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Ama is a state of or products formed due to incomplete digestion, metabolism, or transformation. Agni (digestion and metabolism) is a factor responsible for changing the state of a substance. In human biology, the digestion and metabolic processes convert food and other substances into compatible and nourishing body components. If these processes are incomplete, poor or slow, then the final products formed are of poor quality. Agni is one of the most important factors responsible for health (prakrita) abnormalities, and diseases (vikriti). Life span, strength, health, and immunity all depends on agni. [Cha. Sa. Chikitsa Sthana 15/03] If agni is disturbed, then proper digestion does not occur which results in improperly transformed food/metabolites are termed as ‘Ama’. [A. H. Sutra Sthana 13/25] The concept of ama in ayurveda is very important in pathogenesis of disease. One of the synonyms of vyadhi (disease) is “aamaya” which means caused by ama. [Cha. Sa. Nidana Sthana 1/05] Classification of stages of diseases (vyadhi) is based on the presence and absence of ama i.e., sa-ama avastha (stage associated with ama) and nirama avastha (stage not associated with ama). The treatment protocol also depends on stages of ama such as in diarrhoea associated with ama(ama-atisara), styptic therapy (stambhana) is contraindicated. Whereas, in the diarrhoea without ama (nirama stage) / or chronic diarrhoea (jeerna atisara), styptinc therapy (stambhana) is advised. Thus, concept of ama is significant in understanding the etiopathogenesis, diagnosis as well as treatment of diseases. This chapter describes concept of ama with its contemporary views and researches done on it.

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Ama is a state of or products formed due to incomplete digestion, metabolism, or transformation. [[Agni|Agni]] (digestion and metabolism) is a factor responsible for changing the state of a substance. In human biology, the digestion and metabolic processes convert food and other substances into compatible and nourishing body components. If these processes are incomplete, poor or slow, then the final products formed are of poor quality. [[Agni|Agni]] is one of the most important factors responsible for [[Health|health]] (prakrita) abnormalities, and diseases ([[Vikriti|vikriti]]). [[Ayu|Life span]], strength, [[Health|health]], and immunity all depends on [[Agni|agni]]. [Cha. Sa. Chikitsa Sthana 15/03] If [[Agni|agni]] is disturbed, then proper digestion does not occur which results in improperly transformed food/metabolites are termed as ‘Ama’. [A. H. Sutra Sthana 13/25] The concept of ama in ayurveda is very important in pathogenesis of disease. One of the synonyms of vyadhi (disease) is “aamaya” which means caused by ama. [Cha. Sa. Nidana Sthana 1/05] Classification of stages of diseases (vyadhi) is based on the presence and absence of ama i.e., sa-ama avastha (stage associated with ama) and nirama avastha (stage not associated with ama). The treatment protocol also depends on stages of ama such as in diarrhoea associated with ama(ama-atisara), styptic therapy (stambhana) is contraindicated. Whereas, in the diarrhoea without ama (nirama stage) / or chronic diarrhoea (jeerna atisara), styptinc therapy (stambhana) is advised. Thus, concept of ama is significant in understanding the etiopathogenesis, diagnosis as well as treatment of diseases. This chapter describes concept of ama with its contemporary views and researches done on it.

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== Causes ==

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Impairment of agni (digestive process) due to following reasons causes ama.

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Impairment of [[Agni|agni]] (digestive process) due to following reasons causes ama.

* Fasting or not taking food (abhojana)

* Indigestion (ajirna)

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* Sweda (fomentation)

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

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

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

=== Treatment of alasaka: ===

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== Prevention of recurrence of ama dosha ==

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When the patient is relieved from excessive morbidity of ama, and his digestive capacity (agni) is restored, the following treatment shall be administered to prevent recurrence of ama:

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When the patient is relieved from excessive morbidity of ama, and his digestive capacity ([[Agni|agni]]) is restored, the following treatment shall be administered to prevent recurrence of ama:

* Abhyanga (therapeutic massage)

* Niruha basti (enema with decoction) and anuvasana basti (unctuous enema)

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== Free-radical theory<ref name="ref6">J.S. Tripathi, R. H. Singh. Possible Correlates of Free Radicals and Free Radical Mediated Disorders in Ayurveda with Special Reference to Bhutagni Vyapara and Ama at Molecular Level. Ancient Science of Life. Vol. No. XIX (1&2) July, August, September, October 99. </ref> ==

In recent years, the concept of free radical theory of oxidative damage in human diseases is accepted widely. Free radicals consist of an atom or molecule which have an unpaired electron. The tendency of such atom to gain an electron from other substances makes it highly reactive species to have a high capacity to oxidize biological molecules such as lipids, nucleic acids, proteins, etc. During the disease process, infections, toxins and trauma, these free radicals get released in body and cause diseases. Free radicals play a significant role in some of the diseases like rheumatoid arthritis, inflammatory gut disorder like ulcerative colitis, diseases of connective tissue, atherosclerosis, myocardial infarction, stroke, cancer, parkinsonism, Alzheimer’s, dementia, diabetes mellitus, etc.

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Ama refers to intermediate or by product of metabolism which have a tendency to block the microchannels of the body (srotas avarodha). So ama is an important factor for the manifestation of local or systemic diseases. So, ama plays a key role in pathogenesis of all diseases. Agni (digestive capacity) is not just pertaining to amashaya (stomach) or grahani only, but its present at every cellular level. So disturbance in agni can lead to formation of ama at cellular level also. This ama formation at cellular level can produce various disorders like rheumatoid arthritis etc. as mentioned above. Ama can be related with free radicals at cellular level.

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Ama refers to intermediate or by product of metabolism which have a tendency to block the microchannels of the body (srotas avarodha). So ama is an important factor for the manifestation of local or systemic diseases. So, ama plays a key role in pathogenesis of all diseases. [[Agni|Agni]] (digestive capacity) is not just pertaining to amashaya (stomach) or grahani only, but its present at every cellular level. So disturbance in [[Agni|agni]] can lead to formation of ama at cellular level also. This ama formation at cellular level can produce various disorders like rheumatoid arthritis etc. as mentioned above. Ama can be related with free radicals at cellular level.

== Theory of Auto-immune diseases<ref name="ref7">Yadav, Parag. Medical Perspective on Ama as per Ayurveda and Modern Consideration: A Review. Journal of Drug Delivery and Therapeutics. (2020). 10. 205-207. 10.22270/ jddtv10i1-s.3861.</ref> ==

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== Theses works on ama ==

Following are the some theses work of ama

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<ol style='text-align:justify;'><li style="font-weight:bold">A clinical study on the role of ama in relation to Grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita Discussion over role of ama in relation to Grahani disease: When the vitiated dosha get confined only to the organ grahani (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated doshas travels throughout the rasadi dhatus (seven bodily tissues) i.e. throughout the body, then it should be called as ‘Grahani roga’ (functional impairment of agni). The grahani and agni (digestive process) are having co-existing nature/dependent on each other (adhara adheya sambandha). This view is confirmed by corroborative evidence from recent development in pathology. The mucosal damage in the form of villous atrophy and other microvillus changes in different enteropathies affect the enzymes present in the enterocyte brush borders. When the disease process progresses, further it affects the pancreatic secretion as it depends upon cholecystokinin and secretin secretion from the enterocyte. The immature epithelial cells are unable to secrete the required amount of cholecystokinin and secretin. In the pathogenesis (samprapti) of grahani disease, Acharya Charak elaborated a series of events as below.

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<ol style='text-align:justify;'><li style="font-weight:bold">A clinical study on the role of ama in relation to Grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita Discussion over role of ama in relation to Grahani disease: When the vitiated dosha get confined only to the organ grahani (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated doshas travels throughout the rasadi dhatus (seven bodily tissues) i.e. throughout the body, then it should be called as ‘Grahani roga’ (functional impairment of [[Agni|agni]]). The grahani and [[Agni|agni]] (digestive process) are having co-existing nature/dependent on each other (adhara adheya sambandha). This view is confirmed by corroborative evidence from recent development in pathology. The mucosal damage in the form of villous atrophy and other microvillus changes in different enteropathies affect the enzymes present in the enterocyte brush borders. When the disease process progresses, further it affects the pancreatic secretion as it depends upon cholecystokinin and secretin secretion from the enterocyte. The immature epithelial cells are unable to secrete the required amount of cholecystokinin and secretin. In the pathogenesis (samprapti) of grahani disease, Acharya Charak elaborated a series of events as below.

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Indulgence in causes that vitiate agni (digestive f) → agni dushti (vitiation og agni) → indigestion (apachana) → production of ama (non-metabolized, poorly formed product) → putreification (shukta paka)→ advanced condition of ama manifestating as a poisoning codition (anna visha or ama visha) → grahani dosha (functional impairement of grahini) → grahani dushti (vitiation of grahani)→ grahini roga (diseases manifestating as functional impairement of agni/digestive funtions). Ama is the root cause of almost all diseases produced in the body and the treatment of any disease can be based on stage of the disease associated with ama (saama) & stage of the disease not associated with ama (nirama avastha).

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Indulgence in causes that vitiate [[Agni|agni]] (digestive f) → [[Agni|agni]] dushti (vitiation og [[Agni|agni]]) → indigestion (apachana) → production of ama (non-metabolized, poorly formed product) → putreification (shukta paka)→ advanced condition of ama manifestating as a poisoning codition (anna visha or ama visha) → grahani dosha (functional impairement of grahini) → grahani dushti (vitiation of grahani)→ grahini roga (diseases manifestating as functional impairement of [[Agni|agni]]/digestive funtions). Ama is the root cause of almost all diseases produced in the body and the treatment of any disease can be based on stage of the disease associated with ama (saama) & stage of the disease not associated with ama (nirama avastha).

Outcome of clinical study: This clinical trial was carried out in 66 patients of 16-60 year of age group having cardinal sign and symptoms of grahani disease. Patients were selected randomly into Group A, Group B and Group C treated by kallingadi ghanavati, tryushnadi ghrita and combination of both (ghanavati & ghrita) respectively for 2 weeks. The overall effect of therapies showed that better results observed in group B in comparison to group A. In comparison of all three groups, group C showed slight better results than those of rest two groups.<ref name="ref8">A clinical study on the role of ama in relation to grahini roga and its management by kallingadi ghanavati and tryushnadi ghrita by Alpesh P. Sorathiya, Dept. of Kayachikitsa, IPGT&RA, Jamnagar, 2009. </ref> </li>

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<li style="font-weight:bold">Association of stress inducing factors (manoabhitapakara bhava) and free radical over madhumeha Discussion over association of stress inducing factors (manoabhitapakara bhava) and free radicals with chronic metabolic diseases such as diabetes mellitus type 2 (madhumeha): This research explains about how adherence with stress (manobhitapakara bhava) lead to produce ama or free radical, and in turn produces chronic metabolic diseases. The harmony of mind (manas) responsible for the perfect harmony of body. Altered external living sources like demographic alteration, change in family system, urbanization, industrialization, westernisation have a potent role to induce the pathogenesis at psychic level as well as body level by the faulty pattern of adaptataion. Repeated attachment with stress (kamadi bhavas) are the potent cause for morbidity and mortality rate of obstinate urinary disease/diabetes melitus type 2(madhumeha). This is not only for the cause but it also responsible for the complication. Excessive generation of free radical sustained affection of stress (manobhitapakara bhavas) altered the body defence mechanism, which in terms can be understand. Treatment like pacifying vitiated manasika dosha (manasa doshahara), counseling, antistress approach, dipana (appetizers), pachana (digestives), can check the vicious pathogenesis involved in madhumeha (obstinate urinary disease/ diabetes mellitus type 2). Outcome of the study: There is a direct relation of the mean score of manobhitapakara bhavas (stress), lipid peroxide and fasting blood sugar. By changing mode of life style, optimistic attitude, keeping faith in good, decreasing the high blood pressure level stress hormones can be reduced. Which it reflects through the sufficient decrease in signs and symptoms of the disease.<ref name="ref9">Manoabhitapakara bhava, free radical, madhumeha by Bishnupriya, Dept. of Basic principles, IPGT& RA, Jamnagar,2001.</ref></li>

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<li style="font-weight:bold">Association of stress inducing factors (manoabhitapakara bhava) and free radical over madhumeha Discussion over association of stress inducing factors (manoabhitapakara bhava) and free radicals with chronic metabolic diseases such as diabetes mellitus type 2 (madhumeha): This research explains about how adherence with stress (manobhitapakara bhava) lead to produce ama or free radical, and in turn produces chronic metabolic diseases. The harmony of mind (manas) responsible for the perfect harmony of body. Altered external living sources like demographic alteration, change in family system, urbanization, industrialization, westernisation have a potent role to induce the pathogenesis at psychic level as well as body level by the faulty pattern of adaptataion. Repeated attachment with stress (kamadi bhavas) are the potent cause for morbidity and mortality rate of obstinate urinary disease/diabetes melitus type 2(madhumeha). This is not only for the cause but it also responsible for the complication. Excessive generation of free radical sustained affection of stress (manobhitapakara bhavas) altered the body defence mechanism, which in terms can be understand. Treatment like pacifying vitiated manasika dosha (manasa doshahara), counseling, antistress approach, dipana (appetizers), pachana (digestives), can check the vicious pathogenesis involved in madhumeha (obstinate urinary disease/ diabetes mellitus type 2). Outcome of the study: There is a direct relation of the mean score of manobhitapakara bhavas (stress), lipid peroxide and fasting blood sugar. By changing mode of [[Ayu|life]] style, optimistic attitude, keeping faith in good, decreasing the high blood pressure level stress hormones can be reduced. Which it reflects through the sufficient decrease in signs and symptoms of the disease.<ref name="ref9">Manoabhitapakara bhava, free radical, madhumeha by Bishnupriya, Dept. of Basic principles, IPGT& RA, Jamnagar,2001.</ref></li>

<li style="font-weight:bold">A critical and comparative study of Ama and Free radical theory with special reference to Amavata Outcome of study: Free radical is an atom/molecule that contains one or more unpaired electron, which requires neutralisation by free radical scavengers. Thus it exists in an incomplete metabolic state which is also the state of ama described as incompletely digested (avipakvam). Free radicals cause damage to cell membrane and thus the cell is destroyed. This destruction may lead to putrification and foul smell generations which is similar to one of the property of ama described as unpleasant smell (durgandham). Though ama remains in the body as isolated or not mized (asamyuktam), but due to its properties like excessive sliminess (bahupicchilam) etc. it sticks to normal healthy body tissues very quickly, similar is the case with free radicals. To seek stability in their structure they quickly attack the healthy molecules of the body and thus setting a chain reaction. The cells throughout body are continously exposed to these damaging molecules, same has been described for ama as causing sluggishness of whole body (sadanam sarva gatranam). From above one can observe that properties of free radicals are similar to the properties of ama described in classics. Now the process of production of free radicals in body and production of ama would be considered. So it may be concluded that the causative factors (nidana) such as heavy to digest (guru ), unctuousness (snigdha) etc. qualities of diet (ahara) of amavata (rheumatism) as mentioned in the classics have a specific role to play in production of ama and also in the generation of free radicals. Also the line of treatment of ama advocated in the classics is effective in reducing the level of ama as well as free radicals. So it can be inferred that a positive correlation exists between ama and free radicals.<ref name="ref10">A critical and comparative study of Ama and Free radical theory with special reference to Amavata by Gaurav sharma, Department of Basic principles, IPGT& RA, Jamnagar, 2001.</ref></li>

<li style="font-weight:bold">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management Outcome of study: In this study, 2 groups are there, group I (treatment group) patients have been given chaturushna churna (powder) followed by wholesome diet (pathya) and light to digest food. Whereas, in group II (control group) patients received placebo treatment and wholesome diet (pathya) and light to digest food.. Dosha (ama dosha and tridosha (vata,pitta and kapha)) when adhere to amashaya (stomach), the desired response of the medicine may not be obtained which is observed in clinical study. Due to this the 21 days duration of therapy did not produce total cure response. So, we can say that if in disease, treatment regimens opposite to disease (vyadhi viparita ausadha) doesn’t produce good response, then it is to be inferred that here amashaya (stomach) is adhered with ama dosha. In this stage, as advised in Trividhakuksiyavimana adhyaya (2nd chapter of Charak Samhita Vimana Sthana), depleting therapy (apatarpna) should be administered. If presence of disease stage (vyadhi anubandha) remains, then the treatment regimens opposite to disease (vyadhi viparita aushadha) is to be advised.<ref name="ref11">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management by Mihir vyas, Dept. of Basic principles, IPGT& RA, Jamnagar, 2005.</ref></li></ol>

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