Changes

<div style="text-align:justify;">

<div style="text-align:justify;">

The effect of food articles on body tissues primarily depends on eight factors (ashta aahara vidhi vishesha aayatan), including the quantity of food (rashi). This chapter discusses the effect of food articles on body physiology concerning amount explicitly. It further explains [[dosha]]-vikara; under this category, [[doshas]] are predominant pathogenic units responsible for the manifestation of the disease; the involvement of dushyas ([[dhatu]] and [[mala]]) is negligible.  

A wholesome diet reserves the highest place for proper growth, development, and health maintenance in human life [Cha.Sa.[[Sutra Sthana]]25/31], [Chakrapani on Cha.Sa.[[Sutra Sthana]] 5/2]. The effect of food articles on body tissues primarily depends on eight factors (ashta aahara vidhi vishesha aayatana), including the quantity of food (rashi). The tetrad of chapters on health (Swastha chatushka) in [[sutra sthana]] aims preservation of health and prevention of diseases. It commences with a discussion on food (ahara) and importance of its proper quantity (matra). This indicates the utmost importance of the quantity of food for the maintenance of health [Cha.Sa.[[Sutra Sthana]] 5/3]. This chapter discusses the effect of food articles on body physiology concerning amount explicitly. It further explains [[dosha]] specific disorders with predominant involvement of [[dosha]] in manifestation of the disease; and negligible involvement of [[dushya]] ([[dhatu]] and [[mala]]).

A wholesome diet reserves the highest place for proper growth, development, and health maintenance in human life [Cha.Sa.[[Sutra Sthana]]25/31], [Cha.Sa.[[Sutra Sthana]] 5/2-Chakrapani]. Swastha chatushka, the tetrad of chapters on health, aims preservation of health and prevention of diseases.  Health tetrad commences with a discussion on food (ahara), and among various aspects of food, the prime importance is given to quantity (matra). This indicates the utmost importance of the quantity of food for the maintenance of health [Cha.Sa.[[Sutra Sthana]] 5/3].

=== Assessment of food ingestion capacity (ahara shakti) ===

The food ingestion capacity (aahara shakti) of a person is assessed on two parameters:  

The food capacity (aahara shakti) of a person shall be assessed by two ways namely:  

a)food ingestion capacity (abhyavaharan shakti) and  

# Food ingestion capacity (abhyavaharana shakti) and  

b)digestion capacity (jarana shakti) [Cha.Sa.[[Vimana Sthana]] 8/120].

The proper quantity of food depends on the strength of [[agni]] ( factors responsible for digestion and metabolism). The strength of [[agni]] varies according to season, age and other factors. Thus the amount of food will also vary as per the power of [[agni]]. The suitable variation in quantity of food helps maintaining proper digestion and metabolism. The quantity further subjects to heavy to digest (gurutva) and light to digest (laghutva) nature of food.  

It is advised to take food in proper quantity and that quantity depends on the strength of [[agni]] (digestive fire). The strength of [[agni]] depends on season, age and other factors. Thus the amount of food will also vary as per the power of [[agni]]. The quantity of food helps maintain proper digestive fire. The quantity further subject to heaviness (gurutva) and lightness (laghutva) of food stuff.

==== Proper quantity of food ====

Suppose the person has taken excellent quality food with reference to eight factors (ashtau-aahara-vidhi-visheshayatan) and followed all the rules while taking food (aahara-vidhi-vidhana), in that case, the food is digested in due time without disturbing the equilibrium of [[dosha]] (prakriti), and that amount of food is termed as the proper quantity of food for that person.  

If a person has taken excellent quality food as per the eight specific dietary factors (ashta aahara vidhi vishesha ayatana) and followed all the rules while taking food ([[aahara vidhi]] vidhana), then the food is digested in due time without disturbing the equilibrium of [[dosha]] ([[prakriti]]), and that amount of food is termed as the "proper quantity of food for that person".  

Satiety is one of the subjective parameters to assess the ingestion capacity of a person.The maximum ingestion capacity of a person should be divided into three parts. One-third part of food intake should be consumed in solid form and one third part as liquid diet, remaining one third part of total capacity should be kept empty for movement of [[vata]], [[pitta]] and [[kapha]]. This is the indicator of satiety. This means once the two third part of stomach will be filled, a person will have the feeling of satisfaction [Cha.Sa.[[Sutra Sthana]]25/40]. At this point you should stop eating. If you will cross this limit the later food stuff will occupy the third part of stomach which interrupts the process of digestion, causing extra burden on digestive fire and may result indigestion. The divisions of stomach(aamashaya) are not in equal proportion, but it is in accordance with user’s suitability and the adaptive pattern of food consumption [Cha.Sa.[[Vimana Sthana]]2/3-Chakrapani]. Power of ingestion (abhyavaharana shakti) is different for every individual and it depends upon the strength of digestive fire (jatharagni).  The proper quantity of food (aahara matra) to be consumed is subjected to power of ingestion and consistency of food articles i.e. solid and liquid.

 

Satiety is one of the subjective parameters to assess the ingestion capacity of a person. The maximum ingestion capacity of a person should be divided into three parts. One-third part of food intake should be consumed in solid form and one third part as liquid diet, remaining one third part of total capacity should be kept empty for movement of [[vata]], [[pitta]] and [[kapha]]. This is the indicator of satiety. This means once the two third part of stomach will be filled, a person will have the feeling of satisfaction [Cha.Sa.[[Sutra Sthana]]25/40]. At this point the person should stop eating. If this limit is crossed, the excess food stuff will occupy the third part of stomach which interrupts the process of digestion, causing extra burden on [[agni]] (digestive power) and may result indigestion. The divisions of stomach (aamashaya) are not in equal proportion, but it is in accordance with user’s suitability and the adaptive pattern of food consumption [Chakrapani on Cha.Sa.[[Vimana Sthana]]2/3]. Power of ingestion (abhyavaharana shakti) is different for every individual and it depends upon the strength of digestive capacity (jatharagni).  The proper quantity of food (aahara matra) to be consumed is subjected to power of ingestion and consistency of food articles i.e. solid and liquid.

===Classification of food===

===Classification of food===

Depending on the consistency, the food articles are classified into four categories: drinkable, likable, eatable, and chew-able. These four types are further abbreviated under two classes as liquid foods and solid foods respectively. Thus both type of food shall be consumed till half of it satiety or till feeling of satiety. This quantity will definitely be digested in due time, without disturbing [[doshas]]' physiology ([[prakriti]]), thus indicating aahara matra. Subjective parameters shall be observed carefully to decide the proper quantity of food [Cha. Sa.[[Vimana Sthana]] 2/6]. Food consumed in the appropriate quantity enhances strength, complexion, and nourishment of tissues.  

 

Depending on the consistency, the food articles are classified into four categories: drinkable, likable, eatable, and chewable. These four types are further abbreviated under two classes as liquid foods and solid foods respectively. Thus both type of food shall be consumed till half of it satiety or till feeling of satiety. This quantity will definitely be digested in due time, without disturbing [[dosha]] physiology ([[prakriti]]), thus indicates proper qunatity (aahara matra). Subjective parameters shall be observed carefully to decide the proper quantity of food. [Cha. Sa.[[Vimana Sthana]] 2/6] Food consumed in the appropriate quantity enhances strength, complexion, and nourishment of tissues.  

</div>

</div>

==='''Effects of Deficient quantity of food'''===

 

==== Effects of deficient quantity of food ====

<div style="text-align:justify;">

<div style="text-align:justify;">

A deficient and excessive quantity of food both are detrimental to human health. The deficient quantity of food reduces strength, complexion, and nourishment of body tissues and makes the person a home for various disorders of [[vata dosha]]. The quantity of food is one of the major factors which decide the wholesome and unwholesome effect of food on body tissues [Cha.Sa.[[Sutra Sthana]]25/32]. Under eating or intake of food in reduced quantity (pramitashanam) is mentioned as the principal cause of emaciation (karshaniyanam) [Cha.Sa.[[Sutra Sthana]]25/40]. Fasting or over eating does not kindle digestive fire, as like fire in environment is extinguished if there is no fuel supply or if excessive fuel covers the fire [Cha.Sa.[[Chikitsa Sthana]] 15/211]. Taking wholesome food in appropriate quantity after complete digestion of previously eaten food helps to continue good health for long duration [Cha.Sa.[[Chikitsa Sthana]] 15/214]. It is observed that deficient quantity of food deteriorate the digestive capacity of [[agni]] and in absence of sufficient nutrients leads to malnourishment disorders and poor health status. Two ways to measure the quantity of food - include total quantity of food to be consumed in a meal (sarvagraha) and quantity of each food article in a meal (parigraha).The inclusion of different food articles in a meal is to ascertain all the six rasas (tastes) in the required proportion. The nutritional requirement of everybody tissue is different. Proportionate quantity of six rasas will ensure the tissue requirement. The balanced diet concept of Ayurveda is essentially based of this Shadrasa Principle. Imbalanced diet concerning six rasas leads to improper nourishment of body tissues, which further leads to depletion of body tissues ([[dhatus]]) [Cha. Sa.[[Sutra Sthana]] 5/4-Chakrapani]. Long-term exposure of imbalanced diet triggers wear and tear mechanism of tissues and may result in early senility.  

A deficient and excessive quantity of food both are detrimental to human health. The deficient quantity of food reduces strength, complexion, and nourishment of body tissues and makes the person a home for various disorders of [[vata dosha]]. The quantity of food is one of the major factors which decide the wholesome and unwholesome effect of food on body tissues. [Cha.Sa.[[Sutra Sthana]] 25/32]  

 

Under eating or intake of food in reduced quantity (pramitashanam) is mentioned as the principal cause of emaciation (karshaniyanam) [Cha.Sa.[[Sutra Sthana]]25/40]. Fasting or over eating does not kindle digestive fire, as like fire in environment is extinguished if there is no fuel supply or if excessive fuel covers the fire. [Cha.Sa.[[Chikitsa Sthana]] 15/211] Taking wholesome food in appropriate quantity after complete digestion of previously eaten food helps to continue good health for long duration.[Cha.Sa.[[Chikitsa Sthana]] 15/214] It is observed that deficient quantity of food deteriorate the digestive capacity of [[agni]] and in absence of sufficient nutrients leads to malnourishment disorders and poor health status.  

 

There are two ways to measure the quantity of food:

# Total quantity of food to be consumed in a meal (sarvagraha)  

# Quantity of each food article in a meal (parigraha).

 

The inclusion of different food articles in a meal is to ascertain all the six rasas (tastes) in the required proportion. The nutritional requirement of everybody tissue is different. Proportionate quantity of six [[rasa]] will ensure the tissue requirement. The balanced diet concept of [[Ayurveda]] is essentially based of this principle. Imbalanced diet concerning six [[rasa]] leads to improper nourishment of body tissues, which further leads to depletion of body tissues ([[dhatu]]) [Cha. Sa.[[Sutra Sthana]] 5/4-Chakrapani]. Long-term exposure of imbalanced diet triggers wear and tear mechanism of tissues and may result in early senility.  

</div>

</div>

==='''Effects of Excessive Quantity of Food'''===

=== Effects of excessive quantity of food ===

<div style="text-align:justify;">

<div style="text-align:justify;">

Excessive food triggers all three [[doshas]]' vitiation as there is no space left for [[doshas]]' functioning. [[Doshas]] are the main functional unit of human physiology. [[Doshas]] govern the physiology of digestion. Samana [[vayu]] functions nearby the abode of digestive fire (jatharagni), kindles [[agni]]. Prana [[vayu]] and apana [[vayu]] supports the functions of [[agni]]. Pachaka [[pitta]] when devoid of its liquid property, functions as digestive fire [A.Hr.Sutra Sthana 12/10-11]. Kledaka [[kapha]] is responsible to moisten the ingested food. Thus the process of digestion is driven by [[doshas]]. Factors responsible for complete transformation and absorption of food(Ahara parinamakara bhavas) explain this phenomenon in-depth. [Cha.Sa.[[Sharira Sthana]]6/14],[ Cha. Sa.[[Chikitsa Sthana]] 15/6-8]. The vitiated [[dosha]] leads to the formation of [[ama]].  

Excessive food triggers all three [[dosha]] vitiation as there is no space left for [[dosha]] functioning. [[Dosha]] are the main functional unit of human physiology. [[Dosha]] also govern the physiology of digestion. Samana [[vayu]] functions nearby the abode of digestive fire (jatharagni), kindles [[agni]]. Prana [[vayu]] and apana [[vayu]] supports the functions of [[agni]]. Pachaka [[pitta]] when devoid of its liquid property, functions as digestive fire.[A. Hr. Sutra Sthana 12/10-11]<ref name="A. Hridaya">Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>  Kledaka [[kapha]] is responsible to moisten the ingested food. Thus the process of digestion is driven by [[dosha]]. Factors responsible for complete transformation and absorption of food(ahara parinamakara bhava) explain this phenomenon in-depth. [Cha.Sa.[[Sharira Sthana]]6/14],[Cha.Sa.[[Chikitsa Sthana]] 15/6-8]. The vitiated [[dosha]] leads to the formation of [[ama]].  

Excessive eating is one of the etiological factors for non-communicable diseases like obesity and diabetes mellitus which are more prevalent in society. Excess intake of calorie food which is not processed properly by digestive fire (Jathragni) and further utilized by dhatvagni (type of [[agni]] present at tissue level) leads to obesity and related disorders.  

Excessive eating is one of the etiological factors for non-communicable diseases like obesity and diabetes mellitus which are more prevalent in society. Excess intake of calorie food which is not processed properly by digestive power (jatharagni) and further utilized by dhatvagni (type of [[agni]] present at tissue level) leads to obesity and related disorders.  

==='''Causes of Ama formation-'''===

==== Causes of [[ama]] formation ====

This chapter provides details regarding causative factors of ama formation. Ama is unique terminology of Ayurveda. It is the undigested and non-metabolized food material which remains inside the body and produces toxic effects. Quantity of food is considered as an important causative factor in formation of ama. Excessive as well as deficient quantity of food leads to ama formation. Along with quantity, if dietetic code and conduct are not followed it may leads to ama formation. Quality of food like heavy to digest and food with properties like dry, cold, dehydrated, disliked by the consumer, constipation-causing, causing a burning sensation, unclean, incompatible, and/or consumed untimely leads to ama formation. Mental factors like food intake while the mind being afflicted with passion/desires, anger, greed, infatuation, envy, bashfulness, grief, conceit, excitement, and fear are also the cause of formation of ama. Any unwholesome food, even if taken in right quantity also leads to ama formation. An individual who regularly consumes an incompatible diet, multiple heavy meals (in short intervals) and eats even before the previous meal is digested, results in ama visha (clinical state of indigestion characterized by the manifestation of toxic symptoms). Some scholars opine that ama originate from highly vitiated doshas itself by their conjugation; as visha (aflatoxins) develops in (stored up, edible) kodo millet (kodrava) [A.Hr.Sutra Sthana 13/26]. In recent years many non-communicable and metabolic disorders like obesity, diabetes, and thyroid dysfunction are prevalent in society due to indulgence of above factors leading to ama formation which triggers enormous pathological conditions. Various causal factors should be avoided by an individual to maintain the status [[agni]] and preserve health.  

This chapter provides details regarding causative factors of [[ama]] formation. [[Ama]] is unique concept of [[Ayurveda]]. It is the undigested and non-metabolized food material which remains inside the body and produces toxic effects. Quantity of food is considered as an important causative factor in formation of [[ama]]. Excessive as well as deficient quantity of food leads to [[ama]] formation. Along with quantity, if dietetic code and conduct are not followed it may leads to [[ama]] formation. Quality of food like heavy to digest and food with properties like dry, cold, dehydrated, disliked by the consumer, constipation-causing, causing a burning sensation, unclean, incompatible, and/or consumed untimely leads to [[ama]] formation.  

'''Nature of Ama-'''

Mental factors like food intake while the mind being afflicted with passion/desires, anger, greed, infatuation, envy, bashfulness, grief, conceit, excitement, and fear are also the cause of formation of [[ama]]. Any unwholesome food, even if taken in right quantity also leads to [[ama]] formation. An individual who regularly consumes an incompatible diet, multiple heavy meals (in short intervals) and eats even before the previous meal is digested, results in a clinical state of indigestion characterized by the manifestation of toxic symptoms termed as "ama visha". Some scholars opine that [[ama]] originate from highly vitiated [[dosha]] itself by their conjugation; as visha (aflatoxins) develops in (stored up, edible) kodo millet (kodrava). [A.Hr. Sutra Sthana 13/26]<ref name="A. Hridaya"/> In recent years many non-communicable and metabolic disorders like obesity, diabetes, and thyroid dysfunction are prevalent in society due to indulgence of above factors leading to [[ama]] formation which triggers enormous pathological conditions. Various causal factors should be avoided by an individual to maintain the status [[agni]] and preserve health.

The ama dosha is termed as ama visha (clinical state of indigestion characterized by manifestation of toxic symptoms) because of resemblance of manifested symptoms to that of poisoning. It is considered incurable because of its acute presentation and contradictory line of management. Physicians describe two types of diseases caused by ama doshas namely visuchika (cholera like symptoms) and alasaka (sluggish bowels). The ama which is formed due to weak digestive fire is heavy, liquid, different colored, unctuous, slimy, sticky, undigested, have fetid smell, continuous pain and considered as root cause of many diseases [Arundatta on A.H.Sutra Sthana.13/27]. This form of food will not be absorbed, gets associated with doshas leading to saama dosha (undigested food with vitiated dosha) condition.

==== Nature of Ama ====

Food if it is properly digested and metabolized by [[agni]] leads to proper tissue formation otherwise leads to poisonous state like ama formation. Due to various etiological factors deteriorated state of agni is unable to digest even the light food. [Cha.Sa.[[Chikitsa Sthana]].15/43]. This vitiated digestive fire forms an intermediate substance called ama, which turns sour (shukta) during fermentation and finally turns in poisonous substance (amavisha) [Cha.Sa.[[Chikitsa Sthana]].15/44].  

The [[ama]] is termed as "ama visha" (clinical state of indigestion characterized by manifestation of toxic symptoms) because of resemblance of manifested symptoms to that of poisoning. It is considered incurable because of its acute presentation and contradictory line of management. Physicians describe two types of diseases caused by [[ama]] namely [[visuchika]] (cholera like symptoms) and [[alasaka]] (sluggish bowels). The [[ama]] which is formed due to weak digestive fire is heavy, liquid, different colored, unctuous, slimy, sticky, undigested, have fetid smell, continuous pain and considered as root cause of many diseases [Arundatta on A.Hr.Sutra Sthana 13/27].<ref name="A. Hridaya"/> This form of food will not be absorbed, gets associated with [[dosha]] leading to "saama dosha" (undigested food with vitiated [[dosha]]) condition.  

'''Symptoms produced due to Ama-'''

Food if it is properly digested and metabolized by [[agni]] leads to proper tissue formation otherwise leads to poisonous state like [[ama]] formation. Due to various etiological factors deteriorated state of agni is unable to digest even the light food. [Cha.Sa.[[Chikitsa Sthana]] 15/43]. This vitiated digestive fire forms an intermediate substance called [[ama]], which turns sour (shukta) during fermentation and finally turns in poisonous substance. (ama visha) [Cha.Sa.[[Chikitsa Sthana]] 15/44]

Obstruction of body channels (srotorodha), loss of strength (balabramsha), heaviness of body (gaurava), laziness (alasya), impaired activity of [[vata dosha]] (anila mudhata), indigestion (apakti), excessive salivation (nishthivana), constipation (mala sanga), lack of taste (aruchi), lethargy (klama) comprise symptoms of doshas coupled with ama [A.H. Sutra Sthana.13/23-24]. The doshas and dusyas (the dhatus and malas) which are in liaison with ama are designated as sama i.e. mixed with ama and the diseases originating from these are termed as sama diseases.

==== Symptoms produced due to [[ama]] ====

Following  are symptoms produced by ama in various body systems and comprise symptoms of [[dosha]] assoicated with [[ama]] [A.H. Sutra Sthana.13/23-24]<ref name="A. Hridaya"/>

Two types of diseases caused by ama dosha namely cholera-like symptoms (visuchika) and sluggish bowels (alasaka). A frail person having weak digestive power and aggravated kapha condition, even exerting pressure does not push the undigested food out of the passage since it is obstructed by [[kapha]]. This condition is called alasaka. Taking food either in excess quantity or very little quantity is a type of vishamashana (a type of unhealthy dietary pattern) which leads to various [[ama]] disorders [Cha.Sa.[[Chikitsa Sthana]] 15/236].

'''Treatment principles of Ama-'''

*Obstruction of body channels (srotorodha)

Ama is the preliminary cause for many disorders; hence the term ‘aamay’ (means indigestion) is enlisted as the synonym of disease [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/15]. Physician should assess the status of [[agni]] and severity of ama before start of any treatment or therapeutic procedure. Treatment in sama (presence of ama in pathogenesis of disease) and nirama (absence of ama in pathogenesis) conditions are totally different. Langhana (fasting) and pachana (digestive) is the foremost treatment used to treat ama disorders [Cha.Sa.[[Chikitsa Sthana]]15/95]. Fasting helps to digest ama and kindles digestive fire.  Absolute fasting or liquid light food is advised considering state of ama. Agni is responsible for digestion of food; kindled digestive fire in absence of food will digest increased doshas or leftover ama in the body [A. Hr. Chikitsa Sthana 10/91].

 

 

 

 

[[Ama]] is the preliminary cause for many disorders; hence the term ‘aamay’ (means indigestion) is enlisted as the synonym of disease. [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/15] Physician should assess the status of [[agni]] and severity of [[ama]] before starting any treatment or therapeutic procedure. Treatment in saama (presence of ama in pathogenesis of disease) and niraama (absence of ama in pathogenesis) conditions are totally different.  

 

[[Langhana]] (measures of fasting) and [[pachana]] (digestive) is the foremost treatment used to treat ama disorders [Cha.Sa.[[Chikitsa Sthana]] 15/95]. Fasting helps to digest ama and kindles digestive fire.  Absolute fasting or liquid light food is advised considering state of ama. Agni is responsible for digestion of food; kindled digestive fire in absence of food will digest increased doshas or leftover ama in the body [A. Hr. Chikitsa Sthana 10/91].

When the food has undergone digestion, but yet patient experience fullness and heaviness of the stomach, medicines are to be given which bring about the breakdown of the leftover doshas and increase digestive fire. After langhana and pachana, patient should be advised to follow peyadi-sansarjan-kram (special dictum of dietary regimen) to ignite digestive fire. Fasting reduces the aggravated dosha, kindles digestive fire, restores appetite, and renders lightness to the body. Fasting should be performed to that extent which will not hamper the vitality or strength of an individual. The aim of all these measures is to regain the health which also depends on the physical, mental and spiritual well being [Cha.Sa.[[Chikitsa Sthana]] 3/140-142]. When patient is relieved from excessive morbidity of ama; the doshas are get rid of ama state (pakava avastha) and once digestive fire is kindled; oil embrocation (abhyanga), internal unction (snehapana), corrective and unctuous enema (asthapana and anuvasana types of basti) should administer. Sama doshas which are spread all over the body, which  remain latent/dissolved in tissues (dhatus) and are not dislodged should not be expelled out by eliminative (shodhana) therapy as it can lead to destruction of the substratum, similar to the extraction of juice from an unripe fruit [Cha.Sa.[[Chikitsa Sthana]] 3/147-149]. Therapeutic elimination procedures should commence once person will get rid of ama state. Stool mixed with ama (sama mala) sinks into the water due to heaviness property of ama whereas stool without ama (pakva or nirama mala) floats over the water; provided the stools consistency is not watery or not very compact and if not vitiated by cold (sheeta) property of [[kapha]] [Cha.Sa.[[Chikitsa Sthana]] 15/94]. Patient should first be evaluated for presence or absence of ama and then appropriately be treated with pachana etc. treatment. [Cha.Sa.[[Chikitsa Sthana]] 15/94-95]

When the food has undergone digestion, but yet patient experience fullness and heaviness of the stomach, medicines are to be given which bring about the breakdown of the leftover doshas and increase digestive fire. After langhana and pachana, patient should be advised to follow peyadi-sansarjan-kram (special dictum of dietary regimen) to ignite digestive fire. Fasting reduces the aggravated dosha, kindles digestive fire, restores appetite, and renders lightness to the body. Fasting should be performed to that extent which will not hamper the vitality or strength of an individual. The aim of all these measures is to regain the health which also depends on the physical, mental and spiritual well being [Cha.Sa.[[Chikitsa Sthana]] 3/140-142]. When patient is relieved from excessive morbidity of ama; the doshas are get rid of ama state (pakava avastha) and once digestive fire is kindled; oil embrocation (abhyanga), internal unction (snehapana), corrective and unctuous enema (asthapana and anuvasana types of basti) should administer. Sama doshas which are spread all over the body, which  remain latent/dissolved in tissues (dhatus) and are not dislodged should not be expelled out by eliminative (shodhana) therapy as it can lead to destruction of the substratum, similar to the extraction of juice from an unripe fruit [Cha.Sa.[[Chikitsa Sthana]] 3/147-149]. Therapeutic elimination procedures should commence once person will get rid of ama state. Stool mixed with ama (sama mala) sinks into the water due to heaviness property of ama whereas stool without ama (pakva or nirama mala) floats over the water; provided the stools consistency is not watery or not very compact and if not vitiated by cold (sheeta) property of [[kapha]] [Cha.Sa.[[Chikitsa Sthana]] 15/94]. Patient should first be evaluated for presence or absence of ama and then appropriately be treated with pachana etc. treatment. [Cha.Sa.[[Chikitsa Sthana]] 15/94-95]

Amashaya described here is in physiological consideration where digestion of food is taking place. Surface anatomy describes amashaya as the organ situated between the umbilicus and the breast. All that is eaten, masticated, drunk and licked up is digested. All the food articles are fully digested after reaching the amashaya. Once the digestion is completed, the digested essence of food reaches all the body organs by means of vessels. Amashaya is also considered as seat of [[pitta dosha]] and [[kapha dosha]] [Cha. Sa.[[Sutra Sthana]] 20/8]. There observes predominance of [[kapha]] and [[vata dosha]] in manifestation of hiccough and asthama (shvasa). These disorders originate at the site of [[pitta]] [Cha.Sa.[[Chikitsa Sthana]]17/8]. In this context, Chakrapani has mentioned the two segments of amashaya as upper segment (urdhva amashaya) and the lower segment (adho-amashaya). Seat of [[pitta]] refers lower segment (adho amashaya) which clearly differentiates from the upper segment of [[kapha dosha]]. Anatomically Stomach can be considered as upper segment of amashaya and small intestine along with liver and pancreas can be considered as the lower segment of amashaya. Aamashaya rooted disorders are specifically grouped as the disorders having a predominance of [[kapha]] and [[pitta dosha]].[Cha.Sa.[[Vimana Sthana]] 6/3]   

Amashaya described here is in physiological consideration where digestion of food is taking place. Surface anatomy describes amashaya as the organ situated between the umbilicus and the breast. All that is eaten, masticated, drunk and licked up is digested. All the food articles are fully digested after reaching the amashaya. Once the digestion is completed, the digested essence of food reaches all the body organs by means of vessels. Amashaya is also considered as seat of [[pitta dosha]] and [[kapha dosha]] [Cha. Sa.[[Sutra Sthana]] 20/8]. There observes predominance of [[kapha]] and [[vata dosha]] in manifestation of hiccough and asthama (shvasa). These disorders originate at the site of [[pitta]] [Cha.Sa.[[Chikitsa Sthana]]17/8]. In this context, Chakrapani has mentioned the two segments of amashaya as upper segment (urdhva amashaya) and the lower segment (adho-amashaya). Seat of [[pitta]] refers lower segment (adho amashaya) which clearly differentiates from the upper segment of [[kapha dosha]]. Anatomically Stomach can be considered as upper segment of amashaya and small intestine along with liver and pancreas can be considered as the lower segment of amashaya. Aamashaya rooted disorders are specifically grouped as the disorders having a predominance of [[kapha]] and [[pitta dosha]].[Cha.Sa.[[Vimana Sthana]] 6/3]   

   

   

'''Updates and views of other Ayurveda classics helpful to understand the content –'''  

'''Updates and views of other Ayurveda classics helpful to understand the content '''  

Some Ayurveda scholars have divided ingestion capacity of amashaya in four parts and advised to take two parts with solid food, one part with liquids and rest one fourth part to be left empty for doshas (as a normal physiology of digestion) [A.Hr.[[Sutra Sthana]]8/46-47]. Arundutta, commentator of Vagbhata has considered this capacity of amashaya as the measurement of satiety.

Some Ayurveda scholars have divided ingestion capacity of amashaya in four parts and advised to take two parts with solid food, one part with liquids and rest one fourth part to be left empty for doshas (as a normal physiology of digestion) [A.Hr.[[Sutra Sthana]]8/46-47]. Arundutta, commentator of Vagbhata has considered this capacity of amashaya as the measurement of satiety.

There are six types of food patterns described depending upon the consistency of food: suckables(chushya), drinkable(peya), lickables (lehya)- e.g. rasala-curd mixed with sugar and spices and kadhi- an traditional Indian dish consisting mainly of yogurt and gram floor), Bhojya (soft eatables- e.g. Dal Rice),  Bhakshya (hard eatables- e.g. Laddu, Modak-kind of sweetmeat), Charvya (chewables e.g. poha, roasted horse gram). These food articles are heavy for digestion in ascending order [B.P.Pradhama Khanda 4/142-143].

There are six types of food patterns described depending upon the consistency of food: suckables(chushya), drinkable(peya), lickables (lehya)- e.g. rasala-curd mixed with sugar and spices and kadhi- an traditional Indian dish consisting mainly of yogurt and gram floor), Bhojya (soft eatables- e.g. Dal Rice),  Bhakshya (hard eatables- e.g. Laddu, Modak-kind of sweetmeat), Charvya (chewables e.g. poha, roasted horse gram). These food articles are heavy for digestion in ascending order [B.P.Pradhama Khanda 4/142-143].

</div>

</div>

'''CONTEMPORARY VIEWS AND RESEARCH UPDATES-'''  

'''CONTEMPORARY VIEWS AND RESEARCH UPDATES-'''  

Leptin, insulin, and ghrelin act as long term regulators of appetite. These are long-acting adiposity hormones. While studying the role of leptin in prandial patterns, researchers observed that plasma leptin concentrations increase during a spontaneous intermeal interval and decline before the onset of a meal. Leptin works through regulation of hypothalamic feeding circuits. Through negative feedback mechanism leptin reduces food intake and regulates body weight homeostasis. Thus decreased leptin levels observed to stimulate appetite behavior. Leptin has an influential role in meal frequency and observed less responsible to control meal size.<ref>Chapelot D, Aubert R, Marmonier C, Chabert M, Louis-Sylvestre J. An endocrine and metabolic definition of the intermeal interval in humans: evidence for a role of leptin on the prandial pattern through fatty acid disposal. Am J Clin Nutr. 2000 Aug;72(2):421-31. doi: 10.1093/ajcn/72.2.421. PMID: 10919937.https://academic.oup.com/ajcn/article/72/2/421/4729460</ref>

Leptin, insulin, and ghrelin act as long term regulators of appetite. These are long-acting adiposity hormones. While studying the role of leptin in prandial patterns, researchers observed that plasma leptin concentrations increase during a spontaneous intermeal interval and decline before the onset of a meal. Leptin works through regulation of hypothalamic feeding circuits. Through negative feedback mechanism leptin reduces food intake and regulates body weight homeostasis. Thus decreased leptin levels observed to stimulate appetite behavior. Leptin has an influential role in meal frequency and observed less responsible to control meal size.<ref>Chapelot D, Aubert R, Marmonier C, Chabert M, Louis-Sylvestre J. An endocrine and metabolic definition of the intermeal interval in humans: evidence for a role of leptin on the prandial pattern through fatty acid disposal. Am J Clin Nutr. 2000 Aug;72(2):421-31. doi: 10.1093/ajcn/72.2.421. PMID: 10919937.https://academic.oup.com/ajcn/article/72/2/421/4729460</ref>

Ghrelin potentially enhances appetite. It is the first hormone which shows stimulating effect on food intake.<ref>Wren AM, Seal LJ, Cohen MA, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86(12):5992. doi:10.1210/jcem.86.12.8111</ref><ref>Kalra SP, Bagnasco M, Otukonyong EE, Dube MG, Kalra PS. Rhythmic, reciprocal ghrelin and leptin signaling: new insight in the development of obesity. Regul Pept. 2003;111(1-3):1-11. doi:10.1016/s0167-0115(02)00305-1</ref> Ghrelin secreted mainly from the gastric mucosa, its level are at their peak just before a meal, and decreased slowly when food nutrients are travelled into intestine.It acts on hippocampal neurons involved in spatial learning and memory, thus empty stomach passes signal to brain for asking to engage in appetite behavior, filling of hunger.Ghrelin as orexigenic factor promoted food intake and weight gain.Various cognitive components participate in the initiation of eating and in the selection of food. Schmid DA et al research findings suggest that along with stimulation of appetite, Ghrelin affects cognitive functions. They have noted vivid, plastic visualization of preferred meal by study subjects after administration of ghrelin.<ref>Schmid DA, Held K, Ising M, Uhr M, Weikel JC, & Steiger A (2005). Ghrelin Stimulates Appetite, Imagination of Food, GH, ACTH, and Cortisol, but does not Affect Leptin in Normal Controls. Neuropsychopharmacology, 30(6), 1187–1192. https://doi.org/10.1038/sj.npp.1300670</ref> Peptide YY has a suppressive effect on food intake.<ref>Jones ES, Nunn N, Chambers AP, Østergaard S, Wulff BS, Luckman SM. Modified Peptide YY Molecule Attenuates the Activity of NPY/AgRP Neurons and Reduces Food Intake in Male Mice. Endocrinology. 2019 Nov 1;160(11):2737-2747. doi: 10.1210/en.2019-00100. PMID: 31074796; PMCID: PMC6806261.</ref>PPY rise is observed in post prandial phase and are lowest in fasting state. Peripheral administration of PYY3e36 reduces food intake. PPY have shown effect on intestinal motility, delays gastric emptying.<ref>Asakawa A, Inui A, Yuzuriha H, Ueno N, Katsuura G, Fujimiya M, Fujino MA, Niijima A, Meguid MM, Kasuga M. Characterization of the effects of pancreatic polypeptide in the regulation of energy balance. Gastroenterology. 2003 May;124(5):1325-36. doi: 10.1016/s0016-5085(03)00216-6. PMID: 12730873.</ref>  

Ghrelin potentially enhances appetite. It is the first hormone which shows stimulating effect on food intake.<ref>Wren AM, Seal LJ, Cohen MA, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86(12):5992. doi:10.1210/jcem.86.12.8111</ref><ref>Kalra SP, Bagnasco M, Otukonyong EE, Dube MG, Kalra PS. Rhythmic, reciprocal ghrelin and leptin signaling: new insight in the development of obesity. Regul Pept. 2003;111(1-3):1-11. doi:10.1016/s0167-0115(02)00305-1</ref> Ghrelin secreted mainly from the gastric mucosa, its level are at their peak just before a meal, and decreased slowly when food nutrients are travelled into intestine. It acts on hippocampal neurons involved in spatial learning and memory, thus empty stomach passes signal to brain for asking to engage in appetite behavior, filling of hunger. Ghrelin as orexigenic factor promoted food intake and weight gain.Various cognitive components participate in the initiation of eating and in the selection of food. Schmid DA et al research findings suggest that along with stimulation of appetite, Ghrelin affects cognitive functions. They have noted vivid, plastic visualization of preferred meal by study subjects after administration of ghrelin.<ref>Schmid DA, Held K, Ising M, Uhr M, Weikel JC, & Steiger A (2005). Ghrelin Stimulates Appetite, Imagination of Food, GH, ACTH, and Cortisol, but does not Affect Leptin in Normal Controls. Neuropsychopharmacology, 30(6), 1187–1192. https://doi.org/10.1038/sj.npp.1300670</ref> Peptide YY has a suppressive effect on food intake.<ref>Jones ES, Nunn N, Chambers AP, Østergaard S, Wulff BS, Luckman SM. Modified Peptide YY Molecule Attenuates the Activity of NPY/AgRP Neurons and Reduces Food Intake in Male Mice. Endocrinology. 2019 Nov 1;160(11):2737-2747. doi: 10.1210/en.2019-00100. PMID: 31074796; PMCID: PMC6806261.</ref>PPY rise is observed in post prandial phase and are lowest in fasting state. Peripheral administration of PYY3e36 reduces food intake. PPY have shown effect on intestinal motility, delays gastric emptying.<ref>Asakawa A, Inui A, Yuzuriha H, Ueno N, Katsuura G, Fujimiya M, Fujino MA, Niijima A, Meguid MM, Kasuga M. Characterization of the effects of pancreatic polypeptide in the regulation of energy balance. Gastroenterology. 2003 May;124(5):1325-36. doi: 10.1016/s0016-5085(03)00216-6. PMID: 12730873.</ref>  

'''Signaling pathways involved in the mechanism of satiation-'''

'''Signaling pathways involved in the mechanism of satiation-'''

Gastrointestinal track releases various peptide hormones. Stomach has its hormonal and neural control mechanism. Presence of food nutrients along with distention of stomach release gut hormones such as PPY, GLP-1, and oxyntomodulin (OXM).Theses are mainly responsible for phenomenon of satiation. These peptide, decreases hypothalamic orexigenic signaling and increases anorexigenic signaling. Negative feedback mechanism results due to these peptides also contribute to increase satiety between meals. Effect of these gut hormones in union with CNS effect results in satiation and satiety. The enteroendocrine cells released hormones interact at different brain levels through circulation and or through primary afferent neurons. Along with induction of satiation and meal termination, gut hormones also produce a positive feeling of reward and satisfaction.Nutrient sensors and their signaling to brain are vital to give feeling of satisfaction.<ref>Sam AH, Troke RC, Tan TM, Bewick GA. The role of the gut/brain axis in modulating food intake. Neuropharmacology. 2012 Jul;63(1):46-56. doi: 10.1016/j.neuropharm.2011.10.008. Epub 2011 Oct 21. PMID: 22037149</ref> <ref>Murphy KG, Bloom SR. Gut hormones and the regulation of energy homeostasis. Nature. 2006 Dec 14;444(7121):854-9. doi: 10.1038/nature05484. PMID: 17167473.</ref> <ref>Berthoud HR. Vagal and hormonal gut-brain communication: from satiation to satisfaction. Neurogastroenterol Motil. 2008;20 Suppl 1(0 1):64-72. doi:10.1111/j.1365-2982.2008.01104.</ref>

Gastrointestinal track releases various peptide hormones. Stomach has its hormonal and neural control mechanism. Presence of food nutrients along with distention of stomach release gut hormones such as PPY, GLP-1, and oxyntomodulin (OXM).Theses are mainly responsible for phenomenon of satiation. These peptide, decreases hypothalamic orexigenic signaling and increases anorexigenic signaling. Negative feedback mechanism results due to these peptides also contribute to increase satiety between meals. Effect of these gut hormones in union with CNS effect results in satiation and satiety. The enteroendocrine cells released hormones interact at different brain levels through circulation and or through primary afferent neurons. Along with induction of satiation and meal termination, gut hormones also produce a positive feeling of reward and satisfaction.Nutrient sensors and their signaling to brain are vital to give feeling of satisfaction.<ref>Sam AH, Troke RC, Tan TM, Bewick GA. The role of the gut/brain axis in modulating food intake. Neuropharmacology. 2012 Jul;63(1):46-56. doi: 10.1016/j.neuropharm.2011.10.008. Epub 2011 Oct 21. PMID: 22037149</ref> <ref>Murphy KG, Bloom SR. Gut hormones and the regulation of energy homeostasis. Nature. 2006 Dec 14;444(7121):854-9. doi: 10.1038/nature05484. PMID: 17167473.</ref> <ref>Berthoud HR. Vagal and hormonal gut-brain communication: from satiation to satisfaction. Neurogastroenterol Motil. 2008;20 Suppl 1(0 1):64-72. doi:10.1111/j.1365-2982.2008.01104.</ref>

D Chapelot has described subjective and objective tools for measuring meal size, microstructure of the meal, meal request and intermeal intervals. A multidimensional approach for assessing satiety is proposed with intensity, duration and intake as main variables.<ref>Chapelot D. Quantifying satiation and satiety. In: Blundell JE, Bellisle F, ed. Satiation, Satiety and the Control of Food Intake:Woodhead Publishing Series in Food Science, Technology and Nutrition; 2013:Pages12-39.  https://www.sciencedirect.com/science/book/9780857095435</ref> Commings DE et.al have reviewed the interaction of gastric, intestinal, and pancreatic signals in food regulation. They have also discussed the important role of short acting GI factors and long-acting adiposity hormones in food intakeregulation. Gerry Smith survey indicates that gastric signals are volumetric in nature and intestinal signals are nutritive in nature.<ref>Powley TL, Phillips RJ. Gastric satiation is volumetric, intestinal satiation is nutritive. Physiol Behav. 2004 Aug;82(1):69-74. doi: 10.1016/j.physbeh.2004.04.037. PMID: 15234593.</ref>

D Chapelot has described subjective and objective tools for measuring meal size, microstructure of the meal, meal request and intermeal intervals. A multidimensional approach for assessing satiety is proposed with intensity, duration and intake as main variables.<ref>Chapelot D. Quantifying satiation and satiety. In: Blundell JE, Bellisle F, ed. Satiation, Satiety and the Control of Food Intake:Woodhead Publishing Series in Food Science, Technology and Nutrition; 2013:Pages12-39.  https://www.sciencedirect.com/science/book/9780857095435</ref> Commings DE et.al have reviewed the interaction of gastric, intestinal, and pancreatic signals in food regulation. They have also discussed the important role of short acting GI factors and long-acting adiposity hormones in food intake regulation. Gerry Smith survey indicates that gastric signals are volumetric in nature and intestinal signals are nutritive in nature.<ref>Powley TL, Phillips RJ. Gastric satiation is volumetric, intestinal satiation is nutritive. Physiol Behav. 2004 Aug;82(1):69-74. doi: 10.1016/j.physbeh.2004.04.037. PMID: 15234593.</ref>

Graaf CD et al have discussed various biomarkers of satiation and satiety and suggest there use as a tool to assess satiating efficiency of foods and energy balance. This study has also explained PET and fMRI techniques and referred many works that used these technologies to measure the brain responses to various stimuli in context of satiation.<ref>de Graaf C, Blom WA, Smeets PA, Stafleu A, Hendriks HF. Biomarkers of satiation and satiety. Am J Clin Nutr. 2004 Jun;79(6):946-61. doi: 10.1093/ajcn/79.6.946. PMID: 15159223.</ref>

Graaf CD et al have discussed various biomarkers of satiation and satiety and suggest there use as a tool to assess satiating efficiency of foods and energy balance. This study has also explained PET and fMRI techniques and referred many works that used these technologies to measure the brain responses to various stimuli in context of satiation.<ref>de Graaf C, Blom WA, Smeets PA, Stafleu A, Hendriks HF. Biomarkers of satiation and satiety. Am J Clin Nutr. 2004 Jun;79(6):946-61. doi: 10.1093/ajcn/79.6.946. PMID: 15159223.</ref>

===Abbreviations===

===Abbreviations===

*A.Hr.-Ashtanga Hridaya  

 

*A.Hr.: Ashtanga Hridaya  

 

 

 

*A.S.-Ashtanga Sngraha

*[[ Matrashiteeya Adhyaya]],

==References ==

==References ==