spring) and grishma (summer)

Vata undergoes chaya (mild increase) during summer by the use of foods possessing qualities such as lightness, dryness etc. It is especially so, in the bodies of  persons possessing such qualities. But during summer, Vata does not undergo profound increase due to the heat of the summer. (Remember, cold is a quality of vata). Hot is opposite to Vata, hence there is no increase to a large extent.

Similarly, Pitta undergoes chaya in rainy season, because of production of Amla vipaka (sour taste at the end of digestion) of water and foods. But it does not undergo further increase in rainy season, because of coldness. (Remember, hot is the quality of Pitta) Coldness checks further increase of Pitta in rainy season.

Kapha undergoes Chaya in winter by the use of foods with cold and oily qualities. But it does not undergo prakopa because Kapha becomes solidified due to severe cold of the winter.

So, activities and food habits can cause increase or decrease of Dosha. At the same time, seasonal effect also may cause Dosha increase or decrease.

Action of increased Dhosha

AH Su 12.28b-29a

Influence of seasonal and food variations on chaya, kopa and prashamana of doshas

इति कालस्वभावोऽयमाहारादिवशात्पुनः॥२८॥
चयादीन् यान्ति सद्योऽपि दोषाः कालेऽपि वा न तु।
iti kālasvabhāvo’yamāhārādivaśātpunaḥ||28||
cayādīn yānti sadyo’pi doṣāḥ kāle’pi vā na tu|

इति अयम् – iti ayam – as said above, the chaya, Kopa and Shamana of Vata, Pitta and Kapha
कालस्वभावो – kālasvabhāvo – take place under the influence of seasonal effect and
आहारादि वशात् – āhārādi vaśāt – also due to the effect of the foods consumed,
पुनः दोषाः सद्यो अपि – punaḥ doṣāḥ sadyo api – apart from this, the doshas also suddenly
चयादीन् यान्ति – cayādīn yānti – undergo increase, aggravation and pacification (even in the absence of the favorable seasons for their increase or decrease)
कालेऽपि वा न तु – kāle’pi vā na tu – and sometimes do not undergo increase, aggravation or pacification in spite of the presence of favorable seasons, if the foods are monitored and sensibly consumed according to the season.

AH Su 12.29b-30a

Aggravation of doshas is fast, their decrease is slow

व्याप्नोति सहसा देहमापादतलमस्तकम्॥२९॥
निवर्तते तु कुपितो मलाऽल्पाल्पं जलौधवत्।
vyāpnoti sahasā dehamāpādatalamastakam||29||
nivartate tu kupito malā’lpālpaṃ jalaudhavat|

कुपितो मला सहसा व्याप्नोति – kupito malā sahasā vyāpnoti – the vitiated doshas quickly spread
देहम् आपादतल मस्तकम् – deham āpādatala mastakam – throughout the body from foot to head (and cause many diseases) but
निवर्तते तु अल्पाल्पं – nivartate tu alpālpaṃ – the decrease of doshas and restoration of normalcy takes place very slowly,
जलौधवत् – jalaudhavat – just like the floods (when flood occurs, the water gushes into the cities very fast, but the reversal process i.e. evacuation is very slow)

AH Su 12.30b-31

Cause of dosha aggravation and disease formation in this context

नानारूपैरसङ्ख्येयेर्विकारैः कुपिता मलाः॥३०॥
तापयन्ति तनुं तस्मात्तद्धेत्वाकृतिसाधनम्।
शक्यं नैकैकशो वक्तुमतः सामान्यमुच्यते॥३१॥
nānārūpairasaṅkhyeyervikāraiḥ kupitā malāḥ||30||
tāpayanti tanuṃ tasmāttaddhetvākṛtisādhanam|
śakyaṃ naikaikaśo vaktumataḥ sāmānyamucyate||31||

कुपिता मलाः – kupitā malāḥ – the aggravated doshas
तापयन्ति तनुं – tāpayanti tanuṃ – trouble the body by causing
नानारूपै: असङ्ख्येये: विकारैः – nānārūpair asaṅkhyeyer vikāraiḥ – different forms and innumerable types of diseases
तस्मात् न शक्यं – tasmāt na śakyaṃ – therefore it is not possible
एकैकशो वक्तुम् तद्धेत्वाकृति साधनम् – ekaikaśo vaktum tadd hetvākṛti sādhanam – to individually explain their causes, symptoms and treatments (since they are also innumerable), अतः सामान्यमुच्यते – ataḥ sāmānyamucyate – therefore (in this context) they have been generalized (grossly explained)

When there is a flood, the water gushes into the cities very fast, but the reversal process is very slow. Similarly, the increased Doshas spread throughout body from foot to head to produce diseases but the decrease of Dosha and restoration of normalcy takes a very long time.

Dosha is the main cause for disease

AH Su 12.32-34b ½

Doshas are the main causes for all the diseases

दोषा एव हि सर्वेषां रोगाणामेककारणम्।
यथा पक्षी परिपतन् सर्वतः सर्वमप्यहः॥३२॥
छायामत्येति नात्मीया यथा वा कृत्स्नमप्यदः।
विकारजातं विविधं त्रीन् गुणान्नातिवर्तते॥३३॥
तथा स्वधातुवैषम्यनिमित्तमपि सर्वदा।
विकारजात त्रीन्दोषान्
doṣā eva hi sarveṣāṃ rogāṇāmekakāraṇam|
yathā pakṣī paripatan sarvataḥ sarvamapyahaḥ||32||
chāyāmatyeti nātmīyā yathā vā kṛtsnamapyadaḥ|
vikārajātaṃ vividhaṃ trīn guṇānnātivartate||33||
tathā svadhātuvaiṣamyanimittamapi sarvadā|
vikārajāta trīndoṣān

रोगाणाम् दोषा एव हि एककारणम् सर्वेषां – rogāṇām doṣā eva hi ekakāraṇam sarveṣāṃ – always the doshas alone are the sole causative factors for all the diseases,
यथा पक्षी परिपतन् सर्वतः सर्वमप्यहः – yathā pakṣī paripatan sarvataḥ sarvamapyahaḥ – just like a bird which keeps flying everywhere, throughout the day
नात्येति आत्मीया छायाम् – nātyeti ātmīyā chāyām – cannot escape from its own shadow,
यथा वा विविधं विकारजातं – yathā vā vividhaṃ vikārajātaṃ – just like the different species of creation
कृत्स्नमप्यदः – kṛtsnamapyadaḥ – without any exclusions,
नातिवर्तते त्रीन् गुणान् – nātivartate trīn guṇān – cannot be separated from the (their predecessors or causative elements) – three gunas i.e. sattva, raja and tama,
तथा विकारजात स्वधातु वैषम्य निमित्तमपि – tathā  vikārajāta svadhātu vaiṣamya nimittamapi – similarly the diseases (in spite of) getting manifested due to the disturbance of related tissues (swa dhatu vaishamya)
नातिवर्तते त्रीन्दोषान् सर्वदा – nātivartate trīndoṣān  sarvadā – will not be separated from the three doshas (will not manifest without the involvement of three doshas) as a rule, always.  

Like a bird flying high in the sky cannot escape from its shadow, the root cause for disease lies in Tridosha. Even the mental qualities such as Satva, Raja and Tama are influenced by Tridosha. Dosha get vitiated, then cause vitiation of body tissues (Dhatu) and waste products (Mala) to cause disease.  

Three kinds of causes for Dosha increase

AH Su 12.34b ½-35

Three kinds of causes for dosha increase

तेषां कोपे तु कारणम्॥३४॥
अर्थैरसात्म्यैः संयोगः कालः कर्म च दुष्कृतम्।
हीनातिमिथ्यायोगेन भिद्यते तत्पुनस्त्रिधा॥३५॥
teṣāṃ kope tu kāraṇam||34||
arthairasātmyaiḥ saṃyogaḥ kālaḥ karma ca duṣkṛtam|
hīnātimithyāyogena bhidyate tatpunastridhā||35||

तेषां कारणम् तु कोपे – teṣāṃ kāraṇam tu kope – among these (vata, pitta and kapha), the causes for dosha increase (can be categorized as),
असात्म्यैः अर्थै: संयोगः – asātmyaiḥ arthair saṃyogaḥ – wrong (improper, efective) contact of sense organs with their respective sense objects,
कालः  (दुष्कृतम्) – kālaḥ – contamination of seasons (abnormal seasonal variations) and
दुष्कृतम् कर्म च – duṣkṛtam karma ca – wrong deeds
तत्पुन: भिद्यते त्रिधा – tatpunas bhidyate tridhā – this is again of three types,
हीनयोगः – hīnāyoga – less or deficit involvement of sense objects, manifestation of seasons and indulgence in actions
अतियोगः – atiyoga – excessive involvement of sense objects, manifestation of seasons and indulgence in actions and
मिथ्यायोग: – mithyāyoga – wrong (erratic, perverted) contact of sense objects, manifestation of seasons and indulgence in actions

The causes of Dosha increase  can be categorized as
–         Less involvement (Heena yoga),
–         Wrong involvement (Mithya yoga)
–         Over involvement (Atiyoga)
Of
Artha – sense organs
Kala – season
Karma – action .
So, less, wrongful or more involvement of sense organs / seasons / action leads to Dosha imbalance. It is explained further.

Artha – Senses and their correlation

AH Su 12.35b-38b ½

Artha – their deficit, excessive and perverted contact with their sense organs

हीनोऽर्थेनेन्द्रियस्याल्पः संयोगः स्वेन नैव वा।
अतियोगोऽतिसंसर्गः, सूक्ष्मभासुरभैरवम्॥३६॥
अत्यासन्नातिदूरस्थं विप्रियं विकृतादि च।
यदक्ष्णा वीक्ष्यते रूप मिथ्यायोगः स दारुणः॥३७॥
एवमत्युञ्चपूत्यादीनिन्द्रियार्थान् यथायथम्।
विद्यात्
hīno’rthenendriyasyālpaḥ saṃyogaḥ svena naiva vā|
atiyogo’tisaṃsargaḥ, sūkṣmabhāsurabhairavam||36||
atyāsannātidūrasthaṃ vipriyaṃ vikṛtādi ca|
yadakṣṇā vīkṣyate rūpa mithyāyogaḥ sa dāruṇaḥ||37||
evamatyuñcapūtyādīnindriyārthān yathāyatham|
vidyāt

हीनो – hīno – hinayoga or poor association
अल्पः संयोगः नैव वा – alpaḥ saṃyogaḥ naiva vā – insufficient contact or absence of contact
अर्थेन स्वेन इन्द्रियस्य – arthena svena indriyasya – of the sense objects (sound, touch, sight, taste and smell) with their corresponding sense organs (ear, skin, eye, tongue and nose respectively)
अतियोगो अतिसंसर्गः – atiyogo atisaṃsargaḥ – over indulgence (of the sense objects with their respective sense organs)
सूक्ष्म भासुर भैरवम् – sūkṣma bhāsura bhairavam – like gazing at the objects which are very minute, very bright and frightful
मिथ्यायोगः – mithyāyogaḥ – mithya yoga or wrong indulgence (contact of sense objects with their sense organs) like
यदक्ष्णा वीक्ष्यते रूप अत्यासन्नातिदूरस्थं – yadakṣṇā vīkṣyate rūpa atyāsannātidūrasthaṃ – seeing the objects which are very near or very far,
विप्रियं विकृतादि च – vipriyaṃ vikṛtādi ca – objects which are disliked and abnormal (awkward, shapeless, crooked) etc.
स दारुणः – sa dāruṇaḥ – that (mithyayoga) is harmful
एवम् अत्युञ्चपूत्यादीनिन्द्रियार्थान् – evam atyuñcapūtyādīnindriyārthān – similarly, hearing to loud sounds, perceiving foul smells and other perverted perceptions of sense organs 

Hinayoga – Poor association of sense organs – insufficient, inadequate, contact or non- contact with the objects of senses – sound, touch, sight, taste and smell with their respective sense organs. For example, not at all listening to sounds, or living in a low lit area etc

 Atiyoga is over indulgence. Seeing objects which are very minute, bright etc, gazing for a very long time, hearing to loud music etc.

Mithya Yoga – wrong indulgence with sense organs – seeing / hearing frightening, very close, very far, disliked and abnormal objects etc. 36-38 ½

Kala and their correlation

AH Su 12.38b-39

Kala – its deficit, excessive and perverted manifestation
कालस्तु शीतोष्णवर्षाभेदांस्त्रिधा मतः॥३८॥
स हीनो हीनशीतादिरतियोगोऽतिलक्षणः।
मिथ्यायोगस्तु निर्दिष्टो विपरीतस्वलक्षणः॥३९॥
kālastu śītoṣṇavarṣābhedāṃstridhā mataḥ||38||
sa hīno hīnaśītādiratiyogo’tilakṣaṇaḥ|
mithyāyogastu nirdiṣṭo viparītasvalakṣaṇaḥ||39||
कालस्तु त्रिधा मतः शीतोष्णवर्षा भेदात् – kālastu tridhā mataḥ śītoṣṇavarṣābhedāṃs – season is of three kinds i.e. cold, hot and rainy,  
स हीनो हीनशीतादि: – sa hīno hīnaśītādir – hina yoga of kala (deficit manifestation of season) is less cold in winter, less temperature in summer and less rain in rainy season
अतियोगो अतिलक्षणः – atiyogo atilakṣaṇaḥ – atiyoga of kala (excessive manifestation of season) is more cold in winter, more heat in summer and more rain in rainy season,  
मिथ्यायोगस्तु निर्दिष्टो विपरीतस्वलक्षणः – mithyāyogastu nirdiṣṭo viparītasvalakṣaṇaḥ – mithyayoga of kala (perverted manifestation of season) is marked by manifestation of qualities opposite to the natural ones of the season (unseasonal), like rain in summer, heat in winter, cold in rainy season or summer etc.

Kala – seasons :-
Kala is of three kinds, cold, hot and rainy.
Hinayoga of Kala is – less cold in winter, less temperature in summer and less rain in rainy season.

Karma and their correlation

AH Su 12.40-43a

Karma – deficit, excessive and perverted indulgence in actions

कायवाक्चित्तभेदेन कर्मापि विभजेत्त्रिधा।
कायादिकर्मणा हीना प्रवृत्तिर्हीनसज्ञकः॥४०॥
अतियोगोऽतिवृत्तिस्तु, वेगोदीरणधारणम्।
विषमाङ्गक्रियारम्भपतनस्खलनादिकम्॥४१॥
भाषणं सामिभुक्तस्य रागद्वेषभयादि च।
कर्म प्राणातिपातादि दशधा यञ्च निन्दितम्॥४२॥
मिथ्यायोगः समस्तोऽसाविह वाऽमुत्र वा कृतम्।
kāyavākcittabhedena karmāpi vibhajettridhā|
kāyādikarmaṇā hīnā pravṛttirhīnasajñakaḥ||40||
atiyogo’tivṛttistu, vegodīraṇadhāraṇam|
viṣamāṅgakriyārambhapatanaskhalanādikam||41||
bhāṣaṇaṃ sāmibhuktasya rāgadveṣabhayādi ca|
karma prāṇātipātādi daśadhā yañca ninditam||42||
mithyāyogaḥ samasto’sāviha vā’mutra vā kṛtam|

कर्मापि विभजेत्त्रिधा कायवाक्चित्तभेदेन – karmāpi vibhajettridhā kāya vāk cittabhedena – actions are also classified into three types
i.e. kayaka (physical, pertaining to body activities),
vak (speech, pertaining to speaking activities) and
chitta (mental, pertaining to mind activities)
हीनसज्ञकः हीना प्रवृत्ति: कायादि कर्मणा – hīnasajñakaḥ hīnā pravṛttir kāyādi karmaṇā – hinayoga of karma (deficit actions) is indulgence in very less physical activity, very less speaking and very less thought process,
अतियोगोऽतिवृत्तिस्तु – atiyogo ativṛttistu – atiyoga of karma (excessive actions) is indulgence in excessive physical activities, excessive speaking and thinking,  
वेगोदीरण धारणम् – vegodīraṇa dhāraṇam – forceful expulsion and suppression of natural urges,
विषमाङ्गक्रियारम्भ – viṣamāṅgakriyārambha – improper postures (doing activities with weird body postures),
पतन स्खलनादिकम् – patana skhalanādikam – activities like abrupt falling, abrupt jumping etc (are the examples of perverted physical activities or mithyayoga of kayika karma)
भाषणं सामिभुक्तस्य – bhāṣaṇaṃ sāmibhuktasya – speaking too much while taking food or immediately after food (is the example of perverted speech action or mithyayoga of vachika karma)
राग द्वेष भयादि च – rāga dveṣa bhayādi ca – harbouring of desires, hatred, fear etc (are the examples of perverted mind actions or mithyayoga of manasika karma)
प्राणातिपातादि दशधा यञ्च निन्दितम् कर्म – prāṇātipātādi daśadhā yañca ninditam karma – the pranatipata and other ten heinous actions mentioned in dinacharya chapter,
समस्तो असौ मिथ्यायोगः – samasto asāv mithyāyogaḥ – all these are the perverted actions,
कृतम् ह वाऽमुत्र वा – kṛtam iha vā’mutra vā – immaterial of they being done in this world (this incarnation) or that world i.e. eternal world (or previous birth)

Karma: Activities :-
Three types of actions pertaining to mind, body and speech lead to Dosha imbalance.
Heenayoga – speaking very less, very little physical activity, very less thought process.
Atiyoga – excessive speaking, excess physical activity and excessive thinking.
Mithyayoga – wrong speaking, wrong physical activities and wrong, evil thinking, suppression of natural urges, improper postures, abrupt jumping and falling, speaking too much immediately after meals, harboring of desires- attachment, passion, hatred, fear etc.

AH Su 12.43b-44a

Manifestation of diseases pertaining to viscera, tissues and vital organs

निदानमेतद्दोषाणां, कुपितास्तेन नैकधा॥४३॥
कुर्वन्ति विविधान् व्याधीन् शाखाकोष्ठास्थिसन्धिषु।
nidānametaddoṣāṇāṃ, kupitāstena naikadhā||43||
kurvanti vividhān vyādhīn śākhākoṣṭhāsthisandhiṣu|

निदानमेतद्दोषाणां – nidānametaddoṣāṇāṃ – these are the causes for the increase of doshas,
कुपितास्तेन नैकधा विविधान् व्याधीन् कुर्वन्ति – kupitāstena naikadhā vividhān vyādhīn kurvanti – the doshas thus increased by the above mentioned causes will produce many diseases
शाखाकोष्ठास्थिसन्धिषु – śākhākoṣṭhāsthisandhiṣu – involving shakas (tissues), koshta (viscera and visceral organs), bones and joints

These are the causes for increase of Doshas, which lead to production of many kinds of diseases, involving the mind, tissues, viscera, bones and joints.

Pathways of diseases  – Rogamargas

AH Su 12.44b-45

Bahi Koshta / Bahi (bahya) Rogamarga – The external pathway of diseases

शाखारक्तादयस्त्वक् च बाह्यरोगायनं हि तत्॥४४॥
तदाश्रया मषव्यङ्गगण्डालज्यर्बुदादयः।
बहिर्भागाश्च दुर्नामगुल्मशोफादयो गदाः॥४५॥
śākhāraktādayastvak ca bāhyarogāyanaṃ hi tat||44||
tadāśrayā maṣavyaṅgagaṇḍālajyarbudādayaḥ|
bahirbhāgāśca durnāmagulmaśophādayo gadāḥ||45||

शाखा रक्तादय: त्वक् च – śākhā raktādayas tvak ca – Shakha – blood, muscle etc tissues and skin
बाह्य रोगायनं हि तत् – bāhya rogāyanaṃ hi tat- disease afflicting these tissues is considered Bahya Roga Marga – external disease pathway
तदाश्रया – tadāśrayā – diseases residing in these tissues are
मष – maṣa – moles
व्यङ्ग – vyaṅga – discoloured patches, freckles
गण्डा – gaṇḍa – cervical lymphadenitis, thyroid gland swelling, goiter,  
अलजी – alaji – glandular ulcer
अर्बुदादयः – arbudādayaḥ – tumors etc
दुर्नाम गुल्म शोफादयो गदाः बहिर्भागाश्च – durnāma gulma śophādayo gadāḥ bahirbhāgāśca – difficult to treat, chronic abdominal tumor, inflammatory disorders are examples of external disease pathway.

The body is divided into three sections to explain different diseases.
Antarogamarga – internal path – refers to gastro intestinal tract.
Bahi roga marga – external path – refers to Rakta, Mamsa etc Dhatu (tissues) and skin.
Madhyama rogamarga – it includes vital organs such as brain, heart, blood vessels, joints, nerves etc.
This concept is explained below in detail.

Bahi Koshta / Bahi roga marga – External pathway 

Raktha- blood and others tissues (Blood, muscles, bone, fat, bone marrow and sex related secretions) and skin continue the Bahya Rogamarga – external pathway of disease.

It is related with diseases such as moles, discolored patches on face, Gandalaji – goiter, glandular ulcer on the face, malignant tumors, hemorrhoids, abdominal tumor, swelling and other external diseases.

Anta Koshta / Anta Rogamarga – Internal path

AH Su 12.46-47a

Anta Koshta / Anta Rogamarga – The internal pathway of diseases

अन्तःकोष्ठो महास्रोत आमपक्वाशयाश्रयः।
तत्स्थानाः च्छर्द्यतीसारकासश्वासोदरज्वराः॥४६॥
अन्तर्भागं च शोफार्शोगुल्मवीसर्पविद्रधि।
antaḥkoṣṭho mahāsrota āmapakvāśayāśrayaḥ|
tatsthānāḥ cchardyatīsārakāsaśvāsodarajvarāḥ||46||
antarbhāgaṃ ca śophārśogulmavīsarpavidradhi|

अन्तः – antaḥ – the anta rogamarga or the internal pathway of the diseases is made up of
कोष्ठो महास्रोत आम पक्वाशयाश्रयः – koṣṭho mahāsrota āma pakvāśayāśrayaḥ – the koshta (or the interior hollow of the body including thoracic and abdominal cavity) containing the mahasrota (big channel) which is occupied by amashaya (stomach and small intestine) and pakwashaya (large intestine),
तत्स्थानाः – tatsthānāḥ – there, in the anta roga marga occurs the diseases like
छर्दि –chardi – vomiting,
अतीसार – atīsāra – diarrhea,
कास – kāsa – cough,
श्वास – śvāsa – dyspnoea (short of breath),
उदर – udara – enlargement of the abdomen (belly, tummy),
ज्वराः – jvarāḥ – fever,
शोफ अर्शो गुल्म वीसर्प विद्रधि – śopha arśo gulma vīsarpa vidradhi – dropsy, hemorrhoids, abdominal tumors, herpes, abscess, etc अन्तर्भागं च – antarbhāgaṃ ca – which occur in the interior of the body (inside the body)

Amashaya – stomach and small intestine,
Pakwashaya – large intestine
The above two, along with the entire gastro intestinal tract is called as Mahasrota. (The big channel). This constitutes the Anta Koshta.

Diseases which affect this path are – vomiting, diarrhea, cough, dyspnoea, enlargement of the abdomen, fever, dropsy, hemorrhoids, abdominal tumors, Visarpa (herpes), abscess etc.

Madhyama Koshta / Madhyama Rogamarga – The middle path

AH Su 12.47b-49a

Madhyama Koshta / Madhyama Rogamarga – The middle pathway of diseases

शिरोहृदयवस्त्यादिमर्माण्यस्थ्नां च सन्धयः॥४७॥
तन्निबद्धाः शिरास्नायुकण्डराद्याश्च मध्यमः।
रोगमार्गः स्थितास्तत्र यक्ष्मपक्षवधार्दिताः॥४८॥
मूर्धादिरोगाः सन्ध्यस्थित्रिकशूलग्रहादयः।
śirohṛdayavastyādimarmāṇyasthnāṃ ca sandhayaḥ||47||
tannibaddhāḥ śirāsnāyukaṇḍarādyāśca madhyamaḥ|
rogamārgaḥ sthitāstatra yakṣmapakṣavadhārditāḥ||48||
mūrdhādirogāḥ sandhyasthitrikaśūlagrahādayaḥ|

शिरो हृदय वस्त्यादि मर्माणि – śiro hṛdaya vastyādi marmāṇy – the head, heart, urinary bladder and such other vital organs,
अस्थ्नां च सन्धयः – asthnāṃ ca sandhayaḥ – bony joints,
शिरा स्नायु कण्डराद्याश्च तन्निबद्धाः – śirā snāyu kaṇḍarādyāśca tannibaddhāḥ – the blood vessels, tendons, ligaments (nerves) etc bound to the bony joints,   
मध्यमः रोगमार्गः – madhyamaḥ rogamārgaḥ – constitute the madhyama rogamarga or the middle path of disease manifestation
तत्र स्थिता: – tatra sthitās – in the madhyama rogamarga are manifested (from the middle path arise) –
यक्ष्म – yakṣma – consumption,
पक्षवध – pakṣavadha – hemiplegia,
अर्दिताः – arditāḥ – facial paralysis,
मूर्धादि रोगाः – mūrdhādi rogāḥ – diseases of the head and other organs,  
सन्ध्यस्थि त्रिक शूल ग्रहादयः – sandhy asthi trika śūla grahādayaḥ – pain and stiffness (loss of movement) of the joints, bones, waist etc

The head, heart, urinary bladder and such other vital organs, joints of bones, blood vessels, tendons, ligaments, nerves constitute the madhyama rogamarga. From it arise, consumption, hemiplegia, facial paralysis, diseases of the head and other organs, pain, stiffness- loss of movement of the joints, bones, waist etc.

Different symptoms produced by increased Dosha

Symptoms of Vata increase

AH Su 12.49b-51b ½

Symptoms of increase (aggravation) of vata

स्रंसव्यासव्यधस्वापसादरुक्तोदभेदनम्॥४९॥
सङ्गाङ्गभङ्गसङ्कोचवर्तहर्षणतर्षणम्।
कम्पपारुष्यसौषिर्यशोषस्पन्दनवेष्टनम्॥५०॥
स्तम्भः कषायरसता वर्णः श्यावोऽरुणोऽपि वा।
कर्माणि वायोः
sraṃsavyāsavyadhasvāpasādaruktodabhedanam||49||
saṅgāṅgabhaṅgasaṅkocavartaharṣaṇatarṣaṇam|
kampapāruṣyasauṣiryaśoṣaspandanaveṣṭanam||50||
stambhaḥ kaṣāyarasatā varṇaḥ śyāvo’ruṇo’pi vā|
karmāṇi vāyoḥ

कर्माणि वायोः – karmāṇi vāyoḥ – the functions (signs and symptoms) of increased (aggravated) vata (vayu) are –
स्रंस – sraṃsa – drooping down (ptosis)
व्यास – vyāsa – dilation
व्यध – vyadha – cutting pain
स्वाप – svāpa – loss of sensation
साद – sāda – weakness, loss of functions
रुक्तोद – ruk toda – pain, throbbing (pricking) pain
भेदनम् – bhedanam – splitting pain
सङ्ग – saṅga – constriction
अङ्गभङ्ग – aṅgabhaṅga – body ache (feel as if the body is being broken)
सङ्कोच – saṅkoca – shrinking of the organ, reduction in size of tissues and organs
वर्त – varta – twisting
हर्षण – harṣaṇa – tingling sensation
तर्षणम् – tarṣaṇam – thirst
कम्प – kampa – tremors  
पारुष्य – pāruṣya – roughness
सौषिर्य – sauṣirya – feeling of empty
शोष – śoṣa – dryness
स्पन्दन – spandana – pulsating feel
वेष्टनम् – veṣṭanam – rigidity (as if tied)
स्तम्भः – stambhaḥ – stiffness
कषाय रसता – kaṣāya rasatā – astringent taste in the mouth
वर्णः श्यावो अरुणोऽपि वा – varṇaḥ śyāvo’ruṇo’pi vā – appearance of blue or crimson discoloration

Sramsa – Ptosis- drooping down
Vyasa – dilation
Vyadha – cutting pain
Swapa – loss of sensation
Sada – weakness, loss of function
Ruk – pain
Toda – continuous pain
Bhedanam – splitting pain
Sanga – Constriction,
Angabhanga – bodyache,
Sankocha – shrinking of the organ, reduction in size
Varta – twisting,
Harshana – tingling sensation
Tarshana – thirst
Kampa – tremors
Parushya – roughness
Saushirya – feeling of empty
Shosha – dryness
Spandana – pulsating
Veshtana – rigidity, as if tied
Sthambha – stiffness
Kashaya rasata – astringent taste in mouth
Aruna, Shyava Varna  – appearance of blue or crimson discoloration
– these are the abnormal signs and symptoms of increased Vayu –Vata. 49-50

 Symptoms of Pitta increase

AH Su 12.51b-52

Symptoms of increase (aggravation) of pitta

पित्तस्य दाहरागोष्मपाकिताः॥५१॥
स्वेदः क्लेदः स्रुतिः कोथः सदनं मूर्च्छनं मदः।
कटुकाम्लौ रसौ वर्णः पाण्डुरारुणवर्जितः॥५२॥
pittasya dāharāgoṣmapākitāḥ||51||
svedaḥ kledaḥ srutiḥ kothaḥ sadanaṃ mūrcchanaṃ madaḥ|
kaṭukāmlau rasau varṇaḥ pāṇḍurāruṇavarjitaḥ||52||

पित्तस्य – pittasya – the signs and symptoms of increase (aggravation of) of pitta are –
दाह – dāha – burning sensation
राग – rāga – reddish discoloration  
ऊष्मा – oṣma – increase of heat (temperature)
पाकिताः – pākitāḥ – suppuration (formation of pus),
स्वेदः –  svedaḥ – sweating
क्लेदः –  kledaḥ – inflammation with wetness, moistness,  
स्रुतिः – srutiḥ – discharges (oozing, secretions, exudation)
कोथः – kothaḥ – putrefaction, decomposition
सदनं – sadanaṃ – debility,
मूर्च्छनं – mūrcchanaṃ – fainting
मदः – madaḥ – toxicity, (intoxication),
कटुक अम्लौ रसौ – kaṭuka amlau rasau – bitter and sour taste in the mouth,
वर्णः पाण्डुरारुणवर्जितः – varṇaḥ pāṇḍurāruṇavarjitaḥ – appearance of color other than white and crimson colors

Sneha – unctuousness, oiliness,
Kathinya – hardness,
Kandu – itching,
Sheetatva – coldness,
Gaurava – heaviness,
Bandha – obstruction,
Upalepa – coating, as if tied with a wet cloth,
Staimitya – stiffness, loss of movement,
Shopha – inflammation,
Apakti – indigestion,
Atinidrata – excessive sleep,
Shveta varna – white discolouration,
Svadu lavana rasa – sweet, salt taste in mouth,
Chirakarita – delay in all activities.

Symptoms of Kapha increase

AH Su 12.53-54a

Symptoms of increase (aggravation) of kapha

श्लेष्मणः स्नेहकाठिन्यकण्डूशीतत्वगौरवम्।
बन्धोपलेपस्तैमित्यशोफापक्त्यतिनिद्रताः॥५३॥
वर्णः श्वेतो रसौ स्वादुलवणौ चिरकारिता।
śleṣmaṇaḥ snehakāṭhinyakaṇḍūśītatvagauravam|
bandhopalepastaimityaśophāpaktyatinidratāḥ||53||
varṇaḥ śveto rasau svādulavaṇau cirakāritā|

श्लेष्मणः – śleṣmaṇaḥ – the signs and symptoms of increase (aggravation) of kapha are –
स्नेह – sneha – unctuousness, oiliness,  
काठिन्य – kāṭhinya – hardness,
कण्डू – kaṇḍū – itching
शीतत्व – śītatva – coldness
गौरवम् – gauravam – heaviness
बन्धोपलेप – bandhopalepa – obstruction (bandha), coating (upalepa),
स्तैमित्य – staimitya – a feel as if tied with a wet cloth
शोफ – śophā – inflammation
अपक्ति – apakty – indigestion
अतिनिद्रताः – atinidratāḥ – excessive sleep
श्वेतो वर्णः – śveto varṇaḥ – white discoloration
स्वादु लवणौ रसौ – svādu lavaṇau rasau – sweet and salt taste in mouth,
चिरकारिता – cirakāritā – delay in all activities

Thus are enumerated, the features, which appear in diseases, are to be recognized by the physician through inspection and others – methods of examination of patient.

Trividha pareeksha

AH Su 12.54b-55

All the diseases should be examined thoroughly by inspection, interrogation and palpation

इत्यशेषामयव्यापि यदुक्तं दोषलक्षणम्॥५४॥
दर्शनाद्यैरवहितस्तत्सम्यगुपलक्षयेत्।
व्याध्यवस्थाविभागज्ञः पश्यन्नार्तान् प्रतिक्षणम्॥५५॥
ityaśeṣāmayavyāpi yaduktaṃ doṣalakṣaṇam||54||
darśanādyairavahitastatsamyagupalakṣayet|
vyādhyavasthāvibhāgajñaḥ paśyannārtān pratikṣaṇam||55||

इति यदुक्तं अशेषामयव्यापि दोष लक्षणम् – ity yaduktaṃ aśeṣāmayavyāpi doṣa lakṣaṇam – Thus, the above said symptoms of all the doshas
तत्सम्यगुपलक्षयेत् दर्शनाद्यै: – tatsamyag upalakṣayet darśanādyair – should be properly learnt by darshana (inspection) and other measures of examination of the patient (sparshana – examination by touch which includes palpation and percussion, prashna – interrogation)
अवहित: व्याध्यवस्था विभागज्ञः – avahitas vyādhyavasthā vibhāgajñaḥ – by a physician who is attentive, knower of stages of diseases,
पश्यन्नार्तान् प्रतिक्षणम् – paśyannārtān pratikṣaṇam – after observing the patients every moment

AH Su 12.56

Need of both theoretical and practical knowledge by a physician to excel in clinical practice

अभ्यासात्प्राप्यते दृष्टिः कर्मसिद्धिप्रकाशिनी।
रत्नादिसदसज्ज्ञानं न शास्त्रादेव जायते॥५६॥
abhyāsātprāpyate dṛṣṭiḥ karmasiddhiprakāśinī|
ratnādisadasajjñānaṃ na śāstrādeva jāyate||56||

अभ्यासात् प्राप्यते दृष्टिः – abhyāsāt prāpyate dṛṣṭiḥ – by constant practice, is gained the practical knowledge and experience
कर्मसिद्धि प्रकाशिनी – karmasiddhi prakāśinī – which would reflect the success in treatment procedures and clinical practice (the status of successful practice which the physician would enjoy in coming days)
रत्नादि सदसज्ज्ञानं – ratnādi sadasajjñānaṃ – just like the knowledge of identifying the gems, gold, precious stones etc
न शास्त्रादेव जायते – na śāstrādeva jāyate – will not be obtained just by theoretical knowledge (one should also have a practice of handling the gems and precious stones to tell which is a genuine one and which not)

Note: This passage explains the need of both comprehensive theoretical and practical exposure and knowledge for a physician to excel in clinical practice

Trividha roga based on nidana

AH Su 12.57

Three kinds of diseases based on the cause

दृष्टापचारजः कश्चित्कश्चित्पूर्वापराधजः।
तत्सङ्कराद्भवत्यन्यो व्याधिरेवं त्रिधा स्मृतः॥५७॥
dṛṣṭāpacārajaḥ kaścitkaścitpūrvāparādhajaḥ|
tatsaṅkarādbhavatyanyo vyādhirevaṃ tridhā smṛtaḥ||57||

व्याधिरेवं स्मृतः त्रिधा – vyādhirevaṃ smṛtaḥ tridhā – the diseases are said to be of three types,
कश्चित् दृष्टापचारजः – kaścit dṛṣṭāpacārajaḥ – (among them) some are due to misdeeds done in the present time (consumption of factors which cause aggravation of doshas and subsequent formation of diseases),
कश्चित् पूर्वार्वापराधजः – kaścit pūrvāparādhajaḥ – some occur due to the misdeeds done previously i.e. without the involvement of any causative factors (in previous incarnation)
तत्सङ्कराद्भवत्यन्यो – tatsaṅkarādbhavatyanyo – and some manifest due to combination of both the above said factors

AH Su 12.58

Explanation of three kinds of diseases based on the cause

यथानिदानं दोषोत्थः कर्मजो हेतुभिर्विना।
महारम्भोऽल्पके हेतावातङ्को दोषकर्मजः॥५८॥
yathānidānaṃ doṣotthaḥ karmajo hetubhirvinā|
mahārambho’lpake hetāvātaṅko doṣakarmajaḥ||58||

यथा निदानं दोषोत्थः – yathā nidānaṃ doṣotthaḥ – (drushtapacharaja or doshaja vyadhis are those) diseases which get manifested due to the doshas – which are aggravated due to the consumption (exposure) of – causative factors which vitiate them   
कर्मजो हेतुभिर्विना – karmajo hetubhirvinā – karmaja vyadhis (purvaparadhaja, adrushtaja) are those diseases which get manifested without the involvement of any causative factors
आतङ्को महारम्भो अल्पके हेतौ दोषकर्मजः – ātaṅko mahārambho alpake hetāv doṣakarmajaḥ – the diseases which get manifested with severe and profound symptoms in spite of available of minimum vitiating factors are called doshakarmaja vyadhis (caused due mixed factors i.e. causative factors of a disease and misdeeds done previously)

Chikitsa of trividha roga based on nidana

AH Su 12.59

Remedies for three kinds of diseases based on the cause

विपक्षशीलनात्पूर्वः कर्मजः कर्मसङ्क्षयात्।
गच्छत्युभयजन्मा तु दोषकर्मक्षयात्क्षयम्॥५९॥
vipakṣaśīlanātpūrvaḥ karmajaḥ karmasaṅkṣayāt|
gacchatyubhayajanmā tu doṣakarmakṣayātkṣayam||59||

पूर्वः विपक्षशीलनात् – pūrvaḥ vipakṣaśīlanāt –  the first type of disease (drushtapacharaja, doshaja vyadhis) get cured by indulgence in food, activities and medicines which have opposite qualities to the causes of the disease
कर्मजः कर्मसङ्क्षयात् – karmajaḥ karmasaṅkṣayāt – the karmaja vyadhis get cured after the termination of the effects of acts or misdeeds done in previous (or current) lives
गच्छत्युभयजन्मा तु दोषकर्म क्षयात्क्षयम् – gacchatyubhayajanmā tu doṣakarma kṣayātkṣayam – dosha-karmaja diseases get cured after the mitigation of doshas and (along with) nullifying of effects of misdeeds done in previous life i.e. past deeds.

Swatantra and Paratantra vyadhi

AH Su 12.60a

Swatantra (independent/primary) and Paratantra (dependent/secondary) types of diseases

द्विधा स्वपरतन्त्रत्वाद्व्याधयोऽन्त्याः पुनर्द्विधा।
dvidhā svaparatantratvādvyādhayo’ntyāḥ punardvidhā|

व्याधयो द्विधा स्वतन्त्र परतन्त्रत्वाद् – vyādhayo dvidhā svatantra paratantratvād – the (above mentioned) diseases are again of two types, they are swatantra (independent / primary) and paratantra (dependent / secondary) diseases
अन्त्याः पुनर्द्विधा – antyāḥ punardvidhā – the second type of disease (paratantra) is again of two types

Types of Paratantra vyadhi

AH Su 12.60b

Two types of Paratantra diseases (secondary diseases)

पूर्वजाः पूर्वरूपाख्या, जाताः पश्चादुपद्रवाः॥६०॥
pūrvajāḥ pūrvarūpākhyā, jātāḥ paścādupadravāḥ||60||

पूर्वजाः पूर्वरूपाख्या – pūrvajāḥ pūrvarūpākhyā – purvaja vyadhis (first type of paratantra disease) are also called as purvarupas (premonitory symptoms which manifest before the manifestation of the actual disease) and
पश्चात् जाताः उपद्रवाः – paścād jātāḥ upadravāḥ – paschat jata vyadhis (second type of paratantra disease) are manifested after the formation of the disease and are also called upadravas (complications of a disease)

Definition of Swatantra and Paratantra vyadhi

AH Su 12.61a

Definition of swatantra or primary disease

यथास्वजन्मोपशयाः स्वतन्त्राः स्पष्टलक्षणाः।
yathāsvajanmopaśayāḥ svatantrāḥ spaṣṭalakṣaṇāḥ|

स्वतन्त्राः – svatantrāḥ – swatantra vyadhi (independent, primary disease) are those which have  
यथा स्व जन्म – yathāsva janma – their own specific causes (due to which they get manifested),
यथास्व उपशयः – yathāsva upaśayāḥ – their own comforting methods (remedies which are specific to them, which when administered will cure those diseases) and स्पष्ट लक्षणाः – spaṣṭa lakṣaṇāḥ – clearly manifest signs and symptoms (which are specific to those diseases).

AH Su 12.61b ½  

Definition of paratantra or secondary disease

विपरीतास्ततोऽन्ये तु
viparītāstato’nye tu

The other type of disease i.e. paratnatra vyadhi (secondary, dependent, associated disease) will have the opposite features as that of primary disease.

Note: Paratantra Vyadhi or secondary disease will not have its own causes, will not have specific remedies of its own and will not have its own signs and symptoms.

Swatantra and Paratantra doshas

AH Su 12.61b ½-62a

Swatantra and Paratantra Doshas

विद्यादेवं मलानपि॥६१॥
vidyādevaṃ malānapi||61||

तांल्लक्षयेदवहितो विकुर्वाणान् प्रतिज्वरम्।
tāṃllakṣayedavahito vikurvāṇān pratijvaram|

मलानपि विद्यादेवं – malānapi vidyādevaṃ – (just like the diseases) the doshas will also have swatantra (independent, primary) and paratantra (dependent, secondary, associated) types (of manifestation)
अवहितो – avahito – an attentive (wise) physician
तांल्लक्षयेद् – tāṃllakṣayed – should understand the independent causative factors (leading to their vitiation), specific comforting measures and specific signs and symptoms of these doshas (vata, pitta, kapha) by observing विकुर्वाणान् – vikurvāṇān – the symptoms of aggravation of doshas
प्रतिज्वरम् – pratijvaram – in particular diseases (caused by those vitiated doshas)

Paratantra vyadhi and dosha chikitsa

AH Su 12.62b-63

Treatment of Paratantra vyadhis and doshas

तेषां प्रधानप्रशमे प्रशमोऽशाम्यतस्तथा॥६२॥
पश्चाञ्चिकित्सेत्तूर्णं वा बलवन्तमुपद्रवम्।
व्याधिक्लिष्टशरीरस्य पीडाकरतरो हि सः॥६३॥
teṣāṃ pradhānapraśame praśamo’śāmyatastathā||62||
paścāñcikitsettūrṇaṃ vā balavantamupadravam|
vyādhikliṣṭaśarīrasya pīḍākarataro hi saḥ||63||

तेषां प्रधान प्रशमे प्रशमो – teṣāṃ pradhāna praśame praśamo – among them, paratantra (secondary) disease subsides when the pradhana or swatantra (primary disease) disease is pacified (through proper treatment administered for primary disease)
अशाम्यत: चिकित्सेत् पश्चात् तथा – aśāmyatas cikitset paścāñ tathā – the secondary diseases which do not get subsided (in spite of the treatment of primary disease) should be treated (independently) after the treatment of the primary disease, considering it as an independent disease (on the lines of treatment of an independent disease)
तूर्णं वा उपद्रवम् बलवन्तम् – tūrṇaṃ vā upadravam balavantam – immediate treatment should be administered if the secondary affections, especially (those which have manifested in the form of) complications are very powerful (as priority, even without administering the treatment for primary disease)
पीडाकरतरो व्याधिक्लिष्ट शरीरस्य हि सः – pīḍākarataro vyādhikliṣṭaśarīrasya hi saḥ – because these complications will cause more trouble to the body which is already debilitated by the primary disease

AH Su 12.64

Every disease does not have a name!

विकारनामाकुशलो न जिह्रीयात् कदाचन।
न हि सर्वविकाराणां नामतोऽस्ति ध्रुवा स्थितिः॥६४॥
vikāranāmākuśalo na jihrīyāt kadācana|
na hi sarvavikārāṇāṃ nāmato’sti dhruvā sthitiḥ||64||

विकारनामाकुशलो न जिह्रीयात् कदाचन – vikāranāmākuśalo na jihrīyāt kadācana – the physician who does not know the names of all the diseases (nomenclature of the diseases) should never feel shy about it, because
सर्व विकाराणां न हि ध्रुवा स्थितिः नामतो अस्ति – sarva vikārāṇāṃ na hi dhruvā sthitiḥ nāmato asti – (there is no rule that) all the diseases do not have a definitive and fixed name Note: This explains that the physician should not be shying, on not able to name a disease or identify a disease by its name because there is no rule that every disease has a name. This also explains that the knowledge of doshas and their vitiation is more important than knowing the names of the diseases. Treatment of the ailing person is important and it shall be focused upon, rather than worrying about the nomenclature of the diseases.

Factors to observe in patient

AH Su 12.65-66

Factors to be considered to treat the diseases

स एव कुपितो दोषः समुत्थानविशेषतः।
स्थानान्तराणि च प्राप्य विकारान् कुरुते बहून्॥६५॥
तस्माद्विकारप्रकृतीरधिष्ठानान्तराणि च।
बुद्ध्वा हेतुविशेषश्च शीघ्रं कुर्यादुपक्रमम्॥६६॥
sa eva kupito doṣaḥ samutthānaviśeṣataḥ|
sthānāntarāṇi ca prāpya vikārān kurute bahūn||65||
tasmādvikāraprakṛtīradhiṣṭhānāntarāṇi ca|
buddhvā hetuviśeṣaśca śīghraṃ kuryādupakramam||66||

स एव कुपितो दोषः – sa eva kupito doṣaḥ – the very same vitiated dosha (doshas)
समुत्थान विशेषतः – samutthāna viśeṣataḥ – depending upon the nature of their causative factors,
प्राप्य च स्थानान्तराणि – prāpya ca sthānāntarāṇi– on reaching to the different parts of the body,  
कुरुते बहून् विकारान् – kurute bahūn vikārān – will produce many diseases,
तस्माद् उपक्रमम् कुर्याद् शीघ्रं – tasmād upakramam kuryād śīghraṃ – therefore,the treatment of the disease should be done quickly,
बुद्ध्वा – buddhvā – after knowing (properly understanding)
विकारप्रकृतीरधिष्ठानान्तराणि च – vikāraprakṛtīr adhiṣṭhānāntarāṇi ca – vikara prakriti (main doshas causing the disease), adhishtana antarani (various parts of the body in which the vitiated doshas have caused the disease i.e. abode or site of manifestation of the disease) and
हेतुविशेषश्च – hetuviśeṣaśca – specific causes for vitiation of doshas (specific qualities of doshas which have undergone increase)

The physician should minutely examine and determine,
Dushya – the Dhatus and Malas involved in a diseases
Desha – the area of the body where disease is manifested, the living place of the patient
Bala – strength of the patient,
Kala- season, how old is the disease, age of the person etc. ,
Anala- digestive power of the patient,
Prakriti- body constitution,
Vayas- age of the patient and disease,
Satva- mind, tolerance capacity of the patient,
Satmya- the food and activities to which the patient is accustomed to.
Ahara- food habits and
Avastha- stages of the diseases

AH Su 12.67-68

Factors to observe in the patient

दूष्यं देशं बलं कालमनलं प्रकृति वयः।
सत्त्वं सात्म्यं तथाऽऽहारमवस्थाश्च पृथग्विधाः॥६७॥
सूक्ष्मसूक्ष्माः समीक्ष्यैषां दोषौषदनिरूपणे।
यो वर्तते चिकित्सायां न स स्खलति जातुचित्॥६८॥
dūṣyaṃ deśaṃ balaṃ kālamanalaṃ prakṛti vayaḥ|
sattvaṃ sātmyaṃ tathā”hāramavasthāśca pṛthagvidhāḥ||67||
sūkṣmasūkṣmāḥ samīkṣyaiṣāṃ doṣauṣadanirūpaṇe|
yo vartate cikitsāyāṃ na sa skhalati jātucit||68||

दोषौषदनिरूपणे – doṣauṣadanirūpaṇe – in order to decide the nature of aggravated doshas and their appropriate treatment,
यो – yo – the physician
सूक्ष्मसूक्ष्माः समीक्ष्यैषां – sūkṣmasūkṣmāḥ samīkṣyaiṣāṃ – who after very minutely examining and determining in a disease (the below mentioned factors)
दूष्यं – dūṣyaṃ – the dhatus (tissues) and malas (excreta) involved in diseases
देशं – deśaṃ – the area of the body wherein the disease is manifested or the living place of the patient,
बलं – balaṃ – strength of the patient,
कालम् – kālam – season, duration of the disease, age of the person etc
अनलं – analaṃ – digestive power of the patient,
प्रकृति – prakṛti – body constitution,
वयः – vayaḥ – age of the patient
सत्त्वं – sattvaṃ – mind (mental state) and tolerance capacity of the patient
सात्म्यं – sātmyaṃ – the food and activities to which the patient is accustomed to
तथा आहारम् – tathā āhāram – and food habits of the patient and
अवस्थाश्च पृथग्विधाः – avasthāśca pṛthagvidhāḥ – stages of the diseases
वर्तते – vartate – will involve himself (put efforts in treating the diseases),
स न स्खलति जातुचित् चिकित्सायां – sa na skhalati jātucit cikitsāyāṃ – such a physician will never make mistakes in treatment

The physician should watch for above factors to decide and only then, should the physician decide on the aggravated Dosha and its appropriate treatment. Such a doctor will never commit mistakes in treatment.

Guru vyadhi and Laghu vyadhi

AH Su 12.69

Guru Vyadhi and Laghu Vyadhi (strong and weak disease)

गुर्वल्पव्याधिसंस्थानं सत्त्वदेहबलाबलात्।
दृश्यतेऽप्यन्यथाकारं तस्मिन्नवहितो भवेत्॥६९॥
gurvalpavyādhisaṃsthānaṃ sattvadehabalābalāt|
dṛśyate’pyanyathākāraṃ tasminnavahito bhavet||69||

सत्त्व देह बलाबलात् – sattva deha balābalāt – depending on the strength and weakness of the mind and body,
गुर्वल्प व्याधि संस्थानं – gurvalpa vyādhi saṃsthānaṃ – the symptoms of guru vyadhi (strong disease) and alpa vyadhi (weak disease)
दृश्यते अपि अन्यथाकारं – dṛśyate apy anyathākāraṃ – (may vary) may appear in a contrasting (opposite) way,
तस्मिन्नवहितो भवेत् – tasminnavahito bhavet – hence the physician should be very attentive

Note: In people having good body and mind strength, a strong disease may appear weak and in people having weak body and mind strength, a weak disease may appear like a strong disease. This contrasting picture will always be misguiding. The physician should not be misguided with such presentations. In fact he should analyze a disease with presence of his mind, his skills, instincts and experience and should be very attentive in handling such cases.

The symptoms may be affected by the disease and also by the mental status of the patient. The strength of the disease varies based on strength and weakness of the mind and body of the patient. Hence the physician should be very attentive.

Treatment going wrong when severe disease is diagnosed as a feeble disease

गुरुं लघुमिति व्याधि कल्पयस्तु भिषग्ब्रुवः।
अल्पदोषाकलनया पथ्ये विप्रतिपद्यते॥७०॥
guruṃ laghumiti vyādhi kalpayastu bhiṣagbruvaḥ|
alpadoṣākalanayā pathye vipratipadyate||70||

भिषग्ब्रुवः – bhiṣagbruvaḥ – an unintelligent physician
कल्पयस्तु – kalpayastu – who considers (diagnoses)
गुरुं व्याधिं लघुमिति – guruṃ vyādhim laghumiti – a severe (strong, grievous) disease as a weak (mild) disease,
विप्रतिपद्यते पथ्ये – vipratipadyate pathye – goes wrong in treatment
अल्पदोषाकलनया – alpadoṣākalanayā  – because of considering alpa doshas (less quantity of dosha aggravation) in a grievous disease (in which there is actually severe aggravation of doshas)

The unintelligent physician, who determines a grievous disease as a mild one, goes wrong in treatment because of under estimating the condition and the Dosha.

He will administer drugs/ therapies in small doses. Such mild treatment causes worsening of the disease because of ineffective treatment.

AH Su 12.71-72

Effect of wrongly diagnosing grievous disease as mild disease and vice versa

ततो अल्पमल्पवीर्यं वा गुरुव्याधौ प्रयोजितम्।
उदीरयेत्तरां रोगान् संशोधनमयोगतः॥७१॥
शोधनं त्वतियोगेन विपरीतं विपर्यये।
क्षिणुयान्न मलानेव केवलं वपुरस्यति॥७२॥
tato’lpamalpavīryaṃ vā guruvyādhau prayojitam|
udīrayettarāṃ rogān saṃśodhanamayogataḥ||71||
śodhanaṃ tvatiyogena viparītaṃ viparyaye|
kṣiṇuyānna malāneva kevalaṃ vapurasyati||72||

ततो – tato – thus (after diagnosing a grievous disease as mild disease),
अल्पम् अल्पवीर्यं वा – alpam alpavīryaṃ vā – when medicines in less quantity and less potency
प्रयोजितम् गुरुव्याधौ – prayojitam guruvyādhau – are administered in severe (strong, grievous) disease,
उदीरयेत्तरां रोगान् – udīrayettarāṃ rogān –  it will lead to worsening of disease
संशोधनम् अयोगतः – saṃśodhanam ayogataḥ – because of deficit (inadequate, ineffective) cleansing (more cleansing and stronger treatment and medicines are needed in strong diseases)
विपर्यये विपरीतं – viparyaye viparītaṃ – (on the other hand) in the opposite condition i.e. in a feeble or weak disease, if medicines and treatment in more quantity and more potency are administered (including the cleansing measures like panchakarma),
क्षिणुयान्न मलानेव केवलं – kṣiṇuyānna malāneva kevalaṃ – they will not only destroy the morbid doshas,
वपुरस्यति– vapurasyati – they will also cause excessive destruction of the body (cause damage to the body in a larger extent)
तु अतियोगेन शोधनं – tu atiyogena śodhanaṃ – because of excessive cleansing (less cleansing is needed in mild diseases)

On the other hand, if the person over estimates the strength of the disease and over treats with Panchakarma and oral medicines, it will also trouble the health of the patient to a very great extent.

AH Su 12.73

Right approach of a determined physician towards comprehensive treatment

अतोऽभियुक्तः सततं सर्वमालोच्य सर्वथा।
तथा युञ्जीत भैषज्यमारोग्याय यथा ध्रुवम्॥७३॥
ato’bhiyuktaḥ satataṃ sarvamālocya sarvathā|
tathā yuñjīta bhaiṣajyamārogyāya yathā dhruvam||73||

अतो सततं अभियुक्तः – ato satataṃ abhiyuktaḥ – hence, the physician who is constantly engaged and committed towards learning the science
सर्वम् – sarvam – should determine the exact condition of all the factors (involved in the causation of a disease)
आलोच्य सर्वथा – ālocya sarvathā – and analyze everything in all ways and at all times (through the Ayurvedic theoretical and practical knowledge he possesses due to constant learning and also through his skills having proved his efficiency)
तथा – tathā – and later (after having considered all the factors like dosha, dushyas, desha etc),
युञ्जीत भैषज्यम् – bhaiṣajyam yuñjīta – should administer the medicines (treatment)
यथा ध्रुवम् आरोग्याय – yathā dhruvam ārogyāya – as needed (and justified) for the sake of proper health (to establish and maintain good health)

Hence the physician should constantly study the science, determine the exact condition of all factors, all the time and then administer appropriate medicines and treatments.

Dosha Samyoga Samkhya

AH Su 12.74a

Number of permutations and combinations of doshas – Dosha Samyoga Samkhya

वक्ष्यन्तेऽतःपरं दोषा वृद्धिक्षयविभेदत।
vakṣyante’taḥparaṃ doṣā vṛddhikṣayavibhedata|

अतः परं वक्ष्यन्ते – ataḥ paraṃ vakṣyante – after this, we are going to expound (explain)
दोषा वृद्धि क्षय विभेदत – doṣā vṛddhi kṣaya vibhedata – the permutations and combinations of dosha increase and decrease

Number of combination of Dosha – Dosha Samyoga Samkhya

The number of combinations of Dosha increase and decrease are 62.

The 63^rd is the condition, where all the Doshas are in equilibrium, which is called as the state of health.

Permutations and Combinations of Dosha

AH Su 12.74b-76

Permutations and combinations of doshas

पृथक् त्रीन् विद्धि संसर्गस्त्रिधा, तत्र तु तान्नव॥७४॥
pṛthak trīn viddhi saṃsargastridhā, tatra tu tānnava||74||
त्रीनेव समया वृद्ध्या, षडेकस्यातिशायने।
trīneva samayā vṛddhyā, ṣaḍekasyātiśāyane|
त्रयोदश समस्तेषु षड् ह्येकातिशयेन तु॥७५॥
trayodaśa samasteṣu ṣaḍ hyekātiśayena tu||75||
एकं तुल्याधिकैः षट् च तारतम्यविकल्पनात्।
ekaṃ tulyādhikaiḥ ṣaṭ ca tāratamyavikalpanāt|
पञ्चविंशतिमित्येवं वृद्धैः क्षीणैश्च तावतः॥७६॥
pañcaviṃśatimityevaṃ vṛddhaiḥ kṣīṇaiśca tāvataḥ||76||

वृद्ध्या, – vṛddhyā, – considering the vriddhi (increase) of doshas, they are –
Eka Dosha Vriddhi (Single dosha increase)
त्रीन् पृथक् विद्धि – trīn pṛthak viddhi – 3 individually

Note: Single dosha increase is of three types:

• Vata Vriddhi
• Pitta Vriddhi
• Kapha Vriddhi

Samsarga, Dwi Dosha Vriddhi (two dosha increase)

संसर्गस्त्रिधा, तत्र तु तान्नव – saṃsargastridhā, tatra tu tānnava – in the combination of 2 doshas, they are 3 and 9, 12 types in total,

त्रीनेव समया – trīneva samayā – 3 in equal proportion of increase of doshas,  

षडेकस्यातिशायने – ṣaḍekasyātiśāyane – 6 with preponderance of one dosha

Note: increase of 2 doshas is of 12 types, they are:

a. 3 types of increase in equal proportions –

• Vata-pitta vriddhi
• Vata-kapha vriddhi
• Pitta-kapha vriddhi

b. 6 types with preponderance of one dosha –

• Vata vriddhi-Pitta vriddhitaram
• Pitta vriddhi-Vata vriddhitaram
• Kapha vriddhi-Pitta vriddhitaram
• Pitta vriddhi-Kapha vriddhitaram
• Kapha vriddhi-Vata vridhhitaram
• Vata vriddhi-Kapha vriddhitaram

(In the above explanation, vridddhi = increase, vriddhitara = more or profound / moderate increase, in comparison to vriddhi)

Sannipata, Tri Dosha Vriddhi (three dosha increase)

समस्तेषु त्रयोदश – samasteṣu trayodaśa – in the combination of all the three doshas, they are of 13 types

षड् ह्येकातिशयेन तु – ṣaḍ hyekātiśayena tu – 6 with preponderance of any one dosha,

एकं तुल्याधिकैः – ekaṃ tulyādhikaiḥ – 1 with equal preponderance of all the three doshas,

षट् च तारतम्य विकल्पनात् – ṣaṭ ca tāratamya vikalpanāt – 6 by disproportionate subdivisions,

Note: increase of 3 doshas is of 13 types, they are:

a. 6 types with preponderance of any one dosha –

• Vata vriddhi-Pitta Kapha Ativriddhi
• Pitta vriddhi-Vata Kapha Ativridddhi
• Kapha vriddhi-Vata Pitta Ativriddhi
• Vata Ativriddhi-Pitta Kapha Vriddhi
• Pitta Ativriddhi-Vata Kapha Vriddhi
• Kapha Ativriddhi-Vata Pitta Vriddhi

b. 1 type with preponderance of all three doshas –

• Vata-Pitta-Kapha Vriddhi

c. 6 types by disproportionate subdivisions –

• Vata vriddhi-Pitta vriddhitara-Kapha vriddhitama
• Vata vriddhi-Kapha vriddhitara-Kapha vriddhitama
• Pitta vriddhi-Kapha vriddhitara-Vata vriddhitama
• Pitta vriddhi-Vata vriddhitara-Kapha vriddhitama
• Kapha vriddhi-Vata vriddhitara-Pitta vriddhitama
• Kapha vriddhi-Pitta vriddhitara-Vata vriddhitama

वृद्धैः पञ्चविंशतिमित्येवं – vṛddhaiḥ pañcaviṃśatimityevaṃ – thus, the vriddhi of doshas is only of 25 types,

तावतः क्षीणैश्च – tāvataḥ kṣīṇaiśca – similarly the decrease of doshas is also of 25 types (should be understood as explained in dosha vriddhi or 25 kinds of dosha increase

(In the above explanation, vridddhi = increase, vriddhitara = more or moderate increase, vriddhitama = severe increase or aggravation)

AH Su 12.77-78a

Other types of combinations of doshas

एकैकवृद्धिसमताक्षयैः षट् ते पुनश्च षट्।
एकक्षयद्वन्द्ववृद्ध्या सविपर्यययाऽपि ते॥७७॥
भेदा द्विषष्टिर्निर्दिष्टाःत्रिषष्टः स्वास्थ्यकारणम्।
ekaikavṛddhisamatākṣayaiḥ ṣaṭ te punaśca ṣaṭ|
ekakṣayadvandvavṛddhyā saviparyayayā’pi te||77||
bhedā dviṣaṣṭirnirdiṣṭāḥ triṣaṣṭaḥ svāsthyakāraṇam|

Increase, normalcy and decrease of one dosha each

वृद्धि समता क्षयैः एकैक षट् ते – vṛddhi samatā kṣayaiḥ ekaika ṣaṭ te – In the combination of increase, normal and decrease of one dosha each, will make up for 6 numbers (types)

Note: increase, normalcy and decrease of one dosha each is of 6 types, they are –

• Vata vriddhi-Pitta sama-Kapha kshaya
• Pitta vriddhi-Vata sama-Kapha kshaya
• Kapha vriddhi-Pitta sama-Vata kshaya
• Kapha vriddhi-Vata sama-Pitta kshaya
• Vata vriddhi-Kapha sama-Pitta kshaya
• Pitta vriddhi-Kapha sama-Vata kshaya

(In the above explanation, vridddhi = increase, sama = normalcy, kshaya = decrease)

Decrease of one dosha and increase of two doshas, Decrease of two doshas and increase of one dosha

एकक्षय द्वन्द्ववृद्ध्या सविपर्यययाऽपि – ekakṣaya dvandvavṛddhyā saviparyayayā’pi – in the combination of one dosha decrease and two dosha increase and two dosha decrease and one dosha increase,

ते पुनश्च षट् – te punaśca ṣaṭ – they once again of 6 types

Note: decrease of 1 dosha and increase of two doshas is of 3 types, they are –

• Vata kshaya-Pitta Kapha vriddhi
• Pitta kshaya-Vata Kapha vriddhi
• Kapha kshaya-Vata Pitta vriddhi

Decrease of 2 doshas and increase of 1 dosha is of 3 types, they are –

• Vata Pitta kshaya-Kapha vriddhi
• Vata Kapha kshaya-Pitta vriddhi
• Pitta Kapha kshaya-Vata vriddhi

(In the above explanation, vridddhi = increase, kshaya = decrease)

द्विषष्टि भेदा र्निर्दिष्टाः – dviṣaṣṭir bhedā nirdiṣṭāḥ – thus 62 types of combination of dosha increase and decrease have been explained

त्रिषष्टः स्वास्थ्य कारणम् – triṣaṣṭaḥ svāsthya kāraṇam – the 63^rd is the condition where all the doshas are in equilibrium, which is called as the state of health.

AH Su 12.78b-79a

Permutations and combinations of doshas and dhatus are innumerable

संसर्गाद्रसरुधिरादिभिस्तथैषा
दोषास्तु क्षयसमताविवृद्धिभेदैः।
आनन्त्यं तरतमयोगतश्च यातान्
जानीयादवहितमानसो यथास्वम्॥७८१/२॥
saṃsargādrasarudhirādibhistathaiṣā
doṣāstu kṣayasamatāvivṛddhibhedaiḥ|
ānantyaṃ taratamayogataśca yātān
jānīyādavahitamānaso yathāsvam||781/2||

क्षय समता विवृद्धि भेदैः दोषास्तु – kṣaya samatā vivṛddhi bhedaiḥ doṣāstu – different levels of decrease, normalcy and increase of doshas (permutations and combinations as explained in the above mentioned contexts)
संसर्गाद्रसरुधिरादिभिस्तथैषा – saṃsargād rasa rudhirādibhistathaiṣā – when associated with rasa, rakta and other tissues (along with different levels of decrease, normalcy and increase of these tissues),
यातान् आनन्त्यं तरतमयोगतश्च – yātān ānantyaṃ taratamayogataśca – there can occur innumerable permutations and combinations,  
जानीयाद् यथास्वम् अवहितमानसो – jānīyād yathāsvam avahitamānaso – the physician should understand them by their features (signs and symptoms) with attentive mind.

इति श्रीवैद्यपतिसिंहगुप्तसूनश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया सूत्रस्थाने दोषभेदीयो नाम द्वादशोऽध्यायः॥१२॥
iti śrīvaidyapatisiṃhaguptasūnaśrīmadvāgbhaṭaviracitāyāmaṣṭāṅgahṛdayasaṃhitāyā sūtrasthāne doṣabhedīyo nāma dvādaśo’dhyāyaḥ||12||

Thus ends the 12^th chapter of Ashtangahridaya Samhita Sutrasthana, named Doshabhediya Adhyaya, written by Shrimad Vagbhata, son of Shri Vaidyapati Simhagupta.