Dvividhopakramaneeya Adhyaya – Ashtanga Hrudaya Sutrasthana 14

Dvividha means two types. Upakrama means treatment. The two main types of treatments namely nourishing (bulk promoting) and depleting (making the body light) treatments will be explored in detail in this chapter, hence the name – Dvividha Upakramaneeyam Adhyayam

Pledge by the author(s)

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

अथातो द्विविधोपक्रमणीयमध्यायं व्याख्यास्यामः – athāto dvividhopakramaṇīyamadhyāyaṃ vyākhyāsyāmaḥ – after having offered prayers to the God, henceforth we are going to explain the chapter pertaining to two kinds of treatment
इति ह स्माहुरात्रेयादयो महर्षयः – iti ha smāhurātreyādayo maharṣayaḥ – thus pledge Atreya and other sages.

Dvi vidha Upakrama

AH Su 14.1-2

Treatments are of two kinds

उपक्रम्यस्य हि द्वित्वाद्द्विधैवोपक्रमो मतः।
एकः सन्तर्पणस्तत्र द्वितीयश्चापतर्पणः॥१॥
बृंहणो लङ्घनश्चेति तत्पर्यायावुदाहृतौ।
बृंहणं यद्बृहत्त्वाय लङ्घनं लाघवाय यत्॥२॥
upakramyasya hi dvitvāddvidhaivopakramo mataḥ|
ekaḥ santarpaṇastatra dvitīyaścāpatarpaṇaḥ||1||
bṛṃhaṇo laṅghanaśceti tatparyāyāvudāhṛtau|
bṛṃhaṇaṃ yadbṛhattvāya laṅghanaṃ lāghavāya yat||2||

उपक्रम्यस्य हि – upakramyasya hi – Since the diseases are

द्वित्वाद्द्विधैवोपक्रमो मतः – dvitvāddvidhaivopakramo mataḥ – mainly of two types (sama and nirama, as explained in previous chapter), the treatment is also of two kinds.

Names of two types of treatment

तत्र एकः सन्तर्पण: द्वितीयश्च अपतर्पणः – tatra ekaḥ santarpaṇas dvitīyaśca apatarpaṇaḥ – one among them is santarpana (nourishing, enriching) and the second one is apatarpana (depleting, cleansing)
बृंहणो लङ्घन: चेति तत्पर्यायावुदाहृतौ – bṛṃhaṇo laṅghanaḥ ceti tatparyāyāvudāhṛtau –
brimhana (bulk promoting, stoutening, increasing weight, imparting heaviness) and
langhana (lightening, losing weight, fasting) are the synonyms of santarpana and apatarpana respectively
बृंहणं यत् बृहत्त्वाय देहस्य – bṛṃhaṇaṃ yad bṛhattvāya dehasya – brimhana is that which makes the body stout and fat
लङ्घनं यत् लाघवाय देहस्य – laṅghanaṃ yat lāghavāya dehasya – langhana is that which makes the body light and thin

Dvividha Upakarma- two kinds of therapy :-
Because, that to be treated, the human body is of two types – Obese and lean, the treatment is also of two kinds.
1. Santarpana– nourishing, enriching. It is also called as Brihmana (Stoutening, increasing weight, imparting heaviness)
2. Apartarpana –depleting, cleansing. It is also called as Langhana (fasting, losing weight, imparting lightness etc).

AH Su 14.3a

Composition of brimhana and langhana treatments

भवतः प्रायो भौमापमितरञ्च ते।
bhavataḥ prāyo bhaumāpamitarañca te|

भवतः प्रायो भौम आपम् – bhavataḥ prāyo bhauma āpam – Among these two therapies, generally brimhana treatment is predominant with bhauma (Earth element) and ap (water element) whereas
ते इतरञ्च – te itarañca –langhana is predominantly made up of fire, air and ether elements

Generally, Brihmana treatment is dominant with Prithvi (Earth element) and Ap (water element).
Langhana is dominant with the rest three elements (Fire, air and ether).

AH Su 14.3b-4a

All functions fall into one of the categories of brimhana and langhana treatments

स्नेहनं रूक्षणं कर्म स्वेदनं स्तम्भनं च यत्॥३॥
भूतानां तदपि द्वैध्याद्द्वितयं नातिवर्तते।
snehanaṃ rūkṣaṇaṃ karma svedanaṃ stambhanaṃ ca yat||3||
bhūtānāṃ tadapi dvaidhyāddvitayaṃ nātivartate|

कर्म च यत् स्नेहनं रूक्षणं स्वेदनं स्तम्भनं – karma ca yat snehanaṃ rūkṣaṇaṃ svedanaṃ stambhanaṃ – the functions which are considered of 4 types namely
snehana (oleation),
rukshana (imparting dryness),
swedana (sweating therapy, sudation) and
stambhana (withholding, obstructing, constipating)
द्वितयं नातिवर्तते – dvitayaṃ nātivartate – are also not apart from these two types of treatment (brimhana and langhana)
भूतानां तदपि द्वैध्यात् – bhūtānāṃ tadapi dvaidhyād – because the bhutas (five elements of nature) which make up the snehana (unctuous) and other substances are also distributed among brimhana and langhana

Functions such as Snehana (oleation/ lubrication) and Rukshana – (imparting dryness),
Swedana– (sweating therapy, sudation, diaphoresis), Sthambhana– (withholding, obstructing)  are also of these two kinds- Brihmana and Langhana.
Snehana and Sthambhana can be categorised as Brihmana and
Rukshana and Swedana can be categorised as Langhana.
Thus all functions are not apart from two.

Types of langhana

AH Su 14.4b

Types of Langhana or lightening treatments

शोधनं शमनं चेति द्विधा तत्रापि लङ्घनम्॥४॥
śodhanaṃ śamanaṃ ceti dvidhā tatrāpi laṅghanam||4||

तत्रापि लङ्घनं द्विधा शोधनं शमनं चेति – tatrāpi laṅghanam dvidhā śodhanaṃ śamanaṃ ceti – among these two types of treatment, langhana (lightening treatments) are of two types –
shodhana (purification procedures i.e. Panchakarma treatments) and
shamana (palliative treatments)

Langhana therapy is of two types.
Shodhana – Purification procedures (Panchakarma) and
Shamana- palliative treatment.

Types of Shodhana

AH Su 14.5

Meaning of shodhana, types of shodhana

यदीरयेद्बहिर्दोषान् पञ्चधा शोधनं च तत्।
निरूहो वमनं कायशिरोरेकोऽस्रविस्रुतिः॥५॥
yadīrayedbahirdoṣān pañcadhā śodhanaṃ ca tat|
nirūho vamanaṃ kāyaśiroreko’sravisrutiḥ||5||

यदीरयेद्बहिर्दोषान् शोधनं च तत् – yadīrayedbahirdoṣān śodhanaṃ ca tat – that which forcibly expels the vitiated doshas out of the body is called shodhana  
पञ्चधा – pañcadhā – shodhana is of five kinds, they are –
निरूहो – nirūho – decoction enema
वमनं – vamanaṃ – emesis, vomiting therapy
काय रेको – kāya reko – virechana, purgation of the body,
शिरोरेको – śiroreko – or nasya, purgation of the head, nasal instillation of the medicines,
अस्रविस्रुतिः – asravisrutiḥ – or raktamokshana, blood-letting

Shodhana treatment expels imbalanced Doshas out of the body forcibly.
It is of five kinds, viz
Niruha– decoction enema,
Vamana– emesis, vomiting therapy
Kaya reka– Virechana – purgation for the body
Shiro reka – Shiro Virechana – nasya – purgation for the head, nasal instillation of medicines.
Asra-visruti – Raktamokshana – blood letting .

Tpes of Shamana

AH Su 14.6-7a

Meaning of shamana, types of shamana

न शोधयति यद्दोषान् समान्नोदीरयत्यपि।
समीकरोति विषमान् शमनं तच्च सप्तधा॥६॥
पाचनं दीपनं क्षुत्तृड्व्यायामातपमारुताः।
na śodhayati yaddoṣān samānnodīrayatyapi|
samīkaroti viṣamān śamanaṃ tacca saptadhā||6||
pācanaṃ dīpanaṃ kṣuttṛḍvyāyāmātapamārutāḥ|

यत् दोषान् न शोधयति – yat doṣān na śodhayati– that which does not expel the increased doshas out of the body,
समान् न उदीरयत्यपि –  samān na udīrayatyapi– does not increase the normal doshas,
विषमान् समीकरोति – viṣamān samīkaroti – but makes the imbalanced doshas normal,
शमनं – śamanaṃ – is called as shamana  
तच्च सप्तधा – tacca saptadhā – that is of 7 types, they are,
पाचनं – pācanaṃ – digestive (medicines which destroy ama)
दीपनं – dīpanaṃ – hunger producing, appetizers, stomachic,
क्षुत् – kṣut – withstanding hunger, fasting, avoidance of food,   
तृट् – tṛṭ – withstanding thirst, avoidance of water and liquid foods,
व्यायाम – vyāyāma – indulgence in physical activities and exercise,
आतप – ātapa – exposure to sunlight and
मारुताः – mārutāḥ – exposure to breeze

Shamana – palliative treatment is that which does not expel the increased Doshas out of the body, it does not increase the normal Dosha, but makes the abnormal- Doshas normal.
In short, Shamana treatment brings imbalanced Dosha back to normalcy.
Shamana – 7 types –
Pachana – digestive, carminatives,
Deepana – hunger producing, stomachic,
Kshut – withstanding hunger,  avoidance of food, fasting
Trut –  withstanding thirst/avoidance of water drinking, avoiding liquid food intake
Vyayama- physical activity,
Aatapa- exposure to sunlight and
Maruta- exposure of breeze.

Brimhana Chikitsa

AH Su 14.7b

Brimhana is also shamana

बृंहणं शमनं त्वेव वायोः पित्तानिलस्य च॥७॥
bṛṃhaṇaṃ śamanaṃ tveva vāyoḥ pittānilasya ca||7||

बृंहणं शमनं त्वेव वायोः पित्तानिलस्य च – bṛṃhaṇaṃ śamanaṃ tveva vāyoḥ pittānilasya ca – brimhana (stoutening therapies) are also form of shamana (palliative treatments) since they pacify aggravated vata and vata-pitta.

Brimhana- stoutening therapy also is Shamana only because it alleviates/ mitigates both Vata and Vata Pitta- combination .

Brimhana indications

AH Su 14.8-9a

Brimhaneeya – Persons needing stoutening (nourishing) therapies,

बृंहयेद्व्याधिभैषज्यमद्यस्त्रीशोककर्शितान्।
भाराध्वोरःक्षतक्षीणरूक्षदुर्बलवातलान्॥८॥
गर्भिणीसूतिकाबालवृद्धान् ग्रीष्मेऽपरानपि।
bṛṃhayedvyādhibhaiṣajyamadyastrīśokakarśitān|
bhārādhvoraḥkṣatakṣīṇarūkṣadurbalavātalān||8||
garbhiṇīsūtikābālavṛddhān grīṣme’parānapi|

बृंहयेत् – bṛṃhayet – nourishing therapies should be given to the persons who are
व्याधि कर्शितान् – vyādhi karśitān – emaciated and debilitated by diseases,
भैषज्य कर्शितान् – bhaiṣajya karśitān – emaciated by medicines or therapies,
मद्य कर्शितान् – madya karśitān – emaciated by excessive consumption of alcohol,
स्त्री कर्शितान् – strī karśitān – emaciation due to excessive indulgence in sexual activities,
शोक कर्शितान् – śoka karśitān – emaciated by excessive grief,
भार – bhāra – who carries heavy loads frequently,
अध्व – adhva – who has walked a long distance (or accustomed to frequent long distance walking),
उरःक्षत – uraḥkṣata – who have chest injuries,
क्षतक्षीण – kṣatakṣīṇa – who is debilitated due to injury,
रूक्ष – rūkṣa – who has excessive dryness of the body,
दुर्बल – durbala – debilitated,  
वातलान् – vātalān – persons who have vata constitution or those who are suffering from disorders caused due to increased vata,
गर्भिणी – garbhiṇī – pregnant women,  
सूतिका – sūtikā – the woman who has delivered a child recently,  
बाल – bāla – children,
वृद्धान् – vṛddhān – the aged people,
ग्रीष्मे अपरानपि – grīṣme aparānapi – in summer, even the other people who are not indicated for brimhana above should be given the nourishing therapy (everyone deserves nourishing therapy in summer)

Persons requiring stoutening therapy  – Brimhaneeya –

Brimhana- stoutening therapy should be given to persons who are

Vyadhi karshita – emaciated by diseases,
Bhaishajya Karshita – emaciated by medicines- therapies,
Madya Karshita – emaciated by alcohol,
Stri Karshita – Emaciated by excess sexual activity,
Shoka karshita – Emaciated by  grief,
Bhara – who carries heavy loads frequently,
Adhva – who has walked / travelled a long distance,
Urakshata – person with chest injury,
KShatakseena – who is debilitated due to injury,
Ruksha – who has excess dryness,
Durbala – debilitated,
Vatala – Person with Vata body type,
Garbhini – pregnant,
Sutika –the women who has delivered,
Bala – children,
Vruddha – the aged and
Greeshme – in the month of summer, even the other people, who are not indicated above should be given Nourishing therapy.

Method of Brimhana

AH Su 14.9b-10a

Things used for bringing about brimhana (nourishing things, foods and activities)

मांसक्षीरसितासर्पिर्मधुरस्निग्धबस्तिभिः॥९॥
स्वप्नशय्यासुखाभ्यङ्गस्नाननिर्वृतिहर्षणैः।
māṃsakṣīrasitāsarpirmadhurasnigdhabastibhiḥ||9||
svapnaśayyāsukhābhyaṅgasnānanirvṛtiharṣaṇaiḥ|

Nourishing therapies should be given in the above mentioned conditions by administration of one or more of the below foods, activities –

मांस – māṃsa – meat,
क्षीर – kṣīra – milk,
सिता – sitā – sugar,
सर्पि: – sarpiḥ – ghee
मधुर स्निग्ध बस्तिभिः – madhura snigdha bastibhiḥ – enemas prepared with sweet substances and fats (oil, ghee),
स्वप्न – svapna – sleep,
शय्यासुखा – śayyāsukhā – comfortable bed,
अभ्यङ्ग – abhyaṅga – massage,
स्नान – snāna – bath,  
निर्वृति – nirvṛti – keeping the mind in a pleasant condition (rest),
हर्षणैः – harṣaṇaiḥ – happiness, mood elevating therapies

By the use of meat, milk, sugar, ghee, enema  prepared sweet substances and fats (oil, ghee), sleep, comfortable bed, oil- massage, bath, comforts, rest and happiness of the mind.

Langhana indications

AH Su 14.10b-11

Langhaneeya – Persons needing lightening (thinning) therapies,

मेहामदोषातिस्निग्धज्वरोरुस्तम्भकुष्ठिनः॥१०॥

विसर्पविद्रधिप्लीहशिरःकण्ठाक्षिरोगिणः।

स्थूलांश्च लङ्घयेन्नित्यं शिशिरे त्वपरानपि॥११॥

mehāmadoṣātisnigdhajvarorustambhakuṣṭhinaḥ||10||

visarpavidradhiplīhaśiraḥkaṇṭhākṣirogiṇaḥ|

sthūlāṃśca laṅghayennityaṃ śiśire tvaparānapi||11||

लङ्घयेन्नित्यं – laṅghayennityaṃ – langhana or lightening (thinning) therapies should be administered daily to those persons who

मेह – mehā – have diabetes (urine disorders),  

आमदोषा – āmadoṣa – have their body afflicted by ama,  

अतिस्निग्ध – atisnigdha – have undergone excessive oleation therapy or those who have excessive unctuousness in their body,  

ज्वर – jvara – fever,  

ऊरुस्तम्भ – urustambha – stiffness of thighs,  

कुष्ठिनः – kuṣṭhinaḥ – skin disorders,

विसर्प – visarpa – herpes,

विद्रधि – vidradhi – abscess,

प्लीह – plīha – spleen enlargement (diseases of spleen),

शिरःकण्ठाक्षिरोगिणः – śiraḥkaṇṭhākṣirogiṇaḥ – diseases of head, throat and eyes,

स्थूलांश्च – sthūlāṃśca – are obese,

शिशिरे त्वपरानपि – śiśire tvaparānapi – in winter, even the other people who are not indicated for langhana above should be given the lightening therapies (everyone deserves lightening therapy in summer)

Persons requiring thinning therapy – Langhaneeya –

Langhana- thinning, slimming therapy should be done to
Meha – diabetics
Amadosha – persons suffering  from Ama
Atisnigdha –who has undergone excess oleation treatment
Jvara – fever
Urustambha – stiffness of the thighs,
Kushta – skin diseases
Visarpa – herpes,
Vidhradi – abscess,
Pleeha – diseases of spleen,
Shira, Kanta Akshi roga – head, throat, and eyes;
Sthula – Those are obese
Even to others during Shishira – winter, Langhana treatment should be done.

Indications for Shodhana type of langhana

AH Su 14.12-13a

Indications for Langhana therapy by means of shodhana (panchakarma)

तत्र संशोधनैः स्थौल्यबलपित्तकफाधिकान्।
आमदोषज्वरच्छर्दिरतीसारहृदामयैः॥१२॥
विबन्धगौरवोद्गारहृल्लसादिभिरातुरान्।
tatra saṃśodhanaiḥ sthaulyabalapittakaphādhikān|
āmadoṣajvaracchardiratīsārahṛdāmayaiḥ||12||
vibandhagauravodgārahṛllasādibhirāturān|

तत्र आतुरान् संशोधनैः – tatra āturān saṃśodhanaiḥ – among these forms of langhana, the patients should be treated with lightening therapies administered in the form of shodhana (panchakarma, cleansing therapies) in the below mentioned conditions –
स्थौल्य – sthaulya – those who are obese,
बल – bala – those who are strong,
पित्तकफाधिकान् –pittakaphādhikān – those having predominance of pitta and kapha,
आमदोष – āmadoṣa – those having excess ama,
ज्वर – jvara – fever,
च्छर्धि: – cchardhi – vomiting,
अतीसार – atīsāra – diarrhea,
हृदामयैः – hṛdāmayaiḥ – heart diseases,
विबन्ध – vibandha – constipation,
गौरव – gaurava – heaviness of the body,
उद्गार – udgāra – belching,
हृल्लसादिभि: – hṛllasādibhiḥ – nausea (feel of vomiting) etc.

AH Su 14.13b

Indications for Langhana therapy by means of pachana (digestive) and deepana (hunger enhancing)

मद्यस्थौल्यादिकान् प्रायः पूर्व पाचनदीपनैः॥१३॥
madyasthaulyādikān prāyaḥ pūrva pācanadīpanaiḥ||13||

प्रायः मद्य स्थौल्यादिकान् पूर्व पाचन दीपनैः – prāyaḥ madya sthaulyādikān pūrva pācana dīpanaiḥ – generally in obesity and other conditions having moderate strength (not severe conditions) and in patients having moderate strength, the langhana should be initially administered in the form of pachana (digestives) and deepana (appetite or hunger producing medicines) and later should be subjected to shodhana (purification treatments)

Indication for Langhana therapy by means of Shodhana (Panchakarma) –
Patients with these diseases should be given Panchakarma treatment as the means for Langhana therapy –  Those who are very obese, strong and having predominance of Pitta and Kapha, those suffering  from Amadosha, fever, vomiting, diarrhoea , hearts diseases, constipation, feeling of heaviness, excess of belching, nausea, etc.

Indication for Deepana, Pachana and then Shodhana (Panchakarma) –
Those who are moderately obese, medium in strength of the body and also of the diseases mentioned, first by administration of digestives and hunger producing substances generally, later with other purification therapies;

Indications for Shamana type of langhana

Indication for Shamana type of Langhana –
Those who are troubled by increased Doshas, who are of medium strength, with medium strength disease, who are capable of withstanding strain by the control of hunger and thirst; those again of poor strength- of the body and of disease by exposing them to breeze, sunlight and exercise. 12-14 ½

Those who are to be given Langhana – thinning therapy, should not be given Brimhana – stoutening; those who are to be given Brimhana should be given mild Langhana, or both Langhana and Brimhana together, simultaneously may be given depending upon the nature of habitat, season, strength etc.

AH Su 14.13b

Indications for Langhana therapy by means of pachana (digestive) and deepana (hunger enhancing)

मद्यस्थौल्यादिकान् प्रायः पूर्व पाचनदीपनैः॥१३॥
madyasthaulyādikān prāyaḥ pūrva pācanadīpanaiḥ||13||

प्रायः मद्य स्थौल्यादिकान् पूर्व पाचन दीपनैः – prāyaḥ madya sthaulyādikān pūrva pācana dīpanaiḥ – generally in obesity and other conditions having moderate strength (not severe conditions) and in patients having moderate strength, the langhana should be initially administered in the form of pachana (digestives) and deepana (appetite or hunger producing medicines) and later should be subjected to shodhana (purification treatments)

AH Su 14.14a-14b ½

Indications for Langhana therapy by means of kshut-trishna nigraha (control of hunger and thirst)

एभिरेवामयैरार्तान् हीनस्थौल्यबलादिकान्
क्षुत्तृष्णानिग्रहै:
ebhirevāmayairārtān hīnasthaulyabalādikān|
kṣuttṛṣṇānigrahair

आर्तान् एभिरेव आमयै: – ārtān ebhireva āmayaiḥ – in patients suffering from the same diseases
हीन स्थौल्य – hīna sthaulya – of the likes of obesity etc (explained above) having less strength and
हीन बलादिकान् – hīna balādikān – in patients having less strength,
क्षुत्तृष्णानिग्रहै: – kṣuttṛṣṇānigrahair – langhana (lightening therapies) should be administered in the form of kshut-trishna nigraha (forcible control of hunger and thirst).

AH Su 14.14b ½-15a  

Indications for Langhana therapy by means of samirana-atapa-ayasa (exposure to breeze, sunlight and exercise)

दोषैस्त्वार्तान् मध्यबलैर्दृढान्
समीरणातपायासैः किमुताल्पबलैर्नरान्
doṣaistvārtān madhyabalairdṛḍhān||14||
samīraṇātapāyāsaiḥ kimutālpabalairnarān|

र्दृढान् आर्तान् दोषै: मध्यबलै: तु – dṛḍhān ārtān doṣaiḥ madhyabalaiḥ tu – for strong patients who have vitiated doshas of moderate strength and
किमुत अल्पबलैर्नरान् – kimuta alpabalairnarān – those who have less strength,
समीरण आतप आयासैः – samīraṇa ātapa āyāsaiḥ – langhana should be administered in the form of
samirana (exposure to wind or breeze),
atapa (heat of the Sun) and
ayasa (exercise).

AH Su 14.15b-16a

Rules for implementing nourishing and lightening therapies

न बृंहयेल्लङ्घनीयान् बृंह्यांस्तु मृदु लङ्घयेत्॥१५॥
युक्त्या वा देशकालादिबलतस्तानुपाचरेत्।
na bṛṃhayellaṅghanīyān bṛṃhyāṃstu mṛdu laṅghayet||15||
yuktyā vā deśakālādibalatastānupācaret|

लङ्घनीयान् न बृंहयेत् – laṅghanīyān na bṛṃhayet – to those who are to be given lightening therapy (langhana), bulk promoting therapy or medicines should not be given
बृंह्यांस्तु मृदु लङ्घयेत् – bṛṃhyāṃstu mṛdu laṅghayet – to those who are to be given bulk promoting therapy, lightening or thinning treatments can be given in a milder form
युक्त्या वा तानुपाचरेत् – yuktyā vā tānupācaret – or skillfully both thinning and bulk promoting therapies can be given together
देश कालादि बलत: – deśa kālādi balataḥ – after having considered the nature of habitat, season, strength and other factors in the patient.

Brimhana benefits

AH Su 14.16b

Benefits of brimhana therapy

बृंहिते स्याद्बलं पुष्टिस्तत्साध्यामयसङ्क्षयः॥१६॥
bṛṃhite syādbalaṃ puṣṭistatsādhyāmayasaṅkṣayaḥ||16||

बृंहिते – bṛṃhite – in those who have undergone brimhana therapy (stoutening),  
स्याद्बलं पुष्टि: – syādbalaṃ puṣṭiḥ – strength is obtained, body is nourished properly, and
तत्साध्यामयसङ्क्षयः – tatsādhyāmayasaṅkṣayaḥ – diseases which are curable by that therapy are cured.

Benefits of Bruhmana therapy – Brimhana therapy makes for strength, nourishment of the body, and cure of such diseases which are curable by that therapy.

Langhana benefits

AH Su 14.17-18a

Benefits of langhana therapy

विमलेन्द्रियता सर्गो मलानां लाघवं रुचिः।
क्षुत्तृट्सहोदयः शुद्धहृदयोद्गारकण्ठता॥१७॥
व्याधिमार्दवमुत्साहस्तन्द्रानाशश्च लङ्घिते।
vimalendriyatā sargo malānāṃ lāghavaṃ ruciḥ|
kṣuttṛṭsahodayaḥ śuddhahṛdayodgārakaṇṭhatā||17||
vyādhimārdavamutsāhastandrānāśaśca laṅghite|

लङ्घिते – laṅghite – in those who have undergone langhana or lightening therapies, the below mentioned benefits are obtained –
विमलेन्द्रियता – vimalendriyatā – keenness and clarity of sense organs,
सर्गो मलानां – sargo malānāṃ – timely and proper expulsion of wastes (doshas and excreta)
लाघवं – lāghavaṃ – feeling of lightness of the body,
रुचिः – ruciḥ – good taste perception,
क्षुत्तृट्सहोदयः – kṣuttṛṭsahodayaḥ – appearance of hunger and thirst together,
शुद्ध हृदयो – śuddha hṛdaya – feeling of purity in the chest region (heart),  
शुद्ध उद्गार कण्ठता – śuddha udgāra kaṇṭhatā – clear belching and clear throat,
व्याधिमार्दवम् – vyādhimārdavam – softening of the diseases (decreased severity of diseases),
उत्साह: – utsāhaḥ – energy and enthusiasm
तन्द्रानाशश्च – tandrānāśaśca – loss of stupor, laziness

Benefits of Langhana Therapy –
Keenness and clarity of sense organs,
Expulsion of Malas- Doshas and wastes,
Feeling of lightness of the body,
Good taste perception,
Appearance of hunger and thirst together,
Feeling of purity in the chest region (heart),
Clear belching and clear throat,
Softening of the diseases- decreased severity,
Increase of enthusiasm and
Loss of stupor- laziness

Excessive Brimhana and Langhana

AH Su 14.18b-19

Excessive use of stoutening and thinning therapies

अनपेक्षितमात्रादिसेविते कुरुतस्तु ते॥१८॥
अतिस्थौल्यातिकार्ष्यादीन्, वक्ष्यन्ते ते च सौषधाः।
रूपं तैरेव च ज्ञेयमतिबृंहितलङ्घिते॥१९॥
anapekṣitamātrādisevite kurutastu te||18||
atisthaulyātikārṣyādīn, vakṣyante te ca sauṣadhāḥ|
rūpaṃ taireva ca jñeyamatibṛṃhitalaṅghite||19||

ते अनपेक्षित मात्रादिसेविते कुरुतस्तु – te anapekṣita mātrādisevite kurutastu – these therapies (brimhana and langhana) unintentionally when taken in excess will cause
अतिस्थौल्य अतिकार्ष्यादीन् – atisthaulya atikārṣyādīn – profound obesity and profound emaciation etc.
ते वक्ष्यन्ते च सौषधाः – te vakṣyante ca sauṣadhāḥ – they will be enumerated now along with their treatment
तैरेव रूपं च ज्ञेयम् अतिबृंहितलङ्घिते – taireva rūpaṃ ca jñeyaṃ atibṛṃhitalaṅghite – the same symptoms should be considered as the symptoms of excessive stoutening and excessive thinning (lightening) therapies respectively.

These therapies indulged into in great measure than required, lead on to profound obesity and emaciation etc. which will be enumerated now, along with their treatment.

Excessive Brimhana effects

AH Su 14.20

Symptoms of Ati Brimhana or excessive administration of stoutening therapy      

अतिस्थौल्यापचीमेहज्वरोदरभगन्दरान्।
काससन्न्यासकृच्छ्रामकुष्ठादीनतिदारुणान्॥२०॥
atisthaulyāpacīmehajvarodarabhagandarān|
kāsasannyāsakṛcchrāmakuṣṭhādīnatidāruṇān||20||

अतिदारुणान् – atidāruṇān – dreadful diseases get manifested, like
अतिस्थौल्य – atisthaulya – profound obesity,  
अपची – apacī – scrofula,  
मेह – meha – diabetes, urinary disorders,  
ज्वर – jvara – fever,
उदर – udara – enlargement of abdomen,  
भगन्दरान् – bhagandarān – fistula-in-ano,
कास – kāsa – cough,   
सन्न्यास – sannyāsa – loss of consciousness,  
कृच्छ्र – kṛcchra – dysuria,   
आम – āma – disorders of poor digestion,
कुष्ठादीन् – kuṣṭhādīn – skin diseases etc.

Ati Brimhana- excess of stoutening therapy :-

Excess of Brimhana therapy produces
Atisthaulya – profound obesity
Apachi – scrofula,
Meha – Diabetes, UTI
Jvara – fever
Udara – enlargement of abdomen,
Bhagandara – fistula-in-ano,
Kasa – cough,
Sanyasa – loss of consciousness,
Mutrakruchra – Dysuria,
Ama- disorders of poor digestive activities,
Kushta -skin diseases which are very dreadful.

Excessive Brimhana treatment

AH Su 14.21-24

Treatment for disorders (like obesity etc) manifested due to excessive administration of stoutening therapies

तत्र मेदोनिलश्लेष्मनाशनं सर्वमिष्यते।
कुलत्थजूर्णश्यामाकयवमुद्गमधूदकम्॥२१॥
मस्तुदण्डाहतारिष्टचिन्ताशोधनजागरम्।
मधुना त्रिफलां लिह्याङ्गुडूचीमभयां घनम्॥२२॥
रसाञ्जनस्य महतः पञ्चमूलस्य गुग्गुलोः।
शिलाजतुप्रयोगश्च साग्निमन्थरसो हितः॥२३॥
विडङ्ग नागरं क्षारः काललोहरजो मधु।
यवामलकचूर्णं च योगोऽतिस्थौल्यदोषजित्॥२४॥
tatra medonilaṣleṣmanāśanaṃ sarvamiṣyate|
kulatthajūrṇaśyāmākayavamudgamadhūdakam||21||
mastudaṇḍāhatāriṣṭacintāśodhanajāgaram|
madhunā triphalāṃ lihyāṅguḍūcīmabhayāṃ ghanam||22||
rasāñjanasya mahataḥ pañcamūlasya gugguloḥ|
śilājatuprayogaśca sāgnimantharaso hitaḥ||23||
viḍaṅga nāgaraṃ kṣāraḥ kālaloharajo madhu|
yavāmalakacūrṇaṃ ca yogo’tisthaulyadoṣajit||24||

तत्र सर्वम् मेदो अनिल श्लेष्म नाशनं इष्यते – tatra sarvam medo anila ṣleṣma nāśanaṃ iṣyate – in these (excessive obesity and other conditions) all medicines and treatments which reduce fat, vata and kapha are desirable
योगो च अतिस्थौल्यदोषजित् – yogo ca atisthaulyadoṣajit – the medicines which would destroy excessive obesity and other symptoms caused due to excessive use of stoutening therapies are –
कुलत्थ – kulattha – horse gram,  
जूर्ण – jūrṇa – variety of wild rice,  
श्यामाक – śyāmāka – a type of cereal (Panicum frumentaceum)
यव – yava – barley,
मुद्ग – mudga – green gram,  
मधूदकम् – madhūdakam – honey water,
मस्तु – mastu – curd water (whey)
दण्डाहत – daṇḍāhata – churned buttermilk,
अरिष्ट – ariṣṭa – fermented medicinal liquids,
चिन्ता – cintā – indulgence in thoughts, worries and stressful activities,  
शोधन – śodhana – purification therapies, (panchakarma),
जागरम् – jāgaram – avoidance of sleep at night,   
त्रिफलां गुडूचीम् अभयां घनम् मधुना लिह्यात् – triphalāṃ guḍūcīm abhayāṃ ghanam madhunā lihyāt – Triphala (fruits of Terminalia chebula, Terminalia bellerica, Emblica officinalis), Tinospora cordifolia, Terminalia chebula or Cyperus rotundus should be consumed with (licked after mixing with) honey,  
रसाञ्जनस्य महतः पञ्चमूलस्य गुग्गुलोः शिलाजतु प्रयोगश्च साग्निमन्थरसो हितः – rasāñjanasya mahataḥ pañcamūlasya gugguloḥ śilājatu prayogaśca sāgnimantharaso hitaḥ – aqueous extract of Berberis aristata, 5 great roots (roots of Aegle marmelos, Clerodendrum phlomidis, Oroxylum indicum, Stereospermum suaveolens, Gmelina arborea), Commiphora mukul or Asphaltum mixed in fresh juice of Clerodendrum phlomidis is beneficial,  
विडङ्ग नागरं क्षारः काललोहरजो यव आमलकचूर्णं मधु –  viḍaṅga nāgaraṃ kṣāraḥ kālaloharajo yava āmalakacūrṇaṃ madhu – Powder of Embelia ribes, Ginger, Alkali of barley plant, ash of black iron, powder of barley and Emblica officinalis should be mixed in honey and licked.

Treatment for over nourishing  –
Treatments which reduce Medas – fat, Anila- Vata and Kapha are desirable;
Use of Kulattha – horse gram – Dolichos Biflorus,
Jurna, Shyamaka,
Yava – Barley – Hordeum Vulgare,
Mudga – green gram – Averrhoa Carambola, and Honey water;

Indulgence in worry, stressful activities
Purification therapies, avoidance of sleep,
Either Triphala, Guduci, Abhaya –(Chebulic Myrobalan fruit rind – Terminalia chebula) and Musta (Cyperus rotundus), should be licked with honey daily;
Either Rasanjana (Aqueous extract of Berberis aristata), Brihat Pancamula (Agnimantha, Shyonaka, Gambhari, Patala, Bilva), Guggulu – along with the fresh juice of Agnimnatha is suitable;
Powder of Vidanga (False black pepper – Embelia ribes), Nagara – (Ginger), Kshara- Yavakshara and iron filing or powder of Yava (Barley – Hordeum vulgare) and Amla along with honey – should be licked  daily.

AH Su 14.25-28

Powder of Vyosha and other herbs

व्योषकट्वीरशिग्रुविडङ्गातिविषास्थिराः।
हिङ्गुसौवर्चलाजाजीयवानीधान्यचित्रकाः॥२५॥
निशे बृहत्यौ हपुषा पाठा मूलं च केम्बुकात्।
एषा चूर्ण मधु घृतं तैलं च सदृशाशकम्॥२६॥
सक्तुभिः षोडशगुणैर्युक्तं पीत निहन्ति तत्।
अतिस्थौल्यादिकान् सर्वान् रोगानन्यांश्च तद्विधान्॥२७॥
हृद्रोगकामलाश्वित्रश्वासकासगलग्रहान्।
बुद्धिमेधास्मृतिकरं सन्नस्याग्नेश्च दीपनम्॥२८॥
vyoṣakaṭvīraśigruviḍaṅgātiviṣāsthirāḥ|
hiṅgusauvarcalājājīyavānīdhānyacitrakāḥ||25||
niśe bṛhatyau hapuṣā pāṭhā mūlaṃ ca kembukāt|
eṣā cūrṇa madhu ghṛtaṃ tailaṃ ca sadṛśāśakam||26||
saktubhiḥ ṣoḍaśaguṇairyuktaṃ pīta nihanti tat|
atisthaulyādikān sarvān rogānanyāṃśca tadvidhān||27||
hṛdrogakāmalāśvitraśvāsakāsagalagrahān|
buddhimedhāsmṛtikaraṃ sannasyāgneśca dīpanam||28||

चूर्ण एषा – cūrṇa eṣā –  the powder of these (below mentioned herbs) –
व्योष कट्वी वरा शिग्रु विडङ्ग अतिविषा स्थिराः – vyoṣa kaṭvī varā śigru viḍaṅga ativiṣā sthirāḥ – Vyosha (Long pepper, black pepper and ginger), Picrorrhiza kurroa, Vara (fruits of Terminalia chebula, Terminalia bellerica and Emblica officinalis), drumstick, Embelia ribes, Aconitum heterophyllum, Desmodium gangeticum
हिङ्गु सौवर्चल आजाजी यवानी धान्य चित्रकाः – hiṅgu sauvarcala ājājī yavānī dhānya citrakāḥ – asafetida, sauchal salt, cumin, carom seeds, coriander, Plumbago zeylanica,
निशे बृहत्यौ हपुषा पाठा मूलं च केम्बुकात् – niśe bṛhatyau hapuṣā pāṭhā mūlaṃ ca kembukāt – turmeric, Berberis aristata, Solanum indicum, Solanum xanthocarpum, Juniperus communis, root of Cyclea peltata and root of Costus speciosus,  
सदृशाशकम् मधु घृतं तैलं च – sadṛśāśakam madhu ghṛtaṃ tailaṃ ca – taken in equal quantity and mixed in equal quantity of honey, ghee and oil, and    
षोडशगुणैर्युक्तं सक्तुभिः – ṣoḍaśaguṇairyuktaṃ saktubhiḥ – sixteen parts of corn flour,
पीत निहन्ति तत् – pīta nihanti tat – when consumed, will destroy
अतिस्थौल्यादिकान् सर्वान् रोगान् – atisthaulyādikān sarvān rogān – excessive obesity and other diseases listed above (as caused by excessive administration of stoutening therapy)
अन्यांश्च तद्विधान् – anyāṃśca tadvidhān – and even other diseases of similar nature such as
हृद्रोग कामला श्वित्र श्वास कास गलग्रहान् – hṛdroga kāmalā śvitra śvāsa kāsa galagrahān – heart diseases, jaundice, leucoderma, dyspnoea, cough, obstruction in the throat (hoarseness of voice),
बुद्धि मेधा स्मृतिकरं – buddhi medhā smṛtikaraṃ – improves power of thinking, intelligence and memory, and सन्नस्याग्नेश्च दीपनम् – sannasyāgneśca dīpanam – kindles the weakened fire (digestive activity, metabolism)

Powder of Vyosha- (Trikatu – pepper, long pepper and ginger), Katvi, Vara (Triphala), Shigru (drum stick), Vidanga (False black pepper – Embelia ribes), Ativisha, Sthira (Desmodium gangeticum), Hingu – (Asa foetida), Sauvarcala, Ajaji – (Cuminum cyminum), Yavani – (Trachyspermum ammi), Dhanya, Chitraka, the two Nisa (turmeric and tree turmeric), the two Brihati (brihati and kantakari), Hapusa, root of Patha (Cyclea peltata) and of Kebuka, should be mixed with honey, ghee and oil in equal proportion and sixteen parts of saktu (corn flour), this mixture diseases- mentioned earlier and even others of similar nature such as heart diseases, Jaundice, Leucoderma, Dyspnoea, cough, obstruction in the throat- hoarseness of  voice etc. Improves powder of thinking, intelligence, memory and kindles the weakened fire- digestive activity.

Symptoms of Ati Langhana

AH Su 14.29-31a

Symptoms of Ati Langhana or excessive administration of thinning (lightening) therapy

अतिकार्श्य भ्रमः कासस्तृष्णाधिक्यमरोचकः।
स्नेहाग्निनिद्रादृक्श्रोत्रशुक्रौजःक्षुत्स्वरक्षयः॥२९॥
बस्तिहृन्मूर्धजङ्घोरुत्रिकपार्श्वरुजा ज्वरः।
प्रलापोर्ध्वानिलग्लानिच्छर्दिपर्वास्थिभेदनम्॥३०॥
वर्चोमूत्रग्रहाद्याश्च जायन्तेऽतिविलङ्घनात्।
atikārśya bhramaḥ kāsastṛṣṇādhikyamarocakaḥ|
snehāgninidrādṛkśrotraśukraujaḥkṣutsvarakṣayaḥ||29||
bastihṛnmūrdhajaṅghorutrikapārśvarujā jvaraḥ|
pralāpordhvānilaglānicchardiparvāsthibhedanam||30||
varcomūtragrahādyāśca jāyante’tivilaṅghanāt|

अतिविलङ्घनात् जायन्ते – ativilaṅghanāt jāyante – due to excessive administration of thinning (emaciating, lightening) therapies are manifested (the below mentioned conditions)
अतिकार्श्य – atikārśya – profound emaciation,
भ्रमः – bhramaḥ – delusion, dizziness, giddiness,  
कास: – kāsaḥ – cough
तृष्णाधिक्यम् – tṛṣṇādhikyam – severe thirst,  
अरोचकः – arocakaḥ – anorexia,
क्षयः स्नेहाग्नि निद्रा दृक्श्रोत्र शुक्रौजः क्षुत्स्वर – kṣayaḥ snehāgni nidrā dṛk śrotra śukraujaḥ kṣutsvara – loss of (decrease of) moistness, digestive power, sleep, vision, hearing,  semen, ojas (essence of tissues), hunger and voice,
रुजा बस्ति हृन्मूर्ध जङ्घोरु त्रिक पार्श्व – rujā basti hṛnmūrdha jaṅghoru trika pārśva – pain in the urinary bladder, heart, head, calves, thighs, upper shoulders and flanks,  
ज्वरः – jvaraḥ – fever,
प्रलापोर्ध्वानिल ग्लानि च्छर्दि पर्वास्थि भेदनम् – pralāpordhvānila glāni cchardi parvāsthi bhedanam – delirium (excess talking, irrelevantly), belching, exhaustion, vomiting, cutting pain in the joints (of fingers) and bones,
वर्चो मूत्र ग्रहाद्याश्च – varco mūtra grahādyāśca – obstruction of faeces, urine etc.

Atilanghana- excess of thinning therapy:-

Profound emaciation,
Bhrama – Delusion, Dizziness,
Kasa – cough,
Trushna – severe thirst,
Aruchi – anorexia,
Loss / decrease of moistness and digestive power, of sleep, vision, hearing, semen, Ojas, hunger and voice;
Pain in the urinary bladder, heart, head, calves, thighs, upper shoulders and flanks;
Fever, delirium- excess of talk, belching, exhaustion, vomiting, cutting pain in the joints and bones;
Non-elimination of faeces, urine etc., arise from excess of Langhana 29-30

Emaciation is better than obesity

AH Su 14.31b-33a

Being thin is better than being obese, because there is no medicine for obesity

कार्श्यमेव वरं स्थौल्यात् न हि स्थूलस्य भेषजम्॥३१॥
बृंहणं लङ्घनं वाऽलमतिमेदोग्निवातजित्।
मधुरस्निग्धसौहित्यैर्यत्सौख्येन च नश्यति॥३२॥
क्रशिमा स्थविमाऽत्यन्तविपरीतनिषेवणैः।
kārśyameva varaṃ sthaulyāt na hi sthūlasya bheṣajam||31||
bṛṃhaṇaṃ laṅghanaṃ vā’lamatimedognivātajit|
madhurasnigdhasauhityairyatsaukhyena ca naśyati||32||
kraśimā sthavimā’tyantaviparītaniṣevaṇaiḥ|

कार्श्यमेव वरं स्थौल्यात् – kārśyameva varaṃ sthaulyāt – emaciation (being thin) is better than obesity (being fat),  
न हि भेषजम् स्थूलस्य – na hi bheṣajam sthūlasya – there is no treatment for the obese,
बृंहणं लङ्घनं वा न अलम् अतिमेदो अग्निवातजित् – bṛṃhaṇaṃ laṅghanaṃ vā na alamatimedo agnivātajit – because stoutening therapies or thinning therapies are incapable of vanquishing excess of fat, excessive digestive activity or excessive vata
क्रशिमा नश्यति मधुर स्निग्ध सौहित्यै: यत्सौख्येन च – kraśimā naśyati madhura snigdha sauhityaiḥ yatsaukhyena ca – emaciation gets cured (destroyed) by use of sweet and unctuous (fatty) foods and comfortable living, whereas  
स्थविमा अत्यन्त विपरीत निषेवणैः – sthavimā atyanta viparīta niṣevaṇaiḥ – obesity gets cured by the use of foods and activities which are extremely opposite to those mentioned above, that too when used in maximum quantity.

Emaciation is better than obesity, there is no treatment for the obese, for , neither Brimhana nor Langhana are capable of vanquishing excess of fat, digestive activity and vata.

Emaciation gets cured by use of sweet and unctuous- fatty foods and comfortable living, whereas obesity gets cured by the use of foods and activities which are extremely opposite to those mentioned above, that too when used in maximum quantity.

Karshya Chikitsa

AH Su 14.33b-35

Treatment principles of emaciation

योजयेद्बृंहणं तत्र सर्वं पानान्नभेषजम्॥३३॥
अचिन्तया हर्षणेन ध्रुवं सन्तर्पणेन च।
स्वप्नप्रसङ्गाच्च कृशो वराह इव पुष्यति॥३४॥
न हि मांससमं किञ्चिदन्यद्देहबृहत्त्वकृत्।
मांसादमांसं मासेन सम्भृतत्वाद्विशेषतः॥३५॥
yojayedbṛṃhaṇaṃ tatra sarvaṃ pānānnabheṣajam||33||
acintayā harṣaṇena dhruvaṃ santarpaṇena ca|
svapnaprasaṅgācca kṛśo varāha iva puṣyati||34||
na hi māṃsasamaṃ kiñcidanyaddehabṛhattvakṛt|
māṃsādamāṃsaṃ māsena sambhṛtatvādviśeṣataḥ||35||

तत्र सर्वं पान अन्न भेषजम् बृंहणं योजयेत् – tatra sarvaṃ pāna anna bheṣajam bṛṃhaṇaṃ yojayet – therein (in emaciation), all sorts of liquids, foods and drugs which are stoutening (bulk promoting, nourishing) should be adopted
कृशो पुष्यति वराह इव – kṛśo puṣyati varāha iva – the emaciated person becomes stout like a boar
अचिन्तया – acintayā – by absence of worry,
हर्षणेन – harṣaṇena – by happiness,
ध्रुवं सन्तर्पणेन च – dhruvaṃ santarpaṇena ca – more use of nutritious food and
स्वप्नप्रसङ्गाच्च – svapnaprasaṅgācca – more of sleep
न हि किञ्चिदन्यत् मांस समं देह बृंहत्त्वकृत् – na hi kiñcidanyad māṃsa samaṃ dehabṛhattvakṛt – there is nothing equivalent to the meat to cause stoutness of the body,
विशेषतः मांसाद मांसं मांसेन सम्भृतत्वात् – viśeṣataḥ māṃsāda māṃsaṃ māsena sambhṛtatvād – especially so the meat of meat eating (carnivorous) animals, for they get nourished by (feed on) meat itself.

Therein (in emaciation), all sorts of liquids, foods and drugs which are stoutening (bulk promoting, nourishing) should be adopted the emaciated person becomes stout like a boar by absence of worry, by happiness, more use of nutritious food and more of sleep there is nothing equivalent to the meat to cause stoutness of the body, especially so the meat of meat eating (carnivorous) animals, for they get nourished by (feed on) meat itself.

AH Su 14.36

Foods those are good for obese and thin people

गुरु चातर्पणं स्थूले विपरीतं हितं कृशे।
यवगोधूममुभयोस्तद्योग्याहितकल्पनम्॥३६॥
guru cātarpaṇaṃ sthūle viparītaṃ hitaṃ kṛśe|
yavagodhūmamubhayostadyogyāhitakalpanam||36||

गुरु चातर्पणं स्थूले – guru cātarpaṇaṃ sthūle – foods which are heavy and non-nutritious (depleting) are ideal for obese,  
विपरीतं हितं कृशे – viparītaṃ hitaṃ kṛśe – whereas the opposites are ideal for the emaciated (foods which are light and nutritious)

यव गोधूमम् तद्योग्या उभयो: हितकल्पनम् – yava godhūmam tadyogyā ubhayos hitakalpanam – yava (barley) and godhuma (wheat) should be used in both these conditions considering them as beneficial foods respectively (yava being heavy and non-nutritious is good for obese people while godhuma (wheat) being light and nutritious is beneficial for emaciated people).

Foods which are heavy and non- nutritious are ideal for the obese whereas the opposites- are ideal for the emaciated;
Yava – Barley – Hordeum vulgare- barley is heavy and non nutritious, ideal for obese and
Godhuma- wheat is light to digest and nutritious, Hence good for emaciated.

AH Su 14.37

Brimhana and langhana are the only two important forms of treatments

दोषगत्याऽतिरिच्यन्ते ग्राहिभेद्यादिभेदतः।
उपक्रमा न ते द्वित्वाद्भिन्ना अपि गदा इव॥३७॥
doṣagatyā’tiricyante grāhibhedyādibhedataḥ|
upakramā na te dvitvādbhinnā api gadā iva||37||

दोषगत्या अतिरिच्यन्ते – doṣagatyā atiricyante – though the states of doshas are innumerable,  
उपक्रमा ग्राहि भेद्यादि भेदतः – upakramā grāhi bhedyādi bhedataḥ – and the types of treatments are also innumerable, like grahi (withholding, constipating), bhedi (purgatives) etc,
न ते द्वित्वाद्भिन्ना – na te dvitvādbhinnā – still the treatments do not surpass these two kinds i.e. brimhana (stoutening) and langhana (thinning),  
अपि गदा इव – api gadā iva – as the diseases, though innumerable fall into two kinds only i.e. sama and nirama (with ama and without ama).

Though the states of Doshas are innumerable and innumerable are the kinds of treatments such as Grahi – withholding etc, still they do not surpass these two kinds- Brimhana and Langhana, just as the diseases- though innumerable fall into two kinds only, viz Sama and Nirama. (with and without Ama)

इति श्रीवैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया सूत्रस्थाने द्विविधोपक्रमणीयो नाम चतुर्दशोऽध्यायः॥१४॥
iti śrīvaidyapatisiṃhaguptasūnuśrīmadvāgbhaṭaviracitāyāmaṣṭāṅgahṛdayasaṃhitāyā sūtrasthāne dvividhopakramaṇīyo nāma caturdaśo’dhyāyaḥ||14||

Thus ends the 14^th chapter of Ashtangahridaya Samhita Sutrasthana, named Dvividhopakramaniyo Adhyaya, written by Shrimad Vagbhata, son of Shri Vaidyapati Simhagupta.