Ama is the outcome of improper digestion. The product which brings discomfort in Srotas is Ama. Agni is having great role in the formation of Ama. Ama formation takes place in Jataragni, Bhutagni and Dhatuagni level, mainly due to hypo functioning state of digestive fire.[1] Ama can be identified in body through urine examination, stool examination, blood investigation and biochemical test. Based on this, the concept of inflammatory condition, autoimmune diseases and other non communicable diseases can be identified and treated in Ayurveda. Thus for the treatment of Ayurveda understanding the concept of Ama is important

Dr. C. V. Rajashekhar

Dr. Jeena George

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

                                                      REVIEW ARTICLE July-Aug 2020  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2020 | Vol. 5 | Issue 4 126  Diagnostic criteria for Amadosha Dr. Jeena George1, Dr. C. V. Rajashekhar2 1Post Graduate Scholar, 2Professor and HOD, Dept. of Kayachikitsa, Sri Kalabhairaweshwara Swami Ayurveda Medical College and Research Centre, Bengaluru, Karnataka, INDIA.                INTRODUCTION As the digestive fire is not functioning normally the formation of Aadyadhatu gets hampered and this improperly metabolized substance is called Ama, which manifest in Amashaya.[2] It can be understood as Apakvaaahara Rasa in Amashaya, Rasashesha in Amashaya, Apakvamala in Annavahasrotas, Aadidhatu resulting out of Apakvaaahara Rasa. Thus Ama is something which comes in contact with Dehagni, and the derangement of this result in Ama. Amalakshana Ama is liquid, heavy (high molecular weight), attain different colors, etiological factor for almost all disease, slimy, visid, thread, sticky nature, manifest various   kinds   of  pain,  yields  foul  smell,  increased  Address for correspondence:  Dr. Jeena George Post Graduate Scholar, Dept. of Kayachikitsa, Sri Kalabhairaweshwara Swami Ayurveda Medical College and Research Centre, Bengaluru, Karnataka, INDIA.  E-mail: annajeenageorge18@gmail.com  Submission Date: 12/07/2020 Accepted Date: 13/08/2020 Access this article online Quick Response Code Website: www.jaims.in  Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA sourness, excess in quantity, thick increased turbidity, obstruct various pathways etc.[3] When Ama mixes with Dosa, Dhatu, Mala, develops certain complex adverse reactions,which is the basis for the manifestation of the disease. It does obstruction in Srotas, diminution of strength, heaviness, disturbance in the normal movements of Vata, drowsiness, indigestion, excess secretions from oral cavity, obstruction for urine and stool, lack of desire towards food, exhaustion.[4] Saama and Niraama are the two states of Amadosha. INDICATORS OF SAMA Urine examination The presence of markers of Sama condition depends upon the tissue (Dhatu) involved. Shuklatva and Amlatva which is seen in acidosis indicates  Ama with Pitta Dushti.[5] Acidosis is a high level of acid in the body which causes imbalance in body’s pH. it results in breathing difficulty, infection,rapid shallow breathing etc. Alkalosis is excessive blood alkalinity caused by an overabundance of bicarbonate in the blood or loss of acid from the blood or by low level of carbon dioxide in the blood. Alkalosis can be understood as Kaphadusti with Ama. Presence of bile salts and pigments indicates presence of Ama in Raktadhatu. This can be considered as “Asrujahamala Pitta” A B S T R A C T  Ama is the outcome of improper digestion. The product which brings discomfort in Srotas is Ama. Agni is having great role in the formation of Ama. Ama formation takes place in Jataragni, Bhutagni and Dhatuagni level, mainly due to hypo functioning state of digestive fire.[1] Ama can be identified in body through urine examination, stool examination, blood investigation and biochemical test. Based on this, the concept of inflammatory condition, autoimmune diseases and other non communicable diseases can be identified and treated in Ayurveda. Thus for the treatment of Ayurveda understanding the concept of Ama is important.  Key words: Ama, Urine Examination, Stool Examination, Blood Investigations, Treatment.  Dr. Jeena George et al. Diagnostic criteria for Amadosha ISSN: 2456-3110                                                      REVIEW ARTICLE July-Aug 2020  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2020 | Vol. 5 | Issue 4 127  increased due to Raktadhatumandhyata, Raktavahasrotodushti. Sama Mutra Lakshanas can be understood by Tailabindu Pareeksha. If a drop of Taila floats over urine surface but not spreads indicates disease become difficult to cure. If Tila Taila drops sinks in urine Indicates incurability of the disease. Other symptoms of Sama in Mutra include, increased frequency and micturition, increased turbidity. When it mixes with Dosha, Dhatu and other Malas leading to manifestation of various urological disorder. There will be change in colour, consistency and specific gravity. It develops discomfort in Mutravahasroto Avayava. Ama when combined with Pitta manifest inflammatory symptoms like burning sensation and other Amlapitta Lakshanas. These symptoms when shown up in urine can be taken as the indicators of Ama in urine.[6] Stool examination There are several reference for identification of Ama in the Purisha by various texts. The common and sure among them are Appsumajah, Atidrava, Atisaitya, Sleshmayukta and Guru. All the Amalakshana present in stool shows the presence of Stulaamarasa in GIT and its associated Dosha Gunas which indicates the involvement of Saama Doshas in GIT.  When considering the modern parameters Saama Pureesha can be taken if the quantity of the stool is more than 100gm/day with putrefied odour, hard and purulent stool, either more acidic or alkaline, presence of parasite, occult blood etc. The presence of RBC, WBC, ingested food and bacteria or parasites in stool microscopic study indicates the presence of Ama. Other than Ashtavidha Pareeksha, Susruta also highlights Samapureesha Lakshanas in Atisara Chikitsa. It is mentioned as when the Sama Mala combines with Dosha Dhatu and other Malas diseases manifest accordingly. The symptoms are, the mala will sinks in water, there will be increase in quantity and frequency. This can be associated with foul smell, change in colour and consistency and heaviness, pain in abdomen.[7] Blood investigation Heamoglobin Haemoglobin below 12g indicates Raktadhatualpata. Shows the condition of Raktagnimandhyata and Amlatva in Rakta. Hence any abnormality or subnormality in the production of RBC/hb indicates Raktadhatvagnimandhyatva. Ashtanga Hrudaya explains Sama is a condition manifest due to amalgamation of Dosha and Dushya resulting into formation of various kinds of disorder. Further Arunadhatta opines that Dushya should be understood as Rakta.[8] If WBC increased, indicates the presence of Ama, because the increase of leucocytes takes place where in Vijatiya factor (antigen) is in circulation, and similarly decreased number also indicates Ama condition since less production (Sarabaga) due to Dhatvagnimandhyata.[9] Inflammation is characterised by rubor, color, dolor and swelling which are nothing but Shwayathu Lakshanas results due to Srotoavarodha by various factors, “Utsedalingamswayathumkaroti”. Thus inflammation markers are essential parameters to know the Sama condition. Dr. Jeena George et al. Diagnostic criteria for Amadosha ISSN: 2456-3110                                                      REVIEW ARTICLE July-Aug 2020  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2020 | Vol. 5 | Issue 4 128  ESR ESR can be affected by the concentration of fibrinogen, immunoglobulins and their plasma proteins. The rate of erythrocyte sedimentation depends upon the increased fibrinogen and globulin, decreased albumin in blood, which indicates all condition in which Dhatvagnimandhyata and Dhatukshyaya. Since Ama Gunas like Guru, Abhishyandi, Picchila are attained by RBC leads to sedimentation fastly and there by increased sedimentation rate. It indicates Ama in Raktadhatu. Thus the inflammatory arthritis, abscess and other infections can be correlated to Ama Lakshanas and can be treated. Here Samarakta Dhatu Lakshanas can be also considered. Various dermatological disorders including leprosy, herpes, infections, pimples, hemorrhages, bleeding from genital organs, inflammation of anus, penis and oral cavity, spleenic disorders, internal growths, blue moles, liver disorders, freckles, portwine mark, blackmoles, ringworm, dermatitis, leucoderma, papules, urticarial rashes, red rounded patches are the symptoms of Samarakta.[10] CRP C reactive protein test measures the level of CRP in blood. CRP is a protein made by the liver sent into the bloodstream in response to inflammation. It increases in concentration within few hours of acute inflammatory stimulus and reaches a peak in 2-3 days and then falls relatively rapidly after the withdrawal of stimulus. CRP measurement help to differentiate inflammatory condition from non-inflammatory mechanical problems. CRP  is one of the strong indicators of Ama condition, since it is responsible for Agnimandya which produce Amadosha. Biochemical test Biochemical test levels which are above the normal levels indicates the presence of Ama. In the case of hyperglycemia the Ahara consumed by person is not utilized by body tissue due to Bhutagnimandyata, Thus becoming Amalakshana like Bahumutrata, Guru, Tantra, Utsahahani, Upalepadi etc. Similarly hyperlipidemia condition indicates Medoagnimandyata. Decreased protein indicates Rakta and Mamsa Agnimandyata and hence less production of Mamsadhatu. DISCUSSION  The application of diagnostic method can be appreciable in case of different treatment aspects. For example in case of Amavata the inflammatory changes will be highlighted in investigations like ESR, RA factor, CRP levels indicates Amalakshanas as mentioned above. By understanding the concentration and the level of Ama present in the disease the dose and other treatment approach can be followed. These also leads to the scope of research work in Ayurveda in order to standardize the treatment protocol. CONCLUSION  For the standardization of Ayurvedic classic and for the accurate treatment Ama can be identified by various diagnostic techniques. Urine, stool examination, biochemical test, blood investigation, provide the criteria for better understanding of Ama. Based on the diagnostic values obtained treatment can be planned. Pachana, Deepana and other Apatarpana Chikitsa can be adopted for Amadosha. REFERENCES 1. Vagbhata, Ashtanga Hridaya, Nidanastana, chapter 12. Verse  1, Sarvangasundara  and  Ayurveda  rasayani commentary of Arunadatta and Hemadri.  Pandit Hari Sadashiv Sastri Paradkar,  Chaukhambha Surabharati Prakashan. Varanasi. Edition 2016. Page no. 513.  2. Vagbhata, Ashtanga Hridaya, Nidanastana, chapter 13. Verse  25. Sarvangasundara  and  Ayurveda  rasayani commentary of Arunadatta and Hemadri.  Pandit Hari Sadashiv Sastri Paradkar,  Chaukhambha Surabharati Prakashan. Varanasi. Edition 2016. Page no. 216 3. Vagbhata, Ashtanga Hridaya, Nidanastana, chapter 13, Verse  26, Sarvangasundara  and  Ayurveda  rasayani commentary of Arunadatta and Hemadri.  Pandit Hari Sadashiv Sastri Paradkar,  Chaukhambha Surabharati Prakashan. Varanasi. Edition 2016. Page no. 216 4. Vagbhata, Ashtanga Hridaya, Nidanastana, chapter 13, Verse  23-24, Sarvangasundara  and  Ayurveda  Rasayani commentary of Arunadatta and Hemadri.  Pandit Hari Dr. Jeena George et al. Diagnostic criteria for Amadosha ISSN: 2456-3110                                                      REVIEW ARTICLE July-Aug 2020  Journal of Ayurveda and Integrated Medical Sciences | July - Aug  2020 | Vol. 5 | Issue 4 129  Sadashiv Sastri Paradkar,  Chaukhambha Surabharati Prakashan. Varanasi. Edition 2016. Page no. 216.  5. Pro. Dr. M. Srinivasulu, Concept of Ama in Ayurveda, Chaukamba Sanskrit Series Office, edition 2, 2010, page no. 89 6. Agnivesha,  Charaka Samhita,  Sutrasthana,  chapter 24,  verse  04,  Ayurveda  deepika  commentary  by Chakrapanidatta.  Editor:  Yadavaji Trikamaji Acharya.  Chaukhambha Surabharati Prakashana, Varanasi. Edition 2014.  Page no.518 7. Sushruta, Sushruta Samhita,  Uttaratantra, Chapter 40, verse  17,    Nibandhasangraha  Commentary  by  Dalhanacharya,  Edited  by,  Vaidya  Yadavji Trikamaji Acharya, Chaukhambha Orientalia, Varanasi, Edition 2014, page no. 698 8. Vagbhata, Ashtanga Hridaya, Nidanastana, chapter 1, Verse  6, Sarvangasundara  and  Ayurveda  rasayani commentary of Arunadatta and Hemadri.  Pandit Hari Sadashiv Sastri Paradkar,  Chaukhambha Surabharati Prakashan. Varanasi. Edition 2016. Page no. 6. 9. Pro. Dr. M Srinivasulu, Concept of Ama in Ayurveda, Chaukambha Sanskrit Series Office,edition 2,2010,page no.92 10. Agnivesha,  Charaka Samhita,  Sutrasthana,  chapter 28, verse  11,  Ayurveda  deepika  commentary  by Chakrapanidatta.  Editor:  Yadavaji Trikamaji Acharya.  Chaukhambha Surabharati Prakashana, Varanasi. Edition 2014. Page no.179      *******************************  How to cite this article: Dr. Jeena George, Dr. C. V. Rajashekhar. Diagnostic criteria for Amadosha. J Ayurveda Integr Med Sci 2020;4:126-129.  Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2020 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  

Diagnostic criteria for Amadosha

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Diagnostic criteria for Amadosha

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