14. DVIVIDHOPAKRAMANIYA / द्विविधोपक्रमणीय - two kinds of therapy

14. DVIVIDHOPAKRAMANIYA / द्विविधोपक्रमणीय - two kinds of therapy


Dvividha Upakarma- two kinds of therapy :-

उपक्रम्यस्य हि द्वित्वाद् द्विधैषोपक्रमो मतः
एकः संतर्पणस्तत्र द्वितीयाश्चापतर्पणाः
बृंहणो लङ्घनश्चेति तत्पर्यायावुदाहृतौ
बृंहणं यद्बृहत्वाय लङ्घनं लाघवाय यत्
देहस्य

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).

भवतः प्रायो भौमापमितरञ्च ते

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).


स्नेहनं रूक्षणं कर्म स्वेदनं स्तम्भनं च यत्
भूतानां तदपि द्वैध्याद्द्वितयं नातिवर्तते

Functions such as

a)               Snehana (oleation/ lubrication) and

b)               Rukshana – (imparting dryness),

c)                Swedana- (sweating therapy, sudation, diaphoresis),

d)               Sthambhana- (withholding, obstructing)


·    are also of these two kinds- Brihmana and Langhana.

a)                Snehana and Sthambhana can be categorized as Brihmana and

b)                Rukshana and Swedana can be categorized as Langhana

Thus all functions are not apart from two .


LANGHANA THERAPY – to make the body light / thin
imparts lightness to the body. It makes the body thin and light.

शोधनं शमनं चेति द्विधा तत्रापि लङ्घनं

It is of two types.

a)               Shodhana – Purification procedures (Panchakarma) and

b)               Shamana- palliative treatment.


SHODHANA – PURIFICATION PROCEDURES (PANCHAKARMA)

यदीरयेद्बहिर्दोषान् पञ्चधा शोधनं च यत्
निरूहो वमनं कायशिरोरेको अस्रविस्रुतिः

·    Shodhana treatment expels imbalanced Doshas out of the body forcibly.

     It is of five kinds, viz

1.   Niruha- decoction enema,

2. Vamana- emesis, vomiting therapy

3. Kaya reka- Virechana – purgation for the body

4. Shiro reka – Shiro Virechana – nasya – purgation for the head, nasal instillation of medicines.

5. Asra-visruti – Raktamokshana – blood letting .


SHAMANA – PALLIATIVE TREATMENT

न शोधयति यद्देषान् समानोदीरयत्यापि
समीकरोति विषमान् शमनं तच्च सप्तधा
पाचनं दीपनं क्षुत्तृड्व्यायामातपमारुताः
     
·    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 to normalcy.



Shamana 7 types –

1. Pachana – digestive, carminatives,
2. Deepana – hunger producing, stomachic,
3. Kshut – withstanding hunger, avoidance of food, fasting
4. Trut –  withstanding thirst/avoidance of water drinking, avoiding liquid food intake
5. Vyayama- physical activity,
6. Aatapa- exposure to sunlight and
7. Maruta- exposure of breeze.



बृंहणं शमनं त्वेव वायोः पित्तानिलस्य च


Brimhana- stoutening therapy also is Shamana only

·      because it alleviates/ mitigates both Vata and Vata Pitta- combination .



BRIMHANEEYA -PERSONS REQUIRING STOUTENING THERAPY  -

बृंहयेद्व्याधिभैषज्यमध्यस्त्रीशोककर्शितान्
भारोध्वारः क्षतक्षीणरूक्षदुर्बलवातलान्
गर्भिणीसूतिकाबालवृद्धान्ग्रीष्मेअपरानपि
मांसक्षीरसितासर्पिर्मधुरस्निग्धबस्तिभिः
स्वप्नशय्यासुखाभ्यङ्गस्नाननिर्वृतिहर्षणैः

Brimhana- stoutening therapy should be given to persons who are

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



Method of Brihmana - 

a)      by the use of meat, milk, sugar, ghee,
b)      enema  prepared sweet substances and fats(oil, ghee), 
c)       sleep,
d)      comfortable bed,
e)       oil- massage,
f)       bath,
g)      comforts,
h)      rest and
i)        happiness of the mind.



LANGHANEEYA –PERSONS REQUIRING THINNING THERAPY –

मेहामदोषअतिस्निग्धज्वर उरुस्तम्भकुष्ठिनः
विसर्पविद्रधिप्लीहशिरकण्ठाक्षिरोगिणः
स्थूलांश्च लङ्घयेन्नित्यं शिशिरे तु अपरानपि

Langhana- thinning, slimming therapy  should be done to

1.         Meha – diabetics
2.       Amadosha – persons suffering  from Ama
3.      Atisnigdha –who has undergone excess oleation treatment
4.      Jvara – fever
5.      Urustambha – stiffness of the thighs,
6.       Kushta – skin diseases
7.      Visarpa – herpes,
8.        Vidhradi – abscess,
9.       Pleeha – diseases of spleen,
10.    Shira, Kanta Akshi roga – head, throat, and eyes;
11.      Sthula – Those are obese
12.    Even to others during Shishira – winter, Langhana treatment should be done.



INDICATION FOR LANGHANA THERAPY BY MEANS OF SHODHANA (PANCHAKARMA) –

तत्र संशोधनैः स्थौल्यबलपित्तकफाधिकान्
आमदोषज्वरच्छर्द्दिरतीसारहृदामयैः
विबन्धगौरवोद्गारहृल्लासादिभिरातुरान्
मध्यस्थौल्यादिकान् प्रायः पूर्वं पाचनदीपनैः
एभिरेवामयैरार्तान् हीनस्थौल्यबलादिकान्
क्षुत्तृष्णानिग्रहैर्दोषैस्त्वार्तान् मध्यबलैर्दृढान्
समीरणातपायासैः किमुताल्पबलैर्नरान्

Patients with these diseases should be given Panchakarma treatment as the means for Langhana therapy. -  

a)      Those who are very obese,
b)      strong and
c)       having predominance of Pitta and Kapha,
d)      those suffering  from Amadosha,
e)       fever,
f)       vomiting,
g)      Diarrhoea ,
h)      heart diseases,
i)        constipation,
j)       feeling of heaviness,
k)     excess of belching,
l)        nausea, etc.




Indication for Deepana, Pachana and then Shodhana (Panchakarma) -

1.   Those who are moderately obese,
2. medium in strength of the body and

3. also of the diseases mentioned,

·      first by administration of digestives and hunger producing substances generally,

·      later with other purification therapies;



Indication for Shamana type of Langhana –

1.   Those who are troubled by increased Doshas,
2. who are of medium strength,
3. with medium strength disease,
4. who are capable of withstanding strain by the control of hunger and thirst;
5. those again of poor strength- of the body
6. and of disease by exposing them to breeze, sunlight and exercise.


न बृंहयेत् लङ्घनीयान् बृंहयांस्तु मृदु लङ्घयेत्
युक्त्या वा देशकालादिबलतस्तान् उपाचरेत्

a)               Those who are to be given Langhana- thinning therapy, should not be given Brimhana-stoutening;

b)               those who are to be given Brimhana should be given mild Langhana,

c)                or both Langhana and Brimhana together, simultaneously may be given depending upon the nature of habitat, season, strength etc.



बृंहण लाभ – चिकित्सा फल / BENEFITS OF BRUHMANA THERAPY –

बृंहिते स्याद्बलं पुष्टिस्तत् साध्यामयसक्षयः

Brimhana therapy makes for
1.   strength,
2. nourishment of the body,
3. and cure of such diseases which are curable by that therapy.



लङ्घन लाभ / BENEFITS OF LANGHANA THERAPY

विमलेन्द्रियता सर्गोमलानां लाघवं रुचिः
क्षुत्तृट्सहोदयः शुद्धहृदयोद्गारकण्ठता
व्याधिमार्दवमुत्साहस्तन्द्रानाशश्च लङ्घिते

1.   Keenness and clarity of sense organs,
2. Expulsion of Malas- Doshas and wastes,
3. Feeling of lightness of the body,
4. Good taste perception,
5. Appearance of hunger and thirst together,
6.  Feeling of purity in the chest region (heart),
7. Clear belching and
8.  clear throat,
9.  softening of the diseases- decreased severity,
10. increase of enthusiasm and
11.loss of stupor- laziness



अनपेक्षितमात्रादिसेविते कुरुतस्तु ते
अतिस्थौल्यादिकार्ष्यादीन्, वक्ष्यन्ते ते च सौषधाः



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.

रूपं तैरेव च ज्ञेयमातिबृंहितलङ्घिते



ATI BRIMHANA- EXCESS OF STOUTENING THERAPY :-

अतिस्थौल्यापचीमेहज्वरोदरभगन्दरान्
काससन्न्यासकृच्छ्रामकुष्ठादीनतिदारुणान्

Excess of Brimhana therapy produces

1.         Atisthaulya – profound obesity
2.       Apachi – scrofula,
3.      Meha – Diabetes, UTI
4.      Jvara – fever
5.      Udara – enlargement of abdomen,
6.       Bhagandara – fistula-in-ano,
7.      Kasa – cough,
8.        Sanyasa – loss of consciousness,
9.       Mutrakruchra – Dysuria,
10.    Ama- disorders of poor digestive activities,
11.      Kushta -skin diseases which are very dreadful.


TREATMENT FOR OVER NOURISHING -

तत्र मेदोनिलश्लेष्मनाशनं सर्वमिष्यते
कुलात्थजूर्णश्यामाकयवमुद्गमधूदकम्
मस्तुदण्डाहतारिष्टचिन्ताशोधनजागरम्
मधुना त्रिफलां लिह्याद्गुडूचीमभयां घनम्
रसाञ्जनस्य महतः पञ्चमूलस्य गुग्गुलोः
शिलाजतु]प्रयोगश्च साग्निमन्थरसो हितः
विडङ्गं नागरं क्षारः काललोहरजो मधु
यवामलक चूर्णं च योगो अतिस्थौल्यदोशजित्


1. Treatments which reduce
·      Medas- fat,
·      Anila- Vata and Kapha are desirable;

2.Use of
a)      Kulattha – horse gram – Dolichos Biflorus,
b)      Jurna,
c)       Shyamaka,
d)      Yava – Barley – Hordeum Vulgare,
e)       Mudga – green gram – Averrhoa Carambola,
f)       and Honey water;
g)      Indulgence in worry,
h)      stressful activities
i)        Purification therapies,
j)       avoidance of sleep,
k)     either
·                   Triphala,
·                   Guduci,
·                   Abhaya –(Chebulic Myrobalan fruit rind – Terminalia chebula)
·                   and Musta (Cyperus rotundus), should be licked with honey daily;

l)   Either

·      Rasanjana (Aqueous extract of Berberis aristata),
·      Brihat Pancamula (Agnimantha, Shyonaka, Gambhari, Patala, Bilva),
·      Guggulu – along with the fresh juice of Agnimnatha is suitable;


m)    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.



व्योषकटवीवराशिग्रुविडङ्गातिविषास्थिराः
हिङ्गुसौवर्चलाजाजीयवानीधान्यचित्रकाः
निशी बृहत्यौ हपुषा पाठामूलं च केम्बुकात्
एषां चूर्णं मधु घृतं तैलं च सदशांशकम्
सक्तुभिः षोडशगुणैर्युक्तं पीतं निहन्ति तत्
अतिस्थौल्यादिकान् सर्वान्रोगानन्यांश्च तद्विधान्
हृद्रोगकामलाश्वित्रश्वासकासगलग्रहान्
बुद्धिमेधास्मृतिकरं सन्नस्याग्नेश्च दीपनम्

1.               Powder of Vyosha- (Trikatu – pepper, long pepper and ginger),
2.             Katvi,
3.             Vara (Triphala),
4.             Shigru (drum stick),
5.             Vidanga (False black pepper – Embelia ribes),
6.              Ativisha,
7.             Sthira (Desmodium gangeticum),
8.              Hingu – (Asa foetida),
9.             Sauvarcala,
10.           Ajaji – (Cuminum cyminum),
11.            Yavani – (Trachyspermum ammi),
12.          Dhanya,
13.          Chitraka,
14.          the two Nisa (turmeric and tree turmeric),
15.          the two Brihati(brihati and kantakari),
16.           Hapusa,
17.          root of Patha (Cyclea peltata)
18.           and of Kebuka,


·      should be mixed with honey, ghee and oil in equal proportion and sixteen parts of saktu (corn flour), this mixture taken as a drink daily

·      cures severe obesity and all other diseases- mentioned earlier

·      and even others of similar nature such as

a)         heart diseases,
b)         Jaundice,
c)          Leucoderma,
d)          Dyspnoea,
e)          cough,
f)          obstruction in the throat- hoarseness of  voice etc.
g)          improves powder of thinking,
h)         intelligence,
i)            memory and
j)          kindles the weakened fire- digestive activity.



ATILANGHANA- EXCESS OF THINNING THERAPY:-

अतिकार्श्ये भ्रमः कासस्तृष्णाधिक्यमरोचकः
स्नेहाग्निनिद्रादृक्श्रोत्रशुक्रौजः क्षुत्स्वरक्षयः
बस्तिहृन्मूर्धजङ्घोरूत्रिकपार्श्वरुजा ज्वरः
प्रलापोर्ध्वानिलग्लानिच्छर्द्दिपर्वास्थिभेदनम्
वर्चोमूत्रग्रहाध्याश्च जायन्ते अतिविलङ्घनात्

1.         Profound emaciation,
2.       Bhrama – Delusion, Dizziness,
3.      Kasa – cough,
4.      Trushna – severe thirst,
5.      Aruchi – anorexia,
6.       loss / decrease of moistness,
7.      and digestive power,
8.        of sleep,
9.       vision,
10.    hearing,
11.      semen,
12.    Ojas,
13.    hunger
14.    and voice;
15.    Pain in the urinary bladder, heart, head, calves, thighs, upper shoulders and flanks;
16.    fever,
17.    delirium- excess of talk,
18.     belching,
19.    exhaustion,
20.  vomiting,
21.    cutting pain in the joints and bones;
22.  non-elimination of faeces, urine etc., arise from excess of Langhana



कार्ष्यमेव वरं स्थौल्यात् न हि स्थूलस्य भेषजम्
 बृंहणं लङ्घनं वाऽलम्तिमेदोग्निवातजित्

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.


मधुर स्निग्ध साहित्यैर्यत्सौख्येन च नश्यति
क्रशिमा स्थविमाअत्यन्त विपरीत निषेवणैः
योजयेत्बृंहणं तत्र सर्वं पानान्नभेषजम्

Emaciation gets cured by use

a)               of sweet and unctous- fatty foods and
b)                comfortable living,



where as obesity gets cured by the use of

a)               The foods etc, of the opposites- qualities to the above that too when used in maximum quantity.

b)               There, liquids, foods and drugs which are Brimhana should be adopted


अचिन्त्या हर्षणेन ध्रुवं संतर्पणेन च
स्वप्नप्रसङ्गाच कृशोवराह इव पुष्यति

The emaciated person becomes stout like a boar
·    by absence of worry,
·    by happiness,
·    more use of nutritious food
·    and more of sleep.


नहि मांससमं किञ्चिदन्यदेहबृहत्त्वकृत्
मांसादमांसं मांसेन सम्भृतत्वात् विशेषतः

There is nothing other than meat to stouten the body, especially so the meat of carnivorous animals, for they feed on meat itself.



गुरु चातर्पणं स्थूले विपरीतं हितं कृशो
यवगोधूममुभयोस्तध्योग्याहितकल्पनम्


1.    Foods which are heavy and non- nutrition are ideal for the obese
2.                whereas the opposites- are ideal for the emaciated;
3.                Yava – Barley – Hordeum vulgare- barley is heavy and non nutritious, ideal for obese and
4.                Godhuma- wheat is light to digest and nutritious, Hence good for emaciated.
5.                Yava and godhuma are good for both when prepared in a way as suitable to either



दोषगत्या अतिरिच्यन्ते ग्राहिमेध्यादिभेदतः
उपक्रमा न ते द्वित्वाद्भिन्ना अपि गदा इव



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)