Sharira Vichaya Sharira
Sharira Sthana Chapter 6. Analytical study of the Human body
|Section/Chapter||Sharira Sthana Chapter 6|
|Preceding Chapter||Purusha Vichaya Sharira|
|Succeeding Chapter||Sharira Sankhya Sharira|
|Other Sections||Sutra Sthana, Nidana Sthana, Vimana Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana|
|Translator and commentator||Bhalerao S., Kulkarni S.|
|Reviewer||Patwardhan K., Shilwant A.A|
|Editors||Patwardhan K., Deole Y.S., Basisht G.|
|Year of publication||2020|
|Publisher||Charak Samhita Research, Training and Skill Development Centre|
Keywords: sharira vichaya, dhatu, fetal growth, fetal development, factors affecting strength, lifespan, timely death, pre-term death.
This sixth chapter of the Sharira Sthana, entitled Sharira Vichaya Sharira(analytical study of the body) follows the chapter on [[ Purusha Vichaya Sharira]] (detail study of the purusha). To achieve divine bliss and moksha (salvation) that the preceding chapter talked about, it is imperative that the body is free from diseases. To achieve a disease-free life, it is of utmost importance to know the components of the body and what vitiates them or affects them, thus, causing diseases or complete destruction of the body, etc. Overall, the chapter is divided into two broad sections – the first one dealing with all the above mentioned subjects and the second one dealing with embryology, development and growth of various body parts in the fetus. The chapter ends with a very important aspect related to death viz. timely and untimely death. Since death is an inevitability, the discussion about timely and untimely death has been aptly placed here in this chapter after deliberations on the development and growth of an embryo, a person yet to born.
The first section starts with a definition of the body, followed by the concept of homeostasis (balance of various bodily elements). Interestingly, disease or death has been defined as partial or complete deviation from the homeostasis respectively. In this context, the physiology of homeostasis and its importance as a final outcome while administering treatment has been narrated in a very systematic way. Samanya vishesha siddhanta (theory of similarity and dissimilarity) is one of the most important and fundamental principles of Ayurveda. The practical application of this siddhanta to maintain homeostasis has been well described in this chapter. Although samanya and vishesha can be understood in three broad categories - dravya, guna,and karma - the emphasis is given on guna samanya and vishesha in this chapter. The treatment of various conditions using dravya with similar or opposite guna has been given with examples.
The primary objective of Ayurveda is to maintain health, or in other words, to maintain homeostasis and attain excellence in health of body elements. Hence, before the disease manifests, it is equally important to make efforts for growth and improved strength of the body. Accordingly, the factors responsible for both these things have been discussed. The third important thing for good health is proper nutrition. It is imperative therefore to know the factors responsible for digestion of food and further assimilation of the ingested food into body elements. The discussion about these factors is followed by types of body elements, their building blocks and waste products.
The second part of the chapter deals with embryology, focusing specifically on the development of fetal organs, the fetus's position in the womb, its nourishment through placental blood, and the process of labor and post-labor survival of the new born. It is interesting to note that all these descriptions match with the current understanding of embryology.
The chapter ends with a discussion on life expectancy in the present era and timely and untimely death.
Sanskrit text, Transliteration and English Translation
अथातः शरीरविचयं शारीरं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātaḥ śarīravicayaṁ śārīraṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2||
athAtaH sharIravicayaM shArIraM vyAkhyAsyAmaH||1||
iti ha smAha bhagavAnAtreyaH||2||
Now we shall expound the chapter "Sharira Vichaya Sharira" (Analytical study of the Human body). Thus said Lord Atreya. [1-2]
Note: The knowledge of anatomy and physiology is given simultaneously under common heading of "sharira vichaya".
Advantages of analytical knowledge of body
शरीरविचयः शरीरोपकारार्थमिष्यते| ज्ञात्वा हि शरीरतत्त्वं शरीरोपकारकरेषु भावेषु ज्ञानमुत्पद्यते| तस्माच्छरीरविचयं प्रशंसन्ति कुशलाः||३||
śarīravicayaḥ śarīrōpakārārthamiṣyatē| jñātvā hi śarīratattvaṁ śarīrōpakārakarēṣu bhāvēṣu jñānamutpadyatē| tasmāccharīravicayaṁ praśaṁsanti kuśalāḥ||3||
sharIravicayaH sharIropakArArthamiShyate| j~jAtvA hi sharIratattvaM sharIropakArakareShu bhAveShu j~jAnamutpadyate| tasmAccharIravicayaM prashaMsanti kushalAH||3||
Gaining this analytical knowledge of the human body helps in improving the well-being of the individual. Only after gaining such knowledge of the body, one can know the factors that are healthy and unhealthy. Hence, the analytical knowledge of the body is advocated by the experts. 
Definition of sharira and disequilibrium in body elements
तत्र शरीरं नाम चेतनाधिष्ठानभूतं पञ्चमहाभूतविकारसमुदायात्मकं समयोगवाहि | यदा ह्यस्मिञ् शरीरे धातवो वैषम्यमापद्यन्ते तदा क्लेशं विनाशं वा प्राप्नोति| वैषम्यगमनं हि पुनर्धातूनां वृध्दिह्रासगमनमकार्त्स्न्येन प्रकृत्या च||४||
tatra śarīraṁ nāma cētanādhiṣṭhānabhūtaṁ pañcamahābhūtavikārasamudāyātmakaṁ samayōgavāhi  | yadā hyasmiñ śarīrē dhātavō vaiṣamyamāpadyantē tadā klēśaṁ vināśaṁ vā prāpnōti| vaiṣamyagamanaṁ hi punardhātūnāṁ vr̥ddhihrāsagamanamakārtsnyēna prakr̥tyā ca||4||
tatra sharIraM nAma cetanAdhiShThAnabhUtaM pa~jcamahAbhUtavikArasamudAyAtmakaM samayogavAhi | yadA hyasmi~j sharIre dhAtavo vaiShamyamApadyante tadA kleshaM vinAshaM vA prApnoti| vaiShamyagamanaM hi punardhAtUnAM vRuddhihrAsagamanamakArtsnyena prakRutyA ca||4||
The body is defined as the site of manifestation of chetana (consciousness) and a union of factors derived from the five mahabhuta in a specific proportion that maintains equilibrium. When the relative proportions of these dhatus become inappropriate, then there is either discomfort or destruction of the body. The change in the relative proportion of the dhatu is either in terms of aggravation or diminution, either partially or completely. 
Factors responsible for increase and decrease of body elements
यौगपद्येन तु विरोधिनां धातूनां वृध्दिह्रासौ भवतः| यध्दि यस्य धातोर्वृध्दिकरं तत्ततो विपरीतगुणस्य धातोः प्रत्यवायकरं सम्पद्यते||५||
yaugapadyēna tu virōdhināṁ dhātūnāṁ vr̥ddhihrāsau bhavataḥ| yaddhi yasya dhātōrvr̥ddhikaraṁ tattatō viparītaguṇasya dhātōḥ pratyavāyakaraṁ sampadyatē||5||
yaugapadyena tu virodhinAM dhAtUnAM vRuddhihrAsau bhavataH| yaddhi yasya dhAtorvRuddhikaraM tattato viparItaguNasya dhAtoH pratyavAyakaraM sampadyate||5||
Dhatus with mutually opposing properties simultaneously undergo increase and decrease. A factor which increases a particular dhatu can prove antagonist for the other dhatu of opposing properties.
Objective of therapy
तदेव तस्माद्भेषजं सम्यगवचार्यमाणं युगपन्न्यूनातिरिक्तानां धातूनां साम्यकरं भवति, अधिकमपकर्षतिन्यूनमाप्याययति||६||
tadēva tasmādbhēṣajaṁ samyagavacāryamāṇaṁ yugapannyūnātiriktānāṁ dhātūnāṁ sāmyakaraṁ bhavati, adhikamapakarṣati nyūnamāpyāyayati||6||
tadeva tasmAdbheShajaM samyagavacAryamANaM yugapannyUnAtiriktAnAM dhAtUnAM sAmyakaraM bhavati, adhikamapakarShati nyUnamApyAyayati||6||
Therefore medical therapies, when properly administered simultaneously, bring both the reduced and increased dhatus to their normal states by reducing the increased ones and increasing the diminished ones.
एतावदेव हि भैषज्यप्रयोगे फलमिष्टं स्वस्थवृत्तानुष्ठाने च यावध्दातूनां साम्यं स्यात्| स्वस्था ह्यपि धातूनां साम्यानुग्रहार्थमेव कुशला रसगुणानाहारविकारांश्च पर्यायेणेच्छन्त्युपयोक्तुं सात्म्यसमाज्ञातान्;एकप्रकारभूयिष्ठांश्चोपयुञ्जानास्तद्विपरीतकरसमाज्ञातया चेष्टया सममिच्छन्ति कर्तुम्||७|
ētāvadēva hi bhaiṣajyaprayōgē phalamiṣṭaṁ svasthavr̥ttānuṣṭhānē ca yāvaddhātūnāṁ sāmyaṁ syāt| svasthā hyapi dhātūnāṁ sāmyānugrahārthamēva kuśalā rasaguṇānāhāravikārāṁśca paryāyēṇēcchantyupayōktuṁ sātmyasamājñātān;ēkaprakārabhūyiṣṭhāṁścōpayuñjānāstadviparītakarasamājñātayā  cēṣṭayā samamicchanti kartum||7||
etAvadeva hi bhaiShajyaprayoge phalamiShTaM svasthavRuttAnuShThAne ca yAvaddhAtUnAM sAmyaM syAt| svasthA hyapi dhAtUnAM sAmyAnugrahArthameva kushalA rasaguNAnAhAravikArAMshca paryAyeNecchantyupayoktuM sAtmyasamAj~jAtAn;ekaprakArabhUyiShThAMshcopayu~jjAnAstadviparItakarasamAj~jAtayA ceShTayA samamicchanti kartum||7||
While administering medicines and also while following regimens for the maintenance of health, the ultimate aim should be to balance the dhatus. Even healthy persons should use the food with different rasa and guna alternately so as to maintain the equilibrium of dhatus. After taking the food dominated by a particular attribute, it is desirable to neutralize its effects with regimens that have opposing attributes. 
Guidelines for sustaining equilibrium
देशकालात्मगुणविपरीतानां हि कर्मणामाहारविकाराणां च क्रियोपयोगः सम्यक्, सर्वातियोगसन्धारणम्,असन्धारणमुदीर्णानां च गतिमतां, साहसानां च वर्जनं, स्वस्थवृत्तमेतावध्दातूनां साम्यानुग्रहार्थमुपदिश्यते||८||
dēśakālātmaguṇaviparītānāṁ hi karmaṇāmāhāravikārāṇāṁ ca kriyōpayōgaḥ samyak, sarvātiyōgasandhāraṇam, asandhāraṇamudīrṇānāṁ ca gatimatāṁ,sāhasānāṁ ca varjanaṁ, svasthavr̥ttamētāvaddhātūnāṁ sāmyānugrahārthamupadiśyatē||8||
deshakAlAtmaguNaviparItAnAM hi karmaNAmAhAravikArANAM ca kriyopayogaH  samyak, sarvAtiyogasandhAraNam, asandhAraNamudIrNAnAM ca gatimatAM,sAhasAnAM ca varjanaM, svasthavRuttametAvaddhAtUnAM sAmyAnugrahArthamupadishyate||8||
For the maintenance of the equilibrium of dhatus, one should follow proper activities and diet having properties opposite to the geographical condition, season and physical constitution of the individual; one should observe proper utilization of (physical and mental) capabilities as well as of available resources like time; One should avoid excess utilization of anything; one should not suppress manifested natural urges and should also avoid working beyond one’s capacity. 
Increase and decrease in body elements
धातवः पुनः शारीराः समानगुणैः समानगुणभूयिष्ठैर्वाऽप्याहारविकारैरभ्यस्यमानैर्वृध्दिं प्राप्नुवन्ति, ह्रासं तुविपरीतगुणैर्विपरीतगुणभूयिष्ठैर्वाऽप्याहारैरभ्यस्यमानैः||९||
dhātavaḥ punaḥ śārīrāḥ samānaguṇaiḥ samānaguṇabhūyiṣṭhairvā'pyāhāravikārairabhyasyamānairvr̥ddhiṁ prāpnuvanti,hrāsaṁ tu viparītaguṇairviparītaguṇabhūyiṣṭhairvā'pyāhārairabhyasyamānaiḥ||9||
dhAtavaH punaH shArIrAH samAnaguNaiH samAnaguNabhUyiShThairvA~apyAhAravikArairabhyasyamAnairvRuddhiM prApnuvanti, hrAsaM tuviparItaguNairviparItaguNabhUyiShThairvA~apyAhArairabhyasyamAnaiH||9||
Dhatus get increased by the habitual use of food preparations which are either of similar attributes or are dominated by such attributes. Habitual use of food having opposite qualities or having elements that are predominantly of opposing qualities reduces the dhatus. 
तत्रेमे शरीरधातुगुणाः संख्यासामर्थ्यकराः; तद्यथा-गुरुलघुशीतोष्णस्निग्धरूक्षमन्दतीक्ष्णस्थिरसरमृदुकठिनविशदपिच्छिलश्लक्ष्णखरसूक्ष्मस्थूलसान्द्रद्रवाः| तेषु ये गुरवस्ते गुरुभिराहारविकारगुणैरभ्यस्यमानैराप्याय्यन्ते, लघवश्च ह्रसन्ति; लघवस्तु लघुभिराप्याय्यन्ते, गुरवश्चह्रसन्ति| एवमेव सर्वधातुगुणानां सामान्ययोगाद्वृध्दि:, विपर्ययादध्द्रासः| तस्मान्मांसमाप्याय्यते मांसेन भूयस्तरमन्येभ्यः शरीरधातुभ्यः, तथा लोहितं लोहितेन, मेदो मेदसा, वसा वसया, अस्थितरुणास्थ्ना, मज्जा मज्ज्ञा, शुक्रं शुक्रेण, गर्भस्त्वामगर्भेण||१०||
tatrēmē śarīradhātuguṇāḥ saṅkhyāsāmarthyakarāḥ; tadyathā-gurulaghuśītōṣṇasnigdharūkṣamandatīkṣṇasthirasaramr̥dukaṭhinaviśadapicchilaślakṣṇakharasūkṣmasthūlasāndradravāḥ| tēṣu yē guravastē gurubhirāhāravikāraguṇairabhyasyamānairāpyāyyantē, laghavaśca hrasanti; laghavastu laghubhirāpyāyyantē, guravaśca hrasanti| ēvamēva sarvadhātuguṇānāṁ sāmānyayōgādvr̥ddhiḥ, viparyayāddhrāsaḥ| tasmānmāṁsamāpyāyyatē māṁsēna bhūyastaramanyēbhyaḥ śarīradhātubhyaḥ, tathā lōhitaṁ lōhitēna, mēdō mēdasā, vasā vasayā, asthi taruṇāsthnā, majjāmajjñā, śukraṁ śukrēṇa, garbhastvāmagarbhēṇa||10||
tatreme sharIradhAtuguNAH sa~gkhyAsAmarthyakarAH; tadyathA-gurulaghushItoShNasnigdharUkShamandatIkShNasthirasaramRudukaThinavishadapicchilashlakShNakharasUkShmasthUlasAndradravAH| teShu ye guravaste gurubhirAhAravikAraguNairabhyasyamAnairApyAyyante, laghavashca hrasanti; laghavastu laghubhirApyAyyante, guravashca hrasanti| evameva sarvadhAtuguNAnAM sAmAnyayogAdvRuddhiH, viparyayAddhrAsaH| tasmAnmAMsamApyAyyate mAMsena bhUyastaramanyebhyaH sharIradhAtubhyaH, tathA lohitaM lohitena, medo medasA, vasA vasayA, asthi taruNAsthnA, majjAmajj~jA, shukraM shukreNa, garbhastvAmagarbheNa||10||
Guru, laghu, sheeta, ushna, snigdha, ruksha, manda, tikshna, sthira, sara, mridu, kathina, vishada, picchila, shlakshna, khara, sukshma, sthula, sandra and drava - these are the twenty attributes of bodily dhatu that increase or decrease. For example, the habitual use of guru food preparations cause an increase in dhatu among them that are guru whilst reducing the laghu dhatu. Conversely, the use of laghu (food preparations) cause the dhatu that are laghu to get increased whilst reducing the guru dhatu.
Thus, the mamsa dhatu get increased predominantly with the consumption of meat, rakta by rakta, meda by fat, vasa by muscle fat, asthi by tarunasthi(cartilage), shukra by shukra(semen) and garbha(fetus) by ama garbha, like egg. 
Management of disequilibrium of body elements
यत्र त्वेवंलक्षणेन सामान्येन सामान्यवतामाहारविकाराणामसान्निध्यं स्यात्, सन्निहितानां वाऽप्ययुक्तत्वान्नोपयोगो घृणित्वादन्यस्माद्वा कारणात्, स च धातुरभिवर्धयितव्यः स्यात्, तस्य ये समानगुणाः स्युराहारविकारा असेव्याश्च, तत्रसमानगुणभूयिष्ठानामन्यप्रकृतीनामप्याहारविकाराणामुपयोगः स्यात्| तद्यथा- शुक्रक्षये क्षीरसर्पिषोरुपयोगो मधुरस्निग्धशीतसमाख्यातानां चापरेषां द्रव्याणां, मूत्रक्षये पुनरिक्षुरसवारुणीमण्डद्रवमधुराम्ललवणोपक्लेदिनां, पुरीषक्षये कुल्माषमाषकुष्कुण्डाजमध्ययवशाकधान्याम्लानां, वातक्षयेकटुकतिक्तकषायरूक्षलघुशीतानां, पित्तक्षयेऽम्ललवणकटुकक्षारोष्णतीक्ष्णानां, श्लेष्मक्षये स्निग्धगुरुमधुरसान्द्रपिच्छिलानां द्रव्याणाम्| कर्मापि यद्यस्य धातोर्वृध्दिकरं तत्तदासेव्यम्| एवमन्येषामपि शरीरधातूनां सामान्यविपर्ययाभ्यां वृध्दिह्रासौ यथाकालं कार्यौ| इति सर्वधातूनामेकैकशोऽतिदेशतश्च वृध्दिह्रासकराणि व्याख्यातानि भवन्ति||११||
yatra tvēvaṁlakṣaṇēna sāmānyēna sāmānyavatāmāhāravikārāṇāmasānnidhyaṁ syāt, sannihitānāṁvā'pyayuktatvānnōpayōgō ghr̥ṇitvādanyasmādvā kāraṇāt, sa ca dhāturabhivardhayitavyaḥ syāt, tasya yē samānaguṇāḥsyurāhāravikārā asēvyāśca, tatra samānaguṇabhūyiṣṭhānāmanyaprakr̥tīnāmapyāhāravikārāṇāmupayōgaḥ syāt| tadyathā- śukrakṣayē kṣīrasarpiṣōrupayōgō madhurasnigdhaśītasamākhyātānāṁ cāparēṣāṁ dravyāṇāṁ, mūtrakṣayēpunarikṣurasavāruṇīmaṇḍadravamadhurāmlalavaṇōpaklēdināṁ, purīṣakṣayēkulmāṣamāṣakuṣkuṇḍājamadhyayavaśākadhānyāmlānāṁ, vātakṣayē kaṭukatiktakaṣāyarūkṣalaghuśītānāṁ,pittakṣayē'mlalavaṇakaṭukakṣārōṣṇatīkṣṇānāṁ, ślēṣmakṣayē snigdhagurumadhurasāndrapicchilānāṁ dravyāṇām| karmāpi yadyasya dhātōrvr̥ddhikaraṁ tattadāsēvyam| ēvamanyēṣāmapi śarīradhātūnāṁ sāmānyaviparyayābhyāṁ vr̥ddhihrāsau yathākālaṁ kāryau| iti sarvadhātūnāmēkaikaśō'tidēśataśca vr̥ddhihrāsakarāṇi vyākhyātāni bhavanti||11||
yatra tvevaMlakShaNena sAmAnyena sAmAnyavatAmAhAravikArANAmasAnnidhyaM syAt, sannihitAnAM vA~apyayuktatvAnnopayogo ghRuNitvAdanyasmAdvAkAraNAt, sa ca dhAturabhivardhayitavyaH syAt, tasya ye samAnaguNAH syurAhAravikArA asevyAshca, tatrasamAnaguNabhUyiShThAnAmanyaprakRutInAmapyAhAravikArANAmupayogaH syAt| tadyathA- shukrakShaye kShIrasarpiShorupayogo madhurasnigdhashItasamAkhyAtAnAM cApareShAM dravyANAM, mUtrakShayepunarikShurasavAruNImaNDadravamadhurAmlalavaNopakledinAM, purIShakShaye kulmAShamAShakuShkuNDAjamadhyayavashAkadhAnyAmlAnAM, vAtakShayekaTukatiktakaShAyarUkShalaghushItAnAM, pittakShaye~amlalavaNakaTukakShAroShNatIkShNAnAM, shleShmakShaye snigdhagurumadhurasAndrapicchilAnAMdravyANAm| karmApi yadyasya dhAtorvRuddhikaraM tattadAsevyam| evamanyeShAmapi sharIradhAtUnAM sAmAnyaviparyayAbhyAM vRuddhihrAsau yathAkAlaM kAryau| iti sarvadhAtUnAmekaikasho~atideshatashca vRuddhihrAsakarANi vyAkhyAtAni bhavanti||11||
If a particular dhatu is to be increased and the dietary articles with similar properties cannot be consumed because of their non-availability or even if available they cannot be used because of unsuitability, intolerable nature or any other cause, then food preparations of different nature having the predominance of the attributes of the dhatu (that needs to be enhanced) should be used. Here are some examples to illustrate this. When there is a deficiency of shukra, milk, ghee and other such substances known to be madhura (sweet), snigdha(unctuous), and sheeta(cold) should be administered. In case of diminution of mutra, sugarcane juice, varuni type of wine, manda (thin gruel), liquid food articles and substances having madhura, lavana,and amla tastes and sticky nature should be administered. For diminution of purisha (feces), kulmasha, masha, kuskund (mushrooms), ajamadhya (meat of abdomen and trunk of goat), yava, shaka (leafy vegetables), and dhanyamla (sour rice gruel) should be given. The diminution of vata should be treated with substances having katu, tikta, and kashaya tastes, and ruksha, laghu and sheeta properties. In case of diminution of pitta, substances having amla, lavana, katu tastes, and ushna and tikshna properties should be administered whereas for diminution of vata, substances having madhura taste, and snigdha, guru, sandra and picchila properties should be administered. The activities which would increase these dhatu should also be followed. Similarly other dhatu should also be either increased or decreased by the administration of similar and dissimilar substances respectively in appropriate time.
Thus, the factors which increase or decrease all the dhatus have been described- some dhatu have been specifically described while for the rest of the dhatus, the same principles should be extended. 
Factors responsible for growth
कार्त्स्न्येन शरीरवृध्दिकरास्त्विमे भावा भवन्ति; तद्यथा- कालयोगः, स्वभावसंसिध्दि:, आहारसौष्ठवम्,अविघातश्चेति||१२||
kārtsnyēna śarīravr̥ddhikarāstvimē bhāvā bhavanti; tadyathā- kālayōgaḥ, svabhāvasaṁsiddhiḥ, āhārasauṣṭhavam,avighātaścēti||12||
kArtsnyena sharIravRuddhikarAstvime bhAvA bhavanti; tadyathA- kAlayogaH, svabhAvasaMsiddhiH, AhArasauShThavam, avighAtashceti||12||
Overall, the following factors are responsible for the growth of the body:
- Favourable time (in terms of age and season): For example, youth is the proper time for the growth of an individual.
- Natural tendencies: For example, favourable natural tendency for growth of an individual’s body (these factors may be unseen).
- Observance of all rule of taking diet of good quality.
- Absence of inhibiting factors for growth i.e. not indulging one in improper, less or excess utilization 
Factors responsible for strength
बलवृध्दिकरास्त्विमे भावा भवन्ति| तद्यथा- बलवत्पुरुषे देशे जन्म बलवत्पुरुषे काले च, सुखश्च कालयोगः, बीजक्षेत्रगुणसंपच्च, आहारसंपच्च, शरीरसंपच्च,सात्म्यसंपच्च, सत्त्वसंपच्च, स्वभावसंसिध्दिश्च, यौवनं च, कर्म च, संहर्षश्चेति||१३||
balavr̥ddhikarāstvimē bhāvā bhavanti| tadyathā- balavatpuruṣē dēśē janma balavatpuruṣē kālē ca, sukhaśca kālayōgaḥ, bījakṣētraguṇasampacca,āhārasampacca, śarīrasampacca, sātmyasampacca, sattvasampacca, svabhāvasaṁsiddhiśca, yauvanaṁ ca, karma ca,saṁharṣaścēti||13||
balavRuddhikarAstvime bhAvA bhavanti| tadyathA- balavatpuruShe deshe janma balavatpuruShe kAle ca, sukhashca kAlayogaH, bIjakShetraguNasampacca, AhArasampacca, sharIrasampacca,sAtmyasampacca, sattvasampacca, svabhAvasaMsiddhishca, yauvanaM ca, karma ca, saMharShashceti||13||
The following factors are responsible for enhancing strength:
- Birth in a geographical region where people are naturally strong
- Birth in a race of strong people
- Birth at a time when people naturally gain strength
- Favorable disposition of time
- Excellence of beeja (sperm and ovum) and kshetra (uterus) qualities
- Excellence of ingested food
- Excellence of physique
- Excellence of satmya (adaptability to various factors responsible for the maintenance of the body)
- Excellence of mind qualities
- Natural tendency
- Cheerful nature 
Factors responsible for transformation of food
आहारपरिणामकरास्त्विमे भावा भवन्ति| तद्यथा- ऊष्मा, वायुः, क्लेदः, स्नेहः, कालः, समयोगश्चेति ||१४||
āhārapariṇāmakarāstvimē bhāvā bhavanti| tadyathā- ūṣmā, vāyuḥ, klēdaḥ, snēhaḥ, kālaḥ, samayōgaścēti ||14||
AhArapariNAmakarAstvime bhAvA bhavanti| tadyathA- UShmA, vAyuH, kledaH, snehaH, kAlaH, samayogashceti ||14||
Factors responsible for transformation (digestion, assimilation and metabolism) of food are ushma, vayu, kleda, sneha, kala (time required for digestion) and samayoga (appropriate administration). 
तत्र तु खल्वेषामूष्मादीनामाहारपरिणामकराणां भावानामिमे कर्मविशेषा भवन्ति| तद्यथा- ऊष्मा पचति, वायुरपकर्षति, क्लेदः शैथिल्यमापादयति, स्नेहो मार्दवं जनयति, कालः पर्याप्तिमभिनिर्वर्तयति,समयोगस्त्वेषां परिणामधातुसाम्यकरः सम्पद्यते||१५||
tatra tu khalvēṣāmūṣmādīnāmāhārapariṇāmakarāṇāṁ bhāvānāmimē karmaviśēṣā bhavanti| tadyathā- ūṣmā pacati, vāyurapakarṣati, klēdaḥ śaithilyamāpādayati, snēhō mārdavaṁ janayati, kālaḥparyāptimabhinirvartayati, samayōgastvēṣāṁ pariṇāmadhātusāmyakaraḥ sampadyatē||15||
tatra tu khalveShAmUShmAdInAmAhArapariNAmakarANAM bhAvAnAmime karmavisheShA bhavanti| tadyathA- UShmA pacati, vAyurapakarShati, kledaH shaithilyamApAdayati, sneho mArdavaM janayati, kAlaH paryAptimabhinirvartayati, samayogastveShAMpariNAmadhAtusAmyakaraH sampadyate||15||
Factors that are responsible for transformation (digestion, assimilation and metabolism) of food (mentioned in the preceding verse), perform the following specific actions:
- Ushma (in the form of pitta) digests the food
- Vata transports the food for digestion
- Kleda loosens the food particles
- Sneha makes the ingredients softer
- Kala indicates duration which is required to complete the digestion
- Appropriate administration of food brings about equilibrium of dhatu. 
परिणमतस्त्वाहारस्य गुणाः शरीरगुणभावमापद्यन्ते यथास्वमविरुध्दा: ; विरुध्दाश्च विहन्युर्विहताश्च विरोधिभिःशरीरम्||१६||
pariṇamatastvāhārasya guṇāḥ śarīraguṇabhāvamāpadyantē yathāsvamaviruddhāḥ; viruddhāśca vihanyurvihatāścavirōdhibhiḥ śarīram||16||
pariNamatastvAhArasya  guNAH sharIraguNabhAvamApadyante yathAsvamaviruddhAH; viruddhAshca vihanyurvihatAshca virodhibhiH sharIram||16||
The attributes of the food ingredients assume the attributes of (or become homologous with) the tissue elements of the body during the process of transformation. These are not contradictory in nature. Whereas when they are contradictory, the properties of one act against the other resulting in the destruction of the body.
Categories of attributes
शरीरगुणाः पुनर्व्दिविधाः संग्र्हेण- मलभूताः, प्रसादभूताश्च| तत्र मलभूतास्ते ये शरीरस्याबाधकराः स्युः| तद्यथा- शरीरच्छिद्रेषूपदेहाः पृथग्जन्मानो बहिर्मुखाः, परिपक्वाश्च धातवः, प्रकुपिताश्च वातपित्तश्लेष्माणः, ये चान्येऽपिकेचिच्छरीरे तिष्ठन्तो भावाः शरीरस्योपघातायोपपद्यन्ते, सर्वांस्तान्मले संचक्ष्महे; इतरांस्तु प्रसादे , गुर्वादींश्चद्रवान्तान् गुणभेदेन, रसादींश्च शुक्रान्तान् द्रव्यभेदेन||१७||
śarīraguṇāḥ  punardvividhāḥ saṅgrahēṇa- malabhūtāḥ, prasādabhūtāśca| tatra malabhūtāstē yē śarīrasyābādhakarāḥ syuḥ| tadyathā- śarīracchidrēṣūpadēhāḥ pr̥thagjanmānō bahirmukhāḥ, paripakvāśca dhātavaḥ, prakupitāścavātapittaślēṣmāṇaḥ, yē cānyē'pi kēciccharīrē tiṣṭhantō bhāvāḥ śarīrasyōpaghātāyōpapadyantē, sarvāṁstānmalē sañcakṣmahē; itarāṁstu prasādē  , gurvādīṁśca dravāntān guṇabhēdēna, rasādīṁśca śukrāntān dravyabhēdēna||17||
sharIraguNAH punardvividhAH sa~ggraheNa- malabhUtAH, prasAdabhUtAshca| tatra malabhUtAste ye sharIrasyAbAdhakarAH syuH| tadyathA- sharIracchidreShUpadehAH pRuthagjanmAno bahirmukhAH, paripakvAshca dhAtavaH, prakupitAshca vAtapittashleShmANaH, ye cAnye~api keciccharIretiShThanto bhAvAH sharIrasyopaghAtAyopapadyante, sarvAMstAnmale sa~jcakShmahe; itarAMstu prasAde , gurvAdIMshca dravAntAn guNabhedena,rasAdIMshca shukrAntAn dravyabhedena||17||
The attributes of the body are of two categories viz. prasada (nourishing factors) and mala (body wastes). Of these, the body wastes afflict the body with pain. These impurities stick to the various orifices inside the body. These are either paripakva dhatu (mature tissue elements of the body) or vitiated vata, pitta and kapha doshas which while existing in the body cause its destruction.
All the remaining are prasada (building blocks). Further, they are classified into twenty categories on the basis of their guna (attributes), beginning with gurutva and ending with dravatva and also seven types of tissues (dravya bheda), beginning with rasa and ending with shukra. 
तेषां सर्वेषामेव वातपित्तश्लेष्माणो दुष्टा दूषयितारो भवन्ति, दोषस्वभावात्| वातादीनां पुनर्धात्वन्तरे कालान्तरे प्रदुष्टानां विविधाशितपीतीयेऽध्याये विज्ञानान्युक्तानि| एतावत्येव दुष्टदोषगतिर्यावत् संस्पर्शनाच्छरीरधातूनाम्| प्रकृतिभूतानां तु खलु वातादीनां फलमारोग्यम्| तस्मादेषां प्रकृतिभावे प्रयतितव्यं बुध्दिमद्भ्दिरिति||१८||
tēṣāṁ sarvēṣāmēva vātapittaślēṣmāṇō duṣṭā dūṣayitārō bhavanti, dōṣasvabhāvāt| vātādīnāṁ punardhātvantarē kālāntarē praduṣṭānāṁ vividhāśitapītīyē'dhyāyē vijñānānyuktāni| ētāvatyēva duṣṭadōṣagatiryāvat saṁsparśanāccharīradhātūnām| prakr̥tibhūtānāṁ tu khalu vātādīnāṁ phalamārōgyam| tasmādēṣāṁ prakr̥tibhāvē prayatitavyaṁ buddhimadbhiriti||18||
teShAM sarveShAmeva vAtapittashleShmANo duShTA dUShayitAro bhavanti, doShasvabhAvAt| vAtAdInAM punardhAtvantare kAlAntare praduShTAnAM vividhAshitapItIye~adhyAye vij~jAnAnyuktAni| etAvatyeva duShTadoShagatiryAvat saMsparshanAccharIradhAtUnAm| prakRutibhUtAnAM tu khalu vAtAdInAM phalamArogyam| tasmAdeShAM prakRutibhAve prayatitavyaM buddhimadbhiriti||18||
Of all these, the three doshas are, by their very nature, vitiators that, when vitiated (by extraneous factors), vitiate other (doshas and dhatus) in the body. Signs and symptoms of the vitiation of various dhatus in different times have already been described (Cha.Su 28). Such are the manifestations of the vitiated dosha when they come in contact with the tissue elements of the body. When in normal state, the doshas maintain the health of the individual. Hence, the wise man should try to keep them in normal state. 
भवति चात्र- शरीरं सर्वथा सर्वं सर्वदा वेद यो भिषक्| आयुर्वेदं स कार्त्स्न्येन वेद लोकसुखप्रदम्||१९||
bhavati cātra- śarīraṁ sarvathā sarvaṁ sarvadā vēda yō bhiṣak| āyurvēdaṁ sa kārtsnyēna vēda lōkasukhapradam||19||
bhavati cAtra- sharIraM sarvathA sarvaM sarvadA veda yo bhiShak| AyurvedaM sa kArtsnyena veda lokasukhapradam||19||
The physician who is always well versed with the various aspects of the entire body is highly proficient in Ayurveda, and therefore can bring about happiness to the universe. 
Questions by Agnivesha
एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच श्रुतमेतद्यदुक्तं भगवता शरीराधिकारे वचः| किन्नु खलु गर्भस्याङ्गं पूर्वमभिनिर्वर्तते कुक्षौ, कुतो मुखः कथं चान्तर्गतस्तिष्ठति, किमाहारश्च वर्तयति, कथम्भूतश्चनिष्क्रामति, कैश्चायमाहारोपचारैर्जातः सद्यो हन्यते, कैरव्याधिरभिवर्धते, किं चास्य देवादिप्रकोपनिमित्ता विकाराःसम्भवन्ति आहोस्विन्न, किंचास्य कालाकालमृत्य्वोर्भावाभावयोर्भगवानध्यवस्यति, किंचास्य परमायुः, कानि चास्यपरमायुषो निमित्तानीति||२०||
ēvaṁvādinaṁ bhagavantamātrēyamagnivēśa uvāca śrutamētadyaduktaṁ bhagavatā śarīrādhikārē vacaḥ| kinnu khalu garbhasyāṅgaṁ pūrvamabhinirvartatē kukṣau, kutō mukhaḥ kathaṁ cāntargatastiṣṭhati, kimāhāraścavartayati, kathambhūtaśca niṣkrāmati, kaiścāyamāhārōpacārairjātaḥ sadyō hanyatē, kairavyādhirabhivardhatē, kiñcāsyadēvādiprakōpanimittā vikārāḥ sambhavanti āhōsvinna, kiñcāsya kālākālamr̥tyvōrbhāvābhāvayōrbhagavānadhyavasyati,kiñcāsya paramāyuḥ, kāni cāsya paramāyuṣō nimittānīti||20||
evaMvAdinaM bhagavantamAtreyamagnivesha uvAca shrutametadyaduktaM bhagavatA sharIrAdhikAre vacaH| kinnu khalu garbhasyA~ggaM pUrvamabhinirvartate kukShau, kuto mukhaH kathaM cAntargatastiShThati, kimAhArashca vartayati, kathambhUtashca niShkrAmati,kaishcAyamAhAropacArairjAtaH sadyo hanyate, kairavyAdhirabhivardhate, ki~jcAsya devAdiprakopanimittA vikArAH sambhavanti Ahosvinna, ki~jcAsyakAlAkAlamRutyvorbhAvAbhAvayorbhagavAnadhyavasyati, ki~jcAsya paramAyuH, kAni cAsya paramAyuSho nimittAnIti||20||
After listening to the above deliberations by Lord Atreya, Agnivesha said, “Now we would like to hear the following:
- Which of the organs of the foetus is manifested first in the womb of the mother?
- Where does the face of the foetus lie and what posture does it maintain inside?
- Which food nourishes it and how does it come out?
- Which food and regimens are responsible for its immediate death after the delivery process?
- What factors help in the growth of the foetus without any disease?
- Are there afflictions of diseases caused by Gods or divinities? Or not? (idiopathic)
- What is your opinion regarding the existence or non-existence of the child’s timely or untimely death?
- What is the span of its life?
- What are the factors which are responsible for the maintenance of its life span? 
Different views regarding origin of foetus
तमेवमुक्तवन्तमग्निवेशं भगवान् पुनर्वसुरात्रेय उवाच- पूर्वमुक्तमेतद्गर्भावक्रान्तौ यथाऽयमभिनिर्वर्तते कुक्षौ, यच्चास्य यदासंतिष्ठतेऽङ्गजातम्| विप्रतिवादास्त्वत्र बहुविधाः सूत्रकृतामृषीणां सन्ति सर्वेषां; तानपि निबोधोच्यमानान्- शिरः पूर्वमभिनिर्वर्तते कुक्षावितिकुमारशिरा भरव्दाजः पश्यति, सर्वेन्द्रियाणां तदधिष्ठानमिति कृत्वा; हृदयमिति काङ्कायनो बाह्लीकभिषक्,चेतनाधिष्ठानत्वात्; नाभिरिति भद्रकाप्यः, आहारागम इति कृत्वा; पक्वाशयगुदमिति भद्रशौनकः, मारुताधिष्ठानत्वात्;हस्तपादमिति बडिशः, तत्करणत्वात् पुरुषस्य; इन्द्रियाणीति जनको वैदेहः, तान्यस्य बुध्द्याधिष्ठानानीति कृत्वा;परोक्षत्वादचिन्त्यमिति मारीचिः कश्यपः; सर्वाङ्गाभिनिर्वृत्तिर्युगपदिति धन्वन्तरिः; तदुपपन्नं, सर्वाङ्गानांतुल्यकालाभिनिर्वृत्तत्वाध्दृदयप्रभृतीनाम्| सर्वाङ्गानां ह्यस्य हृदयं मूलमधिष्ठानं च केषाञ्चिद्भावानाम्, नच तस्मात् पूर्वाभिनिर्वृत्तिरेषां; तस्माध्दृदयप्रभृतीनां सर्वाङ्गानां तुल्यकालाभिनिर्वृत्तिः, सर्वे भावा ह्यन्योन्यप्रतिबध्दा:; तस्माद्यथाभूतदर्शनं साधु||२१||
tamēvamuktavantamagnivēśaṁ bhagavān punarvasurātrēya uvāca- pūrvamuktamētadgarbhāvakrāntauyathā'yamabhinirvartatē kukṣau, yaccāsya yadā santiṣṭhatē'ṅgajātam| viprativādāstvatra bahuvidhāḥ sūtrakr̥tāmr̥ṣīṇāṁ santi sarvēṣāṁ; tānapi nibōdhōcyamānān- śiraḥ pūrvamabhinirvartatēkukṣāviti kumāraśirā bharadvājaḥ paśyati, sarvēndriyāṇāṁ tadadhiṣṭhānamiti kr̥tvā; hr̥dayamiti kāṅkāyanō bāhlīkabhiṣak,cētanādhiṣṭhānatvāt; nābhiriti bhadrakāpyaḥ, āhārāgama iti kr̥tvā; pakvāśayagudamiti bhadraśaunakaḥ,mārutādhiṣṭhānatvāt; hastapādamiti baḍiśaḥ, tatkaraṇatvāt puruṣasya; indriyāṇīti janakō vaidēhaḥ, tānyasyabuddhyadhiṣṭhānānīti kr̥tvā; parōkṣatvādacintyamiti mārīciḥ kaśyapaḥ; sarvāṅgābhinirvr̥ttiryugapaditi dhanvantariḥ;tadupapannaṁ, sarvāṅgānāṁ tulyakālābhinirvr̥ttatvāddhr̥dayaprabhr̥tīnām| sarvāṅgānāṁ hyasya hr̥dayaṁ mūlamadhiṣṭhānaṁ ca kēṣāñcidbhāvānām, naca tasmāt pūrvābhinirvr̥ttirēṣāṁ;tasmāddhr̥dayaprabhr̥tīnāṁ sarvāṅgānāṁ tulyakālābhinirvr̥ttiḥ, sarvē bhāvā hyanyōnyapratibaddhāḥ;tasmādyathābhūtadarśanaṁ sādhu||21||
tamevamuktavantamagniveshaM bhagavAn punarvasurAtreya uvAca- pUrvamuktametadgarbhAvakrAntau yathA~ayamabhinirvartate kukShau, yaccAsya yadAsantiShThate~a~ggajAtam| viprativAdAstvatra bahuvidhAH sUtrakRutAmRuShINAM santi sarveShAM; tAnapi nibodhocyamAnAn- shiraH pUrvamabhinirvartate kukShAviti kumArashirAbharadvAjaH pashyati, sarvendriyANAM tadadhiShThAnamiti kRutvA; hRudayamiti kA~gkAyano bAhlIkabhiShak, cetanAdhiShThAnatvAt; nAbhiriti bhadrakApyaH,AhArAgama iti kRutvA; pakvAshayagudamiti bhadrashaunakaH, mArutAdhiShThAnatvAt; hastapAdamiti baDishaH, tatkaraNatvAt puruShasya; indriyANIti janakovaidehaH, tAnyasya buddhyadhiShThAnAnIti kRutvA; parokShatvAdacintyamiti mArIciH kashyapaH; sarvA~ggAbhinirvRuttiryugapaditi dhanvantariH; tadupapannaM,sarvA~ggAnAM tulyakAlAbhinirvRuttatvAddhRudayaprabhRutInAm| sarvA~ggAnAM hyasya hRudayaM mUlamadhiShThAnaM ca keShA~jcidbhAvAnAm, naca tasmAt pUrvAbhinirvRuttireShAM; tasmAddhRudayaprabhRutInAM sarvA~ggAnAM tulyakAlAbhinirvRuttiH, sarve bhAvA hyanyonyapratibaddhAH; tasmAdyathAbhUtadarshanaM sAdhu||21||
Lord Atreya’s reply to Agnivesha is already well described in the fourth chapter of the Sharira Sthana dealing with the formation of embryo, detailing the manner in which the foetus is formed in the uterus of the mother and the mode of manifestation of its various organs. However, there are various controversies on this subject, which are listed below:
- Kumarashira Bharadvaja observed that the head of the foetus is first manifested in the uterus because it is the seat/base of all sense organs.
- According to Kankayana, the physician from Bahlika, heart being the seat of chetana, consciousness is the first to be formed.
- According to Bhadrakapya, nabhi (umbilicus) is first formed as it serves to provide nourishment to the fetus.
- According to Bhadrashaunaka, rectum located near the colon is first formed as it is the site for vata.
- According to Badisha, hands and feet are first formed being the instruments of individual for his activities.
- According to Janaka of Videha, sense organs being the seat of senses are first formed.
- Marichi Kashyapa is of the view that is not possible to make any statement about first formation of any organs as they cannot be observed directly.
- Dhanvantari is of the view that all organs are formed simultaneously.
Of these, the view of Dhanvantari seems to be correct as all the organs like heart etc. are formed at the same time. Since the heart is the origin of all organs and also serves as developmental origin of certain organs, it is less likely that development of other organs precedes the formation of heart. Hence, it is evident that all organs are formed simultaneously. All organs are connected to each other. Hence the view of Dhanvantari seems to be quite correct. 
Position of foetus
गर्भस्तु खलु मातुः पृष्ठाभिमुख ऊर्ध्वशिराः सङ्कुच्याङ्गान्यास्तेऽन्तःकुक्षौ ||२२||
garbhastu khalu mātuḥ pr̥ṣṭhābhimukha ūrdhvaśirāḥ saṅkucyāṅgānyāstē'ntaḥkukṣau ||22||
garbhastu khalu mAtuH pRuShThAbhimukha UrdhvashirAH sa~gkucyA~ggAnyAste~antaHkukShau ||22||
The foetus lies in the uterus with its face towards the back of the mother, head upwards and the limbs folded. 
व्यपगतपिपासाबुभुक्षस्तु खलु गर्भः परतन्त्रवृत्तिर्मातरमाश्रित्य वर्तयत्युपस्नेहोपस्वेदाभ्यां गर्भाशये सदसभ्दूताङ्गावयवः,तदनन्तरं ह्यस्य कश्चिल्लोमकूपायनैरुपस्नेहः कश्चिन्नाभिनाड्ययनैः| नाभ्यां ह्यस्य नाडी प्रसक्ता, नाड्यां चापरा, अपरा चास्य मातुः प्रसक्ता हृदये, मातृहृदयं ह्यस्य तामपरामभिसम्प्लवतेसिराभिः स्यन्दमानाभिः; स तस्य रसो बलवर्णकरः सम्पद्यते, स च सर्वरसवानाहारः| स्त्रिया ह्यापन्नगर्भायास्त्रिधा रसः प्रतिपद्यते- स्वशरीरपुष्टये, स्तन्याय, गर्भवृध्दये च| स तेनाहारेणोपष्टब्धः (परतन्त्रवृत्तिर्मातरमाश्रित्य ) वर्तयत्यन्तर्गतः||२३||
vyapagatapipāsābubhukṣastu khalu garbhaḥ paratantravr̥ttirmātaramāśritya vartayatyupasnēhōpasvēdābhyāṁgarbhāśayē sadasadbhūtāṅgāvayavaḥ, tadanantaraṁ hyasya kaścillōmakūpāyanairupasnēhaḥ kaścinnābhināḍyayanaiḥ| nābhyāṁ hyasya nāḍī prasaktā, nāḍyāṁ cāparā, aparā cāsya mātuḥ prasaktā hr̥dayē, mātr̥hr̥dayaṁ hyasyatāmaparāmabhisamplavatē sirābhiḥ syandamānābhiḥ ; sa tasya rasō balavarṇakaraḥ sampadyatē, sa casarvarasavānāhāraḥ| striyā hyāpannagarbhāyāstridhā rasaḥ pratipadyatē- svaśarīrapuṣṭayē, stanyāya, garbhavr̥ddhayē ca| sa tēnāhārēṇōpaṣṭabdhaḥ (paratantravr̥ttirmātaramāśritya) vartayatyantargataḥ||23||
vyapagatapipAsAbubhukShastu khalu garbhaH paratantravRuttirmAtaramAshritya vartayatyupasnehopasvedAbhyAM garbhAshaye sadasadbhUtA~ggAvayavaH,tadanantaraM hyasya kashcillomakUpAyanairupasnehaH kashcinnAbhinADyayanaiH| nAbhyAM hyasya nADI prasaktA, nADyAM cAparA, aparA cAsya mAtuH prasaktA hRudaye, mAtRuhRudayaM hyasya tAmaparAmabhisamplavate sirAbhiHsyandamAnAbhiH ; sa tasya raso balavarNakaraH sampadyate, sa ca sarvarasavAnAhAraH| striyA hyApannagarbhAyAstridhA rasaH pratipadyate- svasharIrapuShTaye, stanyAya, garbhavRuddhaye ca| sa tenAhAreNopaShTabdhaH (paratantravRuttirmAtaramAshritya) vartayatyantargataH||23||
The foetus is free from thirst and hunger. It is dependent upon the mother for all its activities. Its manifested and non-manifested organs get nourishment by the process of upasneha (perfusion) and upasweda (thermal regulation). It gets nourishment by the process of perfusion- sometimes through the hair follicles and sometimes through the umbilical cord. The umbilical cord of the fetus is attached to the umbilicus on one end and the placenta on the other end. The placenta is in turn connected with the heart (circulatory system) of the mother. The heart of the mother floods the placenta (with nourishment) through the pulsating vessels. This rasa (nutritive fluid) promotes strength and complexion of the fetus as it is composed of material having all six rasa (tastes).
Rasa (digestive product of food) of the pregnant woman serves three purposes viz.
- Nourishment of her own body
- Lactation and
- Growth of the fetus
Being supported by that food, the foetus that is dependent upon the mother keeps living inside (the uterus). 
स चोपस्थितकाले जन्मनि प्रसूतिमारुतयोगात् परिवृत्त्यावाक् शिरा निष्क्रामत्यपत्यपथेन, एषा प्रकृतिः, विकृतिःपुनरतोऽन्यथा| परं त्वतः स्वतन्त्रवृत्तिर्भवति||२४||
sa cōpasthitakālē janmani prasūtimārutayōgāt parivr̥ttyāvākśirā niṣkrāmatyapatyapathēna, ēṣā prakr̥tiḥ, vikr̥tiḥpunaratō'nyathā| paraṁ tvataḥ svatantravr̥ttirbhavati||24||
sa copasthitakAle janmani prasUtimArutayogAt parivRuttyAvAkshirA niShkrAmatyapatyapathena, eShA prakRutiH, vikRutiH punarato~anyathA| paraM tvataH svatantravRuttirbhavati||24||
During a normal labor, the fetus turns its head downwards by virtue of the prasuti maruta (vayu, which regulates the process of delivery) and gets delivered through the vaginal path. Any deviation in this process constitutes abnormality. After delivery, the child starts behaving independently. 
तस्याहारोपचारौ जातिसूत्रीयोपदिष्टावविकारकरौ चाभिवृध्दिकरौ भवतः||२५||
ताभ्यामेव च विषमसेविताभ्यां जातः सद्य उपहन्यते तरुरिवाचिरव्यपरोपितो वातातपाभ्यामप्रतिष्ठितमूलः||२६||
tasyāhārōpacārau jātisūtrīyōpadiṣṭāvavikārakarau cābhivr̥ddhikarau bhavataḥ||25||
tābhyāmēva ca viṣamasēvitābhyāṁ jātaḥ sadya upahanyatē tarurivāciravyaparōpitōvātātapābhyāmapratiṣṭhitamūlaḥ||26||
tasyAhAropacArau jAtisUtrIyopadiShTAvavikArakarau cAbhivRuddhikarau bhavataH||25||
tAbhyAmeva ca viShamasevitAbhyAM jAtaH sadya upahanyate tarurivAciravyaparopito vAtAtapAbhyAmapratiShThitamUlaH||26||
The diet and regimen mentioned in the eighth chapter of this section, if adopted, promotes the growth of fetus without causing any disorder.
The same diet and regimens inappropriately administered might destroy the fetus immediately after birth as the wind and sun destroy a newly planted tree whose roots are not yet firmly established. [25-26]
आप्तोपदेशादद्भुतरूपदर्शनात् समुत्थानलिङ्गचिकित्सितविशेषाच्चादोषप्रकोपानुरूपा देवादिप्रकोपनिमित्ता विकाराःसमुपलभ्यन्ते||२७||
āptōpadēśādadbhutarūpadarśanāt samutthānaliṅgacikitsitaviśēṣāccādōṣaprakōpānurūpā dēvādiprakōpanimittā vikārāḥsamupalabhyantē||27||
AptopadeshAdadbhutarUpadarshanAt samutthAnali~ggacikitsitavisheShAccAdoShaprakopAnurUpA devAdiprakopanimittA vikArAH samupalabhyante||27||
The displeasure of the Gods (supernatural powers) can also cause diseases and this can be established with the following evidence:
- Authoritative statements by peers
- Some unbelievable experiences like super-natural strength, knowledge, charm etc.
- (Unexplainable) nature, etiology, signs, symptoms and treatment of certain diseases which do not have any basis corresponding to the aggravation of any of these dosha. 
Timely and untimely death
कालाकालमृत्य्वोस्तु खलु भावाभावयोरिदमध्यवसितं नः- “यः कश्चिन् म्रियते स काल एव म्रियते, न हि कालच्छिद्रमस्ति”इत्येके भाषन्ते| तच्चासम्यक्| न ह्यच्छिद्रता सच्छिद्रता वा कालस्योपपद्यते, कालस्वलक्षणस्वभावात्| तत्राहुरपरे- यो यदा म्रियते स तस्य नियतो मृत्युकालः; स सर्वभूतानां सत्यः, समक्रियत्वादिति| एतदपि चान्यथाऽर्थग्रहणम्| न हि कश्चिन्न म्रियत इति समक्रियः| कालो ह्यायुषः प्रमाणमधिकृत्योच्यते| यस्य चेष्टं यो यदा म्रियते स तस्य मृत्युकाल इति, तस्य सर्वे भावा यथास्वं नियतकाला भविष्यन्ति; तच्च नोपपद्यते, प्रत्यक्षंह्यकालाहारवचनकर्मणां फलमनिष्टं, विपर्यये चेष्टं; प्रत्यक्षतश्चोपलभ्यते खलु कालाकालव्यक्तिस्तासु तास्ववस्थासु तंतमर्थमभिसमीक्ष्य, तद्यथा- कालोऽयमस्य व्याधेराहारस्यौषधस्य प्रतिकर्मणो विसर्गस्य, अकालो वेति| लोकेऽप्येतभ्दवति- काले देवो वर्षत्यकाले देवो वर्षति, काले शीतमकाले शीतं, काले तपत्यकाले तपति, काले पुष्पफलमकाले चपुष्पफलमिति| तस्मादुभयमस्ति- काले मृत्युरकाले च; नैकान्तिकमत्र| यदि ह्यकाले मृत्युर्न स्यान्नियतकालप्रमाणमायुः सर्वं स्यात्; एवं गते हिताहितज्ञानमकारणं स्यात्,प्रत्यक्षानुमानोपदेशाश्चाप्रमाणानि स्युर्ये प्रमाणभूताः सर्वतन्त्रेषु, यैरायुष्याण्यनायुष्याणि चोपलभ्यन्ते| वाग्वस्तुमात्रमेतद्वादमृषयो मन्यन्ते- नाकाले मृत्युरस्तीति||२८||
kālākālamr̥tyvōstu khalu bhāvābhāvayōridamadhyavasitaṁ naḥ- “yaḥ kaścin mriyatē sa kāla ēva mriyatē, na hikālacchidramasti” ityēkē bhāṣantē| taccāsamyak| na hyacchidratā sacchidratā vā kālasyōpapadyatē, kālasvalakṣaṇasvabhāvāt| tatrāhuraparē- yō yadā mriyatē sa tasya niyatō mr̥tyukālaḥ; sa sarvabhūtānāṁ satyaḥ, samakriyatvāditi| ētadapi cānyathā'rthagrahaṇam| na hi kaścinna mriyata iti samakriyaḥ| kālō hyāyuṣaḥ pramāṇamadhikr̥tyōcyatē| yasya cēṣṭaṁ yō yadā mriyatē sa tasya mr̥tyukāla iti, tasya sarvē bhāvā yathāsvaṁ niyatakālā bhaviṣyanti; taccanōpapadyatē, pratyakṣaṁ hyakālāhāravacanakarmaṇāṁ phalamaniṣṭaṁ, viparyayē cēṣṭaṁ; pratyakṣataścōpalabhyatēkhalu kālākālavyaktistāsu tāsvavasthāsu taṁ tamarthamabhisamīkṣya, tadyathā- kālō'yamasyavyādhērāhārasyauṣadhasya pratikarmaṇō visargasya, akālō vēti| lōkē'pyētadbhavati- kālē dēvō varṣatyakālē dēvō varṣati, kālē śītamakālē śītaṁ, kālē tapatyakālē tapati, kālēpuṣpaphalamakālē ca puṣpaphalamiti| tasmādubhayamasti- kālē mr̥tyurakālē ca; naikāntikamatra| yadi hyakālē mr̥tyurna syānniyatakālapramāṇamāyuḥ sarvaṁ syāt; ēvaṁ gatē hitāhitajñānamakāraṇaṁ syāt,pratyakṣānumānōpadēśāścāpramāṇāni syuryē pramāṇabhūtāḥ sarvatantrēṣu, yairāyuṣyāṇyanāyuṣyāṇi cōpalabhyantē| vāgvastumātramētadvādamr̥ṣayō manyantē- nākālē mr̥tyurastīti||28||
kAlAkAlamRutyvostu khalu bhAvAbhAvayoridamadhyavasitaM naH- “yaH kashcin mriyate sa kAla eva mriyate, na hi kAlacchidramasti” ityeke bhAShante| taccAsamyak| na hyacchidratA sacchidratA vA kAlasyopapadyate, kAlasvalakShaNasvabhAvAt| tatrAhurapare- yo yadA mriyate sa tasya niyato mRutyukAlaH; sa sarvabhUtAnAM satyaH, samakriyatvAditi| etadapi cAnyathA~arthagrahaNam| na hi kashcinna mriyata iti samakriyaH| kAlo hyAyuShaH pramANamadhikRutyocyate| yasya ceShTaM yo yadA mriyate sa tasya mRutyukAla iti, tasya sarve bhAvA yathAsvaM niyatakAlA bhaviShyanti; tacca nopapadyate, pratyakShaMhyakAlAhAravacanakarmaNAM phalamaniShTaM, viparyaye ceShTaM; pratyakShatashcopalabhyate khalu kAlAkAlavyaktistAsu tAsvavasthAsu taMtamarthamabhisamIkShya, tadyathA- kAlo~ayamasya vyAdherAhArasyauShadhasya pratikarmaNo visargasya, akAlo veti| loke~apyetadbhavati- kAle devo varShatyakAle devo varShati, kAle shItamakAle shItaM, kAle tapatyakAle tapati, kAle puShpaphalamakAle ca puShpaphalamiti| tasmAdubhayamasti- kAle mRutyurakAle ca; naikAntikamatra| yadi hyakAle mRutyurna syAnniyatakAlapramANamAyuH sarvaM syAt; evaM gate hitAhitaj~jAnamakAraNaM syAt, pratyakShAnumAnopadeshAshcApramANAnisyurye pramANabhUtAH sarvatantreShu, yairAyuShyANyanAyuShyANi copalabhyante| vAgvastumAtrametadvAdamRuShayo manyante- nAkAle mRutyurastIti||28||
Our opinion on the existence and non-existence of timely and untimely death is as follows: Some scholars opine that ‘Whosoever dies, dies on time since time has no void’. However, this is not correct. Time has neither void nor absence of void. Time has a distinct feature of its own which does not admit any void or absence thereof in its definition. Some others say ‘whenever one dies, he dies at the scheduled, or pre-destined hour of death’. Being free from hatred or attachment (and therefore unbiased), time deals equally with all creatures (so death always occurs at the predestined moment)’. This also is simply a distortion of facts. The universal fact of equality is that there is no one who is not going to die. Time is always construed in relation to the standard span of life. If it is said that the time when one dies is the time predetermined for his death, then every movement of life as and when it occurs can be taken as pre- determined in respect of time. However, this also is not true as it is seen that inappropriate food, speech and activities lead to undesirable effects and if these factors are rectified appropriately, desirable effects are seen.
One can also observe by means of pratyaksha (direct perception), manifestation of various factors depending upon their timely or untimely action. For example, such and such diseases, food, medicine, therapy and remission (can act timely or untimely). Even a layman talks in these terms, such as, it rains on time or otherwise. This thing holds true even for death and hence it can occur on time and even otherwise. One cannot say that it always occurs on time. If there was no untimely death, then the lifespan of every one would have been fixed and therefore the knowledge of wholesome and unwholesome objects would be of no use at all. The sources of knowledge like perception, inference and verbal testimony accepted in all scriptures would cease to be sources of knowledge because all these sources of knowledge clearly prove that there are factors which are conducive to longevity and otherwise. Hence, the statement of some sages that untimely death cannot occur is confined to words only and not to facts. 
Lifespan of human beings
वर्षशतं खल्वायुषः प्रमाणमस्मिन् काले||२९||
तस्य निमित्तं प्रकृतिगुणात्मसंपत् सात्म्योपसेवनं चेति||३०||
varṣaśataṁ khalvāyuṣaḥ pramāṇamasmin kālē||29||
tasya nimittaṁ prakr̥tiguṇātmasampat sātmyōpasēvanaṁ cēti||30||
varShashataM khalvAyuShaH pramANamasmin kAle||29||
tasya nimittaM prakRutiguNAtmasampat sAtmyopasevanaM ceti||30||
In the Kali Age, the normal span of life (of human beings) is one hundred years. The factors responsible for the maintenance (of the normal span) of life are:
- Prakriti sampat i.e. equilibrium of dosha in the constitution of individual
- Guna sampat i.e. excellence of the compactness of the body and excellence of hereditary qualities; and
- atma sampat i.e. virtuous acts [29-30]
तत्र श्लोकाः- शरीरं यद्यथा तच्च वर्तते क्लिष्टमामयैः| यथा क्लेशं विनाशं च याति ये चास्य धातवः||३१||
वृध्दिह्रासौ यथा तेषां क्षीणानामौषधं च यत्| देहवृध्दिकरा भावा बलवृद्धिकराश्च ये||३२||
परिणामकरा भावा या च तेषां पृथक् क्रिया| मलाख्याः सम्प्रसादाख्या धातवः प्रश्न एव च||३३||
नवको निर्णयश्चास्य विधिवत् संप्रकाशितः| तथ्यः शरीरविचये शारीरे परमर्षिणा||३४||
tatra ślōkāḥ- śarīraṁ yadyathā tacca vartatē kliṣṭamāmayaiḥ| yathā klēśaṁ vināśaṁ ca yāti yē cāsya dhātavaḥ||31||
vr̥ddhihrāsau yathā tēṣāṁ kṣīṇānāmauṣadhaṁ ca yat| dēhavr̥ddhikarā bhāvā balavr̥ddhikarāśca yē||32||
pariṇāmakarā bhāvā yā ca tēṣāṁ pr̥thak kriyā| malākhyāḥ samprasādākhyā dhātavaḥ praśna ēva ca||33||
navakō nirṇayaścāsya vidhivat samprakāśitaḥ| tathyaḥ śarīravicayē śārīrē paramarṣiṇā||34||
tatra shlokAH- sharIraM yadyathA tacca vartate kliShTamAmayaiH| yathA kleshaM vinAshaM ca yAti ye cAsya dhAtavaH||31||
vRuddhihrAsau yathA teShAM kShINAnAmauShadhaM ca yat| dehavRuddhikarA bhAvA balavRuddhikarAshca ye||32||
pariNAmakarA bhAvA yA ca teShAM pRuthak kriyA| malAkhyAH samprasAdAkhyA dhAtavaH prashna eva ca||33||
navako nirNayashcAsya vidhivat samprakAshitaH| tathyaH sharIravicaye shArIre paramarShiNA||34||
To summarize this chapter: The following nine topics were duly discussed by the great sage in this chapter on the ‘Analytical Study of the Body’:
- Definition of sharira (body), with a focus on how it is afflicted leading to disease and destruction
- Increase or decrease of dhatu
- Treatment of deficient dhatu
- Factors responsible for the growth of the body
- Factors responsible for the promotion of strength
- Factors which help in the digestion and metabolism of food
- The mode of action of each of the above mentioned factors
- mala (body wastes) and prasada (building blocks) types of dhatu (body elements)
- Various queries (related to fetus development, birth process, life span and time of death etc.) [31-34]
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते शारीरस्थाने शरीरविचयशारीरं नाम षष्ठोऽध्यायः||६||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē śārīrasthānē śarīravicayaśārīraṁ nāma ṣaṣṭhō'dhyāyaḥ
ityagniveshakRute tantre carakapratisaMskRute shArIrasthAne sharIravicayashArIraM nAma ShaShTho~adhyAyaH||6||
Thus ends the sixth chapter of Sharira Sthana on the ‘Analytical Study of the Body’ of Agnivesha’s work as redacted by Charaka.
Tattva Vimarsha (Fundamental Principles)
- Human body is the site of manifestation of chetana (consciousness) and a union of factors derived from the five mahabhuta in a specific proportion that maintains equilibrium.
- Inappropriate change in the relative proportions of dhatus (disequilibrium) causes discomfort or destruction of the body. The change in the relative proportion of the dhatu is either in terms of aggravation or diminution, either partially or completely.
- Dhatus with mutually opposing properties undergo increase and decrease simultaneously. A factor which increases a particular dhatu can prove antagonist for the other dhatu of opposing properties.
- Properly administered medical therapies, following the principle of samanya and vishesha, administered simultaneously, bring both the reduced and increased dhatus to their normal states by reducing the increased ones and increasing the diminished ones.
- For the maintenance of the equilibrium of dhatus, one should follow activities and diet with properties opposite to the geographical condition, season and physical constitution of the individual. One should observe proper utilization and avoid excessive utilization of physical and mental capabilities as well as of available resources like time. One should not suppress manifested urges and should also avoid working beyond one’s capacity.
- Substitute dietary articles with similar properties can be used in certain conditions of diminution of dhatu, where the tissue replacement is not possible.
- The factors responsible for proper growth and development of body include favorable time (in terms of age and season), favorable natural tendencies for growth, observance of all rule of taking diet of good quality and absence of inhibiting factors for growth.
- Factors responsible for enhancement of strength:
- Birth at a time when people naturally gain strength
- Favorable disposition of time
- Excellence of beeja and kshetra qualities
- Excellence of ingested food
- Excellence of physique
- Excellence of satmya (adaptation to various factors responsible for the maintenance of the body)
- Excellence of mind qualities
- Natural tendency
- Cheerful nature
- Factors responsible for transformation (digestion, assimilation and metabolism) of food are ushma, vayu, kleda, sneha, kala (time required for digestion) and samayoga (appropriate administration).
- Specific actions of factors of transformation of food:
- Pitta/ushma digests the food.
- Vata/vayu transports the food for digestion.
- Kleda loosens the food particle.
- Sneha makes the ingredients softer.
- Kala indicates duration which is required to complete the digestion.
Seasons of the year as well as the age under the kala factor influence strength. In certain seasons like hemanta and shishira, people generally gain strength, and birth in such seasons makes the individual strong. Moderate climate when there is no excess heat and cold and which is pleasant also promotes the strength of the individual.
- Transformation of food (digestion, assimilation and metabolism) results in two attributes, prasada (building blocks) and mala (waste products). Mala are either paripakva dhatu (mature tissue elements of the body) which are reutilized or vitiated (either aggravated or diminished) doshas/dhatu which need to be excreted .
- The vitiated dosha when come in contact with the tissue elements of the body, manifest disorders. When in normal state, the doshas maintain the health of the individual.
- The fetus is dependent upon the mother for all its activities. It gets nourishment by the process of upasneha (perfusion) and upasweda (thermal regulation). It gets nourishment by the process of perfusion- sometimes through the hair follicles and sometimes through the umbilical cord and placenta connected with the heart (circulatory system) of the mother. The heart of the mother floods the placenta (with nourishment) through the pulsating vessels. This rasa (nutritive fluid) promotes strength and complexion of the fetus as it is composed of material having all six rasa (tastes). Therefore the diet and lifestyle of mother during gestation is of utmost importance to prevent disorders in the fetus.
- Vata dosha plays a key role in regulation of movement of fetus during a normal labor. Hence vata pacifying diet is advised to prevent gestational and post natal disorders in women. (24)
- Kala (Time) is an important determining factor for all processes of life and lifespan.
- The factors responsible for the maintenance (of the normal span) of life are: prakriti sampat i.e. equilibrium of dosha in the constitution of individual, guna sampat i.e. excellence of the compactness of the body and excellence of hereditary qualities; and atma sampat i.e. virtuous acts. (30)
Vidhi Vimarsha (Applied Inferences)
Concept of analytical knowledge: The concept of analytical knowledge or detailed knowledge of the body elements that is described here is very much similar to the concept of systems biology in contemporary science.
Systems biology studies biological systems by analyzing them (biologically, genetically, or chemically), by monitoring the gene, protein, and informational pathway responses, integrating these data and ultimately, formulating mathematical models that describe the structure of the system and its response to individual variations. Systems biology does not investigate individual genes or proteins one at a time. Rather, it investigates the behavior and relationships of all of the elements in a particular biological system while it is functioning. Thus, the systems biology theory understands the importance of the constituent units of the body as well as their networking. (Timothy Galitski, 2001)
A simple example that can illustrate System biology approach is of sickle cell anemia. This disease is caused by a single point mutation at position 6 of the β-chain of hemoglobin, which changes hemoglobin’s oxygen affinity and promotes polymerization under hypoxic conditions. However, individuals with sickle cell disease can present with variety of symptoms which include hemolysis, inflammation, cell adhesion and end-organ ischemia-reperfusion injury and infarction. Patients also experience intermittent painful episodes due to acute vascular obstruction. (Mack KA)  There are many reasons for these different clinical manifestations, including the presence of other genes modifying the disease modifying genes (e.g., hemoglobin F). Hence, this example indicates that the knowledge of single gene is not sufficient to understand the disease. There is need to consider other genes or in other words other constituents of the body. [verse 3]
Definition of sharira and disequilibrium in body elements
The consciousness manifested in the body is because of the soul. Since the soul does not have any dwelling place, the word bhuta is added to the term chetana sthana in the text.
Dhatus are derived from the mahabhuta and the body represents the union of these dhatus in specific proportions. Hence, maintenance of these proportions becomes important for the maintenance of health. Any change in the quantity of individual dhatu, thereby disturbing the relative proportion of the other dhatu results in ill health. A minor change in proportion results in discomfort while the major change destroys the body completely i.e. it can lead to death. It is important to note here that the change in proportion should be manifested and it should produce klesha (discomfort) and/or vinasha (destruction) to consider it significant.
A change in proportion of these dhatus can be due to circadian, seasonal variations etc. Sometimes the change can also occur due to dietary or behavioural changes. For example, increase in the quantity of shukra (one among the seven structural elements) by consumption of milk. However, this kind of change is transitory in nature. To differentiate this transitory state of disequilibrium, the term gamana has been suffixed to the term vaishamya (any increase or decrease beyond the normal range). This indicates that the vaishamya has to be long standing.
Sometimes a change in proportion of these dhatus can also be seen without discomfort and destruction.
- The effects of aphrodisiacs by which there is an increase in the quantity of shukra and
- The increase in dhatus of a child along with the increase of its age.
In both of these examples, there is no discomfort or destruction. This type of interpretation is not valid as an increase in dhatus of a child is owing to its age, which is natural and does not exceed the desired quantity at the given age of the individual. Even the increase of shukra by the administration of aphrodisiacs does not cause any disease and therefore, this increase should be considered as within the normal range.
In the seventh chapter of this section, we would see that the average quantity of dhatu is described in terms of anjali pramana (a measurement by joining palms of both hands). In spite of the description of these quantities one has to depend on the signs and symptoms of aggravation and diminution of dhatu as they are not available directly for measurement. Therefore, the maximum increase of shukra which does not produce a disease should be considered as the limit of the normal range of this dhatu and vaishamya should be diagnosed when abnormal symptoms will get manifested.
Some scholars opine that sometimes the increase or decrease can be physiological (prakrita). They cite the example [Cha. Sa. Sutra Sthana 17/45-46] that the diminution of kapha aggravates vata and further draws the pitta which is in its normal state from its site and makes it circulate through the body to produce pain in the sites of its circulation. In this case, even though the pitta dosha is in its normal state, it causes discomfort in the body because of external factors (paratantra prakopa/ashayapakarsha gati).
This statement is not convincing because in another verse of the same chapter [Cha.Sa. Sutra Sthana 17/62], the author has described three different states of dhatu viz. increase, decrease and normalcy along with their diagnostic criteria. In its normal state, a dhatu does not produce any kind of discomfort or destruction. Also, a disease is defined as the result of the imbalance of dhatus and the normal state of these dhatus is described to constitute the health. [Cha.Sa. Sutra Sthana 9/4]
The correct understanding of the verse [Cha.Sa. Sutra Sthana 17/45-46] therefore should be that if the pitta in its normal state, when carried by the aggravated vata, circulates in the body, and gets mixed up with the pitta of other places, and then actually there is an increase in local pitta of those places, this increased state of pitta is in fact responsible for the cause of symptoms/disease. Even when dhatus are in their normal states before they come in contact with the aggravated dosha, their equilibrium gets disturbed after the interaction with dosha. The manifestation of diseases, therefore, is possible only when dhatu are either increased or decreased due to this interaction and the consequent imbalance.
Factors responsible for increase and decrease of body elements
A factor which is responsible for the increase of one dhatu will at the same time reduce the dhatu of opposing properties. For example, milk increases kapha and shukra and at the same time, reduces vata etc. which are of opposing properties. With this view, the authors have used a verb bhavatah, which is dvivachana (changes are happening in two dhatus).
Cow’s urine and kapha dosha share similar physical properties i.e. both are liquid. Still cow’s urine reduces kapha because of differences in other attributes, viz. katu (pungent), ushna (producing heat in the body), ruksha(dry, desiccating) etc. Thus, it can be inferred that more than the physical nature (jati),the attributes (guna) are responsible for the increase or decrease of dhatu, and to reiterate this, the term guna has been added as a suffix to viparita (opposite) in the text.
The concept explained here is simultaneous changes happening in two or more dhatus having mutually opposite attributes. An etiological or causative factor can cause an increase or decrease in different body elements disturbing the equilibrium. It is possible that the introduction of the etiological or causative factor may be catalyzing a cascade of events either independent or related to the dhatu bringing changes in them. This concept can be further understood by the concept of “cross-organ talks” explained in modern medicine. When there is change in status of any organ, there can be changes seen even in the distant organs through cellular networks. For example, adipose tissue is an endocrine organ. The tissue produces and secretes a wide range of mediators regulating adipose tissue function in an auto-/paracrine manner and important distant targets, such as the liver, skeletal muscle, the pancreas and the cardiovascular system. The enlargement of adipocytes leads to adipose tissue dysfunction and a shift in the secretory profile with an increased release of pro-inflammatory adipokines in metabolic disorders such as obesity. Adipose tissue dysfunction has a central role in the development of insulin resistance, type 2 diabetes, and cardiovascular diseases. (Romacho T).
Objective of therapy
Medicines bring dhatus to normalcy only when administered in appropriate regimen (dose, duration, concomitant medicine/vehicle etc.) Further, they should be administered only till the dhatu is in an imbalanced state. Medicines administered without taking into account these factors do not produce adequate results.
For simultaneous reduction of aggravated kapha and increase of reduced pitta, dravya having katu rasa (pungent taste) is used. If they are administered, beyond a desired effect then there will be increase in pitta and reduction of kapha from their normal level resulting again in imbalance.
Medicines need to be used appropriately (samayaka avacharyamana) in terms of (dose, duration, concomitant medicine/vehicle etc.). The use of yukti pramana can help to understand the scope of samyaka in a given situation at a given point in time. These are the pharmacotherapeutics principles of clinical pharmacology in Ayurveda.
The major focus of administering therapies for the cure of diseases as well as maintenance of health is to bring about the balance of dhatu which results into alleviation of diseases. Rasayana therapy which is administered for promotion of the strength of a healthy individual is primarily aimed at maintaining the equilibrium of dhatu and further improving them qualitatively. So the ultimate objective of Ayurveda is to establish the equilibrium of dhatu. [Cha.Sa. Sutra Sthana1/53]. In healthy persons, although dhatus are in a state of equilibrium, rasayana and vajikarana therapies are given to maintain this state of equilibrium. Even the selection of dietary articles should be done with this objective in mind.
The term satmyasamadnyata means the food preparations which are consistently wholesome at all times and which exclude the preparations that are wholesome only when taken habitually (abhyasa) but not otherwise. The wholesomeness of substances is to be considered in terms of rasa and guna.
Consumption of food preparations dominated by one type of rasa may produce imbalance of dhatu and then it becomes necessary to counterbalance the changes by following regimens having opposite effects. For example, when a person eats food dominated by madhura (sweet) taste then kapha dosha gets aggravated and hence, he should follow regimens like exercise that produce opposite effects i.e. reduce kapha. It is needless to say that even such regimens should not be taken in excess.[verse 7]
Guidelines for sustaining equilibrium
The concept has been explained with an example of obese individuals. For them, activity contrary to their “usual” place would be to sleep in an arid zone, activity contrary to time would be to exercise in spring season, and activity contrary to their make up or constitution would be to exercise at late nights.
The concept of indulging in food and activities contrary to the environmental conditions and constitutions of an individual is a part of swasthavritta vidhi. This has been described in [Cha.Sa. Sutra Sthana 7/50], [Cha.Sa. Vimana Sthana 5/23] and [Cha.Sa. Sutra Sthana 26/8]. Interestingly, the samprapti (pathogenesis) of rajayakshma includes all the above mentioned conditions as etiological factors. It would be worth exploring whether compliance/adherence to swasthavritta vidhi can prevent development of rajayakshma. [verse 8]
Increase and decrease in body elements
The nature of food ingredients that either increase or decrease dhatus is described. Only physical factors follow the above mentioned principles. Other factors like intellect etc. do not increase or decrease.
A substance may be either identical totally (i.e., similar in all respects (including form)) or have partial similarities (in terms of majority of qualities). Yogindranath says that the former refers to dravya while the latter is gunasamanya. For example, meat is identical to mamsa dhatu (one of the seven structural elements or dhatus) completely and hence the intake of meat increases mamsa dhatu. Shukra and milk, on the other hand, are not identical with each other but the major qualities of semen are predominantly found in milk. For example, both of them are liquid in nature. Hence, the habitual use of milk increases semen although to a lesser extent as compared to meat’s increasing mamsa dhatu.
Such increase or decrease of dhatu by similar or dissimilar food ingredients takes place only when they are taken habitually. Occasional intake of such food does not cause any such effect.
The twenty attributes represent ten pairs of mutually opposite attributes. For example, effects of substances having one pair of such mutually contradictory attributes, viz. guru and laghu are described. These specific attributes directly take part in increase and decrease of dosha and body tissues.
Samanya is considered in view of guna (attributes) as well as jati (form). For example the properties and form of meat are similar to mamsa dhatu. Therefore meat can be used in condition of depletion of mamsa. This is applied also in cases, where form is different but properties are similar, such as milk to shukra. We already discussed about the effect of mamsa on mamsa dhatu. The immature fetus in the form of egg etc. is a conglomeration of all dhatus. Hence, the mother’s consuming a chicken egg would promote all the dhatus of her fetus. Karma (activities) here includes sedentary habit, anxiety etc.
Factors responsible for strength
The child is characterized by two fundamental facts- development and growth. Development refers to the increase of functional capacity in perfect form resulting from production of specialised tissues from unspecialised ones. Growth means increase in the size of various parts and organs of the body by multiplication of cells and intercellular components during the period commencing from fertilization to physical maturity. Changes in size are outcomes of three underlying cellular processes: (a) an increase in cell number or hyperplasia; (b) an increase in cell size or hypertrophy; and (c) an increase in intercellular substances or accretion. Hyperplasia, hypertrophy and accretion all occur during growth. This increase in body size is limited by predetermined constitutional and hereditary factors. It is however influenced by exogenous factors like diet, climate, race, environment etc.
Effect of season
During the year, there are periods of more rapid growth when growth rate is three times greater than the time of slowest growth. These periods of growth rate are synchronized with the seasons, and most rapid growth occurs in spring. (Marshall,1971) Climate is also affected by high altitude, where people exposed to lower oxygen saturation in the air have a shorter stature.(Eveleth PB,1990).
Effect of nutrition
Malnutrition results in failure to grow, involving both weight and height. Increased growth hormone secretion occurs in protein malnutrition, presumably inducing mobilization of the remaining fat tissue. On the other hand, growth hormone levels are decreased in calorie malnutrition. When malnutrition is corrected, the affected children soon recover, and when this reversal occurs at a young age, most children will attain a complete remission in height and weight to equal their siblings before puberty. (Henriette A,1993)
Effect of stress
Acute stress elicits a burst of growth hormone secretion, but chronic exposure to stress such as is caused by psychosocial deprivation suppresses growth hormone secretion, resulting in failure to grow. Once the stress is removed, growth hormone secretion rapidly returns to normal and then there is a period of catch-up growth. Postnatal growth is affected by nutrition, socioeconomic factors, disease, urbanization, psychosocial stress, and physical activity. There is a complex interaction among these different factors, and periods of retardation can be compensated by ensuing catch-up growth if the adverse factors are remedied. (Henriette A,1993)
Excellence of mind
The sympathetic nervous system regulates the function of the immune system primarily via adrenergic neurotransmitters released through neuronal routes. Neuroendocrine regulation of immune function is essential for survival during stress or infection and to modulate immune responses in inflammatory disease. Glucocorticoids are the main effector end point of this neuroendocrine system and, through the glucocorticoid receptor, have multiple effects on immune cells and molecules.(Webster JI,2002). [verse 13]
Factors responsible for transformation of food
Ahara parinamakara bhava (factors responsible for the process of digestion) should be considered in both the ways i.e. prakrita and vikrita. Food consumed in the appropriate manner (by considering ahara parinamakara bhava) leads to the production of param sukshma ahara rasa which in turn leads to good health. Conversely, improperly formed ahara rasa may in turn become the cause for the production of various diseases.[verse 15]
The ahara which has undergone the complete digestion process only is able to provide nutrition to the body [Cha.Sa. Chikitsa Sthana 15/5]. Improperly formed ahara rasa (not having undergone the proper digestion process) cannot do the nourishment of dhatu. [verse 16]
According to contemporary science, it has been observed that after the formation of the zygote, the cells further divide and form into a ball of cells called blastocyst. Once this blastocyst reaches the uterus, it buries itself in the uterine wall. The blastocyst sticks tightly to the wall of the uterus and receives nourishment from the mother's blood. Further the embryonic cells multiply and start to take on specific functions. This is called differentiation. Blood cells, kidney cells, and nerve cells all develop. Simultaneously the brain, spinal cord, heart and gastrointestinal tract begin to develop. Further the arm, leg buds, cranial nerves, main vessels, lungs and other begin to develop.  
Hence it may be appropriate to accept Dhanvantari’s view that all the organs start developing simultaneously. [verse 21]
The presently accepted cephalopelvic position correlates well to the position of the foetus explained in the classics.[verse 22]
Modern embryology supports that the fetal blood flows through villi in which the capillaries are covered only by fetal tissue. It bathes directly in the intervillous space in a pool of flowing maternal blood. The transfer, processing and synthesis of nutrients under the influence of maternal, fetal and placental hormones is carried by various parts of the placenta through several modes. Lipid soluble molecules such as respiratory gases, anesthetic agents, several drugs and unconjugated bilirubin cross easily by penetrating the cell membrane. Small water soluble molecules such as urea and water also cross easily by diffusion or osmosis. A specific carrier molecule facilitate transfer of glucose. Specific carrier mediated processes are carried to transport most amino acids, calcium, potassium and phosphorous from mother to fetus. This consumes energy leads to active transport leading to higher concentration in fetal than in maternal plasma. IgG, iron and vitamin B12 are transported by means of a receptor mediated mechanism into the fetal circulation. Any changes in the rate of blood flow hardly affect permeability of lipid insoluble substances. Their passage is ‘membrane limited’ and control of their transfer is largely by a change in placental tissue carrier mechanisms. Large increases in placental blood flow as gestation proceeds are important so that the transport of respiratory gases can be increased to meet the needs of the growing fetus. This mechanism of transport is similar to upasneha and upasweda nyaya described in this chapter.  [verse 23]
Kalayoga is interpreted as ‘attainment of proper time’ e.g. development of body in adolescence (seventeen years of age and onwards). The seasons of the year are also considered. Swabhava means the invisible factor of nature. Avighata is the absence of inhibiting factors such as excessive sexual act, mental stress etc. Avighata to ahara and thus interprets in restricted sense as ‘non-antagonism of dietary factors’. [verse 12 ]
Inhabitants of certain places like Sindh are strong by nature. This is because of the specific characteristics of those places. Birth in such countries makes the individuals strong. Similarly, in certain seasons like hemanta and shishira, people generally gain strength, and birth in such seasons makes the individual strong. Moderate climate when there is no excess heat and cold and which is pleasant also promotes the strength of the individual.
The progeny of parents having no abnormality or having the excellence of beeja and kshetra is endowed with strength. Here beeja means the healthy sperm and ovum, while kshetra means the uterus where implantation and further growth of embryo takes place.
Mind also has control over the body. [Cha.Sa. Sharira Sthana 4/ 36]. If the individual is mentally strong, then his body will also be quite strong. Some people are also endowed with a strong physique because of their virtuous actions in their past lives. Habitual performance of exercise is also known to promote the strength of an individual.[verse 13]
Eight factors to be kept in mind for the administration of food in appropriate manner are described in first chapter of Vimana Sthana[Cha.Sa. Vimana Sthana 1/21-22]. Balanced use of these eight factors regarding diet is considered as samayoga. [verse 14]
Ushma takes part directly in the digestion of food and the remaining factors take part indirectly. Vata transports food to the site of agni to facilitate and stimulate digestion [Cha.Sa.Chikitsa Sthana 15/6,17]. Apart from this, specific time is required to complete the digestive process. The detail process of digestion and metabolism is described in fifteenth chapter of Chikitsa Sthana [Cha.Sa.Chikitsa Sthana 15/6-11]. [verse 15]
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