Doshopakramaneeya Adhyaya – Ashtanga Hrudaya Sutrasthana 13

The 13^th chapter of Sutrasthanam of Ashtanga Hridayam is Doshopakramaniyam Adhyayam. This chapter explains treatment options to combat dosha imbalance. The concept of ama, the way in which the doshas combined with ama produce disease symptoms and the ways of treating these conditions, time of administration of medicines based on the disease are also explained in this chapter.

Pledge by the author

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

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

Shloka recitation video

Vatasya Upakrama: Vriddha Vata Chikitsa

AH Su 13.1-3

Treatment for Vata increase –

वातस्योपक्रमः स्नेहः स्वेदः संशोधनं मृदु।
स्वाद्वम्ललवणोष्णानि भोज्यान्यभ्यङ्गमर्दनम्॥१॥
वेष्टन त्रासनं सेको मद्यं पैष्टिकगौडिकम्।
स्निग्धोष्णा बस्तयो बस्तिनियमः सुखशीलता॥२॥
दीपनैः पाचनैः सिद्धाः स्नेहाश्चानेकयोनयः।
विशेषान्मेद्यपिशितरसतैलानुवासनम्॥३॥
vātasyopakramaḥ snehaḥ svedaḥ saṃśodhanaṃ mṛdu|
svādvamlalavaṇoṣṇāni bhojyānyabhyaṅgamardanam||1||
veṣṭana trāsanaṃ seko madyaṃ paiṣṭikagauḍikam|
snigdhoṣṇā bastayo bastiniyamaḥ sukhaśīlatā||2||
dīpanaiḥ pācanaiḥ siddhāḥ snehāścānekayonayaḥ|
biṣeṣānmedyapiśitarasatailānuvāsanam||3||

वातस्य उपक्रमः – vātasya upakramaḥ – treatments or remedies for vata are –  
स्नेहः – snehaḥ – oleation (oral administration and external administration of oil or ghee or fat)
स्वेदः – svedaḥ – sudation  or sweating therapy
मृदु संशोधनं – mṛdu saṃśodhanaṃ – mild purification procedures (mild panchakarma measures
like vamana i.e. emesis, virechana i.e. purgation etc)
भोज्यानि स्वाद्वम्ल लवणोष्णानि – bhojyāny svādu amla lavaṇoṣṇāni –  foods which are of sweet, sour and salt taste,
अभ्यङ्ग – abhyaṅga – oil massage,   
मर्दनम् – mardanam – gentle massage,
वेष्टन – veṣṭana – wrapping / covering the body or organ with a cloth
त्रासनं – trāsanaṃ – threatening, frightening,  
सेको – seko – pouring of herbal decoctions, oils, processed milk etc on the affected parts of the body  
पैष्टिक गौडिकम् मद्यं – paiṣṭika gauḍikam madyaṃ – wine prepared from corn flour and jaggery (molasses)
बस्तयो बस्तिनियमः स्निग्धोष्णा – bastayo bastiniyamaḥ snigdhoṣṇā – decoction and unctuous enemas in which lot of fats and drugs with hot potency are used,
सुखशीलता – sukhaśīlatā – comforting the patient (allowing the patient to live in comforts),
दीपनैः पाचनैः सिद्धाः स्नेहाश्चा अनेक योनयः – snehāśca aneka yonayaḥ siddhāḥ dīpanaiḥ pācanaiḥ – fats of different kinds obtained from different sources and prepared with herbs improving digestion strength and appetite are used,
विशेषात् मेद्य पिशित रस तैल अनुवासनम् – viṣeṣāt medya piśita rasa taila anuvāsanam – specially, oil enemas (anuvasana) using the oil processed from the juice of fatty meats (or oleation enema prepared from the juice of fatty meat along with sesame oil)

Treatment for Vata imbalance (increase) –  

Treatment options for increased Vata Dosha are-
Sneha – oleation – oral administration of oil / ghee / fat and external oil massage
Sveda – Sudation – diaphoresis, sweating therapy
Mrudu Samshodhana – Mild purification procedure, Mild Panchakarma (Vamana and Virechana). Excess of Panchakarma might lead to Vata increase.
Svadu Amla Lavana Ushna Bhojya – foods which are of sweet, sour and salt taste;
Abhyanga – Oil massage
Mardana – Simple massage
Veshtana – Wrapping / covering the body/ organ with cloth
Trasana – Threatening, frightening
Seka – pouring of herbal decoctions / oils on the affected part
Paishtika Goudika Madya – wine prepared from corn flour and jaggery- molasses
Snigdha Ushna Basti – enema therapy with fat-oil, enema with drugs of hot potency
Sukhasheelata – comforting the patient
Deepana Pachana Siddha Sneha – medicated fats of different kinds- sources prepared with drugs causing increase  of hunger and improving digestion;
Medya Pishita Taila Anuvasana – oleation enema prepared from juice of fatty meat and oil- 1-3

Pittasya Upakrama – Vriddha Pitta Chikitsa

AH Su 13.4-9

Treatment for Pitta increase –

पित्तस्य सर्पिषः पानं स्वादुशीतैर्विरेचनम्।
स्वादुतिक्तकषायाणि भोजनान्यौषधानि च॥४॥
सुगन्धिशीतहृद्यानां गन्धानामुपसेवनम्।
कण्ठेगुणानां हाराणां मणीनामुरसा धृतिः॥५॥
कर्पूरचन्दनोशीरैरनुलेपः क्षणे क्षणे।
प्रदोषश्चन्द्रमाः सौधं हारि गीतं हिमोऽनिलः॥६॥
अयन्त्रणसुखं मित्र पुत्रः सन्दिग्धमुग्धवाक्।
छन्दानुवर्तिनो दाराः प्रियाः शीलविभूषिताः॥७॥
शीताम्बुधारागर्भाणि गृहाण्युद्यानदीर्घिकाः।
सुतीर्थविपुलस्वच्छसलिलाशयसैकते॥८
साम्भोजजलतीरान्ते कायमाने द्रुमाकुले।
सौम्या भावाः पयः सर्पिर्विरेकश्च विशेषतः॥९॥
pittasya sarpiṣaḥ pānaṃ svāduśītairvirecanam|
svādutiktakaṣāyāṇi bhojanānyauṣadhāni ca||4||
sugandhiśītahṛdyānāṃ gandhānāmupasevanam|
kaṇṭheguṇānāṃ hārāṇāṃ maṇīnāmurasā dhṛtiḥ||5||
karpūracandanośīrairanulepaḥ kṣaṇe kṣaṇe|
pradoṣaścandramāḥ saudhaṃ hāri gītaṃ himo’nilaḥ||6||
ayantraṇasukhaṃ mitra putraḥ sandigdhamugdhavāk|
chandānuvartino dārāḥ priyāḥ śīlavibhūṣitāḥ||7||
śītāmbudhārāgarbhāṇi gṛhāṇyudyānadīrghikāḥ|
sutīrthavipulasvacchasalilāśayasaikate||8||
sāmbhojajalatīrānte kāyamāne drumākule|
saumyā bhāvāḥ payaḥ sarpirvirekaśca viśeṣataḥ||9||

पित्तस्य – pittasya – treatments or remedies for increased pitta are –  
सर्पिषः पानं – sarpiṣaḥ pānaṃ – drinking of ghee
स्वादु शीतै: विरेचनम् – svādu śītaiḥ virecanam – purgation therapy with herbs of sweet taste and cold potency,
भोजनानि औषधानि स्वादु तिक्त कषायाणि च –bhojanāni auṣadhāni svādu tikta kaṣāyāṇi ca – intake of foods and medicines having sweet, bitter and astringent tastes,
उपसेवनम् गन्धानाम् सुगन्धि शीत हृद्यानां – upasevanam gandhānām sugandhi śīta hṛdyānāṃ – experiencing the fragrance of perfumes, coolant and good for heart,
कण्ठेगुणानां हाराणां मणीनाम् उरसा धृतिः – kaṇṭheguṇānāṃ hārāṇāṃ maṇīnām urasā dhṛtiḥ – wearing necklaces, garlands and precious stones and gems over the chest,  
क्षणे क्षणे कर्पूर चन्दन उशीरै: अनुलेपः – kṣaṇe kṣaṇe karpūra candana uśīraiḥ anulepaḥ – frequently anointing the body with pastes of camphor, sandalwood, vetiver.
सौधं चन्द्रमाः प्रदोष: हारि गीतं हिमो अनिलः – saudhaṃ candramāḥ pradoṣaḥ hāri gītaṃ himo anilaḥ – residing in white rooms  with terraces lit by moonlight in the evening time, enjoying the pleasant music and soft cold breeze,
अयन्त्रणसुखं मित्र – ayantraṇasukhaṃ mitra – company of good and compatible friends who do not restrain him (in fact support him) and 
पुत्रः सन्दिग्ध मुग्धवाक् – putraḥ sandigdha mugdhavāk – companyof sons who speak unclearly and with innocence and,
दाराः छन्दानुवर्तिनो प्रियाः शीलविभूषिताः – dārāḥ chandānuvartino priyāḥ śīlavibhūṣitāḥ – wife, who is obedient, adorable and virtuous,
गृहाणि शीताम्बु धारागर्भाणि उद्यान दीर्घिकाः – gṛhāṇi śītāmbu dhārāgarbhāṇi udyāna dīrghikāḥ – residing in homes which are well equipped with fountains emitting cooled water, parks and ponds,
कायमाने सुतीर्थ विपुल स्वच्छ सलिलाशय सैकते – kāyamāne sutīrtha vipula svaccha salilāśaya saikate – spending time in huts made up of grass or thatches, having sacred bathing places and near large and clean water reservoirs, having sand on their banks,
साम्भोज द्रुमाकुले जलतीरान्ते – sāmbhoja drumākule jalatīrānte – with lotus and other attractive plants spread out on the banks of the water reservoirs,
सौम्या भावाः पयः सर्पि: र्विरेकश्च विशेषतः – saumyā bhāvāḥ payaḥ sarpir virekaśca viśeṣataḥ – anything which keeps the mind pleasant, milk, ghee and purgation therapy are the special remedies for increased pitta

Treatment for Pitta imbalance (increase) –

Treatment options for increased Pitta Dosha are –
Sarpi paana – drinking of Ghrita (clarified Butter). It can be plain or medicated, based on physician’s advice.
Svadu, sheeta Virechana – purgation therapy with drugs of sweet taste and cold potency,
Intake of foods and drugs having sweet, bitter and astringent tastes.
Inhaling of fumes from herbs that are coolant, pleasant and cordial
Anointing the body with camphor, sandalwood paste, Vetiver paste, very frequently.
Residing on terraces lit by moonlight in the evenings, enjoying pleasant music and soft cold breeze, company of friends who do not restrain him, of sons who speak cordially and with innocence.
Spending time with wife, who is obedient, pleasing and virtuous;
Residing in houses equipped with fountains emitting cooled water, parks and ponds,
Spending time in houses near water reservoirs having clean water, sand, lotus, flowers, and trees, with a calm mind;
Consuming milk, ghee and Purgation therapy (Virechana)

Kaphasya Upakrama – Vriddha Kapha Chikitsa

AH Su 13.10-12

Treatment for increased Kapha –

श्लेष्मणो विधिना युक्तं तीक्ष्णं वमनरेचनम्।
अन्नं रूक्षाल्पतीक्ष्णोष्णं कटुतिक्तकषायकम्॥१०॥
दीर्घकालस्थितं मद्यं रतिप्रीतिः प्रजागरः।
अनेकरूपो व्यायामश्चिन्ता रूक्षं विमर्दनम्॥११॥
विशेषाद्वमनं यूषः क्षौद्रं मेदोघ्नमौषधम्।
धूमोपवासगण्डूषा निःसुखत्वं सुखाय च॥१२॥
śleṣmaṇo vidhinā yuktaṃ tīkṣṇaṃ vamanarecanam|
annaṃ rūkṣālpatīkṣṇoṣṇaṃ kaṭutiktakaṣāyakam||10||
dīrghakālasthitaṃ madyaṃ ratiprītiḥ prajāgaraḥ|
anekarūpo vyāyāmaścintā rūkṣaṃ vimardanam||11||
viśeṣādvamanaṃ yūṣaḥ kṣaudraṃ medoghnamauṣadham|
dhūmopavāsagaṇḍūṣā niḥsukhatvaṃ sukhāya ca||12||

श्लेष्मणो – śleṣmaṇo – treatments for increased kapha are –  
तीक्ष्णं वमन रेचनम् विधिना युक्तं – tīkṣṇaṃ vamana recanam vidhinā yuktaṃ – strong emesis and purgation in accordance with prescribed procedure,
अन्नं रूक्षाल्प तीक्ष्णोष्णं – annaṃ rūkṣālpa tīkṣṇoṣṇaṃ – consuming foods which are dry (ruksha), less in quantity (alpa), strong and piercing (tikshna) and hot in potency (ushna)
अन्नं कटु तिक्त कषायकम् – kaṭutiktakaṣāyakam – foods which are pungent, biter and astringent in taste,
दीर्घकालस्थितं मद्यं – dīrghakālasthitaṃ madyaṃ – old wines,  
रतिप्रीतिः – ratiprītiḥ – interest and indulgence in sexual activities,
प्रजागरः – prajāgaraḥ – keeping awake at night,
अनेकरूपो व्यायाम: – anekarūpo vyāyāmaś – exercises of different kinds,
चिन्ता – cintā – worrying,  

रूक्षं विमर्दनम् – rūkṣaṃ vimardanam – dry (oil less) massage of the body (rubbing of body with dry powders of herbs or without oil),
विशेषाद्वमनं – viśeṣād vamanaṃ – emesis therapy is the special treatment for vitiated kapha,   
यूषः – yūṣaḥ – drinking soups prepared from grains,
क्षौद्रं – kṣaudraṃ – use of honey,
मेदोघ्नम् औषधम् – medoghnam auṣadham – medicines and therapies which reduce fat,
धूम – dhūma – inhalation of medicinal smoke,
उपवास – upavāsa – fasting,
गण्डूषा – gaṇḍūṣā – gargling,
निःसुखत्वं सुखाय च – niḥsukhatvaṃ sukhāya ca – rejecting comforts (facing difficulties),
are beneficial to pacify morbid kapha

Treatment for Kapha imbalance (increase) –

Treatment options for increased Kapha Dosha are-
Vidhiyukta Teekshna Vamana Virechana – Strong emesis and purgation in accordance with prescribed procedure,
Consuming food which are dry,
Consuming food in limited quantity,
Consuming food that have Teekshna (strong, piercing), Ushna (hot), pungent, bitter and astringent taste,
Old wine,
Sexual activity,
keeping awake at night,
Exercises of different kinds,
Worry,
Dry massage of the body;
Vamana – emesis therapy,
Drinking of soups of grains,
Use of honey,
Therapies and medicines that reduce fat,
Inhalation of medicinal smoke,
Fasting,
Gargling,
Facing difficulties.

Samsarga and Sannipata Chikitsa

AH Su 13.13-15

Treatment for simultaneous increase of two doshas (samsarga) and three doshas (sannipata)

उपक्रमः पृथग्दोषान् योऽयमुद्धिश्य कीर्तितः।
संसर्गसन्निपातेषु तं यथास्वं विकल्पयेत्॥१३॥
ग्रैष्मैः प्रायो मरुत्पित्ते वासन्तः कफमारुते।
मरुतो योगवाहित्वात्, कफपित्ते तु शारदः॥१४॥
चय एव जयेद्दोषं कुपितं त्वविरोधयन्।
सर्वकोपे बलीयांसं शेषदोषाविरोधतः॥१५॥
upakramaḥ pṛthagdoṣān yo’yamuddhiśya kīrtitaḥ|
saṃsargasannipāteṣu taṃ yathāsvaṃ vikalpayet||13||
graiṣmaiḥ prāyo marutpitte vāsantaḥ kaphamārute|
maruto yogavāhitvāt, kaphapitte tu śāradaḥ||14||
caya eva jayeddoṣaṃ kupitaṃ tvavirodhayan|
sarvakope balīyāṃsaṃ śeṣadoṣāvirodhataḥ||15||

उपक्रमः पृथग्दोषान् योऽयमुद्धिश्य कीर्तितः – upakramaḥ pṛthagdoṣān yo’yamuddhiśya kīrtitaḥ – the different treatments for each individual dosha which have been specifically explained,
तं यथास्वं विकल्पयेत् संसर्ग सन्निपातेषु – taṃ yathāsvaṃ vikalpayet saṃsarga sannipāteṣu– theymay be combined appropriately, according to the predominance of doshas and administered in cases of
samsarga – 2 Doshas simultaneous aggravation or
Sannipata – 3 doshas simultaneous aggravation.
प्रायो मरुत्पित्ते ग्रैष्मैः – prāyo marutpitte graiṣmaiḥ – generally the treatment of combined vitiation of vata and pitta is similar to the regimen of summer season,
कफमारुते वासन्तः – kaphamārute vāsantaḥ – the treatment of combined vitiation of kapha and vata is similar to the regimen of spring season,
मरुतो योगवाहित्वात् –  maruto yogavāhitvāt – because vata possesses yogavahi property (yogavahi means, when vata is associated with pitta it boosts pitta dosha and behave in accordance to pitta, producing heat and other symptoms typical of pitta and when it is associated with kapha, it boosts kapha dosha and behave in accordance to kapha, producing cold and other symptoms typical of kapha) कफपित्ते तु शारदः – kaphapitte tu śāradaḥ – the treatment of combined vitiation of kapha and pitta is similar to the regimen of autumn season,
दोषं जयेत् चय एव – doṣaṃ jayed caya eva – the vitiated doshas should be conquered when they are in the chaya (mild accumulation) stage itself,
कुपितं त्वविरोधयन् – kupitaṃ tvavirodhayan – in their stage of kopa (dosha aggravation, enhanced imbalance) they should be vanquished with such measures which are not interfering with other doshas
सर्वकोपे बलीयांसं शेषदोष अविरोधतः – sarvakope balīyāṃsaṃ śeṣadoṣa avirodhataḥ – when there is simultaneous increase of all the three doshas, the most powerful and aggravated dosha should be controlled first, without opposing the remaining 2 doshas.

Shuddha Chikitsa

AH Su 13.13-16

Definition of good (pure) treatment

प्रयोगः शमयेद्व्याधिमेकं योऽन्यमुदीरयेत्।
नाऽसौ विशुद्धः शुद्धस्तुशमयेद्यो न कोपयेत्॥१६॥
prayogaḥ śamayedvyādhimekaṃ yo’nyamudīrayet|
nā’sau viśuddhaḥ śuddhastuśamayedyo na kopayet||16||

यो प्रयोगः – yo prayogaḥ – that treatment
शमयेद्व्याधिमेकं – śamayed vyādhim ekaṃ – which cures on disease but  
अन्यमुदीरयेत् – anyam udīrayet – gives rise to another disease
ना असौ विशुद्धः – nā asau viśuddhaḥ – is not pure (good, appropriate) treatment,
शुद्धस्तु शमयेद्यो न कोपयेत् – śuddhastu śamayedyo na kopayet – A pure treatment is that which cures one disease but does not give rise to another

That treatment which cures on disease but gives rise to another disease is not pure (good, appropriate) treatment, A pure treatment is that which cures one disease but does not give rise to another.

Movement of doshas from Koshtha to Shakha

AH Su 13.17-18a ½

Movement of doshas from koshta (digestive tract) to shakhas (tissues)

व्यायामादूष्मणस्तैक्ष्ण्यादहिताचरणादपि।
कोष्ठाच्छाखास्थिमर्माणि द्रुतत्वान्मारुतस्य च॥१७॥
दोषा यान्ति
vyāyāmādūṣmaṇastaikṣṇyādahitācaraṇādapi|
koṣṭhācchākhāsthimarmāṇi drutatvānmārutasya ca||17||
doṣā yānti

व्यायामाद् – vyāyāmād – by the effect of exercise, 
ऊष्मणः तैक्ष्ण्याद् – ūṣmaṇas taikṣṇyād – by the strength and intensity of excess heat,
अहिताचरणादपि – ahitācaraṇādapi – due to unsuitable activities,
द्रुतत्वान्मारुतस्य च – drutatvānmārutasya ca – and due to quick movements of vata
दोषा यान्ति कोष्ठाच्छाखास्थिमर्माणि – doṣā yānti
koṣṭhācchākhāsthi marmāṇi – the increased doshas move out of the koshta (gastrointestinal tract) to the shakhas (tissues), asthi (bones) and marmas (vital points)

By the effect of exercise,  increase of heat, unsuitable/unhealthy activities and due to quick movement of Vata, the increased Doshas move out of the Kostha (gastrointestinal tract) to the Shakhas- tissues, Asthi – bones and Marmas- vital organs and vulnerable points.

Movement of doshas from Shakha to Koshtha

AH Su 13.18-19

Movement of doshas from shakhas (tissues) to koshta (digestive tract)

तथा तेभ्यः स्रोतोमुखविशोधनात्।
वृद्ध्याऽभिष्यन्दनात्पाकात्कोष्ठं वायोश्च निग्रहात्॥१८॥
तत्रस्थाश्च विलम्बेरन् भूयो हेतुप्रतीक्षिणः।
ते कालादिबलं लब्ध्वा कुप्यन्त्यन्याश्रयेष्वपि॥१९॥
tathā tebhyaḥ srotomukhaviśodhanāt|
vṛddhyā’bhiṣyandanātpākātkoṣṭhaṃ vāyośca nigrahāt||18||
tatrasthāśca vilamberan bhūyo hetupratīkṣiṇaḥ|
te kālādibalaṃ labdhvā kupyantyanyāśrayeṣvapi||19||

तथा तेभ्यः कोष्ठं – tathā tebhyaḥ koṣṭhaṃ – then, from there (tissues, body channels, bones, vital points) the doshas move into the digestive tract,  
स्रोतोमुख विशोधनात् – srotomukha viśodhanāt – by the effect of purification, clearing and widening of the minute body channels,
वृद्ध्या – vṛddhyā –  by further increase of doshas,
अभिष्यन्दनात् – abhiṣyandanāt – by liquefaction,
पाकात् – pākāt – by maturity
वायोश्च निग्रहात् – vāyośca nigrahāt – by control of vayu
तत्रस्थाश्च – tatrasthāśca – the doshas having entered the koshta (digestive tract)
विलम्बेरन् – vilamberan – will wait there for sometime (not causing any disease due to their decreased strength),
भूयो हेतुप्रतीक्षिणः – bhūyo hetupratīkṣiṇaḥ – again waiting for some aggravating factor
ते लब्ध्वा कालादि बलं कुप्यन्त्यन्याश्रयेष्वपि – te labdhvā kālādi balaṃ kupyanty anyāśrayeṣvapi – these doshas after having derived strength by season, time etc, they get further aggravated and move to other places as well.

Doshas move from body channels and tissues to the gastro intestinal tract,
by the effect of purification, clearing and widening of the minute body channels.
By further increase of Doshas,
By liquefaction,
By maturity,
By Balancing and controlling Vata.

Sthayi and Agantu Doshas

AH Su 13.20-21a

Native (sthayi) and foreign (agantu) doshas

तत्रान्यस्थानसंस्थेषु तदीयामबलेषु तु।
कुर्याञ्चिकित्साम् स्वामेव बलेनान्याभिभाविषु॥२०॥
आगन्तुं शमयेद्दोषं स्थानिन प्रतिकृत्य वा।
tatrānyasthānasaṃstheṣu tadīyāmabaleṣu tu|
kuryāñcikitsām svāmeva balenānyābhibhāviṣu||20||
āgantuṃ śamayeddoṣaṃ sthānina pratikṛtya vā|

तत्र – tatra – there (among the doshas),  
अबलेषु तु अन्यस्थान संस्थेषु – abaleṣu tu anyasthāna saṃstheṣu – for the weak doshas which have travelled into the sites of other doshas,  
तदीयाम् कुर्याञ्चिकित्साम् – tadīyām kuryāñcikitsām – treatment should be done for the local dosha (sthanika or sthayi dosha),
बलेनान्याभिभाविषु स्वामेव कुर्याञ्चिकित्साम् – balenānyābhibhāviṣu svāmeva tadīyām kuryāñcikitsām – for the doshas which have the capacity to dominate i.e. for strong doshas which have travelled into other sites, treatment for these strong doshas should be administered
आगन्तुं दोषं शमयेद् प्रतिकृत्य स्थानिनं वा – āgantuṃ doṣaṃ śamayed pratikṛtya sthāninam vā – the foreign dosha (agantu) should be treated either after treating the native dosha (sthanika) or even otherwise.

Native and foreign Doshas:-  Sthayi- and Agantu Doshas:-
Treatment should be done- especially on priority to that Dosha which has travelled into the seats of other Doshas and which is weak,
Priority should also be given to that Dosha which, by its own strength overcomes other Doshas.

Agantu Dosha – Foreign Dosha, should be treated either after treating the Sthanika (native Dosha) or even otherwise. The choice of Dosha, to be treated first depends on the level of aggravation and strength of Doshas.

Tiryak gata Dosha

AH Su 13.20-21b-23a

Tiryak gata dosha (obliquely placed doshas, those localized stubbornly in the tissues)

प्रायस्तिर्यग्गता दोषाः क्लेशयन्त्यातुरांश्चिरम्॥२१॥
कुर्यान्न तेषु त्वरया देहाग्निबलवित् क्रियाम्।
शमयेत्तन् प्रयोगेण सुखं वा कोष्ठमानयेत्॥२२॥
ज्ञात्वा कोष्ठप्रपन्नाश्च यथासन्नं विनिर्हरेत्।
prāyastiryaggarāḥ doṣāḥ kleśayantyāturāṃściram||21||
kuryānna teṣu tvarayā dehāgnibalavit kriyām|
śamayettan prayogeṇa sukhaṃ vā koṣṭhamānayet||22||
jñātvā koṣṭhaprapannāśca yathāsannaṃ vinirharet|

प्राय: तिर्यग्गताः दोषाः – prāyaḥ tiryaggatāḥ doṣāḥ – usually the tiryag gata doshas (doshas which are not localized in the gastrointestinal tract but localized in the tissues),
क्लेशयन्त्यातुरांश्चिरम् – kleśayanti āturāṃściram – causes troubles to the patient for a long time,
तेषु देहाग्निबलवित् क्रियाम् कुर्यान्न त्वरया – teṣu dehāgnibalavit kriyām kuryānna tvarayā – In these conditions, the physician knowing the strength of the body and digestive activity should not do the treatment in a hurry
तान् शमयेत् – tān śamayet – they should be mitigated with stipulated palliative treatment
कोष्ठमानयेत् सुखं वा – koṣṭhamānayet sukhaṃ vā – or they should be brought into the alimentary tract without causing much trouble by  
प्रयोगेण – prayogeṇa – administration of snehana (oleation) and swedana (sudation)
ज्ञात्वा कोष्ठप्रपन्नाश्च – jñātvā koṣṭhaprapannāśca – after knowing that the doshas have come into the alimentary tract,
यथासन्नं विनिर्हरेत् – yathāsannaṃ vinirharet – they should be expelled out by the nearby route (through mouth in the form of emesis or vamana or by anal route, by purgation or virechana)

Usually, the Triyaggata Doshas – which are not localized in the gastrointestinal tract but localized in the tissues, cause troubles to the patient for a long time; should not be treated in haste. They should be carefully treated only after determining the strength of the body and digestive activity.

They should be mitigated with stipulated palliative treatment or they should be brought into the alimentary tract and then they should be expelled out by the nearby route (either by mouth – by emesis – Vamana or by anal route, by purgation – Virechana).

Sama Dosha lakshana

AH Su 13.23b-24

Sama dosha lakshanas – Symptoms of doshas associated with ama

स्रोतोरोधबलभ्रंशगौरवानिलमूढताः॥२३॥
आलस्यापक्तिनिष्ठीवमलसङ्गारुचिक्लमाः।
लिङ्गं मलानां सामानां, निरामाणां विपर्ययः॥२४॥
srotorodhabalabhraṃśagauravānilamūḍhatāḥ||23||
ālasyāpaktiniṣṭhīvamalasaṅgāruciklamāḥ|
liṅgaṃ malānāṃ sāmānāṃ, nirāmāṇām viparyayaḥ||24||

लिङ्गं मलानां सामानां – liṅgaṃ malānāṃ sāmānāṃ – the symptoms of doshas associated with ama are as below mentioned –
स्रोतोरोध – srotorodha – obstruction of the channels and pores of the body,  
बलभ्रंश – balabhraṃśa – loss of strength,  
गौरव – gaurava – heaviness of the body,  
अनिलमूढताः – anilamūḍhatāḥ – inactivity of the Vata,  
आलस्य – ālasya – laziness, lassitude,  
अपक्ति – apakti – loss of digestive power (indigestion)  
निष्ठीव – niṣṭhīva – person spits saliva frequently, excessive expectoration,
मलसङ्ग – malasaṅga – constipation, or less urination leading to accumulation of waste products in the body,   
अरुचि – aruci – anorexia,
क्लमाः – klamāḥ – exhaustion,
निरामाणां विपर्ययः – nirāmāṇām viparyayaḥ – the symptoms of nirama doshas (doshas devoid of ama) will be opposite to the above mentioned symptoms of sama dosha

When imbalanced Doshas get associated with Ama (a factor of indigestion / false metabolism), it is called Saama Dosha. (Sa aama Dosha, Sa means ‘with’). The features that are seen due to Sama Dosha are –

Srotorodha –  Obstruction of the channels, pores
Balabhramsha – loss of strength,
Gaurava – feeling of heaviness of the body,
Anila Moodata – inactivity of Anila-vata,
Alasya – laziness, lassitude,
Apakti – loss of digestive power,
Nishteeva – Person spits saliva frequently, more of expectoration,
Malasanga – constipation or low frequency of urination leading to accumulation of wastes
Aruchi – anorexia,
Klama – exhaustion
The opposites of the above symptoms are of the Nirama Doshas –Doshas not mixed up with the Ama. (undigested materials)

Ama Utpatti

AH Su 13.25-26

Definition of ama and formation of ama

ऊष्मणोऽल्पबलत्वेन धातुमाद्यमपाचितम्।
दुष्टमामाशयगतं रसमामं प्रचक्षते॥२५॥
अन्ये दोषेभ्य एवातिदुष्टेभ्योऽन्योन्यमूर्च्छनात्।
कोद्रवेभ्यो विषस्येव वदन्त्यामस्य सम्भवम्॥२६॥
ūṣmaṇo’lpabalatvena dhātumādyamapācitam|
duṣṭamāmāśayagataṃ rasamāma pracakṣate||25||
anye doṣebhya evātiduṣṭebhyo’nyonyamūrcchanāt|
kodravebhyo viṣasyeva vadantyāmasya sambhavam||26||

अल्प बलत्वेन ऊष्मणो – alpa balatvena ūṣmaṇo – due to the less strength of digestive fire (lack of digestion strength),
धातुमाद्यम् अपाचितम् – dhātumādyam apācitam – the rasa dhatu (the useful nutrition rich part of food, formed after the digestion of food in the stomach, i.e. nutritive juice or essence) is not formed well,
दुष्टम् रसं आमाशय गतं आम प्रचक्षते – duṣṭam rasam āmāśaya gataṃ āma pracakṣate – this contaminated rasa, which stays in the stomach and intestines will become ama.
अन्ये वदन्ति – anye vadanti – other authors opine that
कोद्रवेभ्यो विषस्येव – kodravebhyo viṣasyeva – just like the mixing up of many kinds of rotten grains lead to the formation of poison,
दोषेभ्य एव अतिदुष्टेभ्यो अन्योन्य मूर्च्छनात् – doṣebhya eva atiduṣṭebhyo anyonya mūrcchanāt – the mixing of greatly increased doshas with one another
आमस्य सम्भवम् – āmasya sambhavam – leads to the formation of ama

 Origin of Ama –
Soon after digestion process, the useful part gets separated from the waste. The useful, nutrition rich part is called as Rasa dhatu.
Due to lack of digestion strength, The Rasa Dhatu does not form well, it remains in raw, weak form. It gets vitiated,  it stays in the Amashaya (stomach and intestines) itself, and becomes ‘Ama’. 25
Other authors opine that Ama gets formed from intimate mixing with one another of greatly increased Doshas. 26
The Doshas and Dusyas (the Dhatus and Malas) which get mixed with this Ama are designated as Sama – mixed with Ama;
The diseases originating from this Saama dosha are called as Saama Vyadhi.

Definition of Sama Dosha

AH Su 13.27

Definition of sama

आमेन तेन सम्पृक्ता दोषा दूष्याश्च दूषिताः।
सामा इत्युपदिश्यन्ते ये च रोगास्तदुद्भवाः॥२७॥
āmena tena sampṛktā doṣā dūṣyāśca dūṣitāḥ|
sāmā ityupadiśyante ye ca rogāstadudbhavāḥ||27||

दूषिताः दोषा दूष्याश्च – dūṣitāḥ doṣā dūṣyāśca – the vitiated doshas and dushyas (dhatus and malas, i.e. tissues and excreta)
सम्पृक्ता तेन आमेन – sampṛktā tena āmena – when gets mixed or associated with that ama,
सामा इत्युपदिश्यन्ते – sāmā ityupadiśyante – are called as sama (mixed with or associated with ama)
ये च रोगास्तदुद्भवाः – ye ca rogāstadudbhavāḥ – the diseases originating from these sama doshas are called as sama rogas

The Sama Doshas which are spread all over the body, which are lurking in the Dhatus and which are not moving out of their places of accumulation, should not be forced out by purification Panchakarma therapies like emesis, purgation etc.

Sama Dosha Chikitsa

AH Su 13.28-29a

Treatment of Saama Doshas

सर्वदेहप्रविसृतान् सामान् दोषान् न निर्हरेत्।
लीनान् धातुष्वनुत्क्लिष्टान् फलादामाद्रसानिव॥२८॥
आश्रयस्य हि नाशाय ते स्युर्दुर्निर्हरत्वतः।
sarvadehapravisṛtān sāmān doṣān na nirharet|
līnān dhātuṣvanutkliṣṭān phalādāmādrasāniva||28||
āśrayasya hi nāśāya te syurdurnirharatvataḥ|

सामान् दोषान् – sāmān doṣān –  the sama doshas
सर्वदेहप्रविसृतान् – sarvadehapravisṛtān – which are spread all over the body,
लीनान् धातुष्वनुत्क्लिष्टान् – līnān dhātuṣvanutkliṣṭān – which are lurking in the tissues and which are not moving out of their places of accumulation,  
न निर्हरेत् – na nirharet – should not be forcibly removed through purification or Panchakarma therapies like emesis, purgation etc.
स्युर्दुर्निर्हरत्वतः – syurdurnirharatvataḥ – because it is difficult to expel them out,
फलात् आमात् रसानिव – phalāt āmāt rasāniva – just as attempts of extracting the juice from an unripe fruit leads to destruction of the fruit,
आश्रयस्य हि नाशाय ते – āśrayasya hi nāśāya te – the dwelling place (human body) will get destroyed if the sama doshas are tried to expel out.

The sama doshas which are spread all over the body, which are lurking in the tissues and which are not moving out of their places of accumulation, should not be forcibly removed through purification or Panchakarma therapies like emesis, purgation etc. because it is difficult to expel them out, just as attempts of extracting the juice from an unripe fruit leads to destruction of the fruit, the dwelling place (human body) will get destroyed if the sama doshas are tried to expel out.

AH Su 13.29b-30a

Right approach in Sama Dosha treatment

पाचनैर्दीपनैः स्नेहैस्तान् स्वेदैश्च परिष्कृतान्॥२९॥
शोधयेच्छोधनैः काले यथासन्नं यथाबलम्।
pācanairdīpanaiḥ snehaistān svedaiśca pariṣkṛtān||29||
śodhayecchodhanaiḥ kāle yathāsannaṃ yathābalam|

परिष्कृतान् – pariṣkṛtān – after preparing (and processing) them so as to be expelled from the body
पाचनैर्दीपनैः स्नेहै: स्वेदैश्च – pācanair dīpanaiḥ snehaiḥ svedaiśca –  by administering drugs which are digestive and which increase hunger, next with oleation (snehana) and sudation (swedana) therapies,
तान् – tān – the sama doshas (which have been brought to maturity by the above mentioned therapies)
शोधयेत् शोधनैः – śodhayet shodhanaiḥ – should be expelled out with shodhana therapies (emesis, purgation etc.)
काले – kāle – at the appropriate time,
यथासन्नं – yathāsannaṃ – from the nearest routes (expelling kapha from mouth through vamana, expelling pitta from anal route through virechana)
यथाबलम् – yathābalam – and in accordance with the strength of the patient

After preparing (and processing) them so as to be expelled from the body by administering drugs which are digestive and which increase hunger, next with oleation and sudation therapies, the sama doshas (which have been brought to maturity by the above mentioned therapies) should be expelled out with shodhana therapies (emesis, purgation etc.) at the appropriate time, from the nearest routes (expelling kapha from mouth through vamana, expelling pitta from anal route through virechana) and in accordance with the strength of the patient

AH Su 13.30b-31a

Passages from which the doshas are eliminated

हन्त्याशु युक्तं वक्त्रेण द्रव्यमामाशयान्मलान्॥३०॥
घ्राणेन चोर्ध्वजत्रूत्थान् पक्वाधानाद्गुदेन च।
hantyāśu yuktaṃ vaktreṇa dravyamāmāśayānmalān||30||
ghrāṇena cordhvajatrūtthān pakvādhānādgudena ca|

द्रव्यम् वक्त्रेण युक्तं – dravyam vaktreṇa yuktaṃ – medicines administered through the mouth,
हन्त्याशु मलान् आमाशयात् hantyāśu malān āmāśayāt – expels out the doshas from stomach and intestines
घ्राणेन चोर्ध्वजत्रूत्थान् – ghrāṇena cordhvajatrūtthān – medicines administered through the nose will expel the doshas from the parts above the shoulder (head and neck),
गुदेन पक्वाधानाद् च – gudena pakvādhānād ca – medicines administered through the anus (rectum) will expel out the doshas from the large intestine.

Medicines administered through the mouth, expels out the doshas from stomach and intestines medicines administered through the nose will expel the doshas from the parts above the shoulder (head and neck), medicines administered through the anus (rectum) will expel out the doshas from the large intestine.

AH Su 13.31b-32a

The sama doshas in the normal course of getting expelled should not be stopped by administering medicines

उत्क्लिष्टानधः ऊर्ध्वं वा न चामान् वहतः स्वयम्॥३१॥
धारयेदौषधैर्दोषान् विधृतास्ते हि रोगदाः।
utkliṣṭānadhaḥ ūrdhvaṃ vā na cāmān vahataḥ svayam||31||
dhārayedauṣadhairdoṣān vidhṛtāste hi rogadāḥ|

उत्क्लिष्टान् च आमान् दोषान् – utkliṣṭān cā āmān doṣān – greatly vitiated ama doshas
वहतः स्वयम् अधः ऊर्ध्वं वा – vahataḥ svayam adhaḥ ūrdhvaṃ vā – going out of the body on their own accord, either in downward or upward routes
न धारयेद् औषधैः – na dhārayed auṣadhaiḥ – should not be stopped by medicines,
विधृतास्ते हि रोगदाः – vidhṛtāste hi rogadāḥ – because, when stopped forcibly, the sama doshas produce diseases.

Greatly vitiated ama doshas going out of the body on their own accord, either in downward or upward routes should not be stopped by medicines, because, when stopped forcibly, the sama doshas produce diseases.

AH Su 13.32b-33a

Conditions for ignoring and removing the ama doshas

प्रवृत्तान् प्रागतो दोषानुपेक्षेत हिताशिनः॥३२॥
विबद्धान् पाचनैस्तैस्तैः पाचयेन्निर्हरेत् वा।
pravṛttān prāgato doṣānupekṣeta hitāśinaḥ||32||
vibaddhān pācanaistaistaiḥ pācayennirharet vā|

अतो हिताशिनः – ato hitāśinaḥ – therefore in patients who are habituated to take good and compatible foods,  
दोषान् प्रवृत्तान् उपेक्षेत प्रागतो – doṣān pravṛttān upekṣeta prāgato –  the sama doshas which are going out should be ignored in the early stages,
विबद्धान् – vibaddhān – the doshas which are not getting expelled (or getting expelled in small quantities)  
पाचनैस्तैस्तैः पाचयेन्निर्हरेत् वा – pācanaistaistaiḥ pācayennirharet vā – should be administered with pachana (ama destroying medicines) or expelled out by administration of purification (Panchakarma) therapies as per the situational demand.

Therefore in patients who are habituated to take good and compatible foods, the sama doshas which are going out should be ignored in the early stages, the doshas which are not getting expelled (or getting expelled in small should be administered with pachana (ama destroying medicines) or expelled out by administration of purification (Panchakarma) therapies as per the situational demand.

AH Su 13.33b-34a

Time and proper seasons for eliminating doshas out of the body

श्रावणे कार्तिके चैत्रे मासि साधारणे क्रमात्॥३३॥
ग्रीष्मवर्षाहिमचितान् वाय्वादीनाशु निर्हरेत्।
śrāvaṇe kārtike caitre māsi sādhāraṇe kramāt||33||
grīṣmavarṣāhimacitān vāyvādīnāśu nirharet|

वाय्वादीन् ग्रीष्म वर्षा हिम चितान् – vāyvādīn grīṣma varṣā hima citān – vata, pitta and kapha which have undergone chaya (mild increase) in greeshma (summer), varsha (rainy season) and shishira (winter) respectively
आशु निर्हरेत् – āśu nirharet – should be quickly expelled from the body
श्रावणे कार्तिके चैत्रे मासि क्रमात् – śrāvaṇe kārtike caitre māsi kramāt – in the months of Shravana (July-August), Karthika (Oct-Nov) and Chaitra (March-April) respectively साधारणे – sādhāraṇe – which happen to be the sadharana kala (seasons in which the doshas do not undergo severe increase) for these doshas (vata, pitta and kapha) respectively.

Time for Dosha elimination

Vata which undergoes mild increase (Chaya) in Greeshma (summer) should be removed from the body (by basti- enema) in Shravana masa (August)
Pitta which undergoes mild increase in Varsha (rainy season), should be expelled out of the body in Kartika Month (by Virechana – purgation)
Kapha which undergoes mild increase in Shishira (winter) should be expelled out in Chaitra month (April) by Vamana.

AH Su 13.34b-35b ½

Rules for elimination of doshas in healthy people

अत्युष्णवर्षाशीता हि ग्रीष्मवर्षाहिमागमाः॥३४॥
सन्धौ साधारणे तेषां दुष्टान् दोषान् विशोधयेत्।
स्वस्थवृत्तमभिप्रेत्य
atyuṣṇavarṣāśītā hi grīṣmavarṣāhimāgamāḥ||34||
sandhau sādhāraṇe teṣāṃ duṣṭān doṣān viśodhayet|
svasthavṛttamabhipretya

ग्रीष्म वर्षा हिमागमाः अत्युष्ण वर्षा शीता हि – grīṣma varṣā himāgamāḥ atyuṣṇa varṣā śītā hi  – greeshma (summer), varsha (rainy season) and hemanta (winter) seasons will have too much of heat, rain and cold respectively  
तेषां दुष्टान् दोषान् विशोधयेत् – teṣāṃ duṣṭān doṣān viśodhayet – therefore these vitiated doshas should be cleared out
सन्धौ साधारणे – sandhau sādhāraṇe – in the period between these seasons (like period between summer and rain, rainy and winter, and winter and summer)
स्वस्थवृत्तमभिप्रेत्य – svasthavṛttamabhipretya – and this is applicable when cleansing is done as part of healthy regime.

Greeshma (summer), varsha (rainy season) and hemanta (winter) seasons will have too much of heat, rain and cold respectively  therefore these vitiated doshas should be cleared out in the period between these seasons (like period between summer and rain, rainy and winter, and winter and summer) and this is applicable when cleansing is done as part of healthy regime.

AH Su 13.35b ½-36  

Rules for elimination of doshas in diseases

व्याधौ व्याधिवशेन तु॥३५॥
कृत्वा शीतोष्णवृष्टीनां प्रतीकारं यथायथम्।
प्रयोजयेत्क्रिया प्राप्तां क्रियाकालं न हापयेत्॥३६॥
vyādhau vyādhivaśena tu||35||
kṛtvā śītoṣṇavṛṣṭīnāṃ pratīkāraṃ yathāyatham|
prayojayetkriyā prāptāṃ kriyākālaṃ na hāpayet||36||

व्याधौ व्याधिवशेन तु – vyādhau vyādhivaśena tu – in diseased conditions, the cleansing should be done as and when the diseases are manifested
कृत्वा प्रतीकारं शीतोष्णवृष्टीनां यथायथम् – kṛtvā pratīkāraṃ śītoṣṇavṛṣṭīnāṃ yathāyatham – after having overcome the effects of cold, hot and rainy seasons suitably (according to season),
प्रयोजयेत्क्रिया – prayojayetkriyā – proper treatments should be administered
प्राप्तां क्रियाकालं – prāptāṃ kriyākālaṃ – according to the manifested kriyakala (appropriate time for giving treatment, planned according to the successive stages of dosha aggravation and disease formation)
न हापयेत् – na hāpayet – not allowing further progression of disease (not allowing the pathological stages of disease manifestation i.e. kriyakala to progress ahead)

In diseased conditions, the cleansing should be done as and when the diseases are manifested after having overcome the effects of cold, hot and rainy seasons suitably (according to season), proper treatments should be administered according to the manifested kriyakala (appropriate time for giving treatment, planned according to the successive stages of dosha aggravation and disease formation) not allowing further progression of disease (not allowing the pathological stages of disease manifestation i.e. kriyakala to progress ahead)

Aushadha sevana kala

AH Su 13.37

Time of administration of medicines (aushadha sevana kala)

युञ्ज्यादनन्नमन्नादौ मध्येऽन्ते कवलान्तरे।
ग्रासे ग्रासे मुहुः सान्नं सामुद्गं निशि चौषधम्॥३७॥
yuñjyādanannamannādau madhye’nte kavalāntare|
grāse grāse muhuḥ sānnaṃ sāmudgaṃ niśi cauṣadham||37||

औषधम् च युञ्ज्यात् – auṣadham ca yuñjyāt – medicines should be administered (in the below mentioned 10 timings)
अनन्नम् – anannam – on empty stomach or when there is no food in the stomach,
अन्नादौ – annādau – just before food or at the beginning of food intake,  
(अन्न) मध्ये – (anna) madhye – in between food intake
(अन्न) अन्ते – (anna) ante – at the end of food intake,  
कवलान्तरे – kavalāntare – in between morsels of food
ग्रासे ग्रासे – grāse grāse – with each morsel of food
मुहुः – muhuḥ – repeatedly, many times a day
स अन्नं – sa annaṃ – mixed with food
सामुद्गं – sāmudgaṃ – before and after food,  
निशि – niśi – at night, bedtime

Aushadha Sevana Kala – time of administration of medicines:-

Medicines should be administered,
1. Ananna –  on empty stomach – For diseases arising from increase of Kapha, which are severe and for persons who are strong, the time of administration of medicine shall be when there is no food- in the stomach ;
2. Annadau – just before food or at the beginning of food intake – in disorders of Apanavata,
3. Anna Madhye – During / in between food intake – in disorders of Samana vata
4. Anna ante – at the end of food intake – in disorders of Vyana vata at the end of the morning meal. , in disorders of Udana vata at the end   of evening meal.
5. Kavalantare – in between morsels – in disorders of Prana- vata
6. Grase Grase – With each morsel – in anorexia, loss of taste it shall be mixed with different kinds of tasty foods
7. Muhu: – Repeatedly, many a times a day – in diseases produced by poison, vomiting,  hiccup, thirst, dysponea and cough
8. Sa annam – Mixed with food – in anorexia
9. Samudgam – before and after food – in tremors, Akshepaka (convulsions), Hiccup,
10 Nishi – at night, bed time – for diseases affecting head and neck.

AH Su 13.38-41

Reasons for time of administration of medicines

कफोद्रेके गदेऽनन्नं बलिनो रोगरोगिणोः।
अन्नादौ विगुणेऽपाने, समाने मध्य इष्यते॥३८॥
व्यानेऽन्ते प्रातराशस्य, सायमाशस्य तूत्तरे।
ग्रासग्रासान्तयोः प्राणे प्रदुष्टे मातरिश्वनि॥३९॥
मुहुर्मुहुर्विषच्छर्दिहिध्मातृट्श्वासकासिषु।
योज्यं सभोज्यं भैषज्यं भोज्यैश्चित्रैररोचके॥४०॥
कम्पाक्षेपकहिध्मासु सामुद्गं लघुभोजिनाम्।
ऊर्ध्वजत्रुविकारेषु स्वप्नकाले प्रशस्यते॥४१॥
kaphodreke gade’nannaṃ balino rogarogiṇoḥ|
annādau viguṇe’pāne, samāne madhya iṣyate||38||
vyāne’nte prātarāśasya, sāyamāśasya tūttare|
grāsagrāsāntayoḥ prāṇe praduṣṭe mātariśvani||39||
muhurmuhurviṣacchardihidhmātṛṭśvāsakāsiṣu|
yojyaṃ sabhojyaṃ bhaiṣajyaṃ bhojyaiścitrairarocake||40||
kampākṣepakahidhmāsu sāmudgaṃ laghubhojinām|
ūrdhvajatruvikāreṣu svapnakāle praśasyate||41||

अनन्नं गदे कफोद्रेके बलिनो रोगरोगिणोः – anannaṃ gade kaphodreke balino rogarogiṇoḥ – medicines should be administered on empty stomach in the diseases arising from increase of kapha, in severe diseases and in diseases occurring in strong persons,  
विगुणे अपाने अन्नादौ – viguṇe apāne annādau – medicines should be administered just before food when apana vayu is disturbed
मध्य समाने इष्यते – madhya samāne iṣyate – medicines should be administered in between food intake (or during food intake) when samana vayu is disturbed (disorders caused by disturbed or vitiated samana vayu)
अन्ते प्रातराशस्य व्याने – ante prātarāśasya vyāne – medicines should be administered at the end of morning meals when Vyana vayu is disturbed
अन्ते सायमाशस्य तूत्तरे – ante sāyamāśasya tūttare – medicines should be administered at the end of dinner when Udana vayu is disturbed
ग्रास ग्रासान्तयोः प्राणे प्रदुष्टे मातरिश्वनि – grāsa grāsāntayoḥ prāṇe praduṣṭe mātariśvani – medicines should be administered in between morsels when Prana Vayu is disturbed
मुहुर्मुहु: विष च्छर्दि हिध्मा तृट्श्वास कासिषु – muhurmuhur viṣa cchardi hidhmā tṛṭ śvāsa kāsiṣu – medicines should be repeatedly administered, many times in a day, in diseases caused by poison, vomiting, hiccough, thirst, dyspnoea and cough,
भैषज्यं योज्यं सभोज्यं भोज्यैश्चित्रैः अरोचके – bhaiṣajyaṃ yojyaṃ sabhojyaṃ bhojyaiścitraiḥ arocake – medicines should be administered mixed with different kinds of tasty foods in anorexia
सामुद्गं लघु भोजिनाम् कम्प आक्षेपक हिध्मासु – sāmudgaṃ laghu bhojinām kampa ākṣepaka hidhmāsu – medicines should be administered before and after food, in those who consume light food, in conditions of tremors, convulsions, hiccough,  
स्वप्नकाले ऊर्ध्वजत्रु विकारेषु प्रशस्यते – svapnakāle ūrdhvajatru vikāreṣu praśasyate – medicines should be administered at bedtime, in those who are suffering from diseases affecting head and neck

Reasons for time of administration of medicines

Medicines should be administered on empty stomach in the diseases arising from increase of kapha, in severe diseases and in diseases occurring in strong persons,
Medicines should be administered just before food when apana vayu is disturbed,
Medicines should be administered in between food intake (or during food intake) when samana vayu is disturbed (disorders caused by disturbed or vitiated samana vayu),
Medicines should be administered at the end of morning meals when Vyana vayu is disturbed,
Medicines should be administered at the end of dinner when Udana vayu is disturbed,
Medicines should be administered in between morsels when Prana Vayu is disturbed,
Medicines should be repeatedly administered, many times in a day, in diseases caused by poison, vomiting, hiccough, thirst, dyspnoea and cough,
Medicines should be administered mixed with different kinds of tasty foods in anorexia
medicines should be administered before and after food, in those who consume light food, in conditions of tremors, convulsions, hiccough, medicines should be administered at bedtime, in those who are suffering from diseases affecting head and neck.

इति श्रीवैद्यपतिसिंहगुप्तप्रसूनश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां सूत्रस्थाने दोषोपक्रमणीयो नाम त्रयोदशोऽध्यायः॥१३॥
iti śrīvaidyapatisiṃhaguptaprasūnaśrīmadvāgbhaṭaviracitāyāmaṣṭāṅgahṛdayasaṃhitāyāṃ sūtrasthāne doṣopakramaṇīyo nāma trayodaśo’dhyāyaḥ||13||

Thus ends the 13^th chapter of Ashtangahridaya Samhita Sutrasthana, named Doshopakramaniya Adhyaya, written by Shrimad Vagbhata, son of Shri Vaidyapati Simhagupta.