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Ama (view source)

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== Etymology (nirukti) ==

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<ol style='text-align:justify;'><li style="font-weight:bold">Aamyate ishat pachyate: It means the product formed due to poor or improper digestion(apurna paka or paka rahita or alpa paka).<ref name="ref1"></ref></li>

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<ol style='text-align:justify;'><li style="font-weight:bold">Aamyate ishat pachyate: It means the product formed due to poor or improper digestion(apurna paka or paka rahita or alpa paka).<ref name="ref1">Shabdakalpadruma by Raja Radhakanta Deva, Prathama Khand. Second edition. Delhi: Naaga Publishers; 2003. pg.no. 180.</ref></li>

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<li style="font-weight:bold">Soannajo rasa iti amah, annarasasyo va apakvasya tanyantare aam vyapdeshat: Ama is originated from the food. If the initial product of food after digestion (annarasa) is not properly formed, then the outcome of such digestion is known as ama.<ref name="ref2"></ref></li></ol>

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<li style="font-weight:bold">Soannajo rasa iti amah, annarasasyo va apakvasya tanyantare aam vyapdeshat: Ama is originated from the food. If the initial product of food after digestion (annarasa) is not properly formed, then the outcome of such digestion is known as ama.<ref name="ref2">Madhukosha. Madhava Nidanam (Roga vinischaya). Nidana sthana. 25/1-5. Translated from Sanskrit by Dr. Brahmananda Tripathi. Purvardha . 8th ed. Varanasi: Chaukhambha orientalia;2008 pg no. 574.</ref></li></ol>

== Definition ==

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== Diseases caused by ama ==

The undigested food gets fermented (shuktata) leading to onset of toxic symptoms. [Cha. Sa. Chikitsa Sthana 15/42-44] Ama further leads to various digestive disorders like amajirna (indigestion due to saama pitta), vishtabdhajirna (indigestion due to saama vata), vidagdha ajirna (indigestion due to saama kapha), visuchika (non-infectious gastroenteritis), alasaka (sluggish bowels), vilambika (gastro-intestinal stasis). [Su. Sa. Uttara Sthana 56/3] The diseases caused by ama at various dhatu level are jwara (fever), atisara (diarrhoea), pravahika (dysentery), etc. The chronic conditions caused by ama are such as grahini-dosha (functional impairment of agni), udara roga (ascites and abdominal enlargement), yakrit vyadhi (liver disorders), jalodara (ascites), shotha (oedema), pandu (anemia), prameha (obstinate urinary disease), amavata (rheumatism), etc.

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The acidic nature (amla bhava) of undigested food (apakva anna) is called as suktata (acidic /sour nature of undigested food) which further acts like a visha (poison) that will further produce number of other diseases, so this can be compared to symptoms of amavisha.<ref name="ref3"></ref> This uncooked food further combines with dosha (regulatory functional factors of the body), dhatu (major structural components of the body) or mala (metabolic waste or byproducts) and produces their respective symptoms accordingly. [Cha. Sa. Chikitsa Sthana 15/46-49]

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The acidic nature (amla bhava) of undigested food (apakva anna) is called as suktata (acidic /sour nature of undigested food) which further acts like a visha (poison) that will further produce number of other diseases, so this can be compared to symptoms of amavisha.<ref name="ref3">Chakrapani. Charaka Samhita. Chikitsa Sthana. Chapter 15/44. Edited by Jadavaji Trikamji Aacharya. Chaukambha Surbharti Prakashana. Varanasi;2005.pg no. 517.</ref> This uncooked food further combines with dosha (regulatory functional factors of the body), dhatu (major structural components of the body) or mala (metabolic waste or byproducts) and produces their respective symptoms accordingly. [Cha. Sa. Chikitsa Sthana 15/46-49]

When ama combines with pitta dosha, it produces pitta dominant diseases such as burning sensation (daha), thirst (pipasa), diseases of oral cavity (mukha roga), hyperacidity (amlapitta) etc. When it combines with kapha dosha, it produces kapha dominant diseases such as rajayakshma (consumption), pinasa (chronic rhinitis), prameha (obstinate urinary disease), etc. When combines with vata dosha, it produces different types of vata dominant diseases. When combines with mutra (urine) or gets lodged in mutravaha srotasa (urinary tract), to produce mutra roga such as mutrakrichhra (dysuria), mutraghata (urinary retention), prameha (obstinate urinary disease), etc. When combines with purisha (feces) produces diseases of kukshi (pelvis) or udara roga (diseases of abdomen). When combines with rasa etc. dhatu (seven major structural components of the body), then produces their respective diseases.

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== Characteristics of ama ==

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Ama possesses characteristics such as liquid (drava), heavy (guru), attains different colors, slimy (snigdha), viscid (pichchila), thready (tantumatva), foul smelling (durgandhi). Ama is etiological factor of all diseases and produces symptoms such as various types of pain (shoola), obstructs channels (srotorodhaka), undigested (avipakva), lethargic (sadanakaraka), etc.<ref name="ref4"></ref>

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Ama possesses characteristics such as liquid (drava), heavy (guru), attains different colors, slimy (snigdha), viscid (pichchila), thready (tantumatva), foul smelling (durgandhi). Ama is etiological factor of all diseases and produces symptoms such as various types of pain (shoola), obstructs channels (srotorodhaka), undigested (avipakva), lethargic (sadanakaraka), etc.<ref name="ref4">Arundatta. A. H. Sutra Sthana 13/27. Editted by Pandit Hari Sadasiva Sastri Paradakara. Chaukambha Surbharti Prakashana Publications. Varanasi. Ed: 2016. Pg, no. 216.</ref>

== Clinical features of dosha (saama dosha) and dhatu (saama dhatu) associated with ama ==

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~~'''~~Features of state without ama (nirama dhatu lakshana) [A. H. Sutra Sthana 11/4]~~'''~~

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== Features of state without ama (nirama dhatu lakshana) [A. H. Sutra Sthana 11/4] ==

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In stage devoid of ama (nirama avastha), all seven dhatus perform their normal functions and are devoid of symptoms of ama.

{| class="wikitable"

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|Stool floats on water, laghuta (lightness).

|}

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== Clinical presentations due to ama ==

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There are mainly two types of ama dosha or ama dosha vikara (disease) viz; visuchika (non-infectious gastroenteritis /choleretic diarrhoea) and alasaka (sluggish bowel/intestinal obstruction). [Cha. Sa. Vimana Sthana. 2/10] Food taken in excessive quantity is the cause for sudden aggravation of all three dosha and formation of ama. All aggravated three dosha combine with ama and produce diseases like alasaka and visuchika. [A. H. Sutra Sthana. 8/5-12]

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<ol style='text-align:justify;'><li style="font-weight:bold">Visuchika (gastro-enteritis): The word visuchika derived from “suchi” means needle or “suchi vidh vedana” (pricking pain). The expulsion of ama dosha (undigested food) through both upper and lower passages of the gastrointestinal tract is called visuchika (non-infectious gastroenteritis). The doshas when tend to move outwards from both upper and downwards routes means both vomiting and diarrhoea occurs simultaneously. Due to aggravation of vata and other doshas different types of pain occur as the patients feels as if his body is being pricked by needles (suchi) so the disease is named visuchika. It can be compared with gastro-enteritis due to pathogens such as Cholera bacilli. Complications caused by visuchika are, abdominal colic, vertigo, abdominal distension, tremors and rigidity by vata dosha. Pitta causes jwara (fever), atisara (diarrhoea), burning sensation within body, thirst, fainting and drowsiness. Kapha dosha leads to chardi (vomiting), heaviness of the body, unable to speak, excessive salivation and cough. </li>

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<li style="font-weight:bold">Alasaka (sluggish bowels): The word Alasaka derived from word “Alasa” means no movement. When frail person having weak digestive power and excess of kapha in the body, it habitually suppresses the urges of passing flatulence, micturition and bowels and at the same time consumes sthira (solid), guru (heavy), atishushka (excessively dry), and sheeta (cold), in excessive quantities then his ingested food gets afflicted by vayu (vata dosha). Even exerting pressure does not push the undigested food out of the passage since it is obstructed by kapha, by excreta accumulated already, and also because of sluggish nature caused by all these factors. Vishtambhan (stasis) of dosha occurs so the ama remains/stagnated within the stomach i.e., food neither passes upwards nor downward. This condition is called alasaka. All the characteristic features of ama dosha, except vomiting and diarrhoea, are manifested severely in alasaka. This can be compared with Cholera sicca where, the entire body fluids are dragged into the intestines and intestines gets paralyzed and the patients dies because of tissue dehydration. Aggravated vata dosha vitiates the consumed food and kapha dosha obstructs the channels. The undigested food remains in gut without any further process. It causes irritation and colicky pain without vomiting or diarrhoea. </li></ol>

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'''Dandaka alasaka''' (delayed and obstructive digestive process wherein body becomes stiff like a stick):

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Severely vitiated dosha associated with ama spreads all over the channels of body and spreads throughout the body. The extremely vitiated dosha move obliquely towards other body channels to block them. As all body channels are blocked by ama, the body becomes rigid like wooden rod/staff (danda). This condition is critical and needs urgent medical care. Such clinical condition is known as dandalasaka/ dandaka alasaka.

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== Ama visha ==

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An individual who regularly consumes incompatible diet, indulge in adhyashana (multiple heavy meals in short intervals) and ajirnashana (eats even before the previous meal is digested), the ama dosha is formed. It resembles and manifests features of poisoning. Hence it is called ama visha. It is a difficult to cure because of its acute presentation and its contradictory line of management. [Cha. Sa. Vimana Sthana 2/12] The symptoms produced by ama visha are such as stasis in body (vishtambha), fatigue (sadana), indigestion (ajirna), headache (shirashoola), fainting (moorcha), vertigo (bhrama), stiffness of back (pristha-kati graha), yawning (jrimbha), malaise (angamarda), thirst(trishna), fever(jwara), vomiting (chhardi), tenesmus(pravahana), anorexia (arochaka), indigestion (avipaka).

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== Chikitsa (management) ==

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===Treatment of ama dosha: ===

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* The following principles are adopted to manage a clinical condition associated with ama.

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* Deepana (stimulating the digestive process)

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* Pachana (assisting the digestion and metabolism)

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* Sneha (oleation with medicines having digestion stimulant properties)

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* Sweda (fomentation)

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* Shodhana (purification) at appropriate time when dosha are in a state of getting expelled out.

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In a condition without ama, the main principle of treatment is shamana (palliative). Shodhana is indicated based on the state of dosha. If the dosha are in dormant (leena) state, then shodhana is prohibited. [A. H. Sutra Sthana 13/28-29] Apatarpana (depleting procedure) is the prime line of treatment for ama dosha. The apatarpana is of three types viz., langhana (fasting), langhana- pachana and dosha avasechana (shodhana). Based on the avastha of dosha the type of apatarpana is to be advised i.e., in low grade (alpa) dosha stage, langhana (fasting) as it stimulates the digestive process by predominance of agni (fire element) and vayu (air element) mahabhuta. In moderate grade (madhyama) dosha stage, langhana and pachana (fasting with digestant) should be adopted. In highly aggravated (bahu) dosha state, dosha avasechana or shodhana (purification) as to remove out vitiated dosha and ama from the body. [Cha. Sa. Vimana Sthana 3/43-44]

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=== Treatment of alasaka: ===

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The curable variety of ama dosha should be eliminated through vamana (emesis), by administering warm saline water and thereafter swedana (fomentation) and application of phala varti (suppositories) while the patient is kept on upavasa (fasting). [Cha. Sa. Vimana Sthana 2/13]

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=== Treatment of visuchika: ===

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In case of visuchika, treatment should start with langhana (fasting) followed by specific dietary regimen as followed in therapeutic purgation (virechana). [Cha. Sa. Vimana Sthana 2/13]

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=== Amadosha chikitsa: ===

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In case of reoccurrence of the diseases caused by ama, the first line of treatment is apatarpana i.e., depletion therapy. If the disease further progresses even after depletion therapy, appropriate measures should be adopted to counter the morbid condition. Experts recommend the use of vyadhi viprit ausadha measures (treatment which is antagonistic to the disease) rather than hetu viprita aushadha (treatment which is antagonistic to the etiological factors). [Cha. Sa. Vimana Sthana 2/13]

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