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|title=Ama (undigested, non-metabolized, poorly formed product or state)
|title=Ama (undigested, non-metabolized, poorly formed product or state)
|titlemode=append
|titlemode=append
|keywords=carakasamhitaonline, charak samhita, caraka samhita, ayurved, Ama, Ama in ayurveda, Ama meaning, Contemporary views and research updates on ama, Metabolic waste functions as ama
|keywords=carakasamhitaonline, charak samhita, caraka samhita, ayurved, Ama, Ama in ayurveda, Ama meaning, Contemporary views and research updates on ama, Metabolic waste functions as ama, autoimmune diseases in ayurveda, free radical theory, amavata, Deole Y.S., Basisht G., Indian Systems of Medicine
|description=Ama is a state of or products formed due to incomplete digestion, metabolism, or transformation.
|description=Ama is a state of or products formed due to incomplete digestion, metabolism, or transformation.
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
</p>
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== Modern view/Contemporary sciences view on ama ==
== Current researches ==
=== Theses works on ama ===
== Free-radical theory<ref name="ref6">J.S. Tripathi, R. H. Singh. Possible Correlates of Free Radicals and Free Radical Mediated Disorders in [[Ayurveda|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> ==
== Theses works on ama ==
Following are the some theses work of ama
Following are the some theses work of ama
<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<span style="font-weight:normal"><br/><b>Discussion over role of ama in relation to [[Grahani Chikitsa|Grahani]] [[Vyadhi|disease]]: </b>When the vitiated [[Dosha|dosha]] get confined only to the organ [[Grahani Chikitsa|grahani]] (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated [[Dosha|doshas]] travels throughout the rasadi [[Dhatu|dhatus]] (seven bodily tissues) i.e. throughout the [[Sharira|body]], then it should be called as ‘Grahani roga’ (functional impairment of [[Agni|agni]]). The [[Grahani Chikitsa|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 [[Vyadhi|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|samprapti]]) of [[Grahani Chikitsa|grahani]] [[Vyadhi|disease]], Acharya Charak elaborated a series of events as below.
<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<span style="font-weight:normal"><br/><b>Discussion over role of ama in relation to [[Grahani Chikitsa|Grahani]] [[Vyadhi|disease]]: </b>When the vitiated [[Dosha|dosha]] get confined only to the organ [[Grahani Chikitsa|grahani]] (duodenum), then it should be called ‘Grahani dosha’. But when the vitiated [[Dosha|doshas]] travels throughout the rasadi [[Dhatu|dhatus]] (seven bodily tissues) i.e. throughout the [[Sharira|body]], then it should be called as ‘Grahani roga’ (functional impairment of [[Agni|agni]]). The [[Grahani Chikitsa|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 [[Vyadhi|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|samprapti]]) of [[Grahani Chikitsa|grahani]] [[Vyadhi|disease]], Acharya Charak elaborated a series of events as below.
<li style="font-weight:bold">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management<span style="font-weight:normal"><br/><b>Outcome of study: </b>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|Dosha]] (ama dosha and [[Tridosha|tridosha]] ([[Vata dosha|vata]], [[Pitta dosha|pitta]] and [[Kapha dosha|kapha]])) when adhere to [[Amashaya|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 [[Vyadhi|disease]], treatment regimens opposite to [[Vyadhi|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 [[Preface- Charak Samhita New Edition|Charak Samhita]] [[Vimana Sthana|Vimana Sthana]]), depleting therapy (apatarpna) should be administered. If presence of [[Vyadhi|disease]] stage (vyadhi anubandha) remains, then the treatment regimens opposite to [[Vyadhi|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></span></li></ol>
<li style="font-weight:bold">A critical study of Trividhakuksiyavimana w.s.r. to amotpatti and its management<span style="font-weight:normal"><br/><b>Outcome of study: </b>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|Dosha]] (ama dosha and [[Tridosha|tridosha]] ([[Vata dosha|vata]], [[Pitta dosha|pitta]] and [[Kapha dosha|kapha]])) when adhere to [[Amashaya|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 [[Vyadhi|disease]], treatment regimens opposite to [[Vyadhi|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 [[Preface- Charak Samhita New Edition|Charak Samhita]] [[Vimana Sthana|Vimana Sthana]]), depleting therapy (apatarpna) should be administered. If presence of [[Vyadhi|disease]] stage (vyadhi anubandha) remains, then the treatment regimens opposite to [[Vyadhi|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></span></li></ol>
== Current researches ==
== Contemporary views and research updates on ama ==
Ama is an important principle to understand the etiopathogenetic of all disorders and to decide the treatment modalities. [[Agni]] is the digestive and metabolic factor responsible for any transformation in body. Transformation of food material predominantly takes place at the level of gastrointestinal tract ([[grahani]]-seat of jatharagni) and at the level of tissues ([[dhatvagni]]-abodes of [[dhatu]]). Dysfunction of [[agni]] results into undigested or partly digested intermediator product called as ama. Ama act as toxic element and form the basis for many pathological conditions. It can be considered raw, uncooked, unripe, immature, undigested or incompletely oxidized / metabolized or similar to a poisonous substance that disrupts body physiology. Accumulation of metabolic waste ([[mala]]) may takes place at various levels in body physiology. The amalgamation of aggravated [[dosha]] with metabolic waste results in ama formation, which is considered the initial stage of disease formation. Origin of ama is mainly considered from gastrointestinal tract ([[amashaya]]). [[Agni]] functions at different levels; hence, ama can be formed at different levels at different body sites. Forms of [[agni]] - jatharagni, bhutagni and dhatvagni functions at different level hence any impairment at the corresponding level leads to ama formation.
Digestion process starts from mouth where mechanical and chemical digestion of food takes place. Thinking, smelling and seeing food secrets saliva, helps in digestion. Component of saliva like water, mucus, electrolytes and enzymes has a unique function. Starch breakdown starts here due to the enzyme in saliva called salivary amylase. Mucus lubricates the food and helps in the formation of bolus in mouth. Small food particles are dissolved by saliva and it makes dry food moist enough to swallow comfortably. If person is not following dietary codes, eating hurriedly without proper mastication, disturbed mental health while taking food will affect this cephalic phase of digestion. It will lead to ama formation due to improper digestion process in mouth. Mastication of food is subjected to condition of teeth. Studies have attempted to find a correlation between tooth loss and nutrition. Deteriorated dental health affects mechanical digestion process and leads to nutritional deficiency.<ref>Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Almas K. The role of nutrition in periodontal health: An Update. Nutrients. 2016 Aug 30;8(9):530. doi: 10.3390/nu8090530. PMID: 27589794; PMCID: PMC5037517. </ref> Another study observed that modifying the mastication rate alters the glycemic index of rice. Its glycemic index classification shows impact of digestion process on the final outcome of food.<ref>Ranawana, V., Leow, M. K.-S., & Henry, C. J. K. (2014). Mastication effects on the glycemic index: impact on variability and practical implications. European Journal of Clinical Nutrition, 68(1), 137–139. https://doi.org/10.1038/ejcn.2013.231</ref>
Health of a person is essentially dependents on healthy gut. Mucosal integrity is more important for proper absorption of nutrient from villi. The intestines also play an essential role in protecting the body from harmful bacteria and toxins. If mucosal integrity is hampered it results into leaky gut syndrome. It affects the lining of intestinal mucosa leading to bacteria and other toxins to pass into the bloodstream. It also leads to the imbalance of gut microbiome.<ref>Gerwyn Morris, Michael Berk, André F. Carvalho, Javier R. Caso, Yolanda Sanz and Michael Maes, “The Role of Microbiota and Intestinal Permeability in the Pathophysiology of Autoimmune and Neuroimmune Processes with an Emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome”, Current Pharmaceutical Design (2016) 22: 6058. https://doi.org/10.2174/1381612822666160914182822</ref>
This gut leakage and dysbiosis leads to gut inflammation, also disrupt an immune homeostasis. It causes systemic immune activation, neurological disturbances and auto immune diseases. All these predisposing conditions cause ama formation which triggers many complex pathological conditions, act as route cause for many diseases.<ref>Sharma H. Leaky Gut Syndrome, Dysbiosis, Ama, Free Radicals, and Natural Antioxidants. AYU. 2009; 30 (2): 88-105.</ref>
=== Ama and free radical theory ==
<p style='text-align:justify;'>In contemporary sciences, the concept of ama can be related with free radical oxidative damage and autoimmune disorders.<ref name="ref6">J.S. Tripathi, R. H. Singh. Possible Correlates of Free Radicals and Free Radical Mediated Disorders in [[Ayurveda|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> </p>
In recent years, the concept of free radical theory of oxidative damage in human [[Vyadhi|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 [[Vyadhi|disease]] process, infections, toxins and trauma, these free radicals get released in [[Sharira|body]] and cause [[Vyadhi|diseases]]. Free radicals play a significant role in some of the [[Vyadhi|diseases]] like rheumatoid arthritis, inflammatory gut disorder like ulcerative colitis, [[Vyadhi|diseases]] of connective tissue, atherosclerosis, myocardial infarction, stroke, cancer, parkinsonism, Alzheimer’s, dementia, diabetes mellitus, etc.
<br/>Ama refers to intermediate or by product of metabolism which have a tendency to block the microchannels of the [[Sharira|body]] (srotas avarodha). So ama is an important factor for the manifestation of local or systemic [[Vyadhi|diseases]]. Ama plays a key role in pathogenesis of all [[Vyadhi|diseases]]. [[Agni|Agni]] (digestive capacity) is not just pertaining to amashaya (stomach) or grahani only, but its present at every cellular level. 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. </p>
====Ama at cellular level====
Formation of ama occurs at the level of tissues or cellular level due to impaired metabolism or due to free radical activity. Free radicals are highly reactive atom or molecule which is having one or more unpaired electrons. It always tries to have stability by giving its electron or by acquiring extra electron form adjacent molecules. After providing the electron adjacent molecule becomes unstable and acts as a free radical, a chain reaction sets in to damage many molecules. A higher concentration of free radicals causes damage to the cellular structure like DNA, protein, lipid, and other cell parts. It causes disturbance in homeostasis of body leading to disease condition.<ref>Sharma GN, Gupta G, Sharma P. A Comprehensive Review of Free Radicals, Antioxidants, and Their Relationship with Human Ailments. Crit Rev Eukaryot Gene Expr. 2018;28(2):139-154. doi:10.1615/CritRevEukaryotGeneExpr.2018022258</ref>
==== Metabolic waste functions as ama====
Tissue nutrients after action of metabolism ([[dhatvagni]]) nourishes body tissues and part is formed as excretory product ([[mala]]). Accumulation of this metabolic waste beyond certain limits disrupts the [[dosha]] homeostasis, leads to formation of ama. Depending on the type of metabolic waste and predominance of [[dosha]] exhibits many diseases.
Ama formation occurs due to the accumulation of toxic or intermediate product of metabolism in the body termed as [[mala]]. These intermediate products are formed due to defect in the metabolism of protein, carbohydrate or lipid. Excessive uric acid is formed due to improper metabolism of protein which is hazardous to body tissue and joint structure. Lactic acid, acetone and ketone bodies are formed due to improper metabolism of carbohydrate and fats. Lack of insulin activity defunct carbohydrate metabolism and leads to formation of intermediate products in the body. This intermediate products act as ama and leads to many disease conditions.
=== Ama and auto-immune diseases ===
<p style='text-align:justify;'>Auto-immune [[Vyadhi|diseases]] occur when immune system is attacked by anticipated response against antigen or toxins. These antigens or toxins trigger the inflammatory response. This concept of auto-immune disorders can be compared with the concept of ama.<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> The antigen/toxins can be compared with ama, that produce improper metabolites/toxins within the [[Sharira|body]]. This ama triggered inflammatory response in [[Sharira|body]] results in number of the [[Vyadhi|diseases]]. Ama at cellular level modulates the response of the [[Sharira|body]] leading to develop incompatible autoimmune response that damages tissues. Crohn’s [[Vyadhi|disease]], psoriasis, rheumatoid arthritis, ankylosing spondylitis, are auto immune [[Vyadhi|diseases]] caused by response against ama or antigen. The immune cells of the [[Sharira|body]] do not attack the [[Sharira|body]] cells suddenly, it happens because of lack of cellular communication as the cells being covered by ama or toxins. The ama is caused by weak digestive fire which affects the proper tissue production and [[Ojas|oja]] (immunity) formation. So, we can consider the poor digestion and weak immunity is the root cause for auto-immune disorders. Therefore, by adopting [[Ayurveda|ayurveda]] principles of treatment of ama, one can manage the auto-immune disorders. </p>
== Related chapters ==
*[[Trividhakukshiya Vimana]]
*[[Matrashiteeya Adhyaya]]
*[[Rasa Vimana]]
*[[Sharira Vichaya Sharira]]
*[[Grahani Chikitsa]]
*[[Ahara vidhi]]
*[[Viruddha Ahara]]
*[[Amavata]]
*[[Rheumatic diseases]]
*[[Obesity and Metabolic Syndrome]]
*[[Langhana]]
*[[Deepana]]
*[[Pachana]]
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