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Monday, July 1, 2013

Ayurveda the divine science of life -4



























































Ayurveda the divine science of life





PART 1
Chapter 4
THE PHYSICAL BODY


4.1 Agni: THE FIRE OF DIGESTION
AND METABOLISM

Agni is the fire within each of us that attends to digestion
and metabolism, and in its higher form, represents
vitality, perception and discrimination. It is characterised
by the qualities of us.n.
a (‘hot’), tiks.n.
a (‘sharp’)
and laghu (‘light’), and in many ways resembles pitta.
It is incorrect, however, to assume that they are one and
the same. Agni is the pure and cleansing fire of the
body, whereas pitta, as a dos.a, ultimately represents
the qualities of agni in a disturbed state.
Agni is located in the aa칢큑ya (‘stomach and small
intestine’) as the jat.harani. Here the jat.harani
attends to separating the food into its subtle essence
(sus.
ma rasa, which feeds the mind), its gross nutrient
portion (rasa, which feeds the body) and waste (kit.t.
a,
further separated into purı.a and mura, or faeces and
urine, respectively). Beyond its role as the jat.harani,
there are several different manifestations of agni in the
body, each having a different name that relates to distinct
metabolic processes. From the activity of post-synaptic
enzymes that break down neurotransmitters, to ATP
generation in the mitochondria, all metabolic processes
are subsets of the jat.harani of the aa칢큑ya. Hence,
when digestion is weak, metabolic activity suffers,
energy levels diminish and waste products begin to accumulate
in the body.
The negative effects of each dos.a results in a specific
disturbance of jat.harani:
In vatika conditions the jat.harani is
vis.amani, digestion that is erratic and irregular.
In paittika conditions the jat.harani is
tiks.n.
ani, extremely intense, with a burning sensation
and thirst.
OBJECTIVES
To understand the concept of digestion.
To understand the concept of tissue
development and metabolism.
To understand the concept of vitality.
To understand the concept of wastes and
toxins.
To understand the flow of energy, nutrients
and tissues elements in the bioenergetic
channels of the body.
36 PART 1: Theory and practice of A-yurveda
In kaphaja conditions the jat.harani is
man˜dani (also called agnimadya), characterised
by sluggishness, with heaviness of the
abdomen and lassitude.
In the absence of dos.a increase or vitiation, the
jat.harani is samyani: correct, proper and normal.
Agni interacts with three different kinds of alimentary
tract (kos.t.
ha), influenced by the predominance of
a particular dos.a during gestation. Vaa is responsible
for a krua or hard bowel, producing dry, rough faeces
that are difficult to evacuate. Pitta is responsible for a
mr.du or soft bowel, producing semi-solid or liquid faeces.
Kapha is responsible for a madhya or medium
bowel, which generally produces bowel movements that
are neither too hard nor too soft. The nature of the
bowel can be tested by introducing certain foods, such
as ghr.ta, jaggery, milk or hot water. If these substances
have a laxative effect, the bowel is stated to be mr.du; if
they have a mild laxative effect, the bowel is stated to be
madhya; if they have no laxative effect, the bowel is
stated to be krua.
It is important to remember that A¯ yurveda considers
the partaking of food to be a yaa, or ‘sacrifice’. In
the Hindu tradition, and in most spiritual traditions
across the world, prayers are usually offered in the
form of a sacrificial fire. A candle is lit, incense is
burned, or certain herbs or foods are placed on a fire,
and as these substances burn they release their smoky
fragrance up to heaven, acting as a kind of vehicle for
our prayers, hopes and dreams. Agni represents this
sacrificial fire within us, and when we consume food
our digestion becomes a spiritual catalyst. The act of
eating therefore is a kind of spiritual ritual, where
proper digestion depends upon eating in a conscious
and mindful fashion. Thus meal times for the most part
should be quiet, without distractions such as talking,
television and books, with proper attention paid to eating
slowly and chewing the food.
Besides the jat.harani there are two additional
kinds of agni or, rather, subsets of the jat.harani,
that attend to the body’s various metabolic activities:
1. Bhuanis: the types of agni which are
responsible for the assimilation and metabolism of
the five mahahuas. Each of the bhuanis
(i.e. pathiva, aya, aneya, vaavya and
aaıya) works on its respective elemental
component (vis. pr.thvı¯, ap, tejas, vau and
aa칢큑) that form corporeality.
2. Dhavanis: dhau-specific agnis which attend
to the particular function of each dhau or
support system (discussed in the next section).
4.2 Sapta dhaus: THE SEVEN
SUPPORTS
As the tridos.a theory is used to explain the principle
of function in the human body, the sapta dhaus, or
‘seven supports’, is used to describe the principle of
structure. The sapta dhaus model is another aid for
the practitioner to discover the specific actions of tridos.
a and understand their function within a structural
model. Just as anatomy cannot be seriously
studied without an understanding of physiology, any
study of the dhaus must take tridos.a into account.
The seven dhaus and their most commonly translated
definitions follow:
1. Rasa: plasma
2. Rakta: blood
3. Ma. sa: muscle
4. Medas: fat
5. Asthi: bone
6. Majja¯: marrow
7. Skra (men), atava (women):
semen, menstrual blood.
The sapta dhaus is a model that describes the
basic principles of structure, and does not literally represent
the specific activities of their respective translated
terms. For example, rakta does not represent the
‘blood’ inasmuch as it represents the ‘blood essence’.
All tissues and organs in the body arise from the combined
effects of vaa, pitta and kapha and are composed
of all seven dhaus in varying proportions. Thus
the blood will contain all the dhaus, but arises principally
from rakta. It would be difficult to develop a general
principle from an in-depth scientific analysis of
blood because it has a multitude of functions and
aspects. The term rakta is used to describe the essential
nature of the ‘blood’, to understand its overall
function within the human body. The following are
descriptions of each of the dhaus:
Rasa dha?tu
When food is consumed it undergoes preliminary
digestion in the aa칢큑ya under the influence of the
The physical body 37
jat.harani, separated into kit.t.
a (‘waste’), aaa
rasa (‘gross nutrient’) and sus.
ma rasa (‘subtle
nutrient’). A?haa rasa is that which enters into and
nourishes the entire dhau system, and is converted
into the first dhau, i.e. rasa dhau, under the influence
of a dhau-specific subset of the jat.harani
called the dhavani.
Rasa literally means ‘taste’, and in this sense, rasa
dhau is the essential nutrient quality of the food consumed.
As it is created, rasa is directed to the hr.daya
(‘heart’) where it undergoes distribution throughout
the body by the actions of vyaa vau. Rasa is
responsible for the nourishment of all the tissues of
the body, circulating as a fluid that bathes the cells
with vitality. One can think of rasa as the internal
manifestation of the primordial ocean from which all
life arose, as the amniotic and interstitial fluid that
supports growth and maintains proper development.
A secondary manifestation of rasa are endometrial
fluids that support gestation and breast milk (stanya).
Rasa dhau displays a strong resemblance to the
qualities of kapha, and in mental terms relates to
feelings of purity, compassion and happiness. When
functioning optimally rasa is an important component
of vitality. If food is consumed that ‘increases’
(caya, vr.ddhi) kapha, however, or if the jat.harani
is impaired, rasa dhau will become vitiated and display
the symptoms of kapha increase such as an
increase of phlegm and catarrh. The symptoms of
decreased (kas큑칪a) rasa dhau are dryness, fatigue,
emaciation, impotency, infertility and an increased
sensitivity to sonic vibrations, all of which correspond
to an increase of vaa.
Rakta dhau
Rasa dhau is then converted by the dhavani into
rakta dhau, which is the ‘blood essence’. Its primary
function, along with rasa, is the maintenance and
nutrition of all bodily tissues, and is more closely associated
with pitta. Rakta dhau gives rise to the
haematopoietic system, including the liver and spleen,
and connective tissue generally through its transformation
into ma. sa dhau. More than any other of
the dhaus, rakta (blood) is an organ unto itself, and
represents a phase of physiological function before it
solidifies into specific tissues. As a result rakta is
sometimes seen to function as a fourth dos.a and when
vitiated produces diseases that are particular to it. In
health rakta dhau provides for a clear complexion
and a deep passion for all living things.
Rakta dhau is thought to generate the skin, seven
separate and distinct layers (i.e. avabhaini, lohita,
seta, tara, vedini, rohin. i, masadhara), in
much the same way as cooking milk generates a layer
of scum. Thus, skin disorders are seen as a manifestation
of impurities within the blood. An increase in
rakta dhau, either inherited from a vitiated rasa
dhau or by direct influence, can manifest as skin diseases,
hepatomegaly, splenomegaly, hepatitis, jaundice,
abscess with infection and inflammation,
arthritis, gout, haemorrhages of the mouth, nose or
anus (i.e. rakta pitta), and a reddish discoloration of
the eyes, skin and urine. A decrease of rakta dhau,
transferred by a deficiency of rasa dhau or other factors,
manifests as a desire for sour and warming foods,
anaemia, hypotension, dryness of the body, and a
weak pulse.
Ma
˙
sa dhau
Rakta dhau is then converted into ma. sa dhau by
the dhavani, which gives rise to all connective tissues
excluding blood and bone. Ma. sa means ‘flesh’
and is responsible for enveloping and covering the
bones, including tissues such as the muscles, tendons,
ligaments, arteries, veins, lymphatic tissue and certain
types of endocrine gland. In health ma. sa dhau
provides for a strong musculature and physical
endurance, and contributes to feelings of charisma
and courageousness. An increase in ma. sa dhau
can manifest as lymphadenitis, lymphadenopathy,
goitre, malignant tumours, fibroids, abscesses and
a general increase in body weight and musculature.
A decrease in ma
˙
sa dhau is understood by signs
and symptoms such as emaciation, fatigue, a lack of
coordination, and muscular atrophy.
Medas dhau
Ma. sa dhau is converted into medas dhau by the
dhavani, and can be thought of as the principle
of ‘fat’ tissue. The primary function of medas in
the body is the protection of delicate organs (e.g. the
kidneys) and tissues (e.g. the myelin that surrounds
neurons), as well as lubrication and the storage
of energy. In health medas dhau provides for a melodious
voice, a sense of joyfulness and a playful,
38 PART 1: Theory and practice of A-yurveda
humorous nature. An increase in medas dhau
may manifest as fatigue, shortness of breath, and sagging
of breasts, buttocks and abdomen. A decrease in
medas dhau may manifest as nervous irritability,
weak eyesight, dryness, joint weakness and emaciation.
Asthi dhau
Asthi dhau is the conversion of medas by the
dhavani, and is the principle of all ‘bone’ tissue in
the body. The primary function of asthi is the physical
structure and shape of the body. In health asthi dhau
provides for a flexible nature, self-assurance, confidence,
mental stability and a hard-working nature. An
increase in asthi dhau can manifest as the overgrowth
of bone tissue such as bone spurs, bone cancer
and metabolic diseases such as gigantism and
acromegaly. A decrease of asthi dhau can manifest
as osteoporosis, brittle bones, splitting or cracking finger
nails, alopecia and tooth decay.
Majja?dhau
Majja?dhau is the transformation of asthi by the
dhavani, and is the principle of ‘marrow,’ or that
which ‘fills the bones’. Majja?is considered to generate
the nervous system in the sense that it ‘fills’ the spinal
column and cranium. Thus majja?can be thought of
as the neural pathways along which electrical
impulses flow, but should not be confused with the
impulses themselves, which are governed by vaa. In
health majja?dhau provides for a sensitive and receptive
mind, a good memory and a compassionate
nature. An increase of majja?usually manifests in
kapha conditions, such as heaviness, lassitude, hypertrophy,
and swelling of joints, and can manifest as
obstinate ulcerous conditions. A decrease of majja¯
may manifest as a sensation of weakness or lightness
in the bones, joint pain, rheumatism, giddiness and
blindness.
ukra/Atava dhau
Majja?is converted by the dhavani into the final
dhau of skra in men, and atava in women. ukra
is responsible for the generation of semen within
a male, while atava is the menstrual blood that usually
indicates ovulation. Technically speaking the menstrual
blood is not a dhau but a kind of eliminatory
product that indicates the health of the numerous
an.d.
a.u or ‘ova’ contained in the ovaries. In health
skra and atava dhaus provide for self-love, attractiveness
and indicate the vitality of the person. In men,
an increase of skra can result in insatiable sexual
urges, seminal calculi, odorous perspiration, greasy
skin, greasy hair and acne. A decrease of skra may
result in impotency, premature ejaculation, prostatitis
and urethritis. In women, a metabolic increase of
atava (i.e. an.d.
a.u) can result in excessive sexual
desire, a consistently short oestrus cycle, odorous perspiration,
greasy skin, greasy hair and acne.
A decrease of atava (i.e. an.d.
a.u) can result in frigidity,
amenorrhoea, infertility, leucorrhoea, dysmenorrhoea,
and menstrual blood that is pellet-like and
malodorous. ukra and atava also generate the ojas,
the final refinement of aaa rasa by the body, which
is discussed in the next section.
Dhau transformation
Besides the process of dhau transformation alluded to
earlier, there are two other ways by which aaa rasa
circulates within the dhaus. While the process of
dhau transformation previously described is much like
the process by which cow’s milk is transformed into
dadhi (curd), which is then churned into butter and
buttermilk, and then the butter finally made into ghr.ta
(clarified butter), the other two processes are somewhat
different. The first analogy of cow’s milk being transformed
into ghr.ta describes how an imbalance within
aaa rasa can affect each dhau in succession,
because the nature of what is being transformed is
passed on through to the next dhau. The obvious deficiency
of this analogy, however, is that it does not
describe how metabolic wastes (kit.t.
a) are eliminated
from the dhaus. The second analogy is that the
dhaus are nourished as if aaa rasa is scattered on
the ground as differing kinds of seed, with each dhau
as a different kind of bird that feeds on these seeds,
selecting the ones most appropriate for its nourishment:
what the birds leave behind is kit.t.
a. This second
analogy describes how an imbalance within aaa
rasa can affect one dhau but not another, because it is
a process of selectivity. The third method by which the
dhaus are nourished is like the irrigation of a paddy
(rice) field, with each paddy being irrigated by specific
channels that draw water from the same main channel
The physical body 39
that carries aaa rasa. This last analogy very much
resembles the physiology of blood flow, from arteries to
capillaries to the interstitium and then to the veins.
Although these three models of dhau metabolism
may seem contradictory, all three processes of transformation
(ks.ıadadhi), selectivity (khalekapota)
and irrigation (kedaikulya¯) describe the complexity
of dhau metabolism, and occur simultaneously. In the
case of ks.ıadadhi (transformation), it is stated that
after the food is digested it is present in the body as rasa
for about 5 days, and then for 5 days for each successive
dhatu until skra and atava are formed. From
this, ojas is directly nourished.
4.3 Ojas: THE VITAL ESSENCE
Ojas is the vital essence of the body, a subtle force that
incessantly works to keep the body, mind and senses
continuously refreshed. A¯ yurveda describes two types
of ojas: para ojas and apara ojas:
Para ojas: also called the as. t.a?bindu (‘eight
drops’), located in the heart, representing the tejas
of vitality and remaining constant in the body until
death. Thus, para ojas is jiva, the life force that
separates the animate from the inanimate.
Apara ojas: also called ardhanjali (‘one handful’),
found in a continual state of flux, derived
directly from the dhaus, circulating throughout
the body in the maintenance of health. In this text
all subsequent references to the term ‘ojas’ refer to
apara ojas.
Just as pra.a represents the unblemished functions
of vaa, and agni represents pitta in an undisturbed
state, ojas most closely resembles kapha. Thus, those
with a kapha prakr.ti typically display an abundance
of ojas, providing for all the beneficial attributes of this
prakr.ti such as longevity, forbearance, generosity and
strength. According to the ancient Vedic agnı.omıiya
principle, ojas (soma) is the feminine counterpart to
the masculine agni, representing ‘lunar’ characteristics
such as the ability to nurture, support, shelter and
pacify. In contrast, agni represents solar, masculine
characteristics such as the ability to consume, destroy,
expose and invigorate.
As described earlier, ojas is the refinement of
skra and atava, the final essence of the dhaus.
The process of dhau transformation is dependent
rasa
rasa
agni
ahara
rasa
ojas
ojas rakta
rakta
sukra/
artava
sukra/
artava
majja majja mamsa mamsa
medas
medas
asthi
asthi
Figure 4.1 Transformation (black arrows),
selectivity (birds) and irrigation (paddy fields) in
dhau metabolism.
40 PART 1: Theory and practice of A-yurveda
upon the health of the individual dhaus, the channels
(srota. si) that carry them throughout the body
(see 4.6 Srota?m. si: the channels of the body), and
most importantly, the entire spectrum of agni, from
the processes of gastric digestion to the progressively
subtle and discriminative efforts of tissue metabolism.
Through the activities of agni, ojas accumulates, supporting
and nourishing the whole body, refreshing the
senses and empowering the heart. Just as ojas is
dependent upon agni, however, so does ojas sacrifice
itself to nourish agni. Ojas ‘gives’ itself to agni, providing
the digestive tract and all subsequent tissues of
the body the energy needed for proper function. Thus,
ojas both feeds on and is fed to the dhaus.
The principle function of any kind of therapy in
yurvedic medicine is based upon understanding the
dynamics of the dhau cycle in individual patients. It
explains why after any kind of sdhana (‘purificatory’)
therapy in which the dhaus are purified a corresponding
rasaana (‘rejuvenative’) treatment is
begun to rebuild the status of ojas. This nourishment
of ojas in turn nourishes agni and the dhaus, and as
a result provides for good health and longevity.
The status of ojas can be assessed by the lustre of
the eyes, the strength of limbs, and the function of the
mind and senses. The greatest concentration of ojas is
found in the reproductive tissue, which is to say, the
needs of reproductive function are served first in
a hierarchical fashion among the various physiological
systems. In normalcy ojas is for the most part distributed
equally all over the body, whereas in acute disease
or trauma the flow of ojas is blocked, and in chronic
disease the flow of ojas gradually becomes deficient.
In the sexual act ojas concentrates in the reproductive
organs to create life (jiva), but it is in the creation
of this life principle that a ‘little death’ (in French, la
petite mort) is brought to ojas. In men the continual
depletion of semen results in the loss of ojas, and
hence, a weakening of physiological function. In light
of this and for several other reasons excessive sexual
activity is discouraged in A¯ yurvedic medicine, and
guidelines are provided for appropriate sexual activity
in accordance with the seasons (see Ch. 5). Among
some tantrik practices, however, a sexually active
man suppresses the ejaculation of semen during copulation,
and by utilising various techniques, attempts to
use this energy to awaken kundalinı¯. As a man ages
the dynamic and masculine aspects of his fertility
slowly decline, allowing the more feminine aspects of
his nature to awaken. Thus, as men age, measures are
usually taken to supplement the declining male
essence, to maintain his masculine nature (see 11.13
Vajı-karan. a karma: virilisation therapy).
In contrast to men, the dynamic between ojas and
reproductive function is somewhat more complex in
women. Physiologically a woman is born with several
hundred oocytes (an.d.
a.u) that represent her fertility
‘essence’, just as semen (skra) does for a man. Unlike
men, who must constantly generate new sperm cells to
produce ojas, a woman draws a limitless supply of
ojas from her ovaries until after menopause. The difference
between a woman and a man therefore is that
a man is constantly at risk of depleting his sexual
essence, whereas a woman contains a large reserve of
potential sexual energy. Thus, while men are counselled
to restrict excessive sexual activity there is no
such similar restriction for women. To access this
energy, however, the body maintains regulatory
processes that promote ovulation, which in turn
results in menstruation. Thus, in a woman experiencing
a normal healthy menstrual cycle all of her
potential energy is available to her, whereas when
menstruation is dysregulated the status of ojas weakens.
Thus, time-honoured strategies that seek to
maintain the menstrual cycle (e.g. atavajanana,
‘emmenagogues’) help to make ojas available to the
woman, even though they may not specifically nourish
ojas.
As a woman ages the number of oocytes becomes
diminished and, as hormone levels drop off with
menopause, a fire begins to awaken. This fire burns
away aspects of her feminine essence, and she begins
to take on more of the attributes of a man. Most
women experience these symptoms as an intense
flushing, which is sometimes quite uncomfortable.
Although the flushing is probably a compensatory
mechanism to liberate hormones such as oestrogen
that are stored in fat, it also an alchemical process by
which the fires of agni are stoked to convert the feminine
essence into the dynamic aspects of spiritual
awakening. As a woman loses the ability to create life,
there is a physiological transition that directs a need to
confront death, and thus menopause can be a time of
great learning. On a physiological level treatment is
directed to support the declining feminine essence by
using herbal therapies that are similarly used to keep
a man sexually potent. These herbs are specifically chosen
for their ability to nourish ojas, and lack the us.n.
a
The physical body 41
(‘heating’) properties of similar herbs used in men,
e.g. Staarı?(Asparagus racemosus) (see 11.13 to
Vajıaran. a karma: virilisation therapy).
The importance of pra.a cannot be overemphasised
when it comes to the issue of ojas. Life is
dependent upon the air we breathe, and by the use of
breath control methods like pra.ayama, ojas can
be increased and its circulation corrected. Without
adequate pra.a, or in cases where the air we breathe
is contaminated by pollutants (e.g. exhaust, recycled
air, fine particulates, microbes), ojas undergoes
decline. According to Caraka, those that wish to preserve
ojas should:
‘. . . avoid unhappiness . . . (and take) diets and
drugs which are conducive to the heart, ojas
and channels of circulation . . . Tranquility and
wisdom should be followed meticulously for
this purpose.’
(Sharma & Dash 1985)
4.4 Malas: BODILY WASTES
The term mala generally refers to any kind of impurity
of the mind or body, but in A¯ yurvedic medicine
usually refers to any ‘waste’ produced by the body.
The malas are an important concept in A¯ yurveda,
as health is absolutely dependent upon the proper
formation and excretion of wastes. The improper formation
and impaired excretion of waste products is
considered to be an important factor in the development
of disease. Thus the dos. as, as ‘wind’, ‘bile’ and
‘phlegm’, also represent a kind of impaired eliminatory
product.
The malas are said to be of two kinds: those that
are sthua or ‘gross’, and those that are sus.
ma, or
‘subtle’. The sthua malas are purı.a (‘faeces’),
sveda (‘sweat’) and mura (‘urine’), collectively
referred to as the trimalas (‘three wastes’). The
sus.
ma malas (‘subtle wastes’) comprise the remaining
waste produced by the body.
Purı.a (‘faeces’) is derived from the refinement of
aaa rasa during the digestion of food and the
resultant formation of kit.t.
a (‘waste’, lit. ‘that which
must be eliminated’). When exposed to the us.n.
a (‘hot’)
and tiks.n.
a (‘sharp’) properties of agni, kit.t.a is
formed into solid lumps that are referred to as purı.a.
During the intense heat of digestion volatile substances
are released from the kit.t.
a and are said to give
rise to flatus, or vaa. Although the regular elimination
of purı.a is considered to be of the utmost importance
in A¯ yurveda, it is said that in cachexia
(rayaksa) the faeces should be protected. In such
conditions (e.g. tuberculosis) the tissues of the body
are being eliminated to excess, and by preventing the
elimination of purı.a, the patient retains some of the
strength lost by the dhaus. Mura is formed in the
same way as purı.a, but represents the liquid portion
of indigestible products and bodily wastes.
The sus.
ma or subtle malas are formed as each
dhau metabolizes the sara (‘essence’) of the previous
dhau. The following list details the waste products
formed by each dhau by the dhavani:
1. Rasa: kapha dos.a, as mucoid secretions
2. Rakta: pitta dos.a, as bilious secretions
3. Ma. sa: impurities and wastes associated with
the jn˜aa indriya (i.e. nose, mouth, eyes, skin,
and ears)
4. Medas: sveda (perspiration)
5. Asthi: nakha (nails), kes (head hair) and loma
(body hair)
6. Majja?: aks (greasy secretions of the eyes), tvak
vit (sebaceous secretions), and purı.a sneha
(greasiness of the faeces)
7. Skra/an.d.
a.u: none.
The state of a specific dhau can be understood by
the qualities of its excretion. If a given dhau is producing
excessive amounts of the waste product associated
with it, then one needs to differentiate between the
causes. If for example cerumen, a waste product of the
ears and a mala of ma. sa, is being produced in
excess, then one needs to look at the state of ma. sa
and the tissues it generates to understand the cause.
Ma. sa generates muscle: is the patient thin and weak?
If so, then there may be a problem with the ma. sa
dhavani such that the essence of the previous dhau
is being transformed into waste instead of healthy
ma. sa. Is the patient well built, with a good musculature?
Then perhaps the cause is based in an excessive
intake of dietary articles that specifically strengthen
ma. sa, i.e. meat and animal products. Similarly, in
cases of excessive perspiration, is the cause too much fat
(medas) or improper dhau metabolism? Such an
understanding of the dhaus enables the practitioner
to refine the treatment strategy.
42 PART 1: Theory and practice of A-yurveda
4.5 Aa: TOXINS AND WASTES
The status of agni is the focal point for diagnosis and
treatment in A¯ yurveda. Its deficiency or impairment is
the cause for the creation of aa, which literally
interpreted means ‘undigested food stuff ’. In a
broader context, however, aa is the impairment of
one’s ability to derive nourishment from life, be it
physical, emotional, mental or spiritual. A correctly
functioning agni confers a harmonious benefit to the
whole organism, with proper discrimination of the
body, mind and senses.
As the by-product of poor digestion aa is opposite
in nature to agni, displaying qualities such guru
(‘heavy’), sta (‘cold’), snigdha (‘greasy’), picchila
(‘slimy’), and manda (‘slow’). All qualities of aa are
essentially identical to kapha. The difference between
aa and kapha, however, is that instead of acting as
a counterbalance to the activities of vaa, aa accumulates
in the srota. si (‘channels’) and blocks the
flow of vaa. The labile nature of vaa causes it to
move backwards when encountering this obstruction,
reversing its flow in the body and thereby producing
dysregulation and disease.
When agni is weak aa is formed instead of ojas,
and as a result, ojas gradually becomes deficient. And,
because ojas feeds agni, a deficiency of ojas results in
a further diminution of agni. In the dichotomy
between ojas and agni, aa represents an entropic
tendency in the dhau cycle. It is the accumulation of
aa over many years that eventually robs ojas and
agni of much of their power, facilitating the processes
of degeneration, decay and death.
Although the qualities of aa are similar to
kapha, aa can associate with any of the dos. as. In
such a state a dos.a is said to be saa, or ‘with aa’.
In the absence of aa a dos.a is said to be niraa, or
‘without aa’. The first treatment of any condition
in A¯yurvedic medicine is the elimination of aa and
enhancement of agni. If the condition persists
beyond the use of these measures, a specific treatment
is administered to the vitiated dos.a(s). Table
4.1 describes the differences between saa and
niraa conditions.
Intestinal permeability syndrome
To put a modern slant on the concept of aa, let us
examine the issue of intestinal permeability, or ‘leaky-
Saa conditions Niraa conditions
Circulatory congestion, feeling of coldness Circulation normal
Loss of strength Normal strength
Lethargy and lassitude after eating Energised and revitalised after eating
Poor appetite Good appetite
Indigestion Good digestion
Constipation At least two bowel movements daily
Sinking stools with mucus congestion Normal stools
Increased urination Normal urination
Joint swelling and inflammation Absence of joint swelling and inflammation
Headache No headache
Thick tongue coating Clear or thin white coating
Orbital oedema, eyes appear dull, poor vision Eyes bright, shining, good vision
The above conditions made worse with cold Health unaffected by changes in weather
and damp weather or climates, and worse or climate
at night
TABLE 4.1 Saa and niraa conditions.
The physical body 43
gut syndrome’. Succinctly put, intestinal permeability
describes a process by which some agent or combination
of agents initiates an inflammatory response in
the digestive tract. Persistent gastrointestinal inflammation
eventually disrupts the integrity of the
mucosal lining of the gut, and tiny perforations allow
for molecules larger than usual to pass across this barrier.
These molecules can be derived from the diet, or
may be in the form of microorganisms such as bacteria
and fungi that naturally inhabit our digestive tract.
In response to this infiltration, an immune response is
initiated and the body begins to manufacture specific
antibodies to these antigens. Unfortunately, many
human tissues have antigenic sites almost identical to
those substances that pass across a permeable intestinal
wall. These antibodies then circulate throughout
the body and bind with endogenous (self) antigens to
initiate an inflammatory response.
yurveda describes a condition analogous to intestinal
permeability, in which a deficiency of agni promotes
the formation of aa. A?ma then enters into
the dhau cycle and begins to localise in areas such as
the joints, or in already weakened or susceptible areas.
Once aa is firmly wedged in these locations the
dos.as become vitiated: first kapha, with an increase
in congestion; followed by pitta, which sets up a cycle of
inflammation; and then vaa, which promotes degenerative
changes. Thus the basic dynamics of intestinal
permeability syndrome were identified several millennia
ago in India as being an important causative factor
in the development of disease, even if the pathogenic
mechanisms described are somewhat different.
4.6 Srota
˙
si: THE CHANNELS
OF THE BODY
The body contains several channels through which
the dos.as, dhaus and malas are transported, called
srota. si (sing. srota). The impaired movement or
obstruction of the dos.as, dhaus or malas through
a srota is called srotorodha. Srotorodha interrupts
proper tissue metabolism, causing the regurgitation of
the dos.as, dhaus and malas, and the local formation
of aa. A?ma then moves into the other
srota. si and circulates through the body, promoting
systemic congestion.
A srota is either baya (an ‘external’ channel) or
abhyan˜ tra (an ‘internal’ channel). The baya
srota. si include the two nostrils, the two ears, the
two eyes, the mouth, the urethra and the rectum.
Females have two additional baya srota. si: the
two lactiferous glands of the breasts (stanyavaha
srota. si), and the cervix (atavaha srota). There
are 13 abhyan˜tra srota. si, each of which relates to
specific organs, and are increased and vitiated by specific
factors. The 13 abhyan˜tra srota. si are listed as
follows:
1. Pra. avaha srota
˙
si
Function: provides the medium through which pra.a
flows, obtained on a corporeal level by the respiratory
and gastrointestinal systems, and through the
sus.
ma sarira.
Governing dos.a: vaa.
Organs: correlates to cardiac function, the respiratory
system and the activities of the digestive tract. In this
sense, pra.a is obtained from three sources:
(i) from the atmosphere, in which pra.a is obtained
by the cyclical nature of breathing, which in turn
regulates the rhythm of the heart
(ii) from food, which contains smaller amounts of
pra.a that supply energy to the tissues of the
body
(iii) from the subtle realm (sus.
ma sarira), where
extrinsic pra.a is absorbed from the universe,
and especially from the sun.
The term hr. daya (‘heart’) correlates to the general
functions of the brain, and thus pra.a has an important
regulatory function in nervous tissue.
Cause of vitiation: consumptive diseases; suppression of
natural urges; seasonal, environmental, lifestyle and
dietary patterns that have a ‘drying’ (rus.
a) nature;
exertion and exercise while hungry.
Symptoms of vitiation: hyperventilation, shortness of
breath, shallow breathing, asthma, hiatus hernia.
2. Ambuvaha srota. si
Function: water metabolism; responsible for the hydration
of bodily tissues and the production of urine.
Governing dos.a: kapha.
Organs: pancreas, palate.
Cause of vitiation: exposure to heat, indigestion, alcoholic
drinks, eating excessively drying food, insufficient
water intake.
44 PART 1: Theory and practice of A-yurveda
Symptoms of vitiation: dryness of the oral mucosa,
tongue and throat, lack of appetite, excessive thirst,
diabetes, pancreatitis.
3. Annavaha srota. si
Function: nutrient assimilation, transports assimilated
nutrients to the dhaus.
Governing dos.a: pitta.
Organs: stomach, duodenum.
Cause of vitiation: overeating, unwholesome foods,
agnimadya (‘poor digestion’).
Symptoms of vitiation: poor appetite, indigestion, malabsorption,
anorexia, vomiting, dry tongue, dry lips.
4. Rasavaha srota. si
Function: carries rasa throughout the body.
Governing dos.a: kapha.
Organs: heart, arteries, lymphatic tissue.
Cause of vitiation: excessive intake of guru, sta or
snigdha dietary articles (e.g. dairy, flour products);
agnimadya (‘poor digestion’).
Symptoms of vitiation: poor appetite, decrease in taste
sensation, indigestion, malabsorption, anorexia, vomiting,
abdominal heaviness, lethargy, fever, malaise,
fainting, oedema, lymphatic congestion, frequent
upper respiratory infections, anaemia, impotence/
infertility, asthenia, premature ageing.
5. Raktavaha srota. si
Function: carries rakta throughout the body.
Governing dos.a: pitta.
Organs: liver, spleen, red bone marrow, skin.
Cause of vitiation: consuming foods that are excessively
us.n.
a, snigdha or tiks.n.
a in nature (e.g. alcohol,
chilies, pork); toxins; excessive exposure to heat and
the sun.
Symptoms of vitiation: skin disorders (e.g. psoriasis,
eczema, herpes, erysipelas), menorrhagia, haemorrhage,
rectal bleeding, hepatomegaly, splenomegaly.
6. Ma. savaha srota. si
Function: carries ma
˙
sa throughout the body.
Governing dos.a: kapha.
Organs: tendons, muscles, ligaments, fascia, basement
membrane of the dermis.
Cause of vitiation: sleeping after eating, eating excessive
amounts of food, especially with guru and snigdha
qualities (e.g. dairy, flour products, fatty meat).
Symptoms of vitiation: myoma, uvulitis, tonsilitis,
epiglotitis, goitre, cervical adenitis, boils, non-malignant
growths.
7. Medovaha srota. si
Function: transports medas throughout the body.
Governing dos.a: kapha.
Organs: adipose tissue, kidneys, glandular tissue,
serosal tissue of the viscera.
Cause of vitiation: lack of exercise, sleeping during the
day, sleeping after eating, eating to excess (especially
sweets), eating excessive amount of foods with a guru
and snigdha quality; excessive alcohol consumption.
Symptoms of vitiation: benign cysts, obesity, atherosclerosis,
dysuria, diabetes.
8. Asthivaha srota. si
Function: carries asthi throughout the body.
Governing dos.a: vaa.
Organs: skeletal system, especially the sacrum and
neck.
Cause of vitiation: excessive exercise, malnutrition, lack
of sleep, vaa-provoking foods and activities.
Symptoms of vitiation: osteoarthritis, osteoporosis,
alopecia, dental caries, abnormal nail growth.
9. Majjaaha srota. si
Function: carries majja?throughout the body.
Governing dos.a: vaa-kapha.
Organs: nervous system, marrow.
Cause of vitiation: broken bones, compression (tight
shoes and clothing), eating incompatible foods (e.g.
fish and dairy).
Symptoms of vitiation: rheumatism, vertigo, fainting,
memory loss, paralysis, tremors.
10. Skravaha srota. si
Function: carries skra and an.d.
a.u throughout the
body, concentrates ojas in the reproductive organs
during sexual activity.
Governing dos.a: kapha.
Organs: reproductive tissue.
The physical body 45
Cause of vitiation: excessive sexual intercourse, suppression
of ejaculation, suppression of sexual activities,
excessive sexual stimulation without release,
sexual activity concurrent with the need to urinate or
defecate.
Symptoms of vitiation: spermatorrhoea, nocturnal
emission, benign prostatic hyperplasia, amenorrhoea,
leucorrhoea, dysmenorrhoea, uterine fibroids, infertility,
miscarriage.
11. Muravaha srota. si
Function: carries urine to elimination.
Governing dos.a: vaa-kapha.
Organs: urinary bladder and kidneys.
Cause of vitiation: overeating, suppression of the urge
to urinate, sexual activity or the consumption of foods
and beverages concurrent with the urge to urinate.
Symptoms of vitiation: frequency, tenesmus, calculi,
pain upon voiding.
12. Purı.avaha srota. si
Function: carries faeces to elimination.
Governing dos.a: vaa.
Organs: colon and rectum.
Cause of vitiation: suppression of the urge to defecate,
overeating, ignoring satiety, agnimadya.
Symptoms of vitiation: constipation, diarrhoea, irritable
bowel syndrome, colitis.
13. Svedavaha srota. si
Function: carries sweat to elimination.
Governing dos.a: pitta.
Organs: sudoriferous glands, hair follicles.
Cause of vitiation: excessive exercise, excessive exposure
to heat, anger, fear, grief.
Symptoms of vitiation: absence of or excessive perspiration,
dry skin, calloused skin, hypersensitive skin, horripilations
(goose bumps), hives, burning sensations in
skin.
A -
yurvedic living 47
47
PART 1
Chapter 5
YURVEDIC LIVING
5.1 Dinaarya?, sadvr. tta AND r.
tucarya¯
Most systems of medicine admit that it is not enough to
understand the cause and treatment of disease, that
there must also be a method by which one can prevent
it. A¯ yurvedic medicine maintains an awareness of
these factors by examining the dynamic quality of each
season, and similarly, the differing influences within
each 24-hour period. Thus dinaarya?and r.
tucarya¯
are ‘daily’ (dina) and ‘seasonal’ (r.
tu) ‘regimens’
(carya¯) to align dietary and lifestyle patterns with
these influences. Extending beyond an assessment of
environmental factors, it is also important to know how
our behaviour and conduct causes the generation and
ripening of karmic fruits, and as such it is useful to
know which behaviours are conducive to ‘spiritual
progress’ (sadvr. tta) and those that are not.
5.2 Dinaarya¯: THE DAILY REGIMEN
Dinaarya?is the daily regimen described in
yurveda, taking into account the dynamic quality of
each day. At any given point during the day or night
a particular dos.a is said to exert an influence, and thus
the potential for an imbalance to occur in these periods
must be moderated by a regimen that takes this into
consideration. The cycles of the three dos.as in each
day are shown in Table 5.1.
It is important to take note of the gradual transition
between the different dos.as and the respective time of
day each governs. Thus as morning wears on the influence
of vaa will gradually diminish as kapha
becomes dominant. Similarly, as the evening gets
closer to midnight kapha gradually declines as the
influence of pitta gradually increases. Thus there will
OBJECTIVES
To review the components of the daily
regimen prescribed by A¯ yurveda.
To review the concept of morality and
conduct in A¯ yurveda.
To review the components of the seasonal
regimen prescribed by A¯ yurveda.
48 PART 1: Theory and practice of A-yurveda
be times of the day and night when two dos.as are
equally active, but only until the ascending dos.a
becomes dominant.
Bramamuhu?rta
The morning routine is especially important in
yurvedic medicine, and much time was traditionally
spent, even as it is today in modern India, on following
specific morning regimens. It is said that one should
arise early in the morning, before sunrise in the period
of time called the bramamuhuta. This period of
time, roughly between the hours of 3 and 7 a.m., is
considered best for receiving brahman, or ‘divine
knowledge’. As such it is a time of great spiritual influence,
best for study and meditation. One of the functions
of sleep is to relax the sense organs, thereby
allowing for the free circulation of ojas to nourish the
entire body. During the process of sleep we are able to
experience the lifting of the veil of the ego (aham. kaa),
where for a brief time we no longer create an identity
based on the conditioned interpretation of sensory
experience. The mind becomes unshackled, free from
having to make sense of sensory experience, and interfaces
with elements of the sus.ma and kaan.
a sriras.
In this state we can experience deep spiritual
lessons through dream imagery and visions, which are
lifted from the unconscious to consciousness by the
functions of vaa. Thus by awakening during the
bramamuhuta we naturally invoke vaa to catalyse
unconscious spiritual revelations for use in our
daily life, in much the same way that vaa appears
to lift the sun from the edge of darkness to illuminate
the day.
Apart from being a time of spiritual awakening the
bramamuhuta is also the time when we can take
advantage of the ascending influence of vaa to
cleanse our bodies of the accumulated kapha of sleep.
Simple problems of lethargy, fatigue, mucus accumulation,
liver and bowel congestion, headaches and
other symptoms of a kapha increase are easily
brought under control by waking up early. By and
Dos.a Period of day Approximate time of day
Vaa Early morning, before and just after sunrise 3 a.m.–7 a.m.
Kapha After sunrise to the end of morning 7 a.m.–11 a.m.
Pitta Late morning to mid-afternoon 11a.m.–3 p.m.
Vaa Mid afternoon to early evening 3 p.m.–7 p.m.
Kapha Early evening to late evening 7 p.m.–11 p.m.
Pitta Late evening to early morning 11 p.m.–3 a.m.
TABLE 5.1 Dos.a influence and times of the day.
Box 5.1 Reclaiming dreams
Although every person enters into visionary states
during sleep it is sometimes difficult to remember
them. We might awaken with the thread of the
dream upon our lips, but begin to lose it as we rouse
ourselves and get on with our day. One way to recall
these visionary states is to keep a journal at the bedside
and upon wakening, spend about 5 minutes
writing in a stream-of-consciousness fashion, writing
down the first words that come into your head. At
first these writings may not make much sense, but
with consistent practice the spiritual intent of your
nocturnal meanderings will become clearer, and you
will begin recalling your dreams more clearly. Our
dreams can even be a kind oracle, answering all kinds
of questions, both spiritual and mundane. Sometimes
visualisation can facilitate this process. Just before
falling asleep create a mental image, such as standing
before the sacred oracle at Delphi, at an ancient
Confucian or Hindu temple, in an alpine meadow or
any other sacred place. In this place humbly ask the
residing forces to enlighten you with the answers you
seek. Remember to receive these visions with an open
mind, and do not be disturbed if the dream content
is strange: over time you will come to know the
meaning and significance of these dreams.
A -
yurvedic living 49
large the habit in the West of ‘sleeping in’ is an artifact
of our artificial living environment. As anyone knows
who has gone camping in the wilderness, the world
awakes much earlier than we might otherwise be
accustomed to. Simple techniques such as sleeping
with one’s head in an easterly direction in front of an
uncurtained window will naturally re-orientate us to
the Earth’s circadian cycles. Persons exempt from
waking up during the bramamuhuta include diseased
persons, the elderly, pregnant and lactating
women, and young children.
Evacuation of wastes
After arising from bed one should attend to the purity
of the body. In a state of health the evacuation of
urine and faeces should occur without effort or treatment.
If evacuation does not occur shortly after awakening,
however, or there is a history of constipation,
one or two glasses of warm water can be an efficient
stimulant to peristalsis. In some cases in which constipation
is the only complaint a stronger stimulant may
be used. Among these are:
Triphala ‘powder’ (cun.
a), consisting of equal
parts Harıakı?fruit (Terminalia chebula), Aalakı¯
(Phyllanthus emblica) and Bibhıaka (Terminalia
belerica). Approximately one large teaspoon (2–3 g)
can be mixed in a small glass of water and left to
steep overnight. First thing the next morning the
glass is stirred again and left to settle once more, and
then all the liquid is drunk, leaving the herbal
residue behind at the bottom of the glass. Prepared
as a cold infusion Triphala has a mild effect upon
the bowels and helps to strengthen digestion and
cleanse the dhaus. For a stronger effect Triphala
can be taken directly as tablets or powder drunk with
water in a dosage between 1 and 3 g. When taken
before bed Triphala has a mild aperient activity,
whereas when taken first thing in the morning the
effect is more laxative.
If Triphala is insufficient to promote a bowel movement
ensure more general changes to the diet,
emphasising a diet high in leafy green vegetables,
fibres such as flax, hemp or oat bran, and a probiotic
supplement (e.g. acidophilus and bifidus). If the
bowel movements tend to be quite hard and dry then
the strategy should be to lubricate the intestines by
increasing the amount of fat in the diet, and to take
herbs such as S큨칗.t.
hı?(Zingiber officinalis), Pippalı¯
(Piper longum) and Hin.gu (Ferula foetida) that enkindle
agni and ensure proper digestion.
If dietary measures fail to promote normal bowel
movements then herbs that have a more laxative
activity can be taken short term; for example Trivr.
t
(Operculina turpethum), Cascara bark (Rhamnus purshiana),
or Da huang root (Rheum palmatum). The
use of such laxatives is indicated only with simple
constipation, and not in active inflammation or
chronic indigestion.
Enema (vasti) therapy may also be indicated in
chronic constipation, but should be avoided on
a regular basis as it will tend to promote rebound
constipation. Please refer to Chapter 11 for more
information on vasti therapy.
Cleaning the mouth
Cleaning the oral cavity is an important component of
hygiene in A¯ yurveda, and involves cleaning the teeth
(da?adhavana), the tongue (jihvairlekhana) and
the use of gargles (gan.
d.
u.a). The teeth are cleaned
with bitter, astringent and pungent tasting herbs,
which traditionally took the form of twigs that were
chewed, and then the frayed end used to gently brush
the teeth. Today such chewing sticks are used all over
the world instead of the abrasive plastic bristles of
a modern toothbrush and saccharin-sweet toothpastes.
It is stated that brushing the teeth specifically
with bitter, astringent and pungent tasting herbs helps
to cleanse the accumulation of kapha from the upper
digestive tract and stimulate agni. Typical herbs used
in India to clean the mouth include the chewed twigs
of Pippala (Ficus religiosa), Nimba (Azadirachta
indica), Arjuna (Terminalia arjuna) and Kara?a
(Pongamia pinnata). Western equivalents such as
Barberry root (Berberis vulgaris), Bayberry bark
(Myrica cerifera), Prickly Ash (Zanthoxylum americanum)
and Oak bark (Quercus spp.) can also be used,
ground into a very fine powder and gently massaged
into the teeth and gums as a dentifrice.10
Contraindications for using very powerful kapha
‘reducing’ (hara) herbs for cleaning the mouth
include fever, nausea, vomiting, EENT diseases and
vatika diseases of the head (e.g. trigeminal neuralgia).
Herbs may also be chosen, however, for their
utility to treat such diseases (e.g. by using vaaara
50 PART 1: Theory and practice of A-yurveda
herbs such as Yas.t.
imadhu root (Glycyrrhiza glabra)
and Bala?root (Sida cordifolia) in trigeminal neuralgia).
One commonly used technique in A¯ yurveda to
cleanse the tongue that is now making inroads into
modern oral hygiene is that of the tongue scraper.
Usually made out of a thin strip of gold or stainless
steel, tongue scrapers are used to cleanse the tongue of
the mucus coating found upon arising in the morning.
While cleansing the tongue of some of the rather nasty
oral bacteria that can accumulate in our mouths,
yurvedic physicians believe that this procedure is
specifically useful because it stimulates a reflex activity
in the gastrointestinal tract, promoting good digestion
and healthy elimination.
Gan.d.
u.a or ‘gargling’ is performed after cleaning
the teeth and tongue. Gargling with warm water is said
to alleviate kapha, and promote digestion and the
elimination of aa. Although water is most commonly
used in cases of hoarseness or sore throat a
variety of preparations can be used, including Indian
herbs such as the fresh juice of Bramı?(Bacopa monniera)
or a decoction of Bibhıaka fruit (Terminalia
belerica). Western herbs such as Sage (Salvia officinalis)
and Purple Coneflower (Echinacea angustifolia) can also
be helpful, used as an infusion or as diluted tinctures
(2.5 mL per 50 mL of water as a rinse). For dryness of
the pharynx, mouth and lips gargling with ghr. ta,
coconut or sesame oil can be helpful.
Cleansing the eyes
Cleansing of the eyes is another facet of the traditional
morning regimen, typically with collyriums (a?ana)
such as Sauvıa?ana, which is prepared from the ore
of antimony sulphide. This preparation is painted as
a thick line on the lower eyelids, directly under the
lashes, and is said to enhance vision and prevent eye
disease.11 A simple alternative to Sauvıa?ana is to
collect the carbon from a wick burning in the oils of
sesame, castor and ghr. ta: this can be done by placing
a clean plate over the flame to collect the carbon as the
candle burns. Both this preparation and Sauvıa?ana
can also be applied at night, before bed.
Another commonly used preparation to cleanse and
strengthen the eyes is Triphala, as either an eyewash
or as a medicated oil. To prepare a sterile eyewash
a small amount of the cun.
a is covered in about eight
times the volume of hot water, steeped for 5–10 minutes
and then strained through a piece of clean linen.
When cool, the filtered infusion can be used to rinse
the eye with the use of an eye cup. Alternatively,
Triphala ghr. ta can be applied, prepared by decocting
one part Triphala in four parts ghr. ta and 16 parts
water until all of the water has evaporated. The resultant
oil is then strained through fine linen, bottled and
stored in a cool and dry location – to enhance shelf life a
little vitamin E oil can be added as an antioxidant. A few
drops are instilled in each eye before bed in conditions
such as dry eye, glaucoma and diabetic retinopathy.
Non-indian alternatives used with an A¯yurvedic
rationale include a weak solution (3% v/v) of tinctures
of Barberry root (Berberis vulgaris), Eyebright
herb (Euphrasia officinalis), Rue (Galega officinalis) or
Goldenrod herb (Solidago spp.), two to three drops
instilled in each eye. Similar to Triphala, these
Western herbs can also be prepared as an infusion for
an eye wash.
Another exceedingly beneficial collyrium is breast
milk, which many mothers will observe to be the single
best thing to treat almost any eye disorder in their
infant, as well as in older children and adults. Human
breast milk has the benefit of being both isotonic and
demulcent, is rich in antimicrobial immunoglobulins,
and is particularly helpful in soothing inflammation
and dryness. Breast milk is a very important component
in many traditional A¯yurvedic ophthalmological
preparations. As an alternative to breast milk fresh
goat’s milk is often used, especially in A¯yurvedic ophthalmological
preparations sold commercially.





Om Tat Sat
                                                        
(Continued...) 





(My humble salutations to H H Maharshi ji,   Sreeman Todd Caldecott, Elsevier’s Health Sciences and others other eminent medical scholars and doctors   for the collection)

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