Koshta: Understanding Gut Behaviour And Gut Reactivity

Article by Dr Raghuram Y.S. MD (Ay)
‘We are what we eat’ and there is no doubt about this. Food is one of the most important necessities for of our life. Food can be considered as an alternate form of life. 

Ayurveda has explained ‘Traya Upastambha’ or 3 supporting pillars supporting our life and are responsible for our healthy existence.
Ahara (food), Nidra (sleep) and Brahmacharya (celibacy or disciplined lifestyle and practices pertaining to sex life) are the Trayopastambhas.
Among the 3, the Ahara or a well balanced food in terms of quality and quantity forms one of the important pillars and 1/3 of the lot.

If taking good food is one of the important factors for health, its proper digestion, absorption and utilization are other equally important factors for the maintenance of health.
All these aspects on one side, the other big factor for the body to be healthy and free from diseases are the ‘timely excretion of metabolic wastes and toxins’.

Sthula Mala

The major metabolic wastes comprise of the faeces formed after the completion of digestion process at the gut level. They are formed in 3 fractions, the Purisha (stools or faeces), the Mutra (urine) and Sweda (sweat).
These 3 metabolic wastes or excreta are formed on a daily basis and are excreted out of the body. In fact, they have to be excreted on a daily account for the balance and maintenance of comprehensive health. These wastes are called Sthula Malas or excreta formed in large quantities (Sthula=big or large, Mala=excreta).

Sukshma Mala

These are metabolic wastes formed after the completion of tissue metabolism. The food, after the digestion in gut, reaches different tissues.
In these tissues, the food or essence of food (ahara rasa) is once again metabolized. This is called tissue metabolism. At the end of this process, the tissues throw away some waste products and are called as Dhatu malas (tissue toxins). They are called as Sukshma Malas or excreta formed in small quantities (Sukshma=small, Malas=excreta).

Ayurveda believes that the small streams of Sukshma malas get drained into the Sthula Malas and are totally excreted en-mass. This forms a comprehensive ‘self detoxification mechanism’ which is a basic intelligence of the body and happens on a regular (daily) basis to keep the body and mind free of diseases.

If the process of the excretion does not take place at proper time and in proper quantities, the unwanted wastes and toxins get stagnated in the body and become responsible for a wide array of psychosomatic disorders.

We may feel ‘What is the big deal in it?
Just go to the loo, pass of the wastes, flush and keep going. Easier said than done! In spite of the appetite, digestion, absorption, everything being fine, many people find it difficult to push of their wastes on a regular basis. It is surely not an easy affair for many people and is a serious issue for some others.

‘Doctor, I don’t have any health issues. Give me some medicines to push of my wastes easily. It is bothering me for years’ is a common condition and complaint that I have encountered in my clinical practice.
Why does a simple mechanism like defecation become so complicated? Why does a simple issue bother you for years?

Why that is any medicine or treatment is failing to help you get relieved from the stubborn bowel movements?
Well, it may not be as simple as you are thinking it to be!!

‘Not able to cleat our stools in a proper way in a consistent way’ – Is this disease or a stubborn condition or a practice (habitual) or Is it just a chronic constipation?
Well, the answer is – ‘It could be anything!!’

If the bowel movements are not good due to the above said conditions, if the bowels pass off too quickly or takes a lot of time to clear or if there are sudden or chronic change of bowel habits, it might be a primary or a secondary gut related problem.
There might be a mind component like stress or anxiety or depression related to disturbance of bowel movements apart from the physical conditions.
All these conditions should be effectively managed with proper medication, treatments, lifestyle corrections and dietetic corrections.

But what if the abnormal behavior of your gut is not abnormal as you are thinking and is quite natural to you?
Yes, we need to see the gut behavior or re-activity in this perspective also…
This question gives us a clue that there is another component which needs to be focused upon. In this article we will be discussing about the different types of gut re activity and bowel movements which are quite natural to us, but when neglected can take a pathological deviation causing many diseases.
These bowel movements are called as ‘Koshta’ in Ayurvedic language.

Concept of Koshta

The bowel movements which you are thinking to be abnormal, subnormal, troublesome or disturbing might be quite natural to you.

It might be a normal gut behavior or response which is a part of your basic birth constitution and might not be pathological.
If this is a case, you need not panic.You just need to know about your gut behaviour or reactivity to understand if your bowel movements are normal or abnormal.
In this article let us learn about Koshta or your gut behaviour or different forms of bowel movements.

Koshta –
Koshta is a term explained in 2 senses in Ayurveda:
Anatomically Koshta means the space or hollows in the body for accommodation of visceral organs.

Thoracic cavity (chest cavity) for accommodation of heart and lungs, abdominal cavity for accommodation of organs including stomach, liver, spleen, pancreas, intestines etc and Pelvic cavity for accommodation of uterus, urinary bladder, lower parts of bowel etc are called Koshta

Related Reading – Anatomical aspect of Koshta

Physiologically (functionally) the Koshta is defined as bowel movements according to the basic constitution of the person. This shows us how the gut responds in different constitutions of the body or in different body types.

These are acquired or inherited at birth. They are quite normal to us. When we do not maintain the normal gut health provided to us and its usual re-activity, it tends to look pathological.

Bowel movement and Agni

Bowel movements and their Relation to Agni

Before the stools are formed and expelled, the food we take should have been properly digested. This happens in the stomach and small intestines.

The belly fire or Agni as it is called in Ayurveda is located in Amashaya (stomach) where partial digestion takes place and Pachyamanashaya or Grahani (small intestine, duodenum) where the digestion process gets completed before the digested food is pushed to the large intestine for the stools to be formed and excreted. This fire helps in digestion of food.

Vishamagni – This is a type of Agni with Vata association. It is found in predominance of Vata or in Vata constitution people. We know that the combination of Air (vata) and fire (agni) is dangerous.

But due to the unpredictable and inconsistent nature of Vata, the fire too keeps varying. Sometimes it is good and sometimes not. The digestion of food is also sometimes good and sometimes worst.

The Koshta or gut behaviour also follows this Agni. The Koshta is also vishama. When the Agni digests the food properly, the bowel movements will be good. When the digestion is bad, the bowel movements will be bad. Thus, Krura Koshta has an unpredictable nature.

Krura Koshta also is found in people with Vata-Kapha constitution (Sushruta Chikitsa 33/29) or Vata-Kapha predominance.

This is a strange condition in which either Vata dries up the liquidity of Kapha (kapha gives smoothness and sticky nature to the stools) or the Kapha blocks the Vayu (avarana) and prevents it from performing the functions of stool formation and excretion.

In both cases, the bowel clearance is difficult. This may not be essentially due to the involvement of Vishamagni. It may be due to mutual interference of the doshas in performing their functions.

Teekshna Agni – This is a type of Agni with Pitta association. It is found in predominance of Pitta or in Pitta constitution people. We know that the fire is represented in the body in the form of Pitta.

Thus, Pitta and Agni are the same elements. This is a common rule for everyone. But when Pitta is predominantly associated with Agni, the fire digests the food quickly. This will inturn have its influence on Koshta.

The Koshta or bowel movements in Pitta predominance is called as Mridu Koshta (soft stools or soft bowel clearance).

Since the food is digested quickly, there is a frequency for bowel clearance. Loose or unformed stools can also be excreted in Mrudu Koshta.

The stools will be oily, sticky and pass out easily owing to the mrudu (soft), snigdha (oily), drava (liquidity) nature of the stools. Since the Pitta will be predominant in Mridu Koshta, the Vayu will be comparably less in the large intestine.

The low strength of Vata will not allow the total moisture or liquidity of Pitta to be absorbed. Thus, the stools tend to be watery most of the times.

Manda Agni – This is a type of Agni with Kapha association. It is found in predominance of Kapha or in Kapha constitution people. The digestion in this type of Agni will be mild to moderate.
Kapha acts like a buffer and does not allow Vata and or Pitta to go to a surge. Therefore the fire is moderate type.
This type of Agni will have its impact on the Koshta. Such type of Koshta predominant with Kapha is called Madhyama Koshta.

The moderate character of the Kapha makes the bowel movements moderate. The stools are neither too hard and difficult as in Krura Koshta nor too frequent and liquid in nature as in Mrudu Koshta. The digestion will take its time, but the bowel clearance will be balanced.

This type of Koshta is also said to be found in healthy people and those who have Sama Agni (equilibrium of fire with good digestion).

In this article we will be discussing about the functional aspect of Koshta

Body types and Koshta

Body Types and Koshta (gut behaviour) –
Basically, the body types or birth constitution is of 7 types:
Vata Prakriti
Pitta Prakriti
Kapha Prakriti

Vata-Pitta Prakriti – Vata Pitta indicates that Vata is predominant and Pitta is secondary in these people. If Pitta is predominant and Vata is secondary Prakriti, it will still not be counted as a different Prakriti.

It will be included in Vata pitta Prakriti itself. For clinical accuracy, doctors may note it down as Vata Pitta or Pitta Vata depending on the predominance of dosha in the Prakriti.

The same rule applies to the other dual Prakritis i.e. Vata-Kapha and Pitta-Kapha Prakritis.
Vata-Kapha Prakriti
Pitta-Kapha Prakriti

Vata-Pitta-Kapha Prakriti or Sama Prakriti – In this all the 3 doshas will be balanced and in equilibrium. This is a state of perfect health and is hardly found in clinical practice.

The gut responses or Koshta varies in different personalities.

Koshta Bheda – Types of digestive tract:

As per Ashtanga Hrudayam Sutrasthana 1st chapter,

कोष्ठः क्रूरो मृदुर्मध्यो मध्यः स्यात्तैः समैरपि ।
koṣṭhaḥ krūro mṛdurmadhyo madhyaḥ syāttaiḥ samairapi | There are three types of digestive tracts (Koshta):
1. Kroora Koshta – hard bowels
2. Mrudu Koshta – soft bowels
3. Madhyama Koshta – normal bowels.

Krura Koshta

Vata type of Koshta or Krura Koshta –
Krura Koshta is basically found in:
Vata predominant constitution (Vata Prakriti)
Vata-Kapha type of constitution (Vata-kapha Prakriti)
Kapha-Vata type of constitution, a variant of Vata-Kapha constitution (Kapha-vata prakriti)

The Vata type of persons will have a bowel movement or response called Krura or Kroora Koshta. Krura means hard or tough, Koshta means bowel movement. Thus Krura Koshta means difficult or tough bowel movements.

By the explanation it is clear that the Vata type of persons will naturally find it difficult to pass the stools. They are born with such a type of gut which evacuates bowel with difficulty

Characteristic features of Krura Koshta –
Difficulty in passing the stools, unpredictable nature, sometimes good and sometimes hard and difficult
Have unpredictable digestion (vishama agni) and appetite
Hard stools with or without constipation (tendency to constipation)
Need to spend lot of time in the loo (rest-room or toilet), we can see people finishing off the newspapers and magazines by the time they flush off.
Bowel movements will be seen once in a day, at non-specific time
Bowel movements may be occasionally absent on a few days
Bowel needs motivation like a glass of coffee, hot water etc to keep the stools moving
Stools will be dry, pellet like, devoid of smoothness, oiliness, stickiness and moisture
Occasionally the passage of stools will be associated with pain abdomen, straining, passage of blood through the stools, bloating, and distension of abdomen etc symptoms

If the going gets tough, the condition needs to be managed with strong purgatives (teekshna virechana). Snigdha Virechana (oil based purgatives like Gandharvahastadi Eranda Tailam, Nimbamritadi Eranda Tailam, mishraka Tailame etc should be administered.

Many times Sneha Vasti (enemas with medicated oils, ghee or both) shall be given to get rid of this condition. The bowel movements many times are difficult with the strong purgatives also. Herbs like Danti (Baliospermum montanum), Jayapala (Croton tiglium) etc are sometimes useful in evacuating bowels.

Mild laxatives like milk, grape juice, sugarcane juice, Avipattikar churna (herbal laxative), Triphala churna (herbal laxative) etc do not yield results

There is no urgency to defecate

Tends to aggravate in monsoon seasons (varsha ritu), cold climate, cold foods and cold comforts

Aggravates on taking excessive dry foods, foods rich in pungent, bitter and astringent tastes, excessive sex and exercise and on consumption of any Vata aggravating factors, The opposite factors will relieve the symptoms.

Why it happens?
Among many sites of Vata, Pakwashaya or Large intestine is the main site. This clearly shows that be it any Prakriti, the large intestine which forms and excretes the stools is basically an abode of Vata. In Vata Prakriti people, this local Vata is considerably stronger than in any other Prakritis.

Large intestine is the site of Malavaha / Pureeshavaha Srotas (channels responsible for carrying the stools or faeces) and Pureeshadhara Kala (membranes helping in forming and processing the stools into fully formed waste.

This function is contributable to the Ruksha (dry) and Khara (rough) qualities of Vata. Just like putting water on a dry or rough surface, the water content of the stools getting exposed to ultra-dryness of the Vata predominant Koshta gets almost absorbed.

This leaves the hard stools behind, devoid of much water content. The basic liquidity or unctuous nature of the stool required for it to pass off easily from the bowel to exterior is absent.

This makes the stools stubborn and pellet form. The stools due to less moisture or no moisture content gets adhered to the walls of the intestine. This makes the stool passing or defecation difficult in Vata predominant Koshta.

The Vayu is made up of Vayu and Akasha Mahabhutas (i.e. predominance of wind and ether or space elements of nature). The combination usually tends to create dryness and roughness.

Does everyone having Vata Prakriti have Krura Koshta?
It is not always that the person of Vata Prakruti will have a Krura Koshta. But the inborn tendency will always be there. The intestines have a coded memory of producing hard and difficult bowels.

It depends on the food and lifestyle of the person having Vata Prakriti. If he or she takes food and life activities which have similar qualities to Vata, they will surely aggravate Vata.

The normal tendency of the bowel to be hard will become from severe to worst. Then the Krura Koshta will not be a part of Prakriti, it will be Vikriti (morbidity or a diseased condition, deviation of normal things and functions in an abnormal way).

Other significant points about Krura Koshta –
Krura Koshta will worsen in Varsha Ritu (monsoon season), natural season of aggravation of Vata. Tha Varsha Ritucharya (following the strict diet and lifestyle regime explained in context of Varsha Ritu) shall be strictly followed to overcome this condition and balance Vata.

The Krura Koshta can occur even in Pitta and or Kapha personalities (prakritis). This happens when the Pitta and Kapha constitution people start taking in excess, the foods and activities which cause vitiation of Vata. In them, Krura Koshta is not natural; it is a part of pathology.

If the Krura Koshta appears every now and then in a Vata Prakriti person, then it is natural because of inconsistent nature and behaviour of the Vata. So, even Vata prakriti people have normal bowel movements on many days unless their Vata gets vitiates.

In normal Vata personalities (healthy) the behavior of Koshta is normal on most days with episodes of Krura Koshta every now and then. But if the bowel corrects itself and the Krura Koshta reverses back to normal, it is a natural process.

In Vikrita Vata (vitiated Vata conditions), the condition will be reverse. The number of episodes of Krura Koshta in comparable to samanya koshta (normal gut behaviour) will be more.

The Krura Koshta will be predominant with occasional normal bowel movements. This is a condition of difficulty to the person of Vata constitution. This shows that he or she has been playing constantly with their mother constitution.

They were highly undisciplined and have risked by getting exposed to Vata aggravating foods and activities. In this condition treatment and medicines to relieve Krura Koshta should be administered skilfully.

In dual personalities (dwandwa prakrities) – Vata-Kapha and Vata-Pitta people will have Krura Koshta in comparison to Kapha-Vata and Pitta-Kapha types.

How to maintain a healthy Krura Koshta?
Prevention is better than cure. Vata severely aggravated will worsen the Krura Koshta. When Krura Koshta will get worst, it will no longer be called as Krura Koshta.

In fact the vitiated Vata would have given rise to many diseases including constipation. It needs aneffective management. Therefore managing the Koshta is a key in comparison to treating it.

We cannot change what has been offered to us in the form of Prakriti. Vata predominant persons always have a hidden tendency to develop Krura Koshta, they cannot do much about it.

But they can help selves by managing their Vata by foods and lifestyle antagonistic to Vata, by following seasonal regime in the monsoon (Varsha ritu) season.

Therefore people of Vata constitution should have knowledge about the aggravating and relieving factors of Vata. So balancing their wind factor is the secret of prevention of Krura koshta getting manifested often. They cannot expect to have a happy bowel but they can try to keep it peaceful.

Vata aggravating factors – The Vata constitution people should avoid the below said factors which will aggravate Vata. This will take care of the bowel movements in Vata predominant person and will not allow the Krura Koshta to get worse.

Vyayama – Excessive exercises
Vyavaya – Excessive indulgence in sexual activities
Apatarpana – Fasting in excess
Prapatana – Fall, injury
Bhanga – Fractures
Kshaya – Depletion of tissues
Jaagarat – Excessive vigil (awakening all night)
Veganam cha vidharanat – Suppression of natural body urges (reflexes)
Ati shuchi – Excessive administration of cleansing procedures (Panchakarma)
Shaityadi – Excessive consumption of cold foods and activities
Traasaat – Fear
Ruksha – Excessive consumption of dry foods
Kshobha – Irritation
Kashaya – Excessive consumption of astringent foods
Tikta – Excessive consumption of bitter foods
Katu – Excessive consumption of pungent foods
Vari-ghanagame – cloudy and rainy season
Parinate anne – After the digestion of food
Aparahne – Evening

Tips to combat Vayu:
Sneha – Administration of medicated oils / ghee, Massage, oil pouring etc
Sweda – Steaming / sudation / sweating therapy
Mridu shodanam – Evacuation treatment (mild cleansing treatments like Virechana etc)
Svadu bhojana – Consuming sweet foods
Amla bhojana – consuming sour foods
Lavana bhojana – consuming salt foods
Ushna bhojana – Hot and fresh foods
Abhyangam – Massage with herbal oils
Mardana – Tapping the body with closed fists after application of vata alleviating oils
Seka – Pouring of medicated oils over the body in streams
Paishtika Madhya – Alcohol or fermented products prepared with flours
Goudika Madhya – Alcohol or fermented products prepared with jaggery
Snigdhoshna Vasti – Medicated enemas with oils and ghee, given luke warm
Deepana pachana sneha – Oils and ghee processed with deepana (appetizer) and pachana (digestant) drugs

Mrudu Koshta

Pitta type of Koshta or Mrudu Koshta –
Mrudu Koshta is basically found in:
Pitta predominant constitution (Pitta Prakriti)

The Vata type of persons will have a bowel movement or response called Mridu or Mrudu Koshta. Mrudu means soft or smooth or easy, Koshta means bowel movement. Thus Mrudu Koshta means smooth and easy bowel movements.

By the explanation it is clear that the Vata type of persons will naturally find it difficult to pass the stools. They are born with such a type of gut which evacuates bowel with difficulty

Characteristic features of Mrudu Koshta –
Passing the stools is smooth and easy
Associated with intense or severe digestion pattern (teekshna agni) and appetite
Stools are soft and smooth in consistency with or without loose stools
There is quick evacuation and the person need to spend lot of time in the loo (rest-room or toilet) as in Krura Koshta
Bowel movements will be seen twice or thrice in a day, may be even more
No motivation like coffee, hot water etc is needed to keep the stools moving
Stools will be smooth, watery, yellowish, sometimes unformed due to hurried digestion, shining (due to snigdha guna of pitta)
Occasionally the passage of stools will be associated with burning sensation

Mild laxatives like warm water, ghee, milk, grape juice, sugarcane juice, Avipattikar churna (herbal laxative), Triphala churna (herbal laxative) etc will be sufficient to keep the bowels moving (if there is difficulty)
There is no frequency and urgency to defecate
Tends to aggravate in autumn seasons (sharad ritu), hot climate, hot foods and comforts
Aggravates on taking excessive oily and spicy foods, foods rich in pungent, sour and salty tastes, excessive exposure to sunlight and fire and on consumption of any Pitta aggravating factors. The opposite factors will relieve the symptoms.

Why it happens?
This happens due to the predominance of qualities of Pitta in the people having Pitta constitution (or morbidity), mainly the Snigdha (unctuous or oily or slippery nature), Ushna and Teekshna (hot and deep penetrating qualities which cause bowel movements frequently due to irritation), Sara (tendency to flow) and Drava (liquid nature of Pitta.

The Pitta predominance in Large Intestine which happens to be the Vata place in the body will disable the functions of Vata. Vata will not be able to absorb the fluidity from the stools as it is beyond its capacity.

The roughness and dryness of Vata needed to squeeze off the water and moisture from the stools so as to make it formed and hard is masked by the unctuous and liquidity of Pitta.

Thus the stools often will pass out in watery or semisolid state. The stools will not be formed many times and there will be an urgency to void stools. The frequency of the stools also will be more due to irritant nature of ushna and teekshna gunas of pitta.

The Pitta is made up of Agni and Jala Mahabhutas (i.e. predominance of wind and ether or space elements of nature). The combination usually tends to have more liquidity.

The liquid will be a hot liquid owing to the hot nature of agni component of Pitta. This combination will have a tendency to cause more irritation in the intestines and that is the reason behind frequent defecation and loose stools in Mrudu Koshta.

The fire always has an upper course but when the liquidity of Pitta gets to be more than its fire component, Pitta naturally gravitates (nature of water) downwards and dominates the large intestine which is a Vata site.

Does everyone having Pitta Prakriti have Mridu Koshta?
It is not always that the person of Pitta Prakruti will have a Mrudu Koshta. But the inborn tendency will always be there. The intestines have a coded memory of producing easy and smooth stools and bowel movements.

It depends on the food and lifestyle of the person having Pitta Prakriti. If he or she takes food and life activities which have similar qualities to Pitta, they will surely aggravate Pitta.

The normal tendency of the bowel to be smooth will become smoother and easier, which again may be a disturbance to the patient. Then the Mrudu Koshta will not be a part of Prakriti, it will be Vikriti (morbidity or a diseased condition, deviation of normal things and functions in an abnormal way).

Other significant points about Mridu Koshta –
Mrudu Koshta will worsen in Sharad Ritu (autumn season), natural season of aggravation of Pitta. The Sharad Ritucharya (following the strict diet and lifestyle regime explained in context of Sharad Ritu or autumn) shall be strictly followed to overcome this condition and balance pitta.

The Mrudu Koshta can occur even in Vata and or Kapha personalities (prakritis). This happens when the Vata and Kapha constitution people start taking in excess, the foods and activities which cause vitiation of Pitta. In them, Mrudu Koshta is not natural; it is a part of pathology.

In normal Pitta personalities (healthy) the behaviour of Koshta is normal on most days with episodes of Mrudu Koshta every now and then. But if the bowel corrects itself and the Mrudu Koshta reverses back to normal, it is a natural process.

Tendency to have Mrudu Koshta is natural and normal. Mrudu Koshta being present always denotes pathology. In normalcy, the bowel movements will be easy and smooth always. But loose and unformed stools may be occasional.

In Vikrita Pitta (vitiated Pitta conditions), the condition will be reverse. The number of episodes of loose stools and unformed stools in comparable to samanya koshta (normal gut behaviour of pitta i.e. easy and smooth excretion) will be more.

The Mridu Koshta now will be predominant with occasional normal bowel movements. This is a condition of difficulty to the person of Pitta constitution. This shows that he or she has been playing constantly with their mother constitution.

They were highly undisciplined and have risked by getting exposed to Pitta aggravating foods and activities. In this condition treatment and medicines to relieve Mrudu Koshta should be administered skilfully.

Among dual personalities (dwandwa prakrities) – Vata-pitta people will have tougher excretion (predominance of Vayu) in comparison to Pitta-vata people (pitta predominance). Kapha-pitta and Pitta-Kapha will also have easy to moderate evacuation.

How to maintain the healthy Mrudu Koshta?
Prevention is better than cure. Pitta severely aggravated will worsen the Mrudu Koshta. When Mrudu Koshta will get worst, it will no longer be called as Mrudu Koshta.

In fact the vitiated Pitta would have given rise to many diseases including diarrhoea, dysentery, mal-absorption syndrome etc. It needs an effective management. Therefore managing the Koshta is a key in comparison to treating it.

Pitta predominant persons always have a hidden tendency to develop Mrudu Koshta, they cannot do much about it. But they can help selves by managing their Pitta by foods and lifestyle antagonistic to Pitta, by following seasonal regime in the spring (Vasantha ritu) season.

Therefore people of Vata constitution should have knowledge about the aggravating and relieving factors of Pitta. So balancing their fire factor is the secret of prevention of Mrudu koshta getting manifested often. They cannot expect to have a happy bowel but they can try to keep it peaceful.

Pitta aggravating factors – The Pitta constitution people should avoid the below said factors which will aggravate Pitta. This will take care of the bowel movements in Pitta predominant person and will not allow the Pitta Koshta to get worse.

Katu – Excessive consumption of pungent foods
Amla – Excessive consumption of sour foods
Lavana – Excessive consumption of salty foods
Ushna – Excessive consumption of hot foods
Vidaahi – Excessive consumption of foods which cause burning sensation or corrosive in nature
Teekshna – Intense or deep penetrating, fast acting
Krodha – Anger
Upavasa – Starvation
Atapa – Exposure to sunlight
Stree samparka – Excessive sexual indulgence
Tila – excessive consumption of sesame or its derivatives and food prepared from it
Atasi – Excessive intake of flax seeds
Dadhi – Curds
Sura, Shukta, Aranala – fermented drinks, alcoholic in nature
Bhukte Jeeryate – During digestion
Sharad and Greeshma – Autumn and Summer season
Madhyahna – Afternoon
Ardha Ratri – Middle part of night, midnight

Tips to combat Pitta:
Sarpi Pana – Intake of ghee
Svadu sheeta virechana – Purgation with medicines which have sweet taste and cold potency
Swadu tikta kashaaya, aushadha bhojanaani – Decoctions, medicines and foods which are sweet and bitter in taste
Sugandha – Using fragrant things
Sheeta – cold foods and comforts

Hrudhya – Medicines, foods and activities which are pleasing to the heart
Gandha – Soothing cool anointments over the body, prepared from sandal wood paste
Mani haara – wearing necklaces made up of gems and corals
Lepa – Anointments made with chandana (sandal), ushira (Vetiveria zizanioides), karpura (camphor) repeatedly

Chandrama – exposure to moonlight
Geetam – listening to soothing songs and music
Hima – enjoying in snow, eating ice
Anila – exposure to cool breeze

Sukha mitra putra – Living in the company of compatible friends, kids and family
Daaraa – hugging beloved wife who has been adorned with flowers, decorative, garlands, perfumes and clean wet clothes
Sheetambu dhaaraa garbha – Living in underground rooms which have showering fountains
Udhyaana – Walking in pleasant and lush green gardens
Salilaashaya – Spending time on the banks of lakes and ponds, swimming

Paya – drinking milk
Sarpi – always taking ghee and foods prepared in ghee
Virechana – Regularly undergoing Virechana or therapeutic purgation

Madhyama Koshta

Kapha type of Koshta or Madhyama Koshta –
Madhyama Koshta is basically found in:
Kapha predominant constitution (Kapha Prakriti)
Sama Prakriti or Arogya (Balanced doshas, perfect health)

The Kapha type of persons will have a bowel movement or response called Madhyama Koshta. Madhyama means moderate (neither too hard nor too smooth and soft), Koshta means bowel movement. Thus Madhyama Koshta means moderate bowel movements.

By the explanation it is clear that the Kapha type of persons or those with balanced doshas or those enjoying perfect health will pass the stools with moderate easiness.

They are born with such a type of gut which evacuates bowel easily but not as easily as that in Mridu Koshta and also not as difficult as in persons with Krura Koshta.

Characteristic features of Madhyama Koshta –
Stools get excreted with moderate easiness; the evacuation is neither too easy nor too difficult
Associated with moderate type of digestion (manda agni) and appetite

May be associated with kapha type of indigestion (ama ajeerna) where the food is digested slowly and leads to formation of lot of unformed essence of food called ama which being sticky in nature tends to block the channels of transportation in the body.

Can cause constipation when it is associated with Vata or vitiated Vata and tend to cause hard stools (krura koshta)
The person may not take long time to clear the bowel as in Krura Koshta but might not pass it off with ultimate ease as in Mrudu Koshta.

Formed stools will take moderate time to get evacuated. But it is considered to be easy.
Bowel movements will be seen once or twice in a day

Bowel needs no much motivation like a glass of coffee, hot water etc to keep the stools moving
Stools will be smooth and heavy, but not as soft as in pitta predominant koshta

Mild laxatives like milk, grape juice, sugarcane juice, Avipattikar churna (herbal laxative), Triphala churna (herbal laxative) etc may be helpful to evacuate the Koshta or bowels as in Mridu Koshta (if the movements get troublesome

There is moderate urgency, can tolerate but need not sit for long time to evacuate the bowel
Tends to aggravate in spring seasons (vasantha ritu), cold climate, cold foods and cold comforts

Aggravates on taking excessive oily, cold and heavy to digest foods, foods rich in sweet, sour and salty tastes, excessive rest and day sleep, sedentary life habits, and on consumption of any Kapha aggravating factors, The opposite factors will relieve the symptoms.

Why it happens?
This happens due to the predominance of qualities of Kapha in the people having Kapha constitution (or morbidity), mainly the Snigdha (unctuous or oily or slippery nature), Sheeta (cold), Guru (heavy), Sthira (stable), Pichchila (sticky), Manda (slow) and Shlakshna (smooth) nature of Kapha.

Since Kapha imparts heaviness, oiliness and smoothness to the bowel, it tends to pass of easily. But its slow, stable and sticky nature prevents the stools from getting cleared with accurate easiness as in Mrudu Koshta.

The Kapha predominance in Large Intestine which happens to be the Vata place in the body will disable the functions of Vata. The above said qualities of Kapha being antagonistic to those of Vata will disable Vata from imparting a drying effect on the intestine.

The natural qualities of Kapha will provide the stools its natural consistency, gravity, smoothness and oiliness. Thus the stools of Madhyama Koshta will pass of with moderate ease. The same factors will work in the people having Sama Prakriti or those who are healthy.

The Kapha is made up of Jala and Prithvi Mahabhutas (i.e. predominance of water and earth elements of nature). The combination is usually heavy and facilitates the gravitation. This enables easy movement of stools in Madhyama Koshta.

The Kapha is also termed as bala in its normalcy. Kapha acts as a buffer and antagonizes the degenerative and drying action of Vata and also nullifies the inflammatory and hot nature of Pitta when it has its dominance shown in the body.

Does everyone having Kapha Prakriti have Krura Koshta?
It is not always that the person of Kapha Prakruti will have a Madhyama Koshta. But the inborn tendency will always be there. The intestines have a coded memory of producing moderately easy bowel movements.

It depends on the food and lifestyle of the person having Kapha Prakriti. If he or she takes food and life activities which have similar qualities to Kapha, they will surely aggravate Kapha.

The normal tendency of the bowel to be moderately easy will change its behaviour and gets tough. Then the Madhyama Koshta will not be a part of Prakriti, it will be Vikriti (morbidity or a diseased condition, deviation of normal things and functions in an abnormal way).

Other significant points about Madhyama Koshta (in Kapha predominance) –
Madhyama Koshta or Kapha predominant Koshta will worsen in Vasantha Ritu (spring season), natural season of aggravation of Kapha.

Tha Vasantha Ritucharya (following the strict diet and lifestyle regime explained in context of Vasantha Ritu) shall be strictly followed to overcome this condition and balance Kapha.

The Madhyama Koshta can occur even in Pitta and or Vata personalities (prakritis). This happens when the Pitta and Vata constitution people start taking in excess, the foods and activities which cause vitiation of Kapha. In them, Madhyama Koshta is not natural; it is a part of pathology.

In normal Kapha personalities (healthy) the behaviour of Koshta is normal i.e. moderate clearance on most days unless afflicted or vitiated or associated with other morbid doshas.

If the behaviour of the gut in Madhyama Prakriti shows abnormal changes, it indicates that he or she has been playing constantly with their mother constitution.

Un-skilful management or negligence of the mother constitution (kapha) by getting exposed to causative factors which aggravate Kapha and also taking Tridosha disturbing foods and activities by healthy people will cause change in gut behaviour in Madhyama Prakriti. Unless otherwise, it is said to be a uttama koshta, i.e. well behaved ‘gut response’.

How to maintain the Madhyama Koshta?
Prevention is better than cure. Kapha severely aggravated or when admixed with other doshas, mainly Vata will worsen the Madhyama Koshta and alter the bowel response.

When Madhyama Koshta will get worst, it will no longer be called as Madhyama Koshta. In fact the vitiated Kapha would have given rise to many diseases including constipation. It needs an effective management. Therefore managing the Koshta is a key in comparison to treating it.

Kapha predominant persons always have a hidden tendency to develop Madhyama Koshta, they cannot do much about it, in fact they can feel themselves blessed because it is not a complicated type of bowel movement after all.

They can still help selves by managing their Kapha by foods and lifestyle antagonistic to Kapha, by following seasonal regime in the spring (Vasantha ritu) season.

Therefore people of Kapha constitution should have knowledge about the aggravating and relieving factors of Kapha. So balancing their water factor is the secret of maintaining a healthy Madhyama Koshta.

The people with Madhyama Koshta should also check with the balances and imbalances between Kapha with Vata and Pitta. This is important because, if Vata and Pitta become predominant, they will dominate the Kapha. This will change the configuration of the Koshta. So Tridosha balance is the key in Madhyama Koshta.

Kapha aggravating factors – The Kapha constitution people should avoid the below said factors which will aggravate Kapha.

This will take care of the bowel movements in Kapha predominant person and will not allow the Madhyama Koshta to get worse.

Guru Ahara – Taking in excess the foods which are heavy and hard to digest
Madhura – Excessive consumption of sweet foods
Ati snigdha – Excessive consumption of oily foods or fat rich foods
Dugdheshu – Excessive consumption of milk and its derivatives
Bhakshya – High caloric foods
Drava – Excessive consumption of liquid foods or water
Divaswapna – Day sleep in excess
Sarpi – Excessive consumption of ghee
Vasanta – Spring season
Divasaadau – Early in the morning
Bhukta matre – Immediately after food
Avyayama – Deficit exercises

Tips to combat Kapha:
Teekshna Vamana – Strong emesis
Rechanam – Strong purgation
Ruksha ahara – Dry foods
Alpa Ahara – Limited food consumption

Teekshna ushna ahara – hot and intense foods
Katu tikta kashayakam – Foods which are predominant in pungent, bitter and astringent tastes

Deergha kala sthitam madhyam – alcoholic preparations which have been fermented for a long period
Rati preeti – Sexual activities
Prajaagara – Awakening late nights
Aneka vyaayama – various types of physical exercises
Chinta – mental strain
Ruksha vimardana – Dry massages

Yusha – lighter gruels and soups
Kshaudra – honey
Medaghna aushadham – fat depleting medicines

Dhuma – Smoking (medicated)
Upavasa – starvation, fasting
Gandusha – gargles
Nisukhatwam – Keeping away from comforts

The Koshtas of other Prakritis (dwandwa or dual constitutions) will have a mixture of qualities of those 2 doshas involved in duality.

Therefore, the 3 dwandwa personalities will have unpredictable bowel movements (koshta) with the predominant dosha showing its symptoms most of the time keeping the other dosha recessive.

Just before Finish –
The bowel movement is an important part of detoxification process taking place in the body. If the intestines fail to clear off the stools in right time in right quantity, the left out wastes and tissue toxins will cause many diseases which will be stubborn and difficult to handle.
The knowledge of Koshta, knowing its types and behavior will help in treating any mischievous activities taking place in the intestine promptly.
This will also help us to keep our Koshta sterile and healthy, which in turn is very essential to keep the body-mind health in good balance.
Because to have a healthy interior, we need to keep that part of our home clean and tidy. Healthy Koshta is the key for a perfect health.
Click to Consult Dr Raghuram Y.S. MD (Ayu) Email: drraghuramys@gmail.com